The diagnostic value and validation of IL-22 combimed with sCD40L in tuberculosis pleural effusion.

BACKGROUND: There is substantial evidence indicating that cytokines play a role in the immune defense against tuberculosis. This study aims to evaluate the levels of various cytokines in pleural effusion to ditinguish between tuberculosis pleurisy and malignant pleurisy. METHODS: A total of 82 participants with pleural effusion were included in the training cohort, and 76 participants were included in the validation cohort. The individuals were divided into tuberculosis and malignant pleurisy groups. The concentrations of interleukin-1ß (IL-1ß), IL-4, IL-6, IL-10, IL-17 A, IL-17 F, IL-21, IL-22, IL-25, IL-31, IL-33, interferon-γ (IFN-γ), soluble CD40 ligand (sCD40L) and tumor necrosis factor-α (TNF-α) in pleural effusion were measured using a multiplex cytokine assay. The threshold values were calculated according to the receiver operating characteristic (ROC) curve analysis to aid in diagnosing tuberculosis pleurisy. Furthermore, the combined measure was validated in the validation cohort. RESULTS: The levels of all 14 cytokines in pleural effusion were significantly higher in participants with tuberculosis compared to those with malignant pleurisy (all P < 0.05). The area under the curve (AUC) was ≥ 0.920 for the IL-22, sCD40L, IFN-γ, TNF-α and IL-31, which were significantly increased in tuberculous pleural effusion (TPE) compared to MPE in the training cohort. Threshold values of 95.80 pg/mL for IFN-γ, 41.80 pg/mL for IL-31, and 18.87 pg/mL for IL-22 provided ≥ 90% sensitivity and specificity in distinguishing between tuberculosis pleurisy and malignant pleurisy in the training cohort. Among these, IL-22 combined with sCD40L showed the best sensitivity and specificity (94.0% and 96.9%) for diagnosing tuberculosis pleurisy, and this finding was validated in the validation cohort. CONCLUSION: We demonstrated that the levels of IL-1ß, IL-4, IL-6, IL-10, IL-17 A, IL-17 F, IL-21, IL-22, IL-25, IL-31, IL-33, IFN-γ, sCD40L and TNF-α in pleural effusion had significant difference between tuberculosis pleurisy and malignant pleurisy. Specifically, IL-22 ≥ 18.87 pg/mL and sCD40L ≥ 53.08 pg/mL can be clinically utilized as an efficient diagnostic strategy for distinguishing tuberculosis pleurisy from malignant pleurisy.

Anxiety, depression, and post-traumatic stress disorder in nurses exposed to horizontal violence: a network analysis.

BACKGROUND: Horizontal violence can cause serious mental health problems for nurses, particularly anxiety, depression, and post-traumatic stress disorder. However, the intrinsic linkage mechanism between mental symptoms of anxiety, depression, and post-traumatic stress disorder in nurses exposed to horizontal violence is unclear. This study aims to elucidate the characteristics of anxiety, depression, and post-traumatic stress disorder networks among nurses with horizontal violence exposure. METHODS: Data for this cross-sectional study were obtained from the baseline portion of a short longitudinal survey conducted at four tertiary hospitals in Shandong Province, China. A total of 510 nurses with horizontal violence exposure completed the General Information Scale, the Negative Acts Questionnaire, the Seven-item Generalized Anxiety Disorder Scale, the Nine-item Patient Health Questionnaire, and the Four-item SPAN. The network model was constructed using network analysis. The expected influence and the bridge expected influence of nodes were calculated. The stability and accuracy of the network were estimated. RESULTS: The results show that A4 (Trouble relaxing) and P1 (Startle) had the highest expected influence in the network. D9 (Suicidality ideation) and A5 (Restlessness) were the key bridge symptoms. CONCLUSIONS: "Trouble relaxing", "Startle", "Suicidality ideation", and "Restlessness" are all mental symptoms that need to be urgently improved the most in nurses exposed to horizontal violence. Nursing administrators and policymakers should implement mental health intervention programs for these symptoms as early as possible to maximize nurses' mental health.

Pickering emulsion stabilized by casein-caffeic acid covalent nanoparticles to enhance the bioavailability of curcumin in vitro and in vivo.

BACKGROUND: In recent years, the design of food-grade Pickering emulsion delivery systems has become an effective strategy for improving the low bioavailability of bioactive substances. Protein-based Pickering emulsions have received extensive attention because of a high biocompatibility and loading capacity. The bioavailability of active substances is mainly evaluated by simulating in vitro gastrointestinal digestion. As a model organism for antioxidation and anti-aging, Caenorhabditis elegans can provide additional biological information for the in vivo utilization of active substances. RESULTS: After the introduction of caffeic acid, the average particle size and Zeta potential of the casein-caffeic acid covalent complex nanoparticles (CCP) were 171.11 nm and - 37.73 mV, respectively. The three-phase contact angle was also increased to 89.8°. By using CCP to stabilize Pickering emulsion (CCE), the retention quantity of the embedded curcumin increased by 2.19-fold after 28 days. In the simulated gastric digestion, curcumin degradation in CCE was reduced by 61.84%, released slowly in the intestinal environment, and the final bioaccessibility was increased by 1.90-fold. In C. elegans, CCE significantly reduced ROS accumulation, increased SOD activity by 2.01-fold and CAT activity by 2.30-fold, decreased MDA content by 36.76%, prolonging the lifespan of nematodes by 13.33% under H2 O2 stimulation and improving bioavailability in vivo. CONCLUSION: The results indictae that CCP-stabilized Pickering emulsion can efficiently implement the physiological activities of bioactive compounds in vitro digestion and C. elegans, and thus it can be regarded as a reliable delivery system for food and medicine. © 2023 Society of Chemical Industry.

Efficacy of Early Application of 1540 nm Non-ablative Fractional Laser and Silicones to Improve Post-epicanthoplasty Scars.

The combination of epicanthoplasty and blepharoplasty is a popular choice in Asians to acquire a pair of charming big eyes. However, the obvious scarring in the medial canthal area may result in unsatisfactory aesthetic outcomes. Recently, various laser treatments have been used to deal with scars had achieved detectable improvement, but only a few studies investigating the efficacy of lasers used in post-epicanthoplasty scarring were developed. A total of 70 participants who underwent Z-epicanthoplasty were enrolled in this prospective clinical trial and were randomly assigned to the groups of 1540nm non-ablative fractional laser (NAFL) combined with silicones treatment and silicones alone treatment. The NAFL-exposure in the treated group was additionally applied to the medial canthal area on day 21 postoperatively, compared with the participants in the control group who had only been treated with the daily usage of silicone sheets for 12 hours and silicone gels twice for 5 months after scab had fallen from the skin. Scar evolution was performed by patient and observer scar assessment Scales (POSAS) and visual analogue scale (VAS) for 21 days, and 6 months postoperatively. 64 participants have completed the entire follow-up process. The scar recovery was statistically detected in treated group compared with the control group at 6-month postoperatively assessed by POSAS, especially in pliability of scars. Furthermore, the VAS evaluations showed superior satisfaction in treated group. The early treatment of NAFL combined with silicones has improved scar formation in medial canthal region after epicantholplasties efficiently.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Aptamer based fluorometric sulfamethazine assay based on the use of graphene oxide quantum dots.

The authors have developed a homogeneous "off-on" fluorometric method for the determination of the antibiotic sulfamethazine (SMZ). Aptamer against SMZ was labeled with graphene oxide quantum dots upon which the Graphene oxide quenched the blue fluorescence of the GOQDs. On addition of SMZ, the aptamers will bind SMZ and this will cause the release of GOQDs. As a result, fluorescence will be regenerated. Fluorescence, best measured at excitation/emission wavelengths of 365/455 nm, increases linearly in the 8 pg·mL-1 to 60 ng·mL-1 SMZ concentration range, with a 5 pg·mL-1 detection limit. The method is reliable and was successfully applied to the determination of SMZ in spiked milk samples, with recoveries ranging from 89 to 96% depending on analyte concentration. Graphical abstract Graphene oxide quantum dots (GOQDs) were covalently bound to the aptamer (apt) against sulfamethazine (SMZ) and adsorbed on the surface of graphene oxide (GO). This results in quenching of the fluorescence of GOQDs. On addition of SMZ, fluorescence is restored due to the release of GOQD@apt from GO.

Investigation of dye regeneration kinetics in sensitized solar cells by scanning electrochemical microscopy.

Sensitizers are responsible for the light harvesting and the charge injection in dye-sensitized solar cells (DSSCs). A fast dye-regeneration process is necessary to obtain highly efficient DSSC devices. Herein, dye-regeneration rates of two DSSC device types, that is, the reduction of immediately formed photo-oxidized sensitizers (ruthenium complex C106TBA and porphyrin LD14, k(ox)') by iodide ions (I(-)) and [Co(bpy)3](2+), and the oxidation of formed photo-reduced sensitizers (organic dye P1, k(re)') by triiodide ions (I3(-)) and the disulfide dimer (T2) are investigated by scanning electrochemical microscopy (SECM). We provide a thorough experimental verification of the feedback mode to compare the kinetics for dye-regeneration by using the above mentioned mediators. The charge recombination at the dye/semiconductor/electrolyte interface is further investigated by SECM. A theoretical model is applied to interpret the current response at the tip under short-circuit conditions, providing important information on factors that govern the dynamics of dye-regeneration onto the dye-sensitized heterojunction.

A cyclopenta[1,2-b:5,4-b']dithiophene-porphyrin conjugate for mesoscopic solar cells: a D-π-D-A approach.

This work introduces cyclopenta[1,2-b:5,4-b']dithiophene (CPDT) as a spacer between the porphyrin chromophore and cyanoacetic acid to obtain a porphyrin dye (coded as LW9). The resultant novel porphyrin dye exhibits extended absorption spectra and a split B band at 520 nm. Therefore, a full spectrum light harvesting characterization of sensitized TiO2 mesoporous film can be achieved. To conduct a thorough investigation of the influence of the spacer unit, new sensitizers conjugated with biphenyl (LW7) and bithiophene (LW8) have been synthesized. As the electron-donating ability of the spacer varies from biphenyl to bithiophene and cyclopenta[1,2-b:5,4-b']dithiophene, stepwise red-shifted electronic absorption spectra and the consistently decreasing energy gap of the dye are presented. These novel porphyrins have been evaluated in dye-sensitized solar cells, achieving a power efficiency of 6.5% employing a [Co(bpy)3](2+/3+) redox couple for the LW9 device under reporting conditions. Detailed investigation, including time-resolved photoluminescence, transient photovoltage decay, and scanning electrochemical spectroscopy measurements, provides important information on the factors affecting the principal photovoltaic parameters. The present report highlights the potential of D-π-D-A porphyrin for the development of efficient sensitizers with broad light absorption properties.

Effects of individualized positive end-expiratory pressure on intraoperative oxygenation and postoperative pulmonary complications in patients requiring pneumoperitoneum with Trendelenburg position: A systematic review and meta-analysis.

BACKGROUND: Whether individualized positive end-expiratory pressure (PEEP) improves intraoperative oxygenation and reduces postoperative pulmonary complications (PPCs) remains unclear. This systematic review and meta-analysis examined whether individualized PEEP is associated with improved intraoperative oxygenation and reduce PPCs for patients needing pneumoperitoneum with the Trendelenburg position during surgery. METHODS: Medline, Embase, the Cochrane Library, and www.clinicaltrials.gov were searched for randomized controlled trials evaluating the effects of individualized PEEP on intraoperative oxygenation and PPCs in patients who required Trendelenburg positioning with pneumoperitoneum. The primary outcome was the oxygenation (PaO2/FiO2) during the procedure. Secondary outcomes included PPCs, intraoperative respiratory mechanics (driving pressure, compliance), and vasopressor consumption. DerSimonian-Laird random effects models were used to calculate mean differences (MDs) and log risk ratios (log RRs) with 95% confidence intervals (CIs). The Cochrane Risk-of-Bias tool 2.0 was applied to assess the risk of bias in included studies. The protocol of this meta-analysis has been registered in PROSPERO. RESULTS: We included 14 studies (1121 patients) that employed different individualized PEEP strategies. Compared with control groups, individualized PEEP groups exhibited a significantly improved intraoperative PaO2/FiO2 (MD=56.52 mm Hg, 95% CI: [33.98, 79.06], P<0.001) and reduced incidence of PPCs (log RR=-0.50, 95% CI: [-0.84, -0.16], P=0.004). Individualized PEEP reduced driving pressure while improving respiratory compliance. Intraoperative vasopressor consumption was similar between both groups. The weighted mean PEEP in the individual PEEP groups was 13.2 [95% CI, 11.7, 14.6] cmH2O. No evidence indicated that one individualized PEEP strategy is superior to others. CONCLUSIONS: Individualized PEEP seems to work positively for lung protection in the Trendelenburg position and pneumoperitoneum in patients undergoing general anesthesia.

Crystallographic dependence of CO activation on cobalt catalysts: HCP versus FCC.

Identifying the structure sensitivity of catalysts in reactions, such as Fischer-Tropsch synthesis from CO and H2 over cobalt catalysts, is an important yet challenging issue in heterogeneous catalysis. Based on a first-principles kinetic study, we find for the first time that CO activation on hexagonal close-packed (HCP) Co not only has much higher intrinsic activity than that of face centered-cubic (FCC) Co but also prefers a different reaction route, i.e., direct dissociation with HCP Co but H-assisted dissociation on the FCC Co. The origin is identified from the formation of various denser yet favorable active sites on HCP Co not available for FCC Co, due to their distinct crystallographic structure and morphology. The great dependence of the activity on the crystallographic structure and morphology of the catalysts revealed here may open a new avenue for better, stable catalysts with maximum mass-specific reactivity.

Preparation of extracellular matrix of fish swim bladders by decellularization with supercritical carbon dioxide.

Fish swim bladders used to be considered as byproducts or waste in fishery; however, they are potential materials for biological medicine with abundant collagen. In this work, an efficient noncytotoxic decellularization process using sodium dodecyl sulfate (SDS) ternary system assisted with supercritical carbon dioxide (scCO2) as the green extraction fluid and ethanol (ET) as the cosolvent has been developed to harvest acellular fish swim bladders (AFSBs). The experimental results show that the tissue treated by SDS assisted with scCO2 and ethanol at 37 °C and 25 MPa can be decellularized thoroughly and maintains intact fibers and uniform pore distribution, which resulting in a tensile strength of 5.61 MPa and satisfactory biocompatibility. Meanwhile, the residual SDS content in scCO2/SDS/ET ternary system is 0.0122% which is significantly lower than it in scCO2/SDS system due to the enhanced mass transfer rate of SDS in tissues by scCO2 with ethanol. The synergy between SDS and ethanol can enhance the diffusion coefficient and the solubility of SDS in scCO2, which reduced the contact time between SDS and tissues. Meaningfully, the results obtained in this work can not only provide a novel strategy to produce acellular matrix with superior properties, but also offer a further understanding of the decellularization through scCO2 extraction processing with the synergy of suitable detergent/cosolvent.

Constructing single atom sites on bipyridine covalent organic frameworks for selective electrochemical production of H2O2.

We developed a series of single atom catalysts (SACs) anchored on bipyridine-rich COFs. By tuning the active metal center, the optimal Py-Bpy-COF-Zn shows the highest selectivity of 99.1% and excellent stability toward H2O2 production via oxygen reduction, which can be attributed to the high *OOH dissociation barrier indicated by the theoretical calculations. As a proof of concept, it acts as a cathodic catalyst in a homemade Zn-air battery, together with efficient wastewater treatment.

Interactions between Jumbo Phage SA1 and Staphylococcus: A Global Transcriptomic Analysis.

Staphylococcus aureus (S. aureus) is an important zoonotic pathogen that poses a serious health concern to humans and cattle worldwide. Although it has been proven that lytic phages may successfully kill S. aureus, the interaction between the host and the phage has yet to be thoroughly investigated, which will likely limit the clinical application of phage. Here, RNA sequencing (RNA-seq) was used to examine the transcriptomics of jumbo phage SA1 and Staphylococcus JTB1-3 during a high multiplicity of infection (MOI) and RT-qPCR was used to confirm the results. The RNA-seq analysis revealed that phage SA1 took over the transcriptional resources of the host cells and that the genes were categorized as early, middle, and late, based on the expression levels during infection. A minor portion of the resources of the host was employed to enable phage replication after infection because only 35.73% (997/2790) of the host genes were identified as differentially expressed genes (DEGs). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses showed that the phage infection mainly affected the nucleotide metabolism, protein metabolism, and energy-related metabolism of the host. Moreover, the expression of the host genes involved in anti-phage systems, virulence, and drug resistance significantly changed during infection. This research gives a fresh understanding of the relationship between jumbo phages and their Gram-positive bacteria hosts and provides a reference for studying phage treatment and antibiotics.

Characterization and Genomic Analysis of a Novel Jumbo Bacteriophage vB_StaM_SA1 Infecting Staphylococcus aureus With Two Lysins.

The development of new antimicrobial agents is critically needed due to the alarming increase in antibiotic resistance in bacterial pathogens. Phages have been widely considered as effective alternatives to antibiotics. A novel phage vB_StaM_SA1 (hereinafter as SA1) that can infect multiple Staphylococcus strains was isolated from untreated sewage of a pig farm, which belonged to Myoviridae family. At MOI of 0.1, the latent period of phage SA1 was 55 min, and the final titer reached about 109 PFU/mL. The genome of phage SA1 was 260,727 bp, indicating that it can be classified as a jumbo phage. The genome of SA1 had 258 ORFs and a serine tRNA, while only 53 ORFs were annotated with functions. Phage SA1 contained a group of core genes that was characterized by multiple RNA polymerase subunits and also found in phiKZ-related jumbo phages. The phylogenetic tree showed that phage SA1 was a phiKZ-related phage and was closer to jumbo phages compared with Staphylococcus phages with small genome. Three proteins (lys4, lys210, and lys211) were predicted to be associated with lysins, and two proteins with lytic function were verified by recombinant expression and bacterial survival test. Both lys210 and lys211 possessed efficient bactericidal ability, and lys210 could lyse all test strains. The results show that phage SA1 and lys210/lys211 could be potentially used as antibiotic agents to treat Staphylococcus infection.

Evaluation of digestibility differences for apple polyphenolics using in vitro elderly and adult digestion models.

We evaluated the in vitro digestibility of apple polyphenols mimicking elderly and adult digestion models (dynamic and static systems). The digestibility of total apple polyphenols in small intestine was much higher in the adult dynamic system (62 µg/100 g fresh apple) compared to the static system (20 µg/100 g fresh apple) and elderly dynamic digestion conditions (33 µg/100 g fresh apple). Elderly in vitro static digestion showed better antioxidant activity than the adult system (OH and ABTS+ methods). Thus, the in vitro dynamic digestion system can more truly reflect the digestion of apple polyphenols than static digestion system. Moreover, elderly digestion conditions negatively influenced the digestibility of apple polyphenols including chlorogenic acid, epicatechin, phlorizin, rutin, phloretin, hyperoside, proanthocyanidin B2, and quercetin. Hence, appropriate selection of in vitro digestion models for elderly is a prerequisite to exploring the digestibility of phytochemicals for the development of functional food products for elderly.

Latent Cytomegalovirus Reactivation in Patients With Liver Failure: A 10-Year Retrospective Case-Control Study, 2011-2020.

Background: The aim of this study was to explore potential risk factors for cytomegalovirus (CMV) reactivation and their impact on liver failure patient outcomes. Methods: A 10-year retrospective case-control study was conducted in adult participants, who were diagnosed with liver failure and had undergone CMV DNA tests. CMV reactivation cases were matched with controls at a 2:1 ratio based on age, sex, and year of admission. Univariate and multivariate analyses were used to explore risk factors for CMV reactivation. Results: Between January 2011 and April 2020, 198 adult patients with liver failure and available CMV DNA test results were enrolled into the study. Among them, 33 patients had detectable CMV DNA in their plasma (16.7%). Clinical manifestations and liver function were comparable between the CMV reactivation and non-reactivation groups. However, CMV reactivation may triple mortality in patients with liver failure. We found that nearly 50% of patients in the CMV-positive group received glucocorticoids, compared to 13.6% in the CMV-negative group (P=0.000). The median total glucocorticoid dose included 836.5 mg of methylprednisolone (IQR 308.7-1259.0 mg) in the CMV-positive group, which was significantly higher than that in the CMV-negative group. A multivariate analysis revealed that glucocorticoid use significantly increased the risk of CMV reactivation (adjusted OR, 4.84; 95% CI, 1.61-14.49; P=0.005). Patients with CMV reactivation tended to be associated with higher white cell counts (adjusted OR, 1.21; 95% CI, 1.08-1.36; P=0.002). Conclusions: High intravenous glucocorticoid doses may be the most important risk factor for CMV reactivation in liver failure.

Cytokine profiles in cerebrospinal fluid of patients with meningitis at a tertiary general hospital in China.

BACKGROUND: There has been a great deal of evidence indicating that cytokines participate in meningeal inflammation. Different cytokine profiles may be presented in central nervous system (CNS) infection due to different pathogens. We have attempted to investigate cytokine profiles in cerebrospinal fluid (CSF) of patients with CNS infection. METHODS: Forty-three patients with CNS infection including tuberculous meningitis, purulent meningitis and cryptococcal meningitis were enrolled and 11 patients with normal CSF were enrolled as control group. The concentrations of Th1-, Th2- and Th17-type cytokines in CSF were detected using multiplex cytokine assay. Furthermore, the correlation between CSF cytokines and CSF parameters in CNS infection was analyzed. RESULTS: The CSF levels of IL-1ß, IL-4, IL-6, IL-10, IL-17, IL-23, IL-33, IFN-γ, TNF-α and sCD40L among the patients with CNS infection were all higher than control group (all P < 0.05). A remarkable elevation of CSF IL-6 in the patients with CNS infection was observed with the least overlap of the CSF concentrations compared to controls. Moreover, CSF IL-6 levels were strongly negatively correlated with CSF glucose and the CSF/blood glucose ratio (r = -0.4375, P = 0.0042; r = -0.4991, P = 0.0009). CONCLUSIONS: The excessive activation of immune response characterized by elevated levels of CSF Th1-, Th2- and Th17-type cytokines has been observed during CNS infection. Furthermore, we observed negative correlations between CSF IL-6 levels and CSF glucose and CSF/blood glucose ratio in CNS infection. And we suggested that combined CSF IL-6 levels with CSF glucose may serve as a novel biomarker pool for the differential of CNS infection.

Precise diagnosis of Neisseria macacae infective endocarditis assisted by nanopore sequencing.

Infective endocarditis caused by Neisseria macacae in humans is extremely rare. We presented here a case of N. macacae infective endocarditis in a 61-year-old man with a native aortic valve infection. N. macacae was isolated from blood culture and was detected by nanopore-based metagenomic sequencing in the vegetations. Finally, the patient recovered completely after surgery and antibiotic therapy.

Serial anti-tuberculous immune responses during the follow-up of patients with tuberculous pleurisy.

Little is known about the decay kinetics of interferon (IFN)-γ response and its influencing factors in tuberculous pleurisy. We enrolled thirty-two patients with tuberculous pleurisy prospectively and followed up at month 0, 6, and 9, at which time peripheral venous blood was drawn for interferon gamma release assay (IGRA) by means of QuantiFERON-TB Gold In-Tube (QFT-GIT). Demographic and clinical data were captured. To identify significant predictive factors influencing the IFN-γ response, multiple linear regression analyses were performed. Percentage of CD4+, CD8+, Vγ2Vδ2 T cells and Treg cells were measured by flow cytometry. The percentage of QFT-GIT-positive patients at baseline, month 6 and month 9 were 96.9% (30/32), 90.6% (29/32) and 84.4% (27/32), respectively. Quantitative IFN-γ response at baseline were significantly correlated with symptom duration (P = .003, R = 0.261) and age (P = .041, R = 0.132). Besides, the decreases of the IFN-γ response at month 6 and month 9 were positively correlated with the IFN-γ level at baseline. The dynamic tendency of the percentages of Treg cells was similar to the IFN-γ responses at each time-point. Quantitative IFN-γ response could be influenced by host immune status, instead of disease burden and anti-tuberculosis treatment. IGRA is probably not a useful biomarker of treatment efficacy in tuberculous pleurisy.

Effects of acupuncture on breast cancer-related lymphoedema: a systematic review and meta-analysis of randomised controlled trials.

OBJECTIVE: Breast cancer-related lymphoedema (BCRL) is a common complication after breast cancer treatment. We investigated whether acupuncture could be used to manage limb oedema in women after breast cancer surgery. METHODS: The Cochrane Library, PubMed, Embase, Web of Science, CINAHL, and four Chinese databases were electronically searched for papers published through November 2017. Randomised controlled trials (RCTs) of acupuncture for BCRL were included. RESULTS: In total, six RCTs with 318 patients were identified. The main analysis revealed a positive overall effect of acupuncture intervention on pre/post-treatment differences in the diameter of the elbow joint, reductions in upper limb lymphoedema and effectiveness index based on arm measurement data in patients with breast cancer. Two studies evaluating the outcome of acupuncture on the diameter of the elbow joint found a significant reduction in diameter between the acupuncture and control groups (weighted mean difference (WMD) 6 cm, 95% CI 5.11 to 6.89 cm; P<0.001). The same two studies investigated the effect of acupuncture on upper limb lymphoedema reduction and found a significant difference between the acupuncture and control groups (risk ratio 1.4, 95% CI 1.17 to 1.67; P<0.001). Two other studies used the effectiveness index to assess the arm and found a significant difference between the acupuncture and control groups (WMD 23.34, 95% CI 10.74 to 35.94; P<0.001). The fifth study used bioelectrical impedance spectroscopy to assess lymphoedema at several points on the arm before and after acupuncture; this study also reported a significant reduction in lymphoedema. The sixth study reported no significant difference in bioimpedance between the groups. CONCLUSIONS: The present meta-analysis and systematic review suggests that acupuncture is effective at reducing BCRL in patients after breast cancer treatment.