Objective To compare the surgical outcomes between conventional coronary artery bypass grafting (CABG) and minimally invasive direct coronary artery bypass grafting via left small thoracotomy stratified by different levels of non-invasive fractional flow reserve computed tomography (FFR-CT), and to explore the recommended FFR-CT cut-off values for selecting appropriate coronary vessels for grafting in the two surgical procedures. MethodsA retrospective enrollment was conducted on patients who underwent isolated CABG at the Minimally Invasive Cardiac Surgery Center of Beijing Anzhen Hospital from 2022 to 2025, including conventional median sternotomy CABG and minimally invasive CABG. Clinical data comprising preoperative FFR-CT of target vessels, preoperative coronary angiography, intraoperative instantaneous flow of corresponding bypass grafts, peak postoperative troponin level, postoperative graft patency after discharge, and the incidence of major adverse cardiovascular and cerebrovascular event (MACCE) were collected. Patients were divided into two groups according to FFR-CT value: FFR-CT＞0.80 and FFR-CT≤0.80. Intraoperative graft flow was classified into three grades: Grade 1 (flow≤30 mL/min), Grade 2 (30 mL/min＜flow≤60 mL/min), and Grade 3 (flow＞60 mL/min). The differences in intraoperative flow corresponding to different FFR-CT levels were compared between patients undergoing conventional CABG and minimally invasive CABG respectively, and regression analyses were performed separately. Postoperative troponin was also graded into three levels: Grade 1 (troponin I＜2 000 ng/L), Grade 2 (2 000 ng/L≤troponin I＜5 000 ng/L), and Grade 3 (troponin I≥5 000 ng/L). Troponin I levels were compared between the two groups. ResultsA total of 390 patients with 928 target vessels were enrolled, including 207 patients undergoing conventional CABG (542 target vessels; 153 males and 54 females, aged 43-81 years) and 183 patients undergoing minimally invasive CABG (386 target vessels; 144 males and 39 females, aged 46-84 years). For conventional CABG, target vessels with FFR-CT≤0.80 presented better intraoperative graft flow. The regression equation was Q (flow grade)=–3.077FFR3+3.455. FFR-CT＜0.78 was recommended to achieve optimal intraoperative graft flow. For minimally invasive CABG, superior intraoperative graft flow was also observed in target vessels with FFR-CT≤0.80, with the regression equation Q (flow grade)=–24.560FFR2+30.207FFR–6.492, and the recommended cut-off value was FFR-CT＜0.80. For coronary arteries with angiographically moderate stenosis, intraoperative graft flow differed significantly among different FFR-CT subgroups (P＜0.001), with higher flow in the FFR-CT≤0.80 group. Moreover, lower FFR-CT value of target vessels was associated with lower peak postoperative troponin I level. ConclusionFFR-CT serves as a reliable reference indicator for target vessel selection in conventional CABG and left small thoracotomy minimally invasive CABG, especially for coronary lesions with angiographically moderate stenosis. In addition, FFR-CT has certain predictive value for postoperative surgical efficacy.
ObjectiveTo systematically review the association between Helicobacter pylori (HP) infection and Parkinson's disease (PD). MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect case-control studies on the association between HP and PD from January 2000 to July 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software. ResultsA total of 16 case-control studies involving 2 790 subjects were included. The results of meta-analysis showed that the HP infection rate was higher in PD patients than that in healthy patients (OR=1.87, 95%CI 1.38 to 2.54, P<0.000 1). The results of subgroup analysis showed that the infection rate of HP in PD group in Asia and Africa region was significantly higher than that in control group, but not in Europe region. Breath tests and other detection methods were used to detect HP infection, and the HP infection rate in PD group was significantly higher than that in the healthy control group. However, there was no significant difference in HP infection between the two groups by ELISA. UPDRS Ⅲ score of PD patients with HP infection was significantly higher than that of PD patients without HP infection. ConclusionsCurrent evidence shows that PD patients have a higher HP infection rate than the normal population, and the rates are affected by regions and HP detection methods. In addition, HP infection can aggravate the motor symptoms and motor complications of PD patients. Due to limited quality and quantity of included studies, more high-quality studies are required to verify the above conclusions.