Can single progesterone concentration predict miscarriage in early pregnant women with threatened miscarriage: a systematic review and meta-analysis.

BACKGROUND: About 25% of pregnant women experience bleeding in the early stage, and half of them eventually progress to pregnancy loss. Progesterone serves as a useful biomarker to predict miscarriage in threatened miscarriage, yet its performance is still debated. AIM: To evaluate the performance of single serum progesterone predicting miscarriage in early pregnant patients with threatened miscarriage. METHOD: The online database was searched to yield the literature using the terms of 'Abortion', 'Miscarriage', and 'serum Progesterone', including PubMed, Scopus, Embase, Cochrane library, and China national knowledge infrastructure. Receiver operating characteristic (ROC) curve, likelihood ratio (LLR) and diagnostic odds ratio (DOR) and 95% confidence interval (CI) were computed. Publication bias was assessed by the deeks funnel plot asymmetry test. Subgroup analyses were conducted according to the progesterone level (< 12 ng/mL), recruited location and region, progesterone measurement method, exogenous progesterone supplement and follow up. RESULTS: In total, 12 studies were eligible to be included in this study, with sample sizes ranging from 76 to 1087. The included patients' gestational age was between 4 and 12 weeks. No significant publication bias was detected from all included studies. The threshold of progesterone reported ranged from 8 to 30 ng/ml. The synthesized area under the ROC curve (0.85, 95% CI 0.81 to 0.88), positive LLR (6.2, 4.0 to 9.7) and DOR (18, 12 to 27) of single progesterone measurement distinguishing miscarriage were relatively good in early pregnant patients with threatened miscarriage. When the threshold of < 12 ng/mL was adapted, the progesterone provided a higher area under the ROC curve (0.90 vs. 0.78), positive LLR (8.3 vs. 3.8) and DOR (22 vs.12) than its counterpart (12 to 30 ng/mL). CONCLUSION: Single progesterone measurement can act as a biomarker of miscarriage in early pregnant patients with threatened miscarriage, and it has a better performance when the concentration is <12 ng/mL. TRIAL REGISTRATION: PROSPERO (CRD42021255382).

The clinical course of untreated CIN2 (HPV16/18+) under active monitoring: A protocol of systematic reviews and meta-analysis.

BACKGROUND: Cervical cancer (CC) is one of the most prevalent and fatal cancers among women. Nearly all forms of CC are related to HPV, and 70% of invasive CCs are associated with HPV16 and HPV18. A histologically confirmed case of cervical intraepithelial neoplasia (CIN)2 or a more severe histological diagnosis is considered to be the demarcation point for treatment, but overtreatment will increases the risk of preterm birth in subsequent pregnancies. This study will evaluate the progress of CIN2 (progression, persistence, or regression) in HPV16/18+ CIN2 patients who were managed conservatively for 3 months. METHODS: PubMed, Cochrane Library, China National Knowledge Infrastructure, Cumulative Index for Nursing and Allied Health Literature (CINAHL), and the Excerpta Medica Database will be searched. We will include studies reporting on women with CIN2 and HPV16/18+, conservative treatment for 3 to 60 months with disease outcomes including progression (CIN3 or worse), persistence (CIN2), and regression rates (CIN1 or less). The primary outcome will be the progress of CIN2. Two authors will search the relevant literature, extract the data, and assess the risk of bias. A funnel chart will be used to identify publication or other reporting biases, and the AHRQ guidelines will be used to assess the risk of bias in each included study. The I2 statistic will be used to assess heterogeneity. If there is a high degree of heterogeneity between the studies, the random effects model will be used; otherwise, a fixed effects model will be used. RESULTS: The results of this systematic review will be published in a peer-reviewed journal. CONCLUSION: This systematic review will evaluate the clinical development of patients with conservatively monitored histologically confirmed HPV16/18+ CIN2.

Construction of ceRNA network and key gene screening in cervical squamous intraepithelial lesions.

BACKGROUND: This study aimed to construct an endogenous competition network for cervical squamous intraepithelial lesions using differential gene screening. METHODS: GSE149763 was used to screen differentially expressed long non-coding RNAs (lncRNAs) and mRNAs to predict correlated microRNAs (miRNAs). The correlated miRNAs and GSE105409 were used to screen differentially expressed miRNAs for differential co-expression analysis, and the co-expressed differentially expressed miRNAs were used to predict correlated mRNAs. Differentially expressed mRNAs, miRNAs, and lncRNAs were visualized, and differential gene screening, enrichment, and pathway analysis were performed. RESULTS: The ceRNA network of cervical squamous intraepithelial was successfully established and a potential differentially expressed network was identified. The key genes were VEGFA and FOS, and the key pathway was the MAPK signaling pathway. CONCLUSIONS: The differential expression and potential effects of the lncRNA BACH1-IT1/miR-140-5p/VEGFA axis, key genes, VEGFA and FOS, and MAPK signaling in CIN were clarified, and the occurrence and potential effects of CIN were further clarified. The underlying molecular mechanism provides a certain degree of reference for subsequent treatments and experimental research.

[Progress of researches on non-specific effect of acupuncture].

Acupuncture therapy is effective in the treatment of quite a lot of clinical conditions. Accumulating evidence demonstrates that acupuncture therapy not only has specific therapeutic effects, but also in a large part has non-specific effects such as the patient's and/or acupuncture practitioner's "unity of form and spirit", "treatment experience and environment" and "expectations and trust", etc. In the present article, we make a review about progresses of recent researches on the non-specific effect of acupuncture therapy and its influencing factors from 1) placebo acupuncture, 2) expectancy effect, 3) Hawthorne effect, and 4) Pygmalion effect. The placebo acupuncture intervention may enhance the therapeutic effect by triggering the cutaneous somatosensory afferents, brainstem, hypothalamus, limbic system, etc. to produce cognitive and emotional responses. The patient's expectancy and belief about acupuncture analgesia are associated with activities of the spino-thalamo-cortical pathway, cingulate gyrus, endogenous opioid system, emotional and reward circuits, etc. Regarding the Hawthorne effect and Pygmalion effect, it is supposed that the patients' behavioral tendency changes and higher expectations for acupuncture treatment may produce a positive impact on the outcomes of treatment. In-depth exploration of the influencing factors and the therapeutic targets of acupuncture treatment will further improve clinical effect, and serve the patients better.