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Sepsis and its severe form, septic shock, are serious health concerns characterized by organ failure and acute circulatory problems like low blood volume, blood vessel dilation, and heart dysfunction. Researchers are evaluating whether measuring microcirculation parameters such as the peripheral perfusion index and skin marbling by nurses can improve early treatment decisions and patient outcomes. This study focuses on the early detection of tissue blood flow problems that may not be obvious through standard measurements and aims to assess if early vascular filling based on these measures can reduce deterioration and mortality. Participants will be monitored using classic hemodynamic parameters plus additional measurements of peripheral perfusion index and marbling score. If the peripheral perfusion index is 3 seconds or more or marbling is present at a score of 1 or higher, nurses will initiate a vascular filling test by administering 500 cc of fluid over 30 minutes after confirmation by a senior doctor. All patients will continue to receive standard care treatments. This intervention period is closely linked to emergency department admission. Throughout the study, patients will be followed for 7 days to track clinical outcomes including deterioration within 24 hours after inclusion, organ function changes, mortality, lung fluid overload, and care setting decisions such as discharge or intensive care admission. The study also compares nurse and physician assessments of microcirculation. This detailed monitoring includes timing of treatment bundles and safety checks to evaluate how early microcirculation measurement impacts sepsis management and patient prognosis.

Researchers are evaluating treatments for pelvic organ prolapse, a condition affecting many women over 50, causing loss of pelvic support and impacting quality of life. The study compares two surgical approaches for repairing cystocele, a common type of prolapse, focusing on combined anatomic and functional success one year after surgery. This comparison addresses concerns about complications related to mesh and aims to identify effective native tissue repair methods. The study compares anterior colporraphy, which involves retensioning the bladders median support with colpectomy, to the vaginal patch plastron, which uses a vaginal strip attached to the bladder and suspended to the pelvic fascia. Surgeries will be standardized among surgeons. Patients will be randomly assigned to one of these procedures and will not know which surgery they received. Follow-up includes a visit 45 days after surgery for complication assessment, phone calls at 4 and 8 months, and a 1-year visit by an independent assessor. Participants will have evaluations including anatomic and functional success of the surgery, monitored complications, and sexual function assessments. Follow-up visits and phone calls will track recovery and outcomes up to three years. The main measure is the rate of prolapse surgery success at one year. Safety and complications will also be reviewed shortly after surgery, ensuring comprehensive monitoring throughout the study period.