Fan Yang’s research while affiliated with Sichuan University and other places

目的 利用孟德尔随机化（Mendelian randomization, MR）的研究方法，探讨代谢综合征（metabolic syndrome, MetS）组成部分与子宫内膜癌的因果关联。 方法 对全基因组关联研究数据库（Genome-Wide Association Studies, GWAS）进行数据挖掘，暴露因素为MetS组成部分（血脂、血压、血糖和肥胖），结局因素为子宫内膜癌。借助MR-Egger法、加权中位数法、逆方差加权法（inverse variance weighting, IVW）等回归模型进行MR分析，以比值比（odds ratio, OR）评价MetS组成部分与子宫内膜癌的因果关系。对正向MR分析中发现的与子宫内膜癌有因果关系的MetS组成部分进行反向MR分析。 结果 IVW结果经Benjamini-Hochberg校正试验后显示多个MetS组分（肥胖、血脂、血压及血糖）均与子宫内膜癌存在因果关联。其中，肥胖的3个组分体质量指数、超重及体脂率均与子宫内膜癌的风险增加具有因果关联（P<0.001，OR>1）；血脂中高胆固醇水平（P<0.001，OR<1）、高甘油三酯水平及高磷脂水平等与子宫内膜癌风险降低有因果关联（P<0.05，OR<1）；血压中心脏病、动脉粥样硬化及卒中等与子宫内膜癌风险降低有因果关联（P<0.05，OR<1）；血糖中低空腹胰岛素水平、1型糖尿病、胰岛素抵抗及高糖化血红蛋白水平与子宫内膜癌风险降低有因果关联（P<0.05，OR<1），2型糖尿病及高空腹胰岛素水平与子宫内膜癌风险增加有因果关联（P<0.05，OR>1）。在反向MR分析中，没有证据表明上述阳性的MetS组分与子宫内膜癌存在反向因果关系。 结论 MR研究提示肥胖和2型糖尿病是子宫内膜癌的危险因素，而MetS的其他组分，如高血脂、心脑血管疾病、胰岛素抵抗及糖尿病合并症等是子宫内膜癌的保护因素。尚需进一步研究以阐明MetS与子宫内膜癌之间的关联，并进一步探索其中的潜在机制。

Observational studies have reported an association between gastroesophageal reflux disease (GERD) and endometriosis. We conducted a two-sample and bidirectional Mendelian randomization analysis to determine whether those associations are causal. Two-sample and bidirectional MR analyses were performed using summary statistics from the European Individual Genome-Wide Association Study (GWAS). The inverse variance weighting (IVW) method is used as the main analysis method to evaluate causality. Sensitivity analyses were performed to assess heterogeneity, horizontal versatility, and stability. The results showed no significant causal association between GERD in women with endometriosis in the UK Bank database [ratio (OR) ≈ 0, 95% adjusted interval (CI) 1.0007∼1.0044, P = 0.006] and Finn databases [ratio (OR) = 1.29, 95% adjusted interval (CI) 0.99∼1.67, P = 0.06]. However, when studying the Finn database only for endometriosis, which is confined to the uterus, a significant increase in GERD was limited to the risk of endometriosis in the uterus [ratio (OR) = 1.47, 95% adjusted interval (CI) 1.00∼2.17, P = 0.05]. Sensitivity analysis showed that the results were robust and did not detect multi efficacy or heterogeneity. Meanwhile, reverse MR analysis showed that endometriosis did not increase the risk of GERD. This MR study supports a causal relationship between GERD and an increased risk of endometriosis confined to the uterus. Therefore, patients with gastric esophageal reflux should be treated with gynecological examination to avoid and prevent the development of endometriosis.

The gut microbiota is a crucial component of the intricate microecosystem within the human body that engages in interactions with the host and influences various physiological processes and pathological conditions. In recent years, the association between dysbiosis of the gut microbiota and tumorigenesis has garnered increasing attention, as it is recognized as a hallmark of cancer within the scientific community. However, only a few microorganisms have been identified as potential drivers of tumorigenesis, and enhancing the molecular understanding of this process has substantial scientific importance and clinical relevance for cancer treatment. In this review, we delineate the impact of the gut microbiota on tumorigenesis and treatment in multiple types of cancer while also analyzing the associated molecular mechanisms. Moreover, we discuss the utility of gut microbiota data in cancer diagnosis and patient stratification. We further outline current research on harnessing microorganisms for cancer treatment while also analyzing the prospects and challenges associated with this approach.

Introduction Applying transumbilical laparoendoscopic single-site surgery to endometrial cancers is worldwide, and the depiction of the learning curve is rarely described, which leads to the vagueness of young clinical practitioners. We accumulated the data to identify the completion of the learning curve by analyzing the operative and postoperative outcomes of the patients with endometrial cancer for transumbilical laparoendoscopic single-site surgery (TU-LESS). Methods This was a retrospective, consecutive single-center study of patients with endometrial cancer undergoing standard endometrial cancer comprehensive staging surgery (extrafascial hysterectomy, bilateral salpingectomy, and pelvic lymphadenectomy) through TU-LESS by an experienced surgeon from December, 2017 to June, 2021 in the Department of Gynecologic Oncology, West China Second Hospital, Sichuan University, China. Results After applying the inclusion and exclusion criteria, 42 patients were included in the study. The learning curve for this study was evaluated using both cumulative sum (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) methods. Applying CUSUM and RA-CUSUM has grouped 42 cases into three phases. The prior five cases represented the learning period. The following six cases were needed to lay a technical foundation (cases 6–11). The third phase was regarded as achieving proficiency (cases 12–42). The operative time decreased drastically with the learning curve. There were no significant differences in terms of postoperative complications and lymph node retrieval among the three phases. More difficult patients were confronted in the third phase. Discussion In our study, the learning curve was composed of three phases. According to the results of our study, 11 cases were required for experienced surgeons to achieve a technical foundation.

Introduction Hysterectomy is the most common surgical procedure in the field of gynaecology. The traditional multiport laparoscopy, transumbilical laparoendoscopic single-site surgery (TU-LESS) and transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy approaches have been implemented to varying degrees in clinical practice. At present, although their feasibility has been proven, there are no large randomised controlled studies on postoperative rehabilitation. This study aims to evaluate postoperative recovery and assess the safety and effectiveness of these three surgical approaches for total laparoscopic hysterectomy. Method and analysis This is a multicentre, randomised, single-blind, three-arm, parallel-group, interventional clinical trial. Recruitment will be carried out in five tertiary hospitals in China. Patients diagnosed with benign uterine disease or precancerous lesions will be assigned to the vNOTES group, TU-LESS group and conventional laparoscopy group at a 1:1:1 ratio. The achievement rate of comprehensive indices of enhanced recovery after surgery (ERAS) within 24 hours postoperatively will be considered the primary outcome (the comprehensive indicators of ERAS include fluid intake, passing flatus, urination after catheter removal, ambulation and a Visual Analogue Scale score ≤3.) This study will use a non-inferiority test, with a power (1−ß) of 80% and a margin of −0.15, at a one-sided α of 0.0125. The sample size will be 480 patients (including an assumed 15% dropout rate), calculated according to the primary outcome. Ethics and dissemination This study was approved on 25 April 2022 by the Medical Ethics Committee of West China Second University Hospital (2022(057)), Sichuan University, Chengdu, China. All participants will be required to provide informed consent before their participation in the study. The results of the trial will be submitted for publication in a peer-reviewed journal and presented at international conferences. Protocol version V.3.0, 31 August 2023. Trial registration number ChiCTR2200057405.