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The relationship between pancreatic ductal adenocarcinoma (PDAC) and the intestinal environment is not fully understood. The purpose of this study was to elucidate the characteristics of the intestinal environment in PDAC. We performed a case-control study of 5 Japanese patients with unresectable PDAC located in the body or tail (PDAC-bt). The number of patients analyzed was limited for this preliminary study. We included 68 healthy subjects, herein control, of pre-printed study in the preliminary study. 16S rRNA amplicon sequencing and metabolomic analysis were performed using fecal samples from the subjects. There was no difference in the Shannon index and Principal Coordinate Analysis between PDAC-bt and the control. However, a significant increase in oral-associated bacteria (Actinomyces, Streptococcus, Veillonella, Lactobacillus) was observed. A significant decrease of Anaerostipes was demonstrated in the feces of PDAC-bt compared with the control. The intestinal propionic acid and deoxycholic acid were significantly lower in PDAC-bt compared with the control. We showed that the intestinal environment of PDAC-bt is characterized by an increase in oral-associated bacteria and an imbalance of metabolites but without changes in alpha and beta diversity of the gut microbiota profiles. Clinical Trial Registration: www.umin.ac.jp, UMIN 000041974, 000023675, 000023970.

Rationale: API2-MALT1 positive gastric mucosa-associated lymphoid tissue (MALT) lymphomas are considered to have favorable prognosis. We report a case of API2-MALT1 positive gastric MALT lymphoma, treated by endoscopic submucosal dissection (ESD). Patient concerns: A 51-year-old man underwent esophagogastroduodenoscopy (EGD) for the annual health checkup examination. Diagnoses: The EGD showed a reddish depressed lesion with small reddish spots in the lower gastric body. There was no endoscopic atrophy in the entire stomach and Helicobacter pylori (H. pylori) serum test was negative. Infiltration of small lymphocytes was shown in the gastric tissues obtained by the endoscopic biopsy. The fluorescence in situ hybridization using the biopsy samples confirmed the presence of genetic translocation of API2-MALT1, suggesting that the lesion is API2-MALT1 positive MALT lymphoma. Interventions: Since endoscopic ultrasound suggested that the lesion was localized within the lamina propria mucosae, we performed ESD to achieve the en bloc resection of the lesion. Outcomes: Conclusive diagnosis of gastric MALT lymphoma was made based on the resected specimen. Lateral and vertical margins were negative. No lymphoma cells were detected using endoscopic biopsy after 5 years. Lessons: Our report suggests that ESD can be considered as alternative treatment for API2-MALT1 positive gastric MALT lymphoma if the lesion was localized within the gastric mucosa.

Background and study aims Probe-based confocal laser endomicroscopy (pCLE) enables real-time optical biopsy. Little is known about pCLE imaging deep inside the small bowel, therefore the aim of this study was to determine its usefulness. Patients and methods Between April 2014 and January 2016, we performed 38 pCLE examinations during double-balloon enteroscopy with intravenous fluorescein in 37 patients with: tumors (n = 10), vascular disorders (n = 6), inflammatory diseases and drug injuries (n = 13), other disorders (n = 4), and normal findings (n = 4). We measured the calibers of capillary and lymphatic vessels at 15 different sites and compared the calibers between pCLE images and histopathology. We also compared pCLE findings with pathologic diagnosis. Results The inner diameters of capillary vessels beneath the epithelium and in the middle of villi were 16.2 ± 3.0 µm and 14.5 ± 3.1 µm, respectively, in the pCLE images, but these were not consistent with formalin-fixed paraffin-embedded histology. In tumors, larger capillary vessels were observed in aggressive malignant lymphoma and metastasis, and a “soccer ball-like pattern” constituting homogenous dark cells packed with polygonal, narrower capillary vessels was characteristic in pCLE images of a malignant lymphoma follicle. Hereditary hemorrhagic telangiectasia and angiodysplasia contained anastomosis of capillary vessels of different calibers. In IgA vasculitis, segmental capillary strictures were observed. Intestinal lymphangiectasia with protein-losing enteropathy contained a reticular network of lymphatic vessels and dilated lymphatic ducts accompanied by numerous cell gaps. pCLE findings corresponded to pathologic diagnosis in 32 examinations (91 %). Conclusions pCLE is useful for in vivo analysis of abnormalities of the capillary and lymphatic vessels and epithelium, and for diagnosis in various small-bowel diseases.

島根県津和野地域の舞鶴帯北縁部から古原生代の花崗岩類と正片麻岩を見出した．この岩体は苦鉄質岩類を伴い，ペルム系の堆積岩類に挟まれた幅数百mの狭長な地帯にブロックの集合体として産する．ジルコンのU-Pb年代は，正片麻岩が1836±17Ma，トーナル岩-石英閃緑岩が1853±14Ma，花崗閃緑岩が415.2±2.5Maであった．古原生代のジルコンは2.8-2.1Gaの古いコアを持ち，北中国地塊由来と考えられる．デボン紀のものは年代から舞鶴-大江地域の舞鶴帯北帯西部岩体に対比され，岩相構成と産状から古原生代岩体も舞鶴帯北帯構成要素と考えられる．本岩体は，古い地質体ほど構造的上位に位置するという西南日本内帯のパイルナップ構造の一般則から外れ，ジュラ紀の付加体・変成岩と接する舞鶴帯北縁部に産することから，舞鶴帯北縁に沿う横ずれ断層によって異地性ブロックとして定置した可能性がある．, We report a newly discovered Paleoproterozoic granitoid at the northern margin of the Maizuru Terrane (Tsuwano area, southwestern Shimane Prefecture, SW Japan). The granitoid is associated with metadolerite and metagabbro, and appears as lenticular blocks within a narrow (150-300 m wide) zone. Orthogneiss and tonalite-quartz diorite from the granitoid yield zircon U‒Pb ages of 1836±17 Ma and 1853 ± 14 Ma, respectively. Younger U‒Pb ages of 415.2±2.5 Ma were obtained from a granodioritic lithology. The Paleoproterozoic zircon grains commonly contain inherited older (2800‒2100 Ma) cores. The Paleoproterozoic age of the granitoid body supports the suggestion that this part of the Maizuru Terrane includes exotic blocks that originated from the North China Craton. The younger (Early Devonian) granodiorite is possibly related to igneous rocks of similar age from the Maizuru‒Oe area (Northern Zone of the Maizuru Terrane). Based on the lithology and structural position of the Paleoproterozoic rocks, it is suggested that they are part of the Northern Zone. The recognition of a narrow zone of Paleoproterozoic rocks embedded in Permian strata is in contrast to the nappe structure in SW Japan, which typically contains older units at higher structural positions. We therefore suggest that the Paleoproterozoic blocks were displaced by strike-slip faulting along the northern boundary of the Maizuru Terrane., 本研究には，文部科学省の2013-～2015年度科学研究費補助金（課題番号 : 25400486）を使用した．