ObjectiveTo measure test accuracy of non-invasive prenatal testing (NIPT) for Down, Edwards and Patau syndromes using cell-free fetal DNA and identify factors affecting accuracy.DesignSystematic review and meta-analysis of published studies.Data sourcesPubMed, Ovid Medline, Ovid Embase and the Cochrane Library published from 1997 to 9 February 2015, followed by weekly autoalerts until 1 April 2015.Eligibility criteria for selecting studiesEnglish language journal articles describing case–control studies with ≥15 trisomy cases or cohort studies with ≥50 pregnant women who had been given NIPT and a reference standard.Results41, 37 and 30 studies of 2012 publications retrieved were included in the review for Down, Edwards and Patau syndromes. Quality appraisal identified high risk of bias in included studies, funnel plots showed evidence of publication bias. Pooled sensitivity was 99.3% (95% CI 98.9% to 99.6%) for Down, 97.4% (95.8% to 98.4%) for Edwards, and 97.4% (86.1% to 99.6%) for Patau syndrome. The pooled specificity was 99.9% (99.9% to 100%) for all three trisomies. In 100 000 pregnancies in the general obstetric population we would expect 417, 89 and 40 cases of Downs, Edwards and Patau syndromes to be detected by NIPT, with 94, 154 and 42 false positive results. Sensitivity was lower in twin than singleton pregnancies, reduced by 9% for Down, 28% for Edwards and 22% for Patau syndrome. Pooled sensitivity was also lower in the first trimester of pregnancy, in studies in the general obstetric population, and in cohort studies with consecutive enrolment.ConclusionsNIPT using cell-free fetal DNA has very high sensitivity and specificity for Down syndrome, with slightly lower sensitivity for Edwards and Patau syndrome. However, it is not 100% accurate and should not be used as a final diagnosis for positive cases.Trial registration numberCRD42014014947.

Objective To examine the accuracy of artificial intelligence (AI) for the detection of breast cancer in mammography screening practice. Design Systematic review of test accuracy studies. Data sources Medline, Embase, Web of Science, and Cochrane Database of Systematic Reviews from 1 January 2010 to 17 May 2021. Eligibility criteria Studies reporting test accuracy of AI algorithms, alone or in combination with radiologists, to detect cancer in women’s digital mammograms in screening practice, or in test sets. Reference standard was biopsy with histology or follow-up (for screen negative women). Outcomes included test accuracy and cancer type detected. Study selection and synthesis Two reviewers independently assessed articles for inclusion and assessed the methodological quality of included studies using the QUality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. A single reviewer extracted data, which were checked by a second reviewer. Narrative data synthesis was performed. Results Twelve studies totalling 131 822 screened women were included. No prospective studies measuring test accuracy of AI in screening practice were found. Studies were of poor methodological quality. Three retrospective studies compared AI systems with the clinical decisions of the original radiologist, including 79 910 women, of whom 1878 had screen detected cancer or interval cancer within 12 months of screening. Thirty four (94%) of 36 AI systems evaluated in these studies were less accurate than a single radiologist, and all were less accurate than consensus of two or more radiologists. Five smaller studies (1086 women, 520 cancers) at high risk of bias and low generalisability to the clinical context reported that all five evaluated AI systems (as standalone to replace radiologist or as a reader aid) were more accurate than a single radiologist reading a test set in the laboratory. In three studies, AI used for triage screened out 53%, 45%, and 50% of women at low risk but also 10%, 4%, and 0% of cancers detected by radiologists. Conclusions Current evidence for AI does not yet allow judgement of its accuracy in breast cancer screening programmes, and it is unclear where on the clinical pathway AI might be of most benefit. AI systems are not sufficiently specific to replace radiologist double reading in screening programmes. Promising results in smaller studies are not replicated in larger studies. Prospective studies are required to measure the effect of AI in clinical practice. Such studies will require clear stopping rules to ensure that AI does not reduce programme specificity. Study registration Protocol registered as PROSPERO CRD42020213590.

Triacylglycerol (TG) lowering effects of n-3 long-chain PUFA (n-3 LCPUFA) have been repeatedly demonstrated, but studies investigating the individual effects of EPA or DHA on plasma TG and lipoproteins in man are rare. The effects of a new DHA-rich, almost EPA-free microalgae oil (Ulkenia sp.) on plasma lipids and several safety parameters were investigated in a double-blind, placebo-controlled, parallel design intervention study. Normolipidaemic vegetarians (eighty-seven females, twenty-seven males) consumed daily microalgae oil (0·94 g DHA/d) or olive oil (as placebo) for 8 weeks. DHA supplementation decreased plasma TG by 23 % from 1·08 (SEM 0·07) to 0·83 (SEM 0·04) mmol/l (P, 0·001). Absolute TG decreases after DHA supplementation were inversely correlated to baseline TG concentrations (r 20·627, P, 0·001). Plasma total, LDL and HDL cholesterol increased significantly in the DHA group, resulting in lower TG:HDL cholesterol and unchanged LDL:HDL and total cholesterol:HDL cholesterol ratios. The intake of DHA-rich microalgae oil did not result in any physiologically relevant changes of safety and haemostatic factors. In conclusion, DHA-rich oil from microalgae Ulkenia sp. was well tolerated and can be considered a suitable vegetarian source of n-3 LCPUFA. Although DHA supplementation improved some CHD risk factors (plasma TG, TG:HDL cholesterol ratio), LDL cholesterol increased. Therefore, the overall effects of this intervention on CHD risk deserve further investigation. Docosahexaenoic acid: Microalgae oil: Plasma lipids: TriacylglycerolCirculating triacylglycerol (TG) levels in the fasting and postprandial states are associated with the severity and progression of atherosclerosis (Hodis, 1999) and are recognised as independent risk factors for CHD (Hokanson & Austin, 1996). A meta-analysis by Austin et al. (1998) suggested that after adjustment for HDL cholesterol and other risk factors, each 1 mM increase in TG is associated with a 14 % increase in CHD in men and a 37 % increase in women. Griffin (2001) concluded there is convincing evidence to show that even moderately raised plasma TG (.1·5 mM), which has a predicted frequency of between 25 and 30 % in middle-aged men and postmenopausal women, confer increased cardiovascular risk in otherwise normal, healthy individuals.Long-chain n-3 PUFA (n-3 LCPUFA) reduce TG concentrations in man (Conquer & Holub, 1996;Davidson et al. 1997;Grimsgaard et al. 1997;Nelson et al. 1997;Stark & Holub, 2004;Nestel et al. 2002). In a meta-analysis of sixty-five studies, Harris (1997) concluded that an average dose of 4 g EPA and DHA per day results in a 25 -30 % decrease of fasting TG in both normolipidaemic and hypertriacylglycerolaemic subjects. It has been assumed that the hypotriglyceridaemic effect of n-3 LCPUFA is mediated by several mechanisms such as increased hepatic fatty acid oxidation, inhibition of fatty acid and TG synthesis, and reduced assembly and secretion of VLDL TG (Nestel, 2000). Most studies of n-3 LCPUFA have generally used oils containing mixtures of ...

Low red blood cell (RBC) membrane content of EPA + DHA (hereafter called omega-3 index) has recently been described as an indicator for increased risk of death from coronary heart disease. The relationship between plasma and RBC FA, focusing on omega-3 index, and the response to DHA supplementation were investigated in a double-blind, randomized, placebo-controlled, intervention study. Healthy vegetarians (87 f, 17 m) consumed daily a microalgae oil from Ulkenia sp. (0.94 g DHA/d) or olive oil (placebo) for 8 wk. DHA supplementation significantly increased DHA in RBC total lipids (7.9 vs. 4.4 wt%), in RBC PE (12.1 vs. 6.5 wt%), in RBC PC (3.8 vs. 1.4 wt%), and in plasma phospholipids (PL) (7.4 vs. 2.8 wt%), whereas EPA levels rose to a much lesser extent. Microalgae oil supplementation increased the omega-3 index from 4.8 to 8.4 wt%. After intervention, 69% of DHA-supplemented subjects (but no subject of the placebo group) reached an omega-3 index above the desirable value of 8 wt%. Omega-3 index and EPA + DHA levels in RBC PE, RBC PC, and plasma PL were closely correlated (r always > 0.9). We conclude that an 8-wk supplementation with 0.94 g DHA/d from microalgae oil achieves a beneficial omega-3 index of > or =8% in most subjects with low basal EPA + DHA status. RBC total FA analyses can be used instead of RBC lipid fraction analyses for assessing essential FA status, e.g., in clinical studies.

Based on current evidence, routine screening for group B streptococcus colonisation in late pregnancy should not be introduced in the UK, as the potential harms of unnecessary treatment with antibiotics may outweigh the benefits, argue Farah Seedat and colleagues

BackgroundAdverse events from intrapartum antibiotic prophylaxis (IAP) are poorly documented yet essential to inform clinical practice for neonatal group B Streptococcus (GBS) disease prevention. In this systematic review, we appraised and synthesised the evidence on the adverse events of IAP in the mother and/or her child.MethodsWe searched MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Cochrane, and Science Citation Index from date of inception until October 16th 2016. Reference lists of included studies and relevant systematic reviews were hand-searched. We included primary studies in English that reported any adverse events from intrapartum antibiotics for any prophylactic purpose compared to controls. The search was not restricted to prophylaxis for GBS but excluded women with symptoms of infection or undergoing caesarean section. Two reviewers assessed the methodological quality of studies, using the Cochrane Risk of Bias tool, and the Risk of Bias Assessment Tool for Nonrandomised Studies. Results were synthesised narratively and displayed in text and tables.ResultsFrom 2364 unique records, 30 studies were included. Despite a wide range of adverse events reported in 17 observational studies and 13 randomised controlled trials (RCTs), the evidence was inconsistent and at high risk of bias. Only one RCT investigated the long-term effects of IAP reporting potentially serious outcomes such as cerebral palsy; however, it had limited applicability and unclear biological plausibility. Seven observational studies showed that IAP for maternal GBS colonisation alters the infant microbiome. However, study populations were not followed through to clinical outcomes, therefore clinical significance is unknown. There was also observational evidence for increased antimicrobial resistance, however studies were at high or unclear risk of bias.ConclusionsThe evidence base to determine the frequency of adverse events from intrapartum antibiotic prophylaxis for neonatal GBS disease prevention is limited. As RCTs may not be possible, large, better quality, and longitudinal observational studies across countries with widespread IAP could fill this gap.Trial registration CRD42016037195.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1432-3) contains supplementary material, which is available to authorized users.

High short-term isoflavone-containing soy intake slightly affects physiologic fluctuations in bone turnover, but has no significant effects on most circulating sex hormones and on lipoprotein parameters in young healthy women.

Enhanced rapid reviews with 20% checking by a second reviewer may be an appropriate tool for policymakers to expeditiously assess evidence. Basic rapid reviews (single reviewer) have higher risks of important inaccuracies and omissions.