Electro-oscillographic correlation between dorsal raphe nucleus, neocortex and hippocampus during wakefulness before and after serotoninergic inactivation

Theta rhythm in many brain structures characterizes wakefulness and desynchronized sleep in most subprimate mammalian brains. In close relation to behaviors, theta frequency and voltage undergo a fine modulation which may involve mobilization of dorsal raphe nucleus efferent pathways. In the present study we analyzed frequency modulation (through instantaneous frequency variation) of theta waves occurring in three cortical areas, in hippocampal CA1 and in the dorsal raphe nucleus of Wistar rats during normal wakefulness and after injection of the 5-HT1a receptor agonist 8-OH-DPAT into the dorsal raphe. We demonstrated that in attentive states the variation of theta frequency among the above structures is highly congruent, whereas after 8-OH-DPAT injection, although regular signals are present, the variation is much more complex and shows no relation to behaviors. Such functional uncoupling after blockade demonstrates the influence of dorsal raphe nucleus efferent serotoninergic fibers on the organization of alertness, as evaluated by electro-oscillographic analysis

Electro-oscillographic correlation between dorsal raphe nucleus, neocortex and hippocampus during wakefulness before and after serotoninergic inactivation

Theta rhythm in many brain structures characterizes wakefulness and desynchronized sleep in most subprimate mammalian brains. In close relation to behaviors, theta frequency and voltage undergo a fine modulation which may involve mobilization of dorsal raphe nucleus efferent pathways. In the present study we analyzed frequency modulation (through instantaneous frequency variation) of theta waves occurring in three cortical areas, in hippocampal CA1 and in the dorsal raphe nucleus of Wistar rats during normal wakefulness and after injection of the 5-HT1a receptor agonist 8-OH-DPAT into the dorsal raphe. We demonstrated that in attentive states the variation of theta frequency among the above structures is highly congruent, whereas after 8-OH-DPAT injection, although regular signals are present, the variation is much more complex and shows no relation to behaviors. Such functional uncoupling after blockade demonstrates the influence of dorsal raphe nucleus efferent serotoninergic fibers on the organization of alertness, as evaluated by electro-oscillographic analysis

Ozone Therapy As A Treatment For Low Back Pain Secondary To Herniated Disc: A Systematic Review And Meta-analysis Of Randomized Controlled Trials

Background: Low back pain (LBP) is one of the most common and important health problems affecting the population worldwide and remains mostly unsolved. Ozone therapy has emerged as an additional treatment method. Questions persist concerning its clinical efficacy. Objective: The purpose of our study was to evaluate the therapeutic results of percutaneous injection of ozone for low back pain secondary to disc herniation. Study Design: A systematic review and meta-analysis of randomized controlled trials. Methods: A comprehensive literature search was conducted using all electronic databases from 1966 through September 2011. The quality of individual articles was assessed based on the modified Cochrane review criteria for randomized trials and criteria from the Agency for Healthcare Research and Quality. Outcome Parameters: The outcome measure was short-term pain relief of at least 6 months or long-term pain relief of more than 6 months. Results: Eight observational studies were included in the systematic review and 4 randomized trials in the meta-analysis. The indicated level of evidence for long-term pain relief was II-3 for ozone therapy applied intradiscally and II-1 for ozone therapy applied paravertebral. The grading of recommendation was 1C for intradiscal ozone therapy and 1B for paravertebral ozone therapy. Limitations: The main limitations of this review are the lack of precise diagnosis and the frequent use of mixed therapeutic agents. The meta-analysis included mainly active-control trials. No placebo-controlled trial was found. Conclusions: Ozone therapy appears to yield positive results and low morbidity rates when applied percutaneously for the treatment of chronic low back pain.1111530Freynhagen, R., B, R., Gockel, U., Tölle, T.R., painDETECT: A new screening questionnaire to identify neuropathic components in patients with back pain (2006) Curr Med Res Opin, 22, pp. 1911-1920Kaki, A.M., E-Y, A.Z., Youseif, E., Identifying neuropathic pain among patients with chronic low-back pain: Use of the leeds assessment of neuropathic symptoms and signs pain scale (2005) Reg Anesth Pain Med, 30, pp. 422.e1-422.e9Cohen, S.P., Williams, S., Kurihara, C., Griffith, S., Larkin, T.M., Nucleoplasty with or without intradiscal electrothermal therapy (IDET) as a treatment for lumbar herniated disc (2005) J Spinal Disord Tech, 18 (SUPPL.), pp. S119-S124Postacchini, F., Postacchini, R., Operative management of lumbar disc herniation: The evolution of knowledge and surgical techniques in the last century (2011) Acta Neurochir Suppl, 108, pp. 17-21Bocci, V.A., Scientific and medical aspects of ozone therapy. State of the art (2006) Arch Med Res, 37, pp. 425-435Manchikanti, L., Boswell, M.V., Singh, V., Benyamin, R.M., Fellows, B., Abdi, S., Buenaventura, R.M., Hirsch, J.A., Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain (2009) Pain Physician, 12, pp. 699-802. , ASIPP-IPMManchikanti, L., Benyamin, R., Helm, S., Hirsch, J.A., Evidence-based medicine, systematic reviews, and guidelines in Interventional pain management: Part 1: Systematic reviews and meta-analyses of randomized trials (2009) Pain Physician, 12, pp. 35-72Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement (2009) PLoS Med, 6, pp. e1000097. , Group PStaal, J.B., De Bie, R.A., De Vet, H.C.W., Hildebrandt, J., Nelemans, P., Injection therapy for subacute and chronic low back pain: An updated cochrane review (2009) Spine, 34, pp. 49-59Koes, B.W., Sholten, R.J.P.M., Mens, J.M.A., Bouter, L.M., Efficacy of epidural steroid injections for low-back pain and sciatica: A systematic review of randomized clinical trials (1995) Pain, 63, pp. 279-288West, S., King, V., Carey, T.S., Lohr, K.N., McKoy, N., Sutton, S.F., Lux, L., Systems to rate the strength of scientific evidence (2002) Evid Rep Technol Assess, 47, pp. 1-11. , SummBerg, A.O., A, J.D., Introducing the third U.S. Preventive Services Task Force (2001) Am J Prev Med, 20, pp. 21-35Guyatt, G., Gutterman, D., Baumann, M.H., Addrizzo-Harris, D., Hylek, E.M., Phillips, B., Raskob, G., Schünemann, H., Grading strength of recommendations and quality of evidence in clinical guidelines: Report from an American College of Chest Physicians task force (2006) Chest, 129, pp. 174-181Bonetti, M., Fontana, A., Cotticelli, B., Volta, G.D., Guindani, M., Leonardi, M., Intraforaminal O2-O3 versus periradicular steroidal infiltrations in lower back pain: Randomized controlled study (2005) AJNR Am J Neuroradiol, 26, pp. 996-1000Zambello, A., Fara, B., Tabaracci, G., Bianchi, M., Epidural steroid injection vs paravertebral O2-O3 infiltration for symptomatic herniated disc refractory to conventional treatment: A prospective randomized study (2006) Rivista di Neuroradiologia, 5, pp. 123-127Gallucci, M., Limbucci, N., Zugaro, L., Barile, A., Barile, A., Stavroulis, E., Ricci, A., Masciocchi, C., Sciatica: Treatment with intradiscal and intraforaminal injections of steroid and oxygen-ozone versus steroid only (2007) Radiology, 242, pp. 907-913Paoloni, M., DS, L., Cacchio, A., Apuzzo, D., Marotta, S., Razzano, M., Franzini, M., Santilli, V., Intramuscular oxygen-ozone therapy in the treatment of acute back pain with lumbar disc herniation (2009) Spine, 34, pp. 1337-1344Ansede Alonso, J.C., Contreras Joya, M., Perez Hidalgo, S., Prospective and randomized study in patients with low back pain or sciatic pain with ozonetherapy treatment (2007) Patologia del Aparato Locomotor, 5, pp. 46-54Wu, Z., Wei, L.X., Li, J., Wang, Y., Ni, D., Yang, P., Zhang, Y., Percutaneous treatment of non-contained lumbar disc herniation by injection of oxygen-ozone combined with collagenase (2009) Euro J Rad, 72, pp. 499-504Gautam, S., Rastogi, V., Jain, A., Singh, A.P., Comparative evaluation of oxygen-ozone therapy and combined use of oxygen-ozone therapy with percutaneous intradiscal radiofrequency thermocoagulation for the treatment of lumbar disc herniation (2011) Pain Practice, 11, pp. 160-166Corea, F., Amici, S., Murgia, N., Tambasco, N., A case of vertebrobasilar stroke during oxygen-ozone therapy (2004) J Stroke Cerebrovascular Diseases, 13, pp. 259-261Giudice, G.L., Valdi, F., Gismondi, M., Prosdocimo, G., Belvis, V., Acute bilateral vitreoretinal hemorrhages following oxygenozone therapy for lumbar disk herniation (2004) Am J Ophth, 138, pp. 175-177Ginanneschi, F., Cervelli, C., Milani, P., Rossi, A., Ventral and dorsal root injury after oxygen-ozone therapy for lumbar disk herniation (2006) Surgical Neurology, 66, pp. 619-620Chalaupka, F.D., Caneve, G., Mauri, M., Zaiotti, G., Thunderclap headache caused by minimally invasive medical procedures: Description of 2 cases (2007) Headache, 47, pp. 293-295Gazzeri, R., Galarza, M., Neroni, M., Esposito, S., Alfieri, A., Fulminating septicemia secondary to oxygen-ozone therapy for lumbar disc herniation (2007) Spine, 32, pp. 121-123Oder, B., Loewe, M., Reisegger, M., Lang, W., Ilias, W., Thurnher, S.A., CT-guided ozone/steroid therapy for the treatment of degenerative spinal disease: Effect of age, gender, disc pathology and multi-segmental changes (2008) Neuroradiology, 50, pp. 777-785Muto, M., Avella, F., Percutaneous treatment of herniated lumbar disc by intradiscal oxygen-ozone injection (1998) Interventional Neuroradiology, 4, pp. 279-286Muto, M., Andreula, C., Leonardi, M., Treatment of herniated lumbar disc by intradiscal and intraforaminal oxygen-ozone (O2O3) injection (2004) J Neuroradiol, 31, pp. 183-189Muto, M., Ambrosanio, G., Guarnieri, G., Capobianco, E., Piccolo, G., Annunziata, G., Low back pain and sciatica: Treatment with intradiscal-intraforaminal O2-O3 injection. Our experience (2008) Radiologia Medica, 113, pp. 695-706Andreula, C.F., S, L., Santis, F., Minimally invasive oxygen-ozone therapy for lumbar disk herniation (2003) Am J Neuroradiology, 24, pp. 996-1000Buric, J., ML, R., Ozone chemonucleosis in no-contained lumbar disc herniations: A pilot study with 12 months follow-up (2005) Acta Neurochir Suppl, 92, pp. 93-97Xu, L., Li, Z.L., He, X.F., Xiang, D.C., Ma, J., Hong, C.J., He, J.X., Qiu, J., Evaluation of the clinical curative effect of an O2-O 3 mixture to treat lumbar disc herniation with different treatment sessions (2009) Interv Neuroradiol, 15, pp. 159-163Das, G., Ray, S., Ishwarari, S., Roy, M., Ghosh, P., Ozone Nucleolysis for Management of Pain and Disability in Prolapsed Lumber Intervertebral Disc. A Prospective Cohort Study (2009) Interventional Neuroradiology, 15, pp. 330-334Fabris, G., Tommasini, G., Petralia, B., Lavaroni, A., De Nardi, F., De Luca, G., L'ossigeno-ozono terapia intraforaminale (2001) Rivista di Neuroradiologia, 14, pp. 61-66Paradiso, R., Alexandre, A., The different outcomes of patients with disc herniation treated either by microciscectomy, or by intradiscal ozone injection (2005) Acta Neurochir Suppl, 92, pp. 139-142Romeo, A., Cirillo, F., Kinesiatrics and oxygen-ozone therapy for lumbosacral disc-root compression (2001) Rivista di Neuroradiologia, 14, pp. 47-49Bonetti, M., Cotticelli, B., Albertini, F., Brayda-Bruno, M., Valdenassi, L., Richelmi, P., Percutaneous paravertebral ozone therapy (2002) Rivista di Neuroradiologia, 15, pp. 415-419D'Erme, M., Scarchilli, A., Artale, A.M., Pasquali Lasagni, M., Ozone therapy in lumbar sciatic pain (1998) Radiol Med, 95 (1-2), pp. 21-24Alexandre, A., Coro, L., Paradiso, R., Dall'aglio, R., Alexandre, A.M., Fraschini, F., Treatment of symptomatic lumbar spinal degenerative pathologies by means of combined conservative biochemical treatments (2011) Acta Neurochir Suppl, 108, pp. 127-135Masini, M., Calaca, A., Minimally invasive treatment for refractory low back pain, targeted by epidural endoscopy with O2/O3 and steroid therapy (2011) Acta Neurochir Suppl, 108, pp. 33-37Donato, A.D., Fontana, C., Pinto, R., Beltrutti, D., Pinto, G., The effectiveness of endoscopic epidurolysis in treatment of degenerative chronic low back pain: A prospective analysis and follow-up at 48 months (2011) Acta Neurochir Suppl, (108), pp. 67-73Gjonovich, A., Sattin, G.F., Girotto, L., Bordin, M., Gallo, L., Preciso, G., Lombalgie ribelli: L'ossigeno-ozono terapia a confronto con altre metodiche (2001) Rivista di Neuroradiologia, 14, pp. 35-38Peng, J., Xing, H., Zhang, B., Wu, F., Guo, J.F., He, Y.K., Ozone injection for the treatment of lumbar disc herniation: A therapeutic analysis of 104 cases (2010) Journal of Interventional Radiology, 19, pp. 114-116Zhang, L., Li, J.K., Chen, Z.H., Sun, X.J., Liu, J.P., CT-guided intradiscal ozone injection combined with intervertebral facet joint steroid injection for lumbar disk herniation accompanied with intervertebral arthritis (2009) Journal of Interventional Radiology, 18, pp. 853-855Peng, J., Xing, H., Zhang, B., Wu, F., Guo, J., He, X., Analysis of the efficacy of ozone therapy on lumbar disc herniation (2009) International Journal of Ozone Therapy, 8, pp. 206-210Vetro, A., Mantia, F., Mantia, R., Terapia dei confliti disco-radicolari. Comparazione clinica tra ossigeno-ozono terapia paravertebrale e trattamento combinato ossigeno-ozono terapia e un prodotto a base di acido alfalipoico (ALAnerv) (2006) Minerva Ortop Traumatolol, 57, pp. 57-63Baabor, M.G., Vázquez, P.F., Sánchez, J.A., Automated nucleotomy and nucleolysis with ozone (2011) Acta Neurochir Suppl, 108, pp. 97-101Steppan, J.M.T., Muto, M., Murphy, K.J., A Metaanalysis of the Effectiveness and Safety of Ozone Treatments for Herniated Lumbar Discs (2010) J Vasc Interv Radiol, 21, pp. 534-548Koike, Y., Uzuki, M., Kokubun, S., Angiogenesis and inflammatory cell infiltration in lumbar disc herniation (2003) Spine, 28, pp. 1928-1933Peng, B.G., Hao, J.H., Hou, S.X., Possible pathogenesis of painful intervertebral disc degeneration (2006) Spine, 31, pp. 560-566Borrelli, E., Mechanism of action of oxygen ozone therapy in the treatment of disc herniation and low back pain (2011) Acta Neurochir Suppl, 108, pp. 123-125Kushner, F.H., Olson, J.C., Retinal Hemorrhage as a consequence of epidural steroid injection (1995) Archives of Ophthalmology, 113, pp. 309-313Oberman, J., Cohn, H., Grand, M.G., Retinal complications of gas myelography (1979) Archives of Ophthalmology, 97, pp. 1905-1906Andreula, C., Muto, M., Leonardi, M., Interventional spinal procedures (2004) European Journal of Radiology, 50, pp. 112-11