Tzu Chi Medical Journal最新文献

{"title":"Optimizing neourethral coverage in urethroplasty for hypospadias with tunica vaginalis versus dartos fascia: A systematic review and meta-analysis.","authors":"Muhammad Haritsyah Warli, Dianita Halimah Harahap, Elbert Elbert, Felix Khosasi, Kharisma Prasetya Adhyatma","doi":"10.4103/tcmj.TCMJ-D-25-00165","DOIUrl":"10.4103/tcmj.TCMJ-D-25-00165","url":null,"abstract":"<p><strong>Objectives: </strong>Hypospadias repair requires second-layer coverage to minimize complications. This study compares tunica vaginalis flap (TVF) and dartos fascia (DF) as second-layer materials in tubularized incised plate (TIP) urethroplasty, focusing on postoperative complications, functional outcomes, and cosmetic results to determine the superior option.</p><p><strong>Materials and methods: </strong>Comparative studies on TVF versus DF in TIP urethroplasty were identified through five databases (PubMed, Scopus, ScienceDirect, Cochrane Library, and Google Scholar; January 2015-January 2025). A modified PICO framework guided the search, and risk of bias (RoB) was assessed using RoB 2 and ROBINS-I. Meta-analysis evaluated postoperative complications.</p><p><strong>Results: </strong>Ten studies comparing TVF and DF in TIP hypospadias repair were included in the study. TVF significantly reduced the risk of urethrocutaneous fistula (UCF) (risk ratios [RR] = 0.27; 95% confidence interval [CI]: 0.16-0.46; <i>P</i> < 0.00001), wound infection (RR = 0.40; 95% CI: 0.24-0.66; <i>P</i> = 0.0003), wound dehiscence (RR = 0.61; 95% CI: 0.38-0.98; <i>P</i> = 0.04), and penile skin necrosis (RR = 0.22; 95% CI: 0.06-0.73; <i>P</i> = 0.01), with minimal heterogeneity. No significant differences were found for meatal stenosis, urethral stricture, glans dehiscence, residual chordee, or torsion. Cosmetic outcomes slightly favored TVF, although assessment heterogeneity limited definitive conclusions. Functional outcomes were comparable between groups.</p><p><strong>Conclusion: </strong>Findings from this meta-analysis suggest that the tunica vaginalis flap may be associated with lower rates of selected postoperative complications, particularly UCF, wound infection, wound dehiscence, and penile skin necrosis, compared with dartos fascia in TIP hypospadias repair, whereas cosmetic and functional outcomes appear comparable between the two techniques.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"38 3","pages":"383-396"},"PeriodicalIF":2.4,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strengthening the shield: Cognitive behavioral therapy as a critical adjunct in ovarian cancer chemotherapy - Evidence from a systematic review and meta-analysis of randomized controlled trials.","authors":"Dwi Faradina, Cut Adeya Adella, Felix Khosasi, Elbert Elbert","doi":"10.4103/tcmj.TCMJ-D-25-00158","DOIUrl":"10.4103/tcmj.TCMJ-D-25-00158","url":null,"abstract":"<p><p>Ovarian cancer is the most lethal gynecologic malignancy and is frequently diagnosed at an advanced stage. Chemotherapy remains a cornerstone of treatment but is commonly associated with psychological distress, including anxiety, depression, fatigue, and reduced quality of life (QoL). This systematic review and meta-analysis evaluated the effects of cognitive behavioral therapy (CBT) in women with ovarian cancer undergoing chemotherapy. The study was registered in PROSPERO and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Randomized controlled trials published between 2018 and 2025 were identified through PubMed, Scopus, ScienceDirect, and Google Scholar. Risk of bias (RoB-2) was assessed using the Cochrane RoB 2 tool. Outcomes included depression and anxiety measured by the Self-Rating Depression Scale (SDS), Patient Health Questionnaire-8, Hospital Anxiety and Depression Scale (HADS), and Self-Rating Anxiety Scale (SAS), fatigue, fear of cancer recurrence assessed by Fear of Cancer Recurrence Inventory-Short Form, and QoL evaluated using the EORTC QLQ-C30. Meta-analysis was performed using RevMan version 5.4. CBT significantly reduced depressive symptoms measured by SDS (mean difference [MD] = -5.11; 95% confidence interval [CI] -6.45 to -3.76; <i>P</i> < 0.00001; <i>I</i> ² = 0%). Anxiety was significantly reduced across both HADS (MD = -2.35; 95% CI -3.94 to -0.77; <i>P</i> = 0.004; <i>I</i> ² = 0%) and SAS scales (MD = -6.22; 95% CI -7.63 to -4.80; <i>P</i> < 0.00001; <i>I</i> ² = 0%). Fatigue was also significantly decreased (MD = -0.76; 95% CI -1.31 to -0.20; <i>P</i> = 0.008; <i>I</i> ² = 0%), while overall QoL improved (MD = 1.26; 95% CI 0.58-1.94; <i>P</i> = 0.0003; <i>I</i> ² = 38%). These findings suggest that CBT provides beneficial supportive effects in reducing psychological distress and improving QoL in women with ovarian cancer undergoing chemotherapy.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"38 3","pages":"321-331"},"PeriodicalIF":2.4,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic potential of adipose-derived stem cell transplantation in amyotrophic lateral sclerosis: A combined clinical case and preclinical study.","authors":"Hui-I Yang, Kuo-Wei Hsueh, Dah-Ching Ding, Horng-Jyh Harn, Yu-Chen Lin, Chia-Yu Chang, Sheng-Tzung Tsai, Shinn-Zong Lin","doi":"10.4103/tcmj.TCMJ-D-25-00092","DOIUrl":"10.4103/tcmj.TCMJ-D-25-00092","url":null,"abstract":"<p><strong>Objectives: </strong>Amyotrophic lateral sclerosis (ALS) is an inevitably fatal neurodegenerative disease with no adequate treatment. Transplantation of adipose-derived stem cells (ADSCs) may be an effective therapeutic strategy for delaying progression or restoring neurological function in ALS.</p><p><strong>Materials and methods: </strong>We evaluated the safety and therapeutic efficacy of intravenous (i.v.) and intracerebral (i.c.) ADSC injection in a late-stage ALS patient and in a SOD1 transgenic (Tg) mouse model. Magnetic resonance imaging (MRI) and computed tomography (CT) were conducted to examine potential cerebral hemorrhage and tumor generation in the treated patient. In addition, maximal inspiratory pressure, maximal expiratory pressure, tidal volume, and respiratory rate were measured as indices of respiratory function.</p><p><strong>Results: </strong>ADSC transplantation was safe, with MRI and CT showing no hemorrhage or tumorigenesis up to 12 months. The patient's Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised score improved from 7 to 9 at 3 months and remained above baseline for 6 months. Respiratory function was preserved during this period. In SOD1 Tg mice, i.c. and i.v. ADSC infusion significantly prolonged survival (165.0 ± 10.4 and 147.3 ± 4.5 days vs. 129.7 ± 3.9 days) and improved motor scores (<i>P</i> < 0.01).</p><p><strong>Conclusion: </strong>This preliminary finding suggests potential therapeutic feasibility, but further studies with larger cohorts are needed to confirm its safety and efficacy.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"38 3","pages":"332-339"},"PeriodicalIF":2.4,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tracking pericyte dysfunction in Alzheimer's disease: The emerging role of cerebrospinal fluid platelet-derived growth factor receptor-β.","authors":"Sheng-Tzung Tsai, Hock-Kean Liew, Mei-Jen Wang, Wei-Ting Hung, Hsin-Yi Huang","doi":"10.4103/tcmj.tcmj-D-25-00173","DOIUrl":"10.4103/tcmj.tcmj-D-25-00173","url":null,"abstract":"<p><p>Growing human and experimental evidence redefine Alzheimer's disease (AD) as a neurovascular disorder because the early neurovascular unit (NVU) injury triggers proteinopathy. Among NVU, pericytes are a pivotal regulator of capillary tone, blood-brain barrier (BBB) integrity, and amyloid-β (Aβ) clearance. Injured or lost pericytes promote non-selective transcytosis, induce endothelial de-zonation, weaken tight junctions, and drive heterogeneous capillary flow and rarefaction. Here, we collect data from clinical imaging, cerebrospinal fluid (CSF) biomarkers, and transgenic mice with platelet-derived growth factor receptor-β (PDGFRβ) signal defects to discuss the role of CSF soluble PDGFRβ (sPDGFRβ) as a marker of BBB damage across the AD continuum. During normal aging, sPDGFRβ rises slightly, consistent with low-grade pericyte stress. In mild cognitive impairment, sPDGFRβ is elevated and associates with BBB breakdown and accelerated cognitive decline, often independent of core AD biomarkers, suggesting early vascular changes before AD onset. In early AD, pericyte dysfunction (characterized by elevated sPDGFRβ) attenuates pericyte-dependent Aβ processing and endothelial lipoprotein receptor-related protein 1-mediated Aβ efflux, leading to impaired perivascular drainage and favoring Aβ40-rich vascular deposition and capillary cerebral amyloid angiopathy. During AD progression, despite persistent leakage, sPDGFRβ frequently plateaus, reflecting severe pericyte depletion and reduced discrimination of disease stage. We propose a practical approach that integrates sPDGFRβ with BBB imaging analysis and Aβ biomarkers to distinguish between parenchymal-dominant and vascular-dominant pathology in AD. These indicators can identify patients at high risk of developing amyloid-related imaging abnormalities during anti-amyloid therapy and can serve as pharmacodynamic endpoints for BBB-stabilizing or pericyte-targeted interventions to advance personalized dementia care.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"38 3","pages":"275-288"},"PeriodicalIF":2.4,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic advances in Alzheimer's disease: Current strategies and future possibilities.","authors":"Peeraporn Varinthra, Ayooluwa Gabriel Ibiayo, Chin-Hung Liu, Narawut Pakaprot, Ismat Noor Paromi, Thi-Thuy-Nhan Do, Mubashir Raza, Ingrid Y Liu","doi":"10.4103/tcmj.TCMJ-D-25-00175","DOIUrl":"10.4103/tcmj.TCMJ-D-25-00175","url":null,"abstract":"<p><p>Alzheimer's disease (AD) is a progressive neurodegenerative disorder causing memory, cognitive, and behavioral impairments in older adults and poses a major worldwide health challenge. The pathophysiology of AD is highly complex and multifactorial, arising from interrelated processes such as amyloid-β (Aβ) aggregation, tau hyperphosphorylation, synaptic dysfunction, neuroinflammation, mitochondrial impairment, and oxidative stress. In addition, both genetic predisposition and environmental or lifestyle factors play critical roles in disease susceptibility and progression. Despite decades of investigation, therapeutic options with robust disease-modifying potential remain limited. Based on published studies from 2021 to 2025, current treatments primarily focus on symptomatic management with cholinesterase inhibitors, N-methyl-D-aspartate receptor antagonists, and combined therapies, complemented by nonpharmacological interventions to support cognition and quality of life. Recently, advances in disease-modifying strategies, particularly monoclonal antibodies targeting Aβ, tau-directed therapies, and approaches modulating neuroinflammation, have generated cautious optimism for shifting the treatment paradigm. Importantly, emerging evidence suggests that specific herbal extracts with antioxidant, anti-inflammatory, and neuroprotective properties may serve as promising adjuncts to conventional therapy. Effective long-term management of AD may ultimately require multimodal strategies that integrate pharmacological, herbal, and lifestyle interventions with precision medicine approaches guided by biomarkers and neuroimaging. This minireview summarizes current therapeutic strategies, emerging advances, and persistent challenges, while highlighting future directions to enable earlier intervention and more effective modulation of disease progression.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"38 3","pages":"263-274"},"PeriodicalIF":2.4,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modern management of pediatric nocturnal enuresis: Evidence-based treatment and practical guidance.","authors":"Sheng-Fu Chen","doi":"10.4103/tcmj.TCMJ-D-25-00171","DOIUrl":"10.4103/tcmj.TCMJ-D-25-00171","url":null,"abstract":"<p><p>Nocturnal enuresis (NE) is a common and multifactorial pediatric condition characterized by abnormalities in bladder storage, renal water regulation, and central arousal mechanisms. According to the International Children's Continence Society, NE is defined as intermittent urinary incontinence that occurs during sleep in children aged 5 years or older, in the absence of congenital or acquired neurologic or urologic disease. Although often self-limiting, NE imposes a substantial psychosocial burden, causing embarrassment, low self-esteem, sleep disruption, and family stress. Advances in neurophysiology and renal chronobiology have clarified that NE represents a developmental delay involving three major pathophysiological domains: nocturnal polyuria, reduced functional bladder capacity or detrusor overactivity, and impaired arousal responses to bladder filling. Contemporary management emphasizes individualized, mechanism-based strategies tailored to the predominant abnormality. This review summarizes current evidence on the pathophysiology, clinical evaluation, and evidence-based treatment of pediatric NE and highlights the importance of early identification, structured behavioral interventions, and family-centered multidisciplinary support to improve long-term outcomes and quality of life.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"38 3","pages":"312-320"},"PeriodicalIF":2.4,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Jing-Si Herbal Tea as a multitargeted complementary therapy: Evidence from preclinical and clinical studies.","authors":"Po-Chih Hsu, Chung-Che Tsai, Tin-Yi Chu, Chan-Yen Kuo","doi":"10.4103/tcmj.TCMJ-D-25-00196","DOIUrl":"10.4103/tcmj.TCMJ-D-25-00196","url":null,"abstract":"<p><p>Jing-Si Herbal Tea (JSHT) is a traditional multi-herbal preparation composed of flavonoids, polyphenols, triterpenoid saponins, glycyrrhizin, and other bioactive constituents that collectively contribute to a wide spectrum of biological activities. Emerging laboratory and clinical studies indicate that JSHT is associated with modulation of oxidative stress, inflammatory responses, and immune-related pathways, with reported antiviral and cytoprotective effects primarily observed in experimental models and exploratory clinical settings. This review synthesizes current evidence describing the diverse pharmacological actions of JSHT and its potential applications across oncologic, inflammatory, metabolic, and infectious disease contexts. Experimental findings suggest that JSHT may be associated with modulation of tumor progression-related processes, including epithelial-mesenchymal transition and aberrant nuclear factor kappa B activity, while being associated with intracellular oxidative stress-related activation of apoptosis- and ferroptosis-related pathways in cancer cell models. Its immunoregulatory capacity is reflected in the attenuation of pro-inflammatory cytokines and the promotion of anti-inflammatory macrophage phenotypes. In respiratory and infectious diseases such as coronavirus disease 2019 and chronic obstructive pulmonary disease, JSHT has been reported to attenuate hyperinflammatory responses and preserve cellular or organ function and has been associated with clinical improvement in selected observational studies, which should be interpreted cautiously. Early clinical data, including results from a randomized study in functional dyspepsia, suggest benefits for gastrointestinal symptoms and anxiety, accompanied by increases in serum butyrate that may indicate involvement of the gut-brain axis. Across available studies, JSHT has shown good tolerability with few reported adverse effects. Overall, the accumulating evidence suggests that JSHT may have potential relevance as a multitarget complementary approach, pending confirmation through well-controlled clinical studies. Nonetheless, more extensive, well-controlled clinical investigations are warranted to validate its efficacy and clarify its mechanistic pathways.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"38 3","pages":"289-299"},"PeriodicalIF":2.4,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tumor necrosis factor-alpha-mediated inflammatory bone loss: Pathogenic mechanisms and therapeutic potential of its inhibitors.","authors":"Wen-Ying Lin, Yu-Jen Pan, Kuang-Ting Yeh, Kuei-Ying Su, Kameshwara Kumar Dharini, Ing-Ho Chen, Wen-Tien Wu, Ming-Der Lin, Cheng-Huan Peng","doi":"10.4103/tcmj.TCMJ-D-25-00128","DOIUrl":"10.4103/tcmj.TCMJ-D-25-00128","url":null,"abstract":"<p><p>Bone remodeling preserves skeletal integrity through the balanced actions of bone-resorbing osteoclasts and bone-forming osteoblasts, regulated by mechanical, endocrine, and immune signals. Tumor necrosis factor-alpha (TNF-α), a key pro-inflammatory cytokine, disrupts this balance by enhancing osteoclast differentiation and activation in synergy with receptor activator of nuclear factor κB ligand, leading to net bone loss, microarchitectural deterioration, and increased fracture risk. Epidemiological studies consistently demonstrate that TNF-α-mediated inflammatory diseases are associated with systemic reductions in bone mineral density (BMD) and heightened fracture risk. Patients with rheumatoid arthritis have approximately twice the prevalence of osteoporosis compared to the general population. Similarly, individuals with ankylosing spondylitis, psoriatic arthritis, psoriasis, or inflammatory bowel disease often present with generalized BMD loss affecting both axial and appendicular skeletons. Notably, these skeletal deficits are observed even in patients without overt joint destruction, underscoring the systemic nature of TNF-α-driven bone pathology. Biological TNF-α inhibitors - etanercept, infliximab, adalimumab, golimumab, and certolizumab pegol - were primarily developed to control inflammation but have also demonstrated potential skeletal benefits, such as preservation or modest improvement in BMD and favorable modulation of bone turnover markers. This review synthesizes mechanistic and clinical evidence on TNF-α-mediated bone loss across diverse inflammatory diseases, evaluates the bone-protective potential of TNF-α inhibitors, and highlights shared pathogenic mechanisms and therapeutic considerations to guide future research.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"38 2","pages":"125-136"},"PeriodicalIF":2.4,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adaptive immune crosstalk and complement dysregulation in the aging retina.","authors":"Ting-Yi Lin, Ching-Yun Wang, Lawrence Chen, Shun-Ping Huang","doi":"10.4103/tcmj.tcmj-D-25-00162","DOIUrl":"10.4103/tcmj.tcmj-D-25-00162","url":null,"abstract":"<p><p>The eye, long viewed as immune-privileged, is now recognized as a dynamic immunological environment where innate and adaptive mechanisms intersect to maintain retinal homeostasis. In aging and age-related retinal diseases such as age-related macular degeneration (AMD), this balance deteriorates as chronic, low-grade inflammation replaces immune quiescence. Adaptive immune involvement in AMD is reflected by increased antiretinal autoantibodies and systemic immune changes, including accelerated aging of CD8⁺ T-cells. Complement activation further amplifies adaptive responses; C5a stimulates T-cell secretion of proinflammatory cytokines, such as interleukin-17 (IL-17) and IL-22, which contribute to retinal injury. Retinal cells exhibit context-dependent immune plasticity. Retinal pigment epithelial (RPE) cells upregulate major histocompatibility complex molecules in response to stress and can express the regulatory transcription factor forkhead box p3 (FOXP3), indicating an intrinsic immunomodulatory capacity. Myeloid populations are likewise heterogeneous: Resident microglia maintain immune surveillance, whereas infiltrating monocyte-derived macrophages often drive maladaptive inflammation and lesion progression. The complement system also contributes to age-related synaptic remodeling, with C1q and C3 tagging synapses for elimination. This pathway is normally limited by Complement Factor H (CFH), whose regulatory function is strengthened by binding to apolipoprotein E (APOE). However, the neurodegeneration-associated APOE ε4 isoform shows reduced CFH affinity, promoting excessive complement activity. Sex-specific immune aging further modifies complement signaling, microglial behavior, and APOE-dependent susceptibility. Together, these insights illustrate how adaptive immunity shifts from protective surveillance to chronic, pathological inflammation, driving the initiation and progression of age-related retinal degeneration.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"38 2","pages":"145-151"},"PeriodicalIF":2.4,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protective effect of blemish balm cream containing flesh of Salak Pondoh <i>(Salacca zalacca</i> [Gaert.] Voss) fruit extract against ultraviolet B-induced photoaging.","authors":"Wahyu Widowati, Dani Dani, Vera Vera, Fadhilah Haifa Zahiroh","doi":"10.4103/tcmj.TCMJ-D-25-00056","DOIUrl":"10.4103/tcmj.TCMJ-D-25-00056","url":null,"abstract":"<p><strong>Objectives: </strong>Ultraviolet (UV) light, particularly ultraviolet B (UVB), is a major external factor that accelerates skin aging by generating reactive oxygen species (ROS), which damage skin cells and biological molecules. The flesh of snake fruit (<i>Salacca zalacca</i>) contains compounds that may help neutralize ROS and protect the skin from premature aging. This research investigates the protective effects of a Blemish Balm (BB) cream formulated with <i>S. zalacca</i> fruit extract against UVB-induced photoaging.</p><p><strong>Materials and methods: </strong><i>S. zalacca</i> flesh extract (SFE) was formulated with various ingredients, resulting in the BB cream containing SFE (BBSFE). Antioxidant and antiaging <i>in vitro</i> assays were measured by H₂O₂ scavenging, ferric reducing antioxidant power (FRAP), collagenase, and tyrosinase inhibition activities on SFE and BBSFE. Male mice (<i>Mus musculus L</i>.) were used as a UVB-induced photoaging model by shaving the dorsal skin and exposing it to UVB irradiation twice daily for 14 days, except for the negative control. The treated mice were smeared with BBSFE once and twice daily for 14 days. Hematoxylin-eosin staining is used to detect collagen fiber damage and inflammation. An immunohistochemistry (IHC) assay was used to analyze the p53, MMP-2, MMP-13, and COL4A1 protein expression. Quantitative real-time reverse transcription polymerase chain reaction assay was used to analyze the transforming growth factor-β1 (<i>Tgf-β1</i>), interleukin <i>(Il)10</i>, and <i>Il18</i> gene expression.</p><p><strong>Results: </strong>BBSFE shows strong antioxidant and antiaging effects by inhibiting FRAP, H₂O₂, collagenase, and tyrosinase. It enhances collagen levels, reduces skin inflammation, downregulates p53, MMP-2, MMP-13, and <i>Il18</i>, and upregulates COL4A1, <i>Tgf-β1</i>, and <i>Il10</i> in mice skin.</p><p><strong>Conclusion: </strong>BBSFE has potential as an antiaging agent <i>in vitro</i> and <i>in vivo</i> studies.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"38 3","pages":"340-349"},"PeriodicalIF":2.4,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}