Vichy

This research aims to study people who have had their first episode of symptomatic deep vein thrombosis DVT in their lower limbs to understand the risk and severity of post-thrombotic syndrome PTS, the most common long-term complication of DVT. The study focuses on evaluating how the amount of thrombosis blood clot burden measured by the Venous Volumetric Index VVI on ultrasound relates to the development and severity of PTS assessed by the Villalta scale over 6 months. Participants will be followed at multiple times around 1 week, 1 month, 3 months, and 6 months after diagnosis. At each visit, doctors will assess symptoms and signs to calculate the Villalta score and perform venous ultrasounds to measure thrombosis burden using the VVI. Blood samples will be collected at several visits to study inflammation, coagulation, and clot breakdown factors. Quality of life questionnaires will also be completed at 3 and 6 months. During the study, symptom assessments, ultrasound exams, blood tests, and questionnaires will help researchers understand how the thrombosis burden at baseline and over time relates to the occurrence and severity of PTS. The study ends with the 6-month visit. Researchers will monitor the presence of moderate to severe PTS and changes in clot burden to identify important prognostic factors that may guide future prevention and treatment strategies.

Calciphylaxis, also called uremic calcifying arteriolopathy UCA, is a rare condition causing painful skin lesions due to small blood vessel calcification and clotting. This disease mainly affects patients with end-stage renal disease ESRD who require hemodialysis. Researchers are evaluating the safety and effectiveness of adding rheopheresis, a special blood filtration treatment, to the standard care for calciphylaxis in these patients through a prospective randomized controlled trial. In this study, participants will be randomly assigned to one of two groups. The experimental group will receive rheopheresis in addition to standard care, involving an induction phase of 3 sessions in the first week followed by 2 sessions weekly for 3 weeks, then a maintenance phase with 1 session per week up to week 11. The comparator group will receive sham-apheresis sessions on the same schedule, which mimics the procedure without actual filtration. Rheopheresis uses a machine to remove certain high molecular weight proteins from plasma to help treat microcirculation problems. Participants will be followed for 12 weeks during treatment with regular assessments of wound healing, pain levels, quality of life, antibiotic usage, hospital discharge days, survival, and inflammatory protein changes. The primary outcome is the percentage of patients achieving complete healing of calciphylaxis lesions after 12 weeks. Secondary outcomes include partial healing, new lesion occurrence, pain and analgesic use, and overall survival at 12 weeks and one year. Safety and efficacy data will help determine the added value of rheopheresis in calciphylaxis care.

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.