Comparison of the prognostic effect of pyrotinib plus trastuzumab and chemotherapy different lines therapy in HER2-positive advanced breast cancer.

This study aimed to compare the efficacy of pyrotinib, trastuzumab combined with chemotherapy with different lines therapy in human epidermal growth factor receptor 2- (HER2-) positive advanced breast cancer (ABC) and analyze the factors affecting the prognosis. A total of 84 patients with median age of 49 year-old. The mPFS of patients receiving first-line pyrotinib plus trastuzumab and chemotherapy was the longest (11 months) compared with second- and third line patients (p = 0.106). The objective response rate (ORR) and disease control rate (DCR) of the total population were 33.3% and 82.1% respectively. Subgroup analysis suggested that using pyrotinib plus trastuzumab and Albumin-bound paclitaxel was not inferior to combine with Vinorelbine in regards of PFS. Histological grade (OR: 0.233[0.069 ∼ 0.781], p = 0.018) and tumor location (OR: 0.286[0.087 ∼ 0.942], p = 0.040) were independent factors influencing the ORR. Multivariate cox analysis showed that Ki-67 was independently associated with increased risk of progression (HR: 1.843[1.044-3.254], p = 0.035). The most common adverse events were diarrhea (17.9%) and neutropenia (11.9%). In the first-, second- and third-line treatment, pyrotinib plus trastuzumab and chemotherapy is effective and safe. Pyrotinib and trastuzumab combined with Albumin-bound paclitaxel may be a potential ideal treatment plan for HER2-positive advanced breast cancer.

Effect of blood viscosity on the hemodynamics of arteriovenous fistulae based on numerical investigation.

Arteriovenous fistula (AVF) is the most commonly used vascular access for hemodialysis in patients with end-stage renal disease. Vascular diseases such as atherosclerosis and thrombosis, triggered by altered hemodynamic conditions, are the main causes of access failure. Changes in blood viscosity accelerate access dysfunction by affecting local velocities and wall shear stress (WSS) distribution in the circulation. Numerical simulation was employed to analyze and compare the hemodynamic behavior of AVF under different blood viscosities (0.001-0.012 Pa∙s). An idealized three-dimensional model with end-to-side anastomosis was established. Transient simulations were conducted using pulsatile inlet velocity and outflow as boundary conditions. The simulation results reveal the blood flow state of AVF under different viscosity physiological conditions and derive the rule of change. When blood viscosity increases, the local velocity in the disturbed region slows down and the stagnation time becomes longer, resulting in increased deposition of substances. As blood viscosity increases, the level of shear stress on the entire wall of the fistula increases accordingly. WSS values at high viscosities above 0.007 Pa∙s showed significantly larger low-shear regions near the anastomosis and increased chances of inducing atheromatous plaques. This research has revealed the correlation between blood dynamic viscosity and the hemodynamic behavior of AVF. Elevated whole blood viscosity increases the incidence of access obstruction and vascular disease leading to fistula failure. The study provides a basis for optimizing the distribution of hemodynamic parameters in the fistula for hemodialysis patients.

Study on the causal relationship between educational attainment and delirium: A two-sample Mendelian randomization study.

This study aimed to investigate whether there is a causal relationship between educational attainment and delirium at the genetic level using the Mendelian randomization method, and provide new evidence for studies in this field. We found a causal relationship between educational attainment and delirium at the genetic level after excluding confounders using Mendelian randomization. The inverse variance weighting method of random effects was the main analysis method. The weighted median and Mendelian Randomization-Egger methods, as well as simple, and weighted modes were used as supplementary analysis methods. Additionally, horizontal pleiotropy tests were conducted, including the Mendelian Randomization-Egger intercept test and Mendelian Randomization Pleiotropy RESidual Sum and Outlier. Cochran's Q statistic was used to assess the size of heterogeneity. We retrieved all second single nucleotide polymorphism features and performed multivariate Mendelian randomization to adjust for the effect of potential confounders on our results. The inverse variance weighting suggested a negative correlation between genetically predicted educational attainment and delirium (0.67[0.49-0.92], p = 0.013); Mendelian Randomization Pleiotropy RESidual Sum and Outlier (0.67[0.49-0.92], p = 0.013) and multivariate Mendelian randomization (0.52[0.33-0.82], p = 0.005) results were generally consistent with the inverse variance weighting method. The Mendelian Randomization-Egger, simple, and weighted mode results were consistent with the inverse variance weighting results. Our results were not affected by pleiotropy or heterogeneity (p > 0.05, for both pleiotropy and heterogeneity). In addition, the "leave-one-out" analysis showed that the results of our Mendelian randomization analysis were not influenced by individual single nucleotide polymorphisms. Studies have found a causal relationship between educational attainment and delirium at the genetic level; higher educational attainment may be a protective factor against delirium. Clinically, more attention should be paid to patients at a high risk of delirium with low educational attainment.

A multifunctional nanogel encapsulating layered double hydroxide for enhanced osteoarthritis treatment via protection of chondrocytes and ECM.

Osteoarthritis (OA) is characterized by progressive and irreversible damage to the articular cartilage and a consecutive inflammatory response. However, the majority of clinical drugs for OA treatment only alleviate symptoms without addressing the fundamental pathology. To mitigate this issue, we developed an inflammation-responsive carrier and encapsulated bioactive material, namely, LDH@TAGel. The LDH@TAGel was designed with anti-inflammatory and antioxidative abilities, aiming to directly address the pathology of cartilage damage. In particular, LDH was confirmed to restore the ECM secretion function of damaged chondrocytes and attenuate the expression of catabolic matrix metalloproteinases (Mmps). While TAGel showed antioxidant properties by scavenging ROS directly. In vitro evaluation revealed that the LDH@TAGel could protect chondrocytes from inflammation-induced oxidative stress and apoptosis via the Nrf2/Keap1 system and Pi3k-Akt pathway. In vivo experiments demonstrated that the LDH@TAGel could alleviated the degeneration and degradation of cartilage induced by anterior cruciate ligament transection (ACLT). The OARSI scores indicating OA severity decreased significantly after three weeks of intervention. Moreover, the IVIS image revealed that LDH@TAGel enhances the controlled release of LDH in a manner that can be customized according to the severity of OA, allowing adaptive, precise treatment. In summary, this novel design effectively alleviates the underlying pathological causes of OA-related cartilage damage and has emerged as a promising biomaterial for adaptive, cause-targeted OA therapies.

St. Jude Survivorship Portal: sharing and analyzing large clinical and genomic datasets from pediatric cancer survivors.

Childhood cancer survivorship studies generate comprehensive datasets comprising demographic, diagnosis, treatment, outcome, and genomic data from survivors. To broadly share this data, we created the St. Jude Survivorship Portal (https://survivorship.stjude.cloud), the first data portal for sharing, analyzing, and visualizing pediatric cancer survivorship data. Over 1,600 phenotypic variables and 400 million genetic variants from over 7,700 childhood cancer survivors can be explored on this free, open-access portal. Summary statistics of variables are computed on-the-fly and visualized through interactive and customizable charts. Survivor cohorts can be customized and/or divided into groups for comparative analysis. Users can also seamlessly perform cumulative incidence and regression analyses on the stored survivorship data. Using the portal, we explored the ototoxic effects of platinum-based chemotherapy, uncovered a novel association between mental health, age, and limb amputation, and discovered a novel haplotype in MAGI3 strongly associated with cardiomyopathy specifically in survivors of African ancestry.

Study on the effect and regularity of plating parts cleaning wastewater by enhanced aerobic process with high-density bacterial flora.

In this research, we established an enhanced aerobic biological method utilizing a high-density bacterial flora for the treatment of low-biochemical plating parts washing wastewater. The elucidation of pollutant removal mechanisms was achieved through a comprehensive analysis of changes in sludge characteristics and bacterial community structure. The results demonstrated that throughout the operational period, the organic load remained stable within the range of 0.01-0.02 kgCOD/kgMLSS·d, the BOD5/COD ratio increased from 0.004 mg/L to 0.33 mg/L, and the average removal rates for key pollutants, including COD, NH4+-N, and TN, reached 98.13%, 99.86%, and 98.09%. MLSS concentration remained at 7627 mg/L, indicating a high-density flora. Notably, Proteobacteria, Bacteroidota, and Acidobacteriota, which have the ability to degrade large organic molecules, had been found in the system. This study affirms the efficacy of the intensive aerobic biological method for treating low-biochemical plating washing wastewater while ensuring system stability.

Robustness of coupled networks with multiple support from functional components at different scales.

Robustness is an essential component of modern network science. Here, we investigate the robustness of coupled networks where the functionality of a node depends not only on its connectivity, here measured by the size of its connected component in its own network, but also the support provided by at least M links from another network. We here develop a theoretical framework and investigate analytically and numerically the cascading failure process when the system is under attack, deriving expressions for the proportion of functional nodes in the stable state, and the critical threshold when the system collapses. Significantly, our results show an abrupt phase transition and we derive the minimum inner and inter-connectivity density necessary for the system to remain active. We also observe that the system necessitates an increased density of links inside and across networks to prevent collapse, especially when conditions on the coupling between the networks are more stringent. Finally, we discuss the importance of our results in real-world settings and their potential use to aid decision-makers design more resilient infrastructure systems.

Psychometric properties evaluation of the Advance Care Planning Readiness Scale for community-dwelling older adults with chronic diseases residing in suburban counties within the Chinese context.

AIM: To evaluate the psychometric properties of the Advance Care Planning Readiness Scale (ACPRS-C) within the context of community-dwelling older adults with chronic diseases residing in suburban counties in China. DESIGN: Descriptive, cross-sectional survey. METHODS: The research method employed in this study is characterized as a methodological study. Self-reported survey data were collected among community-dwelling older adults with chronic diseases residing in suburban counties in China. Including the following psychometric characteristics, item analysis was performed using the decision value method and Pearson's correlation analysis. Content validity was assessed through expert panel evaluation. The internal consistency of the questionnaire was determined by calculating Cronbach's alpha coefficient and corrected item-total correlation. Additionally, confirmatory factor analysis (CFA) was utilized to assess the construct validity of the ACPRS-C. RESULTS: A total of 228 older adults participated in this psychometric study from August to October 2023. The item content validity index ranged from 0.80 to 1.00, while the scale content validity index was 0.945. The scale demonstrated excellent internal consistency (Cronbach's alpha = 0.931), and the correlation between items and total score was satisfactory. The structural validity was deemed robust (CFA model fit: chi-square/df = 1.121, comparative fit index = 0.992). CONCLUSION: The ACPRS-C is a scale with strong psychometric properties to assess the ACP readiness within the context of community-dwelling older adults with chronic diseases residing in suburban counties in China. Its reliability and validity hold considerable significance for both research and clinical practice.

Several inaccurate or erroneous conceptions and misleading propaganda about brain-computer interfaces.

Brain-computer interface (BCI) is a revolutionizing human-computer interaction, which has potential applications for specific individuals or groups in specific scenarios. Extensive research has been conducted on the principles and implementation methods of BCI, and efforts are currently being made to bridge the gap from research to real-world applications. However, there are inaccurate or erroneous conceptions about BCI among some members of the public, and certain media outlets, as well as some BCI researchers, developers, manufacturers, and regulators, propagate misleading or overhyped claims about BCI technology. Therefore, this article summarizes the several misconceptions and misleading propaganda about BCI, including BCI being capable of "mind-controlled," "controlling brain," "mind reading," and the ability to "download" or "upload" information from or to the brain using BCI, among others. Finally, the limitations (shortcomings) and limits (boundaries) of BCI, as well as the necessity of conducting research aimed at countering BCI systems are discussed, and several suggestions are offered to reduce misconceptions and misleading claims about BCI.

A bibliometric analysis of HIV nursing research between 1999 and 2022.

AIM: Human immunodeficiency virus (HIV) nursing has become more prominent with the increase in chronic HIV infections. This study examined articles related to HIV nursing to determine how the profession has developed and its future direction. DESIGN: A bibliometric analysis was conducted. METHODS: HIV nursing-related articles published in the Web of Science core collection between 1999 and 2022 were searched. VOSviewer was used to identify the contributions of countries, institutions and authors in HIV-related care. Collaborative maps, hot topics and keywords trends were analysed using VOSviewer and CiteSpace. RESULTS: A total of 1513 publications were extracted. An increase in articles published between 1999 and 2012 was observed. After 2012, the increase in the number of publications was relatively stable. Since 2016, a downward trend in the number of publications has occurred. The USA, South Africa and the UK were the leading contributors to publications related to HIV nursing. The focus of the HIV nursing research has gradually shifted from "HIV infection", "risk factors", and "transmission routes" to "social support", "depression", and "public health". The result shows that increased collaboration among countries/regions can improve the development of HIV nursing and effectively reduce the global HIV infection rate. The mental health of patients has become a research centre in the field of HIV nursing. This study provides direction in clinical practice and future research areas in this field.

Self-standing bacterial cellulose-reinforced poly(3,4-ethylenedioxythiophene)/poly(4-styrenesulfonate) doped with graphene oxide composite electrodes for high-performance ionic electroactive soft actuators.

Flexible electrode films with good film-forming properties, large deformation ability, high conductivity, and strong charge and discharge capabilities are crucial for ionic electroactive polymer soft actuators. However, there are still challenges in preparing high-quality electrode films that can combine well with the intermediate polyelectrolyte to form high-performance soft actuators. Herein, we propose an advanced sandwich ionic electroactive actuator utilizing self-standing bacterial cellulose (BC) reinforced poly(3,4-ethylenedioxythiophene)/poly(4-styrenesulfonate) (PP) doped with graphene oxide (GO) conductive composite electrodes and a Nafion ion-exchange membrane via a hot-pressing method. The prepared BC-PP-GO electrodes have good film-forming properties with a Young's modulus of 1360 MPa and a high conductivity of 150 S cm-1. The hot-pressed BC-PP-GO/Nafion ionic actuator exhibited a large bending displacement of 6.2 mm (1 V, 0.1 Hz) with a long-term actuation stability up to 95% over 360 cycles without degradation. Furthermore, we introduced the actuator's potential applications including bionic grippers, flies, and fish, providing more opportunities for the development of next-generation micromanipulators and biomimetic microrobots in cm-scale space.

Investigation into the impact of CeO2 morphology regulation on the oxidation process of dichloromethane.

Four distinct CeO2 catalysts featuring varied morphologies (nanorods, nanocubes, nanoparticles, and nano spindle-shaped) were synthesized through a hydrothermal process and subsequently employed in the oxidation of dichloromethane (DCM). The findings revealed that the nano spindle-shaped CeO2 exhibited exposure of crystal faces (111), demonstrating superior catalytic oxidation performance for DCM with a T90 of 337 °C and notably excellent low-temperature catalytic activity (T50 = 192 °C). The primary reaction products were identified as HCl and CO2. Through obvious characterizations, it showed that the excellent catalytic activity presented by CeO2-s catalyst might be related to the higher oxygen vacancy concentration, surface active oxygen content, and superior redox performance caused by specific exposed crystal planes. Meanwhile, CeO2-s catalyst owned outstanding stability, reusability, and water inactivation regeneration, which had tremendous potential in practical treatment.

Association of impulsive behavior and cerebrospinal fluid/plasma oxidation and antioxidation ratio in Chinese men.

OBJECTIVES: Impulsive behavior is the precursor of many psychiatric and neurological conditions. High levels of impulsive behavior will increase health risk behavior and related injuries. Impulsive behavior is produced and regulated by central and peripheral biological factors, and oxidative stress (OS) can aggravate it. However, previous studies only showed that impulsive behavior was related to the level of the peripheral OS. Therefore, this study aims to clarify the relationship between OS and impulsive behavior in the brain and peripheral blood. METHODS: We recruited 64 Chinese men. We measured superoxide dismutase (SOD) (including copper, zinc and manganese) and nitric oxide synthase (NOS) (including total, inducible and constitutive) in cerebrospinal fluid (CSF) and plasma. The Barratt Impulsiveness Scale version 11 (BIS-11) was used to evaluate impulsive behavior. The relationship between OS and impulsive behavior was evaluated by partial correlation analysis and stepwise multiple regression analysis. RESULTS: Partial correlation analysis showed that the ratio of total NOS-to-MnSOD and iNOS-to-MnSOD in CSF were negatively correlated with the BIS-11 motor scores (r = -0.431, p = -0.001; r = -0.434, p = -0.001). Stepwise multiple regression analysis showed that the ratio of CSF iNOS-to-MnSOD was the most influential variable on the BIS-11 motor scores(ß = -0.434, t = -3.433, 95 %CI(-0.374, -0.098), p = 0.001). CONCLUSIONS AND RELEVANCE: The imbalance of central oxidation and antioxidation is related to impulsive behavior, which broadens our understanding of the correlation between impulsive behavior and OS.

[Development of Wireless Wearable Sleep Monitoring System Based on EEG Signal].

A wireless wearable sleep monitoring system based on EEG signals is developed. The collected EEG signals are wirelessly sent to the PC or mobile phone Bluetooth APP for real-time display. The system is small in size, low in power consumption, and light in weight. It can be worn on the patient's forehead and is comfortable. It can be applied to home sleep monitoring scenarios and has good application value. The key performance indicators of the system are compared with the industry-related medical device measurement standards, and the measurement results are better than the special standards.

Resistance and durability of fly ash based geopolymer for heavy metal immobilization: properties and mechanism.

Geopolymer technology is an effective method of fly ash (FA) disposal developed in recent decades. This study provided a novel technology based on geopolymerization for FA resource, which could solve the problem of long-term heavy metal leakage trends. Firstly, Unconfine compressive strength (UCS) of geopolymer and the heavy metals leaching test was taken to discuss the effects of oxidize species. The results indicated that the UCS of geopolymer samples was increased with the increase of CaO, and the largest 28 d UCS was 24.8 MPa when CaO content was 31.5%. When the CaO content was 32%, the leaching concentration of heavy metals was the lowest (Pb2+ was 0.02 mg L-1, Cd2+ was 0.01 mg L-1), and the solidification rate of heavy metal ions were more than 93.6%. Secondly, two methods were used to evaluate the corrosion resistance of FA based geopolymer. The observations suggested that the FA based geopolymer exhibits a high level of resistance to erosion caused by sulfate ions and chloride ions. Thirdly, carbonation tests were taken to discuss the durability of FA based geopolymer. The results shown that UCS exhibited a modest rise following the process of carbonation, and then demonstrated a stable trend after a period of 28 days, and the heavy metal leaching test results that comply with the limitations specified in the national standard at 7, 14, 28, and 56 days. The findings from accelerated carbonization tests at 56 days, determined by empirical equations, suggest that the carbonization age of geopolymers is projected to be 102 years. Finally, XRD, FTIR and SEM were taken to discuss the microstructure characterization of FA based geopolymer, and solidification mechanisms of heavy metal ions by geopolymer materials could be concluded as gelation, physical encapsulation, and chemical reactions.

Two cases of diquat poisoning in adolescent children.

Diquat (DQ) is among the most widely used herbicides, and its intake can cause severe systemic toxicity that manifests rapidly. The resultant symptoms can cause the dysfunction of a range of tissues and organs,. As there is no specific antidote for diquat poisoning and the efficacy of extant treatments is suboptimal, physicians must acquire a more comprehensive understanding of the most effective approaches to managing affected patients. Relative few studies have been published to date focused on diquat poisoning in pediatric patients. In this report, we compare two similar cases of juvenile diquat poisoning with dynamic changes in clinical manifestations, laboratory values, and imaging results. For the first time, the difference in whether to perform blood flow perfusion and the time difference of initiation of hemoperfusion had a clear clinical difference in the subsequent effects of diquat poisoning in children with diquat poisoning. Limited evidence is available regarding the efficacy of early hemoperfusion for diquat poisoning; however, the differences in clinical outcomes articulated here highlight the benefits of early and timely hemoperfusion therapy in the treatment of DQ toxicity in children, in conjunction with primary supportive care in the management of DQ poisoning in children.

Efficacy and safety of fibrin sealant application in patients undergoing thyroidectomy: a systematic review and meta-analysis.

Various studies have focused on the application of fibrin sealants (FS) in thyroid surgery. Utilizing a meta-analysis, this systematic review analyzed the findings of recent randomized controlled trials on the safety and efficacy of FS in patients who underwent thyroidectomy. The Cochrane Library, Web of Science, Embase, PubMed, and Medline databases were searched for relevant studies, without any language restrictions. Seven randomized controlled trials were included in the originally identified 69 studies. Overall, 652 patients received FS during thyroid surgery; their outcomes were compared with those of conventionally treated patients. The primary outcomes were total volume of wound drainage, length of hospitalization, and operative time. Significant differences were observed in the total volume of wound drainage (mean deviation (MD): -29.75, 95% confidence interval (CI): -55.39 to -4.11, P = 0.02), length of hospitalization (MD: -0.84, 95% CI: -1.02 to -0.66, P < 0.00001), and surgery duration (MD: -7.60, 95% CI: -14.75 to -0.45, P = 0.04). Secondary outcomes were seroma and hypoparathyroidism development. The risk of hypoparathyroidism did not differ between the FS and conventional groups (I = 0%, relative risk = 1.31, P = 0.38). Analysis of "seroma formation that required invasive treatment" indicated that FS showed some benefit (I2 = 8%, relative risk 0.44, P = 0.15). Heterogeneity among the different trials limited their conclusions. The meta-analysis showed that although FS use did not significantly reduce seroma or hypoparathyroidism incidence in patients after thyroidectomy, it significantly reduced the total drainage volume, length of hospitalization, and duration of surgery.

Constructing a 3D Zinc Anode Exposing the Zn(002) Plane for Ultralong Life Zinc-Ion Batteries.

The limited lifespan of aqueous Zn-ion batteries (ZIBs) is primarily attributed to the irreversible issues associated with the Zn anode, including dendrite growth, hydrogen evolution, and side reactions. Herein, a 3D Zn anode exposing Zn(002) crystal planes (3D-Zn(002) anode) is first constructed by an electrostripping method in KNO3 solution. Experiments and theoretical calculations indicate that the priority adsorption of KNO3 on Zn(100) and Zn(101) planes decreases the dissolution energy of Zn atoms, thereby exposing more Zn(002) planes. The 3D-Zn(002) anode effectively regulates ion flux to realize the uniform nucleation of Zn2+. Moreover, it can inhibit water-induced formation of side-products and hydrogen evolution reaction. Consequently, the 3D-Zn(002) symmetrical cell exhibits an exceptionally long lifespan surpassing 6000 h at 5.0 mA cm-2 with a capacity of 1.0 mAh cm-2, and enduring 8500 cycles at 30 mA cm-2 with a capacity of 1.0 mAh cm-2. Besides, when NH4V4O10 is used as the cathode, the 3D-Zn(002)//NH4V4O10 full cell shows stable cycling performance with a capacity retention rate of 75.7% after 4000 cycles at 5.0 A g-1. This study proposes a feasible method employing a 3D-Zn(002) anode for enhancing the cycling durability of ZIBs.

Long-term second-generation antipsychotics decreases bone formation and resorption in male patients with schizophrenia.

RATIONALE: Patients with schizophrenia with second-generation antipsychotics (SGAs) treatment have shown an increased risk of bone fragility and susceptibility to fracture; however, it is still unclear whether this risk is derived from the effect of antipsychotics on balance of bone metabolism. OBJECTIVES: We investigated the changes of two bone turnover biomarkers (BTMs) concentrations in people with schizophrenia receiving SGAs: procollagen type I aminoterminal propeptide (PINP) and C-terminal telopeptide of type I collagen (CTX-1) as BTMs of osteogenesis and bone resorption, respectively, to explore how antipsychotics contribute to bone fragility. METHODS: We recruited 59 Chinese male patients with schizophrenia (32 drug-naïve first-episode (DNFE) patients and 27 chronic patients) to undergo 8 weeks SGAs treatment. Fasting peripheral blood samples of pre- and posttreatment were collected, plasma levels of PINP and CTX-1 were measured. RESULTS: The interaction effects of group and time on PINP and CTX-1 concentrations were found (P = .016 and P = .008). There was a significant decrease for both BTMs concentrations of the posttreatment compared to the pretreatment (P<.001 and P = .003). Chronic patients had significantly higher changes of BTMs concentrations compared to DNFE patients (P = .048 and P = .024). There was a positive correlation of the two BTMs of pretreatment with disease course in DNFE group (r = .37, P = .039;r = .38, P = .035) and a negative correlation of PINP of pretreatment with age in the chronic group (r=-.40, P = .039). CONCLUSION: Long-term SGAs medication inhibited osteogenesis in a dose- and time-dependent manner and damaged the balance of bone formation and bone resorption.

Assessment of iodine nutritional status and gestational thyroid function reference ranges during the first trimester of pregnancy in Taiwan.

BACKGROUND: Iodine nutrition is critical for fetal neurodevelopment in the first trimester of pregnancy, a period associated with dramatic changes in thyroid function. The aim of this study was to evaluate iodine nutritional status and thyroid function reference ranges in the first trimester in Taiwan. METHODS: Pregnant women aged 20 years and above in the first trimester were recruited in Taipei Veterans General Hospital, Taiwan from March 2019 to July 2022. Each participant provided a spot urine sample for measurement of urinary iodine concentration (UIC) and a blood sample for check-up of thyroid function and thyroid autoantibodies. A simple food frequency questionnaire was also completed. RESULTS: A total of 209 women with a mean age of 32.9 ± 4.4 years were enrolled. The median UIC was 160.9 µg/L [interquartile range (IQR): 105.0-246.2 µg/L], indicating overall iodine sufficiency. The gestational thyroid function reference ranges were: TSH [median: 0.93 (0.007-2.9) µIU/mL], free T4 [1.3 (0.93-2.2) ng/dL], free T3 [3.0 (2.3-5.0) ng/dL], total T4 [9.9 (6.4-16.9) ng/dL] and total T3 [135 (88-231) ng/dL]. If the non-pregnant reference range of serum TSH was used, eight women (4.8%) would be misclassified as having subclinical hyperthyroidism, and two women (1.2%) with subclinical hypothyroidism would be missed. In multivariate analysis, nulliparous [adjusted odds ratio (OR) from model 1-3: 2.02, 2.05, 2.02; 95% confidence interval (CI): 1.08-3.77, 1.10-3.81, 1.11-3.66; p = 0.027, 0.023, 0.022, respectively] and multivitamin non-users (adjusted OR from model 1-3: 1.86, 1.85, 1.78; 95% CI: 1.04-3.34, 1.03-3.32, 1.004-3.71; p = 0.038, 0.039, 0.049, respectively) had increased odds of having lower UIC levels <150 µg/L. CONCLUSION: The iodine nutritional status in the first trimester is adequate in Taiwan; however, certain subgroups such as nulliparous and multivitamin non-users are still at risk for iodine deficiency. Gestational thyroid function reference ranges are needed for correct diagnosis of thyroid dysfunction in pregnancy.