Immunomodulation of Fungal β-Glucan in Host Defense Signaling by Dectin-1

During the course of evolution, animals encountered the harmful effects of fungi, which are strong pathogens. Therefore, they have developed powerful mechanisms to protect themselves against these fungal invaders. β-Glucans are glucose polymers of a linear β(1,3)-glucan backbone with β(1,6)-linked side chains. The immunostimulatory and antitumor activities of β-glucans have been reported; however, their mechanisms have only begun to be elucidated. Fungal and particulate β-glucans, despite their large size, can be taken up by the M cells of Peyer''s patches, and interact with macrophages or dendritic cells (DCs) and activate systemic immune responses to overcome the fungal infection. The sampled β-glucans function as pathogen-associated molecular patterns (PAMPs) and are recognized by pattern recognition receptors (PRRs) on innate immune cells. Dectin-1 receptor systems have been incorporated as the PRRs of β-glucans in the innate immune cells of higher animal systems, which function on the front line against fungal infection, and have been exploited in cancer treatments to enhance systemic immune function. Dectin-1 on macrophages and DCs performs dual functions: internalization of β-glucan-containing particles and transmittance of its signals into the nucleus. This review will depict in detail how the physicochemical nature of β-glucan contributes to its immunostimulating effect in hosts and the potential uses of β-glucan by elucidating the dectin-1 signal transduction pathway. The elucidation of β-glucan and its signaling pathway will undoubtedly open a new research area on its potential therapeutic applications, including as immunostimulants for antifungal and anti-cancer regimens.     

Prevalence of urinary incontinence in older Korean women

Worldwide prevalence of any type urinary incontinence (UI) in women 20 years and over is estimated to be over 275 million in 2013 and the 4th International Consultation on Incontinence expects it to increase to over 300 million in 2018. While UI in women is considered to be an aging and public health issue with global implications, most research cited in the UI literature comes from English language sources. The absence of information from many Asian and other countries may be due to reliance on scientific reports written in English by editorial policies, authors of systematic literature reviews and other researchers. Moreover, the financial costs and time constraints associated with translation and dissemination of findings into English language journals could act as dissemination barriers. Therefore, the purpose of this study was to describe the current state of knowledge about prevalence and correlates of UI in Korean older women from non‐English language sources. Twelve research articles, two research monographs and one master's thesis, and data on UI abstracted from South Korea's 2008 National Health Insurance Cooperation Reports were reviewed in full. The prevalence of UI in women 60 years and older ranged from 11·2% to 76·3%. Personal, physical and psychological factors were found to be associated with UI including age, income and educational level, presence of comorbidities, body mass index, depression, anxiety and cognitive impairment. There was little difference between rural and urban dwelling older women in help‐seeking behavior: 93.8% rural and 90.5% urban dwelling older women sought no help for their incontinence. Inclusion of reports from non‐English sources is considered as an important contribution to better understanding of the worldwide epidemiology of UI in older women.     

Elderly long-term care in Korea

The national mandatory elderly long-term care insurance (LTCI) was established in Korea in July 2008. One year after introduction of the LTCI, 5.2% of the elderly population aged 65 years and older were beneficiaries. The applicant's caregiver(s) submit an application form along with a statement of a doctor's medical opinion to the National Health Insurance Corporation, after which one or two National Health Insurance Corporation staff members (either a nurse or social worker) visit the applicant's house to evaluate their physical and mental status.The majority of beneficiaries are reported to have one or more chronic conditions. The problem is that national LTCI and national medical insurance are separate now in Korea. However, it is almost impossible to separate long-term care and health care. Even though long-term care facilities contract physicians or hospitals to have physicians visit care facilities regularly, the reward for these physicians is not satisfactory and sometimes they work without pay. Furthermore, contracted physicians cannot properly manage the elderly in long-term care facilities because they are not legally allowed to provide any medical services to long-term care facilities except for prescribing medicine.The efficient linkage of long-term care and health care is a big task in Korea that is under discussion by full-time physicians working for long-term care facilities.     

Is There Any Objective Improvement of Nocturia by Combination Treatment of Zolpidem and Alpha‐Blocker Therapy for Unresponsive to Alpha‐Blocker Monotherapy in Men with Lower Urinary Tract Symptoms?

Objectives: The aim of the present study was to determine whether administration of zolpidem, a nonbenzodiazepine sedative‐hypnotic agent, at night would improve the nocturia unresponsive to alpha‐blocker monotherapy in men with lower urinary tract symptoms (LUTS). Methods: This was a prospective observational study comprised of 39 men aged 50 years and older. The study inclusion criteria were age more than 50 years, and nocturia twice or more per night after taking alpha‐blockers for more than 8 weeks. A total of 39 patients met the criteria and constituted the study cohort. Pittsburgh Sleep Quality Index (PSQI), International Prostate Symptom Score (IPSS), frequency volume chart (FVCs) and uroflowmetry were recorded. Patients were given 10 mg alfuzosin and 10 mg zolpidem once at night for the 8 weeks. Results: There were no serious side‐effects in any patient. Nocturia decreased from a baseline (3.1 ± 0.1) to 8 weeks (1.6 ± 0.2) (P = 0.001). After treatment, global PSQI scores and severe sleep disorders improved. Storage and voiding symptoms including total IPSS scores and quality of life index improved. Nocturnal urine volume and functional bladder capacity improved. Maximum flow rate, voided volume increased and residual urine volume decreased. Conclusion: Combined zolpidem and alpha‐blocker therapy resulted in a subjective and objective reduction in nocturia episodes when given to men with nocturia unresponsive to alpha‐blocker monotherapy.