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Background: Bone marrow aspiration/biopsy, in patients with hematological cancer, is a painful procedure and may be repeated at regular intervals, so we compared the effects of two different sedative agents (Midazolam and Dexmedetomidine) on haemodynamics, sedation and recovery profile in child patients undergoing bone marrow aspiration/biopsy under conscious sedation with ketamine. Methods: 100 Child aged 3–12 years with haematological diseases were enrolled in this randomized, double blind study, divided into two groups: Group I: Patients received midazolam (IV infusion) 0.05 mg/kg. Group II: Patients received Dexmedetomidine (IV infusion) 0.75 µg/kg, and all patients received Ketamine 1 mg/kg intravenously (IV). We started Dexmedetomidine or midazolam infusion over 10 minutes through a peripheral venous cannula, then 5 minutes from the start, ketamine was administered over 10–20 seconds. In both groups haemodynamics, sedation times and Ramsay scores are obtained. Results: Both dexmedetomidine-ketamine and midazolam-ketamine com¬binations produce stable hemodynamics and satisfac¬tory induction conditions in patients with haematological cancer diseases undergoing bone marrow aspiration. These combinations provide effective sedation with only few side effects and minor hemodynamic fluctuations. With longer sedation time and recovery time were recorded in dexmedetomidine group versus midazolam group. Conclusion: Dexmedetomidine-ketamine is a better sedative combination than midazolam-ketamine and both preserve haemodynamics stable. Trial registeration.gov NCT03647579

Background: The mutated Anaplastic lymphoma kinase (ALK) gene has been identified as a potential and major predisposition oncogene in human neuroblastomas (NBLs). However, the frequency of mutation is only 5-8%. Purpose: The present study was performed to determine the level of ALK mRNA gene expression in primary neuroblastoma and to assess its relation to other prognostic factors of neuroblastoma. Methods: Quantitative real-time RT-PCR was applied to examine the expression level of ALK mRNA in seventy-nine primary neuroblastoma patients, and its prognostic value in those patients. Immunohistochemical staining was used to check the expression level of ALK proteins. Results:In analysis of 79 patients with sporadic primary neuroblastoma, we found that high expression level of ALK mRNA was significantly associated with Shimada’s pathological classification (p0.001), patient’s age (p0.001), MYCN amplification status (p0.001), tumor stage (p0.001) and low TrkA expression level (p=0.0390), all these factors are known to be associated with poor prognosis in neuroblastoma. Of interest, immunohistochemical study revealed positive ALKin ALK-amplified tissues. Furthermore, mutation results showed that ALK mutation represented about4.6% of cases and ALK amplification represented about 1.5% of cases. So that mutations not only occur among unfavorable cases with low ALK but also in favorable cases with high ALK expression. Conclusion: Our findings suggested that high expression of ALK gene is associated with poor prognosis of NBL so it can be used as a prognostic factor in NB in clinical practice.

Background: The mutated Anaplastic lymphoma kinase (ALK) gene has been identified as a potential and major predisposition oncogene in human neuroblastomas (NBLs). However, the frequency of mutation is only 5-8%. Purpose: The present study was performed to determine the level of ALK mRNA gene expression in primary neuroblastoma and to assess its relation to other prognostic factors of neuroblastoma. Methods: Quantitative real-time RT-PCR was applied to examine the expression level of ALK mRNA in seventy-nine primary neuroblastoma patients, and its prognostic value in those patients. Immunohistochemical staining was used to check the expression level of ALK proteins. Results:In analysis of 79 patients with sporadic primary neuroblastoma, we found that high expression level of ALK mRNA was significantly associated with Shimada’s pathological classification (p0.001), patient’s age (p0.001), MYCN amplification status (p0.001), tumor stage (p0.001) and low TrkA expression level (p=0.0390), all these factors are known to be associated with poor prognosis in neuroblastoma. Of interest, immunohistochemical study revealed positive ALKin ALK-amplified tissues. Furthermore, mutation results showed that ALK mutation represented about4.6% of cases and ALK amplification represented about 1.5% of cases. So that mutations not only occur among unfavorable cases with low ALK but also in favorable cases with high ALK expression. Conclusion: Our findings suggested that high expression of ALK gene is associated with poor prognosis of NBL so it can be used as a prognostic factor in NB in clinical practice.

Background: The mutated Anaplastic lymphoma kinase (ALK) gene has been identified as a potential and major predisposition oncogene in human neuroblastomas (NBLs). However, the frequency of mutation is only 5-8%. Purpose: The present study was performed to determine the level of ALK mRNA gene expression in primary neuroblastoma and to assess its relation to other prognostic factors of neuroblastoma. Methods: Quantitative real-time RT-PCR was applied to examine the expression level of ALK mRNA in seventy-nine primary neuroblastoma patients, and its prognostic value in those patients. Immunohistochemical staining was used to check the expression level of ALK proteins. Results:In analysis of 79 patients with sporadic primary neuroblastoma, we found that high expression level of ALK mRNA was significantly associated with Shimada’s pathological classification (p0.001), patient’s age (p0.001), MYCN amplification status (p0.001), tumor stage (p0.001) and low TrkA expression level (p=0.0390), all these factors are known to be associated with poor prognosis in neuroblastoma. Of interest, immunohistochemical study revealed positive ALKin ALK-amplified tissues. Furthermore, mutation results showed that ALK mutation represented about4.6% of cases and ALK amplification represented about 1.5% of cases. So that mutations not only occur among unfavorable cases with low ALK but also in favorable cases with high ALK expression. Conclusion: Our findings suggested that high expression of ALK gene is associated with poor prognosis of NBL so it can be used as a prognostic factor in NB in clinical practice.

Background: The mutated Anaplastic lymphoma kinase (ALK) gene has been identified as a potential and major predisposition oncogene in human neuroblastomas (NBLs). However, the frequency of mutation is only 5-8%. Purpose: The present study was performed to determine the level of ALK mRNA gene expression in primary neuroblastoma and to assess its relation to other prognostic factors of neuroblastoma. Methods: Quantitative real-time RT-PCR was applied to examine the expression level of ALK mRNA in seventy-nine primary neuroblastoma patients, and its prognostic value in those patients. Immunohistochemical staining was used to check the expression level of ALK proteins. Results:In analysis of 79 patients with sporadic primary neuroblastoma, we found that high expression level of ALK mRNA was significantly associated with Shimada’s pathological classification (p0.001), patient’s age (p0.001), MYCN amplification status (p0.001), tumor stage (p0.001) and low TrkA expression level (p=0.0390), all these factors are known to be associated with poor prognosis in neuroblastoma. Of interest, immunohistochemical study revealed positive ALKin ALK-amplified tissues. Furthermore, mutation results showed that ALK mutation represented about4.6% of cases and ALK amplification represented about 1.5% of cases. So that mutations not only occur among unfavorable cases with low ALK but also in favorable cases with high ALK expression. Conclusion: Our findings suggested that high expression of ALK gene is associated with poor prognosis of NBL so it can be used as a prognostic factor in NB in clinical practice.