Background: This study aimed to evaluate the association of hypertension with incident infective endocarditis (IE) by investigating the incidence of IE according to blood pressure levels using the National Health Insurance Service database. Methods: The data of 4 080 331 individuals linked to the health screening database in 2009 were retrieved (males, 55.08%; mean age, 47.12±14.13 years). From 2009 to 2018, the risk factors for the first episode of IE were investigated. Hypertension was categorized into normotension, prehypertension, hypertension, and hypertension with medication. The Cox proportional hazard model assessed the effect of blood pressure level during the health screening exam on incident IE. Results: During the 9-year follow-up, 812 (0.02%) participants were diagnosed with IE. The incidence rates of IE in the normotension, prehypertension, hypertension, and hypertension with medication groups were 0.9, 1.4, 2.6, and 6.0 per 100 000 person-years, respectively. Those with prehypertension, hypertension, and hypertension with medication were correlated with an increased risk of IE in a dose-response manner compared with the normotension group (hazard ratio, 1.33 [95% CI, 1.06–1.68]; hazard ratio, 1.98 [1.48–2.66]; hazard ratio, 2.56 [2.02–3.24], respectively, all P <0.001). Conclusions: In a large national cohort study with an average follow-up of 9 years, increased blood pressure was identified as a risk factor for incident IE in a dose-dependent manner. Hypertension increases the public health care burden by acting as a risk factor for rare infective heart diseases.

Jun Hee Lee, M.D., Jong Yun Won, M.D., Ji Eon Kim, M.D., Hee Jung Kim, M.D., Ph.D., Jae Seung Jung, M.D., Ph.D., Ho Sung Son, M.D., Ph.D.. J Chest Surg 2021;54:36-44. https://doi.org/10.5090/kjtcs.20.123

Summary: We measured heating of isotonic saline by three fluid warmers in six experiments: saline at 5 °C or 20 °C delivered at 30, 50 or 100 ml.min ⁻¹ . At the three flow rates, the enFLOW ^® , buddy lite ^™ and ThermoSens ^® systems heated 5 °C saline to mean ( SD ) temperatures of: 41.1 (0.5) °C, 37.7 (0.6) °C and 39.1 (0.6) °C; to 40.3 (0.8) °C, 33.9 (1.6) °C and 39.3 (0.7) °C; and to 37.1 (0.8) °C, 24.0 (1.3) °C and 37.6 (1.0) °C, respectively, p < 0.0001 for each experiment. The mean ( SD ) times taken to heat 5 °C saline were: 16.6 (1.7) s, 258.4 (58.9) s and 134.2 (79.6) s; 16.9 (1.8) s, 256.2 (62.2) s and 182.5 (74.5) s; and 21.5 (1.5) s, 275.9 (49.3) s and 313.5 (18.0) s, respectively, p < 0.0003 for each experiment. The results for saline at 20 °C were similar. The enFLOW system heated saline above 36 °C faster than the ThermoSens system, whereas the buddy lite often failed to achieve 36 °C.

We sought to evaluate the outcomes of postoperative three-month dual antiplatelet therapy in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) following off-pump coronary artery bypass grafting (OPCAB) with exclusively arterial grafts. Between 2013–2016, dual antiplatelet therapy (DAPT) with either aspirin + clopidogrel (ASA + CPD group, n = 100) or aspirin + ticagrelor (ASA + TCG group, n = 169) was prescribed postoperatively in 269 NSTE-ACS patients after total arterial OPCAB. Patients with indications for other oral anticoagulants were excluded from the study. Three-month DAPT was completed in 259 patients (96%); ASA + CPD group (n = 94) vs. ASA + TCG group (n = 165). A one-to-one propensity score matching was performed. Unadjusted comparison between the groups showed no significant difference in overall survival (P = 0.253) and composite outcome of major adverse cerebrovascular and cardiovascular event (MACCE) and major bleeding (P = 0.276). The rate of freedom from composite outcome at one year in the ASA + CPD and ASA + TCG groups was 91 ± 3% and 93 ± 2%, respectively. In multivariable analysis, being in the ASA + TCG group did not increase the risk of the composite outcome of MACCE and major bleeding (P = 0.972, hazard ratio: 1.0, 95% confidence interval: 0.4–2.3). Propensity score-matched comparison (76 pairs) showed no significant difference in the overall survival (P = 0.423) and composite outcome between the groups (P = 0.442). In the setting of exclusive arterial grafting, post-OPCAB three-month DAPT showed acceptable outcomes in patients with NSTE-ACS. There was no significant difference in overall survival or composite outcome of MACCE and major bleeding between the ASA + CPD and ASA + TCG groups.

-D- is a rare haplotype that determines D without C, c, E or e, and exalted D activity. The extremely rare homozygote propositi (-D-/-D-) are usually ascertained through their immune antibodies, anti-Rh17 (Hro), which react with red cells of all common Rh phenotypes. The authors experienced the first case in Korea of a woman with -D- phenotype. She had a history of spontaneous abortion, therapeutic termination and red cell transfusion, and at her third pregnancy she delivered a baby with severe hemolytic disease of the newborn. In spite of intensive medical intervention, the baby died of hydrops fetalis. An immune antibody to high incidence Rh antigen, namely anti-Rh17(Hro), was demonstrated in the woman's serum. A family study revealed that the -D- gene complex was present in all its members and one of the woman's sisters was also -D- homozygote. In the serum of this sister, anti-Rh17(Hro) was also present.

Jaekwan Lim, Ph.D., Jong Yun Won, M.D., Chi Bum Ahn, Ph.D., Jieon Kim, M.D., Hee Jung Kim, M.D., Ph.D., Jae Seung Jung, M.D., Ph.D.. J Chest Surg 2021;54:81-7. https://doi.org/10.5090/jcs.20.134