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Background/Aim: Arsenic trioxide (As 2 O 3 ), a potent toxin in traditional Chinese medicine, has been utilized as an anticancer agent in Chinese culture for over a millennium. Betulin, commonly extracted from the bark of birch trees, has been identified for its pharmacological properties, including antibacterial, anti-inflammatory, antitumor, and antiviral activities. The aim of this study was to determine the efficacy and underlying anticancer signaling cascade induced by As 2 O 3 and betulin in neuroblastoma cells. Materials and Methods: SK-N-SH cells were treated with As 2 O 3 with or without betulin. Cell viability and apoptotic signaling were assessed using 3-(4,5- dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, measurement of mitochondrial membrane potential (MMP) loss and reactive oxygen species (ROS), and quantitative western blotting analysis. Student's t-test in addition to one-or two-way analysis of variance was used to examine significant differences between comparison groups. Results: The combined treatment of As 2 O 3 plus betulin was more effective than single treatments in suppressing cell viability and induction of apoptosis, which correlated well with elevated ROS levels. The apoptotic signaling cascade of As 2 O 3 plus betulin was revealed as ROS elevation and relative loss of MMP, leading to the cleavage of caspase-3 and -9. As 2 O 3 plus betulin treatment also reduced the expression of BCL2 apoptosis regulator, BH3-interacting domain death agonist, and BCL2-like-1. Conclusion: The novel combination of As 2 O 3 plus betulin has the potential to serve as a practical anti-neuroblastoma drug.Neuroblastoma is one of the most prevalent types of cancer in children globally and arises from genetic mutations during early development; it displays complex biological and clinical heterogeneity, and is not typically inherited from parents (1). Unfortunately, neuroblastoma has an extremely low cure rate, causing immense emotional pain for parents, relatives and the patients themselves. Treatment modalities comprise surgery, radiation, chemotherapy, and even stem cell transplantation, with various determinants influencing therapeutic efficacy and 2467 *These Authors contributed equally to this study.

Multiple myeloma is a hematopoietic cancer that is multicentric and most commonly involves the spine. Multiple myeloma with extraosseous and intradural involvement is an extremely rare condition. Here we present a rare case of spinal multiple myeloma with intracranial and spinal intradural metastasis causing lumbar spinal nerve compression. We present a 60-year-old woman with progressive weakness of the lower limbs for several weeks. Spinal magnetic resonance imaging (MRI) showed a leptomeningeal tumor with nodularity spreading within the cauda equina. Examination of the brain using MRI showed a lytic skull bone lesion and leptomeningeal enhancement. The patient underwent L3-5 laminectomy. Immunohistological staining confirmed a diagnosis of multiple myeloma of the IgA kappa subtype. After surgery, the patient underwent chemotherapy and rehabilitation exercises. Multiple myeloma has a median survival of 2.5 years, while 75% of patients with spinal involvement die within 1 year of diagnosis. Unfortunately, our patient died 3 months after the diagnosis of multiple myeloma with spinal and intracranial involvement. Intracranial and spinal intradural multiple myeloma invasions are quitely rare. Spine biopsies and cerebrospinal fluid cytology can aid in the diagnosis. Early surgical decompression is necessary, especially when neurological deficits occur.