Explore the vast range of titles available.

Although most of the early research studies on fractional-order systems were based on the Caputo or Riemann–Liouville fractional-order derivatives, it has recently been proven that these methods have some drawbacks. For instance, kernels of these methods have a singularity that occurs at the endpoint of an interval of definition. Thus, to overcome this issue, several new definitions of fractional derivatives have been introduced. The Caputo–Fabrizio fractional order is one of these nonsingular definitions. This paper is concerned with the analyses and design of an optimal control strategy for a Caputo–Fabrizio fractional-order model of the HIV/AIDS epidemic. The Caputo–Fabrizio fractional-order model of HIV/AIDS is considered to prevent the singularity problem, which is a real concern in the modeling of real-world systems and phenomena. Firstly, in order to find out how the population of each compartment can be controlled, sensitivity analyses were conducted. Based on the sensitivity analyses, the most effective agents in disease transmission and prevalence were selected as control inputs. In this way, a modified Caputo–Fabrizio fractional-order model of the HIV/AIDS epidemic is proposed. By changing the contact rate of susceptible and infectious people, the atraumatic restorative treatment rate of the treated compartment individuals, and the sexual habits of susceptible people, optimal control was designed. Lastly, simulation results that demonstrate the appropriate performance of the Caputo–Fabrizio fractional-order model and proposed control scheme are illustrated.

Background Acute compartment syndrome (ACS) is a critical condition resulting from increased intra-compartmental pressure, causing tissue ischemia and necrosis. ACS following cardiovascular surgery is rare but catastrophic. Postoperative sedation and analgesia often obscure classic symptoms, delaying diagnosis. This underscores the importance of vigilance and early detection, particularly in high-risk scenarios such as prolonged extracorporeal circulation and femoral artery cannulation. Enhanced monitoring, including tissue oxygen saturation and transcutaneous oxygen pressure, may facilitate timely diagnosis. Case summary We report a 56-year-old male who developed ACS after valve replacement surgery involving femoral artery cannulation for cardiopulmonary bypass. Approximately 12 h postoperatively, the patient exhibited severe lower limb swelling, mottling, and diminished dorsalis pedis pulse. Laboratory findings revealed elevated myoglobin and creatine kinase levels. Diagnosis was confirmed via clinical and ultrasound evaluation, prompting emergent fasciotomy. Postoperative management included wound care, renal replacement therapy, and skin flap reconstruction. At 6 months follow-up, the patient achieved complete functional recovery of the affected limb. Conclusion ACS is a rare but severe complication of cardiovascular surgery. This case highlights the necessity for heightened vigilance, early recognition, and timely intervention to mitigate adverse outcomes. Further studies are needed to validate and establish standardized monitoring protocols and management strategies, including early use of distal perfusion techniques, to improve surgical safety and patient outcomes.

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been increasingly recognized in the critically ill over the past decade. In the absence of consensus definitions and treatment guidelines the diagnosis and management of IAH and ACS remains variable from institution to institution. An international consensus group of multidisciplinary critical care specialists convened at the second World Congress on Abdominal Compartment Syndrome to develop practice guidelines for the diagnosis, management, and prevention of IAH and ACS. Prior to the conference the authors developed a blueprint for consensus definitions and treatment guidelines which were refined both during and after the conference. The present article is the second installment of the final report from the 2004 International ACS Consensus Definitions Conference and is endorsed by the World Society of the Abdominal Compartment Syndrome. The prevalence and etiological factors for IAH and ACS are reviewed. Evidence-based medicine treatment guidelines are presented to facilitate the diagnosis and management of IAH and ACS. Recommendations to guide future studies are proposed. These definitions, guidelines, and recommendations, based upon current best evidence and expert opinion are proposed to assist clinicians in the management of IAH and ACS as well as serve as a reference for future clinical and basic science research.

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901 .

Acute compartment syndrome of the extremities is well known, but diagnosis can be challenging. Ineffective treatment can have devastating consequences, such as permanent dysaesthesia, ischaemic contractures, muscle dysfunction, loss of limb, and even loss of life. Despite many studies, there is no consensus about the way in which acute extremity compartment syndromes should be diagnosed. Many surgeons suggest continuous monitoring of intracompartmental pressure for all patients who have high-risk extremity injuries, whereas others suggest aggressive surgical intervention if acute compartment syndrome is even suspected. Although surgical fasciotomy might reduce intracompartmental pressure, this procedure also carries the risk of long-term complications. In this paper in The Lancet Series about emergency surgery we summarise the available data on acute extremity compartment syndrome of the upper and lower extremities in adults and children, discuss the underlying pathophysiology, and propose a clinical guideline based on the available data.

Purpose Currently no guidance exists within the literature regarding diagnostic criteria or the long-term outcomes for paediatric patients with acute compartment syndrome (ACS). We conducted a retrospective cohort study reviewing all cases of paediatric ACS managed at a single tertiary referral centre with the aim of characterising the factors responsible for the eventual outcomes. Methods The patient cohort was identified retrospectively by interrogating the hospital coding system for all paediatric patients between January 2014 and November 2022. The electronic emergency department, inpatient and operative notes as well as clinic letters for each patient were reviewed and data collected regarding presentation, associated injuries, management and subsequent complications plus length of follow-up. The data was analysed to determine if differences in presentation or management affected long term outcome. Results The final cohort consisted of 34 patients with a mean age of ten years at the time of presentation. The mean time from presentation to fasciotomy was 27.6 h (range 3.0 – 66.6). There was an overall complication rate of 37.5% with a mean follow-up period of 21 months. Patients who had direct closure of their fasciotomy wounds had a significantly lower complications rate and fewer operations compared to those who healed via other wound coverage methods or secondary intention (p < 0.05). Conclusions Significantly higher complication rates were observed in patients who were unable to have direct wound closure following emergency fasciotomy. This information may be utilised to rationalise long term treatment plans and in counselling of patients and parents.

Background Acute compartment syndrome occurs when pressure within a compartment increases and affects the function of the muscle and tissues after an injury. Compartment syndrome is most common in lower leg and may lead to permanent injury to the muscle and nerves if left untreated. Methods 46 patients with acute compartment syndrome were enrolled, including 8 cases with serious complications, between January 2008 and December 2012. The protocols combining early management and the correction of deformities were adjusted in order to attempt to enable full recovery of all patients. Results All patients had necrotic muscles and nerves, damaged vascular, and severe foot deformities. In the early stage, each patient received systemic support and wound debridement to promote wound healing. For patients with serious complications, a number of medical measures, including installation of Ilizarov external frames, arthrodesis, osteotomy fusion, arthroplasty, or tendon lengthening surgery, were performed to achieve satisfactory clinical outcomes. All the patients resumed weight-bearing walking and daily exercises. Conclusion Acute compartment syndrome and sequential complications could be managed using a number of medical procedures.

Background Acute Osteofascial Compartment Syndrome (AOCS) stands as a critical surgical emergency, often secondary to various diseases. Its clinical manifestation arises from increased pressure within the fascial compartment, resulting in diminished tissue perfusion and consequential ischemic damage. Presently, clinical diagnostics lack effective biological markers, and patients face a grim prognosis, experiencing muscle contractures, necrosis, amputations, renal failure, and even mortality. The primary treatment, fasciotomy, poses infection risks and potential nerve damage. Hence, there is an urgent need for research elucidating AOCS's pathogenic mechanism and exploring novel treatments. Methods To address this, we established a rat model of AOCS, extracting toe flexor muscles from both experimental and control groups. Employing second-generation high-throughput sequencing, we obtained comprehensive mRNA, lncRNA, circRNA, and miRNA data. Comparative analysis of expression differences between AOCS and control groups, followed by in-depth examination, allowed us to unravel the intricacies of AOCS occurrence from a multi-omics perspective. Results Our research findings indicate that AOCS is an immune-mediated inflammatory disease, primarily involving immune cells, especially neutrophils. In addition, genes associated with ferroptosis, a form of regulated cell death, are found to be upregulated in the rat model, with non-coding RNAs playing a role in regulatory interactions. Conclusions These results suggest that neutrophils may undergo ferroptosis, thereby enhancing inflammation and immune responses in the fascial compartment, which promotes disease progression. Furthermore, these findings reveal the interactions between immune molecules and pathways in AOCS, which are significant for a deeper understanding of the pathogenesis of the disease and the development of targeted therapeutic strategies.

Background Acquired hemophilia A (AHA) is a rare bleeding disorder caused by autoantibodies against clotting factors, often resulting in spontaneous bleeding or bleeding after minor trauma, potentially leading to Acute Compartment Syndrome (ACS). Diagnosing and managing AHA-induced ACS is challenging due to its rarity and the risks associated with fasciotomy in bleeding disorders. In low- and middle-income countries (LMICs), ACS management is further complicated by the lack of intra-compartmental pressure monitoring devices, necessitating reliance on clinical symptoms. Case Presentation A 36-year-old woman presented to the emergency department with progressive swelling of the left antecubital area after phlebotomy with no trauma or bleeding disorder history. After hospitalization a venous color Doppler ultrasound showed superficial vein thrombosis, and the patient was discharged and referred to the orthopedic service for follow-up of clinical symptoms. Returned to the hospital after approximately six hours due to the development of generalized weakness and hemodynamic instability. Diagnostic challenges arose as initial laboratory results suggested possible acute leukemia due to leukocytosis and thrombocytosis. Her condition deteriorated rapidly with wrist drop which drew increased attention and necessitating a fasciotomy due to suspected ACS, revealing profuse bleeding. Subsequent tests revealed low factor VIII levels and a high factor VIII inhibitor, confirming AHA. Treatment included empirically activated factor VII, prednisolone, cyclophosphamide, and rituximab, resulting in gradual improvement but residual wrist drop. Conclusions This case underscores the importance of considering AHA in patients with ACS-like symptoms and unexplained prolonged activated Partial Thromboplastin Time (aPTT), even without bleeding history. It also highlights the need to investigate any unexplained aPTT prolongation before surgical interventions. Collaboration between orthopedic surgeons and hematologists is essential for optimizing outcomes. Approaching to algorithms for non-traumatic ACS in AHA is an important step. Prompt intervention, patient education, and tailored treatment strategies are crucial for preventing severe complications and optimizing patient outcomes.

Background Acute compartment syndrome (ACoS) following coronary artery bypass grafting (CABG) is a rare yet fatal complication with unclear risk factors and clinical characteristics. This study aimed to analyze the incidence, risk factors, and clinical outcomes of ACoS after CABG. Methods A retrospective analysis was conducted on 77,810 patients who underwent CABG at Beijing Anzhen Hospital between January 2007 and October 2024. Using a 1:4 matched design, clinical data from 20 postoperative patients with ACoS (ACoS group) and 80 patients without ACoS (NACoS group) were compared.The risk factors of ACoS after CABG were identified by logistic regression analysis. Results The incidence of ACoS after CABG was 0.026% (20/77,810). The ACoS group had a significantly lower average body mass index (BMI) compared to the NACoS group (24.54 vs. 26.39, P  = 0.018). Utilization rates of intra-aortic balloon pump (IABP) (80% vs. 21.25%) and extracorporeal membrane oxygenation (ECMO) (55% vs. 3.75%) were significantly higher in the ACoS group ( P  < 0.001). Mean arterial pressure (MAP) at 18 h (72.58 vs. 79.42 mmHg, P  = 0.004) and 24 h postoperatively (73.33 vs. 78.33 mmHg, P  = 0.004) was significantly lower in the ACoS group. ACoS occurred in the lower limb with great saphenous vein (GSV) harvesting in 75% of cases, with a markedly elevated median postoperative myoglobin peak (3970 vs. 237 ng/mL, P  < 0.001). Mortality reached 100% in conservatively treated patients, while survival rate with fasciotomy was 58.3%. Conclusion ACoS after CABG is associated with lower BMI, use of circulatory assist devices (IABP and ECMO), and postoperative hypotension. Clinicians should remain vigilant for patients who are high-risk and optimize intervention strategies. Highlights 1. ACoS is rare but fatal post-CABG, occurring in 0.026% of cases, with a 100% mortality rate in conservatively treated patients. 2. Lower BMI, circulatory assist devices (IABP, ECMO), and postoperative hypotension are major risk factors for ACoS. 3. Saphenous vein harvesting is linked to ACoS, with 75% of cases occurring in the graft donor limb. 4. Postoperative MAP decline beyond 12 h may serve as an early predictor of ACoS development. 5. Early fasciotomy improves survival (58.3%), highlighting the need for prompt diagnosis and intervention.