Clinical trials

This retrospective monocentric study aims to assess the feasibility and clinical relevance of three-dimensional (3D) modeling of deep endometriosis lesions derived from pelvic MRI. The study evaluates whether 3D reconstruction improves surgical planning and multidisciplinary management.

This retrospective monocentric study evaluates adherence to international clinical practice guidelines for soft tissue sarcoma management in Strasbourg and its impact on overall survival. It also compares practices and outcomes between two periods (2010-2016 and 2017-2024).

This retrospective single-center observational study aims to evaluate the association between a history of cardiovascular disease and the occurrence of severe hemodynamic complications within 30 minutes after intubation in adult patients admitted to the intensive care unit. Cardiovascular history includes ischemic, arrhythmic, dilated or valvular heart disease, pulmonary hypertension, and systemic hypertension. Severe hemodynamic complications include severe hypotension, initiation or increase of norepinephrine, fluid resuscitation for hemodynamic instability, or cardiac arrest.

This study aims to assess the knowledge, perceptions and practices of occupational physicians regarding premenstrual dysphoric disorder (PMDD), a condition with significant occupational impact that remains insufficiently explored in occupational health.

This study evaluates the diagnostic yield of invasive genetic testing in fetuses with isolated intrauterine growth restriction diagnosed after 28 weeks of gestation, in order to better define indications for invasive procedures and improve clinical counseling.

Multiple sclerosis (MS) and functional neurological disorders (FND) share clinical features, which may result in FND being overlooked in patients with MS. They also share common comorbidities, including depression and alexithymia. As their management differs, assessing the frequency and determinants of FND in patients with MS is important to improve diagnosis and ensure appropriate management.

This retrospective monocentric observational study aims to evaluate whether basal luteinizing hormone (LH) levels can reliably diagnose central precocious puberty and reduce the need for LHRH stimulation testing. Currently, all patients with suspected precocious puberty undergo LHRH testing regardless of basal LH levels. The study will analyze pediatric patients evaluated between 2019 and 2024 to determine an optimal basal LH threshold with high specificity. Secondary analyses will assess diagnostic performance and explore clinical and biological factors influencing LH levels. The results may help reduce unnecessary testing and improve diagnostic strategies.

Tetralogy of Fallot is the most common cyanotic congenital heart disease. Management strategies vary between primary repair and staged approaches including palliative surgery. The development of pulmonary arteries is a key determinant in surgical decision-making. This multicenter retrospective observational study aims to evaluate the evolution of pulmonary artery dimensions using the Nakata index at key stages of patient management (birth, palliative surgery, and complete repair). The goal is to assess its predictive value in optimizing surgical strategy and improving outcomes in patients with Tetralogy of Fallot or pulmonary atresia with ventricular septal defect.

Open neural tube defects are congenital malformations associated with significant morbidity. Early detection during the first trimester remains a key challenge. This retrospective monocentric study aims to evaluate the diagnostic performance of fetal biometrics (biparietal diameter and abdominal transverse diameter ratios) and maternal serum markers (beta-hCG and PAPP-A) for early screening of open neural tube defects. The study will assess the predictive value of these parameters individually and in combination to define optimal screening thresholds applicable in routine clinical practice

This is a monocentric study assessing hamstring and quadriceps neuromuscular fatigue after 3 consecutive soccer trainings. The purpose of this study was: 1. To quantify the difference of isometric force immediately after a simulated soccer training. 2. To characterize peripheral and central fatigue between hamstring and quadriceps muscles. 3. To compare the level neuromuscular fatigue before each session, to assess the cumulative effect of neuromuscular fatigue 4. To highlight correlation between neuromuscular fatigue and performance markers.

Palliative care aims to improve the quality of life of patients with life-threatening illnesses and their families through early identification, assessment, and management of physical, psychosocial, and spiritual needs. The demand for palliative care is steadily increasing due to population aging, the rising prevalence of chronic diseases, and earlier identification of palliative needs. In France, access to palliative care remains insufficient, with only about half of estimated needs currently met. Early integration of palliative care has been shown to improve quality of life, reduce depressive symptoms, and limit aggressive interventions at the end of life, particularly in oncology, with emerging evidence supporting similar benefits in non-cancer chronic diseases. At the same time, healthcare systems face significant pressure, including limited hospital bed capacity and overcrowded emergency departments, highlighting the importance of optimizing care pathways. This retrospective study aims to analyze the care pathways of patients admitted to the palliative care unit of Strasbourg University Hospitals from their home in 2025. It will compare direct admissions to those preceded by an emergency department visit and identify clinical, organizational, and social factors associated with direct admission. The findings are expected to inform strategies to improve access to palliative care, promote home-based management when appropriate, and reduce avoidable emergency department utilization.

Severe rhabdomyolysis is a common medical emergency that can lead to acute kidney injury (AKI), sometimes requiring extracorporeal renal replacement therapy (ECRT). Myoglobin plays a major role among the molecules involved in nephrotoxicity. While ECRT techniques are commonly used in this situation, their actual effectiveness in eliminating myoglobin and improving renal function remains poorly established. In particular, mid-cut-off membranes, developed to better remove intermediate molecular weight molecules, could improve renal prognosis. This study aims to evaluate, using retrospective clinical data, the impact of these techniques on renal recovery.

Osteosarcomas, like other primitive bone tumors, remain hard-to-treat malignancies, especially after failure of first-line treatments. Multiple mechanisms are initiating or rendering bone tumor cells resistant to the chemotherapies leading to the drastic reduction of treatment possibilities in case of relapses. Among the list of extra-tumoral mechanisms enabling this cancer cell resistance, hypoxia and tumor-associated macrophage modulation seem to be in the top ranks. Based on that, we generated by the past tumor data where the study of hypoxic biomarkers' expressions and the presence of protumoral macrophages were influencing the prognosis of osteosarcoma patients. In fact, the association of HIF1 hyperexpression and a high number of M2 phenotype macrophages (e.g., protumoral cells) were predictive markers of the worst outcome. We recently redone this translational approach in other bone tumors like Ewing sarcomas (EWS) showing the same prognostic tendency. Furthermore, a past pediatric phase I trial, named RAPIRI, targeting both mTor and HIF1, with combination of Sirolimus and Irinotecan, was able to provide in the relapsing bone cancers a partial response or stable disease in more than 50% of patients and particularly in patients with blood concentrations of Sirolimus between 5 and 15 µg/L. To go further and understand the potential links between macrophages and hypoxic resistant tumors, recent preliminary exploration, with an immunofluorescent assessment targeting GD2 expression on tumor cell membranes, was underlining osteosarcomas but also EWS with standard fusions and CIC-DUX4 cancers as hyperexpressing cancers for this disialoganglioside. The cell-surface molecule was highly expressed in 22 out of 32 diagnostic samples (unpublished data). This glycosphingolipid usually presenting a restricted pattern of expression on normal tissues seems to be frequently hyperexpressed in some cancers and therefore amenable to targeting by the monoclonal antibody Dinutuximab beta. The anti-GD2 effect of this drug relies on complement and immune effector cells to mediate cancer cell killing. Recent and unpublished preclinical data in our Lab (UMR-CNRS7021, Strasbourg) envisioned the proof-of-concept combining Sirolimus, Irinotecan and Dinutuximab beta in osteosarcoma models and afford sustainable results to conclude to a clear efficiency of this triple combination stopping completely osteosarcoma cell proliferation and reducing drastically their invasion in microenvironment. Gathering all those prerequisite data and, as the monoclonal therapeutic antibody (Dinutuximab beta) now is extensively evaluated in clinics in multiple indications (e.g., neuroblastomas, Ewing sarcomas and other sarcomas), we propose here a phase I/II trial with this combination of treatments targeting hypoxia and GD2 in bone tumors focusing on relapsing bone tumors with endpoints determining accurate dose to give to patients and its efficacy at 16 weeks of treatment.

This is a study : * Single-center * Prospective * Translational * Based on data and blood samples. In this context, the aim is to collect approximately 10 ml of blood from each patient included in the 3D tumoroid development project. The main objective is to establish and validate a panel of vascularized and perfused 3D tumoroids for personalized medicine based on patient tumors for urological cancers, incorporating autologous immune cells. Translated with DeepL.com (free version)

Islet transplantation restores glucose tolerance in people living with diabetes characterised by high glycaemic variability: 90 per cent of patients were free from severe hypoglycaemia at 5 years, compared with 26 per cent prior to transplantation, and 50 per cent of patients were insulin-independent at 1 year. However, follow-up of participants is characterised by a gradual loss of islet function, with only 30 per cent of patients remaining insulin-independent at 5 years. The greatest limitation and challenge of islet transplantation lies in the substantial loss of islet mass infused via the portal vein at the start of the post-transplant period. Up to 50 per cent of the graft may be lost in the days following transplantation. This early loss is due to a combination of stress and non-specific inflammatory and immune mechanisms, as well as blood-mediated inflammatory reactions, which compromise the survival, engraftment, revascularisation and early function of the transplanted islets. Consequently, multiple islet infusions are often required to achieve satisfactory metabolic outcomes in recipients. However, due to the scarcity of available donors, the widespread application of islet transplantation remains limited as a result. During the culture period, cells in the islet preparation release extracellular vesicles (EVs) - either secreted by the plasma membrane (microvesicles, MVs) or of intracellular endosomal origin (exosomes) - which play a major role in intercellular communication. Microvesicles carry various markers and effectors that can render them either harmful (pro-coagulant, pro-apoptotic, pro-inflammatory and pro-senescent) or protective. We therefore hypothesise that (1) EVs released during the preparation of islets prior to transplantation (hereinafter referred to as Graft-EVs) reflect the quality of the pancreatic islets, (2) certain EVs have a protective or deleterious effect on the pancreatic islet, and (3) reconditioning the islets by enriching them with protective EVs improved graft quality under the pro-inflammatory conditions of IBMIR. We therefore propose to develop an EV-based islet preconditioning strategy to improve graft survival and function.

This study aims to characterize emotional dysregulation in complex post-traumatic stress disorder (cPTSD) and to determine the extent to which it can promote the distinction with borderline personality disorder (BPD) and post-traumatic stress disorder (PTSD). As emotional dysregulation is a dynamic process whose phenomenological manifestations are labile, associated with physiological modifications and modulated by cognitive processing, a multiple methodology associating measurements in a real-life ecological context with measurements performed in the hospital will be preferred. Overall, this study proposes to capture, for the first time, the clinical manifestations associated with cPTSD from the perspective of emotional dysregulation and its underlying processes

Neuroendocrine carcinoma of the cervix (NECC) is an aggressive histological variant of cervical cancer accounting for about 1-1.5% of all cervical cancers. Small cell NEC is the most common type of NECC. This malignancy is induced by the human papillomavirus, like the other more common cervical cancers subtypes (i.e squamous cervical cancer and adenocarcinoma), but has a far worse prognosis. Local and distant relapses occur more often in NECC, and the 5-year overall survival (OS) is significantly poorer with around 30% (compared to \> 65% for the others). Thus, the aggressive nature of NECC resembles that of small cell lung cancer (SCLC), which, at the time of initial diagnosis, is mostly locally advanced or metastasized. The Gynecologic Cancer InterGroup recommends a multimodal approach for advanced disease, with chemoradiation or systemic chemotherapy consisting of etoposide and cisplatin. There is no standard of care in case of recurrence after platinium-based chemotherapy. Retrospective data suggests the combination of Paclitaxel, Topotecan, and Bevacizumab1, but median progression-free-survival (PFS) was only 8,7 months and median OS 16.8 months with this regimen in the NECTuR retrospective register (starting from the initiation of therapy for recurrence). Tarlatamab is a bispecific T-cell engager immunotherapy (BiTE). It binds to both DLL3 on cancer cells and to CD3 on T cells, leading to T-cell-mediated lysis of cancer cells. DLL3, a protein that inhibits Notch signaling, is overexpressed on the surface of SCLC. It is associated with OS benefit in pre-treated SCLC in the randomized phase 3 DeLLphi-304 trial (Mountzios et al). Recently, it has been confirmed that high DLL3 expression is associated with high-grade neuroendocrine features, making it a promising therapeutic target beyond SCLC. Interestingly, gynecological neuro-endocrine neoplasias were classified as DLL3-high expressing tumors with whole-transcriptome sequencing analysis (Lozano et al). Given the biological similarities between SCLC and NECC, and the high expression of DLL3, Tarlatamab should also be evaluated in gynecological NEC.

The causes underlying the development of chronic inflammatory bowel diseases (IBD) and digestive cancers remain poorly understood. They involve both genetic susceptibilities and multiple environmental factors. Research and the development of new therapeutic strategies are essential to provide patients with novel treatment opportunities. A deep understanding of the tumor ecosystem at the molecular level, as well as the interactions between different cell types, is crucial to identify and validate new therapeutic targets. Since animal cancer models have shown their limitations in translating results to humans, studies models are often based on autologous patient tissues and sera. These innovative models make it possible to: * model tumors ex vivo, * perform screenings of new candidate molecules, * or test tumor response to existing therapies in the context of personalized medicine. This work has led to numerous publications on advanced digestive cancers, such as those of the liver or the bile acid pathway To create ex vivo models and reconstruct the tumor in vitro, experiments require treating tumor cells with blood from the same patient (autologous), collected simultaneously with the tumor resection. The tumor tissues used in culture are obtained from residual material of anatomopathological analyses performed as part of clinical care.

BEBOP is a prospective, multicenter, national, comparative, non-randomized, open cohort study aiming to characterize opioid use disorder (OUD) severity and psychosocial severity among adults who use opioids, and to identify biological and psychosocial factors associated with OUD severity and its clinical evolution over a 2-year follow-up period.

Depression in the elderly, or "late life depression" (LLD), is often considered to be homogeneous, legitimizing standardized treatment. Yet the literature suggests that there are different forms of LLD, with different pathophysiology, course and treatment. Our experience has led us to identify an "anergic" form, marked by adynamia and anhedonia (anergic depression, AnD). Highly represented among LLDs, it readily resists the usual antidepressants, so that its course is often chronic. Thanks to the "Chronic Anergic Depression Open Trial", the investigators were able to show that AnD responds to dopaminergic (DA) molecules. Therefore the invastigators hypothesized a pathophysiology linked to dysfunction of the mesolimbic DA system. However, not all patients would present the same form: two subgroups could be isolated, each contributing equally. The first corresponds to patients for whom the episode is a recurrence, the so-called "early onset depression" (EOD). The first episode occurs at 34 ±16 years of age and is frequently associated with a personality disorder (73%). The index episode usually lasts 6 ±3 years and is typically associated with anxiety (96%). The second group corresponds to the onset of primary depression after the age of 60, known as "late onset depression" (LOD). The index episode occurs at around 71 ±6 years of age, in people with no premorbid personality disorders. The episode is shorter (3 ±1 years) and anxiety is frequent (75%) but less marked. These patients showed a high propensity for a course compatible with synucleinopathies, but often less rapid than that of the classic forms of these diseases. The investigators hypothesize that within AnD, EOD and LOD present different pathophysiologies, and that this difference is observable on functional magnetic resonance imaging (MRI): LOD patients should present a greater reduction in functional connectivity in the mesolimbic system. The investigators make the subsidiary hypothesis that LODs also show a structural alteration observable with other types of MRI measurements, i.e. multiparametric imaging.

Despite the increasing availability and advances in the analysis of high-throughput DNA sequencing, the majority of patients with early-onset or familial parkinsonism remain without a molecular diagnosis. Studying the genetic forms of parkinsonian syndromes presents numerous clinical, scientific and therapeutic interests. In clinical practice, identifying the genetic cause in a patient allow to provide genetic counseling and estimate the risk of recurrence in their relatives. Establishing correlations between the genotype and phenotype of patients with genetically determined parkinsonism, allow to better anticipate the evolution of the disease, or even to highlight biomarkers during the presymptomatic phases. Finally, the proteins encoded by the genes implicated in familial parkinsonism represent potential therapeutic targets likely to be modulated by neuroprotective pharmacological agents, even in sporadic Parkinson's disease. In this work,investigators aimed at elucidating the missing genetic causes of parkinsonism through the application of combined RNA and whole genome sequencing.

Attention Deficit Hyperactivity Disorder (ADHD) in adults is a common psychiatric disorder, with important consequences in terms of quality of life, mental health (associated disorders and poorer response to treatment), family life, risk of accidents; with a consequent cost for society. Adult ADHD is frequently associated with psychiatric co-morbidities, and notably associated with mood disorders (major depressive disorder or bipolar disorder) in about 50% of cases. The diagnosis of ADHD in adults is made in patients with an attentional complaint (pure ADHD or ADHD-P), but also very often in the management of a comorbid mood disorder (ADHD associated with mood disorder, or ADHD-MD). In this case, the ADHD had no impact during childhood and adolescence. Medication management is well established for ADHD-P, and medication is based on methylphenidate, which has a rapid and significant effect on attentional symptoms and impulsivity. However, in the case of ADHD-HD, there is little evidence of treatment efficacy and the mechanisms of action of methylphenidate at the brain level are poorly understood. The aim of the study is to determine the neural mechanisms of the effect of methylphenidate, using functional MRI and EEG, in ADHD-P and ADHD-HD patients, and to compare them to healthy subjects. A single dose allows us to observe effects that are then persistent with repeated doses. The aim is to determine, by means of a biomarker, whether methylphenidate treatment responds to the same mechanisms in the different groups and would be relevant in ADHD-P as in ADHD-HD. Main objective: To determine whether methylphenidate impacts differently on brain circuits associated with cognitive functions in the two clinical populations studied (adult ADHD patients and patients with post mood disorder attentional deficit) and in comparison to controls. Secondary objectives: 1. To determine the effect of methylphenidate on baseline brain flow in the two clinical populations and in controls (healthy subjects). 2. To determine whether methylphenidate has a different impact on cognitive performance in the two clinical populations studied and in comparison to controls (healthy subjects). 3. To confirm the effect of methylphenidate on the maintenance of cortical arousal. 4. To distinguish the brain networks impacted by methylphenidate (maintenance of attention or inhibition) with MRI and EEG.

Since the COVID-19 pandemic, discharging patients home on low-flow oxygen therapy has proven to be a safe and effective alternative to hospitalization, helping to relieve overcrowded hospitals while ensuring continuity of care. At the investigating emergency department, a dedicated care pathway ("Oxy-Urg") already allows selected oxygen-dependent patients to return home with a home-care provider, regardless of the cause of their breathlessness, once their condition is stable. This study evaluates whether managing these patients with a team combining an emergency advanced practice nurse (APN) and an emergency physician, rather than a physician alone, improves the organization of care and reduces complications after home discharge. Adult oxygen-dependent patients eligible for the Oxy-Urg pathway are randomly assigned (1:1) to management by an APN-physician team (intervention group) or by a physician alone (control group). Both groups then receive the usual Oxy-Urg pathway (home oxygen therapy, provider tele-monitoring, community nurse and general practitioner follow-up). The main goal is to compare the number of organizational adverse events occurring between inclusion and Day 28 between the two groups. The study also assesses clinical deterioration after discharge, the time professionals spend setting up the pathway, and, through interviews and a focus group, the experience of patients and professionals. The hypothesis is that the APN-physician team allows a more efficient organization and improves the patient experience, supporting the sustainability and wider use of this pathway.

Threatened preterm labor (TPL) is defined by cervical changes and regular and painful uterine contractions occurring between 24 and 36 + 6 weeks of gestation that may or may not lead to premature labor and delivery. There is no reliable way to predict preterm delivery. The study's hypothesis is that the Premaquick® test can improve the prediction of preterm delivery. The investigators also want to compare this test with the Partosure® (Placental alpha microglobulin-1) test.

Dental anxiety is common during third molar extractions and may exacerbate pain perception. Local anesthesia does not prevent exposure to stress-inducing stimuli. Virtual reality (VR) combined with hypnotic scripts (HypnoVR®) provides immersive multisensory distraction. This study tests whether VR reduces perioperative anxiety and postoperative pain compared to local anesthesia alone.