Background and Aim: The spleen is the largest peripheral lymphoid organ in the body. Splenomegaly (SM) is a common complication of portal hypertension; however, the molecular mechanisms driving splenic fibrosis remain incompletely understood. Methods : This study established a portal vein stenosis–induced Sprague–Dawley (SM) rats (n = 20), with a sham-operated control (SO) group (n = 20). Splenic tissue fibrosis was evaluated using special staining techniques, including Masson, elastica van Gieson, and ammonia-silver staining. Matrix metallopeptidase 2 (MMP-2), MMP-9, tissue inhibitor of metalloproteinases 1 (TIMP-1), TIMP-2, transforming growth factor beta 1 (TGF-β1), and mothers against decapentaplegic homolog 7 (Smad7) were detected via immunohistochemistry, quantitative real-time polymerase chain reaction, and Western blotting. Results : In the SM group, microscopic observation revealed diffuse collagen proliferation, elastic fiber fragmentation, and reticular fiber densification. The proportions of MMP-2-, MMP-9-, TIMP-1-, TIMP-2-, TGF-β1-, and Smad7-positive cells were significantly higher than those in the SO group (P < 0.001). Gene and protein expressions of MMP-2, MMP-9, TIMP-1, TIMP-2, TGF-β1, and Smad7 were also significantly higher than those in the SO group (P < 0.001). Conclusion : In this rat model, portal vein stenosis–induced SM is associated with an imbalance in the MMP/TIMP ratio mediated by activation of the TGF-β1/Smad-signaling pathway. These results suggest potential molecular targets for antifibrotic therapeutic interventions.

Portal hypertension (PH) is a common clinical syndrome characterized by a pathologic increase in portal venous pressure. In cirrhosis, PH occurs owing to extensive fibrosis within the liver parenchyma, causing increased vascular resistance. As PH develops, collateral vessel formation and arterial vasodilation progress, enhancing the blood flow to the portal circulation. Increased levels of circulatory vasodilators are believed to be caused by portosystemic shunting and bacterial translocation, leading to the redistribution of the blood volume with central hypovolemia. Esophagogastric varices and splenomegaly develop as a result of hyperdynamic circulatory syndrome. Cirrhosis-induced blood flow obstruction leads to long-term congestion of the splenic sinus, hyperplasia of fibrous tissue, and proliferation of splenic myeloid cells, culminating in splenomegaly. This condition is a marker of advanced chronic liver disease and PH. Angiogenesis plays a pivotal role in forming portosystemic shunts and splenomegaly. As both jointly reflect the hemodynamic abnormalities in PH, they have become key diagnostic and therapeutic targets. However, significant challenges remain. This review focuses on our current understanding of the pathophysiology of collateral circulation and splenomegaly and novel therapeutic approaches for cirrhosis. Interventions targeting these vascular alterations are expected to exert beneficial effects in managing PH in the future.

Rationale: Tuberculosis (TB) is a chronic granulomatous infectious disorder, caused by Mycobacterium tuberculosis. Extrapulmonary TB, which accounts for 20% of cases, includes intestinal TB in 10%. Gastrointestinal TB leads to intestinal perforation in 4% to 7.6% of cases, with a mortality rate of 30%. Patient concerns: We conducted a retrospective analysis of a patient with ileal perforation due to intestinal TB. A male in his early 20s (initial weight, 35 kg) presented with a 2-day history of abdominal pain, exhibiting tenderness, rebound tenderness, and muscular guarding upon physical examination. Computed tomography (CT) imaging revealed a significant amount of free gas and fluid in the abdominal cavity. Subsequently, the patient underwent ileal repair and ileostomy. Diagnoses: Histopathological examination confirmed multifocal amorphous pink caseating necrotic material and Langhans giant cells in the mesenteric lymph nodes. A polymerase chain reaction (PCR) assay confirmed infection with M tuberculosis. Interventions: On the 20th postoperative day, enteral nutrition was initiated concomitantly with antitubercular therapy (ATT). After 1 month, enteral nutrition and oral diet were alternated for 2 months, then changed to oral diet alone, and the patient was discharged to continue ATT. Five months later, the patient’s weight increased by 20 kg, and he began exercising outdoors. The patient underwent a successful ostomy reversal. Outcomes: At the 12-month follow-up, his body weight had increased to 65 kg, PCR testing was negative for M tuberculosis, and antituberculosis drugs were discontinued. Lessons: This case highlights the successful management of ileal perforation due to intestinal TB with peritonitis, without complications such as fistulas. Diagnosis of small bowel perforations due to intestinal TB remains challenging even for experienced clinicians, and surgical approaches are controversial. We emphasized the significance of diagnostics of such cases and often requiring a multidisciplinary approach involving various medical teams.

RATIONALE:Low-grade appendiceal mucinous neoplasm (LAMN) is a rare subtype of appendiceal pathology characterized by epithelial hyperplasia, cellular atypia, and mucinous accumulation within the appendiceal lumen, leading to obstructive expansion of the organ. Representing a mere 0.2% to 0.3% of all appendectomies and approximately 0.5% of gastrointestinal tumors, LAMN poses diagnostic challenges in surgical practice. PATIENT CONCERNS:We conducted a retrospective analysis of a patient with the appendiceal neoplasm. A 39-year-old female presented to Jiaozhou Hospital, East Hospital Affiliated to Tongji University on July 9, 2022, complaining of a nine-day history of right lower abdominal pain, distension, and nausea. Physical examination revealed a palpable measuring 15 × 6 cm in the right lower quadrant, accompanied by tenderness, rebound tenderness, and muscular guarding. DIAGNOSES:Histopathological examination confirmed the diagnosis of a LAMN without evidence of lymphovascular invasion, serosal, or mesenteric infiltration. INTERVENTIONS:After antiinflammatory therapy and comprehensive assessment, the neoplasm was excised through three-dimensional laparoscopic surgery. OUTCOMES:No recurrence was observed during an 32-month postoperative follow-up period. LESSONS:Despite its rarity, LAMN warrants clinical attention due to its nonspecific symptoms. Computed tomography scans significantly improve preoperative diagnostic accuracy, with pathological diagnosis serving as the gold standard. Surgical intervention is the preferred treatment option, albeit controversies persist regarding surgical extent and the utilization of preoperative and postoperative chemotherapy.

Rationale:Ileal perforation caused by the insertion of a drainage tube is a rare complication. Hence, the utilization of surgical drains in abdominal surgery remains controversial. At present, there is a trend to reduce the utilization of drains in abdominal surgery, although certain situations may necessitate their application.Patient concerns:A 25-year-old Chinese woman presented with a history of right lower abdominal pain persisting for 10 days. Imaging examinations, including abdominal computed tomography and ultrasound, identified low-density lesions measuring 10 x 8 x 8cm3 in the right lower abdomen, which are consistent with perforated appendicitis complicated by a peri-appendiceal abscess. A laparoscopic appendectomy was carried out. On the 5th postoperative day, the drainage fluid changed to a grass-green color (80mL). Imaging with retrograde contrast through the drainage tube revealed that the 26 Fr silicon rubber drainage tube tip was positioned 50cm away from the ileocecal junction within the ileum. Both the ileal and ileocecal regions appeared well-developed.Intervention and outcomes:Oral intake was suspended, and the patient received antacids, somatostatin, antibiotics, and total parenteral nutrition. On the 19th postoperative day, a follow-up imaging procedure using retrograde contrast through the drainage tube indicated that the tube tip was sealed. The treatment concluded on day 33 postoperatively, and the patient was discharged.Discussion and conclusion:Ileal perforation due to an abdominal drainage tube following laparoscopic appendectomy constitutes a rare but serious complication. However, due to the adhesion and inflammatory changes around the abscess, laparoscopic dissection becomes a challenging and risky process, and the surgical skills and experiences are particularly important. Removing the abdominal drainage tube promptly based on the characteristics of the drainage fluid is recommended. The findings provide valuable insights for surgeons navigating similar challenges.

Schwannomas localized in the sacrum are relatively infrequent, accounting for 1-5% of all spinal axis schwannomas; they present with vague symptoms or are symptomless, so often grow to a considerable size before detection. Sacral schwannomas occasionally present with enormous dimensions, and these tumors are termed giant sacral schwannomas. However, their surgical removal is challenging owing to an abundant vascularity. The present study retrospectively analyzed the clinical and follow-up data of a patient with a giant sacral schwannoma. The patient experienced numbness in the left buttock and lower extremity, with radiating pain in the sole of the foot that had persisted for 3 years. A presacral mass was found by computed tomography examination 6 months after the stool had become thin. A tumor resection was performed using the anterior abdominal approach. A schwannoma was diagnosed by postoperative pathology. The postoperative course was uneventful, with the complete resolution of symptoms during the 21-month clinical follow-up. Overall, the present study reports the case of a giant sacral schwannoma with pelvic pain that was resected without complications and also discusses its successful management. Additionally, the study presents a systematic review of the literature. We consider that the surgical treatment of giant sacral schwannomas with piecemeal subtotal excision can achieve good outcomes, avoiding unnecessary neurological deficits.

Rationale:Abdominal cocoon is an uncommon abdominal disease. Intestinal rupture complicated with intestinal fistula rarely occurs in patients with abdominal cocoon.Patient concerns:A 51-year-old man was referred to hospital, with a 4-hour history of abdominal injuries caused by traffic accident. Intraoperatively, the small intestine in the abdominal cavity was surrounded by dense, tough, grayish-white fibrous tissue. There were the rupture of 2 sites in the ileum. The ileum was anastomosed side-to-side using a cutting and closing device. The patient was postoperatively transferred to the intensive care unit and received ventilator-assisted breathing, along with anti-infection and supportive treatments. On the 10th day after surgery, grass green turbid fluid of approximately 150 mL was extracted from the abdominal drainage tube. The secondary laparotomy was performed on the 12th day post-surgery, revealing a 1.5 cm diameter fistula at the end of the ileum.Intervention and outcomes:Nursing strategies included ensuring optimal mechanical ventilation for oxygenation, utilizing Li's double cannula for continuous abdominal irrigation and negative pressure drainage to prevent abdominal abscess formation, emphasizing the importance of enteral nutrition, implementing direct suture treatment to manage retrograde infection and expedite stoma healing, and employing Li's double cannula and vacuum-assisted closure technique to promote incision healing. After 48 days secondary post-surgery, the incision was fully healed, and the patient was discharged home with the stoma bag. Five months later, he was readmitted to the hospital, and the stoma was reversed.Lessons:Intestinal fistula poses a remarkable challenge after abdominal cocoon surgery, typically manifesting 4 to 5 days postoperatively. However, in this case, it occurred on the 10th day, highlighting the critical role of vigilant monitoring of drainage fluid color and volume in postoperative care. Navigating the complex management of intestinal rupture in abdominal cocoon necessitates a more efficacious approach, highlighting the importance of accumulating comprehensive nursing expertise through such cases.

Objective: The contribution of hypoxia to the pathophysiology of vascular smooth muscle cells (VSMCs) has not yet been fully elucidated. This study evaluated the effect of hypoxia on the phenotype and function of SMCs derived from the human normal great saphenous veins (NGSVs). Methods: Fifteen NGSV tissue samples were collected. SMCs were isolated and cultured. Proliferation, migration, adhesion, senescence, and the structure of cytoskeletal filaments in SMCs were observed. mRNA and protein expression of Bax, Bcl-2, caspase-3, matrix metalloproteinases (MMP)-2, MMP-9, tissue inhibitor of metalloproteinases (TIMP)-1, and TIMP-2 was detected by fluorescent quantitative polymerase chain reaction and immunoblotting in the cobalt chloride (CoCl2) and the control groups. Results: A decrease in the number of cytoskeletal filaments was observed. mRNA and protein expression of Bas and caspase-3 was significantly decreased, while the quantity of proliferation, migration, adhesion, senescence, and mRNA and protein expression of Bcl-2, MMP-2, MMP-9, TIMP-1, and TIMP-2 in SMCs in the CoCl2 group were significantly increased compared with the control group. Conclusion: Under hypoxic conditions, the phenotype and function of SMCs derived from the human NGSVs were dysregulated, suggesting that VSMCs switch from the contractile phenotype to the secretory or synthetic phenotype, and more dedifferentiate, resulting in extracellular matrix deposition and apoptotic decrease through the intrinsic pathway.

Objectives Superficial venous thrombosis (SVT) is the complications of varicose great saphenous veins (VGSVs), but its pathogenesis remains unclear. This study was designed to measure the changes in expression of matrix metalloproteinases (MMPs) and the tissue inhibitor of metalloproteinases (TIMPs) from SVT, VGSVs, and great saphenous veins (GSVs). Methods In the venous walls of the three groups, the expression of MMP-2, MMP-9, TIMP-1, and TIMP-2 proteins, protein-positive expression ratios, mRNA expression, and protein expression were determined by immunohistochemistry, polymerase chain reaction, and western blot. Results The MMP-2, MMP-9, TIMP-1, and TIMP-2 protein-positive expression ratios, mRNA and protein expression in the SVT group were significantly higher than those in the VGSV and the GSV groups. The corresponding expression in the VGSV group were significantly higher than those in the GSV group. Conclusion Disequilibrium of MMPs and TIMPs in SVT wall occurs due to underlying high hydrostatic pressure and inflammation. These results suggested that MMPs and TIMPs participate in the process of venous wall remodeling.

BACKGROUND:Superficial thrombophlebitis (ST) is a frequent pathology, but its exact incidence remains to be determined. This study tested the hypothesis whether relationships exist among smooth muscle cells (SMCs) derived from ST, varicose great saphenous veins (VGSVs), and normal great saphenous veins (GSVs).METHODS:Forty-one samples of ST, VGSVs, and GSVs were collected. SMCs were isolated and cultured. Proliferation, migration, adhesion, and senescence in SMCs from the three vein walls were compared by various methods. Bax, Bcl-2, caspase-3, matrix metalloproteinase-2 (MMP-2), MMP-9, tissue inhibitor of metalloproteinase-1 (TIMP-1), and TIMP-2 messenger RNA (mRNA) and protein expressions were detected by fluorescence quantitative PCR and Western blot.RESULTS:An obvious decrease in cytoskeletal filaments was observed in thrombophlebitic vascular smooth muscle cells (TVSMCs). The quantity of proliferation, migration, adhesion, and senescence in TVSMCs was significantly higher than in varicose vascular smooth muscle cells and normal vascular smooth muscle cells (NVSMCs) (all P < 0.05). Bax and caspase-3 mRNA and protein expression were decreased, while Bcl-2 mRNA and protein expression were increased in the TVSMCs compared with the varicose vascular smooth muscle cells and the NVSMCs (all P < 0.05). MMP-2, MMP-9, TIMP-1, and TIMP-2 mRNA and protein expression were significantly increased in the TVSMCs compared with the VVGSVs and the NVSMCs (all P < 0.05).CONCLUSION:SMCs derived from ST are more dedifferentiated and demonstrate increased cell proliferation, migration, adhesion, and senescence, as well as obviously decreased cytoskeletal filaments. These results suggest that the phenotypic and functional differences could be related to the presence of atrophic and hypertrophic vein segments during the disease course among SMCs derived from ST, VGSVs, and GSVs.

Background Traumatic avulsion injuries to the anus, although uncommon, can result in serious complications and even death. Management of anal avulsion injuries remains controversial and challenging. This study aimed to investigate the clinical effects of treating large skin and subcutaneous tissue avulsion injuries in the perianal, sacral, and perineal regions with island flaps or skin graft combined with vacuum assisted closure. Methods Island flaps or skin graft combined with vacuum assisted closure, diverting ileostomy, the rectum packed with double-lumen tubes around Vaseline gauze, negative pressure drainage with continuous distal washing, wounds with skin grafting as well as specialized treatment were performed. Results The injuries healed in all patients. Six cases had incomplete perianal avulsion without wound infection. Wound infection was seen in four cases with annular perianal avulsion and was controlled, and the separated prowl lacuna was closed. The survival rate in 10 patients who underwent skin grafting was higher than 90%. No anal stenosis was observed after surgery, and ileostomy closure was performed at 3 months (six cases) and 6 months (four cases) after surgery, respectively. Conclusions Covering a wound with an island flap or skin graft combined with vacuum assisted closure is successful in solving technical problems, protects the function of the anus and rapidly seals the wound at the same time.

Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) can be accomplished with either the preservation or the resection of splenic vessels; the latter is also known as Warshaw technique. Our study is designed to investigate the operation selection strategy when proceeding LSPDP and to evaluate the long-term outcomes of patients undergoing Warshaw surgery. The medical records and follow-up data of patients who underwent LSPDP in Qilu Hospital, Shandong University, were reviewed retrospectively. A total of thirty-five patients were involved in this study, including 17 cases of patients who were treated with Warshaw procedure (WT) while the other 18 cases had splenic vessels preserved (SVP). Compared with the SVP group, the operative time and intraoperative blood loss in WT group were improved significantly. The incidence of early postoperative splenic infarction was higher in WT group. However, there was no report of splenic abscess or second operation. Follow-up data confirmed that there was no significant difference in spleen phagocytosis and immune function compared with normal healthy population. Our study confirms that LSPDP-Warshaw procedure is a safe and efficient treatment for the benign or low grade malignant tumors in distal pancreas in selected patients. The long-term spleen function is normal after Warshaw procedure. Preoperative assessment and intraoperative exploration are recommended for the selection of operation approaches.

BACKGROUND:Varicose great saphenous veins (VGSVs) are a common disorder with a high incidence, but the pathogenesis is unclear. This study was designed to measure the changes in matrix metalloproteinases (MMPs) and the tissue inhibitor of metalloproteinases (TIMPs) in different segments from VGSV walls to determine the relationship between MMPs, TIMPs expression, and expansion of the venous wall.METHODS:Twenty-one VGSV and 12 normal great saphenous vein (GSV) specimens were collected. Venous walls in the two groups, expression of MMP-2, MMP-9, TIMP-1, and TIMP-2 proteins, protein-positive expression ratios, mRNA expression, and protein content were determined by immunohistochemistry, PCR, and western blot.RESULTS:The MMP-2, MMP-9, TIMP-1, and TIMP-2 protein-positive expression ratios, mRNA expression in the upper, middle, and lower segments in the VGSV group were significantly higher than the corresponding regions in the GSV group, respectively. The MMP-2, MMP-9, TIMP-1, and TIMP-2 protein-positive expression ratios, mRNA expression, and protein concentrations in the lower segments in the VGSV group were also significantly higher than the upper and middle segments in the VGSV group and the corresponding regions in the GSV group, respectively.CONCLUSIONS:Under high hemodynamics, disequilibrium of MMPs and TIMPs from VGSVs exists within the upper, middle, and lower segments of VGSVs. These results suggested that MMPs and TIMPs participate in the process of venous wall remodeling and may be one of the mechanisms associated with the formation and development in varicose veins.

Objectives Varicose vein is a common disorder involving extensive venous dilation and remodeling, yet the underlying mechanism is unclear. Studies have shown increased expression of matrix metalloproteinases in human varicose veins and animal models of venous hypertension. We investigated the differences in matrix metalloproteinases and tissue inhibitor of metalloproteinases from human splenic veins and great saphenous veins under high hemodynamics. Methods Seventy-two human diseased splenic vein, splenic vein, varicose great saphenous vein, and great saphenous vein specimens were collected. The mRNA and protein expression of matrix metalloproteinase-2, matrix metalloproteinase-9, tissue inhibitor of metalloproteinase-1, and tissue inhibitor of metalloproteinase-2 were determined. Results The mRNA expression and protein positive expression ratio of matrix metalloproteinase-2, matrix metalloproteinase-9, tissue inhibitor of metalloproteinase-1, and tissue inhibitor of metalloproteinase-2 as well as the content of relative-protein expression were significantly increased in the diseased splenic veins and varicose great saphenous veins compared with the splenic veins and great saphenous veins (P < 0.05). The varicose great saphenous vein-to-great saphenous vein ratio in the protein positive expression ratio and mRNA expression were significantly increased compared with the diseased splenic vein-to-saphenous vein ratio (P < 0.05). There was no significant change in the content of relative-protein expression of the varicose great saphenous vein-to-great saphenous vein and diseased splenic vein-to-splenic vein ratios analyzed by Western blot (P>0.05). Conclusion Under high hemodynamics, dysequilibrium of matrix metalloproteinases and tissue inhibitor of metalloproteinases from human splenic veins and great saphenous veins may be one of the molecular mechanisms underlying vascular remodeling.

目的 探讨隔离皮瓣或皮片联合负压封闭引流(VSD)治疗肛周合并腰背会阴大面积撕脱伤的临床效果.方法 选取该院2010年3月至2016年8月救治的肛周合并腰背会阴大面积撕脱伤的患者10例为研究对象,均为车祸伤.应用隔离皮瓣或皮片联合VSD,附加回肠造口,双腔管绕凡士林油纱布填塞直肠,持续冲洗多管负压引流,创面植皮及多学科专科化处理.观察患者临床治疗效果.结果 10例患者全部治愈.6例肛周不完全性撕脱伤患者,无创面感染发生;4例环形肛周撕脱伤患者,创面感染控制,潜行腔隙闭合;10例植皮患者的整体成活率达90％ 以上.术后无肛门狭窄,分别于术后3个月(6例)和6个月(4例)实施回肠还纳术.结论 隔离皮瓣或皮片联合VSD是一种治疗肛周合并腰背会阴大面积撕脱伤较理想的方法.

Objective:To investigate the differences in matrix metalloproteinases (MMPs) and matrix metalloproteinase inhibitors (TIMPs) from diseased splenic vein (DSVs) and varicose great saphenous vein (VGSVs) under high hemodynamics.Methods:Seventy-two specimens of DSVs,normal splenic veins (SVs),VGSVs,and normal great saphenous vein (GSVs) were collected.Venous wall in the four groups,MMP-2,MMP-9,TIMP-1,and TIMP-2 protein expression were observed and MMP-2,MMP-9,TIMP-1,TIMP-2 proteins positive expression ratio and mRNA expression were determined.Results:DSVs and VGSVs in the two groups,MMP-2,MMP-9,TIMP-1,TIMP-2 proteins with clustered strong expression were observed;In DSVs group,MMP-2,MMP-9,TIMP-1,TIMP-2 protein positive expression ratio and mRNA expression were significantly increased compared with SVs group,while in VGSVs group,MMP-2,MMP-9,TIMP-1,TIMP-2 protein positive expression ratio and mRNA expression were significantly increased compared with GSVs group (P＜0.05).VGSVs/GSVs ratio was significantly increased compared with DSVs/SVs ratio (P＜0.05).Conclusion:Under high hemodynamics,the dysequilibrium of MMPs and TIMPs from splenic vein and great saphenous vein,These results may be one of the molecular mechanism in vascular remodeling.

Objective To measure the mRNA and protein levels of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinase (TIMPs) in residual splenic tissue and serum after subtotal splenectomy due to portal hypertension,and to investigate splenic fibrosis in molecular detail and the value of reserving splenic tissue during surgery.Methods Thirteen patients of splenomegaly due to portal hypertension who had subtotal splenectomy were enrolled in splenomegaly group.Those with spleen tissue puncture biopsy 8 years after splenectomy were selected into residual spleen group.Additionally,13 traumatic spleen samples were collected for control group.Immunohistochemistry,PCR and ELISA were used to detect mRNA and protein levels of MMPs and TIMPs in the residual spleen samples and serum.Results In the residual spleen,splenomegaly and control groups,the positive expressions of MMP-2,MMP-9,TIMP-1 and TIMP-2 were densely distributed in macrophages.The positive expression rates of MMP-2,MMP-9,TIMP-1 and TIMP-2 proteins and mRNAs of the spleen tissues were significantly higher in the residual spleen and the splenomegaly groups compared with the control group (P ＜ 0.05);however,there were no significant differences between the residual spleen group and the splenomegaly group (P ＞0.05).Significantly higher levels of serum MMP-2,MMP-9,TIMP-1 and TIMP-2 were observed in the residual spleen and the splenomegaly groups compared with the control group (P ＜ 0.05);but there were no significant differences between the residual spleen and the splenomegaly groups (P ＞ 0.05).Conclusions After subtotal splenectomy,MMP-2,MMP-9,TIMP-1 and TIMP-2 expressions are increased in the residual splenic tissue and serum of patients with portal hypertension.The results suggested that dysregulated MMPs and TIMPs expressions occur in the residual spleen after subtotal splenectomy due to portal hypertension.

脾脏外科已经历了400多年的发展史,其道路曲折、漫长,并富有戏剧性[1-2].许多学者为破解脾脏的神秘功能,一直做着不懈的努力[3-4].追溯到1549年,Fioravanti为1例疟疾脾肿大患者施行开腹脾切除术;1590年,Franciscus Rosetti为1例脾外伤患者施行开腹脾部分切除术;自此,脾脏外科拉开序幕[5].在很长一段时间里,认为"脾脏无用,切脾无害,随意切脾"的观点占居主流.1952年King与Shumacker在100例脾切除术后儿童中发现5例因严重感染死亡,提出了脾切除术后凶险性感染的概念[6].

Objective: Varicose veins (VVs) are a common disorder of venous dilation and tortuosity, but the underlying mechanism is unclear. The functional integrity and phenotypic differences of VVs are also unclear. This study tested the hypothesis that phenotypic and functional differences exist between smooth muscle cells (SMCs) derived from VVs and normal veins.Methods: SMCs were isolated from 28 samples of varicose great saphenous veins (VGSVs) and normal great saphenous (NGSVs) and cultured. Proliferation, migration, adhesion, and aging capacity in SMCs were compared in the two veins. Bas, Bcl-2, caspase-3, matrix metalloproteinase (MMP)-2 MMP-9, tissue inhibitor of metalloproteinases (TIMP)-1, and TIMP-2 messenger (m)RNA expression and protein content were detected by fluorescence quantitative polymerase chain reaction and immunoblotting.Results: The microfilament structure of the framework was increased in SMCs in the VGSV group. Proliferation, migration, adhesion, and the aging cell count in SMCs in the VGSV group were significantly higher than the corresponding regions in the NGSV group (P < .05). Bas and caspase-3 mRNA expression and protein content were decreased, whereas Bcl-2 mRNA expression and protein content were increased in the VGSV group compared with the NGSV group (P < .05). MMP-2, M MP-9, TIMP-1, and TIMP-2 mRNA expression and protein content in the VGSV group were increased compared with the NGSV group (P < .05).Conclusions: SMCs derived from VGSVs are more dedifferentiated and demonstrate increased proliferative and synthetic capacity. These results suggest the presence of phenotypic and functional differences between SMCs derived from VGSVs and NGSVs. The phenotypic and functional abnormalities in SMCs may be associated with the pathogenesis in VGSVs.