Vichy

Post-thrombotic syndrome (PTS) is a frequent long-term complication of deep vein thrombosis (DVT) that significantly affects patients' quality of life and increases healthcare costs. This research aims to study how the extent of blood clot burden in the veins, measured by a special ultrasound score called the Venous Volumetric Index (VVI), can predict the likelihood and severity of PTS six months after a first episode of symptomatic DVT in the lower limbs. Understanding these predictive factors could help guide better treatment strategies for patients at risk of developing PTS. The study is a multicenter prospective cohort design involving patients diagnosed with a first episode of symptomatic lower limb DVT confirmed by ultrasound. Participants will be followed with clinical assessments and ultrasound scans at one week (only for those in biological research), one month, three months, and six months after diagnosis. Blood samples will be collected at baseline, one week, one month, and three months to examine inflammation and blood clotting factors. Quality of life questionnaires will be completed at three and six months. The VVI score will be calculated from ultrasound data to quantify the clot burden, and the Villalta scale will be used to assess PTS severity over the six-month follow-up period. During each visit, symptoms and clinical signs related to PTS will be evaluated, and color Doppler ultrasound of the lower limbs will be performed. Blood tests will help explore biological markers linked to PTS development. Patients will complete questionnaires about their quality of life to assess the impact of symptoms. The study concludes with the six-month visit, at which point researchers will analyze the association between initial clot burden and PTS outcomes. This comprehensive follow-up aims to improve the prediction and understanding of PTS after DVT.

Calciphylaxis is a rare and painful condition causing ischemic skin lesions due to blocked small blood vessels, mainly affecting patients with end-stage renal disease on hemodialysis. Researchers are conducting a prospective randomized controlled trial to evaluate the safety and effectiveness of adding rheopheresis treatment to standard care for these patients. Rheopheresis is a procedure using double-filtration plasmapheresis to remove specific high molecular weight proteins involved in inflammation and blood clotting. Participants will be randomly assigned to receive either rheopheresis or a sham-apheresis as an additional treatment alongside standard care. Rheopheresis is performed using an automated device (Plasauto) that filters plasma in a double-filtration process, while sham-apheresis uses the same device but returns untreated plasma to the patient. A total of 17 treatment sessions are planned over 12 weeks. During the study, participants will be monitored for complete healing of their calciphylaxis-related skin lesions after 12 weeks of treatment. The trial includes assessments of wound healing progress and safety measures. Participants must be adults on hemodialysis with calciphylaxis lesions, and the study aims to determine if rheopheresis improves healing compared to standard care alone.

Sepsis is a serious condition caused by the body's uncontrolled response to infection, leading to organ failure and potentially death. Septic shock is its most severe form, marked by low blood pressure and poor tissue oxygenation. Current guidelines recommend using serum lactate levels to guide early treatment, but lactate may not always directly reflect tissue blood flow. Researchers are investigating whether measuring the difference in carbon dioxide levels between venous and arterial blood (CO2 gap) can better guide treatment and improve survival in septic shock patients. This study compares two early resuscitation strategies in adults with septic shock: one guided by the venous-to-arterial CO2 gap and the other guided by lactate levels. Patients in the CO2 gap group will have blood sampled via central venous catheters for CO2 analysis, and treatments such as dobutamine or blood transfusions may be adjusted based on oxygen deficiency signs. The goal is to see if CO2 gap-guided care can reduce death rates compared to lactate-guided care. Participants will be closely monitored daily for 28 days after randomization to assess survival. Clinical evaluations, blood tests, and other assessments will be conducted to measure treatment response and organ function. The study focuses on all-cause mortality at 28 days as the primary outcome to determine which resuscitation method better supports recovery in septic shock patients.