Yingxi Xu

Objective: Gestational transient thyrotoxicosis (GTT) and Graves’ disease (GD) are the most common causes of hyperthyroidism during pregnancy. However, few studies have compared pregnancy outcomes of patients who had GTT to those who had GD in the first trimester of pregnancy. Methods: We conducted a prospective, multicenter cohort study in China. Participants received questionnaires, physical examinations, and underwent measurements of TSH, FT4, TPOAb, TRAb, and urinary iodine in the first trimester. The patients diagnosed with either GTT or GD and normal thyroid function (NTF) group were followed until delivery. The thyroid function and pregnancy outcomes were reported. Results: A total of 125 pregnant women with thyrotoxicosis and 246 age-matched pregnant women with NTF were included. (1) The thyroid function of GTT group returned to normal range in the third trimester, but was consistently abnormal in GD group. (2) The incidence of gestational diabetes mellitus (GDM) in GTT group (11.5%, 9/78) was significantly higher than that in NTF group (4.9%, 12/246) (P = 0.037). The incidence of premature delivery in GD untreated (30.8%, 8/26, P = 0.002) and treated group (28.6%, 6/21, P = 0.008) were both respectively higher than in the NTF group (7.7%, 19/246). Miscarriage (15.4%, 4/26 vs. 3.7%, 9/246, P = 0.026) and gestational hypertension were more prevalent in GD untreated group (19.2%, 5/26 vs. 3.3%, 8/246, P = 0.004) than in NTF group. (3) The presence of positive TRAb and positive TPOAb in the first trimester were independent risk factors for miscarriage (OR = 5.23, 95% CI = 1.11–24.78, P = 0.037) and low birth weight infants (OR = 7.76, 95% CI = 1.23–48.86, P = 0.029), respectively. Conclusion: In conclusion, pregnancy outcomes appear variable, according to the etiology of first trimester thyrotoxicosis. GTT appears to be associated with GDM. GD appears to be associated with an increased risk of premature delivery, gestational hypertension, and miscarriage. The diagnosis of GTT and GD patients in early pregnancy and appropriate treatment of GD patients may be associated with improved pregnancy outcomes.

Peripheral nerve regeneration after injury is still a clinical problem. The application of autologous nerve grafting, the gold standard treatment, is greatly restricted. Acellular nerve allografts (ANAs) are considered promising alternatives, but they are difficult to achieve satisfactory therapeutic outcomes, which may be attributed to their compact inherent ultrastructure and substantial loss of extracellular matrix (ECM) components. Regarding these deficiencies, this study developed an optimized multichannel ANA by a modified decellularization method. These innovative ANAs were demonstrated to retain more ECM bioactive molecules and regenerative factors, with effective elimination of cellular antigens. The presence of microchannels with larger pore size allowed ANAs to gain higher porosity and better swelling performance, which improves their internal ultrastructure. Their mechanical properties were more similar to those of native nerves. Moreover, the optimized ANAs exhibited good biocompatibility and possessed significant advantages in supporting the proliferation and migration of Schwann cells in vitro. The in vivo results further confirmed their superior capacity to promote axon regrowth and myelination as well as restore innervation of target muscles, leading to better functional recovery than the conventional ANAs. Overall, this study demonstrates that the optimized multichannel ANAs have great potential for clinical application and offer new insight into the further improvement of ANAs.