Liposomal ozonated oil effectiveness in the signs and symptoms of blepharitis in usual clinical practice

PURPOSE

To analyze the efficacy of liposomal ozonated oil (Ozonest®) treatment, in patients with blepharitis or blepharoconjunctivitis, in improving the signs and symptoms of the pathology.

METHODS

Exploratory, open-label, prospective, single-arm, pre-post comparative pilot study in usual clinical practice, in 20 patients with blepharitis/blepharoconjunctivitis, receiving treatment with liposomal ozonated oil, one drop in each eye, 4 times a day, for 28 days. Main purpose was to assess whether there was a clinically improvement in the blepharitis specific BLISS questionnaire score. Changes in the 12-item OSDI, in eyelid signs of blepharitis assessed by the physicians were also evaluated among other tests, and there was also a subjective evaluation of the treatment by patients.

RESULTS

The BLISS score significantly improved from 16.4 before treatment to 11.8 after treatment (p < 0.05). The OSDI score was also significantly improved from 27.5 before treatment to 20.5 after treatment (p < 0.05). All tests conducted before and after treatment showed significant improvement (p < 0.05), except for NIBUT. The treatment received a score of 7 out of 10 by the patients. There were no adverse events in any patient.

CONCLUSION

Liposomal ozonated oil treatment showed good efficacy in improving the signs and symptoms of blepharitis/blepharoconjunctivitis, satisfaction of patients, and good safety and tolerability.

Ozone Therapy for a Soccer Player With Osteitis Pubis: A Case Report

CONTEXT

Osteitis pubis (OP), which occurs as a result of excessive use of the symphysis pubis and parasymphysis bones, is more common in long-distance runners and kicking athletes, especially football players. Due to the poor results of commonly used treatments for OP, there is a need for investigation of more effective treatments, such as ozone therapy. Ozone therapy is used to treat a variety of diseases, including musculoskeletal conditions.

CASE PRESENTATION

A 30-year-old amateur soccer player diagnosed with OP received conservative treatment with traditional physiotherapy and analgesic medications. After 6 months and no resolution of symptoms, the patient presented to the sports medicine outpatient clinic seeking alternative therapy options.

MANAGEMENT AND OUTCOMES

The patient received ozone injections in 3 sessions administered at 10-day intervals. At 1, 3, 6 and 12 months after the treatment, the patient's complaints and pain levels were re-evaluated and examined. The patient was able to return to competition at the same level after the first injection. No recurrence was revealed at a minimum of 12 months of follow-up.

CONCLUSION

In this article, we present a case in which OP was successfully treated with ozone injection.

The effect of intra-articular ozone injection combined with home-based exercise on pain and function in daily living activities of patients with mild to moderate knee osteoarthritis, a randomized double-blinded controlled clinical trial

BACKGROUND

Knee osteoarthritis is the most common arthritis. Various treatments such as analgesics, exercise therapy, and surgery in high-grade OA have been shown to reduce pain and improve patients' function; however, determining the optimal treatment remains a challenge. Ozone therapy is one of the injection techniques used for symptom relief in these patients. Therefore, this study aimed to evaluate the effect of ozone injection in mild to moderate knee osteoarthritis.

METHODS

Thirty-three patients with grade II-III knee osteoarthritis based on the Kellgren-Lawrence classification were involved in the study, by block randomisation. Totally 42 knees were included. All patients received exercise therapy, 500 mg of acetaminophen tablets (up to 2 g per day as needed), and healthy nutrition. In a double-blinded method, the intervention group received Ozone injections, but the control group received placebo injections. Functional tests, including timed-up-and-go and 6-min walk tests, were assessed at baseline and immediately after the 6-week intervention. In addition, the pain was measured by VAS score, and stiffness and activity of daily living (ADL) were evaluated by KOOS questionnaire before and after a 6-week intervention and then one and six months afterwards.

FINDINGS

Improvements in pain and KOOS scores were seen in both groups in the 6th week of injections (p < 0.05), with significant differences between groups. However, the effects on pain and KOOS scores disappeared in the 1st and 6th months of follow-ups in the control group. Nevertheless, the effects persisted in the intervention group compared to the baseline and control group, which means that in the mentioned time points intervention group showed significant improvement compared to the control group (p < 0.05). In addition, functional tests showed significant differences between the two groups in the 6th week of injections (p < 0.001).

INTERPRETATION

Ozone injection is a non-surgical treatment for mild to moderate knee osteoarthritis that could decrease pain and improve function and ADL of patients in the short to mid-term (3-6 months), so it seems that adding Ozone injection to the routine exercise therapy in management of patients with knee OA could improve outcomes.

Ozone ultrafine bubble water inhibits the early formation of Candida albicans biofilms

This study aimed to investigate the effect of ozone ultrafine bubble water (OUFBW) on the formation and growth of Candida albicans (C. albicans) biofilms and surface properties of denture base resins. OUFBWs were prepared under concentrations of 6 (OUFBW6), 9 (OUFBW9), and 11 ppm (OUFBW11). Phosphate buffered saline and ozone-free electrolyte aqueous solutions (OFEAS) were used as controls. Acrylic resin discs were made according to manufacturer instructions, and C. albicans was initially cultured on the discs for 1.5 h. A colony forming unit (CFU) assay was performed by soaking the discs in OUFBW for 5 min after forming a 24-h C. albicans biofilm. The discs after initial attachment for 1.5 h were immersed in OUFBW and then cultured for 0, 3, and 5 h. CFUs were subsequently evaluated at each time point. Moreover, a viability assay, scanning electron microscopy (SEM), Alamar Blue assay, and quantitative real-time polymerase chain reaction (qRT-PCR) test were performed. To investigate the long-term effects of OUFBW on acrylic resin surface properties, Vickers hardness (VH) and surface roughness (Ra) were measured. We found that OUFBW9 and OUFBW11 significantly degraded the formed 24-h biofilm. The time point CFU assay showed that C. albicans biofilm formation was significantly inhibited due to OUFBW11 exposure. Interestingly, fluorescence microscopy revealed that almost living cells were observed in all groups. In SEM images, the OUFBW group had lesser number of fungi and the amount of non-three-dimensional biofilm than the control group. In the Alamar Blue assay, OUFBW11 was found to suppress Candida metabolic function. The qRT-PCR test showed that OUFBW down-regulated ALS1 and ALS3 expression regarding cell-cell, cell-material adhesion, and biofilm formation. Additionally, VH and Ra were not significantly different between the two groups. Overall, our data suggest that OUFBW suppressed C. albicans growth and biofilm formation on polymethyl methacrylate without impairing surface properties.

CORonavirus-19 mild to moderate pneumonia Management with blood Ozonization in patients with Respiratory failure (CORMOR) multicentric prospective randomized clinical trial

BACKGROUND

Following positive experience on the use of blood ozonation in SARS-CoV-2, the CORMOR randomized trial was designed to evaluate the adjuvant role of oxygen/ozone therapy in mild to moderate SARS-CoV-2 pneumonia.

METHODS

The trial (ClinicalTrial.gov NCT04388514) was conducted in four different Italian centers (April-October 2020). Patients were treated according to best available standard of care (SoC) therapy, with or without O3-autohemotherapy (O3-AHT).

RESULTS

A total of 92 patients were enrolled: SoC + O3-AHT (48 patients) were compared to the SoC treatment (44 patients). The two groups differed in steroids therapy administration (72.7% in SoC arm vs. 50.0% in O3-AHT arm; p = 0.044). Steroid therapy was routinely started when it was subsequently deemed as effective for the treatment of COVID-19 disease. No significant differences in mortality rates, length of hospital stay, mechanical ventilation requirement and ICU admission were observed. Clinical improvement in patients with pneumonia was assessed according to a specifically designed score (decrease in SIMEU class, improvement in radiology imaging, improvement in PaO2/FiO2, reduction in LDH and requirement of oxygen therapy ≤ 5 days). Score assessment was performed on day-3 (T3) and day-7 (TEnd) of O3-AHT treatment. A significant increase in the score was reported at TEnd, in the O3-AHT treatment arm (0 [0-1] in the SoC arm vs. 2 [1-3] the O3-AHT arm; p = 0.018). No adverse events related O3-AHT treatment was observed.

CONCLUSION

In mild-to-moderate pneumonia due to SARS-CoV-2, adjuvant oxygen/ozone therapy did not show any effect on mortality, or mechanical intubation but show a clinical improvement a day 7 from randomization in a composite clinical endpoint. Larger Randomized prospective studies alone or in combination with steroids are needed to confirm our results.

Paravertebral intramuscular ozone therapy in lumbar disc hernia: A comprehensive retrospective study

BACKGROUND

Clinical studies assessing the impacts of ozone on the musculoskeletal framework are slowly expanding.

OBJECTIVE

In this study, we analyzed the impact of paravertebral ozone treatment (OT) injection treatment on distress and disability in patients with lumbar disc hernia (LDH).

METHODS

The records of 432 patients with L4-5 and L5-S1 LDH were examined retrospectively. 298 patients who met the inclusion criteria and who provided written informed consent were divided into two groups. Each group received 15 sets of physiotherapy at a rate of five sets every week (study group (n= 139), control group (n= 159)). Six OT injections were applied solely to the study group, two days per week. A visual pain score (VAS) was set up for distress and the Oswestry Disability Questionnaire (ODI) for disablement was administered when the groups were called to control before treatment, towards the end of the treatment, and three months after the treatment ended.

RESULTS

The groups had significantly reduced (p< 0.05) VAS and ODI scores following and three months after the treatment contrasted with their scores before the treatment. The Physiotherapy + OT group had significantly lower (p< 0.05) VAS and ODI scores than the physiotherapy group following and three months after the treatment.

CONCLUSIONS

Paravertebral OT injection is quite a safe and helpful treatment technique in LDH patients. Further studies should be conducted to investigate the long-term outcomes of the paravertebral OT application.

Ozone in Medicine. The Low-Dose Ozone Concept and Its Basic Biochemical Mechanisms of Action in Chronic Inflammatory Diseases

Low-dose ozone acts as a bioregulator in chronic inflammatory diseases, biochemically characterized by high oxidative stress and a blocked regulation. During systemic applications, “Ozone peroxides” are able to replace H₂O₂ in its specific function of regulation, restore redox signaling, and improve the antioxidant capacity. Two different mechanisms have to be understood. Firstly, there is the direct mechanism, used in topical treatments, mostly via radical reactions. In systemic treatments, the indirect, ionic mechanism is to be discussed: “ozone peroxide” will be directly reduced by the glutathione system, informing the nuclear factors to start the regulation. The GSH/GSSG balance outlines the ozone dose and concentration limiting factor. Antioxidants are regulated, and in the case of inflammatory diseases up-regulated; cytokines are modulated, here downregulated. Rheumatoid arthritis RA as a model for chronic inflammation: RA, in preclinical and clinical trials, reflects the pharmacology of ozone in a typical manner: SOD (superoxide dismutase), CAT (catalase) and finally GSH (reduced glutathione) increase, followed by a significant reduction of oxidative stress. Inflammatory cytokines are downregulated. Accordingly, the clinical status improves. The pharmacological background investigated in a remarkable number of cell experiments, preclinical and clinical trials is well documented and published in internationally peer reviewed journals. This should encourage clinicians to set up clinical trials with chronic inflammatory diseases integrating medical ozone as a complement.

Ozone inactivation of airborne influenza and lack of resistance of respiratory syncytial virus to aerosolization and sampling processes

Influenza and RSV are human viruses responsible for outbreaks in hospitals, long-term care facilities and nursing homes. The present study assessed an air treatment using ozone at two relative humidity conditions (RHs) in order to reduce the infectivity of airborne influenza. Bovine pulmonary surfactant (BPS) and synthetic tracheal mucus (STM) were used as aerosols protectants to better reflect the human aerosol composition. Residual ozone concentration inside the aerosol chamber was also measured. RSV's sensitivity resulted in testing its resistance to aerosolization and sampling processes instead of ozone exposure. The results showed that without supplement and with STM, a reduction in influenza A infectivity of four orders of magnitude was obtained with an exposure to 1.70 ± 0.19 ppm of ozone at 76% RH for 80 min. Consequently, ozone could be considered as a virucidal disinfectant for airborne influenza A. RSV did not withstand the aerosolization and sampling processes required for the use of the experimental setup. Therefore, ozone exposure could not be performed for this virus. Nonetheless, this study provides great insight for the efficacy of ozone as an air treatment for the control of nosocomial influenza A outbreaks.

Ozone inhalation induces exacerbation of eosinophilic airway inflammation and Th2-skew immune response in a rat model of AR

BACKGROUND

Ozone (O3) exposure elicits allergic rhinitis (AR) exacerbations by mechanisms that remain poorly understood. We used a rat model to investigate the effects of O3 on eosinophilic airway inflammation and Th2-related response.

METHODS

Sprague-Dawley (SD) rats were sensitized and challenged with ovalbumin (OVA) to make AR models. Three groups of AR rats were exposed respectively to 0.5, 1.0, 2.0 ppm of O3 for 2 h daily over 6 weeks consecutively and studied 24 h later. Normal rats exposed to O3 alone were used as controls. Nasal symptoms and OVA-specific immunoglobulin E (OVA-sIg E) in the serum were evaluated. Inflammatory cells in nasal lavage fluid (NLF) were classified and counted. Cytokines protein levels in NLF were assessed by ELISA. The pathological changes in the nasal mucosa were examined by histology.

RESULTS

The combination of allergen and repeated O3 exposure in rats induced a significant increase of the number of sneezes, nasal rubs, amount of nasal secretion and OVA-sIgE in the serum, accompanied by enhancement of eosinophils in NLF and nasal mucosa. The increase of interleukin-5 (IL-5), IL-13, Eotaxin and decrease of INF-γ protein levels in NLF were detected in AR rats after O3 inhalation. Hematoxylin and eosin staining showed disordered arrangement of the nasal mucosa epithelium and eosinophilic infiltration in a concentration-dependent manner.

CONCLUSIONS

O3 inhalation deteriorated symptoms in AR rats, and the possible mechanism is that ozone co-exposure could enhance the expression of Th2 cytokines, eosinophilic airway inflammation dose-dependently. The observation is helpful for us to understand the synergistic effect of O3 in the air pollution and allergen on aggravating allergic rhinitis.

The possibilities of using the effects of ozone therapy in neurology

OBJECTIVES

The beneficial effects of ozone therapy consist mainly of the promotion of blood circulation: peripheral and central ischemia, immunomodulatory effect, energy boost, regenerative and reparative properties, and correction of chronic oxidative stress. Ozone therapy increases interest in new neuroprotective strategies that may represent therapeutic targets for minimizing the effects of oxidative stress.

METHODS

The overview examines the latest literature in neurological pathologies treated with ozone therapy as well as our own experience with ozone therapy. The effectiveness of treatments is connected to the ability of ozone therapy to reactivate the antioxidant system to address oxidative stress for chronic neurodegenerative diseases, strokes, and other pathologies. Application options include large and small autohemotherapy, intramuscular application, intra-articular, intradiscal, paravertebral and epidural, non-invasive rectal, transdermal, mucosal, or ozonated oils and ointments. The combination of different types of ozone therapy stimulates the benefits of the effects of ozone.

RESULTS

Clinical studies on O2-O3 therapy have been shown to be efficient in the treatment of neurological degenerative disorders, multiple sclerosis, cardiovascular, peripheral vascular, orthopedic, gastrointestinal and genitourinary pathologies, fibromyalgia, skin diseases/wound healing, diabetes/ulcers, infectious diseases, and lung diseases, including the pandemic disease caused by the COVID-19 coronavirus.

CONCLUSION

Ozone therapy is a relatively fast administration of ozone gas. When the correct dose is administered, no side effects occur. Further clinical and experimental studies will be needed to determine the optimal administration schedule and to evaluate the combination of ozone therapy with other therapies to increase the effectiveness of treatment.

Comparison of Ultrasound-Guided Local Ozone (O2-O3) Injection Versus Corticosteroid Injection in Patients With Mild to Moderate Carpal Tunnel Syndrome

OBJECTIVE

Recently, ozone injection has been used to treat various musculoskeletal diseases. This study was performed to compare ultrasound-guided corticosteroid versus ozone injections in the treatment of carpal tunnel syndrome.

DESIGN

Forty patients with mild to moderate carpal tunnel syndrome were enrolled and randomly placed in one of the two groups of receiving a corticosteroid or ozone injection under ultrasound guidance. To determine the effectiveness of both injection techniques and compare their outcomes, visual analog scale and scores of Boston Carpal Tunnel Questionnaire, as well as ultrasound and electrodiagnostic criteria, were followed at 0, 6, and 12 wks after the injection.

RESULTS

Both groups showed improvement in visual analog scale and Boston Carpal Tunnel Questionnaire at week 6, and this improvement continued until the 12th week after the injections. However, electrodiagnostic values of sensory nerve action potentials and compound motor action potentials latency, and ultrasound carpal tunnel syndrome criteria showed significant improvement only among the subjects in the corticosteroid group at 6 and 12 wks after the injection (P < 0.05).

CONCLUSIONS

Ozone might be as effective as corticosteroid injection in reducing pain and improving the function. Objective improvements in electrodiagnostic and ultrasound criteria of carpal tunnel syndrome were shown only among patients after corticosteroid injection.

Ozone-induced changes in oxidative stress parameters in brain regions of adult, middle-age, and senescent Brown Norway rats

A critical part of community based human health risk assessment following chemical exposure is identifying sources of susceptibility. Life stage is one such susceptibility. A prototypic air pollutant, ozone (O3) induces dysfunction of the pulmonary, cardiac, and nervous systems. Long-term exposure may cause oxidative stress (OS). The current study explored age-related and subchronic O3-induced changes in OS in brain regions of rats. To build a comprehensive assessment of OS-related effects of O3, a tripartite approach was implemented focusing on 1) the production of reactive oxygen species (ROS) [NADPH Quinone oxidoreductase 1, NADH Ubiquinone reductase] 2) antioxidant homeostasis [total antioxidant substances, superoxide dismutase, γ-glutamylcysteine synthetase] and 3) an assessment of oxidative damage [total aconitase and protein carbonyls]. Additionally, a neurobehavioral evaluation of motor activity was compared to these OS measures. Male Brown Norway rats (4, 12, and 24 months of age) were exposed to air or O3 (0.25 or 1 ppm) via inhalation for 6 h/day, 2 days per week for 13 weeks. A significant decrease in horizontal motor activity was noted only in 4-month old rats. Results on OS measures in frontal cortex (FC), cerebellum (CB), striatum (STR), and hippocampus (HIP) indicated life stage-related increases in ROS production, small decreases in antioxidant homeostatic mechanisms, a decrease in aconitase activity, and an increase in protein carbonyls. The effects of O3 exposure were brain area-specific, with the STR being more sensitive. Regarding life stage, the effects of O3 were greater in 4-month-old rats, which correlated with horizontal motor activity. These results indicate that OS may be increased in specific brain regions after subchronic O3 exposure, but the interactions between age and exposure along with their consequences on the brain require further investigation.

Selenium or ozone: Effects on liver injury caused by experimental iron overload

AIMS

Iron is an important metal ion as a biocatalyst on the other hand iron overload causes various diseases. Iron overload can result in fibrosis and hepatocellular carcinoma with various pathophysiological mechanisms, including oxidative damage in the liver. Therefore; in this study the effects of ozone and selenium -whose antioxidant properties are known- were evaluated in liver injury induced by iron overload.

MATERIALS AND METHODS

Iron overload model was provided by intraperitoneal administration of 88 mg/kg iron dextrate for 4 weeks. After iron dextran administration, ozone and selenium administrations were made for 3 weeks. From the obtained blood and tissue samples total oxidant status (TOS) and total antioxidant status (TAS) were determined and histopathological examination was performed in liver tissue samples.

KEY FINDINGS

In rats with iron overload, the lowest mean serum TOS was observed in the selenium administration group. The highest tissue TOS means and the lowest tissue TAS means were determined in the group in which ozone and selenium were administrated together. When histopathological data were evaluated, the presence of increased apoptosis in the ozone group compared to the iron group (p = 0.019) and selenium group (p = 0.019) was noted. Similarly, increased periportal inflammation (p = 0.001) and fibrosis (p = 0.005) were observed in the ozone group compared to the selenium group.

SIGNIFICANCE

In iron-induced liver damage, ozone was thought to be effective by decreasing ROS, but contrary to expectations, it was observed that it may negatively affect the picture by showing synergistic effect. However, the effects of selenium on both serum and tissue levels are promising.

Efficacy of Intradiscal Ozone Therapy with or without Periforaminal Steroid Injection on Lumbar Disc Herniation: A Double-Blinded Controlled Study

BACKGROUND

Intradiscal ozone therapy, a minimally invasive technique, is used in patients that do not respond to standard conservative therapies for low back pain due to degenerative disc-induced lumbar disc herniation (LDH). Many studies on clinical efficacy lack a standardized injection method and are limited by inadequate study design.

OBJECTIVE

This study aimed to determine the efficacy of periforaminal steroid injection together with intradiscal ozone therapy.

STUDY DESIGN

A prospective, double-blinded, randomized controlled trial.

SETTING

A tertiary care center.

METHODS

This study was conducted in 65 patients with low back and leg pain caused by LDH. Group 1 received intradiscal ozone therapy (n = 35) and Group 2 received intradiscal ozone therapy with periforaminal steroid injection (n = 30). Patients were evaluated for pain using the visual analogue scale (VAS), for disability using Oswestry Disability Index (ODI), and for quality of life using the short form 36 health survey administered pre-injection and at one and 6 months post-injection. All procedures were performed under sterile conditions using C-arm fluoroscopy.

RESULTS

Significant improvements were observed in pain, disability, and quality of life in both groups post-treatment compared to pre-injection. Mean pre-injection VAS was not significantly different between the groups (VAS: 7.8 ± 1.1 for Group 1, 7.8 ± 1.2 for Group 2). VAS values at 6 months for Group 1 and Group 2 were as follows: 3.6 ± 2.4, 4.1 ± 1.6, respectively) (P < 0.001). Mean pre-injection ODI was not significantly different between the groups (ODI: 20.9 ± 9.6 for Group 1, 25.2 ± 10.3 for Group 2). ODI values at 6 months for Group 1 and Group 2 were as follows: 12.8 ± 9.2, 14.3 ± 7.2, respectively) (P < 0.001). However, there were no significant differences between the groups. Similarly, there was no significant difference between the 2 groups on any of these parameters.

LIMITATIONS

A limited number of patients and limited follow-up time.

CONCLUSION

This study showed that intradiscal ozone injection alone was sufficient to treat low back and leg pain caused by LDH and that periforaminal steroid injection does not provide additional benefit, which is contrary to the literature.

Intrauterine therapy with ozone reduces subclinical endometritis and improves reproductive performance in postpartum dairy cows managed in pasture-based systems

New postpartum strategies have been developed in dairy cows to ameliorate uterine health and reproductive performance, especially the first service conception rates. This study aimed to assess the effect of intrauterine therapy with ozone (IUTO) in early postpartum on subclinical endometritis prevalence and reproductive parameters in dairy cows under commercial farm conditions. For this purpose, eighty clinically healthy cows with a body condition score between 3.0 and 3.5, from four dairy farms, were randomly allocated into two groups: ozone therapy group (OG, n = 40), which were subjected to IUTO, and control group (CG, n = 40). Content of uterine polymorphonuclear (PMN) leukocytes and subclinical endometritis (SE) percentage were assessed at 35 days after calving by uterine cytology. A second cytology was performed 72 h after IUTO. Reproductive parameters such as interval calving to first service (IFS), number of services per conception (nSC), interval calving to conception (ICC) and first service conception rate (FSCR) were analysed. The second endometrial cytology demonstrated that IUTO reduced (P < 0.01) both PMN (3.7 ± 1.4 vs. 7.6 ± 1.1%) and SE (5.0 vs. 50.0%) percentages compared with CG. Likewise, after ozone treatment, both nSC (2.1 ± 0.3 vs. 3.1 ± 0.2; P < 0.01) and ICC (126.2 ± 9.7 vs. 149.0 ± 9.0; P = 0.0672) decreased, and FSCR increased (50.0 vs. 16.2%; P < 0.01) compared with CG. In conclusion, intrauterine ozone therapy applied at 35 days after calving reduced subclinical endometritis prevalence and improved reproductive performance in postpartum dairy cows managed in a pasture-based system.

Selective nerve root injection of ozone for the treatment of phantom limb pain: Three case reports

RATIONALE

Phantom limb pain (PLP) refers to a common complication following amputation, which is characterized by intractable pain in the absent limb, phantom limb sensation, and stump pain. The definitive pathogenesis of PLP has not been fully understood, and the treatment of PLP is still a great challenge. Till now, ozone injection has never been reported for the treatment of PLP.

PATIENT CONCERNS

We report 3 cases: a 68-year-old man, a 48-year-old woman, and a 46-year-old man. All of them had an amputation history and presented with stump pain, phantom limb sensation, and sharp pain in the phantom limb. Oral analgesics and local blocking in stump provided no benefits.

DIAGNOSIS

They were diagnosed with PLP.

INTERVENTIONS

We performed selective nerve root ozone injection combined with ozone injection in the stump tenderness points.

OUTCOMES

There were no adverse effects. Postoperative, PLP, and stump pain were significantly improved. During the follow-up period, the pain was well controlled.

LESSONS

Selective nerve root injection of ozone is safe and the outcomes were favorable. Ozone injection may be a new promising approach for treating PLP.

[The features of course of chronic abacterial prostatitis with inflammatory compoment in men of the first period of mature age depending on the somatotype. Part 2: laboratory and imaging characteristics]

AIM

to study the course of chronic abacterial prostatitis with the inflammatory component (CAPIC) depending on the somatotype in men of the first period of mature age taking complex treatment with a use of local and systemic ozone therapy.

MATERIALS AND METHODS

A total of 306 men of asthenic, normostenic and pyknic somatotypes with CAPIC were followed-up. Along with standard therapy, all patients received systemic and local ozone therapy. Clinical, laboratory and imaging characteristics were recorded before and after treatment. In addition, hemodynamic parameters in the prostate, prostatic part of the urethra and skin projection of the prostate were evaluated.

RESULTS

In patients with pyknic somatotype (from 34.12+/-0.51 cm3 to 29.08+/-0.64 cm3) the most significant reduction in prostate size during the treatment with CAPIC was observed, while the improvement of microcirculation parameters were seen in patients with asthenic somatotype. Changes in the microcirculation in the mucous membrane of the prostatic part of the urethra and skin projection of the prostate during the treatment of CAPIC are somatotype-dependent. The highest values of tissue perfusion were found in patients of the normostenic somatotype, while pyknic patients had the smallest values. Along with somatotyping, this allows to use in clinical practice the abovementioned methods for early diagnosis and subsequent monitoring of the effectiveness of CAPIC therapy.

Comparison of corticosteroid injection and ozone injection for relief of pain in chronic lateral epicondylitis

To evaluate and compare the therapeutic effects of corticosteroid and ozone injections in the alleviation of pain associated with chronic lateral epicondylitis . Data was collected from the medical records of 80 patients (56 women, 24 men ; average age : 45.8±7.5). Corticosteroid injection was performed once a week for three times, and ozone was injected 6-8 times at 3 day intervals. No additional analgesics were given. Pain assessment was made by means of Verhaar scores before and after the first injection, on 3rd, 6th and 9th months. The duration of pain was 24.4±12.5 months and the right side was more commonly affected (47, 58.8% vs. 33, 41.2%). Corticosteroid and ozone groups were similar with respect to age (p=0.45), gender distribution (p=0.43) and side of epicondylitis (p=0.88). Pain scores at rest, at compression and on activity were not different in two groups before and following injection. Notably, ozone group displayed better scores compared to corticosteroid in terms of pain on 3rd, 6th and 9th months after injection (p<0.001 for all). Our results demonstrated that ozone injection can be an effective therapeutic option for CLE patients who are refractory to conservative treatment.

The interleukin-33 receptor contributes to pulmonary responses to ozone in male mice: role of the microbiome

BACKGROUND

Interleukin-33 is released in the airways following acute ozone exposure and has the ability to cause airway hyperresponsiveness, a defining feature of asthma. Ozone causes greater airway hyperresponsiveness in male than female mice. Moreover, sex differences in the gut microbiome account for sex differences in this response to ozone. The purpose of this study was to determine whether there were sex differences in the role of interleukin-33 in ozone-induced airway hyperresponsiveness and to examine the role of the microbiome in these events.

METHODS

Wildtype mice and mice genetically deficient in ST2, the interleukin-33 receptor, were housed from weaning with either other mice of the same genotype and sex, or with mice of the same sex but opposite genotype. At 15 weeks of age, fecal pellets were harvested for 16S rRNA sequencing and the mice were then exposed to air or ozone. Airway responsiveness was measured and a bronchoalveolar lavage was performed 24 h after exposure.

RESULTS

In same-housed mice, ozone-induced airway hyperresponsiveness was greater in male than female wildtype mice. ST2 deficiency reduced ozone-induced airway hyperresponsiveness in male but not female mice and abolished sex differences in the response to ozone. However, sex differences in the role of interleukin-33 were unrelated to type 2 cytokine release: ozone-induced increases in bronchoalveolar lavage interleukin-5 were greater in females than males and ST2 deficiency virtually abolished interleukin-5 in both sexes. Since gut microbiota contribute to sex differences in ozone-induced airway hyperresponsiveness, we examined the role of the microbiome in these ST2-dependent sex differences. To do so, we cohoused wildtype and ST2 deficient mice, a situation that allows for transfer of microbiota among cage-mates. Cohousing altered the gut microbial community structure, as indicated by 16S rRNA gene sequencing of fecal DNA and reversed the effect of ST2 deficiency on pulmonary responses to ozone in male mice.

CONCLUSIONS

The data indicate that the interleukin-33 /ST2 pathway contributes to ozone-induced airway hyperresponsiveness in male mice and suggest that the role of interleukin-33 is mediated at the level of the gut microbiome.

Ozone treatments activate defence responses against Meloidogyne incognita and Tomato spotted wilt virus in tomato

BACKGROUND

Ozonated water (O₃ wat) soil drench and/or foliar spray applications were evaluated for their potential to control the root-knot nematode Meloidogyne incognita (RKN) and the airborne pathogen Tomato spotted wilt virus (TSWV) in tomato. We investigated how O₃ wat modulates the salicylic acid/jasmonic acid/ethylene (SA/JA/ET) signalling network in the host, locally and systemically, to induce resistance to nematode and virus.

RESULTS

The application as soil drench was effective in reducing the number of galls and egg masses, but did not reduce the incidence and severity of TSWV infection. Conversely, O₃ wat applied by foliar spray decreased TSWV disease incidence and severity (-20%), but was not able to control M. incognita infection. SA-related genes were generally upregulated in both locally treated and systemically reached tissues, showing a positive action of the O₃ wat treatment on SA signalling. Neither O₃ wat application method significantly altered JA-related gene expression in either direction. ET-related genes were differentially regulated by root or leaf treatments, indicating that O₃ wat may have different effects on ET-mediated signalling in different organs. JA/ET/SA related pathways were differentially modulated by O₃ wat in the presence of either RKN or TSWV.

CONCLUSION

O₃ wat had a higher efficacy when applied directly to organs challenged by the pathogens, although it was potentially able to stimulate defence responses through the activation of SA signalling. Owing to its safety and effectiveness in controlling nematode and virus infections, O₃ wat can be considered as a possible alternative tool for sustainable disease management practices. © 2019 Society of Chemical Industry.

Ozone and pulsed electro-magnetic field therapies improve endometrial lining thickness in frozen embryo transfer cycles: Three case reports

RATIONALE

In assisted reproductive technology, a persistently thin endometrial lining represents a huge challenge during frozen embryo transfer (FET) cycles.

PATIENT CONCERNS

Three patients who had a persistently thin endometrial lining despite the use of several medical agents known to improve endometrial lining thickness.

DIAGNOSES

Infertility undergoing FET cycles.

INTERVENTIONS

A combination of transdermal and intravaginal ozone therapy along with Pulsed Electro-Magnetic Field (PEMF) therapy.

OUTCOMES

Ozone with PEMF, both of which are known to have vasodilatatory, anti-inflammatory, and anti-oxidant actions, were successful in improving the thickness of the endometrial lining in all 3 patients. Two out of 3 patients became pregnant following single embryo transfer.

LESSONS

Ozone with PEMF constitute a novel experimental approach for women with persistently thin endometrial lining undergoing FET. This novel approach needs validation by large well-designed studies.

Autohemotherapy with ozone as a possible effective treatment for Fibromyalgia

OBJECTIVE

The objective of this study is to evaluate the effectiveness of autohemotherapy with ozone in the management of fibromyalgia (FM).

DESIGN

20 FM patients (according to the criteria of the American College of Rheumatology), were treated with 10 sessions of ozone hemotherapy (2 sessions per week) with a concentration of 30-60 mcgr/ml. The health condition of the patients was evaluated before and after treatment, through the Fibromyalgia Impact Questionnaire (FIQ). Blood samples were obtained from all patients by venous puncture for biochemical routine analysis and serotonin levels in serum and the following peripheral blood mononuclear cells (BMCs) were isolated for oxidative stress quantification: reactive oxygen species (ROS) generation, and lipid peroxidation (LP) and protein carbonyl (PC) content, as these are signs of oxidative cell damage.

RESULTS

All patients treated with ozone reported an improvement in sleep and mental alertness, a marked decrease of asthenia accompanied by a decrease of FIQ as well as tender points, and a moderate increase of serotonin levels. Also, an important decrease of LP and PC was observed; ROS also decreased, although less obvious, which indicates a reduction in oxidative stress levels.

CONCLUSIONS

The autohemotherapy with ozone in patients with FM showed an important decline of tender points and FIQ score, as well as a decrease of oxidative stress levels. This treatment allows patients to face life with greater vitality and less drug use, diminishing harmful side effects. Further investigation should be carried out, including groups with more patients and clinical trials, to elucidate the effect of ozone therapy in patients suffering from FM.

The effects of elevated ozone on the accumulation and allocation of poplar biomass depend strongly on water and nitrogen availability

Ozone (O₃) pollution can alter carbon allocation and reduce tree growth - both above and below ground, but the extent of these effects depends on the variation in soil water and nutrient availability. Here we present the accumulation and allocation of biomass in poplar clone 546 (Populus deltoides cv. '55/56' × P. deltoides cv. 'Imperial') for one growing season at two O₃ concentrations (charcoal-filtered air [CF] and non-filtered air + 40 ppb of O₃ [E-O₃]), two watering regimes (well-watered [WW] and reduced watering at 40% of WW irrigation [RW]) and two soil nitrogen addition treatments (no addition [N0] and the addition of 50 kg N ha^-1 year^-1 [N50]). We found that the deleterious effects of E-O₃ depended on the supply of water and nitrogen. Specifically, when the supplies of water and/or N (WW and/or N50) were abundant, E-O₃ significantly reduced whole plant biomass by >15% but had no significant effect on biomass when these supplies were limited (RW and N0). A significant reduction of biomass by E-O₃ occurred earlier in fine roots than in other plant organs, indicating greater sensitivity of fine root to E-O₃. These results suggest that rising O₃ concentrations may not ubiquitously lead to a large reduction in plant biomass since plant growth is often jointly constrained by water and nutrients.

Effects of subcutaneous injection of ozone during wound healing in rats

Fibroblast growth factor 2 (FGF2) regulates the wound repair process and it is secreted by inflammatory and endothelial cells, and by myofibroblasts. This study aimed to establish the expression patterns of FGF2 and myofibroblastic differentiation during wound healing in rats treated with subcutaneous ozone injection. We created full-thickness excisional wounds in rats, and the healing process was analyzed through morphometric analyses and digital quantification of immunoreactivity of smooth muscle actin and FGF2. Ozone therapy-treated wounds presented granulation tissue with a reduced number of inflammatory cells and greater dermal cellularity, and intense collagen deposition. FGF2 immunoreactivity, microvessel density, and amount of myofibroblasts were significantly higher in treated wounds compared to controls. In conclusion, it was demonstrated that subcutaneous injections of ozone accelerate and ameliorate wound repairing process. Moreover, injectable ozone therapy's action mechanism may be associated with FGF2 overexpression.

Development of a large-scale computer-controlled ozone inhalation exposure system for rodents

Objective: Complete systems for laboratory-based inhalation toxicology studies are typically not commercially available; therefore, inhalation toxicologists utilize custom-made exposure systems. Here we report on the design, construction, testing, operation and maintenance of a newly developed in vivo rodent ozone inhalation exposure system. Materials and methods: Key design requirements for the system included large-capacity exposure chambers to facilitate studies with large sample sizes, automatic and precise control of chamber ozone concentrations, as well as automated data collection on airflow and environmental conditions. The exposure system contains two Hazelton H-1000 stainless steel and glass exposure chambers, each providing capacity for up to 180 mice or 96 rats. We developed an empirically tuned proportional-integral-derivative control loop that provides stable ozone concentrations throughout the exposure period (typically 3h), after a short ramp time (∼8 min), and across a tested concentration range of 0.2-2 ppm. Specific details on the combination of analog and digital input/output system for environmental data acquisition, control and safety systems are provided, and we outline the steps involved in maintenance and calibration of the system. Results: We show that the exposure system produces consistent ozone exposures both within and across experiments, as evidenced by low coefficients of variation in chamber ozone concentration and consistent biological responses (airway inflammation) in mice, respectively. Conclusion: Thus, we have created a large and robust ozone exposure system, facilitating future studies on the health effects of ozone in rodents.

Low back pain related to a sacral insufficiency fracture: role of paravertebral oxygen-ozone therapy in a paradigmatic case of nociplastic pain

We describe the case of a 68-year-old woman with an acute episode of severe low back pain (LBP) resistant to opioids, who had experienced a sacral insufficiency fracture (SIF) two years earlier. At clinical examination, patient reported constant, dull, non-localizable pain at lumbar and sacral level, exacerbated by paravertebral palpation, particularly at L4-L5 and the sacroiliac joint, with a concomitant and remittent neuropathic component, difficult to localize at lumbar and sacral level. The latest magnetic resonance imaging study revealed disc herniations at L3-L4, L4-L5, and L5-S1 levels. The patient was treated with intramuscularparavertebral injections of oxygen-ozone (O2O3) mixture for 4 weeks (once a week), using a O3 concentration of 20 mcg/mL (5 mL in L4-L5 zone and 5 mL in L5-S1 zone, bilaterally). At 1 week after the first injection, the pain (assessed by Numerical Pain Rating Scale and Brief Pain Inventory) was considerably reduced and the patient's health-related quality of life (assessed by Short Form 12-Item Health Survey and European Quality of Life Index) had improved; these findings were confirmed at follow-up 1 month after the last injection. This paradigmatic case of nociplastic pain successfully treated by paravertebral O2O3 therapy might be a starting point for further studies on the effects of this treatment in terms of decreasing pain and improving HRQoL in patients affected by opioid-resistant LBP.

Efficacy of comprehensive ozone therapy in diabetic foot ulcer healing

BACKGROUND

Diabetic foot ulcer is one of the common complications of diabetes disease that is costly and difficult to treat. This problem can lead to morbidity and even mortality. Ozone is a gas that can optimize cellular metabolism and, because of its antioxidant and antibacterial effects, can help the better healing of diabetic foot ulcer.

METHOD

Two hundred patients, aged 18-85 with diabetic foot ulcers ranging from grade 1 to 4 according to Wagner classification in two groups were studied. Group 1 was treated by full ozone therapy besides the standard regular DFU treatment while group two just was received routine diabetic foot care. Wound size, wound grade, healing time, Fasting blood sugar and inflammatory biomarker before and after treatment were checked.

RESULTS

All patients have had complete wound closure in the ozone group. The mean age of the patients included in the results was 59.03 ± 12.593 and 53.5 ± 10.212 for ozone group and control group. The baseline average surface area of ulcers was 13.41 ± 14.092 cm² (range 1-70 cm²) in ozone group and 12.72 ± 0.911 (range 1_64 cm²) in the control group. Average healing time was 69.44 ± 36.055 days (range 15-180 days), which is significantly lower than the median healing time measured in the control group and some previous studies.

CONCLUSION

Our study results support the efficacy of ozone therapy especially in its comprehensive use in DFU healing and reduction in the chances of infection and amputation.

Stress axis variability is associated with differential ozone-induced lung inflammatory signaling and injury biomarker response

Ozone (O₃), a ubiquitous urban air pollutant, causes adverse pulmonary and extrapulmonary effects. A large variability in acute O₃-induced effects has been observed; however, the basis for interindividual differences in susceptibility is unclear. We previously demonstrated a role for the hypothalamic-pituitary-adrenal (HPA) stress axis and glucocorticoid response in acute O₃ toxicity. Glucocorticoids have important anti-inflammatory actions, and have been shown to regulate lung inflammatory responses. We hypothesised that a hyporesponsive HPA axis would be associated with greater O₃-dependent lung inflammatory signaling. Two genetically-related rat strains with known differences in stress axis reactivity, highly-stress responsive Fischer (F344) and less responsive Lewis (LEW), were exposed for 4 h by nose-only inhalation to clean air or 0.8 ppm O₃, and euthanized immediately after exposure. As expected, baseline (air-exposed) plasma corticosterone was significantly lower in the hypo-stress responsive LEW. Although O₃ exposure increased plasma corticosterone in both strains, corticosterone remained significantly lower in LEW when compared to F334. LEW exhibited greater O₃-induced inflammatory cytokine/chemokine signaling compared to F344, consistent with the lower corticosterone levels. Since we observed strain-specific differences in inflammatory signaling, we further investigated injury biomarkers (total protein, albumin and lactate dehydrogenase). Although the hyper-responsive F344 exhibited lower inflammatory signaling in response to O₃ compared with LEW, they had greater levels of lung injury biomarkers. Our results indicate that stress axis variability is associated with differential O₃-induced lung toxicity. Given the large variability in stress axis reactivity among humans, stress axis regulation could potentially be a determining factor underlying O₃ sensitivity.

Air Health Trend Indicator: Association between Short-Term Exposure to Ground Ozone and Circulatory Hospitalizations in Canada for 17 Years, 1996⁻2012

The Air Health Trend Indicator is designed to estimate the public health risk related to short-term exposure to air pollution and to detect trends in the annual health risks. Daily ozone, circulatory hospitalizations and weather data for 24 cities (about 54% of Canadians) for 17 years (1996⁻2012) were used. This study examined three circulatory causes: ischemic heart disease (IHD, 40% of cases), other heart disease (OHD, 31%) and cerebrovascular disease (CEV, 14%). A Bayesian hierarchical model using a 7-year estimator was employed to find trends in the annual national associations by season, lag of effect, sex and age group (≤65 vs. >65). Warm season 1-day lagged ozone returned higher national risk per 10 ppb: 0.4% (95% credible interval, -0.3⁻1.1%) for IHD, 0.4% (-0.2⁻1.0%) for OHD, and 0.2% (-0.8⁻1.2%) for CEV. Overall mixed trends in annual associations were observed for IHD and CEV, but a decreasing trend for OHD. While little age effect was identified, some sex-specific difference was detected, with males seemingly more vulnerable to ozone for CEV, although this finding needs further investigation. The study findings could reduce a knowledge gap by identifying trends in risk over time as well as sub-populations susceptible to ozone by age and sex.

Effects of medical ozone upon healthy equine joints: Clinical and laboratorial aspects

OBJECTIVE

The aim of this study was to verify whether transient inflammatory reactions induced by intra-articular medicinal ozone administration affect joint components, by in vivo evaluation of inflammatory (prostaglandin E2, Substance P, Interleukin-6, Interleukine-1, Tumor Necrosis Factor), anti-inflammatory (Interleukin-10) and oxidative (superoxide dismutase activity and oxidative burst) biomarkers and extracellular matrix degradation products (chondroitin sulphate and hyaluronic acid) in synovial fluid.

METHODS

The effects of medicinal ozone were analyzed at two ozone concentrations (groups A and B, 20 and 40 μg/ml, respectively), using oxygen-injected joints as controls (group C); each group received ten treatments (15 ml gas per treatment). Physical evaluation, evaluation of lameness, ultrasonography, and synovial fluid analysis were performed.

RESULTS

All joints presented mild and transient effusion throughout the study. Group B exhibited the highest lameness score on day 14 (P<0.05), detected by the lameness measurement system, probably because of the higher ozone concentration. All groups exhibited increased ultrasonography scores on day 14 (P < 0.05). Groups A and B exhibited increased proteins concentrations on day 21 (P<0.05). There was no change in hyaluronic acid concentration or the percentage of high-molecular weight hyaluronic acid throughout the experiment. Chondroitin sulfate concentrations decreased in group B, and did not change in group A and C, indicating that neither treatment provoked extracellular matrix catabolism. Cytokine and eicosanoid concentrations were not significantly changed.

CONCLUSIONS

The ozonetherapy did not cause significant inflammation process or cartilage degradation, therefore, ozonetherapy is safe at both evaluated doses.

The effects of ultrasound-guided corticosteroid injection compared to oxygen-ozone (O2-O3) injection in patients with knee osteoarthritis: a randomized controlled trial

Osteoarthritis (OA) is a chronic multifactorial disease characterized by progressive joint degeneration. The purpose of this study was to compare the effects of ultrasound-guided corticosteroid injection with oxygen-ozone injection in patients with knee OA. This double-blind randomized clinical trial was performed on 62 patients with knee OA. The patients were randomly divided into two groups. In the first group 40 mg triamcinolone (1 cc) and in the second group 10 cc (15 μg/ml) oxygen-ozone (O₂-O₃) were injected into the knee joint under ultrasound guidance. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis (WOMAC), knee flexion range of motion (ROM), effusion in ultrasound images of the suprapatellar recess, and visual analog scale (VAS), which were evaluated before injection, 1 week, 1 month, and 3 months after the treatment. Sixty-two patients (10 men and 52 women) were enrolled with mean age of 57.9 years. VAS improved in both groups (steroid P value = 0.001, oxygen-ozone P value > 0.001). The improvements seen in VAS and WOMAC scores 3 months after treatment were in favor of the oxygen-ozone group when compared to the steroid group (P = 0.041 vs P = 0.19). There was no significant difference between the two groups in ROM and joint effusion seen under ultrasound (ROM p = 0.880, effusion p = 0.362). However, in the oxygen-ozone-receiving group, joint effusion was decreased significantly (p < 0.001). Both steroid and oxygen-ozone injections are effective in patients with knee osteoarthritis. Our study showed that the effects of oxygen-ozone injection last longer than those of steroid injection to the knee joint.

The microbial killing capacity of aqueous and gaseous ozone on different surfaces contaminated with dairy cattle manure

A high reactivity and leaving no harmful residues make ozone an effective disinfectant for farm hygiene and biosecurity. Our objectives were therefore to (1) characterize the killing capacity of aqueous and gaseous ozone at different operational conditions on dairy cattle manure-based pathogens (MBP) contaminated different surfaces (plastic, metal, nylon, rubber, and wood); (2) determine the effect of microbial load on the killing capacity of aqueous ozone. In a crossover design, 14 strips of each material were randomly assigned into 3 groups, treatment (n = 6), positive-control (n = 6), and negative-control (n = 2). The strips were soaked in dairy cattle manure with an inoculum level of 10⁷–10⁸ for 60 minutes. The treatment strips were exposed to aqueous ozone of 2, 4, and 9 ppm and gaseous ozone of 1and 9 ppm for 2, 4, and 8 minutes exposure. 3M™ Petrifilm™ rapid aerobic count plate and plate reader were used for bacterial culture. On smooth surfaces, plastic and metal, aqueous ozone at 4 ppm reduced MBP to a safe level (≥5-log₁₀) within 2 minutes (6.1 and 5.1-log₁₀, respectively). However, gaseous ozone at 9 ppm for 4 minutes inactivated 3.3-log₁₀ of MBP. Aqueous ozone of 9 ppm is sufficient to reduce MBP to a safe level, 6.0 and 5.4- log_10, on nylon and rubber surfaces within 2 and 8 minutes, respectively. On complex surfaces, wood, both aqueous and gaseous ozone at up to 9 ppm were unable to reduce MBP to a safe level (3.6 and 0.8-log₁₀, respectively). The bacterial load was a strong predictor for reduction in MBP (P<0.0001, R² = 0.72). We conclude that aqueous ozone of 4 and 9 ppm for 2 minutes may provide an efficient method to reduce MBP to a safe level on smooth and moderately rough surfaces, respectively. However, ozone alone may not an adequate means of controlling MBP on complex surfaces.

Ultrafine Particulate Matter Combined With Ozone Exacerbates Lung Injury in Mature Adult Rats With Cardiovascular Disease

Particulate matter (PM) and ozone (O3) are dominant air pollutants that contribute to development and exacerbation of multiple cardiopulmonary diseases. Mature adults with cardiovascular disease (CVD) are particularly susceptible to air pollution-related cardiopulmonary morbidities and mortalities. The aim was to investigate the biologic potency of ultrafine particulate matter (UFPM) combined with O3 in the lungs of mature adult normotensive and spontaneously hypertensive (SH) Wistar-Kyoto rats. Conscious, mature adult male normal Wistar-Kyoto (NW) and SH rats were exposed to one of the following atmospheres: filtered air (FA); UFPM (∼ 250 μg/m3); O3 (1.0 ppm); or UFPM + O3 (∼ 250 μg/m3 + 1.0 ppm) combined for 6 h, followed by an 8 h FA recovery period. Lung sections were evaluated for lesions in the large airways, terminal bronchiolar/alveolar duct regions, alveolar parenchyma, and vasculature. NW and SH rats were similarly affected by the combined-pollutant exposure, displaying severe injury in both large and small airways. SH rats were particularly susceptible to O3 exposure, exhibiting increased injury scores in terminal bronchioles and epithelial degeneration in large airways. UFPM-exposure groups had minimal histologic changes. The chemical composition of UFPM was altered by the addition of O3, indicating that ozonolysis promoted compound degradation. O3 increased the biologic potency of UFPM, resulting in greater lung injury following exposure. Pathologic manifestations of CVD may confer susceptibility to air pollution by impairing normal lung defenses and responses to exposure.

Therapeutic Effect of Medical Ozone on Lumbar Disc Herniation

BACKGROUND This study aimed to investigate the therapeutic effect of low, medium, and high concentrations of medical ozone on trauma-induced lumbar disc herniation. MATERIAL AND METHODS A total of 80 patients were included and were grouped into a control group, a low medical ozone (20 μg/ml) group, a medium medical ozone (40 μg/ml) group, and a high medical ozone (60 μg/ml) group. The CT scan and enzyme-linked immunosorbent assay (ELISA) were used to detect IL-6 level, SOD activity, IgM, and IgG levels upon admission and at 6 and 12 months after follow-up. The area under the ROC curve (AUC) was calculated for visual analogue scale (VAS) and efficiency rate. RESULTS All patients showed disc retraction at 6- and 12-month follow-up; while patients in the medium medical ozone (40 μg/ml) group showed the greatest disc retraction rate. The IL-6, IgM, IgG, and VAS levels significantly decreased while SOD activity increased among all groups over time (p<0.05). The AUCIL-6, AUCIgG, AUCIgM, and AUCSOD was closest to 1 in the medium medical ozone (40 μg/ml) group compared with other groups (p<0.01), with the highest efficacy at 6 (35%) and 12 (85%) months during follow-up. CONCLUSIONS Low concentrations of medical ozone (20 μg/ml and 40 μg/ml) reduced the serum IL-6, IgG, and IgM expression, presenting as analgesic and anti-inflammatory effects, while high concentrations of medical ozone (60 μg/ml) increased the serum IL-6, IgG, IgM expression, presenting as pain and pro-inflammatory effects. The medical ozone concentration of 40 μg/ml showed the optimal treatment efficacy.

ULTRASTRUCTURAL CHANGES OF WOUND MACROPHAGES UNDER THE INFLUENCE OF INTRAVENOUS OZONE THERAPY IN PATIENTS WITH DIABETES AND INFLAMMATORY PROCESSES OF SOFT TISSUES

Investigation of ultrastructural peculiarities of morpho-functional changes of macrophages have been studied with the purpose of determining the dynamics and thrust of destructive-necrotic processes in these cells when the ischemic-gangrenous form of diabetic foot syndrome develops show what under the influence of intravenous ozone therapy stimulant effect on functional activity and beneficial effect on elimination, mainly due to genetically programmed cell death (apoptosis), playing a significant role in the regulatory mechanisms of the inflammatory process. The stimulation of macrophages functional activity under the influence of ozone, as well as the presence of destructive changes in such cells without necrotizing lesions, is explained by the inclusion of the mechanism of apoptosis as a positive factor in the regulation of local homeostasis at the completion of the inflammatory (exudative) stage of the wound process.

[Attenuation rules and germicidal efficacy of ozoneted water]

To determine initial concentrations of ozonated water under different temperatures, attenuation rules of ozonated water under the room temperature (25 ℃), and to inspect the effects of ozonated water under different concentrations on common microorganisms.
 Methods: The online test method and the plate cultivation method were employed to check the concentrations and killing rates on common microorganisms of ozonated water produced by HZ-2601 B Ozone Water Generating Instrument.
 Results: The initial concentrations of ozonated water at 20, 25, 30, 35, and 40 ℃ were 4.38, 4.26, 3.12, 2.76, and 1.31 mg/L, respectively. The ozonated water was rapidly attenuated at first 10 min. The concentration of ozonated water still remained at 1.06 mg/L and 0.37 mg/L at 25 and 30 ℃ after 30 min. The average killing rates for Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, and Candida albicans in 1.0 mg/L ozonated water for 1 min were 99%, 100%, 100%, 100%, and 100%, respectively. The average killing rates of Escherichia coli, Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans in 0.3 mg/L ozonated water for 1 min were 100%, 100%, 100%, 95%, and 92%, respectively.
 Conclusion: The initial concentrations of ozonated water produced by HZ-2601 B Ozone Water Generating Instrument decrease with the increase of temperature. Ozonated water under 20-30 ℃ has good sterilization effect on common microorganisms.

Ozone injection with or without percutaneous microdiscectomy for treatment of cervical disc herniation

OBJECTIVE

This retrospective study compared the efficacy of combined percutaneous ozone injection and percutaneous discectomyto percutaneous ozone injection alone for the treatment of cervical disc herniation.

METHODS

Patients with cervical disc herniation who were enrolled in our hospital from October 2010 to June 2015 were divided into two groups: 1) treated with percutaneous ozone injection alone (control; n= 19); and 2) those treated with combined ozone injection and percutaneous microdiscectomy (combined treatment; n= 28). The efficacy of the combined treatment was evaluated relative to the control by visual analogue scale (VAS) and the modified Macnab standard. Effective treatment was defined as excellent or good, and ineffective as fair or poor.

RESULTS

No major complications occurred in either group. For the control group, the VAS scores dropped from 6.75 ± 2.34 before surgery to 2.78 ± 1.85 immediately after surgery, and to 4.18 ± 1.46 during the follow-ups. For patients who received the combined treatment, the VAS scores were 7.12 ± 2.03 before surgery, 3.86 ± 2.87 immediately after surgery, and 3.27 ± 1.53 during the follow-ups. At the 6-month follow-up, 73.7% (14 from 19 patients) in the control group and 89.2% (25 from 28 patients) in the treatment group were judged to have received effective treatment. Difference in efficacy between two groups of treatment was statistically significant (P= 0.033).

CONCLUSION

The rate of effective treatment in patients who received combined percutaneous microdiscectomy and ozone injection was higher than that of patients who received ozone injection alone. Combination of percutaneous microdiscectomy and ozone injection might be an effective method to treat patients with cervical disk hernia.

Implication of Two Different Doses of Intradiscal Ozone-Oxygen Injection upon the Pain Alleviation in Patients with Low Back Pain: A Randomized, Single-Blind Study

BACKGROUND

Low back pain (LBP) is mostly induced by disc herniation (DH) or degeneration and has a burden upon social activity and economical aspects of life. An abundance of medical and surgical interventions have evolved to resolve this problem, but one of the newly introduced techniques, which is the minimally invasive, low cost ozone-oxygen mixture (O₃-O₂) intradiscal injection, offers a rapid onset amelioration of symptoms with a sustained duration of pain relief.

OBJECTIVE

We aim to evaluate the quality of pain alleviation using 2 different doses of intradiscal injections of O₃-O₂ mixture.

STUDY DESIGN

A prospectively randomized, single-blind study.

SETTING

Pain clinic, anesthesia, intensive care, and pain department in Assiut University Hospitals.

METHODS

Sixty patients with symptomatizing single lumbar DH were subjected to O₃-O₂ intradiscal injection and randomly allocated into one of 2 groups; group A: received 10 mL, 40 µg/mL of O₃-O₂ and group B: received 10 mL, 30 µg/mL of O₃-O₂. Pain score and functional ability of the patients using the visual analog scale (VAS) and Oswestry Disability Index (ODI) were evaluated after 1, 6, and 12 months and compared to the basal values. Patient satisfaction and reduction of DH were evaluated after the sixth month.

RESULTS

There were no significant differences between the 2 groups regarding the clinical outcome; however both the ODI and VAS evaluations showed highly significant improvement (decreased) (P < 0.01) after injection and during the entire follow-up period. There were highly significant negative correlations between the DH reduction percentage and both the VAS and ODI scores after 6 months in both of the groups.

LIMITATIONS

This study was limited by a small sample size; it was also an active control trial, which may explain the insignificant difference in between the groups, in addition to being a single-blind trial.

CONCLUSION

Intradiscal injection of O₃-O₂ mixture is a very valuable maneuver in the reduction of DH size and improvement of pain quality, with either ozone concentrations of 40 µg/mL or 30 µg/mL.

KEY WORDS

Low back pain, ozone, disc herniation.

Bleaching efficacy of ozone/hydrogen peroxide versus hydrogen peroxide/ozone application

OBJECTIVE

To compare the efficacy of tooth bleaching after using ozone, before and after application of hydrogen peroxide (H2O2).

METHOD AND MATERIALS

In total, 120 extracted teeth were assigned to three groups (n = 40 in each group). Teeth were bleached using 38% H2O2 application for 20 minutes followed by use of the ozone (delivered by means of the healOzone X4 device) for 60 seconds in group 1, via ozone for 60 seconds then 38% H2O2 for 20 minutes in group 2, and via 38% H2O2 for 20 minutes (plus normal air, delivered by the healOzone X4 device for 60 seconds) in group 3 (control). Teeth shades were assessed using a colorimeter before and after bleaching in each group. Significant statistical differences were recorded at P < .05.

RESULTS

Teeth attained lighter shades (higher L* and lower b* values) subsequent to bleaching in all groups (P < .001). Groups 1 and 2 revealed similar bleaching results (P > .05), and showed lighter final teeth shades than group 3 (P < .05).

CONCLUSIONS

Bleaching using 38% H2O2 for 20 minutes (combined with ozone for 60 seconds) produced similar results, regardless of applying the ozone before or after H2O2. Also, bleaching by combining ozone and H2O2 produced better tooth shades than bleaching by H2O2 only. Therefore, it might be practical to consider ozone when H2O2 is used for bleaching as this might potentially reduce treatment time and concentrations of H2O2, thus leading to improved bleaching results.

Protective Role of Eosinophils and TNFa after Ozone Inhalation

Introduction

Exposure to ozone induces deleterious responses in the airways that include shortness of breath, inflammation, and bronchoconstriction. People with asthma have increased airway sensitivity to ozone and other irritants. Dr. Allison Fryer and colleagues addressed how exposure to ozone affects the immune and physiological responses in guinea pigs. Guinea pigs are considered a useful animal model for studies of respiratory and physiological responses in humans; their response to airborne allergens is similar to that in humans and shares some features of allergic asthma. Fryer and colleagues had previously observed that within 24 hours of exposure, ozone not only induced bronchoconstriction but also stimulated the production of new cells in the bone marrow, where all white blood cells develop. As a result of ozone exposure, increased numbers of newly synthesized white blood cells, particularly eosinophils, moved into the blood and lungs. The central hypothesis of the current study was that newly synthesized eosinophils recruited to the lungs 3 days after ozone exposure were beneficial to the animals because they reduced ozoneinduced bronchoconstriction. The investigators also hypothesized that the beneficial effect seen in normal (nonsensitized) animals was lost in animals that had been injected with an allergen, ovalbumin (sensitized). They also planned to explore the effects of inhibitors of certain cytokines (cellsignaling molecules). Immune responses in sensitized animals are dominated by a Th2 pattern, which is characterized by the synthesis of cytokines (interleukin [IL]-4, IL-5, and IL-13) and the Th2 subset of CD4+ T lymphocytes and the cells they activate (predominantly eosinophils, and B lymphocytes that switch to making immunoglobulin E [IgE]). Thus, sensitized animals were used as a model of allergic humans, whose immune responses tend to be dominated by IgE.

Approach

Fryer and colleagues exposed normal and sensitized (allergic) guinea pigs to 2 ppm ozone or filtered air for 4 hours and measured changes in cell numbers and airway responses 1 or 3 days later. They counted the numbers of eosinophils and other white blood cells (macrophages, neutrophils, and lymphocytes) in bone marrow, blood, and bronchoalveolar lung lavage fluid. The investigators also measured important physiological responses, including bronchoconstriction. Some animals were pretreated with etanercept and monoclonal anti-IL-5, which block tumor necrosis factor-a (TNFa) and IL-5, respectively. TNFa and IL-5 blockers have been used to treat patients with asthma. A key feature of the study was a technique to distinguish which white blood cells were synthesized after exposure from those that already existed, by injecting animals with bromodeoxyuridine (BrdU). BrdU is a thymidine analogue that is incorporated into the DNA of dividing cells, serving as a marker of newly produced cells. Therefore, a snapshot can be obtained of the proportion of newly synthesized (BrdU-positive) versus pre-existing (BrdU-negative) cell types.

Key results

1. Allergic and normal animals differed in the time course of bronchoconstriction and changes in cell types after ozone exposure. In normal animals, bronchoconstriction increased substantially at day 1 but decreased by day 3 after ozone exposure. In contrast, in allergic animals bronchoconstriction remained high at day 3. Ozone also increased the percentage of newly formed, BrdU2 positive eosinophils in the bone marrow and lungs of normal but not allergic animals. 2. Pretreatment with the TNFa blocker etanercept had complex effects, which differed between normal and allergic animals. In normal animals, etanercept decreased ozone-induced new synthesis of eosinophils in the bone marrow and blocked eosinophil migration to the lung; it also increased bronchoconstriction at day 3 (relative to day 1 without etanercept). In allergic animals, etanercept had no effect on any cell type in the bone marrow or lung after exposure to ozone and did not change bronchoconstriction compared with allergic animals not treated with etanercept. Etanercept tended to increase the numbers of blood monocytes and lymphocytes in air- and ozone-exposed normal and allergic animals at day 3, but had no effect on eosinophils in blood at this time point. This was one of the few statistically significant findings in the blood of exposed animals in the study. 3. Anti-IL-5 reduced bronchoconstriction at day 3 after exposure of allergic animals to ozone. In contrast, bronchoconstriction was greatly increased in normal animals treated with anti-IL-5.

Conclusions

Fryer and colleagues explored the airway and cellular responses in guinea pigs exposed to ozone. The HEI Review Committee, which conducted an independent review of the study, agreed that the findings supported the authors’ hypothesis (1) that exposure to ozone stimulates production of eosinophils in bone marrow, (2) that these newly formed eosinophils migrate to the lungs, and (3) that those eosinophils play a delayed but potentially beneficial role in reducing ozone-induced inflammation in the airways of healthy normal animals, but not in allergen-sensitized animals. The Committee also agreed that guinea pigs were a good model for studying responses to an allergen, because a major subtype of asthma (the high Th2 or allergic type) is associated with high levels of eosinophils in the blood. A novel finding was that the TNFa blocker etanercept decreased ozone-induced formation of eosinophils in the bone marrow and blocked eosinophil migration to the lung in normal animals. However, because injecting etanercept had little effect on eosinophils and did not decrease bronchoconstriction in allergic guinea pigs, the potential for treating patients with allergic asthma with TNFa blockers is uncertain. This is consistent with the poor performance of TNFa blockers in clinical studies of asthma treatment. Blocking the cytokine IL-5 with an anti-IL-5 antibody substantially decreased bronchoconstriction in sensitized animals. This suggests that therapies targeting IL-5 and eosinophils would be promising in at least some types of asthma. The Committee expressed caution toward experiments with cytokine blockers, both in animal models and humans, because such blockers are often not specific to a particular cell type and may differ at different sites in the body. Without further detailed confirmation of the effects of the blockers, interpreting these experiments can be challenging. The Committee concluded that the study by Fryer and colleagues raises several intriguing directions for future research, including exploring ways in which newly formed eosinophils differ from pre-existing ones, and how such findings apply to humans with allergy or asthma.

Effects of ozone therapy on facial nerve regeneration

Introduction

Ozone may promote moderate oxidative stress, which increases antioxidant endogenous systems. There are a number of antioxidants that have been investigated therapeutically for improving peripheral nerve regeneration. However, no previous studies have reported the effect of ozone therapy on facial nerve regeneration.

Objective

We aimed to evaluate the effect of ozone therapy on facial nerve regeneration.

Methods

Fourteen Wistar albino rats were randomly divided into two groups with experimental nerve crush injuries: a control group, which received saline treatment post-crush, and an experimental group, which received ozone treatment. All animals underwent surgery in which the left facial nerve was exposed and crushed. Treatment with saline or ozone began on the day of the nerve crush. Left facial nerve stimulation thresholds were measured before crush, immediately after crush, and after 30 days. After measuring nerve stimulation thresholds at 30 days post-injury, the crushed facial nerve was excised. All specimens were studied using light and electron microscopy.

Results

Post-crushing, the ozone-treated group had lower stimulation thresholds than the saline group. Although this did not achieve statistical significance, it is indicative of greater functional improvement in the ozone group. Significant differences were found in vascular congestion, macrovacuolization, and myelin thickness between the ozone and control groups. Significant differences were also found in axonal degeneration and myelin ultrastructure between the two groups.

Conclusion

We found that ozone therapy exerted beneficial effect on the regeneration of crushed facial nerves in rats.

[The experience with the application of ozone therapy for the treatment of periodontitis in musicians-instrumentalists]

Playing various musical instruments is the cause of an additional load that affects the condition of dentition and of all organs and body systems at large. Each group of instruments is known to exert a specific impact on the health of the musicians including the undesirable influence on the state of thir oral cavity, such as a change of occlusion and irritation of oral mucosa. Taken together, these effects contribute to the development of periodontal disease, one of the most common dental disorders.

AIM

The objective of the present study was to evaluate the effectiveness of ozone therapy conducted with the use of the generator producing ozone under effect of ultraviolet radiation for the treatment of periodontitis in musicians-instrumentalists.

MATERIAL AND METHODS

The study included 42 musicians presenting with the diagnosis of periodontitis who were divided into two groups depending on the severity of the disease. Group 1 was comprised of the subjects with mild periodontitis while group 2 consisted of the musicians having periodontitis of moderate severity. All the participants in the study remained under observation over 6 months during which they were treated by ozone therapy. The results of the treatment were estimated immediately after the onset of therapy as well as within the next 3 and 6 months. The variance analysis with the use of Student's t-test was employed for the statistical treatment of the data obtained.

RESULTS

The study has demonstrate that ozone therapy resulted in the reduction of inflammation and normalization of local blood circulation in the periodontal tissues; moreover, it extended and lengthened the periods of remission and stabilization of the process of recovery.

CONCLUSION

The results of the study are of primary importance for the maintenance of oral cavity health in musicians-instrumentalists which is indispensable for the maintenance of their successful professional activity.

Herniated disks unchanged over time: Size reduced after oxygen-ozone therapy

The spontaneous regression of disk herniation secondary to dehydration is a much-debated topic in medicine. Some physicians wonder whether surgical removal of the extruded nucleus pulposus is really necessary when the spontaneous disappearance of a herniated lumbar disk is a well-known phenomenon. Unfortunately, without spontaneous regression, chronic pain leads to progressive disability for which surgery seems to be the only solution. In recent years, several studies have demonstrated the utility of oxygen-ozone therapy in the treatment of disk herniation, resulting in disk shrinkage. This retrospective study evaluates the outcomes of a series of patients with a history of herniated disks neuroradiologically unchanged in size for over two years, treated with oxygen-ozone therapy at our center over the last 15 years. We treated 96 patients, 84 (87.5%) presenting low back pain complicated or not by chronic sciatica. No drug therapy had yielded significant benefits. A number of specialists had been consulted in two or more years resulting in several neuroradiological scans prior to the decision to undertake oxygen-ozone therapy. Our study documents how ozone therapy for slipped disks "unchanged over time" solved the problem, with disk disruption or a significant reduction in the size of the prolapsed disk material extruded into the spinal canal.

Comparison between intrarticular injection of hyaluronic acid, oxygen ozone, and the combination of both in the treatment of knee osteoarthrosis

This study aimed to compare short-term clinical outcomes between intra-articular injection of hyaluronic acid (HA), oxygen ozone (O2O3), and the combination of both, in patients affected by osteoarthrosis (OA) of the knee. Seventy patients (age 45-75 years) with knee OA were randomized to intra-articular injections of HA (n=23), or O2O3 (n=23) or combined (n=24) one per week for 5 consecutive weeks. KOOS questionnaire and visual analog scale (VAS), before treatment (pre) at the end (post), and at 2 months after treatment ended (follow-up) were used as outcome measures. Analysis showed a significant effect (P < 0.05) of the conditions (pre, post and follow-up) in all parameters of the KOOS score and a significant effect (P < 0.05) of groups (HA, O2O3 and combined) for pain, symptoms, activities of daily living and quality of life. The combined group scores were higher compared to the HA and O2O3 groups, especially at follow-up. The combination of O2O3 and HA treatment led to a significantly better outcome especially at 2-month follow-up compared to HA and O2O3 given separately to patients affected by OA of the knee.

Intraforaminal ozone therapy and particular side effects: preliminary results and early warning

BACKGROUND

The term "low back pain syndrome" represents a complex nosological entity. The therapeutic approach is often only symptomatic and not etiologic.

METHODS

Since 2013, 186 patients (97 males and 89 females, mean age 59.8 years) have undergone microsurgery for lumbar disc hernia or lumbar segmental stenosis. Among these patients, 23 had been previously treated with ozone therapy by the intraforaminal approach and 28 by intraforaminal steroid injections in other hospitals between 12 and 24 months before our clinical evaluation. These patients received 16 applications in an 8-week period (standard therapy).

RESULTS

During the surgery, many hard adhesions between the soft tissues and bony structures were unexpectedly discovered. In particular, it was noted that the root contracted and had firm adhesions to the dural sac and/or fragmented disc, which were difficult to resolve. These specific pathological patterns were observed only in the patients who received ozone injections by the intraforaminal approach. We did not find any pathological abnormalities in the patients who did not receive any injections or who received intraforaminal steroid injections. Thus, we could exclude that the tissue damage was due to the mechanical action of the needle.

CONCLUSION

It is important to assert that ozone therapy procedures can be associated with several major complications. Therefore, performing a revision of the guidelines and protocols for ozone therapy application is indispensable.