Machiavellianism, narcissism and psychopathy are socially aversive personality traits that are strongly linked to the propensity of violence. A central determinate of aggression and violence is parental rearing. Interestingly, while the origin of the development of Dark Triad is not yet entirely understood, next to genetic and environmental factors, literature points towards an influence of parenting styles to the development of dark traits. Therefore, in a sample of 1366 9th grade students , we assessed the interplay between parental rearing, dark triad traits, observation of violence among peers and their propensity for violence. The sample has a good representativeness on school types. Results reveal a positive association between the experience of parental rejection by both parents and punishment as well as parental control and overprotection and Machiavellianism, narcissism and psychopathy. Parental emotional warmth was associated negatively with Machiavellianism and psychopathy while no significant association with narcissism was seen. In a path model, parental rearing, dark triad traits and observation of violence among peers significantly contributed to the propensity of violence. However, differences between the experienced parenting behaviour of mothers and fathers should be noted. Both rejection and overly harsh punishments by fathers and emotional warmth by mothers have no significant influence on the dark triad. It is interesting that the effects regarding maternal parenting behaviour are stronger overall than the effects regarding paternal parenting behaviour. These results underline the importance of parental rearing on the development of Machiavellianism, narcissism and psychopathy and suggest a significant role of parental rearing and the dark triad traits on propensity for violence in adolescents. Parenting trainings and family interventions may be a promising starting point to prevent antisocial behavior linked to the dark triad and to prevent violent behavior in future generations Machiavellianism, narcissism and psychopathy are socially aversive personality traits which are collectively referred to as the “dark triad” of antisocial behavior . MachiavThe Dark Triad refers to these traits on a subclinical and therefore non-pathological level . MachiavDifferent underlying mechanisms are discussed to cause this increased aggression. For narcissism, there are hints that aggression is strongly linked to the feeling of shame  and vulnThe origin of the development of Dark Triad is not yet fully understood. Although genetic factors seem to increase vulnerability for Dark traits, the role of environmental factors seem to be pivotal , 21. ImpHowever, also literature exists pointing towards an association between parenting and the other dark traits. High maternal care and secure parental attachment pattern have been shown to be associated negatively with the occurrence of psychopathy, Machiavellianism and Entitlement/Exploitiveness in narcissism while high paternal care was associated also negatively with psychopathy and Machiavellianism, but positively with narcissism . Even thAnother theory strand which promises a high explanatory power are theories of learning and subcultures. One the most prominent theories is differential association theory . The theThe theory assumes that the learning of criminal behaviors depends on whether there is a positive or a negative stimulus due to deviating behavior. Delinquent behavior can either be punished in a group or milieu or amplified. According to the theory the latter leads to delinquent behavior. Another relevant theory is the subculture theory according to Cohen . The theTaken together, there is evidence for the influence of social learning on the development of dark triad traits and aggressive and antisocial behavior. The role of parenting is pivotal for social learning processes. Dark triad traits are a significant risk factor for antisocial behavior. However, to the best of our knowledge, studies assessing the role of dark traits in the relationship between experienced parenting and antisocial behavior are lacking to date. In the here presented study, we aimed to assess the interplay of parenting, the dark traits and a very distinct expression of antisocial behavior: the propensity for violence. We assumed that in addition to personality the learning of deviant behavior through observation in a corresponding violent milieu plays a role in explaining the propensity of violence. We hypothesized 1) negative parenting behavior to be associated with the development of dark traits and 2) the dark traits to be associated with the propensity of violence in our sample of adolescents.The survey took place between September 2017 and May 2018 and was conducted as a paper-pen-survey during school lessons. All general-education schools in city and private sponsorship in Leipzig, which run a 9th grade, were asked to take part. In addition, in order to cover the young people of the age group who left general education school without a formal degree, all municipal and private schools leading to a vocational preparation year were also included in the sampling. The parents of the interviewees had to sign their consent beforehand.A total of 33 schools, which corresponds 38.4% of all Leipzig schools with a 9th grade class or a preparatory year for vocational training, took part in the present study. Among them were 12 secondary schools, 9 grammar schools, 4 special schools, 6 vocational schools as well as one Waldorf and one hospital school. Since in some cases individual classes in the respective schools were not able to take part in the survey, the number of classes surveyed was 84, which corresponds to 34.4% of all classes in question. 39.9% of all respondents were male and 37.7 per cent were female. 22.4% of the respondents did not answer the question on gender. Further information on the representativity of the sample is given in S1 and S2 Tables in Parenting was assessed with a 9 item version of the Questionnaire of Recalled Parental Rearing Behaviour (QRPRB) , a shortNarcissism, Machiavellianism, and psychopathy were assessed with the German version of the “Dirty Dozen”, 12-item measure of the Dark Triad . Each diPropensity of violence was assessed by 6 questions regarding the general propensity for the use of violence  with a value of <0.001 . The RThe results confirm the theoretical assumptions. The influence of the dark triad on the propensity of violence is a relatively strong direct factor that explains the propensity of violence . The observation of violence has a beta of 0.247 (p<0.001) and has also a small effect on the dark triad . All three queried dimensions of parenting experience play a significant role but there are slight differences between the rearing of the father and the mother. An upbringing shaped by control by the mother turns out to be the strongest influence on the Dark Triad . At the same time the effect of control through the father is weaker . The second strongest factor is rejection/punishment through the mother , whereas punishment by the father is not even significant. A weak effect is that of emotional warmth but only regarding the father .To our knowledge, this is the first study to examine the association among parental rearing behavior, Machiavellianism, psychopathy and narcissism and affirmation of violence. Our results suggest a significant role of parental rearing and the dark triad traits on propensity for violence and thereby adds to the relevance of environmental factors, particularly experienced parenting style and social learning, in both, the development of antisocial traits and propensity of violence.Parental rejection and punishment as well as parental control and overprotection by the mother and the father were associated with higher manifestation of Machiavellianism, psychopathy and narcissism while parental emotional warmth by both parents was associated conversely with Machiavellism and psychopathy but not significantly associated with narcissism.As the family has significant impact on character development and primary social experience during childhood and consequently social learning, our result is not surprising. The relevance of the quality of parental care and parental attachment for the development of the dark triad traits were shown before . InteresFurthermore, our results show that higher experience of parental rejection and punishment by the mother as well as parental control and overprotection by both parents is associated with Machiavellianism, psychopathy and narcissism. Jia and colleagues argue unpredictable and harsh conditions to favor accelerated development and the focus on fast gain, which can go along with opportunistic actions, low empathy and social skills—common in individuals with high expression of dark traits .Our results are in line with the results by Jonason and colleagues who show that lower quality of parental care and insecure or avoidant parental attachment patterns are associated with the Dark Triad traits . As thesConsistent with previous research, antisocial Machiavellianism, psychopathy and narcissism were associated with propensity for violence –15, 40. The path model shows that 20% of the propensity for violence is explainable with parenting and dark triad traits, pointing towards the significance of this result. However, it is important to state that the observance of violence was shown to have a significant impact on the propensity for violence, too. As due to social learning, observation of violence is known to have a significant impact on the propensity for violence . NeverthFirst of all—as mentioned before—our study has a cross-sectional design. Therefore, no temporality can be assessed in the interplay between parental rearing, dark triad and propensity for violence. Reversal causality such as that manifestation of Machiavellianism, psychopathy and narcissism may impact the retrospective evaluation of parental rearing cannot be fully excluded, particularly as this was based on self-report and objective measures are missing. Moreover, only 20% of the propensity for violence was explainable by our model. Therefore, other factors such as character traits next to dark triad may play a significant role that were not assessed in our model. Even though the German version of the “Dirty Dozen” reveals good psychometric properties , the ansNevertheless, our results give a significant contribution to the influence of parenting on the development of dark triad traits and the propensity for violence. In particular, they underline the role of harsh parenting and control. Therefore, parenting trainings and family interventions may be a promising starting point in order to prevent antisocial behavior linked to Machiavellianism, psychopathy and narcissism and most importantly, to prevent violent behavior in future generations. Moreover, the expression of Machiavellianism, psychopathy and narcissism are a distinct risk factors for propensity of violence that should be targeted in interventions for adolescents on risk for aggressive behavior. The discovered research gaps in our study allow for indications of possible fields of research. In addition to the early research on authoritarianism which focused on a coldly dominating father figure and traditional views of masculinity as a significant cause of (authoritarian) aggression. –45 futurS1 Appendix(DOCX)Click here for additional data file.S1 Data(SAV)Click here for additional data file.


A method based on a computational intelligence information model is proposed to study the visualization of large data packages. Since the CAIM algorithm only considers the distribution of the largest number of classes in an interval, it offers an optimization method and simultaneously determines the appropriate stopping conditions to avoid overcrowding. The effectiveness of the improved algorithm has been experimentally proven. Methods of character reduction and weight determination are used to reduce the index and weight, establishing a large packaging information system. Experimental results show that the improved algorithm in this article produces more classification rules than the CAIM algorithm, because the discrete intervals created by the CAIM algorithm are relatively simple, but the classification rules are few, but less than the number of CAIM algorithms. Classification rules are generated by entropy-based sampling algorithms. This can make the classification rules simple and universal, and it is clear that the optimal sampling algorithm is more accurate than the CAIM algorithm. After entering the information age, people's production and life are surrounded by a wide variety of information, and we are already in an information-explosive society. Information has a profound impact on social life, economic production, scientific and technological development, cultural exchange, and many other areas. Efficient collection, proper processing, and rapid dissemination of information resources are effective tools for solving various social problems. With the rapid development of information design technology and the rapid opening of information consumption channels, people are demanding more and more diversification of forms of communication and communication in information design. Only with proper processing and design can all types of information be delivered seamlessly and made public. After World War II, people entered the age of technology and brought a third industrial revolution, the information revolution. Information technology is the soul of social reform and progress in the 21st century. It not only promotes the development of science and technology, but also accelerates the distribution of social resources. It has developed into the core technology of contemporary society. The emerging electronic information technology has changed people's ways and means of using information. Machines have gradually replaced part of people's mental activities to obtain information more quickly and effectively. These changes have gradually led to changes in social form [In modern times, human society has experienced many technological changes, among which information technology is very revolutionary. The digital wave and the wide application of new technology have changed the inherent form of traditional printing media such as books, newspapers, and periodicals. With the transformation of technical means such as information collection, information storage, information resource processing, and information integration and transmission, new electronic media such as mobile newspaper, electronic journal, and e-book have emerged one after another. In the context of contemporary social informatization, information design comes from it. Its application scope is wider and wider, its function is stronger and stronger, and its forms of expression are constantly renovated. It has gradually penetrated into all aspects of people's life. As an important function of data integration and data sharing platform, it occupies an important position . NowadayGuo and Dong proposed a production quality evaluation model, which evaluates production quality through users' satisfaction with visual design. At the same time, the functional architecture of the model is given. The model is used to solve the quality problem in the process of visual design. Through the detailed study of key technologies such as collaborative quality design of visual design products based on customer satisfaction, production process quality control technology for multivariety and small batch, and comprehensive quality evaluation technology for the whole product life cycle, the quality assurance of the model for the visual design process is verified. Emerging technologies such as Internet and artificial intelligence are also widely used in large-scale personalized product customization . Li et aBased on current research, this paper proposes an information design approach based on computational intelligence. Since the CAIM algorithm only considers the distribution of the largest number of classes in an interval, it offers an optimization method and simultaneously determines the appropriate stopping conditions to avoid overcrowding. The effectiveness of the improved algorithm has been experimentally proven. Methods of character reduction and weight determination are used to reduce the index and weight, establishing a large packaging information system.Under the action of proximity principle, observers will be more inclined to treat objects with adjacent spatial positions as categories with the same attribute. The proximity principle reveals the potential logical relationship between information and data, making the visual effect of data display more neat and clear.Under the action of similarity principle, the similarity degree of object attributes has become the main basis for object grouping. Using the similarity principle can effectively create a visual guidance path with a simple hierarchical structure, as shown in Under the action of connection principle, when facing multiple objects with different attributes, the observer will first use the basic principle for identification. At this time, if there is a more recognizable element to connect multiple objects, it can provide a more effective mode for image recognition or information reading behavior.In the process of visual information reception, the principle of coherence makes the smooth contour have stronger integrity in the eyes of the observer.The closure principle holds that if there is a significant difference between the boundary of the graphic area and the adjacent area, the objects in the area will be recognized as the same category or group. Although in the three pictures in Text information generally includes three aspects: vocabulary, grammar, and word meaning. Text information visualization is equivalent to optimizing the information again. From the perspective of information content, tag cloud is a simple and commonly used visualization technology. This method first directly extracts the main keywords in the text and arranges and combines them according to the specific order and law. If necessary, different colors and font sizes will be used to highlight the importance of the core information, such as using larger font sizes or brighter colors to reflect the importance of vocabulary. The direct result of text information visualization is to make the audience's acceptance and understanding of information more intuitive and accurate.Multidimensional information visualization is an important goal of industry information data visualization. In reality, massive data information generally has multidimensional characteristics. When multidimensional data is abstractly expressed in the form of information, because the information itself cannot be three-dimensional, corresponding technologies are needed to realize better and more humanized interaction between the audience and the information. The commonly used methods of multidimensional data visualization include parallel coordinate diagram, scatter diagram matrix, multidimensional scatter diagram, and other representations .Hierarchical relationship visualization is a common method to represent the content structure of abstract information. Through the hierarchical relationship, we can effectively sort out the data content and transform its abstract relationship into an intuitive and visible data structure. There are two main types of visual hierarchical relationship construction technology, namely, space filling method and nonspace filling method.At present, the rule mining algorithms used for classification or decision-making include decision tree (ID3), rough set, genetic algorithm, and so on. However, most data mining algorithms are only used for discrete samples. For example, when using rough set method for attribute reduction, it is difficult to judge whether a continuous attribute in the sample is useful for classification or decision-making. Although C4 5 as an improved algorithm of ID3 can mine the classification rules of continuous attributes, the algorithm can not guarantee the efficiency and the calculation is complex. The packaging design index data is not necessarily discrete; it can also be said that it is often continuous and disorderly. Therefore, it is necessary to choose an appropriate discrete method to pave the way for the later rule mining.Most of the data collected from the real world is not suitable for direct application to knowledge learning algorithms. The main reasons are as follows: first, the scale of original data is often very large, and there are some interference information, which is imprecise, inconsistent, and incomplete; second, the attribute types of the original data set are often very complex, including not only discrete attribute space, but also continuous attribute space. If such a data set is not processed and directly used in the later algorithm, the corresponding efficiency and accuracy will not be obtained. In addition, most classification algorithms can only deal with the data set of discrete value attributes.Create a high-quality sorting scheme to help professionals understand the data more easily .The separate circuit produced should improve the accuracy and efficiency of the training algorithm .The sampling process should take place as soon as possible. Discretization of continuous attributes is to transform the value space of continuous value attributes into a limited number of cells, use some different symbols or numbers to represent the divided interval, and give each interval a discrete value, and use this discrete value to represent all attribute values between cells. It can also be discretized through machine learning, and sample learning makes the discretization results more objective and reasonable. The essence of the discretization process is to give some partition points to divide the attribute space .Discretization of continuous attributes is a part of data preprocessing. According to different attribute value ranges, the attributes of the original data set can be divided into three types: Digital attributes , noun attributes , and continuous attributes (such as weight and distance). Both digital attributes and noun attributes belong to discrete attributes. After repeated experimental comparison, it is found that the classification results, whether accuracy or efficiency, are significantly improved by discretizing continuous attributes into discrete attributes and then learning classification. To sum up, the overall objectives of the discrete algorithm should be as follows:The general steps of discretization of continuous attributes are shown in According to whether the interaction between attributes is considered when dividing the number of attribute intervals, it can be divided into dynamic discretization algorithm and static discretization algorithm. Bining algorithm is a static discretization algorithm, which defines a parameter K on each attribute to represent the maximum number of intervals divided during discretization, regardless of the influence of other attributes.x2 distribution belong to supervised discretization algorithm.According to whether the information of decision attributes is used as a reference in the discretization process, it can be divided into supervised discretization and unsupervised discretization algorithms. The early commonly used equal width and equal frequency discretization algorithms belong to unsupervised discretization algorithms. These two algorithms need to preset the number of discrete intervals, which have a large amount of lost information and low classification accuracy. Supervised discretization algorithm refers to decision information, usually combined with classification algorithm. Discretization algorithm based on information entropy and Chi2 correlation algorithm based on statistical According to whether all instances in the dataset are used for attribute discretization, it can be divided into global and local discretization. The local discretization algorithm uses some examples in the data set to divide the attribute interval, which is generally combined with the dynamic discretization algorithm. The global discretization algorithm uses all examples, which is generally combined with the static discretization algorithm. In terms of accuracy, local discretization algorithm is often better than global discretization algorithm, but the execution efficiency of global discretization algorithm is significantly higher than local discretization algorithm.Top-down discretization algorithm and bottom-up discretization algorithm: The top-down discretization algorithm initializes an interval containing all attribute values, then splits it according to a certain standard, and then cycles until a certain stop condition is met; the bottom-up discretization algorithm takes each attribute value as the interval boundary and merges adjacent intervals iteratively according to a certain standard until a certain stop condition is met. The bottom-up discretization algorithm has two key problems: one is how to select adjacent intervals for merging, and the other is how to set a reasonable stop condition. CAIM algorithm belongs to top-down discretization, which is a discretization algorithm based on the relationship between classes and attributes.Continuous attribute discretization algorithm has different division.The classification of main discretization algorithms is shown in k intervals of equal width according to the specified parameters. The parameters are user-defined. When the data distribution is uneven, the effect of this kind of algorithm is very poor. The equal frequency discretization algorithm is also divided into k intervals, and the number of samples in the interval is the same. These two algorithms are very intuitive and simple but do not consider the sample distribution [Equal width and equal frequency discretization algorithm: equal width discretization algorithm is the simplest and earliest attribute discretization method. The value of attribute is divided into ribution .x2 . At the beginning of the algorithm, each attribute value is regarded as an interval point, and x2 is calculated for each pair of adjacent interval points. The interval points with the smallest value are merged until the smallest x2 value is greater than the preset threshold. This algorithm can only merge two adjacent intervals at a time, so the discretization speed is slow. Chi2 algorithm dynamically sets the threshold to xa2 − x2 and introduces a new stop condition: inconsistency rate. Mod-Chi2 algorithm proposes that the degree of freedom V is determined by the number of decision classes in the two adjacent intervals of the current interval and proposes to use the approximate accuracy as the stop condition. The extended Chi2 algorithm proposes to dynamically increase the critical value by dividing the threshold by n discrete intervals:Chi series algorithms: ChiMerge algorithm determines whether to merge intervals by calculating Each value in attribute F can only be divided into one interval, as shown in Dr= to calculate the CAIM value, the two data sets have different data distributions but calculated CAIM values are the same. Such unreasonable situations also occur when considering CAIR guidelines. The two data sets may have the same CAIM value calculated, even if the CAIR values are different.Second, CAIM only considers the distribution of the largest number of classes in an interval. Such thoughts are sometimes unfounded. Take CAIM algorithm used in this paper has been roughly described in r interval and in attribute value is measured, respectively.The distribution of each class in 2(n) to prevent too many discrete intervals when there are too many classes.And the termination condition is set to the interval number less than logThe data collection sources of knowledge Atlas of packaging big data mainly include open knowledge base, industry websites, academic papers, Chinese patents, and other external data. At present, the big data knowledge map of the packaging industry includes 10 first-class concepts , 21 second-class concepts , 29 third-class concepts , and 28 fourth-class concepts  . ThroughA glass data package containing 214 samples and 9 conditional properties was selected to 6 classes.As an example of a second property in a glass sample, the data distribution of this property is shown in Some data of glass dataset after discretization are shown in The discrete data set samples are randomly divided into two groups, 70% as the training set and the remaining 30% as the test set. Rosetta rough set software is used to process and predict the classification accuracy counted by the algorithm. Select rules with accuracy >0.75 and coverage >0.05. The comparison of classification rules and classification test accuracy is shown in From the results, the improved algorithm produces more classification rules than CAIM algorithm. This is because the discrete interval generated by CAIM algorithm is relatively simple, so there are fewer classification rules. However, the number of classification rules generated by the discretization algorithm based on entropy is less than that of the discretization algorithm based on entropy, which can make the classification rules simple and have better universality. Moreover, the optimized discretization algorithm has obviously higher classification accuracy than CAIM algorithm.Behind the information design, the study of big data packaging visualization is a real need to support the packaging industry informatization. The improved algorithms in this article produce more classification rules than the CAIM algorithm. Because the discrete intervals generated by the CAIM algorithm are relatively simple, there are few classification rules, but few classification rules are derived from entropy-based sampling algorithms. It is simple and universal in nature, and it is clear that the optimized sampling algorithm is more accurate than the CAIM algorithm classification. Large-scale packaging imaging based on China's packaging big data knowledge meets the new requirements of production intelligence of packaging service functions, deepens the packaging industry informatization and industrialization, and reduces production costs, and flexible response can be shown, to better meet the needs of the industry.


Exposure to recurrent infections in childhood was linked to an increased risk of cancer in adulthood. There is also evidence that a history of tonsillectomy, a procedure often performed in children with recurrent infections, is linked to an increased risk of leukemia and Hodgkin lymphoma. Tonsillectomy could be directly associated with cancer risk, or it could be a proxy for another risk factor such as recurrent infections and chronic inflammation. Nevertheless, the role of recurrent childhood infections and tonsillectomy on the one hand, and the risk of breast cancer (BC) in adulthood remain understudied. Our study aims to verify whether a history of tonsillectomy increases the risk of BC in women.A systematic review was performed using PubMed, Google Scholar, Scopus, Embase, and Web of Science databases from inception to January 25, 2022, to identify the studies which assessed the association between the history of tonsillectomy and BC in females. Odds ratio (OR) was calculated using the random/fixed-effects models to synthesize the associations between tonsillectomy and BC risk based on heterogeneity.Eight studies included 2252 patients with breast cancer of which 1151 underwent tonsillectomy and 5314 controls of which 1725 had their tonsils removed. Patients with a history of tonsillectomy showed a higher subsequent risk of developing BC  as compared to patients without a history of tonsillectomy. Influence analyses showed that no single study had a significant effect on the overall estimate or the heterogeneity.Our study revealed that a history of tonsillectomy is associated with an increased risk of breast cancer. These findings underscore the need for frequent follow-ups and screening of tonsillectomy patients to assess for the risk of BC. Inflammatory processes can increase the risk of cancer development. Tonsillitis is one of the most common presentations of inflammatory diseases, especially in children. Its treatment strategy includes performing a tonsillectomy, which is a routine procedure. The acute complications of this surgery include hemorrhage and infection, but long term, it has also been correlated with a higher risk for neoplastic development . StudiesTwo theories have been proposed in the literature that might explain the risk between tonsillectomies and the development of cancer. The first is that the immune function of tonsils is greatest in childhood and that it drastically decreases after adolescence. Therefore, children with tonsillectomies are put at a greater risk for viral infections which subsequently aid in the development of cancer . HoweverThe main aim of our study was to conduct the first comprehensive critical review and meta-analysis of observational studies to ascertain the risk of cancer in people with a reported history of tonsillectomy.The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines . The UniThree electronic databases  were searched from inception to January 25, 2022, for relevant studies. The details of the search strategy for each database are presented in All included studies had to meet the following eligibility criteria: cohort or case-control study design; at least 1 study group of patients with tonsillectomy; and a comparison group involving patients without tonsillectomy or the general population. Included studies were also required to investigate breast cancer occurrence, incidence, or prevalence of cancer within this group of patients. Studies investigating only a pediatric population were excluded to minimize age-related bias. For overlapping studies from the same cohort , the latest and most appropriate outcomes were selected by the consensus of all the investigators.Two investigators independently screened the titles and abstracts of all the articles using the predefined inclusion criteria. The full-text articles were examined independently by all investigators to determine whether they met the inclusion criteria. Furthermore, the same authors independently extracted data using a data extraction form. The final inclusion of each article was determined by all investigators’ evaluation discussions. References and data for each included study were carefully cross-checked to ensure that no overlapping data were present and to maintain the integrity of the meta-analysis.To assess the risk of bias in the included cohort and case-control studies, the Newcastle-Ottawa Scale tool was used. Using the tool, each study was judged on 8 items in 3 categories, including the selection of the study groups, the comparability of the groups, and the ascertainment of the exposure of interest for case-control studies or the outcome of interest for cohort studies. Studies that received 7, 8, or 9 of a possible 9 points were regarded as high quality, whereas studies that received 4, 5, or 7 were regarded as fair quality (high risk of bias), and those that received 3 or less were regarded as low quality (very high risk of bias)  analysis to show the effect of every single study on the overall effect and heterogeneity.The systematic search identified 2523 potentially relevant studies. After initial review by title and abstracts, 2450 articles were excluded, leaving 73 to be reviewed in full text. Eight studies ultimately met our prespecified criteria and were included in our analysis. The detailed study selection process is depicted in a PRISMA flowchart in Together, these eight studies included 2252 patients with breast cancer of which 1151 underwent tonsillectomy and 5314 controls of which 1725 had their tonsils removed. Seven were case-control studies –16 and oThree studies were of high quality –17 while2 = 33%; P = .17; 2 = 33%).Our meta-analysis included eight studies comprising 2876 participants with a history of tonsillectomy and 4690 without a history of tonsillectomy. It revealed a statistically significantly increased risk of breast cancer in the group with a history of tonsillectomy as compared to the group without a history of tonsillectomy . The heterogeneity among the studies was of an acceptable level . All analyses showed an increased risk of breast cancer in the group with a history of tonsillectomy as compared to the group without a history of tonsillectomy. However, the test for subgroup differences was not significant for any of the comparisons, as shown in 2= zero) , and women, in particular, were more prone to develop breast cancer later in their lives (n = 2200).Theories put forward to explain this association suggests viral infections as the key driver of mutations, leading up to cancers. Late age tonsillectomies have been proposed as a proxy for a delayed type of infection by the Epstein- Barr virus (EBV) . MoreoveQuite a few studies conducted previously have investigated the association of tonsillectomy with cancers at various locations. Vineis et al. in a case-control study depicted a two-fold risk of lymphocytic leukemia with a tonsillectomy performed at 10 years of age . Liaw etin-vitro setting (Lubin et al. showed an increased risk of breast cancer diagnosed after 65 years of age in women with a history of tonsillectomy . Yasui e setting . Finally setting .This study provides a deeper insight into the relationship between tonsillectomy and developing breast cancer; it extends and confirms previous results. Some other strengths of our study include precise results as a culmination of a comprehensive review that has not been done so far. Moreover, a comprehensive investigation of heterogeneity and use of sensitivity analyses to demonstrate the robustness of our results futher strengthen our meta-analysis.Our study is not without limitations. Some of the major limitations that need to be highlighted include the observational nature of the included studies and the risk of confounding bias. Moreover, adjustment was not available for all of the studies, and some individual studies carried a high risk of bias. Due to inadequate reporting by the studies, we were not able to assess the association between the average age at tonsillectomy and risk of BC. Finally, there was a lack of matching between cases and controls in some studies.Our study underscores the need for frequent follow-ups and screening of tonsillectomy patients to assess for the risk of BC. The indications for tonsillectomy may need to be reconsidered, especially in those patients with pre-existing risk factors for BC. Large-scale studies with a robust design to reduce confounding bias are needed to confirm our findings. Mechanistic research is also needed to fully understand the pathogenesis of BC in tonsillectomy patients.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.SK, AE, MO, HC, AK: Data collection, analysis, screening and scientific writing. AB, MA, KD, LS, OR, NS: Data collection, analysis, screening and scientific writing. AA, JS, SG: Study concept, design, and drafting of the manuscript. All authors contributed to the article and approved the submitted version. SK, AA, JS, SG: Study concept, design, and drafting of the manuscript.Author MO was employed by IQVIA.The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The illness course of bipolar disorder (BD) is highly heterogeneous with substantial variation between individuals with the same BD subtype and within individuals over time. This heterogeneity is not well-delineated and hampers the development of more targeted treatment. Furthermore, although lifestyle-related behaviors are believed to play a role in the illness course, such mechanisms are poorly understood. To address some of these knowledge gaps, we aimed to develop an app for collection of multi-dimensional longitudinal data on BD-relevant symptoms and lifestyle-related behaviors.An app named MinDag was developed at the Norwegian Center for Mental Disorders Research in Oslo, Norway. The app was designed to tap into selected areas: mood, sleep, functioning/activities , substance use, emotional reactivity, and psychotic experiences. Ethical, security and usability issues were highly prioritized throughout the development and for the final app solution. We conducted beta- and pilot testing to eliminate technical problems and enhance usability and acceptability.The final version of MinDag comprises six modules; three which are presented for the user once daily (the Sleep module in the morning and the Mood and Functoning/Activities modules in the evening) and three which are presented once weekly . In general, MinDag was well received in both in the beta-testing and the pilot study, and the participants provided valuable feedback that was taken into account in the final development. MinDag is now in use as part of the research protocol at the NORMENT center and in a specialized treatment unit for BD at Oslo University Hospital in Norway.We believe that MinDag will generate unique longitudinal data well suited for capturing the heterogeneity of BD and clarifying important unresolved issues such as how life-style related behavior may influence BD symptoms. Also, the experiences and knowledge derived from the development of MinDag may contribute to improving the security, acceptability, and benefit of digital tools in mental health. Bipolar disorder (BD) affects 1–2% of the population worldwide , 4. SuchIn addition to a more detailed characterization of the variation in BD symptoms over time, there is a need for a better understanding of the mechanisms, i.e., processes and interplays underlying this variation. On top of the contribution of genetic liability to variations in symptoms and illness episodes, individuals' life-style-related behaviors and contextual factors such as life events and social support play a role during the course of BD. For instance, while substance use , 11 and Several apps for mood monitoring in BD have been developed and tested, and current research using these apps has multiple aims. For instance, frequent self-reports have the potential to reveal symptom exacerbations at an early stage and can be powerful clinical tools to detect changes needing prompt intervention. Thus, several research efforts aim to determine the validity of app-based self-reports of mood and/or mood-related behavioral parameters from digital phenotyping , 16, andTo develop MinDag, the NORMENT project group collaborated with a team of application engineers and visual designers in the Web application group at the University of Oslo's Center for Information Technology (USIT). The framework and content were decided by the project group while engineers and designers determined which features were applicable and conducted the programming. App development was performed in the React Native open-source UI software framework. This allows for deployment across different operation systems, and MinDag was built for both iOS and Android.Downloading MinDag requires a smartphone with iOS or Android operation system, and a user profile for AppStore or GooglePlay. The system is based on HTTPS transfer of data as JSON files through secure web-survey provider “Nettskjema,” hosted at USIT. Data is not stored on app user devices; for each completed task, data is PGP encrypted and transferred to a secure server (Services for Sensitive Data-TSD), as illustrated in MinDag was developed at the Center of Excellence Norwegian Centre for Mental Disorders Research (CoE NORMENT) at Oslo University Hospital (OUH) and the University of Oslo (UiO). NORMENT conducts the Thematically Oriented Psychosis (TOP) study, a naturalistic translational study aiming to increase the knowledge about the underlying mechanisms and treatment of severe mental disorders. The study started in 2003 and is still ongoing, with approximately 2000 participants included as of February 2022. The app development is part of the NORMENT's general strategy to expand and improve the study protocol with digital longitudinal data collection. The MinDag development project group consisted of clinical researchers  with long-term experience in clinical research on BD, personnel with eHealth technology expertise, and the center's user representative.Six main focus areas, shown in sine qua non for capturing illness activity in BD. Furthermore, one of the main aims of the app development was to create a tool better suited for capturing mood lability than traditional interviews or questionnaires where individuals are typically asked about their general tendency to shift frequently between different mood states. With such methods, the risk for recall- and generalization bias is large. Mood monitoring via an app, on the other hand, can be done continuously i.e., with minimal delay between experience and report in the individual's own environment.Monitoring elevated and depressed mood is a Disturbances in sleep and sleep/wake cycles are present in both (hypo) manic and depressive episodes  and persA recent meta-analysis reports that psychotic symptoms are present in 58–68% in bipolar I disorder and 14–33% in bipolar II disorder, which may be higher than previously reported . FurtherEmotional reactivity refers to the threshold for, and magnitude of, emotional responses to salient environmental stimuli and can be classified on a dimension ranging from emotional hyper- to hypo-reactivity . Hypo-reSubstance use is common in individuals with BD and comorbid substance use disorders are present in up to 40% of this patient group , 43. ComBD is one of the leading causes of disability worldwide  and funcThe app was given the name “MinDag,” which means “my day” in Norwegian, to signal that the intention of the app was to capture daily personal experiences and routines while also being neutral i.e., not implying psychopathology. We also decided to develop simple gamification features to increase the users' motivation to complete the intended registrations.The first beta-testing of MinDag was conducted with a group of four users with lived experience of severe mental disorders, recruited through the NORMENT User Council. At the time of the beta-testing, four of the six MinDag modules had been developed: Mood, Sleep, Emotional reactivity, and Psychotic symptoms. The purpose of the beta-testing was to test the technical functioning and receive feedback about the user experience of MinDag, and next, evaluate and further develop the app. After 4 weeks of testing, the test users were asked for feedback using a semi-structured telephone interview. Themes covered in the interview were technical issues, perceived adequacy of the number of questions and notifications, time spent completing the registrations, and perceived relevance of the content and questions in the different modules. The test users were also asked for any additional feedback. The results of the beta-testing were discussed in a meeting with the technical developers and two of the beta-testing participants.After the initial beta-testing phase, a pilot study was launched. Here, the aim was to test what we considered to be the final version of the app. We were particularly interested in uncovering usability issues, paying attention to user experiences, content relevance and general acceptability. In addition to the participants of the beta-testing, new participants were recruited from the Norwegian Bipolar Association through an invitation in their monthly newsletter. Other people with BD who had previously expressed an interest in the project were also invited. In total, nine participants were recruited. An initial meeting was held where the participants downloaded the app and were given information about the project. The participants then used MinDag for 2 weeks, after which they received a phone call from one of the researchers. They were asked about their overall experience with the app and to report any technical problems. After another 2 weeks, all the participants were invited to a focus group meeting. Five participants attended this meeting, where feedback was collected through individual post-it notes, addressing pros and cons for each module, followed by a group discussion and a questionnaire. The questionnaire consisted of the same questions as those used in the beta-testing, with a few additions, such as whether using MinDag had affected their mental health in a negative way, if information about the previous nights' sleep was difficult to remember in the evening, and what they thought about the gamification elements.In addition to user involvement in the beta- and pilot testing, the MinDag development has been discussed with members of the board of the Norwegian Bipolar Association who has expressed a need for quality-controlled apps targeted at individuals with BD. Also, a total of four user representatives employed at NORMENT, two of whom were specifically recruited to join the MinDag project group, have been involved in different phases of the development. Lastly, the project group has performed continuous evaluation and testing during all phases of the development.To cover each of the selected dimensions, we searched for validated self-report measures which were adapted to an app format or could potentially be digitized to cover the selected parameters. If such measures were not available, we developed suitable assessments. Here, we describe the final content and functions of the MinDag, i.e., after changes were made based on beta- and pilot testing. Please refer to As we had a specific focus on exploring symptom variation including mood instability, simple single- or double items for evaluating mood was chosen as opposed to comprehensive assessments of syndromal conditions of depression and (hypo) mania. For the same reason, we followed recommendations to monitor mood on a daily (as opposed to weekly) basis , 55. ForThe sleep module was developed by the project group but in correspondence with the Consensus Sleep Diary, a validated method to collect subjective measures of sleep and diagnose some sleep disorders , 60. TheThis module was developed by the project group. Items were developed to tap areas of everyday functioning often found to be impaired in severe mental illness while also covering activities with a possible beneficial impact on the BD course. Items capture time spent on school/work, work training, rehabilitation and/or treatment, physical exercise, hobbies/leisure activities, and time spent with other people either physically or on the phone/online . The modTo monitor psychotic symptoms, we used selected items from the ClinTouch system  which isTo monitor emotional reactivity, we used the MAThyS  which haThis module was developed by the project group and includes weekly assessments of use of alcohol, nicotine products, and the most commonly used illicit substances , number of days of use, number of units/doses consumed in average, and degree of craving . AlthougParticipants must allow MinDag app-notifications on their smartphone to be prompted for scheduled tasks. “Help”-buttons within the modules were developed with instructive texts to enhance reliability. All daily items in the app were set to be open for response until the next day's questions were opened, i.e., for 24 h. All weekly questions were finally set to be open for response for 36 h . The final version of the launch page with all modules are presented in via the app was anonymous as participants created random study-IDs, undisclosed to the research personnel. For the formal MinDag study, we developed an alert algorithm within the TSD server to detect if a participant reports high and enduring symptom levels. The alert-dashboard will be reviewed weekly by study nurses in the project. In case of alerts, a clinical researcher (doctor or psychologist) will contact the participant to check whether they have an appointment with their treating clinician in the near future or if any measures need to be taken to ensure necessary care. The study has been approved by the Regional Ethics Committee (REK 2018/208).Participants download MinDag to their private smartphones. To unlock the app, the users' personal passcode or face-recognition is needed. Since notifications are easily visible on the screen, they are neutrally formulated with the message “You have a new task to complete.” The TSD data transfer and storage solution for MinDag and the app content have been approved in risk- and vulnerability evaluation by the Data Protection Officer at Oslo University Hospital. There is a safety-feature in the app that holds the completed module-submission for transfer until a network is available. The HTTPS transfer is stable and invulnerable with PGP-encryption of the data. In the beta- and pilot testing, potentially sensitive data collected Feedback from the beta-testing revealed technical issues that prevented two of the users from completing MinDag registrations on a daily basis. In addition, several problems with the notifications were reported. Apart from these issues, the beta-testers found the app easy to use and understand, and the questions were considered relevant. Furthermore, the testers considered time spent engaging with the app as acceptable, and they responded positively to suggestions of adding a few more questions. They proposed to add daily questions about diet, physical activity and some more details about sleep duration and -quality. All the testers expressed a desire to get feedback about their responses within MinDag but were also positive to the possibility of personal feedback through regular meetings with research clinicians. During the beta-testing interview, the test-users were informed about the plan for adding a module on substance use, to which they responded positively. After the beta-testing phase, the technical problems were resolved and the following additions were made to the app: A question about whether one had not slept at all during the night, the Substance use module and the Functioning/activities module.In general, participants reported that they found MinDag easy to use. Some participants reported receiving more notifications than intended, while others reported receiving fewer. Other minor technical issues were also uncovered. The participants suggested to increase the time limit for response to the weekly questions, extending the response time to 36 or 48 h. In the Emotional reactivity module, the participants found it difficult to determine the middle point on the sliding scale and requested this to be more clearly indicated. Some participants found the text in this module too small to read. It was also suggested to add more colors to this module. Some participants reported trouble remembering their sleep behavior from the previous night. On the other hand, the participants generally reported that they found it easy to remember their week when answering questions in the weekly modules. Finally, the gamification elements were well received, and some participants suggested adding even more such features.Participants reported some individual differences in perceived relevance of the questions, particularly pertaining to the questions regarding psychotic experiences. Some participants also found the daily questions somewhat repetitive. A question was raised regarding the meaning of the Norwegian word for “elevated,” where the intention was to capture (hypo) manic mood states. The participants also suggested adding questions about stress, if life is worth living, suicidality and whether something out of the ordinary happened recently. Additionally, the possibility to add questions with personal relevance was suggested to increase the motivation to use MinDag. Responses concerning the number of daily questions varied between “too many” and “two to five questions may be added.” Regarding the number of weekly questions, the responses were “ok” and “five to ten questions may be added.” Participants did not report that using MinDag affected their mental health negatively, although one participant described sometimes feeling a bit surveilled, and another felt irritated. The participants were generally positive about the prospect of using the app for 6 months.Based on the focus group meeting, the following changes were made to the app: The daily questions were split into two, resulting in a morning module and an evening module where items about sleep the night before were placed in the morning module. We also added two more items in the sleep module, and the interval of sleep at daytime was refined. Two words were added to the original single word for mood elevation to clarify the experience we aimed to capture. A question about the degree of satisfaction with today's activities was added in the Functioning/activities module. A question with an open response text field was added at the end of the Emotional reactivity module with the possibility to describe particular experiences that has affected the user the last week. Furthermore, some technical features were revised to increase usability, such as more space between items for easier scrolling, larger text in some places and markers for middle points. The possible response time for the weekly modules was extended from 24 to 36 h. Questions measuring stress, as suggested by the participants, were not added as we considered that this would require an additional module that would add too much to the total MinDag response time. Questions about suicidality were not added as we deemed that this would require a closer follow-up of the data and participants than what was feasible with the available resources of the project. After these changes, we concluded that MinDag had satisfactory content and acceptability, and was ready to be launched.st June 2022, and demographic and clinical characteristics as well as basic data on use periods and adherence are presented in MinDag is currently available in Norwegian language only and restricted to participants recruited to a NORMENT-based study. Formal data collection with MinDag started in September 2019, mainly in a specialized clinical unit for BD at Oslo University Hospital but also in general secondary psychiatric services in the Oslo area. Inclusion criteria are a DSM 5 diagnosis of a bipolar spectrum disorder and age between 18 – 65 years. Exclusion criteria are brain damage  and lack of knowledge of a Scandinavian language. Due to the COVID-19 pandemic , recruitment rates to date have been relatively slow with 37 participants included as of February 2022. Of these, 23 have completed their use of MinDag by 1p =0.95.As seen in The app-based data generates large quantities of data for each participant, allowing testing of associations in a hypothesis-driven as well as data-driven analyses. In line with a few recent studies on mood instability in BD, we will apply the root mean square successive difference (rMSSD) method to capture both the magnitude and the temporal order of changes in mood , 68. We In this paper, we aimed to describe the development of MinDag, an app for long-term monitoring of symptoms and lifestyle-related behaviors in BD. Specifically, we present the overall purpose of the app development, the rationale behind the choice of modules included, the developmental process including beta- and pilot testing and the final product. Important ethical considerations and security solutions are also described. To our knowledge, this is one of the first apps developed to date for parallel monitoring of a wide range of symptoms and behavior in BD. The data generated from MinDag will provide unique opportunities to investigate how mood, sleep and other symptoms fluctuate over time. Furthermore, the data will enable exploration of the interplay between symptoms and lifestyle behaviors such as substance use and participation in occupational, social and physical activities. As MinDag is used as part of the study protocol at NORMENT, the data may also be used in combination with data from other types of assessments: e.g., exposure to early environmental risk factors, neurocognitive function and genotypes and other biomarkers. We expect to contribute to an increased understanding of different mechanisms underlying symptom variation over the course of illness.The aim of the MinDag development was to produce a tool for comprehensive data collection, i.e., not a clinical tool as part of a treatment intervention. However, we considered the involvement of users with lived experience of BD as crucial ensuring that the app would be well received by the target group. This is necessary to obtain as complete data as possible and to enable long-term use. Preliminary user data show that the length of participation varies with some participants using the app for longer and some for shorter than the 6 months they are initially asked to use it. We consider that periods shorter than 6 months will also yield valuable data and that some variation in use lengths is not a major concern. Thus, encouraging 6 months of use while also being flexible regarding use length appears as an adequate strategy moving on. An adherence rate of 72% is acceptable although somewhat lower than expected compared to a previous similar study , and mayAlso, as MinDag provides highly clinically relevant output, we had future clinical use in mind during the development. Overall, MinDag was well-received by the test users. They engaged actively in both the beta-testing and pilot study, and we were able to revise MinDag according to most of the feedback they provided. Thus, we believe to have found a good balance between scientific ambitions and acceptability, where the latter is particularly important for obtaining data of sufficient completeness and reliability. In this patient-group we can expect variability in motivation and insight that may affect the level of engagement with the app and reliability of data. For instance, symptom peaks in both affective polarities may reduce the likelihood of using the app. Being aware of this, the MinDag team will monitor submissions weekly. The monitor dashboard is also rigged to alert the team after 3 days of missing data, and participants will be contacted by phone and asked about the reason for non-adherence.Throughout the development period, there has been a great deal of activity in the field of eHealth for mental disorders including some specific developments for BD. Several challenges have been identified with available apps , and somIn MinDag, we have not developed feedback features in terms of visual illustrations of the user's registrations for two reasons: Firstly, the main purpose of MinDag is to obtain naturalistic data, thus we were reluctant to include features that may serve as an intervention. Providing feedback about the interplay between symptoms and behavior may have psychoeducational effects, although recent studies indicate that such an effect is limited, at least on primary outcomes such as affective recurrence and hospitalizations , 73. SecAlthough most of our participants did not report that use of the app had any negative effects on their mental health, one participant described feeling somewhat surveilled and another feeling irritated. Possible “side-effects” of monitoring personal experiences with an app should be taken seriously. However, we believe that such side-effects can be reduced or even eliminated through measures such as explanations of security issues and personal adaptations of app content . Thus, dialogue with the participants during the study period is vital. This is important also to encourage participants to continue engagement with the app even during periods with high symptom intensity.We are currently adapting MinDag for use in other patient populations, such as people with schizophrenia. Thus, additional modules are under development, and the MinDag set-up will be flexible in the sense that different modules can be activated/de-activated. MinDag is also currently being included in the protocol of a clinical trial, where it enables continuous monitoring of symptomatic change. This may serve as a valuable supplement to traditional (less frequent) paper-and-pencil-based evaluations.Technical problems have emerged in all phases of the current project. When users experience bugs and other technical difficulties, the motivation to use the tool declines rapidly. Hence, access to the necessary technical competence and resources is crucial not only in the developmental phase but also for maintenance.In conclusion, we believe that the unique data that we will obtain from the current project, together with the experiences and knowledge derived from its development, will contribute to improving the benefit, acceptability, and security of digital tools in mental health.The original contributions presented in the study are included in the article/The studies involving human participants were reviewed and approved by Regional Comittee for Medical Research Ethics South East Norway (REK 2018/208). The patients/participants provided their written informed consent to participate in this study.IM and TL initiated the project with support from OA. TL and IM outlined the MinDag rationale. SA, MC, EB, MH, TB, SH, HM, MN, CB-C, and TL constituted the project working group. SA, MC, TB, MH, and TL organized the beta-testing and pilot study. TB and TL supervised the technical development. The first manuscript draft was co-written by all members of the project working group plus RI, refined by TB and TL and revised and approved by all co-authors. All authors contributed to the article and approved the submitted version.The project was financially supported by Oslo University Hospital, the University of Oslo, the Research Council of Norway (#223273 and #288542), and the South-East Health Authority (#2000189-19). The funding organizations had no role in the design of the study, the collection, analysis and interpretation of the data, the writing of the report, or in the decision to submit the paper for publication.OA has received speaker's honorarium from Lundbeck and Sunovion and is a consultant to HealthLytix. RI has been consultant for Indivior, Lundbeck (<2017), talk for Pierre Fabre and in 2019 with fees paid to the CSAPA “Espace Murger” association, regular trainer at the IREMA institute.The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Stroke is a disease with a high disability rate, having a serious impact on that patient's working and daily survival quality and bringing economic burden to the family and society. Patients with stroke hemiplegia are mostly tetraplegic and have difficulty regulating their balance, and their long-term symmetry has been destroyed. The application in the rehabilitation process of acupuncture in patients with hemorrhagic stroke may produce unexpected effects. It is very effective to study the effect of acupuncture combined with rehabilitation training on limb movement and patient survival. It is very helpful in improving normal motor function and normal life, increasing joint mobility and muscle strength, and reducing muscle tension. In this paper, it is found that the observational group has a complication rate of 2.13%, in contrast to 17.02% as in the group of control, and the pin-prick combined with a rehabilitative training makes a significant improvement to the patients. This study provides suggestions for the study to investigate acupuncture combined with recovery exercise on limb movement and living capacities of people with stroke paraparesis. Acupuncture is a rehabilitation treatment for acute cerebrovascular diseases in recent years. It achieves the goal of “Internal Diseases and External Treatments,” by stimulating the meridian, promoting blood circulation and eliminating veins in the blood, and fully providing local and comprehensive treatment. At present, scalp acupuncture and hemispherical acupuncture are common in clinical treatment. Traditional Chinese medical theory believes that the head is where the IQ and the meridian merge. Through scalp acupuncture, IQ is adjusted to improve local microcirculation and increase brain blood. Cerebral edema flow and relief using different acupuncture points and different stimulating forces can lead to brain cell stimulation or inhibition of two-way regulation, stimulating the central dynamic nervous system, improving the signal input to the dynamic area of the cerebral cortex, and thereby promoting recovery.Because the central nervous system is damaged, the patient's dynamic function is also reduced. If the patient does not receive systematic rehabilitation training, it will have serious consequences, which will greatly reduce the quality of life and put more burden on the patient's family. According to related research, when the central nervous cells of the human body are damaged, their adjacent brain cells are stimulated, and a part of their damaged nerve functions is distinguished and compensated. Control patients benefited from standard therapy only, with associated medications to restore neurological function in the patients. In contrast, it was found that acupuncture integrated with rehabilitation traveled far and above conventional therapy.p < 0.01). In the observation subjects 1 and 2, the levels were significantly higher, APTT was significantly prolonged, and AT-III was significantly lower, with striking statistically significant differences (p < 0.05). Detecting indicators 1 and 2 were not significantly different (p < 0.05), and APTT and FIB were positively correlated with stroke  [The Hachisuka A. et al. study found that pituitary stroke is usually the result of a hemorrhagic infarction of pituitary adenomas. Clinical manifestations are diverse, including asymptomatic cases, typical pituitary stroke, and even sudden death. Cerebral ischemia caused by pituitary stroke is very rare. It may be caused by vasospasm or tumor directly compressing the cerebral blood vessels . The SatAcquisitions of comorbid rehabilitation training combined with acupuncture can often have unexpected effects on limb movements and life skills in stroke patients with hemiplegia. In this paper, 94 stroke patients admitted from December 2019 to January 2020 were selected and compared with the reference. The rehabilitation status of the two groups of patients who received “acupuncture incorporating rehabilitation training and no acupuncture combing training” was observed. A better recovery effect with the combination of acupuncture and moxibustion training was observed than that without the combination of needle and moxibustion training. However, these studies still need to be more improved in experiments, especially to pay attention to the innovation of experimental methods.It is the general term for acupuncture and exercise. With guidance from Chinese medical theory, moxibustion refers to the insertion of needles  into a specific angle into a patient's torso. Particular areas will be stimulated to achieve a disease treatment goal. This puncture point is known as a point on the body and is called an acupuncture point. The most current acupuncture manual numbers 361 acupuncture spots throughout the entire body. It is done by rubbing or kneading, fumigation, ironing, and the application of heat stimulation to a “point” on the upper surface of the body to prevent and treat disease. There are also other methods such as moxibustion, moxibustion, core moxibustion, and mature moxibustion. In addition, there are other methods such a moxibustion, osier moxibustion, core moxibustion, and mature moxibustion. It includes “moxibustion” and “moxibustion with medicine,” as an important part of Oriental medicine, including acupuncture theory, the points, acupuncture techniques, and related equipment. During its formation, application, and preparation, the unique Chinese culture and regional characteristics are the result of the valuable heritage of Chinese cultural and social traditions, and in 2006, the school of Chinese medicine announced with the State Council that acupuncture was included in the first inscription of national intake of intangible cultural property . TherefoIn China, acupuncture can be used as a unique treatment for diseases. It is a medicine for internal and external treatment. Which is accomplished by guiding meridians and acupoints and applying certain methods to treat systemic diseases. Acupuncture is used to diagnose the causes of TCM and identify the methods that belong to nature, meridians, and injured organs according to the TCM practice and confirmed as belonging to the TCM category. Discussions are followed by respective prescriptions for acute treatment. Through the channeling of meridians and the regulation of hemoplasm, the functions of yin and yang are rendered relatively balanced for the preventing of diseases. It is part of the ancestral medical heritage and a unique and ethnic Chinese medical approach. Over the centuries, it has made outstanding contributions to the protection of national well-being and reproduction. It remains his task up until now and has won the popular trust .The function of the meridian is to keep the meridian unblocked and exercise its normal physiological functions. This is the most basic and direct treatment method of acupuncture . The merProvide good psychological care for patients and their families: patients and their families should be patiently informed about the purpose, methods, effects, and training of medical physical rehabilitation before rehabilitation training. Rehabilitation cannot be replaced by drugs. Only through early training can the remaining functions be restored in accordance with the “progressive” rehabilitation training plan and cannot be rushed. Only with the active participation of patients and the strong support of family members can rehabilitation training be successfully completed , 8, 9Maintain the correct position of good limbs: good limbs are not the same as functional limbs. This is a temporary location, designed from a therapeutic perspective. Most of the affected limbs in the acute phase of hemiplegia are now relaxed. Not only can it not move, but it can also lead to subluxation of the joints and damage to the soft tissues around the joints and even contracture due to abnormal posture for a long time. Good limb placement can play a role in inhibiting spasm patterns, preventing shoulder bruises and early separation movements. Play is an important measure to prevent many complications and improve rehabilitation , 11Posterior method: place your head on the pillow, tilt it slightly to the healthy side, refer to the affected side, the height of the pillow should be sufficient, and the thoracic spine should not be bent. Place a cushion below the patient's hip to move the affected pelvis forward to prevent hip flexion and external rotation. Place a small pillow under the patient's shoulder joint to push the scapula forward. Stretch your upper elbows on your pillow, and stretch your wrists backwards and your fingers. Place a sandbag on the outside of the thigh and the middle of the thigh to prevent hip dislocation and external rotation and a small pillow in the sleeping area to prevent knee joint extensionThe lateral position below the affected side: the affected side's shoulder belt stretches forward, shoulder reflexes, elbows straight, wrists straight, and fingers straight. The affected limb is straightened, and the knee joint is slightly bent. The hips and knees of the lower limbs on the healthy side are bent, and a cushion is placed below to prevent the affected lower limbs from being squeezed together. A pillow is pressed against the back, and the upper body can be leaned on to obtain a relaxed posture , 13Above the affected side: the upper limb of the affected side is extended forward, and the shoulder joint is bent about 90 degrees. The floor is supported by cushions, and the healthy upper limbs can be placed freely. Hip and knee joints of the affected lower limbs are bent and placed on a cushion. The left hip is stretched, the knees are slightly bent, and the back is pressed against the pillow to relax the trunk. In order to prevent joint contraction and to maintain pressure in a specific position for too long, you must change the position in time according to the situation and generally reverse it every two hours. When changing positions, special care should be taken to protect the shoulder joints and do not pull the affected joints to prevent shoulder injuries –16Avoid intravenous amputation where possible: some patients and family members believe that the affected limb will not move this way, or that it is an intravenous infusion. I do not know that a healthy limb is free, but it does bring the repair of a damaged limb. Side effect. Due to insufficient blood return of the affected limb, coupled with sweating and limited movement, it is easy to cause hand swelling and tissue adhesion, increase the risk of shoulder-hand syndrome, and provide guidance and cooperation for rehabilitation nursing staff to facilitate patient limb repair , 18Academic practice should be avoided in limb rehabilitation training: limb paralysis is a common symptom of stroke patients, and joint training for the ability of amputated limbs is an important rehabilitation measure. The principle is to train in pain, and rehabilitation nurses must have stable knowledge in various fields such as neuroscience, anatomy, psychology, and medicine. Restore. On this basis, they should be processed manually to prevent rough handling. For patients with pain, you can take hot packs or painkillers before training to avoid shoulder dislocation, shoulder joint syndrome, and epilepsy during exercise; exercise should be slow and rhythmic, and the patient should be clearly explained before training. The purpose, content, function, and correct action items of the action inform the patient of the active part, direction, and regular muscles, and then, slowly perform passive activities 2-3 times so that the patient can feel the movement and gradually decrease in this case. Auxiliary active exercise volume , 20Pay attention to the scale and intensity of training during physical rehabilitation: patients often feel anxious when freely moving. Excessive exercise can cause modern compensatory exercise or pain and fatigue, which increases spasm and affects exercise results. Rehabilitation nurses should explain to patients and their families different training methods used at different rehabilitation stages, as well as monitor the general situation of patients, follow small- and long-term nursing principles, and gradually increase education, that is, to complete the total training and avoid the negative effects of overtraining from overtraining. Each time you train an action, you must maintain a precise attitude and focus your brain's thoughts on this action and the main part of your training body to “control” this behavior of the brain. Power is always a passive activity and cannot achieve the purpose of education. Training the passive activity in one's own active action is the real problem of training , 22Attention to the systemic and follow-up of rehabilitation training: to achieve a good training effect and in order to achieve the expected purpose of restoring physical function, it is necessary to carry out serious training at the prescribed time in accordance with the established plan. Classes and holidays should be avoided. Interrupted training is interrupted because the trainee cannot experience specific repetitive stimuli, cannot produce adaptive responses, and has no value to avoid focusing on any training. Although these sections ignore other sections, they must fully consider different joints, muscles, and different functions. Therefore, the restoration of limb function requires some persistence and family supervisionWhen performing physical rehabilitation training, care should be taken to avoid premature walking: some patients and their families are concerned about the slight mobility of the affected limbs. They want to achieve this. They cannot wait for intensive education of many people. Hold on and hold your hand to walk or climb the stairs. It is necessary to know that “not enough speed” does not focus on the training of basic movements and ignore the stages of the patient's movement patternBe careful when dealing with recovery after rejection: some patients become sensitive and vulnerable after illness, overreliance on doctors and their families, lack of initiative in rehabilitation education, and think that the doctor's technology is the treatment of fact. In effect, active training is much better than passive training . Some faHeme is the main manifestation of limb dysfunction in stroke patients, and the main reason is the neuron damage and transplantation abnormality. An implant includes impaired coordination between muscle groups, increased muscle tone, and limited joint mobility. Since joint motion is controlled by the contraction and relaxation of related muscle groups, joint mobility can be improved by strengthening the function of related muscle groups. Traditional Chinese medicine can promote local muscle blood circulation and alleviate the symptoms of edema and pain while improving muscle and neurotrophy, eliminate the pressure of neuroedema, and achieve the effects of promoting functional recovery and inhibiting muscle atrophy. The damage of the upper motor neurons prevents the release of the retroreflector in the lower center, which is the cause of hemophilic contraction, but the effect of simply applying traditional Chinese medicine to repair the damaged neurons is average. Acupuncture can select the puncture site according to the anatomy of the patient's limbs or muscles, stimulate nerve muscles, correct excitement imbalance and inhibit nerves, and promote nerve recovery. Medical aspects. Acupuncture can promote the movement of the affected limb, use and regulate the body's reflexes, strengthen central stimulation, and improve coordinated control of the affected limb. Limited joint mobility is a common manifestation of dyskinesia. Improving joint mobility is the main purpose of rehabilitation for semidisabled patients. Hip and knee joints are important joints that control the movement of the lower limbs, and it is not necessary to increase the effect of Chinese medicine on joint mobility. Muscle failure is the leading cause of stiff limbs. The enhancement of muscle strength after acupuncture combined with Chinese medicine is related to the improvement of muscle strength and the reconstruction of acupuncture function. In addition, the reduction of muscle tension after acupuncture with Chinese medicine is also the basis for increasing joint mobility.(1)General information: from December 2019 to January 2020, 94 stroke patients were selected and treated. Inclusion criteria are as follows: all patients met the diagnostic criteria in the 2016 American Heart Association/American Heart Association Brain Repair Guidelines. Depressive symptoms, signed informed consent, agreed to receive research training, no surgery or thrombolytic therapy, all patients appeared for the first time, and the course of disease was less than two weeks(2)First of all, it is necessary to correctly position and transform the limbs, try to keep the limbs in an anatomical functional position, and often move the limbs to prevent the pressure of ulcersActive and passive movements on the bed, such as upper arm abduction, elbow extension, lower limb extension, and back twist of knees and anklesTo perform a certain massage repair, it is necessary to regularly massage the affected joints and muscles of the patient to accelerate the blood circulation of the limbs. Seated trainingContinuous balance trainingStairs for walking and climbingLife skills training Resistance training: the above active and passive exercises are trained once a day in the morning. The total training time is 2~3 h/d for a total of 3 months. During the training, the patient can endure without feeling tiredGet some psychological treatmentThere was an observation group and a control group divided into 47 cases in each group by the contact ball method. The observer group had 26 cases of males and 21 cases of females, aged 54-76 years, meaning 65.2-1.4 years, including 23 cases of mongrel, 24 cases of right hemizygous, and 25 cases of male. The control group consisted of 22 females and 55 females, ~76 years old, mean age 65.3~1.3) years old, in which 24 cases of left hematoma and 23 cases of right hematoma(2)Both groups of patients received conventional neurological treatment, and the nurses evaluated the patient's symptoms, combined with the cause to give the patient general treatment, assisted to actively fight the disease, and established a correct and good treatment mentality; the observation group was supplemented with rehabilitation training interventions. The specific content is as follows: the medical staff sets up a rehabilitation training intervention group consisting of the attending doctor, rehabilitation physician, and nurse and conducts training work around the content of rehabilitation training to actively improve its self-cognition level and comprehensive ability and develop rehabilitation training based on the patient's condition and actual situation. The plan mainly includes correct posture placement, changes, active and passive joint activities, early seated adaptive training, stance changes, and body center of gravity shifts and monitoring the patient's quality of life and mental state throughout the process. For patients with sexual psychology, the nurses carry out health training work around them in a timely manner, inform the patients of stroke, depression, treatment, and prognosis, improve the patient's self-cognition level, and enable them to actively cooperate with treatment and nursing work to ensure intervention effect. Acupuncture treatment was given, and patients were instructed to take the supine position and take acupuncture points such as Sanyinjiao, Shenmen, Sishencong, and Baihui to get Qi for 30 min, 1 time/d, with 10 d as a course of treatment; for patients with liver qi stagnation, Taichong and Hegu points can be added; those with phlegm fever can be added to the inner court and Fenglong acupoints, and the liver and fire are strong, and those with yin deficiency can be added with acupuncture points such as Taichong, Yongquan, and Taixi. Acupoint, rest 3 d after the end of the treatment course, and proceed to the next course according to the actual situation of the patient. Treatment group rehabilitation content: in addition to the same rehabilitation training as the control group, acupuncture was also used for functional rehabilitation. Acupuncture is mainly based on acupuncture points of the large intestine and stomach, supplemented by acupoints of the bladder and bile. At the beginning of the disease, only the affected side is punctured. After a long course of disease, the healthy side can be punctured first, and then, the affected side can be punctured. Mainly take ring jump, Yanglingquan, Zusanli, and Kunlun, and can take turns to Fengshi, Juegu, Yaoyangguan and other points. Acupuncture points with symptoms: Taiyang and Taichong with liver yang and hyperthyroidism; Fenglong and Hegu with wind and phlegm resistance; varus correction with foot inversion and Qiuxu through the sea; valgus with Zhongfeng, Taixi, and correction of eversion; foot droop with Jiexi and Taichong; and constipation with Fenglong and ditch. Acupoints and needles are routinely disinfected. In the acute phase, twist and diarrhea was used, and the needle was continuously applied for 10-15 minutes. During the recovery period, the needle was used for 20-30 minutes, and moxibustion was performed on the acupuncture points. Once a day, 10 d is a course of treatment, rest 3 d, and continue treatmentz ± 5.Observe the effects after the intervention, including the occurrence of complications, neurological deficit scores, mental health scores, and changes in depression scores before and after the intervention. The NIHSS scoring system was used to assess the degree of neurological deficits. The score was 100 points. The smaller the score, the smaller the neurological deficit, and vice versa. The SCL-90 symptom self-assessment scale was used to assess the mental health of patients. The scale items are as follows: thinking, living habits, consciousness, interpersonal relationships, emotions, feelings, behaviors, diet and sleep, etc., from none, very light, medium, biased, and severely corresponding 1 to 5 grades; scale score is 450 points; the lower the score, the better the mental health. The psychiatric class A PHQ-9 score was used to assess depression, and the questionnaire survey was used. The normal score was 0 to 4 points, with depressive symptoms; 5 to 9 points, the obvious depressive symptoms; and 10 to 14 points, severe depressive symptoms: 15~27 minutes. Efficacy criteria are as follows: Barthel index of daily living ability, FAC lower limb walking function score, Fugl-Meyer score, and other treatment effects were evaluated. The statistical data of the statistical method was expressed as x ± s and t test; count data was expressed by rate and χ2 test; α =0.05 was used as the test criterion. The entire data processing process is shown in Data processing was performed using the statistical software SPSS21.0. The calculation data was described by Higher levels of complications in the two groups are presented in p = 0.035).The score of neurological deficits and mental health ratings of the two groups is compared in p < 0.05) were lower on the control group.As seen in Comparison of before and after interventions for both groups is shown in p < 0.05).The depression scores of the two groups before and after the intervention were compared according to From Tables 1p < 0.05). It also shows that the Barthel index of the control group was higher than that of the treatment group on rehabilitation, and there was a significant difference (p < 0.05).This is seen in The FAC and Fugl-Meyer lower limb basic motor function scores of the two groups of patients after rehabilitation are shown in p < 0.01). After recovery, the FAC scores in the treatment oriented group were significantly higher from the control group (p < 0.05). It can also be seen from p < 0.01). For the basic motor function score, difference was significantly more than control group (p < 0.05).As seen in Acupuncture and rehabilitation both advocate early treatment, and early patient position care is the main link of limb rehabilitation. Acupuncture or modern rehabilitation treatment as soon as possible after the vital signs of stroke patients are stable can effectively improve the symptoms of motor function and neurological deficits and improve their daily activities. The lower extremity FAC score is an evaluation of the lower limb walking ability of a half-life patient, and the Fugl-Meyer score is an assessment of the underlying dynamics of surgical treatment of the lower extremity of a hemiplegia patient. The effective rates of the treatment group and control group are shown in The clinical efficacy can be seen in In the treatment group together with the controls, the limb motor function scores and daily living ability are shown in p < 0.01) when comparing the two groups. There was a statistically significant difference compared with that before treatment (p < 0.01). In the treatment period, no adverse events and side effects occurred. There was no significant change in heart rate and blood pressure before and after treatment in the treatment group. The rehabilitation of patients with stroke hemiplegia can be divided into different stages , and the different acupuncture treatments at different stages are satisfactory.As seen in The difference between FMA-L and MWS before and after treatment in the two groups is shown in p > 0.05) compared to FMA.L and MWS for both groups before treatment. There were elevated FMA-L and MWS in both groups after treatment, but the differences were statistically significant (p < 0.05). Both indices were higher than the control group after of the treatment, and the difference was statistically significant (p < 0.01). Time-dependent parameters of gait of the two groups before and after treatment were compared. There was an increase in gait frequency, stride length, affected and habilitation side stride length, gait cycle, and leg bolstering time after treatment, and the differences were statistically significant (p < 0.05). Each indicator was better than the core group with statistically meaningful differences after treatment (p < 0.05).As seen in Stroke is a common disease in clinical neurology. It is mainly caused by the sudden rupture or blockage of blood vessels in the brain. After the illness, patients may experience dizziness, numbness, vomiting, and hemiplegia. In some severe cases, neurological and motor functions may be impaired, which may threaten their normal life and health. Acupuncture combined with rehabilitation training is effective in treating poststroke interventions. It can improve patients' mental state, depression, and neurological function and effectively reduce the impact of other complications on their prognosis.This article uses a comparative experiment to compare acupuncture and rehabilitation training in patients with stroke. The first group did not use acupuncture combined with rehabilitation training, with the last group which employed acupuncture combined with restoration training, which was found to improve muscle strength. Limb function improves balance and coordination between muscle groups. During recovery, convulsions in the affected limb were relieved. This treatment is mainly based on acupuncture and antidiarrhea, which is beneficial to improve blood circulation in the extremities, increase tissue stimulation, and gradually recover from separated, thin, and controllable surgery, which significantly improves the patient's limb function and daily life. Therefore, the flexible use of acupuncture at different stages in patients with hemistroke is beneficial to functional recovery.This article establishes comparative experiments and shows that a large number of patient rehabilitation training data show that acupuncture has a great effect on the rehabilitation training of stroke patients. The research in this article is limited to the analysis of clinical manifestations and prognosis of patients, and the mechanism of its impact is not clear. Therefore, it is still necessary to conduct analysis and research around the core theories of this study in order to contribute to the further improvement of clinical intervention. This article studies the effects of acupuncture combined with rehabilitation training on the physical activity and living capacity of stroke patients with hemiplegia.This study found that lower limb motor operation, walking ability, and daily life in the observation group were significantly improved, and acupuncture combined with rehabilitation training significantly improved limb motion and survival evidence for stroke patients and intermission. Acupuncture can promote the movement of the affected limb, utilize and regulate the body's reflexes, strengthen central stimulation, and strengthen coordinated control of the affected limb. In combination with rehabilitation for improved limb circulation and limb survival, needles can have an improving action on stroke and hemiplegic patients. We studied the effect of acupuncture combined with convalescent training on limb movement and living capacity in stroke hemiplegic patients. This paper provides guidance for the study of needles combined with rehabilitation training on limb motion and living capabilities in stroke patients with paraplegia.