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).

[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.