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A 74-year-old man was referred to our hospital for a close examination of a mediastinal mass. Contrast-enhanced CT showed a middle mediastinal tumor. We planned to perform a CT-guided percutaneous needle biopsy of the tumor using a retroaortic paravertebral approach to avoid transpulmonary puncture. A coaxial blunt-tip needle with a side hole was used to create space in the mediastinum and avoid azygos vein injury. After injecting normal saline, a blunt-tip needle was advanced through the space between the aorta and the vertebral body to the anterior surface of the tumor, and tissue was obtained. The patient was discharged the following day with no complications. For percutaneous middle mediastinal tumor biopsy, the retroaortic paravertebral approach may be a safe, effective route.

Abstract Background Transcatheter arterial embolization (TAE) has long been used for hemostasis of traumatic or postoperative hemorrhage and embolization of tumors. Previous retrospective studies of TAE for painful bone metastases showed 60%–80% pain reduction with a median time to response of 1–2 days. Compared with radiotherapy and bisphosphonates, time to response appeared earlier than that of radiotherapy or bone-modifying agents. However, few prospective studies have examined TAE for this indication. Here, we describe the protocol for a confirmatory study designed to clarify the efficacy and safety profile of TAE. Methods This study will be a multicenter, single-arm confirmatory study (phase 2–3 design). Patients with painful bone metastases from any primary tumor are eligible for enrollment. TAE will be the main intervention. Following puncture of the femoral artery under local anesthesia and insertion of an angiographic sheath, angiography will confirm that the injected region includes tumor vasculature. Catheter position will be adjusted so that the embolization range does not include non-target tissues. Spherical embolic material will then be slowly injected into the artery to embolize it. The primary endpoint (efficacy) is the proportion of subjects with pain relief at 72 h after TAE and the secondary endpoint (safety) is the incidence of all NCI Common Terminology Criteria for Adverse Events version 5.0 Grade 4 adverse events and Grade ≥ 3 necrosis of the central nervous system. Discussion If the primary and secondary endpoints are met, TAE can be a treatment choice for painful bone metastases. Trial registry number is UMIN-CTR ID: UMIN000040794. Trial registration The study is ongoing, and patients are currently being enrolled. Enrollment started in March 2021. A total of 36 patients have participated as of Aug 2022. Protocol Version: Ver1.4, 13/07/2022.

Introduction Solitary fibrous tumors require complete surgical resection to avoid recurrence. Large solitary fibrous pelvic tumors are difficult to resect completely with conventional surgical methods. We herein report a case in which a joint surgical approach was required for resection due to the location and size of tumor. Case presentation A 45‐year‐old man had a large solitary fibrous tumor in the pelvis, which extended into the left obturator foramen. The patient underwent tumor resection with vesico‐prostatectomy, transanal total mesorectal excision, and opening of the foramen obturatum. The tumor was grossly resected completely. No recurrence was noted nine months after surgery. Conclusion A multidisciplinary team approach with transanal total mesorectal excision may provide complete resect of large pelvic solitary fibrous tumors.

A 70-year-old man presented with pulsatile bleeding upon changing his catheter for cutaneous ureterostomy. He was suspected to have a uretero-arterial fistula. Computed tomography showed an abnormally dilated right inferior epigastric artery, the suspected bleeding source. Angiography revealed a tortuous dilated branch from the inferior epigastric artery. Transcatheter arterial embolization was performed with a gelatin sponge and coil. He was discharged 15 days after the procedure. Uretero-arterial fistula is a rare but fatal complication among patients with long-term indwelling ureter catheters. An abnormal inferior epigastric artery surrounding the cutaneous ureterostomy should be considered a rare cause of uretero-arterial fistula.

Theaflavins are polyphenols found in black tea, whose physiological activities are not well understood. This study on mice evaluated the influence of a single oral administration of theaflavins on energy metabolism by monitoring the initial metabolic changess in skeletal muscle and brown adipose tissue (BAT). Oxygen consumption (VO2) and energy expenditure (EE) were increased significantly in mice treated with theaflavin rich fraction (TF) compared with the group administered vehicle alone. There was no difference in locomotor activity. Fasting mice were euthanized under anesthesia before and 2 and 5, 20-hr after treatment with TF or vehicle. The mRNA levels of uncoupling protein-1 (UCP-1) and peroxisome proliferator-activated receptor gamma coactivator-1α (PGC-1α) in BAT were increased significantly 2-hr after administration ofTF. The levels of UCP-3 and PGC-1α in the gastrocnemius muscle were increased significantly 2 and 5-hr after administration of TF. The concentration of phosphorylated AMP-activated protein kinase (AMPK) 1α was also increased significantly in the gastrocnemius 2 and 5-hr after treatment with TF. These results indicate that TF significantly enhances systemic energy expenditure, as evidenced by an increase in expression of metabolic genes.