Phase angle, calculated as the arc-tangent of the reactance-to-resistance ratio in bioelectrical impedance analysis, represents skeletal muscle quality, and is suggested to be an indicator of sports ability and physical fitness. However, it is unclear whether phase angle is related to physical fitness in early childhood in Japanese subjects. The purpose of this study was to examine the cross-sectional relationship between physical fitness and bioelectrical impedance analysis-based phase angle in 6-year-old Japanese children. The subjects were 85 kindergarten students who participated in a physical fitness test and body composition assessment in 2017, 2018 or 2019, in the third year of kindergarten. Fitness tests included grip strength, standing long jump, and 25 m run. A multi-frequency composition analyzer was used for body composition analysis, and the phase angle of the left half of the body was acquired at 50 kHz. Statistical analysis was performed using a general linear model to calculate the regression coefficient of phase angle for physical fitness. Phase angle correlated significantly with the standing long jump and 25 m run. The regression coefficient (±standard error) of phase angle in the standing long jump in the fully adjusted model was 5.098 ±2.264 (p<0.05), and that in the 25 m run was -0.179 ±0.088 (p<0.05). There was no significant correlation between phase angle and grip strength. These results suggest that phase angle based on bioelectrical impedance analysis might be related to lower limb muscle function and running ability in 6-year-old Japanese children.

Although cardiac rehabilitation (CR) has been shown to improve exercise tolerance and prognosis in patients with cardiovascular diseases, there remains low participation in outpatient CR. This may be attributed to the patients’ busy schedules and difficulty in visiting the hospital due to distance, cost, avoidance of exercise, and severity of coronary disease. To overcome these challenges, many countries are exploring the possibility of remote CR. Specifically, there is increasing attention on the development of remote CR devices, which allow transmission of vital information to the hospital via a remote CR application linked to a wearable device for telemonitoring by dedicated hospital staff. In addition, remote CR programs can support return to work after hospitalization. Previous studies have demonstrated the effects of remote CR on exercise tolerance. However, the preventive effects of remote CR on cardiac events and mortality remain controversial. Thus, safe and effective remote CR requires exercise risk stratification for each patient, telenursing by skilled staff, and multidisciplinary interventions. Therefore, quality assurance of telenursing and multi-disciplinary interventions will be essential for remote CR. Remote CR may become an important part of cardiac management in the future. However, issues such as costeffectiveness and insurance coverage still persist.

A 2-month-old male infant was transferred to our hospital for suspected cardiomyopathy because he had livedo reticularis and peripheral coldness. An electrocardiogram showed ischemic change and an echocardiogram showed a dilated, poorly functioning left ventricle. Therefore, we performed urgent cardiac catheterization. The coronary artery was not visualized by aortography, but the single coronary artery arising from the pulmonary artery was depicted by pulmonary angiography. Therefore, we performed emergent surgery. The whole coronary arteries traveled directly inferiorly from the left side of the pulmonary trunk. A patent ductus arteriosus (PDA) was closed at the operation. We established cardiopulmonary bypass using two arterial cannulae through both ascending aortas and pulmonary trunk to maintain coronary blood flow. Direct implantation is difficult because the coronary ostium is far from the ascending aorta. Therefore, we chose to perform the Takeuchi procedure using an intrapulmonary artery tunnel. The patient's postoperative course was good, and he was discharged on postoperative day 22. A case of an anomalous origin of a single coronary artery from the pulmonary artery without any other heart disease is extremely rare. Management of cardiopulmonary bypass and myocardial protection in this abnormality is discussed.