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Abstract Introduction Hemangioblastomas are highly vascular tumors that can arise within the central nervous system as well as other organ systems within the body. They can arise sporadically or as part of von Hippel-Lindau syndrome. Those arising in critical locations within the central nervous system can be difficult to resect surgically and therefore pose a significant challenge and result in morbidity and even mortality. Hemangioblastomas express high levels of vascular endothelial growth factor that drives angiogenesis and tumor progression. We hypothesized that bevacizumab through its inhibitory effect on vascular endothelial growth factor will result in hemangioblastoma tumor regression as well as a meaningful clinical response. Case presentation We present the case of a 51-year-old Caucasian man with surgically unresectable cervical cord hemangioblastoma presenting with progressive weakness leading to quadriparesis. He was treated with bevacizumab and his follow up magnetic resonance imaging scans showed marked tumor regression. After only six cycles of intravenous bevacizumab (10mg/kg every two weeks), he started ambulating after being wheelchair bound. He is currently still receiving treatment almost two years after initiation of bevacizumab. Conclusions We have shown for the first time that bevacizumab can result in significant tumor regression and a sustained clinical improvement in a patient with an otherwise unresectable spinal cord hemangioblastoma. This novel approach can be immensely useful for patients with difficult to resect hemangioblastomas or those with multiple lesions such as in von Hippel-Lindau syndrome.

Introduction: Human epidermal growth factor receptor 2 (HER-2) targeted therapy regimens can improve tumor response in HER-2-positive metastatic breast cancer (MBC), with overall survival benefits. Objective: We evaluated the efficacy of dual HER-2 blockade combined with chemotherapy for HER-2-positive MBC patients as a first-line therapy in our patient population. Patients and Methods: We identified 75 patients at King Faisal Specialist Hospital and Research Center that received trastuzumab, pertuzumab, and docetaxel as a first-line therapy in HER-2 positive MBC in 2013–2016. Results: Median age at diagnosis was 45 years; 54.7% were estrogen receptor (ER)-positive. 10% of patients presented with only bone metastasis. The median follow-up time was 36 months with an objective response rate of 74.7% (complete response [CR] 18.7%; partial response [PR] 56%). The 5-year progression-free survival (PFS) and overall survival (OS) were 21% and 71.9% respectively, with a median PFS of 36 months (95% confidence interval [CI] 23.6–48.4). The 5-year OS for ER-negative and ER-positive patients was 93.9% and 59.4% respectively (p = 0.189); 23 patients experienced grade 1/2 toxicity and 2 patients had grade 3/4 toxicity. In terms of OS and PFS, the site of metastasis did not make any significant difference. Conclusions: First line pertuzumab, trastuzumab, and docetaxel for HER-2-positive MBC patients was found to be an effective and safe therapy in the Saudi population. This finding was consistent with the results seen in the CLEOPATRA trials. [ABSTRACT FROM AUTHOR]

Introduction: In the past, the prognosis of bladder cancer was dependent on the presence of muscle invasion. Recently High-Grade T1 (HGT1) Transitional Cell Carcinoma (TCC), found to be associated with similar behaviour and prognosis even following Bacillus Calmette Guerin (BCG) therapy. Recognition of new markers that may help in selection of high-risk cases that need aggressive treatment even in the early stage to avoid unwanted toxicity of chemotherapy has to be high priority. Aim: To evaluate the prognostic value of Octamer-Binding Transcription Factor 4 (OCT4) and Epidermal Growth Factor Receptor (EGFR) immunohistochemical expression in urothelial carcinoma of the bladder and their effect as well as the vascular invasion on the recurrence of these tumours. Materials and Methods: Prospective cohort study conducted in Zagazig University hospital from January 2010 till December 2013. Immunohistochemical staining of OCT4, EGFR and Cd34 for 68 cases of bladder cancer samples was done. The correlation between the expressions of each marker and clinicpathologic parameters was then analysed. Results: OCT4 was detected in 53 patients (77.9%) of total cases. EGFR showed high expression in 25 of cases. 18 and 25 cases revealed low and no EGFR expression, respectively. There was a significant association between intensity of OCT4 expression and tumour grade (p<0.001), muscle invasion (p<0.001), vascular invasion (p=0.004) and stage (p=0.001). Significant association was established between EGFR expression and tumour size, grade, lamina propria, muscle and vascular invasion and stage (p 0.005, <0.001, 0.001, <0.001, respectively). Significant association observed between OCT4, EGFR expression and vascular invasion and recurrence (p=0.026, 0.001 and 0.002 respectively). Conclusion: Using selective inhibitors for EGFR and OCT4 especially that approved for EGFR in treating selected cases of urothelial carcinoma of bladder could suppress tumour growth. These markers in addition to presence of vascular invasion have to be used in screening of high risk noninvasive group that benefits from target therapy. [ABSTRACT FROM AUTHOR]

Aging is associated with a series of morphological and functional modifications that leads to reduced physiological efficiency and atrophy of various organs and systems. Tribulus terrestris induces its effect in fertility and sexual functions through the steroidal saponins, particularly the dominant saponins protodioscin. We aimed in this study to evaluate the efficacy and safety profiles of Tribulus terrestris in aging males with partial androgen deficiency who suffered from erectile dysfunction and lower urinary tract symptoms. A total of 70 randomized aging patients with erectile dysfunction and lower urinary tract symptoms were recruited from June 2017 to March 2018 from our andrology outpatient clinic. Thirty-five patients (group A) received Tribulus terrestris three times daily for 3 months and the other 35 patients (group B) received placebo. The mean of aspartate transaminase was elevated in group A after 3 months of receiving Tribulus terrestris (26.5 (before), 27.8 (after), respectively, p = 0.03). Moreover, there were significant elevations in the means of both total testosterone together with the score of the validated Arabic index of erectile function (5-item version of the International Index of Erectile Function) (2.2, 10.7 (before), 2.7, 16.1 (after), p < 0.001, p < 0.001, respectively). Finally, the mean of the total prostate-specific antigen was elevated in this group (1.4 (before), 1.7 (before), p = 0.007, respectively). Interestingly, there were no worsening of the lower urinary tract symptoms in group A as there was no change in the mean score of the international prostate symptom score, which was used to assess these symptoms before and after treatment (mean 14.4 (before), 14.6 (after), p = 0.67, respectively). In sum, this study replicates the findings of previous reports about the robust effect of this herbal medicine in elevating the testosterone level and improving the sexual function of patients who suffered from erectile dysfunction with partial androgen deficiency. [ABSTRACT FROM AUTHOR]

' Candidatus Phytoplasma australasia' causes important damages to the Egyptian vegetable crop production. A prerequisite for controlling the different diseases it causes to eggplant, tomato and squash, is to trace its propagation pathways. To allow the differentiation of 'Ca. P. australasia' strains, a multilocus sequence analysis protocol was developed. Four conserved phytoplama genes namely tuf, secY, dnaK and dppA, were selected among the CDS of a 'Ca. P. aurantifolia' genome draft. The corresponding genes were PCR amplified from tomato, eggplant and squash collected in 2010 from the governorates Sharkia, Elmynia and Beni sueif, as well as from Catharanthus roseus periwinkles collected in 2013 from Kafrelsheikh governorate. Sequence comparisons showed no diversity among the Egyptian isolates of 'Ca. P. australasia' that also constitute a distinct cluster within the 16SrII-D taxonomic subgroup. This low diversity supports a common epidemiology for the different diseases affecting vegetable crops and periwinkle in Egypt and suggests that future investigations on insect vector should focus on polyphagous leafhoppers. [ABSTRACT FROM AUTHOR]

Background prognosis of HER2-positive breast cancer has been transformed Over the past few years, with the introduction of anti-HER2 targeted therapies. Pertuzumab in combination with trastuzumab based chemotherapy is currently FDA- approved as a standard neoadjuvant treatment for stage II-III (HER2+) breast cancer patients. It improves pathological complete response (pCR) if used in combination with standard chemotherapy in many prospective trails. chemotherapy backbone may include: taxane (Docetaxel/paclitaxel), and/or anthracycline, or platinum . Methods Forty-six HER2-positive breast cancer patients received neoadjuvant chemotherapy, with dual anti her blockade Pertuzumab and Trastuzumab from April 2013 to July 2017 in KFSHRC, Riyadh were included. patients were internally divided into 3 groups according to type of chemotherapy used, group A (sequential anthracycline/docetaxel), group B ( sequential anthracycline/paclitaxel) and group C (taxane based chemotherapy without anthracycline), Pertuzumab and Trastuzumab were given with the taxane part. Main objective was to access pCR, Secondary endpoints included the disease-free survival (DFS), overall survival (OS), local control (LC) and toxicity profile. survival endpoints studied were pCR (defined as ypT0/is, ypN0). Results Median age at diagnosis was 46.5 (23-65) years, 26(56.5%) were premenopausal. All patients had IDC [G2 (61%), G3 (39%)],36(78.3%) patients had T3/T4 and 44(95.7%) had node +ve disease. Hormone receptor was positive in 22(48%) patients. patients were internally divided into 3 groups according to type of chemotherapy used, group A (received sequential anthracycline/docetaxel), group B (received sequential anthracycline/paclitaxel) and group C (received taxane based chemotherapy without anthracycline), all the patients received dual anti her blockade Pertuzumab and Trastuzumab with the taxane part . MRM was done in majority of patients 39(85%), while 6(13%) had BCT. Adjuvant radiation therapy was given in 43(93.5%). The treatment course was discontinued only in two cases (one had drop in EF>10% to <50%, second progressed while on treatment), no other reported acute or chronic G3/4 toxicity. Twenty-five (54.3%) patients achieved pathological complete response (pCR). After median follow-up of 26 months (15-59), 45(97.8%) patients were alive, only one patient died due to disease. Five (10.9%) patients developed systemic recurrences; among them 4(8.7%) had also loco-regional recurrences. The 4-year Local Control (LC) rate, disease free survival (DFS) and overall survival (OS) rate were 96%, 93% and 94% respectively. In univariable analysis, clinical response was independent prognostic factors for pCR and loco regional control (LC), while positive hormone receptor status significantly correlated with better LC and DFS. Conclusion Dual anti her blockade in combination with systemic neoadjuvant chemotherapy is effective in our population, with overall observed pCR, DFS and OS rate comparable to published international studies despite the Poor prognostic features (young age, premenopausal status, high grade and large tumor size) but they achieve good disease control. There were no concerns about cardiac safety and cardio toxicity seems similar to previous reported data. Longer follow up and addressing the role of adjuvant dual blockade in such population of locally advanced breast cancer is needed for a better under- standing of dual her2 blockade. [ABSTRACT FROM AUTHOR]