[Analysis of the effect of percutaneous vertebroplasty combined with (125)I seed implantation in the treatment of spinal metastatic epidural spinal cord compression].

Objective: To investigate the clinical efficacy of percutaneous vertebroplasty (PVP) combined with iodine-125 ((125)I) seed brachytherapy in the treatment of spinal metastatic epidural spinal cord compression (MESCC) and toassess the changes inthe grade of epidural spinal cord compression (ESCC) by magnetic resonance imaging (MRI). Methods: A total of 37 MESCC patients treated with PVP combined with (125)I seed brachytherapy in the interventional and vascular surgery department of Zhongda Hospital affiliated to Southeast University from January 2014 to June 2019 were retrospectively analyzed, including 23 cases of bilateral lower limbs paralysis. Total diseased vertebrae are 39 segments. Visual analogue scale (VAS) and paralysis of lower extremities were evaluated regularly before and after treatment, and VAS values at different follow-up time points were compared. At the same time, MRI was used to evaluate the changes of ESCC grade in the spinal canal and calculate the local lesion efficiency after operation. The postoperative local lesion efficiency at different follow-up times was compared. Results: PVP combined with (125)I seed implantation in all diseased vertebral bodies was successful. The average injection volume of polymethylmethacrylate (PMMA) was (3.2±1.3) ml/segment, the average number of (125)I seed implanted was (25.0±8.6) seeds/segment and the average radiation dose was (15.0±5.1) mCi/segment. The VAS before operation was 8.5, and postoperative VAS were respectively 3.6±1.3, 3.8±1.5, 3.4±1.4, 5.5±1.0, 5.9±1.4 at 5 days, 1 month, 3 months, 6 months, and 1 year after operation. The differences between all follow-up time points and preoperative VAS values were statistically significant (all P<0.001). Compared with 5 days, 1 month and 3 months after operation, VAS increased significantly at 6 months and 1 year after operation, and the difference was statistically significant (all P<0.001); there was no significant difference between the VAS value at 6 months after operation and 1 year after operation (P=0.405). At a follow-up of 3 months, 22 of 23 patients with paralysis of bilateral lower limbs regained the functions of autonomous walking and voiding; the effective rates of MESCC local lesions evaluated by MRI at 1 month, 3 months, 6 months, and>1 year were 89.7%, 91.9%, 90.6%, and 94.7%, respectively, and there was no statistically significant differences among those follow-up time points (all P>0.05). Conclusions: PVP combined with (125)I seed brachytherapy in the treatment of MESCC has significant improvement in immediate pain relief and spinal cord function. After combined treatment, MRI showed that the tumors around the spinal cord regressed dramatically, which could considerably reduce the MESCC grade and remain stable for a long time.

[Value of European Organisation for Research and Treatment of Cancer score system for predication of immediate postoperative intravesical instillation of pirarubicin after transurethral resection of non-muscle invasive bladder cancer].

Objective: To assess value of immediate postoperative intravesical instillation of pirarubicin after transurethral resection (TURBT)of non-muscle invasive bladder cancer. Methods: 484 patients diagnosed with non-muscle-invasive bladder cancer admitted to the Second Affiliated Hospital of Kunming Medical University were divided into two groups after transurethral resection of bladder tumor. 285 patients received postoperative intravesical instillation of pirarubicin within 6 hours after the surgery, 199 patients received first instillation of pirarubicin at 10 days after the surgery, after that, all the patients received routine bladder perfusion chemotherapy. Patients who received intravesical instillation of pirarubicin within 6 hours were defined as immediate intravesical instillation group and the other patients as the control group. Based on the European Organisation for Research and Treatment of Cancer risk tables, scores of recurrence and progression of patients were calculated and then stratified into risk groups accordingly. Recurrence and progression rates of the immediate intravesical instillation group were analyzed and then compared with the corresponding reference of the risk tables. Results: The 1-year and 5-year recurrence rate of patients with EORTC table scoring 0 in the immediate intravesical instillation group were significantly lower than that of the EORTC reference group (5.3% and 14.0% vs 15.0% and 31.0%, P<0.05). 1-year recurrence free rate between the immediate intravesical instillation group and the control group in patients scoring 1-4 was significantly different (81.3% vs 76.7%, P=0.014). However, 1-year recurrence free rate of the immediate intravesical instillation group was comparable with that of the control group in patients scoring 5-9, 10-17(P>0.05), which is quite close to the EORTC reference. The probability rates of 1-year and 5-year progression of the 285 patients who received immediate intravesical instillation group did not show significant difference with the EORTC reference. On multivariate analysis, previous recurrence, tumor grade G2-3, tumor multiplicity, delay of immediate intravesical instillation were independent risk factors of recurrence(P<0.05). Conclusions: With the help of EORTC recurrence risk table stratifying the patients into different risk groups, our study showed that delay of immediate postoperative intravesical instillation of chemotherapy after TURBT was an independent risk factor of post-surgery recurrence of tumor. Moreover, patients with EORTC scoring 1-4 might obtain greatest benefits.

[Cement augmentation for vertebral osteolytic metastatic lesions: an evaluation on postoperative CT].

Objective: To evaluate the effectiveness of cement augmentation on the osteolytic lesion in patients with vertebral metastasis. Methods: A total of consecutive 132 patients with 268 vertebral metastatic lesions treated with PVP from January 2008 to December 2016 in Zhongda Hospital were enrolled in this study. Retrospective analysis of preoperative, postoperative 3 days, 3 months, 6 months, 12 months and ≥ 18 months imaging data on CT, the local control and progression of the tumor were evaluated by MDA response criteria. The local control rates were compared between the groups with the different rate of cement filling by Chi2-test. Results: Vertebroplasty procedures were performed successfully in all 268 vertebrae under DSA guidance, and the mean volume of PMMA injected in each vertebra was 0.7-8.5(3.9±1.5)ml.The rate of local control at 3 months, 6 months, 12 months and ≥18 months after PVP was respectively 98.9%, 95.1%, 91.8%, and 85.2%, the difference was statistically significant(all P<0.05). The local control rate showed a statistically significant relationship to the groups with the rate of cement filling at 6 months, 12 months and ≥18 months after PVP, but there was no statistical difference at postoperative 3 months. The rate of local control was higher in 68 patients with lung or gastrointestinal cancer than in 17 patients with liver or kidney cancer at 3 months, 6 months and 12 months, the difference was statistically significant (P<0.05). Conclusion: Cement augmentation has a local anti-tumor effect on vertebral osteolytic metastatic lesion, and the anti-tumor effect will decrease as the follow-up time extended.

[Oblique puncture approach via anterolateral to C2: a study of imaging anatomy on corpses].

Objective: To determine the anatomical relation between the carotid artery or laryngopharynx and the needle path via anterolateral oblique approach to C2 vertebral body, and whether the simulated path can direct the actual procedure. Methods: Contrast agent was injected into bilateral carotid arteries of 10 fresh cadavers (20 sides), and then CT scans were performed on each subject. Bilateral simulated puncture paths were simulated on the image of two-dimensional reconstruction CT. The distance between the puncture site and middle line(AC), the angle between the simulated puncture paths and the median sagittal plane (AOB), the distance between the simulated puncture paths and the side wall of hypopharynx, or the carotid artery was measured respectively. Under the guidance of fluoroscopy, oblique puncture via anterolateral to C2 was performed according to the simulated parameters, and then CT was done. The actual needle path was measured on the image of two-dimensional reconstruction CT. The outcomes were compared by using paired t test between groups. Results: Bilateral simulated puncture paths in all 10 cadavers were achieved on the image of CT. The bilateral punctures via anterolateral to C2 were successfully performed under fluoroscopic guidance in 10 cadavers, and the actual needle path could be showed on the image of two-dimensional reconstruction CT. The AC, angle AOB, the distance to carotid artery and side wall of laryngopharyngeal of the left simulated path was(4.7±1.0)cm, (33±8)°, (6.7±2.6)mm, (6.6±2.8)mm, respectively; and those in the right side was(5.2±1.3) cm, (36±8)°, (7.5±2.2) mm, (7.2±2.5) mm, respectively.The AC, angle AOB, the distance to carotid artery and side wall of laryngopharyngeal of the left actual needle was(4.5±1.1) cm, (33±9) °, (6.7±3.0) mm, (7.1±3.9) mm, respectively; and those in the right side was(5.1±1.5) cm, (35±10) °, (7.4±2.1) mm, (7.2±2.6) mm, respectively.And the actual and simulation data of both sides were compared and no significant differences was found by t test (t=0.104-1.882, all P>0.05). Conclusion: The simulated approach via anterolateral to C2 can be achieved on the image of two-dimensional reconstruction CT, it is consistent with the real needle path and can be used to direct the actual practice to improve the accuracy and safety.

Impaired glucose tolerance in first-episode drug-naïve patients with schizophrenia: relationships with clinical phenotypes and cognitive deficits.

BACKGROUND: Schizophrenia patients have a higher prevalence of type 2 diabetes mellitus with impaired glucose tolerance (IGT) than normals. We examined the relationship between IGT and clinical phenotypes or cognitive deficits in first-episode, drug-naïve (FEDN) Han Chinese patients with schizophrenia. METHOD: A total of 175 in-patients were compared with 31 healthy controls on anthropometric measures and fasting plasma levels of glucose, insulin and lipids. They were also compared using a 75 g oral glucose tolerance test and the homeostasis model assessment of insulin resistance (HOMA-IR). Neurocognitive functioning was assessed using the MATRICS Consensus Cognitive Battery (MCCB). Patient psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS). RESULTS: Of the patients, 24.5% had IGT compared with none of the controls, and they also had significantly higher levels of fasting blood glucose and 2-h glucose after an oral glucose load, and were more insulin resistant. Compared with those patients with normal glucose tolerance, the IGT patients were older, had a later age of onset, higher waist or hip circumference and body mass index, higher levels of low-density lipoprotein and triglycerides and higher insulin resistance. Furthermore, IGT patients had higher PANSS total and negative symptom subscale scores, but no greater cognitive impairment except on the emotional intelligence index of the MCCB. CONCLUSIONS: IGT occurs with greater frequency in FEDN schizophrenia, and shows association with demographic and anthropometric parameters, as well as with clinical symptoms but minimally with cognitive impairment during the early course of the disorder.

Cigarette smoking, psychopathology and cognitive function in first-episode drug-naive patients with schizophrenia: a case-control study.

BACKGROUND: Although patients with chronic schizophrenia have substantially higher smoking rates than either the general population or patients with other mental illnesses, drug-naive patients with a first episode of schizophrenia have received little systemic study. This study examined smoking rates, the association between smoking and symptom severity and cognitive function in Chinese first-episode schizophrenia (FES) patients using cross-sectional and case-control designs. METHOD: Two hundred and forty-four drug-naive FES patients and 256 healthy controls matched for gender, age and education completed the Fagerström Test for Nicotine Dependence (FTND) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Patients were also rated on the Positive and Negative Symptom Scale (PANSS). RESULTS: The rate and quantity of smoking were not significantly higher among FES patients compared to the general population. Among patients, smokers scored higher than non-smokers on the total PANSS and the positive symptom subscale scores. There were no significant associations between cognitive function and smoking in either FES patients or healthy controls. CONCLUSIONS: In contrast to studies in patients with chronic schizophrenia, drug-naive FES patients did not smoke more frequently than the general population. Furthermore, patients with psychotic disorders who smoked did not exhibit significant cognitive differences compared with those who did not smoke. However, smoking may have other detrimental effects on physical and mental health, for example on positive symptoms.

Propofol improves intestinal ischemia-reperfusion injury in rats through NF-κB pathway.

OBJECTIVE: The aim of this study was to investigate the effects of propofol on intestinal ischemia-reperfusion injury in rats through the nuclear factor-kappa B (NF-κB) pathway. MATERIALS AND METHODS: A total of 24 Sprague-Dawley rats were selected and randomly divided into three groups, including sham operation group, ischemia group and propofol group. Rats in sham operation group were only treated with isolation of superior mesenteric artery, which was clipped for 1 h and reperfused for 2 h in ischemia group. Meanwhile, propofol (60 mg/kg) was injected into the femoral vein 1 h before ischemia in propofol group. TUNEL assay was performed to detect cell apoptosis of intestinal tissues. Real-time quantitative polymerase chain reaction (RT-qPCR) was conducted to measure the expression levels of malondialdehyde (MDA), superoxide dismutase (SOD), myeloperoxidase (MPO), caspase-3 and B-cell lymphoma-2 (Bcl-2) in rats of each group. Western blotting was utilized to detect the protein expression levels of NF-κB pathway related molecules, such as myeloid differential protein-88 (MyD88), v-rel avian reticuloendotheliosis viral oncogene homolog A (RelA) and NF-κB. Furthermore, changes in plasma cytokine levels were determined via enzyme-linked immunosorbent assay (ELISA). RESULTS: The number of apoptotic cells in ischemia group was remarkably higher than that in sham operation group (p<0.05). However, it decreased notably in propofol group compared with ischemia group (p<0.05). In comparison with sham operation group, significantly up-regulated expression of caspase-3 and down-regulated expression of Bcl-2 were observed in the intestinal tissues of rats in ischemia group (p<0.05). Caspase-3 was lowly expressed, while Bcl-2 was highly expressed in the intestinal tissues of rats in propofol group compared with ischemia group (p<0.05). In addition, no statistically significant differences were observed in the expression level of SOD among sham operation group, ischemia group and propofol group (p>0.05). The expression levels of MDA and MPO were overtly higher in the intestinal tissues of rats in ischemia group than those in sham operation group and propofol group (p<0.05). Besides, the protein expression levels of MyD88, RelA and NF-κB in the intestinal tissues of rats in ischemia group were remarkably higher than those in sham operation group and propofol group (p<0.05). The activity of the NF-κB pathway in the intestinal tissues of rats in propofol group significantly declined compared with ischemia group (p<0.05). Moreover, compared with sham operation group, plasma levels of TNF-α, interleukin (IL)-2, IL-6 and IL-4 increased significantly in rats of ischemia group (p<0.05). However, they were markedly lower in propofol group than those in ischemia group (p<0.05). CONCLUSIONS: Propofol protects rats from intestinal ischemia-reperfusion injury through the NF-κB pathway.

Burnout and cognitive impairment: Associated with serum BDNF in a Chinese Han population.

BACKGROUND: Some studies have demonstrated that subjects with chronic burnout showed cognitive impairments; however, cognitive performance in burnout has been under-investigated. Increasing evidence show that brain-derived neurotrophic factor (BDNF) plays a critical role in cognitive function. We hypothesized that decreased BDNF may be associated with cognitive impairments in burnout, which has not been investigated yet. The aim of the present study was to examine the association of BDNF with cognitive impairment in burnout. METHOD: Using a cross-sectional design, 712 healthy subjects were recruited from a general hospital and they were all measured with the Maslach Burnout Inventory (MBI). We assessed part of subjects on the repeatable battery for the assessment of neuropsychological status (RBANS) (n=192) and serum BDNF levels (n=127). RESULTS: 30.5% of the subjects had burnout. Compared to those non-burnout subjects, the burnout subjects were younger, had significant lower BDNF levels (p=0.003) and scored lower on immediate memory, RBANS total score and attention (all p<0.05). Interestingly, after the Bonferroni correction, there were negative correlations between BDNF and MBI total score or reduced professional accomplishment (PA). Moreover, BDNF was positively associated with immediate memory, attention and RBANS total score. Further multiple regression analysis showed that BDNF was an independent contributor to the RBANS total score and attention, and BDNF and MBI depersonalization (DP) were independent contributors to immediate memory. In addition, there was mediating effect of BDNF in the relation between burnout and cognitive impairments. CONCLUSIONS: Our results suggest that burnout is associated with significant cognitive impairments and decreased BDNF. Moreover, decreased BDNF is associated with cognitive impairments in burnout.

Preoperative transcatheter hepatic arterial embolization for hepatic malignancy.

RATIONALE AND OBJECTIVES: This retrospective study was undertaken to determine clinically and histopathologically the efficacy of preoperative transcatheter hepatic arterial embolization (PTHAE) in liver malignancies. METHODS: Ten patients underwent either single or multiple episodes of PTHAE with lipiodol in an emulsion with chemotherapeutic agents. Four of the patients were thought to be unresectable before embolotherapy. Eight patients had hepatocellular carcinoma, one had cholangiocarcinoma, and one metastatic colon carcinoma. All patients subsequently underwent surgical resection. Histologic observations were made in all resected specimens. RESULTS: No viable tumor cells were recognized in three of the ten specimens, whereas extensive necrosis (70%-95%) was seen in the remaining seven patients. The four patients with tumors that were that to be unresectable before PTHAE had significant reduction in tumor burden (60%-80%) and were thought to be resectable after their embolization. Effectiveness on satellite nodules, thrombi in the portal veins, and intracapsular infiltration was histologically verified. The mean and median survival times to date have been 24.8 and 24.5 months, respectively. CONCLUSIONS: Preoperative transcatheter hepatic arterial embolization is a useful procedure that, in this small patient series, converted unresectable liver tumors into potentially resectable lesions.

Subclinical neurophysiological effects of manganese in welding workers.

High-level occupational manganese (Mn) exposure has been reported to induce irreversible brain alterations determining a Parkinson-like disease. This study aimed to assess subclinical neurophysiological alterations in welding workers. They were employed in a machine building factory with an average Mn exposure <200 mg/m3. Sixty-eight workers (mean age: 34 years; mean Mn exposure duration: 16 years) and 42 flour factory workers (control group) with similar age and smoking habit were recruited. Autonomic nervous function test battery (ANSFT), composed of Valsalva maneuvre-induced heart rate variation (HR-V), heart rate variation following deep breathing (HR-DB) and heart rate variation following immediate standing up (HR-IS) was assessed. Electroencephalogram (EEG), brain electricity activity mapping (BEAM) were also performed. HR-V, HR-DB, and HR-IS were significantly lower in Mn-exposed subjects showing altered autonomic nervous system activity, parasympathetic-sympathetic imbalance and, and consequently, altered cardiovascular regulation and reactivity. The EEG of the Mn-exposed workers evidenced beta-wave rhythms significantly reduced, theta-waves markedly increased and abnormal wave activities of either localized or diffusive type. In the same workers BEAM revealed higher theta, delta and beta power values in the F7 area, lower d power values in the FP1, FP2 and C4 areas as well as dissymmetry in the central area, parietal region and occipital region. This study suggests that Mn impairs neuron activity within central nervous system. In this context, brainstem parasympathetic and sympathetic centers receiving axon projections from cortical and diencephalic areas, may reflect Mn effects on upper pathways. However, direct actions of Mn on these centers cannot be excluded.

Neurobehavioral, autonomic nervous function and lymphocyte subsets among aluminum electrolytic workers.

The purpose of our study is to determine the alteration of neurobehavioral parameters, autonomic nervous function and lymphocyte subsets in aluminum electrolytic workers of long-term aluminum exposure. 33 men who were 35.16 +/- 2.95 (mean +/- S.D) years old occupationally exposed to aluminum for 14.91 +/- 6.31 (mean +/- S.D) years. Air Al level and urinary aluminum concentration was measured by means of graphite furnace atomic absorption spectrophotometer. Normal reference group were selected from a flour plant. Neurobehavioral core test battery (NCTB) recommended by WHO was utilized. Autonomic nervous function test battery recommended by Ewing DJ was conducted on subjects. FAC SCAN was used to measure the lymphocyte subsets of peripheral blood. The mean air aluminum level in the workshop was 6.36 mg/m3, ranged from 2.90 to 11.38 mg/m3. Urinary aluminum of the Al electrolytic workers (40.08 +/- 9.36 microgram/mg.cre) was obviously higher than that of control group (26.84 +/- 8.93 m/mg.cre). Neurobehavioral results showed that the scores of DSY, PAC and PA in Al electrolytic workers were significantly lower than those of control group, The score of POMSC, POMSF and SRT among Al exposed workers were significantly augmented in relation to those of control group. Autonomic nervous function test results showed that R-R interval variability of maximum ratio of immediately standing up in Al electrolytic workers were decreased compare with the control group, while the BP-IS, HR-V, HR-DB, R30:15 had no significant change. Peripheral blood lymphocyte subsets test showed that CD4-CD8+ T lymphocyte in Al electrolytic workers increased. This study suggests that Al exposure exerts adverse effects on neurobehavioral performance, especially movement coordination and negative mood, and parasympathetic nervous function; moreover it increase CD4-CD8+ T lymphocyte subsets.

A comprehensive neurobehavioral and neurophysiological study for low level lead-exposed workers.

UNLABELLED: A comprehensive neurobehavioral and neurophysiological study was performed to evaluate the adverse effect of low level lead-exposure, and to compare the sensibility, easiness of the test methods utilized. The tests were: WHO recommended Neurobehavioral Core Test Battery (NCTB), Autonomic Nouvers System Function (ANS) Test Battery, Brain Electricity Active Mapping (BEAM), and Nerve Conduction Velocity. 44 lead-exposed workers were selected, with 34 age, education degree, family economic level, smoking and drinking matched referents. RESULT: The mean blood lead concentration of lead-exposed workers was 1.3870 mumol/L, whereas that of referents was 0.6080 mumol/L, the difference was very significant. The negative Profile of Mood State (POMS) score of lead-expose workers was higher than that of referents, whereas the positive POMS score of the referents was higher than that of lead-exposed group, with a covariance analysis. The lead-exposure affected some NCTB test items, such as simple reaction time (SRT), digital symbol (DSY), correct dots (PAC) and total dots (PA). The heart-rate response to Valsalva manoeuvre (HR-V), heart-rate response to deep breathing (HR-DB), and blood-pressure response to immediate standing (BP-IS) were lowered in lead-exposed workers significantly. Some abnormal brain electric waves (dominant beta frequency, semetry-diffuse abnormal and non semetry-diffuse abnormal wave distribution, dominant low wave amplitude) appeared in lead-exposed workers. Left ulnar nerve maximal conduction velocity was significantly lowered in lead-exposed group. CONCLUSION: The NCTB (including POMS), and ANS function test should be the regular screening battery for low level lead-exposed workers. The threshold blood lead concentration for health surveillance should be 30 micrograms/dL, or 1.4 mumol/L.

[Postnatal development of brainstem auditory evoked potential and middle latency response in rats].

AIM: To compare the postnatal development of brainstem auditory evoked potential (BAEP) with that of middle latency response (MLR) in rats. METHODS: The postnatal development of BAEP and MLR had been studied continuously for 10 weeks in the same groups of rat Pups. RESULTS: BAEP and MLR emerged at day 14 and 17 respectively. The peak latencies of BAEP's waves shortened systematically with age, especially during 3-4 weeks. The peak latency of wave I reached adult value at day 29, and the peak latencies of the rest waves reached adult ones at day 70. However, the peak latencies of wave Po and Na in the first time evoked MLR had already been at adult values. Though the peak latencies of wave Pa, Nb and Pb also shortened with age, they reached adult ones quickly at day 20-23. The wave amplitudes of BAEP's wave I ,III, IV and MLR's wave Nb, Pb increased quickly with age during 3-4 weeks. Their peak values were much bigger than adult ones and then decreased gradually. CONCLUSION: The postnatal development of BAEP and MLR proceeded in a similar way in rats, but the peak latencies of MLR reached adult values much earlier than that of BAEP.

Automated percutaneous lumbar discectomy: a prospective multi-institutional study.

PURPOSE: A prospective study in 10 independent hospitals from 1992 to 1994 evaluated automated percutaneous lumbar discectomy (APLD) with a newly designed percutaneous instrument. MATERIALS AND METHODS: One thousand five hundred eighty-two APLD procedures were performed in 1,525 patients with disc herniation or back pain. Mean follow-up after APLD was 18.3 months. Follow-up of at least 1 year was available in 1,474 patients. One thousand two hundred eighty-nine patients had sciatic pain and 185 had back pain only. Eight hundred twenty-two patients had symptoms for less than 2 years, 652 for more than 2 years. One thousand two hundred sixty-two patients were older than 60 years, 212 were younger than 60 years. Nine hundred fifty patients had disc protrusion, and 357 had sequestration. Forty-eight patients had disc or longitudinal ligament calcification. Twenty-two had previous surgical discectomy. All discectomies were done with use of a straight needle with the patient in the lateral decubitus position. RESULTS: Success rate (measured by Hijikata's criteria) was 83% at 1 year. Success was significantly greater for protrusion versus sequestration (86% vs 72%, P < .001); for back pain alone versus leg and back pain (89% vs 80%, P < .005); for duration of symptoms less than 2 years versus more than 2 years (85% vs 79%, P < .005); and for age younger than 60 years versus older than 60 years (84% vs 76%, P < .01). Among postsurgical patients, success rate was 77% (17 of 22 patients). The only complication was discitis (0.06%, nine patients). Technical success at L5-S1 was 99% (795 of 800). CONCLUSION: APLD with Teng's instrument has excellent results. Indications may include back pain alone. A straight needle can be used at L5-S1 in most patients, with proper positioning.