CXCR4 is a chemokine receptor implicated in the homing of cancer cells to target metastatic organs, which overexpress its ligand, stromal cell-derived factor (SDF)-1. To determine the efficacy of targeting CXCR4 on primary tumor growth and metastasis, we used a peptide inhibitor of CXCR4, CTCE-9908, that was administered in a clinically relevant approach using a transgenic breast cancer mouse model. We first performed a dosing experiment of CTCE-9908 in the PyMT mouse model, testing 25, 50 and 100 mg/kg versus the scrambled peptide in groups of 8-16 mice. We then combined CTCE-9908 with docetaxel or DC101 (an anti-VEGFR2 monoclonal antibody). We found that increasing doses of CTCE-9908 alone slowed the rate of tumor growth, with a 45% inhibition of primary tumor growth at 3.5 weeks of treatment with 50 mg/kg of CTCE-9908 (p 5 0.005). Expression levels of VEGF were also found to be reduced by 42% with CTCE-9908 (p 5 0.01). In combination with docetaxel, CTCE-9908 administration decreased tumor volume by 38% (p 5 0.02), an effect that was greater than that observed with docetaxel alone. In combination with DC101, CTCE-9908 also demonstrated an enhanced effect compared to DC101 alone, with a 37% decrease in primary tumor volume (p 5 0.01) and a 75% reduction in distant metastasis (p 5 0.009). In combination with docetaxel or an anti-angiogenic agent, the anti-tumor and anti-metastatic effects of CTCE-9908 were markedly enhanced, suggesting potentially new effective combinatorial therapeutic strategies in the treatment of breast cancer, which include targeting the SDF-1/CXCR4 ligand/receptor pair.Although the survival of patients with breast cancer has improved in recent years, further progress will require a better understanding of the metastatic process, which is the underlying cause of breast cancer mortality. The process of metastasis has been divided into several stages including the invasion of the primary tumor, intravasation into the bloodstream, circulation, extravasation and proliferation at the distant metastatic site. 1 A recently proposed model that explains the process of extravasation of tumor cells from the peripheral circulation into target organs of metastasis is the chemokine-receptor model. Muller et al. showed that chemokines are overexpressed by those organs to which cancer metastasizes and serves to attract cancer cells which express their receptor, 2 analogous to their function in recruiting inflammatory cells to sites of tissue injury. They identified the chemokine/receptor pair, stromal cell-derived factor (SDF)-1/CXCR4 as a candidate metastasis promoter in breast cancer. 2 We have since shown that CXCR4 is overexpressed in 67% of breast cancer samples, that elevated expression of CXCR4 carries a poor prognosis, and that CXCR4 expression is strongly associated with human epidermal growth factor receptor 2 (HER2) expression in these tumors. 3 Therefore, it appears plausible that inhibition of CXCR4 activity may hinder the metastatic process. Moreover,

Lumbar hernias are uncommon and about 300 cases have been reported till date. They commonly occur due to trauma, surgery and infection. They are increasingly being reported after motor vehicle collision injuries. However, spontaneous lumbar hernias are rare and are reported infrequently. It is treated with different surgical approaches and methods. We report a case of primary spontaneous lumbar hernia which was repaired by transperitonial laparoscopic approach using Vypro (polypropylene/polyglactin) mesh and covered with a peritoneal flap.

Esophageal duplication is the second most common site of gastrointestinal duplication and most cases present with complications. These complications include bleeding, infection, dysphagia, and dyspnea. We report an incidental case of a true intramural esophageal duplication cyst in a new military recruit. The patient was diagnosed in Armed Forces Hospital, Oman. The patient came for a pre-recruitment routine check-up, he was found to have a suspicious soft tissue lesion on chest X-ray. He was referred to the thoracic surgeon for further investigations. The investigations included computed tomography and magnetic resonance imaging chest scans, barium swallow, endoscopy and, finally, an endoscopic ultrasound. All workup pointed to a diagnosis of esophageal duplication cyst; therefore, the decision was made to excise the lesion after discussion with the patient about the possible diagnosis and nature of the treatment. The cyst was completely excised thoracoscopically with uneventful recovery. The patient was discharged a few days later and was doing well in subsequent visits to the outpatient department. The histopathological exam confirmed the diagnosis of a true congenital duplication cyst, which was lined by pseudostratified ciliated columnar epithelium overlying double layers of thick bundles of smooth muscle fibers.

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