Erosion Wear of Axial Flow Impellersin a Solid-liquid Suspension

A study was made of the erosion wear of the blades of pitched blade impellers in a suspension of waste gypsum from a thermal power station (vol. concentration CV=18.3 %, particle mean diameter d=0.1 mm, degree of hardness “2.5”) and silicious sand (CV=10 %, d=0.4 mm, degree of hardness “7.5”) in water under a turbulent flow regime of agitated charge when complete homogeneity of the suspension was achieved. Experiments were carried out on pilot plant mixing equipment made of stainless steel (diameter of cylindrical vessel T=390 mm, diameter of impeller D=100 mm, impeller off-bottom clearance h=100 mm) equipped with four wall radial baffles (width b=39 mm) and an impeller with four inclined plane blades (pitch angle α =20°, 30°, 45°, relative blade width W/D=0.2) made either of rolled brass (Brinell hardness 40–50 BH) or of structural steel (Brinell hardness 100–120 BH) always pumping the liquid downwards towards the flat vessel bottom. Two erosion process mechanisms appear, depending on the hardness of the solid particles in the suspension: while the particles of gypsum (lower hardness) generate a uniform sheet erosion over the whole surface of the impeller blade, the particles of silicious sand (higher hardness) generate wear of the leading edge of the impeller blades, together with a reduction of the surface of the worn blade. The hardness of the impeller blade also affects the rate of the erosion process: the higher the hardness of the impeller blade, the lower the wear rate of the blade. This study consists of a description of the kinetics of the erosion process of both mechanisms in dependence on the pitch angle of the tested impellers. While the wear of the leading edge of the blade exhibits a monotonous dependence on the pitch angle, the sheet erosion exhibits the maximum rate within the interval of the pitch angles tested α ϵ <20°; 45°>.However, generally the pitch angle α =45° seems to be the most convenient angle of blade inclination when both investigated mechanisms of the blade erosion process are considered at their minimum rate

Bacteriological study in acute surgical infections in children

Catedra de chirurgie, ortopedie și anesteziologie pediatrică, USMF ,,Nicolae Testemițanu”, Centrul Național Științifico-Practic de Chirurgie Pediatrică ,,Natalia Gheorghiu”, Institutul Mamei și Copilului, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Introducere. La momentul actual numeroase intervenţii chirurgicale sunt efectuate pentru diferite procese patologice, provocate de agenţi infecţioşi. Deci, este de neînchipuit chirurgia fără procese infecţioase. Iată de ce este important de a cunoaște flora patologică care predomină în patologiile chirurgicale în special în contingentul pediatric. Scopul. Scopul acestei lucrări este de a prezenta rolul florei microbiene pentru aprecierea tacticii optime medicochirurgicale în tratamentul afecțiunilor septico-purulente la copil. Studiul bacteriologic a fost efectuat la 107 copii cu afecțiuni septico - purulente acute, ca material servind sângele, punctatul pulmonar, exudatul pleural, peritoneal și osos. Rezultatele. Peritonitele acute generalizate erau preponderent de origine stafilococică (45%), locul doi fiind ocupat de Escherichia Coli (25%). La 28,5% din pacienții cu peritonite s-au depistat asocieri microbiene (E.coli + Enterococcus, E.Coli+S.Aureus). În etiologia osteomielitei acute hematogene predomină S. Aureus (48%) iar flora patogenă mixtă (S.Aureus+Pseudomonas Aerogenosa+S. Epidermidis, (S.Spp+Proteus Vulgaris) a fost prezentă 26,3 % din pacienți. Supurațiile pleuro-pulmonare acute erau determinate de germenii gram-negativi (Proteus Vulgaris 28%, Pseudomonas Aerogenosa 14%), de asocieri microbiene (S.Spp + Proteus Vulgaris). (S.Spp + Pseudomonas Aerogenosa 14%). În cele mai grave sindroame septice (sepsis, sepsis sever,sindromul MODS, șoc septic ) erau prezente infecții cu germeni gram-negativi și asocieri microbiene. Evoluția infecțiilor cu bacterii gram-pozitivi era mai favorabilă iar afecțiunea limitându-se la stadiile SIRS fără generalizarea procesului. Concluzie. Cercetarea efectuată a evidențiat și o multitudine de tulburări biochimice ce corelau cu cele microbiene, fiind potențiali factori de risc în instalarea complicațiilor și principalii promotori ai sepsisului chirurgical, dar și devin ținte vulnerabile pentru prevenția și tratamentul complicațiilor.Introduction. Currently many surgeries are performed for different pathological processes caused by infectious agents. So it is unimaginable to have surgeries without infectious processes. That is why it is important to know pathological flora prevailing in surgical pathologies especially in the pediatric contingent. The purpose. of this paper is to present the role of microbial flora to assess optimal surgical tactics in treatment of septic-purulent diseases in children.This bacteriological study was performed in 107 children with acute septic conditions, serving as material blood, pulmonary punches, pleural, peritoneal and bone exudate.Results. Acute generalized peritonitis were predominantly staphylococcal origin (45%), second place is occupied by Escherichia coli (25%). In 28.5% of patients with peritonitis were detected microbial associations (Enterococcus +E. coli, E. coli + S.aureus). The etiology of acute osteomyelitis marrow predominant S. aureus (48%) and mixed pathogenic flora (S. aureus+ Pseudomonas Aerogenosa + S.epidermidis),(S.Spp + Proteus vulgaris) was present in 26.3% patients. Pleural acute lung abscesses and necrotizing were caused by gram-negative (28% Proteus vulgaris, Pseudomonas Aerogenosa 14%) of microbial associations (S.Spp + Proteus vulgaris). (S.Spp + Pseudomonas Aerogenosa 14%). In the most severe septic syndromes (sepsis, severe sepsis, MODS syndrome, septic shock) were presented Gram-negative infections and microbial associations. Development of infections with gram-positive bacteria was more favorable and affection being focused on limited stages without SIRS. Conclusion. Research carried out revealed a multitude of disorders and correlated with biochemical microbial the potential risks and complications in installing the main promoters of surgical sepsis, but also become vulnerable targets for the prevention and treatment of complications

Interleukin 10 marker of inflammation in acute appendicitis in children

Catedra de chirurgie, ortopedie și anesteziologie pediatrică, USMF ,,Nicolae Testemițanu”, Centrul Național Științifico-Practic de Chirurgie Pediatrică ,,Natalia Gheorghiu”, Institutul Mamei și Copilului, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Introducere. Apendicita acută este o patologie des întâlnită la copii între 6- 10 ani. Sugari și copiii mici au o rată crescută de perforație a apendicelui modificat (50-90%). Varietatea formelor clinice ale apendicitei a cuprins toate vârstele copilului, creând o paletă semiotică vastă. Apendicita acută prin evoluția sa a inflamației permite o explorare paraclinică în permanentă actualizare. Evaluarea markerilor inflamatori în apendicita acută permite de ai cuantifica cu formele clinice evolutive, de a prognoza complicațiile și exodul bolii. Lucrarea de față monitorizează valorile markerilor de inflamație, de tipul Interleukinei 10, la etape clinico-evolutive al apendicitei acute la copil. Material și metode. În studiu au fost incluși 80 de pacienți cu vârsta cuprinsă între 0-18 ani cu diferite forme și stadii clinico-evolutive ale apendicitei acute. A fost studiată dinamica concentrației Interleukinei 10 în 7 etape clinico-evolutive: la internarea pacientului, intraoperator, în prima zi postoperator și respectiv în 3,5,8 zi și la externare și la pacienții la care s-au asociat complicații s-a evaluat concentrația interleukinei10 și la 10 zi. Rezultatele. Studiul denotă reducerea concentrației interleukinei 10 în loturile pacienților care au prezentat forma clinico-evolutivă a apendicitei acute flegmonoase, atât la internare cât și prima zi postoperator, urmată de creșterea lentă la etapele de cercetare atingând valorile normale la a 10 zi postoperator. În peritonita apendiculară acută în cele 3 faze clinico-evolutive ale ei s-a înregistrat o reducere a valorilor IL-10 cu 28% (p 0,05) la internare, I zi postoperator și o creștere la externare. La unii pacienți cu apendicită acută flegmonoasă și peritonită, faza reactivă s-au înregistrat valorile Il-10 mai jos de limitele normei cu - 30% și la internare cu -20% ce poate fi explicat prin reactivitatea scăzută a organismului copilului la răspunsul inflamator sistemic. Concluzii. Conchidem, la importanța evaluării IL-10 în apendicita acută la copil și rolul ei în certificarea concordanței cu formele histologice, clinice și evolutive.Acute appendicitis is the most frequently encountered pathology in children between 6- 10 years. Infants and young children have an increased rate of perforation of the changed appendix (50-90%). The variety of clinical appendicitis covered all ages in children, creating a vast semiotics palette. Acute appendicitis in its developments of inflammation allows an paraclinical constantly updated exploration. Evaluation of inflammatory markers in acute appendicitis allows to quantify evolutionary clinical forms, to forecast complications.This paper monitors the markers of inflammation, such as Interleukin 10, in clinical stage course of acute appendicitis in children. Material and Methods. The study included 80 patients aged 0-18 years with various forms and stages of clinical course of acute appendicitis. It studied the dynamics of Interleukin 10 in 7 stages of concentration in the clinical course: the admission of the patient, intraoperative, postoperative first day ,in the 3,5,8 days and at discharge. Patients who have associated complications were measures the concentration of interleukin10 in 10th day also. Results. The study shows low concentration of interleukin 10 in lots of patients who showed clinical and evolutionary forms of phlegmonous acute appendicitis, both at admission and the first postoperative day, followed by slow growth to the research reaching normal values at the 10th postoperative day.The cecal acute peritonitis in 3 phases of its clinical course was recorded a decrease in IL-10 by 28% (p≥0,05) at admission, I postoperative day and increased by discharge. In some patients with acute phlegmonous appendicitis and peritonitis, there were reactive phase Il-10 values below the normal limits of - 30% and -20% on admission that could be explained by the low reactivity of the child's body systemic inflammatory response . Conclusions. We conclude, the importance of evaluating IL-10 in acute appendicitis in children and its role in certifying the compliance with histological, clinical and evolutionary forms

Leziunea iatrogenică a ductului biliar comun în timpul colecistectomiei laparoscopice la copil

Autorii prezintă un caz clinic de leziune iatrogenă a ductului biliar comun in timpul colecistectomiei laparoscopice, rezolvat prin operaţie reconstructivă – hepaticojejunostomie de ansă Roux in Y cu evoluţie clinică favorabilă. Monitorizarea clinică şi ecografică la distanţă la 2 ani postoperator nu a relevat semne de stenoza a anastomozei bilio-digesitve sau angiocolită de reflux, iar pacientul rămâne în stare satisfăcătoare.The authors present a clinical case of the iatrogenic injury of the common bile duct during laparoscopic cholecystectomy, managed by reconstructive surgery – Roux en Y hepaticojejunostomy with favorable evolution. The clinical and ultrasound follow up after 2 years postoperatively revealed no signs of stenosis of the biliodigestive anastomosis or reflux cholangitis, and the child’s condition remains satisfactory

Laparoscopic management of Gallstone disease in children

Universitatea de Stat de Medicină şi Farmacie “Nicolae Testemiţanu”, Catedra Chirurgie, Ortopedie şi Anesteziologie Pediatrică, Spitalul “Cancelariei de Stat”, Chişinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaScopul studiului a fost aprecierea rolului colecistectomiei laparoscopice (CL) în tratamentuul litiazei biliare la copii. Material şi metode: studiul a inclus o analiză retrospectivă a foilor de observaţie a 21 de copii cu litiază biliară supuşi CL în Centrul Naţional Ştiinţifico-practic de Chirurgie Pediatrică “Academician Natalia Gheorghiu” în perioada decembrie 2015-martie 2019. Indicii analizaţi au inclus caracteristicele demografice, evoluţia clinică, explorările hematologice, investigaţiile imagistice, tehnica operatorie, complicaţiile postoperatorii, vindecarea postoperatorie şi diagnosticul histopatologic. Rezultate: În studiu au fost incluşi 21 de copii cu litiază biliară operaţi prin CL (8 băieţi şi 13 fete). Vârsta medie a fost de 8,3 ani (3-17 ani). 20 de copii cu fost cu litiază biliară simptomatică şi 1 copil cu litiază asimptomatică, dar cu sferocitoză ereditară. La 7 copii au fost depistaţi factori etiologici de risc pentru dezvoltarea litiazei biliare, restul 14 pacienti au fost cu colelitiază idiopatică. 17 copii au fost cu calculi pigmentari şi 4 - cu calculi colesterolici. Copiii au fost supuşi CP programate. 18 copii au suferit de colecistită cronică calculoasă şi 3 copii de colecistită acută calculoasă. La un pacient cu coledocolitiază concomitentă preoperator a fost efectuată papilosfincterotomia. Timpul mediu de operaţie a fost 56,7 minute (30-90 minute). Complicaţii postoperatorii nu au fost. Durata medie de spitalizare a fost de 4,3 zile (3-6 zile). Concluzie: Colecistectomia laparoscopică este o metodă sigura şi eficientă de tratament al litiazei biliare simptomatice la copii.The aim of the study was to assess the role of laparoscopic cholecystectomy (LC) in the treatment of pediatric gallstone disease. Material and methods: the study was based on a retrospective analysis of medical records of 21 children with cholelithiasis treated by laparoscopic cholecystectomy in the “Natalia Gheorghiu” National Scientific and Practical Center of Pediatric Surgery between December, 2015 – March, 2019. The analyzed indices included demographic characteristics, clinical evolution, blood tests, imaging results, operative technique, postoperative complications, postoperative recovery and histological diagnosis. Results: 21 children with gallstone disease were included in the study (8 boys and 13 girls). The average age was 8,3 years (range 3-17 years). 20 children had symptomatic gallstones and 1 child had asymptomatic cholelithiasis, but he also had hereditary spherocytosis. In 7 children etiologic risk factors for gallstone disease were discovered, the rest of them were with idiopathic cholelithiasis. 17 children had pigmental stones and 4 children had cholesterol stones. The elective laparoscopic cholecystectomy was performed in all children. 18 patients suffered from chronic calculous cholecystitis and 3 children had acute calculous cholecystitis. In one child with concomitant choledocholithiasis the endoscopic papillosphincterotomy was preoperatively performed. The average surgery time was 56.7 minutes (range: 30-90 minutes). There were no postoperative complications. The average length of hospitalization was of 4.3 days (range: 3-6 days). Conclusion: Laparoscopic cholecystectomy is a safe and efficient method of symptomatic pediatric gallstones treatment

How to minimise the effect of tumour cell content in detection of aberrant genetic markers in neuroblastoma

Background:Clinical heterogeneity reflects the complexity of genetic events associated with neuroblastoma (NB). To identify the status of all described genetic loci with possible prognostic interest, high-throughput approaches have been used, but only with tumour cell content >60%. In some tumours, necrotic, haemorrhagic and/or calcification areas influence the low amount of neuroblasts. We evaluated the effect of tumour cell content in the detection of relevant aberrant genetic markers (AGM) diagnosed by fluorescence in situ hybridisation (FISH) on tissue microarrays (TMA) in NB.Methods:Two hundred and thirty-three MYCN non-amplified primary NB included in 12 TMAs were analysed.Results:Presence of AGM reduced event-free survival (EFS) (P=0.004) as well as overall survival (OS) (P=0.004) of patients in the whole cohort. There were no differences in prognostic impact of presence of AGM according to tumour cell content.Conclusion:We propose the use of FISH to diagnose AGM of all NB samples having the above-mentioned areas to determine patient risk

Giant pulmonary bulla mimicking pneumothorax in children. Diagnostic and morphopathological considerations

Rezumat Introducere. Bula pulmonară gigantă la copii se întâlnește rar. În acest context, autorii prezintă un caz clinic, care demonstrează dificultățile diagnostice, modalitatea de tratament chirurgical și aspectele morfopatologice ale acestei entități nozologice. Prezentare de caz. Pacient de sex masculin, în vârstă de 12 ani, care prezenta astenie, slăbiciune la efort fizic și dispnee timp de 8 luni, a fost internat pentru pneumotorax spontan pe dreapta, diagnosticul fiind stabilit la radiografie toracică și confirmat la tomografie computerizată. Concomitent, pacientul suferea de timomegalie cu hipotiroidie primară congenitală, în legătură cu ce urmează tratament cu L-tiroxină, și formațiune chistică a glandei tiroide supusă tratamentului chirurgical. Pacientul a fost supus intervenției chirurgicale toracice video asistate (VATS), intraoperator fiind identificată o bulă gigantă localizată în lobul superior al plămânului drept, care a fost excizată prin micro toracotomie latero-posterioară dreaptă. Evoluția postoperatorie a fost fără particularități, radiologic fiind constatată expansiunea treptată a lobului superior al plămânului drept, în care scintigrafia pulmonară a pus în evidență modificări nesemnificative de perfuzie pulmonară. Concluzii. 1. Diagnosticul diferențial dintre bula pulmonară gigantică și pneumotorax este destul de dificil, fiind esențial în aprecierea tacticii de tratament. 2. Bulectomia cu suturarea și aerostaza adecvată a liniei de rezecție la nivelul țesutului pulmonar sănătos reprezintă un procedeu tehnic sigur și fezabil în rezolvarea acestei patologii. 3. Investigațiile histologice efectuate în acest caz au permis de a stabili unele particularități morfopatologice ale componentelor structurale, acestea fiind caracteristice pentru o formațiune chistică de origine bronșică, care conținea elemente de țesuturi musculare reziduale, fascicule nervoase, arterii obliterate sclerogenizate, precum și componenta limfocitară pseudo-foliculară, modificările constatate punând în discuție originea dizontogenetică a bulei pulmonare gigante la copii.Summary Introduction. Giant lung blistering in children is rare. In this context, the authors present a clinical case, which demonstrates the diagnostic difficulties, the way of surgical treatment and the morphopathological aspects of this nosological entity. Case report. A 12-year-old male patient with asthenia, weakness on exertion and dyspnea for 8 months was hospitalized for spontaneous right pneumothorax, the diagnosis being established by chest radiography and confirmed by computed tomography. At the same time, the patient was suffering from thymomegaly with congenital primary hypothyroidism, because of which gets treatment with L-thyroxin, and cystic formation of the thyroid gland undergoing surgical treatment. The patient underwent video-assisted thoracic surgery (VATS), and a giant bladder located in the upper lobe of the right lung was identified intraoperative, which was excised by right latero-posterior micro thoracotomy. The postoperative evolution was without particularities, radiologically being found the gradual re-expansion of the upper lobe of the right lung, in which the pulmonary scintigraphy revealed insignificant changes of pulmonary perfusion. Conclusions. 1. The differential diagnosis between giant lung blister and pneumothorax is quite difficult, being essential in assessing treatment tactics. 2. Bulectomy with suturing and adequate aerostasis of the resection line at the level of healthy lung tissue is a safe and feasible technical procedure in resolving this pathology. 3. The carried out histological investigations, in this case, established some morphopathological features of the structural components, which are characteristic of a cystic formation of bronchial origin, which contained elements of residual muscle tissue, nerve bundles, sclerogenized-obliterated arteries and lymphocyte component. Pseudo-follicular, the changes found questioning the dysontogenetic origin of the giant lung bubble in children

Laparoscopic percutaneous extraperitoneal closure of the internal inguinal ring in children with inguinal hernia

IP Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Catedra Chirurgie, Ortopedie şi Anesteziologie Pediatrică, IMSP Spitalul Cancelariei de Stat, IMSP IMşiC, Chişinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Scopul studiului a fost compararea tehnicii de suturare laparoscopică percutanată extraperitoneală (SLPE) a inelului inghinal profund şi tehnicii de herniotomie inghinala deschisă (HID) la copiii cu hernie inghinală (HI). Material şi metode: studiul a inclus o analiză retrospectivă a foilor de observaţie ale 72 de copii cu HI, 30 de pacienţi operaţi prin tehnica SLPE şi 42 de copii prin tehnica HID, vârsta medie fiind de 33,6±8,9 luni în perioada martie 2018 – martie 2019 în CNŞPCP “ Natalia Gheorghiu”. Din grupul SLPE 20 au fost băieţi şi 10 – fetiţe, 17 pacienţi au fost cu hernii unilaterale şi 13 cu hernii inghinale bilaterale. Rezultate: În grupul HID 28 au fost băieţi şi 14 – fetiţe, cu hernii unilaterale - 29 şi cu hernii bilaterale - 13. Timpul mediu de operaţie - 8,2 minute prin metoda SLPE şi 23,4 minute prin metoda HID (t=2,90, p<0,01). Timpul mediu de spitalizare în grupul SLPE - 31,2 ore, versus 74,4 ore în grupul HID (t=3,26; p<0,01). Complicaţii intraoperatorii nu au fost. În grupul SLPE a survenit o recidivă (3,3%), în grupul HID – 2 recidive (4,8 %). În grupul HID au fost efectuate 15 (35,7%) intervenţii chirurgicale repetate pentru lichidarea herniei inghinale metacrone (13 pacienţi) şi recidivante (2 pacienţi). In grupul pacienţilor SLPE a fost efectuată 1 (3,3%) operaţie repetată, pentru lichidarea herniei recidivante. Concluzii: Tehnica SLPE este o tehnică sigură şi eficientă de lichidare a HI la copii cu o rată de recurenţă comparabilă cu HID, dar cu timp de operaţie şi spitalizare net inferioare faţă de HID.Introduction: The aim of the study was to compare the technique of laparoscopic percutaneous extraperitoneal ligation (LPEC) of the internal inguinal ring and the open herniorrhaphy (OH) in children with inguinal hernia (IH). Material and methods: The study comprised a retrospective analysis of the medical records of 72 children with IH, 30 patients operated by the LPEC and 42 – by the OH between March, 2018 and March 2019 in “Natalia Gheorghiu” National Scientific and Practical Center of Pediatric Surgery. The mean age was 33,6±8,9 months. The LPEC group included 20 boys and 10 girls, 17 patients had unilateral hernia and 13 – the bilateral one. Results: The OH group included 28 boys and 14 girls, 29 patients had unilateral IH and 13 children - bilateral. The mean surgery time was 8,2 minutes in the LPEC group and 23,4 minutes in OH group (t=2,90, p<0,01). The average length of hospitalization was of 31,2 hours in the LPEC group and of 74,4 hours in the OH group. There were no postoperative complications. There was 1 recurrence (3,3%) in the LPEC group and 2 recurrences (4,8%) in the OH group. In the OH group 15 patients (35,7%) were operated repeatedly - 13 patients for metachronous hernias and 2 for recurrences. In the LPEC group only 1 patient was re-operated for recurrence (3,3%). Conclusion: the LPEC is a safe and efficient technique of pediatric IH closure with a comparable with OH recurrence rate, but with a smaller length of operation and hospitalization

Segmental chromosomal alterations have prognostic impact in neuroblastoma: a report from the INRG project

Background: In the INRG dataset, the hypothesis that any segmental chromosomal alteration might be of prognostic impact in neuroblastoma without MYCN amplification (MNA) was tested. Methods: The presence of any segmental chromosomal alteration (chromosome 1p deletion, 11q deletion and/or chromosome 17q gain) defined a segmental genomic profile. Only tumours with a confirmed unaltered status for all three chromosome arms were considered as having no segmental chromosomal alterations. Results: Among the 8800 patients in the INRG database, a genomic type could be attributed for 505 patients without MNA: 397 cases had a segmental genomic type, whereas 108 cases had an absence of any segmental alteration. A segmental genomic type was more frequent in patients >18 months and in stage 4 disease (P<0.0001). In univariate analysis, 11q deletion, 17q gain and a segmental genomic type were associated with a poorer event-free survival (EFS) (P<0.0001, P=0.0002 and P<0.0001, respectively). In multivariate analysis modelling EFS, the parameters age, stage and a segmental genomic type were retained in the model, whereas the individual genetic markers were not (P<0.0001 and RR=2.56; P=0.0002 and RR=1.8; P=0.01 and RR=1.7, respectively). Conclusion: A segmental genomic profile, rather than the single genetic markers, adds prognostic information to the clinical markers age and stage in neuroblastoma patients without MNA, underlining the importance of pangenomic studies

International consensus for neuroblastoma molecular diagnostics: report from the International Neuroblastoma Risk Group (INRG) Biology Committee

Neuroblastoma serves as a paradigm for utilising tumour genomic data for determining patient prognosis and treatment allocation. However, before the establishment of the International Neuroblastoma Risk Group (INRG) Task Force in 2004, international consensus on markers, methodology, and data interpretation did not exist, compromising the reliability of decisive genetic markers and inhibiting translational research efforts. The objectives of the INRG Biology Committee were to identify highly prognostic genetic aberrations to be included in the new INRG risk classification schema and to develop precise definitions, decisive biomarkers, and technique standardisation. The review of the INRG database (n=8800 patients) by the INRG Task Force finally enabled the identification of the most significant neuroblastoma biomarkers. In addition, the Biology Committee compared the standard operating procedures of different cooperative groups to arrive at international consensus for methodology, nomenclature, and future directions. Consensus was reached to include MYCN status, 11q23 allelic status, and ploidy in the INRG classification system on the basis of an evidence-based review of the INRG database. Standardised operating procedures for analysing these genetic factors were adopted, and criteria for proper nomenclature were developed. Neuroblastoma treatment planning is highly dependant on tumour cell genomic features, and it is likely that a comprehensive panel of DNA-based biomarkers will be used in future risk assignment algorithms applying genome-wide techniques. Consensus on methodology and interpretation is essential for uniform INRG classification and will greatly facilitate international and cooperative clinical and translational research studies