Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018.

Non-variceal upper gastrointestinal bleeding remains an important emergency condition, leading to significant morbidity and mortality. As endoscopic therapy is the 'gold standard' of management, treatment of these patients can be considered in three stages: pre-endoscopic treatment, endoscopic haemostasis and post-endoscopic management. Since publication of the Asia-Pacific consensus on non-variceal upper gastrointestinal bleeding (NVUGIB) 7 years ago, there have been significant advancements in the clinical management of patients in all three stages. These include pre-endoscopy risk stratification scores, blood and platelet transfusion, use of proton pump inhibitors; during endoscopy new haemostasis techniques (haemostatic powder spray and over-the-scope clips); and post-endoscopy management by second-look endoscopy and medication strategies. Emerging techniques, including capsule endoscopy and Doppler endoscopic probe in assessing adequacy of endoscopic therapy, and the pre-emptive use of angiographic embolisation, are attracting new attention. An emerging problem is the increasing use of dual antiplatelet agents and direct oral anticoagulants in patients with cardiac and cerebrovascular diseases. Guidelines on the discontinuation and then resumption of these agents in patients presenting with NVUGIB are very much needed. The Asia-Pacific Working Group examined recent evidence and recommends practical management guidelines in this updated consensus statement.

Effect of proinflammatory cytokines on the human MUC5AC promoter activity in vitro and in vivo.

PURPOSE: To investigate the effect of inflammatory cytokines on the activity of the human MUC5AC promoter in vitro and in vivo. METHODS: Conjunctival epithelial cells transfected with MUC5AC-luciferase plasmids challenged with different cytokines (tumor necrosis factor-alpha [TNF-alpha], interleukin [IL]-1beta, IL-2, IL-6, and IL-8) at various concentration (1, 10, 20, 50, 100, 200, 500, 1000, and 2000 pg/mL) for 24 hours. A Helio Gene Gun system (Bio-Rad Laboratories, Hercules, CA, USA) was used to deliver MUC5AC-luciferase plasmids into rabbit conjunctivas, which were also challenged with these cytokines (1000 pg/mL) at the frequency of every six hours for 48 hours. The activity of MUC5AC-luciferase was then evaluated using the luciferase assay. RESULTS: Results of the studies demonstrated that IL-1beta and TNF-alpha upregulated the activity of MUC5AC-luciferase in cultured conjunctival cells, while IL-2, IL-6, and IL-8 had no effect. In rabbit conjunctival tissues, TNF-alpha, IL-1beta, IL-2, IL-8, and IL-6 significantly upregulated MUC5AC gene expression. CONCLUSIONS: This suggests that MUC5AC mucin gene expression is regulated by proinflammatory cytokines, which could have implications in ocular surface disorders.

Sequential argon-YAG laser membranectomy and phacoemulsification for treatment of persistent pupillary membrane and associated cataract.

We report a case of a persistent pupillary membrane (PPM) associated with a cataract managed by sequential argon-YAG laser membranectomy and phacoemulsification. A 30-year-old woman had an extensive PPM and anterior capsular opacity of the lens in the right eye. Best corrected visual acuity (BCVA) was 20/60. Argon laser photocoagulation was performed at the junction of the PPM and the iris collarette. Subsequently, a neodymium:YAG laser was used to sever the strands of the PPM. These laser procedures resulted in shrinkage of the PPM without hemorrhage in the iris or other complications. The patient had clear corneal sutureless phacoemulsification uneventfully on the next day. The BCVA improved to 20/25 3 months following the treatment. We conclude that combined sequential argon-YAG laser membranectomy and modern phacoemulsification surgery can effectively be used to treat PPM associated with cataract without bleeding of the iris or other major side effects.