The XI National Biobank Congress, which will be held on November 19 and 20 at the Santemar Hotel in Santander presents its corporate image.

The National Biobank Congress is held annually and this year 2020 is held in the city of Santander. The Congress is being organized by the Valdecilla Biobank, the National Biobank Network and CIBERES.

We will keep you informed about the registration dates, attendees, etc.

Notably, the report published by the newspaper El País on the key role of Spanish biobanks in research. You can read the report in the following link: link

IDIVAL celebrates the I Week of Women and Girls in Science with a round table on February 12 at 6:00 p.m. at the Caja Cantabria Foundation, Calle Tantín 25, 1st Floor, (CASYC Theater), Santander.

IDIVAL researchers will present their experiences in the field of research in a relaxed environment. A journey through their professional careers, since they decided to study a scientific career, until today as responsible or coordinators of their groups.

A round table moderated by Dr. Carmen Sarabia in which we invite you to participate and that is open to the general public with special interest to the parents of girls in order to motivate and encourage their daughters to study in the future scientific careers.

In addition, during the next few days, videos of researchers and professionals will be disseminated on social networks (twitter: @IDIVALdecilla and Instagram @idivaldecilla) under the motto #RompemosMitos in which the challenges they have achieved will be exposed.

These two activities are included within the I Week of Women and Girls in Science of IDIVAL and which in turn are framed within the activities of Day 11F organized by the University of Cantabria.

On Friday, January 31, Natalia Sanz and Nuria García predoctoral IDIVAL-UC present their doctoral thesis at the Faculty of Medicine at 11:00 and 12:00 hours respectively.

Doctoral thesis: “Differentiation induced by DNA damage, a common physiological response in stratified epithelia and prognostic marker in HNSCC”

Speaker: Natalia Sanz, pre-doctoral scholarship IDIVAL-UC (PREVAL 04/16) in 2015 in the Research Group Cell Cycle, Stem Cells and Cancer of IDIVAL.

Thesis Director: Alberto Gandarillas Solinis

Date and place: Degrees Room of the Faculty of Medicine, Faculty of Medicine, 11:00 hours.

Epidermoid cancer is the leading cause of cancer death. Epidermoid or squamous cell carcinoma of the head and neck (HNSCC) is the sixth most common type of cancer worldwide. HNSCC originates from stratified squamous epithelia that are in continuous renewal and exposed to mutagenic agents. Therefore, keratinocytes must have potent protective mechanisms to eliminate precancerous cells. In this doctoral work we have found a differentiation response induced by DNA damage (DDDR) in head and neck keratinocytes common with the epidermis. The results show that this mechanism protects cells against genetic damage induced by ultraviolet radiation or replication stress through the G2 / mitosis control points, and with mitotic slippage, endorreplication and terminal differentiation. We have also shown that mitosis kinases control squamous differentiation in vivo. In addition, we found a relationship between DDDR and the aggressiveness of HNSCC carcinomas. The results suggest that cellular DDDR could maintain squamous homeostasis automatically and that its alteration contributes to the aggressiveness of epidermoid cancer.

PUBLICACIONES SURGIDAS DE LA TESIS DOCTORAL

1. Gandarillas, A., Molinuevo, R., and Sanz-Gomez, N. (2018). Mammalian endoreplication emerges to reveal a potential developmental timer. Cell Death and Differentiation, 25(3), 471–476.

2. Sanz-Gomez, N., Freije, A., Ceballos, L., Obeso, S., Sanz, J. R., Garcia-Reija, F., Morales-Angulo, C. and Gandarillas, A. (2018). Response of head and neck epithelial cells to a DNA damage-differentiation checkpoint involving polyploidization. Head and Neck, 40(11), 2487–2497.

3. de Pedro, I., Alonso-Lecue, P., Sanz-Gomez, N., Freije, A., and Gandarillas, A. (2018). Sublethal UV irradiation induces squamous differentiation via a p53-independent, DNA damage-mitosis checkpoint. Cell Death and Disease, 9(11), 1094.
4. Gandarillas, A., Sanz-Gomez, N., and Freije, A. (2019). Polyploidy and the mitosis path to epidermal cell fate. Cell Cycle (Georgetown, Tex.), 18(3), 359–362.

5. Sanz-Gomez, N., Freije, A., and Gandarillas, A. (2019). Keratinocyte Differentiation by Flow Cytometry. Methods in Molecular Biology (Clifton, N.J.).

6. Freije, A., Sanz-Gomez, N., and Gandarillas, A. (2019). Genetic Modification of Human Primary Keratinocytes by Lentiviral Vectors. Methods in Molecular Biology (Clifton, N.J.).

7. Sanz-Gómez, N., de Pedro, I., Ortigosa, B., Santamaría, D., Malumbres, M., de Carcer, G. and Gandarillas, A. (En prensa). Squamous differentiation requires G2/mitosis slippage to avoid apoptosis. Cell Death and Differentiation.

Doctoral thesis: “Novel mechanisms of tumorigenesis and progression of cutaneous T cell lymphoma: role of PLCG1-PRKCQ-STAT3 signalling network”

Speaker: Nuria García, IDIVAL-UC predoctoral fellowship (PREVAL 16/01) in 2015 in the IDIVAL Clinical and Translational Research Group on Digestive Diseases.

Thesis directors: José Pedro Vaque Díez and Miguel Ángel Piris Pinilla.

Date and place: Audiovisual Classroom of the Faculty of Medicine at 12: 00 hours.

The work carried out in this doctoral thesis has been to study the role of the PLCG1-PRKCQ-STAT3 malignant signaling network controlling the biological processes of cutaneous T-cell lymphoma (LCCT). To this end, different biomarkers have been studied by immunohistochemistry in 78 LCCT patients and it has been seen that the activation of STAT3 is a marker of disease progression, which could be an important characteristic with relevant clinical implications. In addition, we have studied the possible mechanisms that could lead to the activation of this protein as activating mutations of JAK and PLCG1 and / or amplifications of PRKCQ, all of them described in LCCT patients. These mechanisms have been analyzed both in cellular models of the disease and in a novel animal model for the field of cutaneous lymphomas: the chicken embryo model, which has allowed PRKCQ to be described as an important mediator of tumorigenesis and progression control. of the illness. It also proposes novel approaches to the development of targeted therapies, including calcineurin inhibitors, PRKCQ or JAK used both individually and in combination.

PUBLICATIONS OF THE DOCTORAL THESIS

1. Pérez C, González-Rincón J, Onaindia A, Almaráz C, García-Díaz N, Pisonero H, Curiel-Olmo S, Gómez S, Cereceda L, Madureira R, Hospital M, Suárez-Massa D, Rodriguez-Peralto JL, Postigo C, Leon-Castillo A, González-Vela C, Martinez N, Ortiz-Romero P, Sánchez-Beato M, Piris MÁ, Vaqué JP. Mutated JAK kinases and deregulated STAT activity are potential therapeutic targets in cutaneous T-cell lymphoma. Haematologica. 2015 Nov;100(11):e450-3. doi: 10.3324/haematol.2015.132837

2. Pérez C, Mondéjar R, García-Díaz N, Cereceda L, León A, Montes S, Durán Vian C, Pérez Paredes MG, González-Morán A, Alegre de Miguel V, Sanz Anquela JM, Frías J, Limeres MA, González LM, Martín Dávila F, Beltrán M, Mollejo M, Méndez JR, González MA, González García J, López R, Gómez A, Izquierdo F, Ramos R, Camacho C, Rodriguez-Pinilla SM, Martínez N, Vaqué JP, Ortiz-Romero PL, Piris MA. Advanced-stage mycosis fungoides: role of the signal transducer and activator of transcription 3, nuclear factor-κB and nuclear factor of activated T cells pathways. The British journal of dermatology. 2019 May 3. doi: 10.1111/bjd.18098

The IDIVAL Psychiatry group has published the article “Dissecting the functional outcomes of first episode schizophrenia spectrum disorders: a 10-year follow-up study in the PAFIP cohort” in the journal Psychological Medicine. The objective of the study was to assess the functionality of patients with a diagnosis of schizophrenia spectrum disorder 10 years after having had a first psychotic episode (PEP). The hypothesis of the study was that early intervention programs in psychosis (ITP) have changed the course of schizophrenia, considered a progressive and deteriorating disease, by a condition in which functional normalization is achieved in the vast majority of patients cases.

To carry out the study, patients were contacted who had been in the Initial Psychosis Attention Program (PAFIP), carried out in the Psychiatry Service of the Marqués de Valcedilla University Hospital, between 2001 and 2008 and that, once informed of the objectives of the study, they agreed to complete an analysis and a clinical interview, and perform a battery of neuropsychological tests and an MRI. The entire visit lasted about 3 hours and a nurse, a psychiatrist, a psychologist and a physicist participated for each individual.

In total, 210 patients were reevaluated and, with the data collected, numerous statistical analyzes were analyzed that allowed these patients to be classified into 6 functional clusters 10 years after having debuted with a PEP, and having been in follow-up in PAFIP, which provided ITP for 3 years. These 6 groups represented: those patients with a normalized evolution (42%); to those with slight interpersonal (10%) or instrumental (13%) deficits; to those with severe instrumental deficits (12%); to those with more severe instrumental and interpersonal deficits (14%); and finally to those with generalized functional deficits (9%).

The results obtained show that a high percentage of patients (42%) have reached functional milestones in the family, educational, vocational and social fields, questioning some work in which it is indicated that long-term recovery is only reached in 15% of patients with schizophrenia. The most remarkable of these findings is that patients have great variability and cannot be classified in two groups: good or bad evolution.

A final aspect that should be noted is the role of ITP programs in relapse prevention. Systematic reviews on this topic highlight the differences between usual treatment and ITP. In cases treated with usual treatment, the average relapse rates are 14% at 9 months, 49% at 24 months and 76% after 10 years; while in those served by specialized ITP services they are 17% at 9 months, 38% at 24 months and 54% beyond 10 years. These data coincide with those of one of our recently published studies in which a relapse rate of 56% was demonstrated in the 3-year follow-up, one of the main predictors of these being the lack of adherence to treatment. Relapses are the aspect that most difficult the complete recovery, and its rate continues to be high even in the ITP programs, so its prevention is possibly the aspect that needs more improvements.

In conclusion, there is no doubt that the diffusion of ITP in many countries has led to improvements in the treatment and evolution of PEP. However, these improvements do not necessarily mean that the course of the disease is radically changed or that the overall outcome of the disease can be described as positive. There remains a crucial need for new treatment approaches to improve long-term functionality taking into account the individual variability of patients.
With the information obtained in this PAFIP-10 cohort there are other studies underway, specifically the morphometric evolution of brain structures and metabolic evolution, led by Dr. Diana Tordesillas-Gutiérrez, and Dr. Javier Vázquez-Bourgon respectively.

Ref. Dissecting the functional outcomes of first episode schizophrenia spectrum disorders: a 10-year follow-up study in the PAFIP cohort. Rosa Ayesa-Arriola , Víctor Ortíz-García de la Foz, Obdulia Martínez-García, Esther Setién-Suero. DOI: https://doi.org/10.1017/S0033291719003179. Published online by Cambridge University Press: 18 November 2019

Next Thursday, January 30, the next conference of the fourth edition of the Santander Biomedical Lectures program organized by IDIVAL, the University of Cantabria and the IBBTEC given by Dr. Xavier Bossuyt with the title “Laboratory evaluation of primary immunodeficiency” will take place. Dr. Bossuyt will describe the different approaches from the Immunology laboratory when assessing a suspicion of immunodeficiencies and how the approach can be performed with the new genetic tools.

 Xavier Bossuyt graduated in medicine from the Catholic University of Leuven (Belgium) in 1988. In 1994 he obtained his doctorate (thesis: Regulation of Hepatic Microsomal UDPGlucuronosyltransferase and Nucleotide Sugar: Dolichol Phosphate Glycosyltransferases).

Subsequently, he spent two years in the Department of Clinical Pharmacology and Toxicology at the University Hospital of Zurich as a post-doctoral researcher (subject: liver plasma membrane transporters). He specialized in clinical pathology (1988-1990) at the University Hospitals of Leuven and in immunology at the National Institutes of Health, Bethesda, USA (1995-1996).

Dr. Bossuyt specialized as a doctor in Clinical Pathology in 1996. Since then, he has worked as a clinical laboratory immunologist at the Department of Laboratory Medicine, University Hospitals Leuven.

His research focuses primarily on protein chemistry, serological markers in autoimmune diseases, the immune response to Streptococcus pneumoniae and immunodeficiencies.

The conference is open to all the public of Santander who wants to participate. It will take place on Thursday, January 30 at the Marqués de Valdecilla University Hospital, in the Téllez Plasencia Hall (Hall 16) at 8.15 in the morning.

Promoting a discussion forum on the current advances in biomedicine, the rapporteur will remain in our Community throughout the day of the session, to exchange experiences with members of the scientific and clinical community of Santander, and to visit the research centers of our community to meet interested scientists firsthand.

The speaker is invited by Dr. Marcos López, head of the HUMV Immunology service and responsible for the IDIVAL transplant and autoimmunity research group. Those professionals who wish to have a meeting with the rapporteur during their visit can get in touch through the following e-mails: marcos.lopez@scsalud.es or proyectos1@idival.org. It is important to keep in mind that the rapporteur is an expert not only in Immunodeficiencies, but also in autoimmune diseases, so you can request an appointment to address any of the issues if you are interested.

Next Thursday, January 30, the next conference of the fourth edition of the Santander Biomedical Lectures program organized by IDIVAL, the University of Cantabria and the IBBTEC given by Dr. Xavier Bossuyt with the title “Laboratory evaluation of primary immunodeficiency” will take place. Dr. Bossuyt will describe the different approaches from the Immunology laboratory when assessing a suspicion of immunodeficiencies and how the approach can be performed with the new genetic tools.

Xavier Bossuyt graduated in medicine from the Catholic University of Leuven (Belgium) in 1988. In 1994 he obtained his doctorate (thesis: Regulation of Hepatic Microsomal UDPGlucuronosyltransferase and Nucleotide Sugar: Dolichol Phosphate Glycosyltransferases).

Subsequently, he spent two years in the Department of Clinical Pharmacology and Toxicology at the University Hospital of Zurich as a post-doctoral researcher (subject: liver plasma membrane transporters). He specialized in clinical pathology (1988-1990) at the University Hospitals of Leuven and in immunology at the National Institutes of Health, Bethesda, USA (1995-1996).

Dr. Bossuyt specialized as a doctor in Clinical Pathology in 1996. Since then, he has worked as a clinical laboratory immunologist at the Department of Laboratory Medicine, University Hospitals Leuven.

His research focuses primarily on protein chemistry, serological markers in autoimmune diseases, the immune response to Streptococcus pneumoniae and immunodeficiencies.

The conference is open to all the public of Santander who wants to participate. It will take place on Thursday, January 30 at the Marqués de Valdecilla University Hospital, in the Téllez Plasencia Hall (Hall 16) at 8.15 in the morning.

Promoting a discussion forum on the current advances in biomedicine, the rapporteur will remain in our Community throughout the day of the session, to exchange experiences with members of the scientific and clinical community of Santander, and to visit the research centers of our community to meet interested scientists firsthand.

The speaker is invited by Dr. Marcos López Hoyos, head of the HUMV Immunology service and responsible for the IDIVAL transplant and autoimmunity research group. Those professionals who wish to have a meeting with the rapporteur during their visit can get in touch through the following e-mails: marcos.lopez@scsalud.es or proyectos1@idival.org. It is important to keep in mind that the rapporteur is an expert not only in Immunodeficiencies, but also in autoimmune diseases, so you can request an appointment to address any of the issues if you are interested.

The Interlibrary Loan or Document Obtaining Service (SOD) is a basic form of cooperation between libraries that allows to complement the own fund with that of other libraries. That all libraries have everything subscribed is, in addition to unnecessary, economically unsustainable. The current logic, which the Marquise de Pelayo Library follows, is that all libraries have everything among them, and share it. The SOD regulates this exchange between libraries.

The Marquesa de Pelayo Library collaborates with virtually all specialized, virtual health, hospital and university libraries in Spain. The funds of all of them are indirectly also funds of the Cantabrian library, and vice versa, the funds of this one are shared by all the Spanish libraries.

If a user needs an article and the library does not have the magazine or if they do not have the year, the user can request the article they need through SOD. The application form is available in the “New request” tab. There are two ways to complete it: either by filling in the fields one by one or if the article has PMID (code taken from PUBMED), putting it in the corresponding field and pressing the “Search” button, in which case or the PDF will open directly of the article, if it is available, or, if it is not available, the request will be effectively sent to the librarian, who will proceed with it.

Two alternative access routes are worth noting: the first one related to PUBMED and the second one with Clinical Key (Elsevier). The first is a free tool, in fact if you search on Google it is without problem, but the access offered from the library is recommended because it leads to a version that has the contents of the library loaded inside, so that when the user selects in PUBMED the article of their interest a banner will appear from where you can directly download the PDF of the article if it was subscribed and if not, what will be opened will be the request form with all the self-filled fields. Without leaving PUBMED. Easy and practical. Regarding Clinical Key, this is a tool where the user has at his disposal all the contents of Elsevier (articles, chapters, medication sheets, etc.) in full text (direct download) in addition to all PUBMED, in which case the file or registration of the article (provided that it is not from Elsevier, in which case it will be opened directly) will be accompanied by the banner of the Marquise de Pelayo Library, being able to download the PDF directly if the article was subscribed with another publisher and if not, opening the form of request of the article with all the self-filled fields. Again we can resort to SOD without leaving the tool we are working with, in this case Clinical Key.

Requests are subject to a standard national rate that amounts to € 4 per request. But the Marquise de Pelayo Library has signed mutual free agreements (for which neither is charged nor paid as long as there is proportionality between requests) with practically all libraries in the sector, with which the gratuitousness of the requests is guaranteed. All requests are resolved at zero cost for users.

In addition to free, the commitment reached by the Marquise de Pelayo Library with its users is to serve the articles in no more than 48 hours.

And where do users receive the PDF of the requested item? The PDFs of the documents are deposited in the folder that appears in the name of the user when the user logs into the library's website (remember that to log in, to enter the library you must use the same username and password that is used to any other SCS application, such as the medical records VISOR or the Employee Portal) in addition to being sent to the user's corporate email.

The success that the SOD enjoys fulfills the figures that are handled for 2019: the internal users (of the Marquesa de Pelayo Library) made a total of 7,436 requests in 2019, that is, an average of 620 per month. The net savings associated with the requests of internal users thanks to the free agreements signed with other Spanish libraries in the sector reaches € 29,744 in 2019.

• Number of requests made by users of the library in 2019: 7,436 requests.
• Average requests per month: 620 requests.
• SOD / 2019 savings: € 29,744 in requests.

Project PI19/01580 “New immunotherapies for bladder cancer” directed by Dr. Carmen Álvarez Domínguez has been funded by the Carlos III Health Institute in the 2019 Call for Strategic Health Action 2017-2020, Health Research Projects for an amount of € 105,270.

Bladder cancer is the fifth most common cancer with a higher prevalence in men than in women, the third in charge of somatic mutations and one of the most immunogenic, after melanoma. Although some immunotherapies in bladder cancer have been approved, their immunological characterization has not yet been evaluated, nor are there biomarkers of the efficiency of these immunotherapies. We in this study are going to characterize the immunological response in bladder tumors and we are going to compare them with tumors that have more knowledge of this immune response, such as melanomas. Biomarkers of the efficiency of approved immunotherapies will be sought and will be compared with our proposal for new immunotherapy that the IDIVAL group has developed, Listeria-based nanovaccines. Not only will we look for these biomarkers in the biopsies of patients with these tumors, but we will also look for this “biological footprint” in the blood samples, which will allow us to easily follow these therapies in the future.
In addition, mouse models of bladder cancer and melanoma that admit human samples will be developed, in order to see in these models the efficiency and scope of these therapies. This information, which combines pre-clinical analysis of patient samples and immunological analysis in the laboratory, together with analysis of tumor immunology in mice, combines the research work of clinical researchers of different Hospital Services and the work of a research group. in applied basic immunology of the IDIVAL; what is a challenge of coordination and multidisciplinarity between the HUMV and the IDIVAL that we believe will allow great progress for patients in the future.

In the IDIVAL laboratory together with the HUMV Oncology Service, we are also working on other lines of possible immunotherapies for tumors in which immunotherapies do not work as in colon cancer and in being able to perform all pre-clinical analyzes to develop our Listeria-based immunotherapy with nanovaccines.

Collaborating researchers of the project: Dr. Fernando Rivera y Dr. Ignacio Durán Martínez (Servicio de Oncología Médica), Dra. Sonsoles Yañez (Servicio de Dermatología), Héctor Terán Navarro y David Salcines Cuevas (IDIVAL).

Other clinical collaborators not specifically in the project, but equally relevant and participating: Urology Department (Dr. Jose Luis Gutierrez, Dr. Mario Esteban, Dr. Felix Campos, Dr. Ernesto Herrero), Pathology Department (Dr. Ainara Azueta and Dr. Jose Javier Gomez Román), Medical Oncology Service (Dr. Marta Lopez-Brea and Dr. Almudena Garcia).

IDIVAL, the Health Research Institute of the Marqués de Valdecilla Hospital, presents its participation in Better@Home, a project with European funding framed in the EIT Health program, the European Institute of Innovation and Technology, which is part of the European Commission.

On January 1, 2020, the activities of the Better@Home project began, led by the Infanta Leonor Hospital in Madrid, which will focus on improving the health care of patients included in the home hospitalization program with the help of technology. The user profile will mainly cover COPD, heart failure and infectious processes.

IDIVAL will participate actively throughout the life of the project, which will end on December 31, 2021. The institute will ensure the proper functioning of the activities for the creation and adaptation of protocols, training and validation programs or HFE (Human Factor Engineer).

The Better@Home project seeks to improve the results of home health care, patient satisfaction, as well as reducing health costs through optimizing resources and coordinating a multidisciplinary team, maintaining quality and patient safety.

With Better@Home it will be possible for patients to remain in the comfort of their home and, in turn, be attended by healthcare professionals thanks to the remote monitoring of users, which will improve the efficiency of home care processes. This will be possible thanks to the implementation of a remote monitoring center through the hospital's information system, which will ensure proper coordination in the home hospitalization unit and the creation of a protocolized communication channel between the hospital and Primary Care for to improve the interaction between both parties.

The Better@Home project consists of 5 partners, including IDIVAL and are the following: SERMAS, the Madrid Health Service and the leader of the initiative; Medtronic, world leader in technology, services and medical solutions; the Polytechnic University of Madrid and SMPS, the Shared Service of the Ministry of Health of Portugal.

The budget to carry out the project amounts to a total of € 1,396,150, of which € 1,206,400 is funded by the European Commission.

Guillain-Barré syndrome (GBS) is the most common cause of acute neuropathic ascending paralysis in developed countries. Members of the IDIVAL Group of Neurodegenerative Diseases have carried out two studies on this syndrome.

In the first study, published in Acta Neurologica Scandinavica “A unicenter, prospective study of Guillain ‐ Barré syndrome in Spain” the clinical characteristics, subtypes and prognosis of the syndrome are described (Sedano et al, Acta Neurol Scand 2019; 139: 546‐ 54).

The series included 56 GBS patients treated in Valdecilla between January 2009 and June 2017, with ages ranging from 5 to 86 years (mean, 55). The clinical characteristics were comparable to those described by the IDIVAL Group almost three decades ago (Sedano et al, Acta Neurol Scand 1994; 89: 287-92). Next to the classic forms of GBS, 7 cases were identified with the paraparhetic form, 1 with Miller Fisher syndrome, and 1 case of acute sensory and ataxic neuropathy (ASAN in the Anglo-Saxon acronym).

Based on the neurophysiological findings, 35 (62.5%) of the patients were classified as demyelinating form (AIDP), 16 (28.6%) as axonal form (either AMAN or AMSAN), 1 (1.8% ) as an inexcitable form, and 3 (5.4%) as forms of GBS without definite neurophysiological findings. The relative high frequency of axonal shapes, usually observed in eastern countries, has recently been corroborated in the Italian region of La Spezia (Benedetti et al, JPNS 2019; 24: 80-6). As expected from the literature data, antiganglioside reactivity was only detected in axonal forms. Figure 1, corresponding to the ASAN patient, illustrates for the first time that distal sensory axonopathy is caused by a reversible blockade of conduction mediated by antiganglioside antibody (here anti-GD1a).

Figure 1. The original legend, taken from Figure 3 of Sedano et al (2019) is as follows: Seria l sensory conduction studies of median nerve in an ASAN patient.
(A) On day 4 after symptom onset, when the patie nt showed severe sensory ataxia, note severe amplitude reduction of both recorded SNAPs, D1‐wrist and D3‐wri st, which accounts for the observed SCV slowing.
(B) On day 13, there was a drastic increase of SNAP amplitudes, up to 4.3 µV on D1‐wrist and 1.7 µV on D3‐wrist, with normalization of SCVs. Mixed median nerve conduction velocity (wrist‐elbow) is preserved, though the mixed compound nerve action (MCNAP) potential amplitude is reduced (8.6 µV; normal, 15.5 µV).
(C) On day 50, median nerve sensory conduction parameters are entirely normal; in comparison with the previous study, note further increase of SNAP amplitudes, normalization of MCNAP amplitude, and increase of SCVs and mixed nerve conduction velocity. Note also normal morphology of SNAPs and MCNAPs, and particularly the absence of temporal dispersion. Sensory conduction changes of ulnar nerve were comparable. D1=digit 1; D3=digit 3.


The “Very early Guillain-Barré syndrome: A clinical-electrophysiological and ultrasonographic study” study published in “Clinical Neurophysiology Practice” describes the consecutive ‐ neurophysiological and ultrasonographic clinical findings in 15 patients with classical GBS, whose initial neurophysiological examinations will be carried out. carried out at a very early stage of the syndrome (VEGBS in the Anglo-Saxon acronym), ≤ 4 days of symptomatic onset (Berciano et al, Clin Neurophysiol Practice 2020; 5: 1-9). Initially, in 3 (20%) patients an axonal neurophysiological pattern was detected, in 6 (40%) a mixed pattern, in 5 (33.3%) an equivocal pattern, and in the remaining case (6.6%) as unclassifiable form. Nerve ultrasonography showed that the most relevant lesions are located in the ventral branches of the C6-C7 nerves (Figure 2). The two fundamental conclusions are the following: i / the consecutive neurophysiological study is necessary to discern subtypes in VEGBS; and ii / inflammatory edema of the proximal nerve trunks is pathogenic in the first four days of illness. We propose new pathophysiological perspectives of the initial disorders of nerve conduction.

Figure 2. The original legend, taken from Figure 4 of Berciano et al (2020), is as follows: US of the ventral rami of the sixth cervical nerves of case 13 with a final diagnosis of axonal GBS; sonograms were obtained on day 5 after onset.
(A) Short‐axis sonogram showing marked CSA enlargement of the right C6 nerve (dotted green tracing), its perineurial rim not being identified.
(B) In this sagittal sonogram the right C6 nerve (asterisks), note also disappearance of perineurial rim.
(C) Short‐axis sonogram of the left C6 nerve showing normal CSA (dotted green tracing) with preservation of the perineurial hyperechoic rim.
(D) Sagittal sonogram of the left C6 nerve (asterisks) illustrating quite well preservation of its perineurial hyperechoic rim.