Adrenomedullin (ADM) is a potent vasodilator peptide. ADM and nitric oxide (NO) are produced in vascular endothelial cells. Increased ADM level has been linked to hyperdynamic circulation and arterial vasodilatation in cirrhotic portal hypertension (CPH). The role of ADM in non-cirrhotic portal hypertension (NCPH) is unknown. plasma ADM levels were studied in patients with NCPH, compensated and decompensated cirrhosis in order to determine its contribution to portal hypertension (PH) in these groups. There were 4 groups of subjects. Group 1 consisted of 27 patients (F/M: 12/15) with NCPH due to portal and/or splenic vein thrombosis (mean age: 41+/-12 years), group 2 consisted of 14 patients (F/M: 6/8) with compensated (Child-Pugh A) cirrhosis (mean age: 46+/-4), group 3 consisted of 16 patients (F/M: 6/10) with decompensated (Child-Pugh C) cirrhosis (mean age: 47+/-12). Fourteen healthy subjects (F/M: 6/8) (mean age: 44+/-8) were used as controls in Group 4. ADM level was measured by ELISA. NO was determined as nitrite/nitrate level by chemoluminescence. ADM level in Group 1 (236+/-61.4 pg/mL) was significantly higher than that in group 2 (108.4+/-28.3 pg/mL) and group 4 (84.1+/-31.5 pg/mL) (both P<0.0001) but was lower than that in Group 3 (324+/-93.7 pg/mL) (P=0.002). NO level in group 1 (27+/-1.4 micromol/L) was significantly higher than that in group 2 (19.8+/-2.8 micromol/L) and group 4 (16.9+/-1.6 micromol/L) but was lower than that in Group 3 (39+/-3.6 micromol/L) (for all three P<0.0001). A strong correlation was observed between ADM and NO levels (r=0.827, P<0.0001). Adrenomedullin and NO levels were high in both non-cirrhotic and cirrhotic portal hypertension and were closely correlated, Adrenomedullin and NO levels increased proportionally with the severity of cirrhosis, and were significantly higher than those in patients with NCPH. Portal hypertension plays an important role in the increase of ADM and NO. Parenchymal damage in cirrhosis may contribute to the increase in these parameters.

The Model for End-stage Liver Disease Sodium (MELD-Na) score predicts mortality in liver transplant candidates. MELD 3.0 has been proposed as an improved model for estimating mortality risk. This study evaluated MELD 3.0’s predictive accuracy for short-term mortality among Turkish liver transplant candidates and compared its performance with MELD and MELD-Na scores. Patients listed both for deceased donor transplants and living donor transplants were analyzed in the study. The discriminative abilities of MELD, MELD-Na, and MELD 3.0 scores were assessed using the area under the receiver operating characteristic curve (AUROC). Comparisons between AUROC values used the DeLong test. The most predictive cutoff for MELD 3.0 was determined using the Youden index. Transplant-free survival was analyzed using the Kaplan–Meier method, with survival curves compared using the log-rank test. A total of 1689 patients were included in this nationwide, multicenter study. Hepatitis B was the leading cause of cirrhosis (29%, n=491), followed by metabolic dysfunction–associated steatohepatitis (20%, n=335). For 3-month mortality, MELD 3.0 had the highest AUROC (0.753), followed by MELD-Na (0.747) and MELD (0.725). The most predictive cutoff values were 18 for MELD and 21 for MELD-Na and MELD 3.0. Both MELD-Na and MELD 3.0 outperformed MELD ( p <0.001), but showed no significant difference between them ( p =0.17). MELD 3.0 and MELD-Na demonstrated superior performance to MELD in predicting 3-month mortality among Turkish liver transplant candidates, though their predictive accuracy was comparable. Further refinements are needed to enhance MELD 3.0’s clinical utility.

Background and Objectives: Early risk stratification in acute pancreatitis (AP) remains challenging, particularly for identifying patients who initially appear low-risk but later develop complications. The Modified Endothelial Activation and Stress Index (m-EASIX) reflects endothelial injury and systemic inflammation. This study evaluated the prognostic value of dynamic 48 h m-EASIX assessment for predicting adverse clinical outcomes in AP. Materials and Methods: This retrospective cohort study included adult patients hospitalized with AP between January 2020 and June 2025. Propensity score matching (1:1) was performed using age, sex, BISAP score and etiology. Laboratory parameters were recorded at admission and at 48 h. Adverse outcomes were defined as prolonged hospitalization (≥8 days) and/or pancreatic necrosis, abscess, intensive care unit admission or in-hospital mortality. Multivariable logistic regression was used to identify independent predictors of adverse outcomes. Receiver operating characteristic (ROC) analysis evaluated the predictive performance of m-EASIX and compared it with BISAP and Ranson scores. Results: A total of 258 patients were included in the initial cohort, of whom 93 experienced an adverse clinical course. After propensity score matching, 170 patients remained in the final analysis (85 per group). The 48 h m-EASIX score was independently associated with adverse outcomes in both unmatched and matched cohorts. ROC analysis showed a moderate discrimination for composite outcomes (AUC ≈ 0.76) and a stronger discrimination for hard outcomes (AUC up to 0.867). In all analyses, m-EASIX significantly outperformed BISAP and Ranson scores (DeLong test p < 0.001). Dynamic risk reclassification showed that m-EASIX identified a subgroup of patients initially classified as low-risk by BISAP who later developed adverse outcomes. Conclusions: The dynamic assessment of m-EASIX at 48 h provides additional prognostic information for early risk stratification in AP and may help identify patients at an increased risk of unfavorable clinical courses.

Üst gastrointestinal sistem (ÜGİS) kanamaları özofagusun üst kısmı ile Treitz ligamanı arasındaki herhangi bir yerden lümen içine olan kanamaları kapsar. ÜGİS kanaması olan hasta acil servise hematemez, melena veya hematokezya ile başvurabilir. Akut ÜGİS kanamalı hastalara ilk 24 saat içinde endoskopi uygulamak standart yaklaşımdır. Bununla birlikte erken endoskopinin tanımı konusunda ortak bir görüş yoktur. Çeşitli çalışmalara göre bu tanım acil servise başvurudan sonra 2 saat ile 24 saat arasında çeşitlilik gösterir. Bizim çalışmamızda ÜGİS kanaması ile acil servise başvuran 115 hasta alındı. Hastalar endoskopi yapılma sürelerine göre 3 gruba ayrıldığında ( 24 saat) gruplar arasında endoskopik bulgu, Forrest sınıflandırması, endoskopik veya cerrahi tedavi ihtiyacı, replasman ihtiyacı, takiplerde tekrarlayan kanama, tekrarlayan endoskopi ihtiyacı ve hastaların akıbeti konusunda anlamlı fark saptanmadı. Sonuç olarak ÜGİS kanamalarında erken endoskopinin tanımı, ilk 24 saat içinde ne zaman yapılacağı ve faydaları konusunda ortak bir görüş yoktur, yapılan prospektif randomize çalışmalar da erken endoskopinin kar zarar oranını belirlemede göz önünde bulundurulmalıdır.

Background and Objectives: Ustekinumab has demonstrated high treatment persistence in Crohn’s disease (CD), particularly in biologic-experienced populations. However, the impact of cumulative biologic exposure and disease severity on persistence remains insufficiently characterized in real-world settings. Methods: This single-center retrospective cohort study included adult CD patients initiating ustekinumab between 2017 and 2026. All patients had prior biologic exposure. Treatment persistence was evaluated using Kaplan–Meier analysis, and subgroup comparisons were performed using log-rank tests. Results: A total of 64 biologic-experienced patients were included (mean age 38.3 ± 13.2 years; 50% female). Treatment persistence was 89.7% at 12 months and 79.1% at 24 months, with a median follow-up of 25.5 months. A total of 13 discontinuation events occurred, most commonly due to lack of efficacy (10.9%), followed by extraintestinal manifestations (4.7%). Disease location and prior surgery were significantly associated with reduced persistence (log-rank p = 0.040 and p = 0.031, respectively). Log-rank analysis demonstrated significant differences in treatment persistence according to disease location (p = 0.040) and prior surgery (p = 0.031), while penetrating disease behavior showed a borderline association (p = 0.056). Conclusions: Ustekinumab demonstrated high treatment persistence in this biologic-experienced Crohn’s disease cohort. Lower treatment persistence appeared to be associated with ileocolonic disease location and prior surgery. Given the limited number of discontinuation events, these subgroup findings should be interpreted cautiously. Nevertheless, our findings support ustekinumab as a durable real-world treatment option for biologic-experienced Crohn’s disease patients.

Giriş ve Amaç: Ülseratif kolitli hastaların üçte biri akut şiddetli ülseratif kolit ile başvurmakta ve kortikosteroid tedavisi gerekmektedir. Çalışmada kortikosteroide yanıtsız hastalarda infliksimab ve biyobenzerlerinin kurtarma tedavisinde kolektomisiz sağ kalım üzerine etkisi araştırılmıştır. Gereç ve Yöntem: Truelove-Witts aktivite indeksine göre şiddetli kolit kriterlerini karşılayan ve intravenöz kortikosteroid tedavisine yanıtsız olması nedeniyle infliksimab kurtarma tedavisi verilen 48 hasta retrospektif olarak değerlendirildi. Klinik kötüleşme, yeni tedaviye geçilme gerekliliği ve kolektomi ihtiyacı progresyon olarak tanımlandı. Kısa süreli (3 ay) ve uzun süreli (12 ay) kolektomisiz sağ kalım primer sonlanım olarak kabul edildi. Ayrıca orijinal ve biyobenzer infliksimab etkinlik açısından karşılaştırıldı. Bulgular: 14 hastaya orijinal infliksimab, 34 hastaya biyobenzer infliksimab tedavisi verilmişti. Kısa ve uzun süreli sonlanımda hiçbir hastada kolektomi ihtiyacı saptanmadı. İki yıl ve üzerinde biyobenzer infliksimab tedavisi alan iki hastaya kolektomi uygulanmış olduğu saptandı. Progresyon varlığına göre sağ kalım sürelerinin istatistiksel olarak farklılık gösterdiği belirlendi (p < 0.001). Genel sağ kalım süresinin ise farklılık göstermediği saptandı (p > 0.05). Sonuç: Kortikosteroide refrakter şiddetli ülseratif kolitli hastalarda kolektomisiz sağ kalım için hem orijinal hem de biyobenzer infliksimab etkili bulundu.