Objective To study the modulation in number and function of endothelial progenitor cell ( EPC ) in multiple organ dysfunction syndrome ( MODS ) after trauma in swine, and to investigate its pathogenesis. Methods Forty pigs were divided into sham group and MODS group ( each, n = 20 ). The model of MODS of two-hit injury, namely hemorrhagic shock and endotoxemia, was reproduced. The peripheral blood was collected before hemorrhage ( T1 ) and endotoxin injection ( T2 ), and 1 hour ( T3 ), 24 hours ( T4 ), 48 hours ( T5 ) after endotoxin injection. Phosphorylation of p38 mitogen-activated protein kinase ( p-p38MAPK ) in mononuclear cell was determined by Western Blot, the content of tumor necrosis factor-α ( TNF-α) was determined with enzyme linked immunosorbent assay ( ELISA ), and the number of EPC was determined with flow cytometry. Results Model of MODS was successfully reproduced in 17 pigs. In model group, the expression of p-p38MAPK ( A value ) peaked at T3 ( 4.83±0.52 ), and gradually declined at T4 and T5 ( 4.36±0.43, 1.93±0.33 ), and the expression of p-p38MAPK at T3-T5 was significantly higher than that at T1 ( 1.00±0.22, all P<0.01 ). The plasma concentration of TNF-α( ng/L ) at T3 in MODS group was obviously elevated compared with that of sham group ( 532.43±52.17 vs. 129.03±20.45, t=31.163, P<0.001 ), and it peaked at T3, it then gradually lowered, and it was significantly higher at T4 and T5 than that in sham group ( T4: 398.93±35.75 vs. 131.12±29.53, t = 26.562, P < 0.001; T5: 287.48±27.26 vs. 126.44±26.96, t=17.861, P<0.001 ). The number of EPC ( ×107/L ) was apparently increased in MODS group at T3 compared with sham group ( 4.832±0.624 vs. 3.545±0.363, t=9.542, P<0.001 ), and it peaked at T3, then gradually decreased, and the number of EPC at T4 and T5 was significantly lower than that in sham group ( T4:2.628±0.627 vs. 3.442±0.325, t=5.043, P<0.001;T5:2.203±0.711 vs. 3.471±0.323, t=2.972, P<0.001 ). Conclusion Phosphorylation of p38MAPK could increase the plasma concentration of TNF-αand decrease the quantity of EPC in MODS,which may be one of the mechanisms of MODS.

Objective To compare the long-term survival outcomes of patients with T_1-2N₀M₀ duodenal neuroendocrine tumor (DNET) after endoscopic resection (ER) or surgical resection (SR). Methods Patients diagnosed with T_1-2N₀M₀ DNET between January 1, 2004, and December 31, 2015, were extracted from the SEER database. Kaplan-Meier survival curve and log-rank test were used to compare overall survival (OS) rate and cancer-specific survival (CSS) rate between patients undergoing ER or SR. Propensity score matching (PSM) was used to reduce grouping differences, and multivariate Cox regression was used to analyze factors affecting OS and CSS before and after PSM. Results A total of 656 patients were included, with 457 in ER group and 199 in SR group. Before PSM, there was no significant difference in the 5-year OS rate between the ER and SR groups (88.9% vs 89.6%), but there was a significant difference in the 5-year CSS rate (99.3% vs 96.9%, P＝0.017). Before PSM, multivariate Cox regression analysis showed advanced age was an independent risk factor for decreased OS (P＜0.001). After PSM, there was no significant difference between the ER group (n＝187) and SR group (n＝187) in 5-year OS rate (90.2% vs 88.9%) or CSS rate (98.9% vs 96.7%). After PSM, multivariate Cox regression also showed advanced age was an independent risk factor for decreased OS, while resection method was not an independent factor for OS or CSS. Conclusions There is no significant difference in OS or CSS after endoscopic treatment and surgical treatments for patients with T_1-2N₀M₀ DNET, and advanced age is an independent factor for OS.