Moulins

End-stage renal disease ESRD is a serious condition where kidney function declines, requiring dialysis or transplantation. The number of people undergoing dialysis is rising with an aging population. This research focuses on patients with ESRD undergoing hemodialysis, specifically evaluating how the orientation of the needle bevel during arteriovenous fistula AVF puncture affects complications. The study aims to identify the most conservative puncture technique to reduce risks associated with repeated AVF punctures. Participants will be randomly assigned to one of two groups for the entire study duration of 24 months. One group will have AVF punctures performed with the needle bevel facing up, while the other group will have the bevel facing down. The study involves routine hemodialysis sessions three times a week with double needles. The study will observe the impact of these two techniques on AVF complications, dysfunction, interventions, survival, wall thickening, and patient discomfort. During the study, participants will receive hemodialysis at a dialysis center and be monitored regularly over 12 to 24 months. Assessments include the occurrence of AVF complications during dialysis, ultrasound evaluations, interventions, and patient pain reports. Caregivers feedback on puncture techniques will also be collected. The primary outcome focuses on complications during dialysis over 12 months, with additional evaluations continuing up to 24 months to understand long-term effects and AVF survival.

Researchers are investigating the best noninvasive respiratory support method for patients in intensive care units ICUs who develop respiratory failure after planned removal of their breathing tube extubation. This condition affects about 20% of ICU patients, and many require reintubation, which is linked to high mortality rates. The study aims to compare whether alternating non-invasive ventilation NIV with high-flow nasal oxygen reduces death rates compared to high-flow nasal oxygen alone in these patients. The trial is a multicenter, randomized, controlled study where patients with post-extubation respiratory failure are assigned to one of two groups. One group receives continuous high-flow nasal oxygen treatment for 48 hours, while the other group receives NIV alternating with high-flow nasal oxygen during the same period. NIV involves pressure-support breathing with specific settings to help patients breathe, and the study ensures balance in patient groups based on carbon dioxide levels in the blood. Participants will be closely monitored with assessments including timing of death, reintubation events, days without ventilator use, length of ICU and hospital stay, and mortality at different time points up to 90 days. The main outcome measured is death rate 28 days after respiratory failure onset. The study includes clinical evaluations and blood gas tests to guide treatments and decisions. Participation duration includes the initial 48-hour treatment period and follow-up assessments extending to 90 days.

This research aims to study patients with severe obesity who are considered for bariatric surgery. It evaluates how psychological factors measured before surgery, such as depression, anxiety, eating behaviors, quality of life, body satisfaction, and body perception, relate to changes in body mass index BMI after surgery. The goal is to identify risk factors that might affect surgery success and help tailor therapies before surgery to improve outcomes. The study collects data in two phases. The first phase gathers preoperative clinical information and results from the MMPI-2-RF psychological questionnaire completed before surgery. The second phase involves collecting postoperative data during routine follow-up visits, where patients complete additional psychological questionnaires including the Patient Health Questionnaire PHQ-9, Generalized Anxiety Disorder GAD-7, Three Factor Eating Questionnaire TFEQ-R21, Quality of Life for Obesity and Dietetic Questionnaire EQVOD, Body Esteem Scale BES, and Figure Rating Scale. Participants will be involved through data collection of their psychological assessments before and after surgery, along with clinical follow-up. Researchers will measure how preoperative psychological dimensions predict BMI changes over time. The study also monitors which patients may abandon surgery plans and explores factors related to postoperative difficulties. Participation includes routine consultations and questionnaire completion, with the study continuing until 2027.

Sepsis is a serious condition caused by the bodys uncontrolled response to infection, leading to organ failure and potentially death. Septic shock, the most severe form, causes blood vessels to widen and leak, resulting in low blood pressure and poor oxygen delivery to tissues. Researchers are investigating whether guiding early treatment using the difference in carbon dioxide levels between venous and arterial blood CO2 gap can improve survival compared to the current practice of using blood lactate levels. Participants will be randomly assigned to one of two groups one group will have their treatment guided by maintaining a low CO2 gap, with blood samples taken every 2 to 4 hours and treatment adjusted based on a specific protocol. The other group will receive treatment guided by lowering lactate levels by at least 20% during the same intervals, following established sepsis guidelines. Treatments include the use of medications like dobutamine and blood transfusions as needed. During the study, participants will be closely monitored for 28 days after starting treatment. Researchers will track survival as the main outcome and also assess other health measures daily up to 90 days. Blood samples, organ function scores, and treatment responses will be regularly evaluated to understand the effects of the two strategies on septic shock outcomes.

Cancer treatment often involves surgery, chemotherapy, and radiotherapy, which can cause acute and chronic pain, including neuropathic pain that is hard to predict and treat. Many cancer patients experience chronic pain that significantly affects their quality of life. This research aims to validate a predictive tool to assess the risk of neuropathic pain and pain chronicity in cancer patients, considering factors like preoperative pain, opioid use, age, sleep, psychological state, and social vulnerability. The study involves 500 cancer patients with breast, gynecological, lung, or colorectal cancers, along with 125 healthy volunteers as controls. Participants will undergo assessments of cognitive, emotional, and pain-related factors through questionnaires. Data collection occurs at baseline, 6 months, and 12 months to evaluate pain intensity, neuropathic pain signs, cognitive function, emotional status, social vulnerability, quality of life, sleep quality, disease perception, and analgesic use. Participants will complete various validated questionnaires and scales at these time points to help researchers measure their pain trajectories and related factors. The primary outcome is the CANoPy score, assessed at baseline and during follow-up visits. The study tracks these measures over one year to understand pain development and its impact, aiming to improve predictive abilities for neuropathic pain in cancer management.