Economic evaluations of radioembolization with yttrium-90 microspheres in liver metastases of colorectal cancer: a systematic review.

BACKGROUND: Transarterial radioembolization with yttrium-90 (Y-90 TARE) microspheres therapy has demonstrated positive clinical benefits for the treatment of liver metastases from colorectal cancer (lmCRC). This study aims to conduct a systematic review of the available economic evaluations of Y-90 TARE for lmCRC. METHODS: English and Spanish publications were identified from PubMed, Embase, Cochrane, MEDES health technology assessment agencies, and scientific congress databases published up to May 2021. The inclusion criteria considered only economic evaluations; thus, other types of studies were excluded. Purchasing-power-parity exchange rates for the year 2020 ($US PPP) were applied for cost harmonisation. RESULTS: From 423 records screened, seven economic evaluations (2 cost-analyses [CA] and 5 cost-utility-analyses [CUA]) were included (6 European and 1 USA). All included studies (n = 7) were evaluated from a payer and the social perspective (n = 1). Included studies evaluated patients with unresectable liver-predominant metastases of CRC, refractory to chemotherapy (n = 6), or chemotherapy-naïve (n = 1). Y-90 TARE was compared to best supportive care (BSC) (n = 4), an association of folinic acid, fluorouracil and oxaliplatin (FOLFOX) (n = 1), and hepatic artery infusion (HAI) (n = 2). Y-90 TARE increased life-years gained (LYG) versus BSC (1.12 and 1.35 LYG) and versus HAI (0.37 LYG). Y-90 TARE increased the quality-adjusted-life-year (QALY) versus BSC (0.81 and 0.83 QALY) and versus HAI (0.35 QALY). When considering a lifetime horizon, Y-90 TARE reported incremental cost compared to BSC (range 19,225 to 25,320 $US PPP) and versus HAI (14,307 $US PPP). Y-90 TARE reported incremental cost-utility ratios (ICURs) between 23,875 $US PPP/QALY to 31,185 $US PPP/QALY. The probability of Y-90 TARE being cost-effective at £ 30,000/QALY threshold was between 56% and 57%. CONCLUSIONS: Our review highlights that Y-90 TARE could be a cost-effective therapy either as a monotherapy or when combined with systemic therapy for treating ImCRC. However, despite the current clinical evidence on Y-90 TARE in the treatment of ImCRC, the global economic evaluation reported for Y-90 TARE in ImCRC is limited (n = 7), therefore, we recommend future economic evaluations on Y-90 TARE versus alternative options in treating ImCRC from the societal perspective.

Infection control in long term care institutions for the elderly: A reflection document on the situation in Spain.

A progressively increasing percentage of the elderly live during the last years of their lives in nursing homes. Although these institutions are intended to mimic life at home as much as possible, they have characteristics that make them quite similar to a "nosocomiun", i.e. an establishment for the treatment of the sick. The very coexistence among the elderly, the fact of sharing caregivers and the very significant exposure to third parties, together with the frequent predisposing diseases to infection in this population, make infection frequent among residents and also easily transmissible. This leads us to ask what can be done to prevent infection in this environment and more specifically what is the state of the art of the matter in a Western European nation such as ours. The Board of Trustees of the Health Sciences Foundation has asked itself a series of questions on the subject of infection prevention in Nursing Homes, the structure of procedures, the legislation available, compliance with the measures indicated, the best indicators of the processes and therefore, the need to promote in Spain a document of recommendations to avoid infections in this poplation whose morbidity and mortality need not be highlighted. To this end, a multidisciplinary group of experts in different aspects of this problem has been convened and asked the proposed questions. The questions were discussed by the group as a whole and led to a series of conclusions agreed upon by the participants. The results of the meeting are reported below.

New synthetic nano-immunotherapy (OncoTherad®) for non-muscle invasive bladder cancer: Its synthesis, characterization and anticancer property.

Bacillus Calmette-Guérin (BCG)-based intravesical immunotherapy has been applied as gold standard treatment for high-risk non-muscle invasive bladder cancer (NMIBC) for almost half a century. However, several patients with high-risk disease experience relapse, including those whose condition has worsened and who failed to respond to BCG. Non-significant therapeutic options have been developed for these at-risk patients, for many years. Immunotherapies have shown promising outcomes for bladder cancer treatment. Accordingly, our research group developed the OncoTherad® (MRB-CFI-1) immunotherapy, which has shown positive outcomes in NMIBC treatment. The aim of the current study is to describe, in details, the physicochemical features and potential action mechanisms of OncoTherad® nano-immunotherapy, based on toll-like receptor 4 (TLR4)-mediated interferon and on RANK/RANKL signaling pathways, in animal model with NMIBC. Based on the current findings, OncoTherad® nano-immunotherapy did not have genotoxic effect on the investigated model and did not show signs of limiting local and/or systemic toxicity at therapeutic doses. OncoTherad® nano-immunotherapy was more effective than the BCG treatment, since it reduced by 70% the malignancy rate. Furthermore, it was possible identifying an important action mechanism of OncoTherad®, which was based on the modulation of TLR4-mediated interferon and RANK/RANKL signaling pathways that, altogether, were essential to reduce malignancy rate. OncoTherad® mechanisms in these pathways helped preventing tumor recurrence.

Economic evaluations of radioembolization with Itrium-90 microspheres in hepatocellular carcinoma: a systematic review.

BACKGROUND: Transarterial radioembolization (TARE) with yttrium-90 microspheres is a clinically effective therapy for hepatocellular carcinoma (HCC) treatment. This study aimed to perform a systematic review of the available economic evaluations of TARE for the treatment of HCC. METHODS: The Preferred Reported Items for Systematic reviews and Meta-Analyses guidelines was followed by applying a search strategy across six databases. All studies identified as economic evaluations with TARE for HCC treatment in English or Spanish language were considered. Costs were adjusted using the 2020 US dollars based on purchasing-power-parity ($US PPP). RESULTS: Among 423 records screened, 20 studies (6 cost-analyses, 3 budget-impact-analyses, 2 cost-effectiveness-analyses, 8 cost-utility-analyses, and 1 cost-minimization analysis) met the pre-defined criteria for inclusion. Thirteen studies were published from the European perspective, six from the United States, and one from the Canadian perspectives. The assessed populations included early- (n = 4), and intermediate-advanced-stages patients (n = 15). Included studies were evaluated from a payer perspective (n = 20) and included both payer and social perspective (n = 2). TARE was compared with transarterial chemoembolization (TACE) in nine studies or sorafenib (n = 11). The life-years gained (LYG) differed by comparator: TARE versus TACE (range: 1.3 to 3.1), and TARE versus sorafenib (range: 1.1 to 2.53). Of the 20 studies, TARE was associated with lower treatment costs in ten studies. The cost of TARE treatment varied widely according to Barcelona Clinic Liver Cancer (BCLC) staging system and ranged from 1311 $US PPP/month (BCLC-A) to 71,890 $US PPP/5-years time horizon (BCLC-C). The incremental cost-utility ratio for TARE versus TACE resulted in a 17,397 $US PPP/Quality-adjusted-Life-Years (QALY), and for TARE versus sorafenib ranged from dominant (more effectiveness and lower cost) to 3363 $US PPP/QALY. CONCLUSIONS: Economic evaluations of TARE for HCC treatment are heterogeneous. Overall, TARE is a cost-effective short- and long-term therapy for the treatment of intermediate-advanced HCC.

Amiotrofia neurálgica bilateral. A propósito de un caso y revisión bibliográfica / Bilateral neuralgic amiotrophy. Case report and literature review

Se presenta un caso atípico de amiotrofia neurálgica bilateral que debutó con dolor de intensidad leve-moderada y que evolucionó desfavorablemente hacia una amiotrofia de ambos deltoides que incapacitó permanente y totalmente al paciente para el desempeño de su trabajo habitual (AU)

The following case is an atypical bilateral neuralgyc amiotrophy which started with mild to moderate pain and evolved unfavourably towards atrophy of both Deltoid muscles, leading to a permanent incapacity for the patient´s job (AU)

Modulation of the propagation speed of mechanical waves in silicon quantum dots embedded in a silicon-nitride film.

Using a vectorial picosecond self-diffraction method, we evaluate the modification of the speed of the sound in a silicon-nitride film containing silicon quantum dots prepared by remote plasma-enhanced chemical vapor deposition. Our non-contact technique is based on the stimulation of the electrostriction contribution to the nonlinearity of index exhibited by the sample in a multiwave mixing laser experiment. We identified the electronic birefringence using two of the incident beams to generate a self-diffraction signal, then, we modified the third order nonlinear response by means of the optical Kerr effect given by a phase-mismatched third beam which induced electrostriction. Our results indicated that the speed of the sound in a silicon-nitride film can be simultaneously tailored by an electronic nonlinear refractive index, and by an electrostriction effect, both resulting from silicon quantum dots doping.

Side effects of rodent control on non-target species: Rodenticides increase parasite and pathogen burden in great bustards.

For many years anticoagulant rodenticides have been used in vole control campaigns, in spite of the proven risk of secondary poisoning of non-target predators and scavengers. In this paper we analyse for the first time great bustard exposure and intoxication by anticoagulant rodenticides in Spain, based on residues found in the livers of 71 bustard carcasses collected during 1991-2010. Ten individuals contained chlorophacinone and one flocoumafen. Chlorophacinone level was significantly correlated with the pathogen and parasite burden of intoxicated birds. Moreover, through the last 12 years the annual number of great bustards that present chlorophacinone in liver collected in our study areas was correlated with vole peaks at a nearby area, suggesting that the ingestion of rodenticide was proportional to the amounts spread in the fields. We conclude that rodenticide consumption is a regular event among great bustards when baited cereal is spread on fields, and that this may cause chronic weakening of intoxicated individuals, possibly affecting their survival. Future rodent control actions should consider these negative side effects on non target granivorous steppe and farmland species, particularly when they are globally threatened.

[Does the criterion for prostate biopsy indication impact its accuracy? A prospective population-based outpatient clinical setting study]. / ¿Impacta el criterio para indicar la biopsia prostática sobre su exactitud? Estudio prospectivo llevado a cabo sobre una población de pacientes ambulantes.

INTRODUCTION: Prostate specific antigen (PSA) and digital rectal examination (DRE) are the main tests for initial prostate investigation; there is no consensus about the best criterion for prostate biopsies. We aim to check the accuracy of different criteria in this context including PSA derivatives to detect prostate cancer. MATERIAL AND METHODS: Four different criteria for indication of prostate biopsy were compared: (A) PSA-density (>15 ng/ ml/ cc); (B) PSA > 2,5 ng/ml; (C) PSA-velocity (> 0.7 ng/ ml/ year); (D) free/total PSA ratio (<15%). All biopsies and histopathological examinations were performed by the same urologist and pathologist, respectively. RESULTS: The study was performed on 180 consecutive biopsies with 37.7% overall cancer detection rate: 29 (16.1%) performed following criterion A, 42 (23.3%) criterion B, 65 (36.1%) criterion C and 44 (24.4%) criterion D. Based on PSA criteria alone, the predictive positive value (PPV) was 37.9% for criterion A, 33.3% for B, 32.3% for C and 50.0% for criterion D, respectively, (p > 0.05). Associating positive DRE with changed PSA, the PPV increased to 50%, 50%, 43.9% and 68.2% for criteria A, B, C and D, respectively (p>0.05). In univariate analysis, DRE (positive versus negative), PSA level (>10 ng/ ml versus <4.0 ng/ ml), free/total PSA ratio (<10% versus >15%) and age were associated with PC. In multivariate analysis only positive DRE was associated with prostate cancer. CONCLUSIONS: All the criteria of PSA derivatives are complementary and useful predictors of cancer risk. However, a positive DRE increased the PPV of PSA derivatives. New tools are needed to improve the accuracy of prostate cancer detection.

Fibromyalgia in patients with ankylosing spondylitis: prevalence and utility of the measures of activity, function and radiological damage.

OBJECTIVES: To determine the prevalence of fibromyalgia (FM) in ankylosing spondylitis (AS). To evaluate the effect of FM on the measures of activity in AS. To analyse predictive factors in order to identify this group of patients. PATIENTS AND METHODS: A cross-sectional study based on 462 patients with definite ankylosing spondylitis included in the REGISPONSER. Sociodemographic data, clinical features, Bath AS disease activity index (BASDAI), Bath AS functional index (BASFI), Bath AS radiology index (BASRI), Stoke modified index (Sasss-m), laboratory data, Short-Format 12 (SF-12), AS specific quality of life (ASQoL), Fibromyalgia Impact Questionnaire (FIQ) and treatments used were all documented. To diagnose FM, the ACR 1990 criteria had to be fulfilled. All statistical tests were performed using STATA. RESULTS: The prevalence of fibromyalgia in all AS was 4.11%. Among the women with AS, the prevalence of FM increased to 10.83%. The BASDAI, BASFI and total BASRI were strongly influenced by the presence of FM. The inverse relationship between BASDAI or BASFI and total BASRI was taken to generate a ratio. Accordingly, if the patient presented BASDAI/BASRI ≥1.5 or BASFI/BASRI ≥1.08, the probability of having FM was very high. CONCLUSIONS: There is an increased risk of FM in females with AS. The fact of having FM distorts the measures of activity and functional damage of AS. As a result, it is possible that some patients with AS and FM are being overtreated. The BASDAI/BASRI and BASFI/BASRI ratios are very useful to identify these patients.

Relationship between spinal mobility and disease activity, function, quality of life and radiology. A cross-sectional Spanish registry of spondyloarthropathies (REGISPONSER).

OBJECTIVE: To determine the relationship between anthropometric measurements and disease activity, functional capacity, quality of life and radiology in Spanish patients with ankylosing spondylitis (AS). PATIENTS AND METHODS: A cross-sectional study was made of 842 patients with definite ankylosing spondylitis (REGISPONSER). Sociodemographic data, spinal mobility measurements, Bath AS disease activity index (BASDAI), nocturnal pain, Bath AS radiology index (BASRI), Bath AS functional index (BASFI), the Short-Format 12 (SF-12) and the AS specific quality of life (ASQoL) questionnaire were applied. Pearson correlation coefficient analysis and regression models were constructed. RESULTS: There was moderate correlation between fingertip-to-floor distance and lateral cervical rotation with the BASFI (p<0.01). Good correlation was evident between wall-occiput distance and lateral cervical rotation with the BASRI (p<0.01). Moderate correlation was found between chest expansion, the Schober modified test and fingertip-to-floor distance with the total BASRI (p<0.01). The anthropometric measurement with the lowest correlation value was lateral lumbar flexion. Significant association was found between the Schober modified test and BASFI, BASDAI and BASRI (R(2) = 0.37; p<0.001); chest expansion and BASFI, BASDAI and BASRI (R(2) = 0.25; p<0.001); wall-occiput distance and BASFI, BASRI and ASQoL (R(2) = 0.44; p<0.001); fingertip-to-floor distance and BASFI and BASRI (R(2) = 0.30; p<0.001); and lateral cervical rotation and BASFI and BASRI (R(2) = 0.34; p<0.001). CONCLUSION: In our study, wall-occiput distance and lateral cervical rotation showed the strongest correlation to BASRI. Similarly, fingertip-to-floor distance and lateral cervical rotation exhibited the closest correlation to BASFI.

Modification of the nonlinear optical absorption and optical Kerr response exhibited by nc-Si embedded in a silicon-nitride film.

We studied the absorptive and refractive nonlinearities at 532 nm and 26 ps pulses for silicon-nitride films containing silicon nanoclusters (nc-Si) prepared by remote plasma-enhanced chemical vapor deposition (RPECVD). Using a self-diffraction technique, we measured for the as-grown sample beta=7.7x10(-9)m/W, n(2)=1.8x10(-16)m(2)/W, and /chi(3)1111/ = 4.6x10(-10)esu; meanwhile, when the sample was exposed to an annealing process at 1000 degrees C during one hour in a nitrogen atmosphere, we obtained beta=-5x10(-10)m/W, n2=9x10(-17)m(2)/W, and /chi(3)1111/=1.1x10(-10)esu. A pure electronic nonlinear refraction was identified and a large threshold ablation of 41 J/cm(-2) was found for our films. By fitting nonlinear optical transmittance measurements, we were able to estimate that the annealed sample exhibits a response time close to 1 fs. We report an enhancement in the photoluminescence (PL) signal after the annealing process, as well as a red-shift due to an increment in size of the nc-Si during the thermal process.

Polymorphous silicon thin films obtained by plasma-enhanced chemical vapor deposition using dichlorosilane as silicon precursor.

Polymorphous silicon thin films (pm-Si) have been deposited from mixtures of dichlorosilane and hydrogen, using argon as the diluting gas by plasma-enhanced chemical vapor deposition. The deposition conditions were chosen to simultaneously obtain both Si nanocrystallites and an amorphous silicon matrix in the as-grown samples. High resolution transmission electron microscopy studies show the crystallinity of Si domains whose dimensions are in the interval of 2-14 nm. The surface passivation state of the silicon nanocrystals was inferred from Fourier transform infrared spectroscopy analysis. Two optical absorption edges, corresponding to the amorphous matrix and the Si nanocrystals, were observed for all the pm-Si thin films. Intense visible photoluminescence was observed for the as-grown samples. The possibility of using these thin films for the down-conversion effect in silicon solar cells is discussed.

Photoluminescence of as-grown silicon nanocrystals embedded in silicon nitride: influence of atomic hydrogen abundance.

Silicon nanocrystals embedded in silicon nitride films were grown by direct plasma enhanced chemical vapor deposition at 300 degrees C, using mixtures of SiH2Cl2/NH3/H2/Ar. The films composition and chemical stability was tested by Fourier Transform Infrared Spectroscopy and Rutherford Backscattering Spectroscopy. The influence of hydrogen abundance during the deposition process on the photoluminescence of as-grown samples was studied as a function of the radiofrequency power and hydrogen dilution flow rate. In situ Optical Emission Spectroscopy allowed the diagnostic of the species in the plasma region and their general trends as a function of the radiofrequency power. The changes in the hydrogen content and silicon incorporation to the film as a function of the radiofrequency power were discussed in terms of silicon nanocrystals formation and growth in the silicon nitride matrix. The photoluminescence emission from the as-grown samples was found to red-shift with increasing hydrogen abundance. This observation is consistent with the increase in silicon content associated to nc-Si of larger size. On the other hand, the photoluminescence intensity was observed to decrease for very high radiofrequency powers and hydrogen dilutions. High Resolution Transmission Electron Microscopy confirmed the presence of silicon nanocrystals embedded in the amorphous silicon nitride matrix and allowed the correlation between the nanocrystals size and the photoluminescence emission energy using the quantum confinement model.

Life-history characteristics of the large Amazonian migratory catfish Brachyplatystoma rousseauxii in the Iquitos region, Peru.

The main life-history traits of the dorado Brachyplatystoma rousseauxii, a large Amazonian catfish undertaking the largest migration known for a freshwater fish species (from the nursery area in the estuary of the Amazon to the breeding zones in the head waters of the western Amazon basin close to the Andes), were determined from a 5 year sampling of >15,000 specimens in the Peruvian Amazon. The breeding season occurred during the falling and low-water periods, which is hypothesized to be an adaptation to maximize the chances of young stages to reach the estuary. The size at first sexual maturity was slightly larger for females than males, c. 91 and 83 cm standard length (L(S)), respectively. Both males and females reproduce for the first time at >3 years old. The fecundity per spawning event ranged from 481,734 to 1,045,284 oocytes for females weighing 25 and 34 kg, respectively. Seasonal variations of body condition were similar among sexes, but differed between immature specimens that had a higher condition during the low-water period and lower condition during rising waters, and mature individuals that showed the opposite pattern. The growth characteristics were estimated by L(S) frequency analysis. For females, the best fitting models gave a mean birth date in August, during the height of the breeding cycle, with the following von Bertalanffy growth function parameters: L(Sinfinity) = 153.3, K = 0.29 and t(0) =- 0.37 years. For males, the best fitting model gave a mean birth date in July, also during the height of the breeding period, with L(Sinfinity) = 142, K = 0.30 and t(0) =- 0.36 years. At a given age, females were systematically larger than males and the size difference increased with age. The largest females sampled (148 cm L(S)) was 11 years old and the largest male (134 cm L(S)) was 9 years old. The mortality estimates were higher for males total (Z) = 1.34, natural (M) = 0.52 and fishing (F) = 0.82 than for females (Z = 0.98, M = 0.50, F = 0.48). The life-history patterns of B. rousseauxii are discussed in light of the available knowledge about this species and the understanding of its complex life cycle.

Thermo-optic effect and optical third order nonlinearity in nc-Si embedded in a silicon-nitride film.

Using a self-diffraction experiment with 7ns pulses at 532nm we studied a silicon nitride film containing silicon nanoclusters (nc-Si) of 3.1+/-0.37 nm mean size. The sample was prepared by remote plasma-enhanced chemical vapor deposition (RPECVD), and we found that its nonlinearity consists of a combination of electronic and thermal contributions. By varying the repetition rate of the laser, we discriminated the responsible mechanisms for the nonlinear response. Using this procedure we determined a total /chi((3))1111/ = 3.3x10(-10)esu, n2 = 2.7x10(-16) m(2)/W, beta = 1x10(-9) m/W and dn/dT =1x10(-4) degrees C(-1) for our sample. We also show results for the optical Kerr effect using 80 fs pulses at 820 nm. The purely electronic nonlinearity measured is characterized by /chi((3))1111/=9.5 x10(-11) esu.

Selective hypersensitivity to boiled razor shell.

Many types of seafood require cooking before ingestion and it has been demonstrated that this cooking process may affect the antigenicity and allergenicity of the food. We describe a case of anaphylaxis caused by selective sensitization to razor shell, a mollusc. In vivo and in vitro studies confirmed sensitization to boiled razor shell. Analysis of the nature of the allergen yielded results that were consistent with the findings of other authors and suggested that allergens involved in seafood allergy are commonly high molecular weight proteins that, in most cases, are heat stable.

Disease pattern of spondyloarthropathies in Spain: description of the first national registry (REGISPONSER) extended report.

OBJECTIVE: The national registry of spondyloarthropathies (REGISPONSER) is launched to classify patients with this group of diseases treated in Spanish rheumatology clinics. This manuscript describes the methodological and organizational background as well as characteristics of patients finally included, and provides a comparative analysis between characteristics of both ankylosing spondylitis and undifferentiated spondyloarthropathy groups of patients. PATIENTS AND METHODS: Twelve members of the GRESSER group have participated in the registry, for a one-year recruitment period. All consecutively registered adult patients treated in their clinics met the classification criteria of the European Spondyloarthropathies Study Group (ESSG). Data collected reflect the socio-demographic characteristics, as well as disease activity and functional status, clinical form at onset, treatment used and quality of life; all measured by standard instruments. RESULTS: Throughout 1 yr, 1385 patients have been included in the registry: 939 males (68%) and 440 females (32%), with an average age of 47 +/- 13 years (mean +/- s.d.), and an average disease duration of 12 +/- 9 years. Diagnoses of the included patients were: AS (n = 842, 61%), PsA (n = 290, 21%), u-SpA (n = 205, 15%), reactive arthritis (n = 16, 1.2%), inflammatory bowel disease arthritis (n = 13, 0.9%) and JCA-spondyloathropathy (n = 13, 0.9%). Regarding clinical form, 54% had axial disease, 20% peripheral disease, 24% mixed disease and 0.6% isolated enthesitic form. Low-back pain was the first symptom reported in 53% of the patients, and most common extra-articular disease manifestations were psoriasis (25%), anterior uveitis (16%) and intestinal inflammatory disease (4%). Some kind of work disability was reported by 353 patients (25.5%). CONCLUSIONS: Such databases are very useful to obtain information about characteristics of SpA patients treated in a certain location or following a specific treatment practice, and provide a tool for assessing the impact of the disease. Data collected in this registry provide an appropriate clinical and demographic profile of patients suffering from SpA in Spain.

Estudio prospectivo y aleatorizado en pacientes con lumbalgias o lumbociatálgias tratados con ozonoterapia / Prospective and randomized study in patients with low back pain or sciatic pain with ozonetherapy treatment

Objetivo: estudiar los resultados clínicos en pacientes con lumbalgias y ciáticas, tratados con ozono (O3) paravertebral e intradiscal. Pacientes y método: se incluyeron 103 pacientes, 44 diagnosticados de lumbalgia y 59 de ciatalgia tratados, prospectiva y aleatoriamente, con ozono o con reposo y analgesia. Se evaluaron con la escala de intensidad de dolor, cuestionario Oswestry, distancia mano-suelo, Lasseguè e incorporación laboral. El seguimiento clínico fue de 6 meses. Resultados: en el grupo de lumbagos encontramos diferencias con el tratamiento en ambos grupos (p 0,001) sin ver diferencias entre el grupo control y el tratado con ozono. En el grupo de ciatalgia tratado con O3 encontramos diferencia inicial y final del dolor (p 0,001) y la escala de Oswestry presentó una mejoría del 40,4% (p 0,001). En el grupo control con ciatalgia no mejoró el dolor y empeoró en la escala de Oswestry (p 0,5). En el grupo control un 36,2% mostraron un Lasseguè negativo después del tratamiento, mientras que en los tratados con O3 fueron un 83,2%. En el grupo de lumbalgia control causaron alta laboral, por curación o mejoría el 46,6% y el 58,3% tratados con O3; en el grupo ciatalgia control fueron el 18,2% frente al 78,6% de los tratados con O3. Las hernias de disco contenidas respondieron mejor al tratamiento con O3. Conclusiones: el O3 paravertebral no mejora la evolución clínica de las lumbalgias. El tratamiento con O3 intradiscal y paravertebral puede indicarse en el tratamiento de ciáticas y lumbociáticas secundarias a hernias discales cuando fracasa el tratamiento conservador

Objective: A prospective and randomized study to compare the clinical results between conservative vs. intra-discal/para-lumbar vertebrae ozone treatment in patients with low back pain and patients affected of sciatic pain. Patients and method: This is a randomized study for 103 patients (44 with low back pain and 59 with sciatic pain) whose treatment was ozone versus relative rest and analgesic (control group). To evaluate: scale for measuring the intensity of pain, the Oswestry questionnaire for the disability caused by lumbar pain, the hand-flow distance, the Lasseguè test and the reinsertion of the patients to their labour activities. The clinical follow-up was 6 months. Results: Using the scale for the intensity of pain and the Oswestry questionnaire for all the patients with low back pain (ozone or conservative treatment) we found an improvement of their symptoms (p 0.001), with no differences in the results between the control group and the ozone group. For the group of patients affected of sciatic pain treated with ozone we found improvement of the pain after the treatment (p 0,001) and the Oswestry questionnaire 40,4% (p 0.001).The Lasseguè test was negative or improved in 83,2% patients after the treatment in the ozone group. In the patients with low back pain treated with ozone the 58,3% re-started working in their jobs. For the ozone group with sciatic pain the 78,6% were able to develope their ordinary work. The contained discal herniasdisk responded better to the treatment with O3. Conclusions: paralumbar vertebrae ozone does not improve the clinical evolution of low back pain, although it present analgesic effects in the short term. The treatment with intradisk more paralumbar ozone can be one first option in the treatment of the sciatic pain when the conservative treatment fail