The Cytological Energy Detection of Purulent Inflammation in Synovial Fluid Is Not All Black and White.

Neutrophils are frequently found in the cytological picture of synovial fluid in several joint pathologies, and a higher proportion of them can even wrongly indicate these cases as purulent inflammation. For reliable differentiation between purulent and non-purulent cases, we use the cytological energy analysis of the synovial fluid. Using this method, we examined 350 knee joint synovial fluid samples. Overall, we found that the percentage of neutrophils ranged between 20.0% and 50.0% in 44 (12.6%) cases and was above 50.0% in 231 (66.0%) cases. In the same group, only 85 (24.3%) highly anaerobic synovial fluid samples were evaluated as purulent inflammation, and another 17 (4.9%) cases were evaluated as very likely purulent inflammation. Further, we quantified the immediate risk of purulent inflammation using the "purulent score" (PS). Of the total of 350 samples, 103 (29.4%) cases were classified as having a very high risk of purulent inflammation (PS = 4), 53 (15.1%) cases were classified as having a significant risk of purulent inflammation (PS = 3), 17 (4.9%) cases were classified as having a moderate risk of purulent inflammation (PS = 2), and 75 (21.4%) cases were classified as having no immediate risk of purulent inflammation (PS = 1). Based on our results and analyses, the cytological energy analysis of synovial fluid is an effective method that can be used to detect and specify joint inflammation and the risk of septic arthritis development.

Reactive synovitis of the knee joint after COVID-19 vaccination: The first ultrastructural analysis of synovial fluid.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the resulting coronavirus 2019 disease (COVID-19) have spread all around the world since 2019 and have affected millions of people. The development of COVID-19 vaccines helped to decelerate the spread of the virus. However, as in the case of vaccines against other infectious diseases, adverse events can also present with COVID-19 vaccines. CASE PRESENTATION: We report here a rare case of a 53-year-old man with knee-joint synovitis, after the first dose of messenger RNA vaccine, with no fever and a negative COVID-19 reverse transcription polymerase chain reaction test. During a clinical examination the suspicion of pyogenic arthritis was excluded by blood tests and by a complex joint effusion examination, including a microbiological and cytological-energy analysis of the synovial fluid. The treatment received by our patient consisted of 3 doses of dexamethasone administered intravenously over a period of 3 days. All the symptoms improved after this therapy, and in the 3-week follow-up period we recorded full recovery with no consequences. CONCLUSION: Case reports on patients undergoing COVID-19 vaccination should be examined in order to detect rare and long-term side-effects. This is the first report to present the outcomes of an ultrastructural analysis of post-vaccination synovitis.

The possible role of hypoxia in the affected tissue of relapsed clubfoot.

Our aim was to study the expression of hypoxia-related proteins as a possible regulatory pathway in the contracted side tissue of relapsed clubfoot. We compared the expression of hypoxia-related proteins in the tissue of the contracted (medial) side of relapsed clubfoot, and in the tissue of the non-contracted (lateral) side of relapsed clubfoot. Tissue samples from ten patients were analyzed by immunohistochemistry and image analysis, Real-time PCR and Mass Spectrometry to evaluate the differences in protein composition and gene expression. We found a significant increase in the levels of smooth muscle actin, transforming growth factor-beta, hypoxia-inducible factor 1 alpha, lysyl oxidase, lysyl oxidase-like 2, tenascin C, matrix metalloproteinase-2, matrix metalloproteinase-9, fibronectin, collagen types III and VI, hemoglobin subunit alpha and hemoglobin subunit beta, and an overexpression of ACTA2, FN1, TGFB1, HIF1A and MMP2 genes in the contracted medial side tissue of clubfoot. In the affected tissue, we have identified an increase in the level of hypoxia-related proteins, together with an overexpression of corresponding genes. Our results suggest that the hypoxia-associated pathway is potentially a factor contributing to the etiology of clubfoot relapses, as it stimulates both angioproliferation and fibroproliferation, which are considered to be key factors in the progression and development of relapses.

Rare Case of Traumatic Anterior Knee Dislocation of Total Knee Arthroplasty With a Serious Neurovascular Injury.

Traumatic anterior dislocation of a total knee arthroplasty (TKA) is an extremely rare occurrence. There are only a few known cases of this type of dislocation which discuss the high risk of a neurovascular complication. This article describes a traumatic anterior dislocation of the TKA with a severe vascular lesion in a 75-year-old severely comorbid patient. Further complications led to the development of a compartment syndrome. Despite the repeated effort in performing a well-functioning anastomosis of the popliteal artery tear by the vascular surgeon, reperfusion of the lower extremity was not effective. Furthermore, multiorgan system failure due to the reperfusion syndrome evolved. This led to an above-knee amputation as a lifesaving procedure. Despite thorough intensive care therapy, the patient did not survive this complication. Presently there are no reported cases with such severe complications after the luxation of a previously well-functioning TKA leading to the death of the patient.