[A novel retrograde intubation procedure for treatment of nasolacrimal duct obstruction].

OBJECTIVE: To investigate the effect of a novel intubation procedure for the treatment of nasolacrimal duct obstruction. METHODS: Nasolacrimal duct obstruction patients with chronic dacryocystitis were selected for undergoing the procedure of intubation in outpatient clinic. This procedure was performed under local anesthesia. Retrograde intubation was inserted into the nasolacrimal duct and guided with probing. The location of drainage tube, cleanliness, epiphora, secretion from lacrimal sac and other signs were observed 2-4 weeks after intubation. Patients were grouped according to postoperative follow-up time. Group A consisted 521 cases (613 eyes) who underwent operations from May 1997 to December 2001 in Shenzhen Ophthalmic Hospital and observed for 3-5 years to evaluate long-term results. Group B consisted 381 cases (411 eyes) who underwent operations from October 2003 to October 2005 in Shenzhen Ophthalmic Hospital and 5 cases (6 eyes) who underwent operations at the same time period in Beijing Shunyi District Hospital (a total of 386 cases, 417 eyes) and observed for 0.5-1.5 years as the recent treatment group. The cure rates of these two groups were compared using the chi-square test. RESULTS: The lacrimal system was able to be irrigated one week after the operation. Epiphora symptoms were eliminated 2-3 weeks postoperatively. Lacrimal sac secretions disappeared within 1-3 weeks in most cases, few patients still had mucous secretions after 3 weeks and needed the second intubation operation. The cure rate of second intubation was 92.3% (23/26). The cure rates of Group A and Group B were 84.5% and 88.2%, respectively. There was no significant difference in cure rate between these two groups. Surgery and anesthesia could lead to a short period of diplopia and discomfort without any other complications. CONCLUSIONS: The novel lacrimal retrograde tube and the operation procedure are safe, simple and without obvious trauma. The prognosis of the intubation operation is good and this method could be used as a treatment for nasolacrimal duct obstruction and chronic dacryocystitis.

The Mammalian Target of Rapamycin and DNA methyltransferase 1 axis mediates vascular endothelial dysfunction in response to disturbed flow.

The earliest atherosclerotic lesions preferentially develop in arterial regions experienced disturbed blood flow, which induces endothelial expression of pro-atherogenic genes and the subsequent endothelial dysfunction. Our previous study has demonstrated an up-regulation of DNA methyltransferase 1 (DNMT1) and a global hypermethylation in vascular endothelium subjected to disturbed flow. Here, we determined that DNMT1-specific inhibition in arterial wall ameliorates the disturbed flow-induced atherosclerosis through, at least in part, targeting cell cycle regulator cyclin A and connective tissue growth factor (CTGF). We identified the signaling pathways mediating the flow-induction of DNMT1. Inhibition of the mammalian target of rapamycin (mTOR) suppressed the DNMT1 up-regulation both in vitro and in vivo. Together, our results demonstrate that disturbed flow influences endothelial function and induces atherosclerosis in an mTOR/DNMT1-dependent manner. The conclusions obtained from this study might facilitate further evaluation of the epigenetic regulation of endothelial function during the pathological development of atherosclerosis and offer novel prevention and therapeutic targets of this disease.