Driving us mad: the association of Toxoplasma gondii with suicide attempts and traffic accidents – a systematic review and meta-analysis

AbstractUnnatural causes of death due to traffic accidents (TA) and suicide attempts (SA) constitute a major burden on global health, which remained stable in the last decade despite widespread efforts of prevention. Recently, latent infection with Toxoplasma gondii (T. gondii) has been suggested to be a biological risk factor for both TA and SA. Therefore, a systematic search concerning the relationship of T. gondii infection with TA and/or SA according to PRISMA guidelines in Medline, Pubmed and PsychInfo was conducted collecting papers up to 11 February 2019 (PROSPERO #CRD42018090206). The random-effect model was applied and sensitivity analyses were subsequently performed. Lastly, the population attributable fraction (PAF) was calculated. We found a significant association for antibodies against T. gondii with TA [odds ratio (OR) = 1.69; 95% confidence interval (CI) 1.20–2.38, p = 0.003] and SA (OR = 1.39; 95% CI 1.10–1.76, p = 0006). Indication of publication bias was found for TA, but statistical adjustment for this bias did not change the OR. Heterogeneity between studies on SA was partly explained by type of control population used (ORhealthy controls = 1.9, p < 0.001 v. ORpsychiatric controls = 1.06, p = 0.87) and whether subjects with schizophrenia only were analysed (ORschizophrenia = 0.87, p = 0.62 v. ORvarious = 1.8, p < 0.001). The association was significantly stronger with higher antibody titres in TA and in studies that did not focus on schizophrenia subjects concerning SA. PAF of a T. gondii infection was 17% for TA and 10% for SA. This indicates that preventing T. gondii infection may play a role in the prevention of TA or SA, although uncertainty remains whether infection and outcome are truly causally related.

Download Full-text

How much is reasonable to expect about overall survival (OS) benefit when designing studies with new drugs for patients affected by castration resistant prostate cancer (CRPC)? Meta-analysis of 23 randomized clinical trials (RCT) including 17,640 patients.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e16053 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e16053-e16053

Author(s):

Francesco Massari ◽

Francesca Maines ◽

Sara Pilotto ◽

Camillo Porta ◽

Paolo Carlini ◽

...

Keyword(s):

Treatment Strategy ◽

Significant Interaction ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Phase Iii ◽

Sensitivity Analyses ◽

Significant Heterogeneity ◽

Significant Difference

e16053 Background: Treatment decision making in patients affected by CRPC is difficult because the numerous available therapeutic opportunities can significantly affect OS. To demonstrate that comparing results in absence of head-to-head studies may lead to biased survival estimations, a literature-based meta-analysis was conducted. Methods: Hazard Ratios (HR) with 95% confidence intervals (CI) were extracted and cumulated according to a random-effect model from phase III trials. Sensitivity analyses were performed according to: 1) Treatment Strategy (TS, Chemotherapy versus Hormonal versus Immunotherapy versus Other), 2) Comparison (Chemotherapy versus Placebo versus Other), and 3) Disease setting with regard to treatment with Docetaxel (DOC),. Testing for heterogeneity was performed as well. Results: A significant heterogeneity for the 3 sensitivity analyses was found (p<0.0001). The cumulative HR in favor of (any) experimental arm was 0.91 (95% CI 0.84-0.99, p=0.028). We found a significant interaction according to the chosen TS (p<0.0001), in fact a significant difference in OS was more likely to be detected in RCT evaluating hormonal drugs (HR 0.76, 95% CI 0.64-0.92, p=0.005) versus studies testing immunotherapy (HR 1.16, 95% CI 0.86-1.56, p=0.31). With regard to Comparison, a significant interaction (p<0.0001) was found in favor of RCT having placebo as control (HR 0.86, 95% CI 0.76-0.97, p=0.015), versus studies evaluating chemotherapy (HR 1.00, 95% CI 0.84, 1.19, p=0.99). A significant interaction according to DOC-treatment was also detected (p<0.0001), being the Post-DOC the Setting where a significant OS benefit was more likely to be determined (HR 0.77, 95% CI 0.66-0.90, p=0.001). Conclusions: The cross-trials interpretation in absence of formal direct comparisons may drive biased conclusions with regard to OS estimation. When designing trials to evaluate drugs (or strategies) in CRPC, the expected OS benefit must take into account the comparator, the treatment strategy and the (eventual) pre-treatment with DOC.

Download Full-text

Inflammation and Nitro-Oxidative Stress in Current Suicidal Attempts and Current Suicidal Ideation: a Systematic Review and Meta-Analysis

10.20944/preprints202109.0159.v1 ◽

2021 ◽

Author(s):

Asara Vasupanrajit ◽

Ketsupar Jirakran ◽

Chavit Tunvirachaisakul ◽

Marco Solmi ◽

Michael Maes

Keyword(s):

Oxidative Stress ◽

Suicidal Ideation ◽

Inflammatory Response ◽

Suicide Attempts ◽

Psychiatric Patients ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Healthy Controls ◽

Inflammatory Profile

A meta-analysis showed a significant association between activated immune-inflammatory and nitro-oxidative (IO&NS) pathways and suicide attempts (SA). There are no data whether suicidal ideation (SI) is accompanied by activated IO&NS pathways and whether there are differences between SA and SI. The current study searched PubMed, Google Scholar, and Web of Science, for articles published from inception until May 10, 2021, and systematically reviewed and meta-analyzed the association between recent SA/SI (< 3 months) and IO&NS biomarkers. We included studies which compared psychiatric patients with and without SA and SI and controls (either healthy controls or patients without SA or SI) and used meta-analysis (random-effect model with restricted maximum-likelihood) to delineate effect sizes with 95% confidence intervals (CI). Our search included 59 studies comprising 4.034 SA/SI cases and 12.377 controls. Patients with SA/SI showed activated IO&NS pathways (SMD: 0.299; CI: 0.200; 0.397) when compared to controls. The immune profiles were more strongly associated with SA than with SI, particularly when compared to healthy controls, as evidenced by activated IO&NS pathways (SMD: 0.796; CI: 0.503; 1.089), an immune-inflammatory response (SMD: 1.409; CI: 0.637; 1.462), inflammation (SMD: 1.200; CI: 0.584; 1.816), and neurotoxicity (SMD: 0.904; CI: 0.431; 1.378). The effects sizes of the IO&NS, immune-inflammatory response and inflammatory profile were significantly greater in SA than in SI. In conclusion: increased neurotoxicity due to inflammation and nitro-oxidative stress and lowered neuroprotection may explain at least in part why psychiatric patients show increased SA and SI. The IO&NS pathways are more pronounced in recent SA than in SI.

Download Full-text

Increased Neurotoxicity Due to Activated Immune-Inflammatory and Nitro-Oxidative Stress Pathways in Patients with Suicide Attempts: A Systematic Review and Meta-Analysis

10.20944/preprints202104.0479.v1 ◽

2021 ◽

Author(s):

Asara Vasupanrajit ◽

Ketsupar Jirakran ◽

Chavit Tunvirachaisakul ◽

Michael Maes

Keyword(s):

Oxidative Stress ◽

Immune Activation ◽

Suicide Attempts ◽

Psychiatric Patients ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Control Group ◽

Healthy Controls ◽

New Biomarkers

Background: Suicide attempts (SA) frequently occur in patients with mood disorders and schizophrenia, which are both accompanied by activated immune-inflammatory and nitro-oxidative (IO&NS) pathways. Methods: We searched PubMed, Google Scholar, and Web of Science, for articles published from inception until February 1, 2021. We included studies that compared blood biomarkers in psychiatric patients with (SA+) and without SA (SA-) and heathy controls and we combined different IO&NS biomarkers into immune, inflammatory, and neurotoxic profiles and used meta-analysis (random-effect model with restricted maximum-likelihood) to delineate effect sizes with 95% confidence interval (CI).Findings: Our search included 51 studies comprising 4.945 SA+ patients and 24.148 controls. We stratified the control group into healthy controls and SA- patients. SA+ patients showed significantly (p<0.001) increased immune activation (SMD: 1.044; CI: 0.599-1.489), inflammation (SMD: 1.109; CI: 0.505, 1.714), neurotoxicity (SMD: 0.879; CI: 0.465, 1.293), and lowered neuroprotection (SMD: 0.648; CI: 0.354, 0.941) as compared with healthy controls. When compared with SA- patients, those with SA+ showed significant (p<0.001) immune activation (SMD: 0.290; CI: 0.183, 0.397), inflammation (SMD: 0.311; CI: 0.191, 0.432), and neurotoxicity (SMD: 0.315; CI: 0.198, 0.432), and lowered neuroprotection (SMD: 0.341; CI: 0.167, 0.515). Patients with current, but not lifetime, SA showed significant (p<0.001) levels of inflammation and neurotoxicity as compared with controls. Conclusions: Patients with immune activation are at a higher risk of SA which may be explained by increased neurotoxicity due to inflammation and nitro-oxidative stress. This meta-analysis discovered new biomarkers of SA and therapeutic targets to treat individuals with SA.

Download Full-text

Effects of vitamin D supplementation on apolipoprotein A1 and B100 levels in adults: Systematic review and meta-analysis of controlled clinical trials

Journal of Cardiovascular and Thoracic Research ◽

10.34172/jcvtr.2021.21 ◽

2021 ◽

Vol 13 (3) ◽

pp. 190-197

Author(s):

Nima Radkhah ◽

Sakineh Shabbidar ◽

Meysam Zarezadeh ◽

Abdolrasoul Safaeiyan ◽

Ali Barzegar

Keyword(s):

Vitamin D ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Vitamin D Supplementation ◽

Mean Difference ◽

Apolipoprotein A1 ◽

Sensitivity Analyses ◽

Standardized Mean Difference ◽

The Impact

Cardiovascular disease (CVD) is a leading cause of death around the world. According to the studies, apolipoproteins A1 and B100 play crucial role in CVD development and progression. Also, findings have indicated the positive role of vitamin D on these factors. Thus, we conducted the present meta-analysis of randomized controlled trials (RCTs) to demonstrate the impact of vitamin D supplementation on apolipoproteins A1 and B100 levels in adults. PubMed and Scopus databases and Google Scholar were searched up to 21 December 2020. Relevant articles were screened, extracted, and assessed for quality based on the Cochrane collaboration’s risk of bias tool. Data analysis conducted by random-effect model and expressed by standardized mean difference (SMD). The heterogeneity between studies was assessed by I-squared (I2) test. Subgroups and sensitivity Analyses were also conducted. Seven RCTs were identified investigating the impact of vitamin D on Apo A1 levels and six on Apo B100 levels. The findings showed the insignificant effect of vitamin D supplementation on Apo A1 (SMD=0.26 mg/dL; 95% confidence interval (CI), −0.10, 0.61; P= 0.155) and Apo B100 (standardized mean difference (SMD)=-0.06 mg/dL; 95% CI, −0.24, 0.12; P=0.530) in adults. There was a significant between-study heterogeneity in Apo A1 (I2=89.3%, P<0.001) and Apo B100 (I2=57.1%, P=0.030). However, significant increase in Apo A1 in daily dosage of vitamin D (SMD=0.56 mg/dL; 95% CI, 0.02, 1.11; P=0.044) and ≤12 weeks of supplementation duration (SMD=0.71 mg/dL; 95% CI, 0.08, 1.34; P=0.028) was observed. No significant effects of vitamin D on Apo A1 and Apo B100 levels after subgroup analysis by mean age, gender, study population, dosage and duration of study. Overall, daily vitamin D supplementation and ≤12 weeks of supplementation might have beneficial effects in increasing Apo A1 levels, however, future high-quality trials considering these a primary outcome are required.

Download Full-text

Effects of Non-surgical Periodontal Therapy on Periodontal Clinical Data in Periodontitis Patients With Rheumatoid Arthritis: a Meta-analysis

10.21203/rs.3.rs-173708/v1 ◽

2021 ◽

Author(s):

Yu Huang ◽

Zheng Zhang ◽

Youli Zheng ◽

Zhulan Zhao ◽

Yang Zhong ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Publication Bias ◽

Clinical Efficacy ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Periodontal Therapy ◽

Sensitivity Analyses ◽

Cochrane Central Register ◽

Randomized Controlled Clinical Trials

Abstract Backgrounds: To date, there is still no consensus about the clinical efficacy of non-surgical periodontal therapy in rheumatoid arthritis (RA) patients with periodontitis. Therefore, the overall aim of this study was to summarize available data regarding the clinical efficacy of scaling and root planing (SRP) in patients with RA and periodontitis compared to patients with periodontitis alone.Methods: A meta-analysis of existing randomized controlled clinical trials (RCTs) was conducted. The eligible RCTs were selected through Embase, PubMed and Cochrane Central Register of Controlled Trials and manual retrieval from the earliest records to March 15, 2020 to extract data. The overall effect size of plaque index (PI), gingival index (GI), attachment loss (AL), probing depth (PD) and bleeding on probing (BOP) were calculated by either a fixed or random-effect model, and subgroup analyses were conducted according to the different time points of follow-up. Cochrane Collaboration's tool was responsible for the evaluation of the literature quality and the inter-study heterogeneity was evaluated by Q test and I2 statistic. The authors applied sensitivity analysis for results with heterogeneity. Publication bias was determined by Begg's test, Egger's test and the trim-and-fill method.Results: Eight RCTs eventually met the inclusion criteria for the study. The overall outcomes concerned PI, GI, PD, Al and BOP were 0.42(95% CI 0.02, 0.81), 0.03(95% CI -0.03, 0.10),-0.06mm (95% CI -0.18, 0.06), 0.16mm (95% CI-0.03, 0.36) and 4.15(95% CI -0.26, 8.55), respectively. In subgroup analysis, a larger BOP reduction at 3 months, PI and AL reduction at 6 months were observed in patients with RA and periodontitis group. The results of sensitivity analyses had no significant effect. No evidence of potential publication bias was tested.Conclusions: The authors conclude that SRP is equally effective in patients with periodontitis and RA than in periodontitis ones. This result suggests RA does not affect the clinical efficacy of non-surgical periodontal therapy.

Download Full-text

Association between Toxoplasma gondii infection and headache: a systematic review and meta-analysis

Infectious Disorders - Drug Targets ◽

10.2174/1871526520666200617135851 ◽

2020 ◽

Vol 20 ◽

Author(s):

Tooran Nayeri ◽

Shahabeddin Sarvi ◽

Mahmood Moosazadeh ◽

Zahra Hosseininejad ◽

Afsaneh Amouei ◽

...

Keyword(s):

Toxoplasma Gondii ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Forest Plot ◽

Cross Sectional ◽

Effect Model ◽

Toxoplasma Gondii Infection ◽

And Control ◽

The Impact

Background: The impact of infectious agents, such as Toxoplasma gondii (T. gondii), on human behavior and mental disorders has recently attracted the attention of researchers. T. gondii has emerged as a suitable candidate for such disorders due to its neural nature. Therefore, the current study aimed at investigating the possible relationship between T. gondii infection and headache. Methods: Five databases were thoroughly searched (up to October 4, 2019) for articles on the prevalence of T. gondii in headache sufferer. In this study, the odds ratio (OR) and corresponding 95% confidence interval (CI) were estimated using a random effect model and forest plot to gauge effect size and effect of each study. Results: A total number of four articles, including three case-controls and one cross-sectional studies with 2517 participants entered the meta-analysis out of whom 1205 subjects were afflicted with headache or migraine (17.67% positive for toxoplasmosis) and 1312 participants were not (18.29% for toxoplasmosis). The results of the meta-analysis indicated a common OR of 1.59 (95% CI: 1.03-2.47) by the random effect model. Conclusion: The obtained results of several studies have linked toxoplasmosis and headache. Therefore, more quality studies with larger sample sizes are needed to determine the detailed association between headache and T. gondii infection for the prevention and control of toxoplasmosis among headache sufferers.

Download Full-text

Circulating Resistin Levels and Risk of Colorectal Cancer: A Meta-Analysis

BioMed Research International ◽

10.1155/2016/7367485 ◽

2016 ◽

Vol 2016 ◽

pp. 1-11 ◽

Cited By ~ 8

Author(s):

Gui Yang ◽

Wei Fan ◽

Baohong Luo ◽

Zhigao Xu ◽

Ping Wang ◽

...

Keyword(s):

Colorectal Cancer ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Sensitivity Analyses ◽

Published Data ◽

Significant Heterogeneity ◽

Sample Type ◽

Effect Model ◽

Mean Differences

Objectives. Published data on resistin levels in patients with colorectal cancer (CRC) were conflicting and heterogeneous. We conducted a meta-analysis of observational studies to examine the association of circulating resistin levels with carcinogenesis of the CRC.Methods. Potentially eligible studies published up to November 2015 were searched through MEDLINE, EMBASE, Science Citation Index Expanded database, CNKI, and WanFang database. The pooled weighted mean differences (WMDs) with 95% confidence intervals (CIs) calculated by fixed- or random-effect model were used to estimate the effects.Results. A total of 11 studies involving 965 patients were admitted in our meta-analysis. The pooled effects indicated that resistin levels were higher in CRC patients compared to healthy controls (WMD: 1.47 ng/mL; 95% CI: 0.78 to 2.16), with significant heterogeneity across the studies (I2=72%,p<0.0001). Subgroup analyses and sensitivity analyses revealed that study quality, design, sample type, and resistin assays may account for this heterogeneity. No publication bias was observed.Conclusions. Our meta-analysis suggests that increased circulating resistin levels are associated with greater risk of colorectal cancer. Given the limited number of available studies and significant heterogeneity, larger well-designed randomized studies are warranted.

Download Full-text

Different Associations between DC-SIGN Promoter-336G/A (rs4804803) Polymorphism with Severe Dengue in Asians and South-Central Americans: a Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16081475 ◽

2019 ◽

Vol 16 (8) ◽

pp. 1475

Author(s):

Jiangping Ren ◽

Zhengting Wang ◽

Enfu Chen

Keyword(s):

Subgroup Analysis ◽

Protective Factor ◽

Meta Analysis ◽

Dengue Infection ◽

Random Effect ◽

Random Effect Model ◽

Sensitivity Analyses ◽

Severe Dengue ◽

Central Americans ◽

South Central

Objective: This study was conducted to identify the association between rs4804803 polymorphism in DC-SIGN with the susceptibility of severe dengue. Methods: A comprehensive search was conducted to identify all eligible papers in PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and Google Scholar. Odds ratios (ORs) and corresponding 95% confidence intervals (95% CIs) were used to assess the association. Subgroup analyses were performed by ethnicity. Sensitivity analyses were performed through employing different statistical models (fixed versus random effect model). Results: A total of nine papers and 12 studies, with 1520 severe dengue and 1496 clinical dengue infection were included. The overall meta-analysis revealed significant associations between rs4804803 and severe dengue under the recession (GG versus GA/AA: OR = 0.44, 95%CI, 0.23–0.82) and a codominant model (GG versus AA: OR = 0.43, 95%CI, 0.23–0.81), but sensitivity analysis indicated that the significant pooled ORs were not robust. The subgroup analysis suggested that the carrier of G in rs4804803 was a risk factor for severe dengue under dominant (GG/GA versus AA: OR = 1.86,95%CI, 1.01–3.45), superdominant (GA versus GG/AA: OR = 1.81,95%CI, 1.02–3.21) and a codominant (GA versus AA: OR=1.82,95%CI, 1.02–3.26) models in Asians, while it was a protective factor for severe dengue in South-central Americans under recessive (GG versus GA/AA: OR = 0.27,95%CI, 0.10–0.70) and codominant (GG versus AA: OR=0.24,95%CI, 0.09–0.64) models. The results from subgroup analysis were robust. Conclusions: Dendritic cell-specific intercellular adhesion molecule-3-grabbing non-integrin (DC-SIGN) promoter-336G/A (rs4804803) polymorphism is association with severe dengue, and it acts in different directions for Asians and South-central Americans.

Download Full-text

Suicide attempts in eating disorder subtypes: a meta-analysis of the literature employing DSM-IV, DSM-5, or ICD-10 diagnostic criteria

Psychological Medicine ◽

10.1017/s0033291718003549 ◽

2018 ◽

Vol 49 (08) ◽

pp. 1237-1249 ◽

Cited By ~ 8

Author(s):

Laura Mandelli ◽

Angelo Arminio ◽

Anna-Rita Atti ◽

Diana De Ronchi

Keyword(s):

Eating Disorder ◽

Diagnostic Criteria ◽

Attempted Suicide ◽

Suicide Attempts ◽

Meta Analysis ◽

Random Effect Model ◽

Sensitivity Analyses ◽

Targeted Prevention ◽

Icd 10 ◽

Dsm Iv

AbstractBackgroundQuantification of suicidal risk in specific populations is important for the adoption of targeted prevention and harm reduction measures. Though there remains little systematic evidence, risk of suicide attempts for bulimia nervosa (BN) and binge-purging anorexia nervosa (AN-bp) appears higher than restrictive AN (AN-r); risk in binge eating disorder (BED) is still unclear. The aim of this meta-analysis was to compare proportions of suicide attempts in eating disorder (ED) subgroups.MethodsA literature search using combinations of key-words for ED and suicide attempts was performed. Studies reporting proportions of suicide attempters in at least two ED groups, diagnosed according to DSM-IV or -5 and ICD-10 diagnostic criteria were considered. ED subgroups were analyzed in pairs using a binary random effect model for proportions. Publication bias, meta-regression, and sensitivity analyses were performed.ResultsIn BN, attempted suicide was more frequent (21%) than in AN (12.5%), but the difference was statistically significant only when BN was compared with AN-r (9–10%). In BED, the proportion of suicide attempts was as high as in AN (10–12%).ConclusionsThough limited by heterogeneity across the studies in terms of methodology and aims, inability to control for relevant confounding variables, exclusion of ED not otherwise specified, this study supports suicide attempts as a major issue in EDs, especially in binge-purging subtypes, i.e. BN and AN-bp. Similar suicidal proportions were observed in AN and BED. The reasons for a greater proportion of attempted suicide in binge/purging subtypes need to be explored in future studies.

Download Full-text

Increased neurotoxicity due to activated immune-inflammatory and nitro-oxidative stress pathways in patients with suicide attempts: a systematic review and meta-analysis.

10.1101/2021.04.16.21255605 ◽

2021 ◽

Author(s):

Asara Vasupanrajit ◽

Ketsupar Jirakran ◽

Chavit Tunvirachaisakul ◽

Michael Maes

Keyword(s):

Oxidative Stress ◽

Immune Activation ◽

Suicide Attempts ◽

Psychiatric Patients ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Control Group ◽

Healthy Controls ◽

New Biomarkers

Background: Suicide attempts (SA) frequently occur in patients with mood disorders and schizophrenia, which are both accompanied by activated immune-inflammatory and nitro-oxidative (IO&NS) pathways. Methods: We searched PubMed, Google Scholar, and Web of Science, for articles published from inception until February 1, 2021. We included studies that compared blood biomarkers in psychiatric patients with (SA+) and without SA (SA-) and heathy controls and we combined different IO&NS biomarkers into immune, inflammatory, and neurotoxic profiles and used meta-analysis (random-effect model with restricted maximum-likelihood) to delineate effect sizes with 95% confidence interval (CI). Findings: Our search included 51 studies comprising 4.945 SA+ patients and 24.148 controls. We stratified the control group into healthy controls and SA- patients. SA+ patients showed significantly (p<0.001) increased immune activation (SMD: 1.044; CI: 0.599-1.489), inflammation (SMD: 1.109; CI: 0.505, 1.714), neurotoxicity (SMD: 0.879; CI: 0.465, 1.293), and lowered neuroprotection (SMD: 0.648; CI: 0.354, 0.941) as compared with healthy controls. When compared with SA- patients, those with SA+ showed significant (p<0.001) immune activation (SMD: 0.290; CI: 0.183, 0.397), inflammation (SMD: 0.311; CI: 0.191, 0.432), and neurotoxicity (SMD: 0.315; CI: 0.198, 0.432), and lowered neuroprotection (SMD: 0.341; CI: 0.167, 0.515). Patients with current, but not lifetime, SA showed significant (p<0.001) levels of inflammation and neurotoxicity as compared with controls. Conclusions: Patients with immune activation are at a higher risk of SA which may be explained by increased neurotoxicity due to inflammation and nitro-oxidative stress. This meta-analysis discovered new biomarkers of SA and therapeutic targets to treat individuals with SA.

Download Full-text