Clichy Sous Bois

Researchers are evaluating antimicrobial stewardship strategies in patients with ventilator-associated pneumonia VAP in intensive care units ICU. VAP is a leading cause of healthcare-associated infections in ICU, often treated with antibiotics, which can contribute to the growing problem of multidrug resistant bacteria worldwide. This study aims to determine if daily clinical assessment to guide antibiotic discontinuation can safely reduce antibiotic use without increasing mortality, treatment failure, or new pneumonia episodes. The study is a prospective, national multicenter, phase III, randomized, single-blinded trial comparing two treatment approaches for confirmed VAP. One group receives antimicrobial stewardship based on daily clinical evaluations to decide when to stop antibiotics if signs of clinical cure are met. The control group follows standard management with a mandatory minimum 7-day antibiotic course regardless of clinical improvement. Intensivists assess patients daily in both groups to guide treatment duration. Participants will undergo daily clinical assessments of signs like tracheal secretion regression, temperature normalization, and oxygenation improvement. Researchers will monitor outcomes such as all-cause mortality, treatment failure, new pneumonia episodes, antibiotic-free days, duration of mechanical ventilation, ICU stay length, and antibiotic-related complications over 28 days. The study includes informed consent procedures and aims to assess safety and effectiveness of shorter antibiotic courses in ICU patients with VAP.

Researchers are studying hereditary pancreatitis HP, a rare condition caused by mutations in the PRSS1 gene or family history of chronic pancreatitis without other risk factors like alcohol use. This study aims to track patients with PRSS1 mutations to assess how often they develop pancreatic adenocarcinoma and to better understand the progression and outcomes of hereditary pancreatitis over time. The condition is rare and varies widely among affected families, with limited current scientific knowledge. Patients with PRSS1 mutations are identified through three French genetics laboratories and included by their current doctors. This observational study collects health data from medical records and administers questionnaires every five years during routine care visits. The cohort is updated as new patients are diagnosed, and data completeness is checked every five years. Participants are seen annually as part of their usual care, allowing researchers to gather ongoing medical information. The study measures the incidence of pancreatic adenocarcinoma over 20 years, tracks the natural history and clinical features of hereditary pancreatitis, evaluates risk factors for cancer progression, and assesses quality of life, especially pain impact. This long-term monitoring helps improve understanding of this rare genetic condition.

This research aims to evaluate whether liver transplantation following selective internal radiation therapy SIRT and chemotherapy can improve the three-year overall survival rate for patients with locally advanced intrahepatic cholangiocarcinoma. The study targets patients with unresectable but non-metastatic tumors who are not suitable for initial surgery. The trial is supported by a panel of experts and involves participants recruited from care centers in France. Participants will undergo SIRT using Yttrium-90 combined with chemotherapy drugs gemcitabine and cisplatin. After this treatment phase, tumor response will be assessed using CT scans, hepatic MRI, and PET-CT to confirm no disease progression. Patients passing this evaluation will have exploratory surgery to exclude contraindications before being placed on the liver transplant waiting list, with a minimum wait time of three months. The transplantation will then be performed, followed by immunosuppressive therapy. Throughout the study, participants will be closely monitored for liver graft function and how well they tolerate immunosuppressive treatment. Follow-up will include evaluations of overall survival at three years post-transplant, along with assessments of therapeutic efficacy, quality of life, and treatment tolerance over multiple years. The total participation duration covers induction therapy through five years after transplantation to fully capture long-term outcomes and safety.