Two new compounds, 3-methyl-but-2-en-1-yl-1-O-β-xylopyranosyl-(1ʺ→2ʹ)-O-β-glucopyranoside (1) and 1-O-β-glucopyranosyl-6-hydroxy-2-methyl-hep-2-enoic acid (2), along with sixteen known terpenoids were isolated from the peels ofCitrus unshiu Markov. Their structures were elucidated based on extensive NMR analyses ( 1 H NMR, 13 C NMR, DEPT, COSY, HMQC, and HMBC) and high-resolution mass spectrometry. In addition, all isolates (1 - 18) were tested their effects on nitric oxide (NO) production in RAW264.7 cells. Limonin (15) showed to inhibit LPS-induced NO production in a concentration-dependent manner without cytotoxicity.

Hydrothorax complicating continuous ambulatory peritoneal dialysis (CAPD) occurs approximately 2% of continuous ambulatory peritoneal dialysis. Management might begin with interruption of peritoneal dialysis for 2-6 weeks. But, approximately half of the patients failed to respond to the conservative approach, as thus some authors advocated the combined use of intrapleural sclerosing agents and discontinuation of CAPD. As a rule of thumb, a 10-day wait is recommended after pleurodesis before resuming CAPD. As opposed to closed pleurodesis, the diaphragmatic defects can be identified and repaired under direct vision with surgical approach. But, limited eligibility of dialysis patients for open thoracostomy or video-assisted thoracostomy has been a major impediment for this definitive treatment of choice. From 1999 to 2003, among patients undergoing CAPD in Korea University Hospital, hydrothorax developed in four patients. Discontinuation of CAPD and conventional pleurodesis were performed. Three patients were treated successfully. A patient who interrupted peritoneal dialysis only for four days recurred after resuming CAPD. In conclusion, when pleural effusion complicates in a CAPD patient, chemical pleurodesis and cessation of CAPD during at least 10 days might be an initial tratement of choice.
Dialysis ; Humans ; Hydrothorax* ; Korea ; Peritoneal Dialysis* ; Peritoneal Dialysis, Continuous Ambulatory ; Pleural Effusion ; Pleurodesis* ; Sclerosing Solutions ; Thoracostomy ; Thumb

Patients with neurofibromatosis type 1 (NF1) are at increased risk of developing tumors throughout the gastrointestinal tract, including neuromas, gastrointestinal stromal tumors (GISTs), and periampullary somatostatin-rich carcinoids. The simultaneous occurrence of a GIST and a well-differentiated neuroendocrine carcinoma in a patient with NF1 is very rare. Here, we report two cases of the coexistence of a low-risk GIST in the jejunum with a well-differentiated neuroendocrine carcinoma in the duodenum in patients with NF1. These cases strengthen the known association of GIST with neuroendocrine carcinoma in patients with NF1.
Carcinoid Tumor ; Carcinoma, Neuroendocrine ; Duodenum ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans ; Jejunum ; Neurofibromatoses ; Neurofibromatosis 1 ; Neuroma

Patients with neurofibromatosis type 1 (NF1) are at increased risk of developing tumors throughout the gastrointestinal tract, including neuromas, gastrointestinal stromal tumors (GISTs), and periampullary somatostatin-rich carcinoids. The simultaneous occurrence of a GIST and a well-differentiated neuroendocrine carcinoma in a patient with NF1 is very rare. Here, we report two cases of the coexistence of a low-risk GIST in the jejunum with a well-differentiated neuroendocrine carcinoma in the duodenum in patients with NF1. These cases strengthen the known association of GIST with neuroendocrine carcinoma in patients with NF1.
Carcinoid Tumor ; Carcinoma, Neuroendocrine ; Duodenum ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans ; Jejunum ; Neurofibromatoses ; Neurofibromatosis 1 ; Neuroma

Background: Prostate-specific antigen-based routine screening is not recommended for the general population due to conflicting results with mortality reduction. We aimed to develop a web-based decision aid (DA) for informed decision making for prostate cancer screening. Methods: Using the International Patient Decision Aid Standards (IPDAS) development process model, we developed our DA based on patient and clinician interviews and multidisciplinary expert discussions. The prototype consisted of predicting individual prostate cancer risk and informed decision-making, including knowledge, risk and benefit, cost, personal value, and decision making. We conducted a pilot study on 101 healthy men, evaluating the effectiveness of DA by measuring knowledge, attitude, and intention to screen before and after using the DA, as well as decisional conflict and usefulness after using the DA. Results: Of the 101 participants (median age 60 [50–69] years), 84% had not undergone screening for prostate cancer in the past two years. After using the DA, knowledge on prostate cancer screening increased (mean score [of 10] before versus after: 6.85 ± 1.03 versus 7.57 ± 1.25; P < 0.001), and intention to not screen increased from 27.7% to 51.5% (P < 0.001), but attitude toward screening did not change (P = 0.564). After use of the DA, 79 participants reported no decisional conflict, and the usefulness score was high (mean score [of 100] 77.35 ± 7.69), with 85% of participants reporting that the DA helped with decision making. Conclusion Our web-based DA yielded increased knowledge, decreased screening intention, and high perceived usefulness. These findings indicate potential clinical relevance, especially among younger individuals.

Background: The increasing rate of cesarean delivery (CD) is a significant concern in many societies worldwide. Vaginal delivery (VD) is preferred over CD for subsequent pregnancies after successful VD, for women with no specific obstetrical indications, primarily because of concerns about potential complications arising from the surgical procedure. However, the factors that influence the decision of requesting a CD have not yet been thoroughly investigated. This study aimed to examine the underlying reasons that lead mothers to choose CDs in subsequent pregnancies following a VD. Methods: This retrospective study included women who underwent VD in their first pregnancy between 2011 and 2020 and had a second pregnancy and childbirth within the study period. The analysis focused on women eligible for a trial of labor (TOL) in their second pregnancy, excluding those with conditions necessitating a CD. The study defined two groups: the TOL in second pregnancy (TOLS) group, consisting of women with one previous VD who attempted a VD in their subsequent pregnancy; and the CD on maternal request in second pregnancy (CDRS) group, comprising women with one past VD who opted for a CD in their second pregnancy without medical indication. The TOLS and CDRS groups were compared regarding obstetric and neonatal outcomes. Results: During the study period, 372,749 women met the inclusion criteria: 368,311 women in TOLS group and 4,438 women in CDRS group. In the regression analysis for the CDRS, several factors were identified as increasing the risk of choosing CD, including age (adjusted odds ratio [aOR], 1.06; 95% confidence interval [CI], 1.05–1.07), interval between the first and second pregnancies (aOR, 1.32; 95% CI 1.29–1.35), a history of pre-existing hypertension (aOR, 1.76; 95% CI, 1.17–2.65), gestational diabetes mellitus (GDM) during the first pregnancy (aOR, 1.19; 95% CI, 1.05–1.36), hypertensive disease during pregnancy (HDP) (aOR, 1.33; 95% CI, 1.06–1.67), preterm labor during the first pregnancy (aOR, 1.57;95% CI, 1.32–1.86), postpartum hemorrhage (aOR, 1.33; 95% CI, 1.21–1.47), traumatic event during delivery (aOR, 1.19; 95% CI, 1.12–1.28), surgical VD (aOR, 1.29; 95% CI, 1.19–1.40), and pregnancies with abortive outcomes between the first and second pregnancies (aOR, 1.18; 95% CI, 1.08–1.29). Additionally, women with pre-existing diabetes (aOR, 1.53; 95% CI, 1.24–1.89), pre-existing hypertension (aOR, 1.69; 95% CI, 1.26–2.26), GDM (aOR, 1.23; 95% CI, 1.11–1.37), or HDP (aOR, 2.57; 95% CI, 2.24–2.94) during the second pregnancy continued to exhibit an increased risk of opting for CD even after adjustment. Conclusion CD after VD was more prevalent among women with certain demographic characteristics and obstetric histories. Investigating the factors influencing women to request CD can be helpful in making informed decisions about safe delivery methods and may also affect the CD rate.

Background: The increasing rate of cesarean delivery (CD) is a significant concern in many societies worldwide. Vaginal delivery (VD) is preferred over CD for subsequent pregnancies after successful VD, for women with no specific obstetrical indications, primarily because of concerns about potential complications arising from the surgical procedure. However, the factors that influence the decision of requesting a CD have not yet been thoroughly investigated. This study aimed to examine the underlying reasons that lead mothers to choose CDs in subsequent pregnancies following a VD. Methods: This retrospective study included women who underwent VD in their first pregnancy between 2011 and 2020 and had a second pregnancy and childbirth within the study period. The analysis focused on women eligible for a trial of labor (TOL) in their second pregnancy, excluding those with conditions necessitating a CD. The study defined two groups: the TOL in second pregnancy (TOLS) group, consisting of women with one previous VD who attempted a VD in their subsequent pregnancy; and the CD on maternal request in second pregnancy (CDRS) group, comprising women with one past VD who opted for a CD in their second pregnancy without medical indication. The TOLS and CDRS groups were compared regarding obstetric and neonatal outcomes. Results: During the study period, 372,749 women met the inclusion criteria: 368,311 women in TOLS group and 4,438 women in CDRS group. In the regression analysis for the CDRS, several factors were identified as increasing the risk of choosing CD, including age (adjusted odds ratio [aOR], 1.06; 95% confidence interval [CI], 1.05–1.07), interval between the first and second pregnancies (aOR, 1.32; 95% CI 1.29–1.35), a history of pre-existing hypertension (aOR, 1.76; 95% CI, 1.17–2.65), gestational diabetes mellitus (GDM) during the first pregnancy (aOR, 1.19; 95% CI, 1.05–1.36), hypertensive disease during pregnancy (HDP) (aOR, 1.33; 95% CI, 1.06–1.67), preterm labor during the first pregnancy (aOR, 1.57;95% CI, 1.32–1.86), postpartum hemorrhage (aOR, 1.33; 95% CI, 1.21–1.47), traumatic event during delivery (aOR, 1.19; 95% CI, 1.12–1.28), surgical VD (aOR, 1.29; 95% CI, 1.19–1.40), and pregnancies with abortive outcomes between the first and second pregnancies (aOR, 1.18; 95% CI, 1.08–1.29). Additionally, women with pre-existing diabetes (aOR, 1.53; 95% CI, 1.24–1.89), pre-existing hypertension (aOR, 1.69; 95% CI, 1.26–2.26), GDM (aOR, 1.23; 95% CI, 1.11–1.37), or HDP (aOR, 2.57; 95% CI, 2.24–2.94) during the second pregnancy continued to exhibit an increased risk of opting for CD even after adjustment. Conclusion CD after VD was more prevalent among women with certain demographic characteristics and obstetric histories. Investigating the factors influencing women to request CD can be helpful in making informed decisions about safe delivery methods and may also affect the CD rate.

Background: The increasing rate of cesarean delivery (CD) is a significant concern in many societies worldwide. Vaginal delivery (VD) is preferred over CD for subsequent pregnancies after successful VD, for women with no specific obstetrical indications, primarily because of concerns about potential complications arising from the surgical procedure. However, the factors that influence the decision of requesting a CD have not yet been thoroughly investigated. This study aimed to examine the underlying reasons that lead mothers to choose CDs in subsequent pregnancies following a VD. Methods: This retrospective study included women who underwent VD in their first pregnancy between 2011 and 2020 and had a second pregnancy and childbirth within the study period. The analysis focused on women eligible for a trial of labor (TOL) in their second pregnancy, excluding those with conditions necessitating a CD. The study defined two groups: the TOL in second pregnancy (TOLS) group, consisting of women with one previous VD who attempted a VD in their subsequent pregnancy; and the CD on maternal request in second pregnancy (CDRS) group, comprising women with one past VD who opted for a CD in their second pregnancy without medical indication. The TOLS and CDRS groups were compared regarding obstetric and neonatal outcomes. Results: During the study period, 372,749 women met the inclusion criteria: 368,311 women in TOLS group and 4,438 women in CDRS group. In the regression analysis for the CDRS, several factors were identified as increasing the risk of choosing CD, including age (adjusted odds ratio [aOR], 1.06; 95% confidence interval [CI], 1.05–1.07), interval between the first and second pregnancies (aOR, 1.32; 95% CI 1.29–1.35), a history of pre-existing hypertension (aOR, 1.76; 95% CI, 1.17–2.65), gestational diabetes mellitus (GDM) during the first pregnancy (aOR, 1.19; 95% CI, 1.05–1.36), hypertensive disease during pregnancy (HDP) (aOR, 1.33; 95% CI, 1.06–1.67), preterm labor during the first pregnancy (aOR, 1.57;95% CI, 1.32–1.86), postpartum hemorrhage (aOR, 1.33; 95% CI, 1.21–1.47), traumatic event during delivery (aOR, 1.19; 95% CI, 1.12–1.28), surgical VD (aOR, 1.29; 95% CI, 1.19–1.40), and pregnancies with abortive outcomes between the first and second pregnancies (aOR, 1.18; 95% CI, 1.08–1.29). Additionally, women with pre-existing diabetes (aOR, 1.53; 95% CI, 1.24–1.89), pre-existing hypertension (aOR, 1.69; 95% CI, 1.26–2.26), GDM (aOR, 1.23; 95% CI, 1.11–1.37), or HDP (aOR, 2.57; 95% CI, 2.24–2.94) during the second pregnancy continued to exhibit an increased risk of opting for CD even after adjustment. Conclusion CD after VD was more prevalent among women with certain demographic characteristics and obstetric histories. Investigating the factors influencing women to request CD can be helpful in making informed decisions about safe delivery methods and may also affect the CD rate.

Background: The increasing rate of cesarean delivery (CD) is a significant concern in many societies worldwide. Vaginal delivery (VD) is preferred over CD for subsequent pregnancies after successful VD, for women with no specific obstetrical indications, primarily because of concerns about potential complications arising from the surgical procedure. However, the factors that influence the decision of requesting a CD have not yet been thoroughly investigated. This study aimed to examine the underlying reasons that lead mothers to choose CDs in subsequent pregnancies following a VD. Methods: This retrospective study included women who underwent VD in their first pregnancy between 2011 and 2020 and had a second pregnancy and childbirth within the study period. The analysis focused on women eligible for a trial of labor (TOL) in their second pregnancy, excluding those with conditions necessitating a CD. The study defined two groups: the TOL in second pregnancy (TOLS) group, consisting of women with one previous VD who attempted a VD in their subsequent pregnancy; and the CD on maternal request in second pregnancy (CDRS) group, comprising women with one past VD who opted for a CD in their second pregnancy without medical indication. The TOLS and CDRS groups were compared regarding obstetric and neonatal outcomes. Results: During the study period, 372,749 women met the inclusion criteria: 368,311 women in TOLS group and 4,438 women in CDRS group. In the regression analysis for the CDRS, several factors were identified as increasing the risk of choosing CD, including age (adjusted odds ratio [aOR], 1.06; 95% confidence interval [CI], 1.05–1.07), interval between the first and second pregnancies (aOR, 1.32; 95% CI 1.29–1.35), a history of pre-existing hypertension (aOR, 1.76; 95% CI, 1.17–2.65), gestational diabetes mellitus (GDM) during the first pregnancy (aOR, 1.19; 95% CI, 1.05–1.36), hypertensive disease during pregnancy (HDP) (aOR, 1.33; 95% CI, 1.06–1.67), preterm labor during the first pregnancy (aOR, 1.57;95% CI, 1.32–1.86), postpartum hemorrhage (aOR, 1.33; 95% CI, 1.21–1.47), traumatic event during delivery (aOR, 1.19; 95% CI, 1.12–1.28), surgical VD (aOR, 1.29; 95% CI, 1.19–1.40), and pregnancies with abortive outcomes between the first and second pregnancies (aOR, 1.18; 95% CI, 1.08–1.29). Additionally, women with pre-existing diabetes (aOR, 1.53; 95% CI, 1.24–1.89), pre-existing hypertension (aOR, 1.69; 95% CI, 1.26–2.26), GDM (aOR, 1.23; 95% CI, 1.11–1.37), or HDP (aOR, 2.57; 95% CI, 2.24–2.94) during the second pregnancy continued to exhibit an increased risk of opting for CD even after adjustment. Conclusion CD after VD was more prevalent among women with certain demographic characteristics and obstetric histories. Investigating the factors influencing women to request CD can be helpful in making informed decisions about safe delivery methods and may also affect the CD rate.

Background: Maladaptation to vascular, metabolic, and physiological changes during pregnancy can lead to fetal growth disorders. Moreover, adverse outcomes during pregnancy can further increase the risk of cardiovascular and metabolic diseases in mothers. Delivering a large-for-gestational-age (LGA) baby may indicate a pre-existing metabolic dysfunction, whereas delivering a small-for-gestational-age (SGA) baby may indicate a pre-existing vascular dysfunction. This study aims to assess the risk of hypertension (HTN) and diabetes mellitus (DM) in women with normal body mass index (BMI) scores who did not experience gestational DM or hypertensive disorders during pregnancy based on the offspring’s birthweight. Methods: This retrospective nationwide study included women with normal BMI scores who delivered a singleton baby after 37 weeks. Women with a history of DM or HTN before pregnancy and those with gestational DM or hypertensive disorders, were excluded from the study. We compared the risk of future maternal outcomes (HTN and DM) according to the offspring’s birthweight. Multivariate analyses were performed to estimate the hazard ratio (HR) for the future risk of HTN or DM. Results: A total of 64,037 women were included in the analysis. Of these, women who delivered very LGA babies (birthweight > 97th percentile) were at a higher risk of developing DM than those who delivered appropriate-for-gestational-age (AGA) babies (adjusted HR = 1.358 [1.068–1.727]), and women who delivered very SGA babies (birthweight < 3rd percentile) were at a higher risk of developing HTN than those who delivered AGA babies (adjusted HR = 1.431 [1.181–1.734]), even after adjusting for age, parity, gestational age at delivery, fetal sex, maternal BMI score, and a history of smoking. Conclusion These findings provide a novel support for the use of the offspring’s birthweight as a predictor of future maternal diseases such as HTN and DM.