As to the MD adherence, a significant inverse association between the Medi-Lite score and the percentage of UPF in the diet  was observed. Participants with a low adherence to the MD had a significantly higher contribution of UPF in the diet (22.2%) compared to those with a moderate (16.2%) and high (12.6%) adherence. In terms of individual UPF, the largest difference between low and high MD adherents was observed for pre-packaged biscuits and sweets, soft and energy drinks, sausages and other reconstituted meat products, and pre-packaged bread and bread alternatives. These results suggest that public health strategies are needed to implement more effective actions to promote healthy eating habits in the population.Information on the consumption of ultra-processed foods (UPF) in relation to an adherence to the Mediterranean diet (MD) is limited. Our aim was to assess UPF consumption in a group of Italian adults and to evaluate the relationship with the MD adherence. A total of 670 participants (median age: 30 years) were included in the analysis. The consumption of UPF was assessed through the NOVA Food Frequency Questionnaire (NFFQ). Adherence to the MD was assessed through the Medi-Lite score. The percentage of UPF in the diet was 16.4% corresponding to 299 g of UPF per day. These amounts were significantly ( Ultra-processed foods (UPF) are defined within the NOVA classification system, which groups foods according to the extent and purpose of industrial processing . They arAvailable literature suggests that higher UPF consumption is associated with a lower diet quality, leading to diets high in calories, free sugars, fat, and salt, and low in dietary fiber . This, iThe Mediterranean diet (MD) is one of the most studied dietary patterns in the scientific community. Despite its health benefits, widely documented in epidemiological and clinical studies ,9, many www.surveymonkey.com, accessed on 11 May 2022) . Informed consent was obtained from all participants. A web survey was conducted between January and October 2021. Data were collected anonymously from an online questionnaire prepared on SurveyMonkey (ay 2022) , which iThe NFFQ is a validated questionnaire specifically designed to estimate food intake according to NOVA groups in the Italian adult population . The queWhen processing the NFFQ data, the amount of food consumed is calculated in grams per week and in grams per day for each food item and category. Then, the proportion of MPF, PCI, PF, and UPF in the diet is determined by calculating the weight ratio. As previously reported, the weight ratio is considered rather than the energy ratio because it allows for a better accounting for processed foods that do not provide energy  and non-nutritional factors related to food processing  . FinallyAdherence to MD was assessed through the validated Medi-Lite questionnaire, developed by Sofi et al. . The queDescriptive statistics were used to analyze and report the data. Results were reported as mean ± standard deviation (SD), median and range, or geometric mean with 95% confidence intervals (CIs), as appropriate. Categorical variables were presented in terms of frequencies and percentages. The Mann—Whitney test was used for comparisons between women and men, while the Chi—Square test was used to test for proportions. The correlation between the percentage of UPF in the diet and the Medi-Lite score was estimated using the Spearman (R) test. The possible relationship between UPF consumption and MD adherence was analyzed by grouping the participants according to UPF contribution in the diet , and by MD adherence into low (1st tertile = Medi-Lite score < 9), moderate (2nd tertile = Medi-Lite score between 9 and 11), and high (3rd tertile = Medi-Lite score > 11) adherence. Then, a general linear model adjusted for age, sex, BMI, education level, marital status, and daily food intake was conducted to compare dietary habits according to the percentage of UPF in the diet, and daily UPF intake according to the MD adherence. Since these tests assume normal data distribution, non-distributed data were transformed into logs and further analyses were performed with the processed data. However, to facilitate interpretation, the log data were again converted to the original scale (antilog) and presented as geometric means with 95% CIs.p-values  < 0.05 were considered statistically significant. The statistical package IBM SPSS Statistics for Macintosh, version 28.0  was used.Finally, to evaluate the influence of individual UPF on Medi-Lite score, a linear regression model was performed, and results were expressed as regression coefficient (b) ± SE. The b coefficient estimated in the linear regression analysis indicates the expected mean change in Medi-Lite score associated with 1-unit change in the independent variables. p < 0.001) lower BMI and lower prevalence of overweight and obesity (21.1% vs. 40.9%). No significant differences were observed for education level or marital status. A total of 670 participants (70.4% women) with a mean age of 35.8 years were included in the analysis. p < 0.05) lower values in women (15.6 ± 10%) than in men (18.2 ± 11.1%). No significant differences were observed according to BMI, education level, and marital status. In terms of daily UPF intake, the percentage of UPF in the diet corresponded to 299.0 ± 233.5 g/day in the total sample, 285.5 ± 231.0 g/day in women, and 331.2 ± 236.7 g/day in men. The food categories that contributed most to this amount were ready-to-heat meals or pre-packaged bread, bread alternatives, pizza, and frozen potato chips , pre-packaged sweets and biscuits (20.7%), soft drinks (15.8%), flavored yogurt (12.0%), followed by ready-to-eat vegetables and legumes (10.6%), dairy products and meat substitutes (8%), sausages and other reconstituted meat and fish products (5.8%), and fats and seasonings (2.5%). The contribution of individual UPF, according to sex, is reported in The percentage of UPF in the diet was 16.4 ± 10.4%, with significantly (Food consumption (g/day) according to the percentage of UPF in the diet is reported in p = 0.151) between women (10.4 ± 2.4) and men (10 ± 2.6). Correlation analyses showed a significant inverse association between the Medi-Lite score and percentage of UPF in the diet  (p < 0.001) and men  were analyzed separately.Regarding MD adherence, the mean Medi-Lite score was 10.3 ± 2.5, with no significant differences (< 0.001) , which wTo better explore the possible relationship between MD adherence and UPF consumption, three adherence groups to MD  were considered, and the mean percentage of total UPF in these groups was calculated. As showed in Regarding individual UPF, their intake in terms of daily amounts was significantly higher in subjects with a low MD adherence for most of the items considered, with the largest differences observed for pre-packaged biscuits and other sweets, soft and energy drinks, sausages and other reconstituted meat products, and pre-packaged bread and bread alternatives . Finally, to evaluate the possible influence of individual UPF on Medi-Lite score, a linear regression analysis with the Medi-Lite score as a dependent variable was performed. As shown in In this study we used a validated questionnaire to assess UPF consumption in relation to an adherence to the MD in a group of adult subjects living in the Mediterranean area. In our study group, we observed that subjects reporting a low adherence to MD were also those showing a higher consumption of UPF in their diet. In fact, an increased intake of UPF was associated with a significantly lower intake of some typical products of the MD such as fruits, vegetables, nuts and fish, and a higher intake of meat, fats, seasonings, and sugary products. Furthermore, we observed that some UPF, such as sausages and other reconstituted meat products, pre-packaged pizza, frozen potato chips, industrial biscuits and sweets, and soft and energy drinks, were shown to influence the adherence score to MD.Since Monteiro and colleagues proposed the NOVA classification to identify the level of food processing , severalCurrently, a higher adherence to MD is known to reduce the risk of all-cause mortality, cardiovascular diseases, coronary heart disease, myocardial infarction, overall cancer incidence, neurodegenerative diseases, and diabetes . In lineTo better understand the association between UPF intake and MD adherence in our study population, we also investigated the possible influence of individual UPF on the MD adherence score, observing that the consumption of sugary products, processed meats, soft and energy drinks, and pre-packaged potatoes and pizza negatively influenced the MD adherence score. Interestingly, most of these foods were major contributors to UPF consumption in our population and are present in all countries of the world, supporting the hypothesis of a nutritional transition from traditional diets such as MD to Westernized dietary patterns due to an increased UPF consumption. There is an urgent need to raise awareness on the negative health effects of excessive UPF consumption and new public health strategies to prevent the progressive loss of traditional diets. The present study has several limitations that deserve discussion. First, the cross-sectional design does not allow us to establish any cause-effect relationship. Prospective cohort studies are needed to confirm these preliminary findings. Second, the use of self-administered online questionnaires may have led to recall bias and misclassification. The emergency response due to the COVID-19 pandemic did not allow us to conduct another type of study with a stronger statistical power and less biases. On the other hand, several strengths are present since a validated questionnaire specifically designed to estimate food intake according to NOVA classification was used, avoiding the misclassification of foods into UPF categories. Furthermore, the variables used in the main analyses included the proportion, by weight, of UPF in the diet. This approach is more appropriate than the use of energy proportion, as it takes a better account of non-nutritional factors pertaining to food processing . In conclusion, in our study population of middle-aged Italian adults we were able to observe an inverse relation between adherence to MD and UPF consumption. In considering the over-consumption of UPF as an important risk factor for non-communicable diseases, overweightness and obesity, our results reinforce the importance of public health strategies to improve the population’s health by promoting MD and limiting the intake of UPF, which is also proposed by the World Health Organization (WHO). Examples of such strategies could be taxation, the regulation of marketing, or the control of food labeling standards, some of which have already shown good results ,26. More


Proteobacteria, followed by Bacteroidota, Acidobacteriota, and Actinobacteriota. The community composition varied among different mine waste types. Gammaproteobacteria was the most abundant microorganism in tailings, Actinobacteria was mainly distributed in waste rock, and Saccharimonadia, Acidobacteriae, and Ktedonobacteria were mainly present in slag. At the family level, the vast majority of Hydrogenophilaceae were found in tailings, Ktedonobacteraceae, Chthoniobacteraceae, and Acidobacteriaceae (Subgroup 1) were mostly found in slag, and Pseudomonadaceae and Micrococcaceae were mainly found in waste rock. Actinobacteriota and Arthrobacter are important taxa for reducing heavy metal(loid) mobility, vegetation restoration, and self-sustaining ecosystem construction on antimony mine waste. The high concentrations of Sb and As reduce microbial diversity.Antimony (Sb) and arsenic (As) are two hazardous metalloid elements, and the biogeochemical cycle of Sb and As can be better understood by studying plant rhizosphere microorganisms associated with Sb mine waste. In the current study, samples of three types of mine waste—Sb mine tailing, waste rocks, and smelting slag—and associated rhizosphere microorganisms of adapted plants were collected from Qinglong Sb mine, southwest China. 16S rRNA was sequenced and used to study the composition of the mine waste microbial community. The most abundant phylum in all samples was  Antimony (Sb) is a potentially toxic and carcinogenic metalloid element. Humans and animals can be exposed to Sb in the environment via water, air, food, skin contact, and respiration. Long-term skin contact with dust containing Sb can lead to Sb spots, and inhalation of low concentrations of Sb dust or Sb-containing fumes can induce pneumoconiosis, lung cancer, and other diseases ,2,3. Sb Mining activity is a major cause of the release of anthropogenic Sb into the environment . Mining,The Sb content in the soil around the Xikuangshan Sb mine in Hunan ranged from 527 to 11,798 mg/kg . Fu et aThe establishment of vegetation caps on mine wastes to reduce the mobility of heavy metals is considered an effective method to mitigate mining waste contamination. Plant covering also increases organic matter content, cation exchange capacity, and nutrient levels, further improving the chemical and biological properties of contaminated soils, thus creating a self-sustaining ecosystem ,14. HoweShewanella oneidensis can immobilize Sb through adsorption and complexation [Rhizosphere microorganisms have a strong influence on plant growth and survival, and synergistic interactions between plants and rhizosphere microorganisms facilitate the removal of heavy metals from soil . Rhizosplexation . In addilexation ,28,29. Jlexation  found thThe synergistic evolution of plants and rhizosphere microorganisms in harsh environments makes the use of rhizosphere microbial composition a prerequisite for the remediation of heavy metal-contaminated vegetation at mine waste sites . Soil prMicrobial community composition under heavy metal contamination conditions has become one of the hotspots of current research, but very little research has been conducted on the rhizosphere microorganisms associated with Sb mine waste-adapted plants. Only a few studies have been conducted on Sb mine tailing microorganisms ,40,41. EIn the current study, we characterized the rhizosphere microbial communities of native adapted plants from three types of mining waste from the Qinglong Sb mine in southwestern Guizhou, China: tailing, smelting slag, and mining waste rocks. High-throughput sequencing was used to characterize the rhizosphere microbial communities. The objectives of the study were to (1) understand Sb and As contamination in the three types of mine waste and the compositions of plant rhizosphere microbial communities, (2) compare plant rhizosphere microbial community compositions and diversity in the three waste types, and (3) investigate the underlying mechanisms responsible for differences in microbial community diversity in the three waste types.The Qinglong Sb mine is located in Qinglong County in the southwest of Guizhou Province, China . The area is a typical karst landscape with abundant underground water resources. Qinglong has a mild subtropical monsoonal climate with an average annual temperature of 14 °C and average annual rainfall of 1380 mm. It is estimated that 2,883,700 t of mine waste is piled up in the Qinglong Sb mine area, including 2,700,600 t of mining waste rock, 154,600 t of smelting slag, and 28,500 t of flotation tailings . The samPolygonum capitatum Buch.-Ham. ex D. Don Prodr was found in the slag area, whereas four plants, namely, Trifolium repens L., Rumex acetosa L., Plantago asiatica L., and Conyza canadensis (L.) Cronq. were growing on both tailings and waste rock. In addition to the above plants, Cynoglossum lanceolatum Forssk., Brassica juncea (L.) Czern. et Coss., and Raphanus sativus L. were also found in the waste rock area. Samples were collected in April 2021, and eight species of adapted plants from the mining area were selected; T. repens L. (n = 8), R. acetosa L. (n = 8), P. asiatica L. (n = 8), C. canadensis (L.) Cronq. (n = 8), P. capitatum Buch.-Ham. ex D. Don Prodr (n = 6), C. lanceolatum Forssk. (n = 4), B. juncea (L.) Czern. et Coss. (n = 1), and R. sativus L. (n = 1).Herbaceous and woody plants have been developed to varying degrees in the mine area. In the mine area, we found differences in the types of plants associated with different types of mine wastes. Only For each plant, the roots were dug out with a spade and the excess soil was shaken off, and approximately 200 g of rhizospheric soil samples was taken for chemical analysis. For analysis of the microbial composition, rhizosphere soil samples attached to the root surface were deposited into 1.5 mL microcentrifuge tubes using sterile cotton swabs. Samples were transported back to the laboratory on ice (4 °C), then stored at −40 °C prior to DNA extraction. A total of 44 soil rhizosphere microbial samples were collected, with each plant corresponding to one rhizosphere microbial sample .The samples for chemical analysis were naturally air-dried, then the plant roots, leaves, and gravel were manually removed and passed through a 2 mm sieve. The samples were then ground in an agate mortar and passed through a 200-mesh sieve.For pH determination, 10 g of sample was passed through a 2 mm nylon sieve into a centrifuge tube, 25 mL of ultrapure water was added at a soil-to-water ratio of 1.0:2.5, then the preparation was shaken for 20 min at room temperature to allow the soil to disperse sufficiently. After resting the preparation for 30 min, pH was measured using a calibrated Five Easy Plus PE 28 pH meter . pH tests were conducted at the Key Laboratory of Karst Geological Resources and Environment .3 and HCl (1:3 v/v) for 2 h at 100 °C. An appropriate amount of supernatant was added to 2.5 mL of a 5% thiourea-ascorbic acid mixture which was then incubated at room temperature for 30 min for pre-reduction. Total Sb and As concentrations were then determined via hydride generation-atomic fluorescence spectrometry . The operating conditions of AFS were optimized, and the calibration curves of Sb and As exhibited good linearity (r > 0.999). Sb and As tests were conducted at the Key Laboratory of Karst Geological Resources and Environment . The standard reference material GBW07985  was used for quality control.The sieved samples were digested by heating with concentrated HNOSamples were dried at 105 °C and placed in a platinum crucible, and a mixed melt of lithium tetraborate-lithium metaborate-lithium nitrate was added and mixed thoroughly, and then melted at a high temperature to make a partial flat glass sheet. The sheet was analyzed for major elements via an X-ray fluorescence spectrometer . Analysis of major elements  was conducted at ALS Minerals—ALS Chemex Co. Ltd. . The water used in the experiments was ultrapure water prepared by an ultrapure water instrument , the reagents were of superior purity or above, and the experimental vessels were soaked in 10% nitric acid solution for more than 24 h in advance and cleaned with ultrapure water.® High-Fidelity PCR Master Mix , 0.2 μM of forward and reverse primers, and approximately 10 ng of template DNA. Thermal cycling consisted of an initial denaturation at 98 °C for 1 min, followed by 30 cycles of denaturation at 98 °C for 10 s, annealing at 50 °C for 30 s, and elongation at 72 °C for 30 s, then a final incubation at 72 °C for 5 min. PCR products were mixed with the same volume of IX loading buffer containing SYB green, then electrophoresed on 2% agarose gels for detection. PCR products were mixed at equidense ratios, then the mixture of PCR products was purified with the Qiagen Gel Extraction Kit . Sequencing libraries were generated using the TruSeq® DNA PCR-Free Sample Preparation Kit  in accordance with the manufacturer’s recommendations, and index codes were added. Library quality was assessed with a Qubit@2.0 Fluorometer  and the Agilent Bioanalyzer 2100 system. Lastly, the library was sequenced on the Illumina NovaSeq Platform  and 250 bp paired-end reads were generated. Paired-end reads were merged using FLASH  [http://qiime.org/scripts/split_libraries_fastq.html, accessed on 10 May 2021) [https://www.arb-silva.de/, accessed on 10 May 2021) using the UCHIME algorithm  [The samples were sent to Novogene Bioinformatics Technology Co., Ltd.  for DNA extraction and further sequencing. The CTAB method was used to extract total genomic DNA from samples . DNA conay 2021) . Qualityay 2021)  in accoray 2021)  quality ay 2021)  to detechttp://www.drive5.com/uparse/, accessed on 17 May 2021) [http://www.arb-silva.de/, accessed on 23 May 2021) [http://www.drive5.com/muscle/, accessed on 23 May 2021) was used to perform fast multi-sequence alignment to obtain the system occurrence relations of all OTU representative sequences. Raw sequences obtained in this study were submitted to the NCBI Sequence Read Archive database under the accession number PRJNA849367.The UPARSE algorithm   was useday 2021) ,52. Taxoay 2021)  (VersionQiime software (version 1.9.1) was used to calculate observed OTUs, Chao1, Shannon, Simpson, ACE, goods coverage, and PD_whole_Tree index. R software (version 2.15.3) was used to generate rarefaction curves. Weighted UniFrac distances were used to assess similarities among the microbial communities in the three sample types . UniFracThe geochemical properties of the three types of mining waste are shown in The Illumina NovaSeq Platform was used for splicing and quality control of bacterial sequencing data from 44 rhizosphere microbial samples of Sb mine plants in Qinglong, followed by chimera filtering, yielding 2,862,909 16S rDNA sequences with an average length of 253 nt. Effective Tags of all samples were clustered with 97% identity for OTU clustering, then the sequences of OTUs were annotated with species. Sparsity curves are shown in Alpha diversity including Observed species, Shannon, Simpson, Chao1, ACE, Goods coverage, and PD whole tree was calculated for each sample. In the alpha diversity index, community diversity was analyzed via Shannon and Simpson indices, and community richness was analyzed via Chao1 and ACE indices. Goods coverage indicates the coverage of the measured flora in all communities, and higher values represent a higher probability of sequences being detected in the samples. The Shannon index was positively correlated with microbial diversity, and the larger the index value, the higher the microbial diversity in the sample. Simpson’s Index of Diversity 1-D was also positively correlated with microbial diversity.Alpha diversity followed a similar pattern to OTU number, with M04 and M06 having the highest Shannon indexes, C04 and C06 having the highest Chao1 indexes, and S04 and S03 having the lowest Chao1 indexes . The micProteobacteria, and the relative abundance of Proteobacteria in different samples ranged from 20 to 50% (mean 36%), followed by Bacteroidota (11%), Acidobacteriota (7%), and Actinobacteriota (6%)  were mostly found in slag, and Pseudomonadaceae and Micrococcaceae were mainly found in waste rock, with a relative abundance up to twice that of tailing and slag.Sequences were taxonomically assigned to 90 bacterial phyla, 189 classes, 413 orders, 560 families, and 966 genera. With the exception of samples M01 and M05, the most abundant phylum in all samples were ota (6%) . The comg et al. . At the The microbial OTUs for PCoA analysis are shown in Gammaproteobacteria and negatively correlated with Ktedonobacteria, Phycisphaerae, Acidobacteriae, and Saccharimonadia. Mg content was positively correlated with Actinobacteria. Compared with other geochemical parameters, the effect of As on microbial communities was relatively small. Sb and As content were positively correlated with the microbial communities in the majority of samples from tailing and slag, but they were negatively correlated with the microbial communities in waste rock. Mg had a significant effect on the microbial community in waste rock. Sb had a greater effect on the microbial community in tailing and slag.The compositions of plant rhizosphere microbial communities in the three mine waste types varied widely, which may be due to the combination of Sb contamination levels and other geochemical parameters. Redundancy analysis was performed on geochemical parameters at the class level to investigate interrelationships between geochemical parameters and microbial communities, and the results are shown in The geochemical parameters show that, after beneficiation and smelting, the Qinglong Sb mine waste is at great risk of contamination, and from another point of view, the Qinglong Sb mine contains considerable potential resources. The Sb and As content in slag and tailing was extremely high. Very high Sb content may be one of the reasons why there were few types of plants growing in slag. The smelting process causes the loss of As and S (sulfur) in slag and relative enrichment of Fe.Proteobacteria, Bacteroidota, Acidobacteriota, and Actinobacteriota, which is consistent with previous studies [In general, high concentrations of heavy metal(loid)s are toxic to microorganisms and inhibit their growth, which in turn affects microbial communities and microbial diversity. In comparisons of the relative abundance of microbial communities and α-diversity in the three mine waste types, the microbial diversity in waste rock with relatively low Sb and As content was higher than that of the other two waste types, and it was hypothesized that the two metalloids had an inhibitory effect on the development of microbial communities. The main microorganisms in the mine waste were  studies ,57,58,59Proteobacteria are the major Sb-resistant bacteria in the microbial community [Proteobacteria (mainly Brevundimonas) and γ-Proteobacteria (mainly Pseudomonas). Actinobacteria (mainly Arthrobacter) and Firmicutes are also considered to be highly resistant to Sb(III) [Pseudomonas reportedly has the ability to dissolve heavy metals and form complexes with them, and they can resist heavy metals through bioaccumulation, and fix them via metabolic processes [Proteobacteria, Actinobacteriota, Firmicutes, Pseudomonadales, Comamonadaceae, Acinetobacter, Arthrobacter, Bacillus, and Hydrogenophaga are among the species that have been reported to function in the oxidation of Sb(III) or to be involved in the biotransformation of Sb [ommunity ,61,62, a Sb(III) . Pseudomrocesses . In addion of Sb ,66,67. AActinobacteriota and Arthrobacter in plant rhizosphere microorganisms in antimony mining areas is significantly higher than that in non-mining areas. In the study of Sun et al. [Actinobacteriota are considered to play a key role in the microbial community of active antimony tailing. Members of Actinobacteriota are usually identified as key groups in extremely oligotrophic environments. Oligotrophic bacteria are important contributors to various ecological cycles in nature. They are closely related to the cycles of nitrogen, carbon, sulfur, phosphorus, and trace elements in nature, and play a very important role in the self-purification process of environmental systems [Arthrobacter is considered to have an important role in the ecological restoration of Pb–Zn tailings [Arthrobacter has the functions of phosphorus dissolution and nitrogen fixation [Arthrobacter is considered to be an ideal plant growth-promoting bacterium (PGPB) in acidic mine waste [Actinobacteriota and Arthrobacter are important taxa for reducing the heavy metal(loid) mobility, vegetation restoration, and self-sustaining ecosystem construction on antimony mine waste.Compared with previous studies ,69,70, tn et al. , the mem systems . Arthrobtailings . The stufixation . These fne waste . TherefoAcidobacteriae and Ktedonobacteria. In contrast, their abundance in tailing and waste rock was very low, indicating that these microorganisms can adapt to low-pH environments  can reduce the abundance of specific bacteria and bacterial diversity at the phylum level . Adding Actinobacteria, Firmicutes, Nitrospirae, Tenericutes, and Gemmatimonadetes, was positively correlated with As and Sb content [Proteobacteria, Actinobacteriota, and Pseudomonadales, and the main geochemical parameters  in slag is significantly higher than that of the other two kinds of mine waste, while Pseudomonadaceae and Micrococcaceae were mainly found in waste rock. Since they are closely related to the cycling of nutrients such as nitrogen and phosphorus, Actinobacteriota and Arthrobacter are considered to be important groups in the oligotrophic mine waste environment. We suggest that Actinobacteriota and Arthrobacter can be used as important groups to reduce heavy metal(loid) mobility, revegetation, and create self-sustaining ecosystems in antimony mining areas. The microbial diversity in tailing was slightly higher than that in slag and waste rock is the highest. Increased Sb and As content reduced microbial diversity. Low pH reduces the diversity of rhizosphere microbial communities associated with slag plants, but it also promotes the development of some microorganisms in slag. The present study further revealed the composition and diversity of plant rhizosphere microbial communities in Sb mine waste. From the perspective of geochemistry, the regulatory mechanisms involved in microbial community compositions in Sb mine waste were further clarified.In the current study, the Sb and As content in the three types of mine waste from the Qinglong Sb mine were very high. The investigation of plant rhizosphere microorganisms in the three types of mine waste indicated that there were significant differences in the microbial communities they contained. At the class level, the most abundant species in tailing is


The few studies analyzing Resting Energy Expenditure (REE) in GD involved mainly untreated patients and supported a hypermetabolic condition possibly due to the associated inflammatory state. Definitive conclusions could not be drawn also because of the heterogeneity and the small size of the samples investigated. In order to expand current knowledge concerning, in particular the condition of patients under Enzyme Replacement Therapy (ERT), we evaluated the nutritional status of a relatively large sample of GD patients followed at Federico II University Hospital in Naples, Italy. (2) Methods: The study, having a cross-sectional design and involving 26 patients on ERT, included routine biochemical analyses, bioelectrical impedance analysis, indirect calorimetry, and administration of food frequency and physical activity questionnaires. The results in GD patients were compared with those from an appropriate control group. (3) Results: GD patients had normal biochemical parameters in 80% of cases, except for HDL-cholesterol, consumed a hyper-lipidic diet, and had a 60% prevalence of overweight/obesity. Body composition did not differ between patients and controls; however, measured REE was significantly lower than predicted and was reduced in comparison with the healthy controls. (4) Conclusions: This study provided novel elements to the present knowledge about REE and the nutritional status of GD patients under ERT. Its results warrant confirmation in even larger GD population samples and a more in-depth investigation of the long-term effects of treatment superimposed on the basic pathophysiological disease condition. The Gaucher disease (GD) OMIM ID: 230800) is an autosomal recessive lysosomal storage disease caused by the reduced activity of the lysosomal enzyme β-glucocerebrosidase (GCase), leading to the accumulation of the glycosphingolipid substrate, glucosylceramide GL-1), and its derivative glucosylsphingosine (Lyso-GL1), particularly in macrophages. Very rarely, GD could be caused by saposin C deficiency. The incidence of GD ranges between 1/40,000 and 1/60,000 births in the general population, but in the Ashkenazi Jewish population, it reaches 1/800 births [, and its30800 is Before the introduction of enzymatic replacement therapy (ERT), GD was characterized from the metabolic point of view by a systemic inflammatory state, higher resting energy expenditure (REE) , and risERT, introduced in the early 1990s, modified the natural history of the disease and significantly improved the life expectation and the quality of life of GD patients, reducing visceral, hematological, and bone complications. Not surprisingly, this has led to an increased risk for these patients to develop the usual comorbidities linked to unhealthy lifestyles and food habits, namely overweight and obesity, impaired glucose metabolism ,6, and iThe few studies that analyzed the energy metabolism and the REE of GD1 patients suggested a hypermetabolic state ,5,6,8 inInclusion criteria were: (a) diagnosis of Gaucher disease, confirmed by glucocerebrosidase activity assay and glucosylceramidase beta 1 (GBA1) gene analysis . The patients were seen early in the morning, and all measurements were conducted after a fasting period of 12h according to standardized conditions, i.e., abstaining from alcohol and vigorous physical activity (PA) for 24 h prior to the assessment.The investigations included: (a) the collection of demographic characteristics, (b) the routine biochemical analyses, (c) the analysis of body composition by bioelectrical impedance analysis (BIA), (d) the estimation of REE by indirect calorimetry, (e) the evaluation of food habits and nutritional intakes by the administration of a Food Frequency Questionnaire (FFQ) validated for the Italian population  and the The patients’ data were compared with those obtained in a sample of 78 healthy individuals (1 case: 3 controls) matched by age, sex, and BMI. This sample was randomly selected from our database of healthy individuals who had undergone a body composition analysis and indirect calorimetry during the same period (February–June) of the last 3 years .Body weight and height were measured to the nearest 0.1 kg and 0.5 cm, respectively, with subjects wearing light clothes and no shoes, using a platform beam scale with a built-in stadiometer . BMI was calculated as body weight expressed in kilograms divided by squared height reported in meters.2/W).Bioelectrical Impedance Analysis was performed at 50 kHz  at a constant room temperature of 22–25 °C. Measurements were carried out on the non-dominant side of the body, in the postabsorptive state, after voiding and with the subject in the supine position for 20 min. The BIA variables considered were resistance (R) and reactance (Xc). The Phase angle (PhA) was calculated as arc tangent Xc/R × 180°/π and expressed in degrees. A bioimpedance index (BI-index) was defined as squared height, reported in centimeters, divided by R  and fat mass (FM) were estimated by using the predictive equations developed by Sun et al. To measure REE, indirect calorimetry (IC) with a canopy system  was used . After aREE was also estimated using 2 predictive equations: the standard and universally used Harris–Benedict equation for normal weight subjects  and a vaThe International Physical Activity Questionnaire Short-Form (IPAQ-SF) is a validated, widely used self-report questionnaire to assess the habitual PA level . It consQuality and quantity of food intake were estimated by the administration of a validated food frequency questionnaire (FFQ) for the Italian population . PatientThe food items were categorized as drinks, milk and dairy products, meat, fish, eggs, cereals, vegetables, legumes, fruit, fatty dressings, and others . For coffee, alcoholic and soft drinks, the amount in terms of cups/glasses was also specified.From the record of food items, the daily intake of macronutrients was calculated using the WinFood software , Italy) which refers to the European Institute of Oncology and INRAN Food Composition Tables. Carbohydrates, protein, and fat intakes were classified as a percentage of total daily energy intake.3/mL), total protein (g/dL), aspartate and alanine aminotransferase (U/L), platelet count (103/UL), glucose (mg/dL), insulin (µU/mL), vitamin B12 (pg/mL) and folate (ng/mL). Chitotriosidase (CT), a surrogate plasma marker for Gaucher disease activity and responsiveness to the ERT, was measured in all patients. The enzyme is released by storage cells and is elevated in serum of Gaucher patients. Plasma CT level is measured with the substrate 4-methylumbelliferyl (4MU)-chitotriose [Venous blood samples were taken for the measurement of several potential biomarkers of nutritional status, i.e., albumin (g/dL), haemoglobin (g/dL), total cholesterol (mg/dL), LDL-cholesterol (mg/dL), HDL-cholesterol (mg/dL), total lymphocytes  and diastolic blood pressure (DBP) were measured with automatic validated devices (OMRON 705IT) after having the participant sit for at least 10 min. With the patient in the sitting position, 3 blood pressure measurements were recorded, 1–2 min apart, and additional measurements were collected only if the first two readings differed by >10 mmHg. BP was recorded as the average of the last two BP readings. Spleen and liver volumes were measured by Nuclear Magnetic Resonance (NMR) or by abdominal ultrasound examination in 7 patients who refused to undergo NMR. In patients who underwent NMR, multiples of normal volumes for spleen (0.2% of body weight) and liver (2.5% of body weight) were calculated ,19.t tests. Two-sided p values less than 0.05 were considered statistically significant.The statistical analysis was carried out using the SPSS for Windows, version 27 . The descriptive statistics covered both the whole study population and stratification by sex. Results were expressed as mean and standard deviation (SD). Differences between groups were assessed with unpaired Twenty-six GD1 patients (15 women and 11 men) were included in the analysis. All patients (except for one) received ERT by venous infusion every 2 weeks (Imiglucerase or Velaglucerase). The untreated patient showed no significant clinical signs of GD or altered chitotriosidase values. The mean duration of therapy was 16.4 years, from a minimum of 3 to a maximum of 27 years. The mean age was 50.6 ± 14.8 years, and the mean BMI was 27.6 ± 4.3, with no statistically significant differences between men and women. Eighty percent of the patients featured normal biochemical parameters, except for HDL-cholesterol, which was low (<45 mg/dL) in 48.1% of the sample.Eighteen patients out of the nineteen who underwent NMR had a normal hepatic volume (mean volume: 1455.9 ± 247.1 mL), while three out of seven who underwent abdominal echography had hepatomegaly (mild in two cases and moderate in one case). By contrast, only one of the patients who underwent NMR had a normal splenic volume, with a mean volume of 395.6 ± 185.1 mL , and one patient who underwent abdominal echography had moderate splenomegaly. Finally, three patients had undergone splenectomy.p < 0.0001).Likewise, comparing the REE of GD1 patients and the REE of the healthy controls (33 men and 45 women) matched by age and BMI, both male and female GD1 patients were found to be hypometabolic . In malep < 0.005) whereas no correlations were found between REE and: age , BMI , IPAQ score , splenic volume , duration of treatment , and treatment dosage . Moreover, no correlations were found between fat mass (%) and both duration of treatment  and ERT dosage . Finally, no correlations were found between fat-free mass (kg) and both duration of treatment  and ERT dosage .A direct correlation was also found between REE and hepatic volume  inAccording to the FFQ GD1, patients’ diet is characterized by a high percentage (>40%) of lipids. This reflects the westernization of the global diet, and it is coherent with the results of a survey conducted on a representative sample of the Italian population of 8462 individuals in 2008–2012 through the EPIC questionnaire . The corThe most surprising result of our study was the hypometabolic condition of our treated GD1 patient population. This finding is in contrast with the results of the other authors who measured REE by indirect calorimetry in GD1 patients ,5,6,8 anp < 0.05). In that study, excess REE decreased after splenectomy (five patients), a finding not confirmed by our study, in which three splenoctemized patients had an REE about 100 Kcalories higher than the rest of the sample. REE was also measured in two patients with other lysosomal storage diseases and found to be normal.Barton et al.  measuredCorssmit et al.  in 1995 p < 0.02). These authors did not find any correlation between REE decrease and changes in organ volumesHollak et al.  in 1997 p = 0.007), while it was 16.2% higher in GD1 in the four untreated patients (p = 0.32). No significant difference in the REE of treated and untreated patients was observed. Moreover, two of the latter agreed to repeat indirect calorimetry after 6 and 8 months of ERT. In both patients, a further increase was observed in REE. Additionally, in this study, no correlation was found between REE and hepatomegaly, while a correlation was found between REE and BMI.Doneda et al.  in 2011 Although all previous studies seem to agree on a hypermetabolic condition of GD1 patients, both before and during ERT, they showed contrasting results with regard to the relationships of REE with organomegaly, BMI, and ERT. The large heterogeneity of the populations of these studies  together with the very small sample sizes makes an explanation very difficult. A hypometabolic condition, in general, has been shown to be caused by different factors such as aging, which causes a loss of free fat mass, or clinical conditions such as malnutrition, cachexia, or hypothyroidism, or the use of drugs . Neither of these factors, however, apply to our patient population. Indeed, a possible explanation of the hypometabolic state of the GD1 patients may be their physical inactivity, which, together with their bones and joints pain, may have caused a partial reduction of REE. In order to validate this hypothesis, it could be useful to monitor the patients’ daily physical activity by a recently developed wearable device using a mobile phone application. This recent technology has been tested in a pilot study in patients with Gaucher disease .Our work has several strengths. In addition to being, to our knowledge, the first assessment of the nutritional habits and nutritional status in Italian GD1 patients, it is also the largest analysis of the REE of adult GD1 patients worldwide. The measurement of REE was based on indirect calorimetry performed under accurately standardized conditions. The REE of GD1 patients was compared with that of a substantial number of healthy individuals, accurately matched by age, sex, and BMI, and was also compared with the one estimated by the Harris–Benedict equation. In addition, an additional equation specifically developed and validated for Southern Italy residents further supports our results.Our work also has some limitations. The major one is that we did not have the composition of the diet of the healthy controls and their PA level. Moreover, the sample, although much larger than that of other studies on the REE of GD1 patients, was nevertheless still not large enough to draw definitive conclusions.In our opinion, this study’s results are a useful addition to the present knowledge about the resting energy expenditure and the nutritional status of GD1 patients. At the same time, our study clearly indicates the need for further collaborative research allowing the achievement of much larger sample sizes and the comparison of findings obtained in different populations and at different times relative to the initiation of ERT. The problem represented by the scarcity of patients due to the rare nature of the disease could be overcome by the development of multicentre national studies, a process recently undertaken by the Italian Society of Human Nutrition in collaboration with other scientific societies with the aim to extend the study of nutritional status and energy metabolism to a larger number of GD1 patients recruited in different Italian regions.


Compared with remifentanil, dexmedetomidine as the controlled hypotensive agent showed a lower visual analogue score at the PACU  and incidence of shivering , nausea, and vomiting . However, extubation time was shorter in the remifentanil group . In conclusion, dexmedetomidine and remifentanil are both effective in providing satisfactory controlled hypotension and surgical conditions. Dexmedetomidine is better in easing postoperative pain at the PACU and reducing the occurrence of shivering, nausea, and vomiting. Meanwhile, remifentanil is a fast-track anesthesia with a shorter extubation time. Given the limitations of this meta-analysis, further studies are needed for a more definitive comparison of the efficacy and safety of dexmedetomidine and remifentanil.This meta-analysis aimed to analyze and compare the efficacy and safety of remifentanil and dexmedetomidine applied respectively for controlled hypotension under general anesthesia. We searched the Cochrane Library, PubMed, EMBASE, Web of Science, CNKI, SinoMed, Wanfang, and VIP databases, as well as dissertations and conference papers, to obtain randomized controlled trials comparing remifentanil and dexmedetomidine applied respectively for controlled hypotension before August 23, 2021. The primary outcomes included hemodynamic profiles, surgical field score, and blood loss. Extubation time, sedation and pain score at the PACU, and perioperative adverse events were the secondary outcomes. Nine randomized controlled trials with 543 patients (272 in the dexmedetomidine group and 271 in the remifentanil group) were eventually included. This meta-analysis indicated no significant difference between dexmedetomidine and remifentanil in terms of surgical field score, blood loss, minimum values of mean arterial pressure (MD 0.24 with 95% CI , P = 0.80, I Bl. Bl21]. The exclusion criteria were as follows: (1) non-randomized controlled trials, (2) literature reports of poor quality and ineligibility, (3) failure to provide original data, (4) duplicate literature or crossover of study subjects, and (5) similar reports or incomplete information.Two authors conducted a computer search independently, and the included literature was then checked for duplicates. The titles and abstracts of the remaining literature were read in accordance with the inclusion and exclusion criteria. Following the exclusion of trials that clearly did not meet the inclusion criteria, full texts of trials that might meet the inclusion criteria were read to see if those were eventually included. For the studies that met the inclusion criteria, the data were extracted independently by two reviewers according to a data extraction form developed in advance, which included the following: (i) basic information about the included literature, including title, author, year, and contact information; (ii) methodological characteristics, such as the method of generating random sequences, blinding, etc.; and (iii) general characteristics of the study population, including age, sex, sample size, and specific details of outcome for both groups. Incomplete data were supplemented by contacting the authors by email or other means. Two authors cross-checked the results of the included trials, and differing reviews were addressed by discussion with a third reviewer.The quality of evidence of the included studies was evaluated in strict accordance with the Cochrane Risk of Bias Assessment Tool  in terms2 and Chi-square tests were used to assess heterogeneity among included studies. The degree of heterogeneity was calculated in conjunction with the I2 value. When there is no statistical heterogeneity among the studies (I2<50%), a fixed-effects model was then used; when there was significant heterogeneity among the studies (I2>50%), a random-effects model was used. Sensitivity analysis was performed to explore the sources of heterogeneity when necessary. A subgroup analysis based on different time points was performed. In terms of publication bias, we used Stata15.1 software to perform Egger’s and Begg’s tests, then presented the Egger’s funnel plot and related details. A P<0.05 for each test was considered to indicate obvious publication bias.Review Manager 5.4 software was used for statistical analysis. For continuous variables, the data were counted, and the mean difference (MD) was applied to the 95% confidence interval (CI). For dichotomous variables, odds ratios (OR) with 95% CI were calculated. The IWe generated figures Figs  and 3 deBasic information concerning the included studies are listed in All the results of this meta-analysis are summarized in 2 = 66%) (2 = 40%).Since the relevant hemodynamic parameters in our incorporated RCTs were measured repeatedly during controlled hypotensive administration or depicted intricately in a diagram, we identified and analyzed the minimum values of the hemodynamic responses  in the meta-analysis and the related data were extracted if accessible in the original article. Six studies , 23–26 e2 = 66%) . Meanwhi2 = 74%). Six studies tested blood loss between the two groups.[2 = 0%)  .2 = 90%)  .2 = 92%). We conducted a subgroup analysis according to three different time points . No significant differences were found at the three different time points.Four studies , 25, 27 2 = 0%)  . Further2 = 0%). However, compared with the remifentanil group, there were lower occurrence of shivering , nausea, and vomiting  in the dexmedetomidine group. The results of this meta-analysis indicated that there was no significant difference between dexmedetomidine and remifentanil in overall adverse events   .2>50%) across the four domains: MAP, surgical field score, extubation time, and sedation scores at the PACU. To explore the sources of heterogeneity, a sensitivity analysis was conducted. Sensitivity analysis revealed that heterogeneity of MAP  and surgical field score  were significantly reduced after removing Richa’s study [2 was zeroed . Concerning sedation scores at the PACU, sensitivity analysis cannot reduce the significant heterogeneity in this domain.After conducting the meta-analysis, we found significant heterogeneity , surgical condition indicators , sedation score at the PACU, and the incidence of bradycardia between dexmedetomidine and remifentanil. However, the advantage of the dexmedetomidine group was statistically significant in terms of VAS at the PACU and the occurrence of shivering, nausea, and vomiting. Compared with the dexmedetomidine group, extubation time of the remifentanil group was significantly shorter.Six studies assessed the minimum intraoperative MAP value, and the results of this meta-analysis revealed no significant difference between dexmedetomidine and remifentanil with high heterogeneity , 23–26. Seven studies including 356 participants evaluated the intraoperative minimum values of HR , 23–26. Meanwhile, four RCTs evaluated surgical field score , 24, 25,We tested the extubation time of the two groups , 24–27 aWe analyzed the sedation score at the PACU, and the results of this meta-analysis indicated that there was no significant difference between dexmedetomidine and remifentanil. The following subgroup analysis came to the same conclusion. Although Menshawi et al.  and JangAnother outcome we used to conduct this meta-analysis and subgroup analysis is VAS at the PACU. We found that dexmedetomidine showed a better analgesic effect than remifentanil at the PACU. Similar results were found in the subgroup analysis based on three different timepoints. The two included studies demonstrated that the dose of dexmedetomidine infusion fluctuated from 0.3 to 0.8 μg/kg/h , 16. A pPerioperative shivering, nausea, and vomiting, as well as bradycardia, are common complications after general anesthesia –39. CurrThe current meta-analysis has some strengths. First, this is the first systematic review and meta-analysis to compare dexmedetomidine to remifentanil for CH during general anesthesia. Second, we used sensitivity analysis to reduce the high heterogeneity of most domains. Finally, to investigate publication bias, we used the Egger’s and Begg’s test for primary outcomes, and the results revealed no obvious bias. However, there are a few limitations to this meta-analysis that should be addressed. Our meta-analysis included a small number of high-quality RCTs and participants, which may not result in authoritative conclusions. In addition, there was significant clinical heterogeneity in four domains due to different dexmedetomidine and remifentanil dosages, different types of surgery, and inconsistent outcome measurement methods. Study designs and outcome measurements should be agreed upon to improve the quality of future comparisons between dexmedetomidine and remifentanil under general anesthesia.Dexmedetomidine and remifentanil are both effective in providing satisfactory CH and surgical conditions. However, dexmedetomidine is better in easing postoperative pain at the PACU and reducing the occurrence of shivering, nausea, and vomiting. Meanwhile, remifentanil is a fast-track anesthesia with a shorter extubation time. Given the limitations of our meta-analysis, further studies are still needed for a more definitive conclusion on the comparison of the efficacy and safety of dexmedetomidine and remifentanil.S1 Checklist(DOCX)Click here for additional data file.S1 Fig(TIF)Click here for additional data file.S1 Table(DOCX)Click here for additional data file.S1 File(A) Results of the Begg’s test and Egger’s test. (B) Egger’s publication bias plot.(DOCX)Click here for additional data file.


The omicron variant is thought to cause less olfactory dysfunction than previous variants of SARS-CoV-2, but the reported prevalence differs greatly between populations and studies. Our systematic review and meta-analysis provide information regarding regional differences in prevalence as well as an estimate of the global prevalence of olfactory dysfunction based on 62 studies reporting information on 626,035 patients infected with the omicron variant. Our estimate of the omicron-induced prevalence of olfactory dysfunction in populations of European ancestry is 11.7%, while it is significantly lower in all other populations, ranging between 1.9% and 4.9%. When ethnic differences and population sizes are considered, the global prevalence of omicron-induced olfactory dysfunction in adults is estimated to be 3.7%. Omicron’s effect on olfaction is twofold to tenfold lower than that of the alpha or delta variants according to previous meta-analyses and our analysis of studies that directly compared the prevalence of olfactory dysfunction between omicron and previous variants. The profile of the prevalence differences between ethnicities mirrors the results of a recent genome-wide association study that connected a gene locus encoding an odorant-metabolizing enzyme, UDP glycosyltransferase, to the extent of COVID-19-related loss of smell. Our analysis is consistent with the hypothesis that this enzyme contributes to the observed population differences. Sber 2021 . A totalber 2021 . Since tber 2021 ,8, it isber 2021 .UGT2A1/A2 locus [It is possible that host factors also contribute to the populational differences in COVID-19-related olfactory dysfunction ,11,12,13A2 locus ,16, inclA2 locus ,18,19,20In this study, we conducted a systematic review and meta-analysis of the literature on olfactory dysfunction caused by the omicron variant. In this review, we focused on loss of smell rather than loss of taste. Loss of taste is thought to be, in part, due to loss of smell ; therefoWe generated estimates of the global prevalence of omicron-induced olfactory dysfunction, as well as regional prevalence, which is determined at least in part by genetics (prevailing ethnicity) within populations. The similarities between the results of our analysis and those of a recent genome-wide association study  indicatehttps://icite.od.nih.gov/covid19/search/, accessed on 10 January 2023), for the years 2021, 2022, and 2023. The COVID-19 portal was included in order to capture preprints in addition to peer-reviewed articles. The following search strategy was formulated using the keywords “omicron” and “smell”, as well as “omicron” and “anosmia.” Only English terms were used in the search strategy. Reference lists from the eligible articles were examined to identify additional relevant studies. Duplicates were removed; however, in the case of preprints, the first date of publication was recorded, even when the peer-reviewed version of the paper, when available, was compiled in our list of references. All titles were screened, and when potentially relevant, the abstracts were evaluated to decide whether such a paper should be short-listed for full-text reading. The full texts of all short-listed records were reviewed to determine whether they were eligible according to our inclusion and exclusion criteria; then, they were used to produce the final selection of studies for inclusion in subsequent analyses  . Reportsanalyses . Studies that were deemed eligible for the systematic review met all of the following inclusion criteria: (1) studies reporting the numerical prevalence of olfactory dysfunction in humans infected with the omicron variant (B.1.1.529) and any of the omicron subvariants, namely, BA.1, BA.2, BA.1.1, BA.2.2, BA.2.10, BA.2.38, BA.2.75, BA.5, BQ.1, and XBB— studies solely reporting odds ratios only were not sufficient for inclusion ; (2) stuRisk of bias in cohort studies was assessed using a modified Newcastle–Ottawa scale (adapted Cochrane’s risk of bias tool ). This sThe relevant data of each study were extracted using pre-designed tables; such data included the first date of publication, first author, country, geographic region, the cohort size, the number of cases, and the percentage calculated from the number of cases per cohort. When applicable, the comparator virus variant was also noted, along with its cohort size, number of cases with olfactory dysfunction, and the percentage of prevalence, as well as the name(s) of the previous variant or variants causing the infection. When the comparator virus variant was not disclosed, it was retrieved as G614 vs. D614 . AdditioThe global prevalence of olfactory dysfunction due to omicron infection was calculated by taking ethnic differences and population sizes into account, and this prevalence was compared with the global and regional prevalence due to previous variants using information from studies that reported such data (32 out of 62 studies). Due to ethnic differences between populations, the prevalence for each major ethnicity  was estimated separately and weighted by population size to calculate an estimate of the current global prevalence of hyposmia due to omicron. This was necessary to prevent bias since the largest fraction of available studies and those with the largest cohorts focused on people with European ancestry.The primary purpose of the meta-analysis was to produce a more precise and reliable estimate of the effect of the omicron variant on olfactory dysfunction, compare this estimate with previous estimates that were made before the emergence of omicron , and prepare a direct comparison by compiling the data from those studies that provided internal comparative data on other virus variants. 2 index [Pooled analyses were performed to determine olfactory dysfunction prevalence and risk ratio (RR). The heterogeneity among studies was evaluated by Cochran’s Q test and the I2 index ,34. Rand2 index . The stu2 index . Pooled 2 index , includi2 index  and the 2 index . The ris2 index . The sigWe found 62 studies—published between 27 November 2021, and 10 January 2023—that met our inclusion criteria. Collectively, these studies reported the olfactory status of 626,035 patients infected with the omicron variant . These sWhen we combined all the eligible studies in the Forest Plot , we derip < 0.001). When compared with previous meta-analyses reporting on multiple SARS-CoV-2 variants up to August 15, 2020 .When we compared the prevalence of olfactory dysfunction due to omicron with that of previous variants (mostly delta), we found twofold to tenfold lower prevalence with omicron based on the thirty-two studies that provided a direct comparison A,B. The patients ) and up patients ), the prThe studies compiled in https://www.worldometers.info/geography/7-continents/, accessed 10 January 2023), and use the estimated numbers of COVID-19 cases from the Institute for Health Metrics and Evaluation [When we account for the omicron-caused prevalence of hyposmia among the different major ethnicities, apply the total population sizes of these major ethnicities . The coefficient is positive, which means that hyposmia prevalence is higher when the risk allele frequency is higher, which is consistent with a genome-wide association analysis [The ethnicity profile  for both the risk allele frequency as well as hyposmia prevalence is shown in A1 locus . We usedanalysis . This sup = 0.391). With the previous virus variants, mostly delta, the survey-based studies resulted in a pooled estimate of hyposmia prevalence equaling 45.4% (CI: 22.1–68.8%), which is higher than the 36.6% (CI: 28.4–44.8%) resulting from the traditional studies (p = 0.428).It has been cautioned that survey-type studies  may incorporate bias because people with more severe conditions tend to be more motivated to respond ,29,30,36 studies B. Again,We estimate the global prevalence of omicron-induced olfactory dysfunction in adults to be 3.7%. This estimate accounts for ethnic differences and population sizes and is based on the notion that 90% of the population has been or will be exposed to SARS-CoV-2 . Our estOur analysis reveals significant ethnic differences in the prevalence of omicron-induced olfactory dysfunction. The estimation of the current prevalence level of omicron-induced olfactory dysfunction in Western countries of 11.7% is well supported, and the estimates for South Asians, Latinos/Hispanics, and East Asians, with 14,165, 4542, and 3585 people in the cohorts, respectively, are also fairly well attested. Our estimates for the prevalence in Africa (3.1%) and the Middle East (2.2%) are less certain, as they are based on only 5 and 3 studies, respectively, with 544 and 1100 people in the cohorts.IFITM2 gene is the most highly upregulated gene in support cells at 3 days after infection [Two main reasons have been proposed to explain this phenomenon, and they are not mutually exclusive. The mutations in the spike protein make the omicron variant more hydrophobic , which mnfection , this manfection ,109.UGT2A1 risk allele , andd humans , which mUGT2A1 locus causes a greater degree of olfactory dysfunction [What does the genetic/ethnic difference in the risk allele frequency in the host  tell us about olfactory dysfunction? The risk allele at the function , which mSimilar to pre-omicron COVID-19 research wherein the large majority of studies reported olfactory dysfunction based on patient recall , we wereThe vast majority of the studies we compiled were scored as moderate or high quality according to the modified Newcastle–Ottawa scale  Table 1Table 1, Most studies compiled in our review were not stratified according to age group, but age is a relevant factor ,99,126. and taste or change or loss of smell or taste. Additional studies are needed to better distinguish the effects of omicron on smell and taste.Many studies did not specify change in smell vs change in taste and reported them as either change or loss of smell We did not attempt to resolve whether omicron sub-variants have different effects on olfactory dysfunction; there are still too few studies that report the effects of subvariants on loss of smell ,50,86.Some cohorts of the studies were ethnically mixed, but the exact ethnic composition of the cohort was reported in only a few studies , and noWe did not include studies that focused on olfactory dysfunction in children. Children have lower hyposmia prevalence than adults , and theUGT2A1 locus, and, therefore, the UDP glycosyltransferase, is involved in the ethnic differences in COVID-19-related olfactory dysfunction [Although we have a clue that the function , the mecfunction . A bettefunction .While some studies indicate that a previous SARS-CoV-2 infection may reduce the likelihood of olfactory dysfunction in a subsequent COVID-19 infection , it is kpersistent loss of smell after omicron infection. Will it be similar to previous variants, with an about 5% level of persistent loss of smell among those who experience olfactory dysfunction [If the omicron variant infects about 90% of 6 billion adult people worldwide, what does a global prevalence of 3.7% olfactory dysfunction (200.9 million cases world-wide) mean for trends in global cases of olfactory dysfunction? Our ethnicity-adjusted projections suggest that olfactory dysfunction will decline globally despite the higher infectivity of the omicron variant, contrary to previous predictions . It is nfunction ? Does a


The search of new sustainably produced protein sources for food and feed is vigorously under investigation. One promising possibility is to increase the use of edible insects as a part of our diet. The nutrient content of edible insects, in particular, a high content of good quality protein and unsaturated fatty acids with essential fatty acids, is an important health aspect when screening the most potential insect species for human consumption. Based on this review, the substrate affects the nutrient content of insects. Moreover, our correlation calculations demonstrated that the fatty acid content of the substrate influences the nutritional value of insects. In general, high content of unsaturated fatty acids in the substrate increased the amount of unsaturated fatty acids in insects. For example, the content of essential fatty acids, linoleic and alpha linolenic acids, can be raised by feeding insects with modified substrate. Thus, edible insects can be a healthy protein source to ease the increased demand for high quality food.Demand for new food sources and production methods is increasing due to overall population growth, as well as the aim towards more sustainable use of natural resources and circular economy. Edible insects already used in many parts of the world have recently attracted interest as a new protein source in Europe, and novel food acceptance procedures are ongoing in the European Union for several insect species. In this paper, the effects of substate on the nutritional value, especially the fatty acid composition, of edible insects were reviewed and correlation calculations performed. The nutritional value of edible insects is an important health aspect, in particular, a high content of good-quality protein and unsaturated fatty acids with essential fatty acids, and an optimal fatty acid n6/n3 ratio. On the basis of our findings, the nutrient content of insects can be modified by using a feed substrate carefully designed for each individual insect species. In addition, our correlation calculations demonstrated that the contents of linoleic and alpha linolenic acids in insects reflected the contents of these acids in the substrate. In conclusion, optimizing the composition and structure of the substrate and rearing conditions and duration for each insect species might also aid standardization of the nutritional composition of edible insects. Insects have been a part of the human diet for a long time, especially in Asia, Africa, and South America . GloballAcheta domesticus), yellow mealworm (Tenebrio molitor larvae), lesser mealworm (Alphitobius diaperinus larvae), European honeybee , black soldier fly (Hermetia illucens larvae), and migratory locust (Locusta migratoria) are currently permitted for use as food in Finland [The use of insects as food has increased in Europe in recent years . Cricket Finland . HoweverCommonly used substrates for rearing edible insects are chicken feed and soybean meal, but new options are continuously tested. For example, side streams or byproducts from the food industry could offer economical and sustainable ways to produce animal protein. When side streams or byproducts are used as substrates, feed legislation must carefully be taken into consideration and the safety and quality of substrates ensured. The EU legislation EU/2017/1017) defines substrates that can be used for the rearing of edible insects in Europe and, for example, manure, catering waste, and certain other wastes are not permitted substrates [/1017 defThe nutritional composition of substrate is an important factor for the efficient growth of insects. For this reason, it would be beneficial to formulate the most suitable substrate for each reared insect species. Crucial aspects of optimization of the substrate include, for example, protein and fat contents, which should not be either too high or too low. According to Van Broekhoven et al. , low proAcheta domesticus) and yellow mealworm (Tenebrio molitor) were 7.5–23.7% and 11.4–30.4% of fresh weight, and fat contents 2.4–6.7% and 6.4–23.0%, respectively [Protein and fat contents of insects affect their nutritional value, and, in particular, a high content of essential amino acids and mono- and polyunsaturated fatty acids with a good fatty acid profile increases the nutritional quality. The protein content of insects varies according to species, age, rearing substrate, and analysis method . Payne eN-acetylglucosamine containing a nitrogen atom. This overestimation can be avoided by analyzing non-digestible chitin separately. Alternatively, for example, Ritvanen et al. [The total amount of crude protein of food or feed is often assayed by the Kjeldahl method. With this method, the amount of nitrogen is determined and converted to crude protein by the nitrogen-to-protein conversion factor . According to Jonas-Levi and Martinez , the pron et al.  proposedThe nutritional composition of edible insects has been surveyed in several review publications ,15,16. BIn the following sections, the main findings of the effect of substrate on the macronutrient and mineral composition of edible insects are summarized. Substrates with different protein and fat contents have been used to grow crickets. The total crude protein of substrates for rearing house crickets has been reported as 6.3–22.9% and after rearing, the protein of crickets has been 48.1–76.2% of dry matter ,18. It aDietary calcium and phosphorus levels and their ratio are important for normal growth and development of insects . In a stp = 0.000) negative correlation with the percentage of larvae protein, while the percentage of substrate protein had a positive significant (p = 0.000) correlation with the percentage of larval fat [Black soldier fly (BSF) has been extensively studied due to its efficient utilization of different kinds of substrates. In addition, it has a fast growth rate and life cycle. BSF can be fed with organic byproducts of the agri-food industry, and thus the environmental impact of the produced protein is lower than if a special substrate, such as soybean meal, is used for rearing . In a strval fat . By contrval fat .In a study by Jucker et al. , BSFs wep = 0.008) and fat (EE) (p = 0.040) contents of BSF larvae can be affected by the growth substrate. Furthermore, a positive correlation was estimated to hold between chitin content of larvae and neutral detergent fiber of the substrate [Liu et al.  observedubstrate . By contubstrate .Crude protein content in high protein–low fat substrate (HPLF) was 22.9%, and in high protein–high fat substrate (HPHF), 21.9% . After rp = 0.023) was observed in ash content between substrates and prepupae, as well as between fat (EE) content (p = 0.030) of the prepupae and NFC content of the substrate [The protein content of BSF prepupae was not observed to differ greatly between prepupae reared on various substrates, despite great differences in protein content of the substrates . By contubstrate . No corrubstrate . Howeverubstrate , the cruubstrate . Interesubstrate . Howeverubstrate .In a study by Tschirner and Simon , three dThe chemical composition of yellow mealworm was observed to be affected by the substrate . Larvae Acrocomia aculeata (Jacq.) Lodd) palm tree [The use of novel biomasses as a substrate to increase the nutritional quality of yellow mealworms has been surveyed, and one option could be pulp flour of bocaiuva  for yellow mealworm larvae . SubstraYellow mealworms have also been grown on substrates originating from organic byproducts of beer brewing, bread/cookie baking, potato processing, and bioethanol production . High prIn a study by Zhang et al. , three bp = 0.001) in mealworms.Calcium level of yellow mealworm was observed to increase by substrate with high calcium content supplement while phosphorus did not have a similar effect . The palHigh protein content of the substrate was shown to increase the protein content of lesser mealworm . The conIn migratory locust, correlations between fat content and protein content, and between fat content and ash content, have been observed . When thLinoleic (C18:2n6) and alpha linolenic (C18:3n3) acids are the most important fatty acids in the human diet because they cannot be synthesized in the body. Therefore, the human diet must contain certain amounts of linoleic and alpha linolenic acids. In Nordic nutrition recommendations, the amount of essential fatty acids is 3% of the daily energy intake, and one-sixth of the essential fatty acids are recommended to be alpha linolenic acid .Edible insects often have low n-3 fatty acids content but a relatively high content of n-6 fatty acids , and thup < 0.01) for house cricket, BSF, and yellow mealworm.Our calculations were performed in order to evaluate how efficiently linoleic acid (C18:2n6) and alpha linoleic acid (C18:3n3) can be transferred from substrate to the insects. Spearman correlation test  was applied to obtain the correlations. Based on the calculations, it appears that substrate can affect the linoleic and alpha linolenic acids contents of insects . When coBased on the studies addressed within this review, the amount of linoleic C18:2n6) and alpha linolenic (C18:3n3) acids varies even in insects reared on similar control substrates :2n6 and ,33,34,37Linoleic acid C18:2n6), oleic acid (C18:1n9), palmitic acid (C16:0), and stearic acid (C18:0) have been reported as the main fatty acids in house crickets :2n6, ole. OverallThe concentration of linoleic acid C18:2n6) in house crickets fed on control substrate was 28.7–34.9% of TFA, and the concentration of alpha linolenic acid (C18:3n3) 0.8–1.2% :2n6 in h. FlaxseeBSFs, both prepupae and larvae, were shown to contain mostly SFA (61.3–86.9%) of all fatty acids, although the majority of the used substrates contained mostly unsaturated fatty acids (UFA) ,21,24,37p = 0.009), and that the substrate had a statistically significant effect on the lauric acid (C12:0) (p = 0.035) and myristic acid (C14:0) (p = 0.021) concentrations of larvae. Additionally, oleic acid (C18:1n9) concentration was seen to be affected significantly (p = 0.011) by the substrate [It seems that substrate with a high carbohydrate content increases SFA and especially lauric acid (C12:0) concentration in BSF prepupae ,23,28. Bubstrate .According to Meneguz et al. , the fatp < 0.01) positive correlation between SFA of substrate and prepupae was demonstrated only in the case of myristic acid (C14:0) [Danieli et al.  observed (C14:0) . The MUF (C14:0) . Moreove (C14:0) .Schizochytrium sp. and Isochrysis sp., and was used as substrate for rearing BSF prepupae [p = 0.035) was observed in lipid content between substrate enriched with Schizochytrium sp. and prepupae [Isochrysis sp. and prepupae [Schizochytrium sp. in CS caused a significant increase of docosahexaenoic acid  and eicosapentaenoic acid , and a decrease of SFA, in prepupae compared to CS without microalgae or CS with Isochrysis sp. [Schizochytrium sp. in CS was found to be sufficient to improve the nutritional quality of BSF by increasing the content of UFA, and especially the amount of n3 fatty acids [The byproduct coffee silverskin (CS) was enriched with different amounts of microalgae, prepupae . Inclusiprepupae . After rprepupae . Howeverprepupae . Schizocysis sp. . A totalty acids .Flaxseed oil, containing 57% alpha linolenic acid (C18:3n3), was added to the substrate of BSF . The fatFischer et al.  studied Palmitic acid (C16:0), oleic acid C18:1n9), and linoleic acid (C18:2n6) have been shown to be the most prevalent fatty acids in yellow mealworm and in lesser mealworm :1n9, and,33,34,40Melis et al.  reportedIn a study by Ruschioni et al.  of substDreassi et al.  reared yThe n6/n3 ratio was high in all yellow and lesser mealworms reared on substrates with different n6/n3 ratios, which was thought to be due to carrot included in the diet . HoweverLesser mealworms reared on control substrate had 22.7–26.9% linoleic acid C18:2n6) and 0.7–1.2% alpha linolenic acid (C18:3n3) of TFA :2n6 and . Wheat bInterest in edible insects has increased in Europe in recent years, and novel food applications for many insect species are pending in the EU. Approval processes for the applications are currently in progress, which requires active observation of changes of legislation. Edible insects could be a new sustainable protein source for human diet and animal feed. Thus, the quality and nutritional content of insects are important from a health aspect. However, the number of studies dealing with nutritional composition of edible insects and the effects of the used substrates is currently very limited, thus hampering extensive conclusions.Brachystola magna (Girard) grasshoppers have been reported to have the highest contents of protein, fat, calcium, and magnesium in the adult stage, whereas iron and zinc concentrations are the highest in the nymph stage [The chemical composition of insects is affected by many factors, such as species, substrates, and developmental stage of the insect ,18. For ph stage .It appears clear that substrate has an impact on the nutritional composition of insects, in some species more than in others. The nutritional value of house crickets can be modified via formulation of the substrate, and it has been reported that high protein content of the substrate could increase not only the protein content of crickets, but also the amounts of sodium, calcium, phosphorus, and potassium ,19. AccoThe contents of protein and carbohydrate and their ratio in the substrate have been assumed to affect the contents of protein and fat and their ratio in BSF , and accBlaptica dubia (Serville)) and BSF are able to utilize different kinds of substrates better than yellow mealworm or house cricket [Insect farming should be economically viable, and therefore the nutritional composition of substrate must be suitable for each species in order to maximize the yield, and low-cost substrate raw materials should be favored. Byproducts are a sustainable option for rearing edible insects, and by using them also the costs of insect farming could be decreased. Substrate has an impact on larval performance and feed conversion efficiency, and feed conversion efficiency has been observed to be higher with high-protein substrate than with low-protein substrates . In addi cricket .Lactobacillus buchneri and observed that the treatment increased the protein and fat contents of BSF larvae compared to larvae reared on non-treated SCR or artificial feed (AF). However, when rearing mealworms or other insects for human consumption, the fatty acids quality, and especially the n6/n3 ratio of the substrate, must be taken into consideration [In order to increase the utilization of byproducts, one option could be a treatment with microorganisms. Somroo et al.  treated deration . FurtherFinally, the nutrient content of insects varies considerably between species ,48. In aIt appears that nutrient content of insects can be modified by using a substrate which has been planned carefully for each insect species individually, including both macro- and micronutrients. This is because the ingredients of the substrate can be metabolized in the insect to other compounds, for example, carbohydrates can be converted to fats. For example, according to Finke , the fat


Conclusions: Spontaneous hyperventilation is common in patients with spontaneous cerebellar hemorrhage, and its severity is associated with the outcome.Background: The spontaneous hyperventilation (SHV) accompanying spontaneous cerebellar hemorrhage has yet to attract a sufficient amount of attention. This study aimed to analyze the incidence of SHV in spontaneous cerebellar hemorrhage patients and its risk factors as well as its association with the outcome. Methods: We retrospectively reviewed the medical records of all spontaneous cerebellar hemorrhage patients who underwent surgical treatment at Tongji Hospital from July 2018 to December 2020. Arterial blood gas (ABG) test results and clinical characteristics, including demographics, comorbidities, imaging features, laboratory tests, and therapy choices, were collected. The Glasgow Outcome Scale was used to assess the outcome at two weeks and six months after admission. Results: A total of 147 patients were included, and of these patients 44.9% had spontaneous hyperventilation. Hypertension , usage of sedation drugs , and hypernatremia  seemed to positively correlate to SHV occurrence. Hematoma removal had an inverse association with SHV . Patients with poor and good outcomes had significant differences in pH, PaCO Hypry (TBI) . Thus, i2, high arterial PaO2, and high arterial pH that persists during sleep without the impact of drug or metabolic causes [2 may also lead to hypoxia of the brain parenchyma [However, not all hyperventilation is intentional. Central spontaneous hyperventilation (SHV) has also been observed in patients with a brain injury , subaracc causes . Howeverrenchyma . Thus, trenchyma ,16.Spontaneous cerebellar hemorrhage, as the most serious and least treatable type of stroke, accounts for approximately 10% of all spontaneous intracerebral hemorrhages (ICHs), with a 30-day mortality varying from 30% to 50% ,18,19. DIn clinical practice, spontaneous hyperventilation is often observed in cerebellar hemorrhage patients and, as this manifestation has not attracted a sufficient amount of attention, few studies have focused on it. Therefore, we attempted to study whether spontaneous hyperventilation is a common manifestation in cerebellar hemorrhage patients and its risk factors as well as its association with the prognosis.All patients with spontaneous cerebellar hemorrhage admitted to the neurointensive care unit (NICU) at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China between July 2018 and December 2020 were screened in this retrospective study. Spontaneous cerebellar hemorrhage was diagnosed by a computed tomography (CT) scan and satisfied the following criteria: the patient had no history of trauma, single fourth ventricular or brainstem hemorrhage was excluded, multiple localized intracerebral hemorrhage involving the cerebellum was excluded, and hemorrhage caused by a clear etiology, such as cerebellar arteriovenous malformations and brain tumors, was excluded.All patients were treated in accordance with international guidelines  and undeThe inclusion criteria were as follows: age ≥18 years, onset with only spontaneous cerebellar hemorrhage, and an arterial blood gas (ABG) test at least once during NICU hospitalization for at least one week. Patients were excluded if they had invalid ABG test results.All procedures performed in studies involving human participants were performed in accordance with the ethical standards of the Medical Ethics Committee of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, the 1964 Declaration of Helsinki and its later amendments, or comparable ethical standards. The requirement for patient consent was waived as this retrospective study had no effect on the rights, health, and privacy of the subjects. The risk to the subjects of this study was not greater than the minimum risk.Patients took the ABG test every two days or depending on the actual needs. ABG tests were performed when the body temperature was normal and before or at least 30 min after nursing care or other pain management. If the patient was mechanically ventilated, pressure support ventilation (PSV) was preferred since it improves patient comfort and ventilator synchrony, and ABG tests were used to determine the effectiveness of the PSV settings. As the patient triggers each breath in PSV mode, the patient has more control over the flow delivery and respiratory rate. There tends to be less ventilator desynchrony from patient-triggered breaths during inspiration or passive exhalation and less voluntary movement of the diaphragm compared with delivered breaths . ABG tes2 < 35 mmHg and pH > 7.45 and was divided into three groups according to the PaCO2 results: mild (30 mmHg ≤ PaCO2 < 35 mmHg), moderate (25 mmHg ≤ PaCO2 < 30 mmHg), and severe (PaCO2 < 25 mmHg) [SHV was defined by the presence of at least one ABG with both PaCO25 mmHg) .2 < 35 mmHg, and hypercapnia for PaCO2 > 50 mmHg. The complex etiology of the respiratory system and metabolism were not considered in all results.The parameters of the ABG results were further analyzed and defined as follows: acidemia for pH < 7.35, alkalemia for pH > 7.45, hypocapnia for PaCODemographic data (sex and age) and medical history  for each patient were retrieved by interviews with the patient and/or family on admission. Information on the location and volume of the hematoma, subarachnoid hemorrhage, and hydrocephalus was obtained from computed tomography (CT) scan imaging data. The rest of the information, including laboratory test results , physical examination results , surgical methods, and other information , was collected from the medical record system.Pneumonia was defined by the decision of the treating physician to complete a full antibiotic treatment course based on a chest X-ray, culture results, and clinical symptoms. Fever was treated aggressively with antipyretics and surface cooling devices. Abnormal test results were defined as follows: hypoproteinemia for albumin < 35 g/L, hypernatremia for blood sodium > 145 mmol/L, hyponatremia for blood sodium < 135 mmol/L, hypokalemia for blood potassium < 3.5 mmol/L, hypocalcemia for blood calcium < 1.1 mmol/L, hyperglycemia for fasting blood glucose > 6.1 mmol/L, and anemia for hemoglobin < 120 g/L.The Glasgow Outcome Scale (GOS) was used to assess g/L neurologic functional outcomes at 2 weeks and 6 months in the short term and long term, respectively. The GOS score is a 5-point scale, where 1 = death, 2 = persistent vegetative state, 3 = severe disability, 4 = moderate disability, and 5 = good recovery . GOS sco2 test or Fisher’s exact test (if the sample size was less than 5) was used to compare differences in nominal variables between the groups. A normality test (the Kolmogorov–Smirnov Z test) and a variance homogeneity test were performed for continuous variables, which are reported as the mean and standard deviation (SD) if they obeyed a normal distribution or the median and interquartile range (IQR) if they did not. Student’s t test was used for normally distributed variables to compare the difference between two groups, and the Mann–Whitney U test was used for non-normally distributed variables.Numerical variables are reported as counts and proportions (%). The χVariables that were considered clinically relevant to SHV occurrence or that showed significant differences between the SHV group and the non-SHV group were entered into a multivariate logistic regression model. Variables for inclusion were carefully chosen, given the number of events available, to ensure that the final model would be parsimonious. The final results for each variable are expressed as the odds ratio (OR) and 95% confidence interval (95% CI).p < 0.05 was considered significant.All statistical analyses were performed with IBM SPSS Statistics version 23.0  For all tests, A total of 192 patients were admitted to our neurointensive care unit during the study period, and 147 of these patients satisfied the criteria for inclusion. Sixteen patients were excluded because they had invalid ABG test results, such as missing values or substandard sampling. Nine patients were hospitalized in the NICU for less than one week. Nine patients were younger than 18 years old. Eleven patients were lost by follow-up.2 < 35 mmHg and pH > 7.45 at least once and were classified as the spontaneous hyperventilation group. The remaining 81 (55.1%) patients without spontaneous hyperventilation were treated as the nonspontaneous hyperventilation group  had ABG test results with both PaCOon group .p < 0.05). The median age was 59 years in the SHV group and 58 years in the non-SHV group (p > 0.05). A higher incidence of hypertension was observed in the SHV group compared with the non-SHV group . However, the incidences of other comorbidities, such as diabetes mellitus (21.2% vs. 11.1%), heart dysfunction (7.6% vs. 9.9%), lung dysfunction (9.1% vs. 11.1%), and others (10.6% vs. 13.6%), showed no significant difference (p > 0.05). Hematomas located on the unilateral side or middle line were not different between the SHV group and the non-SHV group , whereas their volume was greater in the SHV group . More than half of the patients in the two groups had subarachnoid hemorrhage , and similar proportions of hydrocephalus occurred .The clinical characteristics of the study population are described in p < 0.05), especially for the proportion of GCS < 6 . However, the times from onset to admission  vs. 12.0 , p > 0.05) and from admission to surgery  vs. 12.0 , p > 0.05) were not different, and the abnormal laboratory tests at admission included hypoproteinemia , hypernatremia , hypokalemia , hypocalcemia , hyperglycemia , and anemia .Notably, although the median GCS score assessed at admission appeared to be the same in the two groups, the statistical analysis still showed a significant difference (p < 0.05). In contrast, the proportions of hematoma removal with decompressive craniectomy , external ventricular drainage , and tracheotomy  were similar in both groups.The proportion of patients who underwent hematoma removal was slightly lower in the SHV group compared with the non-SHV group , usage of sedation drugs , and number of days of fever  vs. 3.0 , p < 0.05) were significantly higher in the SHV group. The incidence of pneumonia  and postoperative laboratory tests, including hypoproteinemia , hyponatremia , hypokalemia , hypocalcemia , hyperglycemia , and anemia , were not significantly different except for hypernatremia .After the operation, the number of days of mechanical ventilation  vs. 3.2 , p < 0.05) and long term (p < 0.05)  .A multivariate logistic analysis was performed to analyze the risk factors for SHV occurrence. The variables were chosen based on the following points: (1) variables should be considered clinically relevant to SHV occurrence, (2) they showed a significant difference between the SHV group and the non-SHV group, and (3) considering the sample size, eight variables needed to be chosen to build a multivariable model for SHV occurrence.We found that patients with the comorbidities of hypertension , postoperative usage of sedation drugs , and hypernatremia  had a positive correlation to SHV occurrence. However, patients who underwent hematoma removal treatment  had a significant, inverse association with SHV compared with patients who did not undergo hematoma removal treatment .p < 0.05). This was also true for the PaCO2 values, which were divided into hypocapnia, eucapnia, and hypercapnia groups . In patients with poor short-term outcomes, 8(17.0%) patients had mild SHV, 8 (17.0%) patients had moderate SHV, and 11 (23.4%) patients had severe SHV. In patients with good short-term outcomes, 26 (26.0%) patients had mild SHV, 9 (9.0%) patients had moderate SHV, and 4 (4.0%) patients had severe SHV. In patients with long-term outcomes, the amounts were 5 (13.5%) patients, 7 (18.9%) patients, and 11 (39.7%) patients for poor outcomes and 29 (26.4%) patients, 10 (9.1%) patients, and 4 (3.6%) patients for good outcomes. SHV severity showed a significant difference in the poor and good outcome groups (p < 0.001)  .SHV was first identified in patients with acute brain stem disease . Most reFirst, a cerebellar hematoma may induce SHV by compression of the brainstem, leading to dysfunction of the respiratory center. That is why, in our results, patients with SHV seem to have a larger volume of hematoma. Undoubtedly, abnormal respiratory function due to a hematoma at the onset of the disease plays an important role. Second, the increase in intracranial pressure caused by a cerebellar hematoma and secondary hydrocephalus causes brain ischemia and hypoxia, leading to an increase in lactic acid metabolism and hyperventilation. It has also been proposed that CNS lactate could cause hyperventilation by stimulating medullary chemoreceptors. This is supported by the presence of lactic acid in the CSF of a patient with SHV and diffuse cerebral lymphoma, with a decrease in lactic acid after treatment .A GCS score < 6 was found to be an important factor in spontaneous hyperventilation, which is consistent with the discovery of Pierre Esnault et al. They found that patients with SHV had a more severe TBI in terms of median initial GCS score, rate of pupillary abnormality, and median head AIS score than those without SHV . A total2 produce neurotoxic effects by inducing the release of cytotoxic excitatory amino acids, increasing dopamine levels in the basal ganglia, and promoting the incorporation of choline into the phospholipids of cell membranes [2) in patients with a severe brain injury , which also supports our finding [Another main finding of this study was the significant association between hypercapnia or hypocapnia and alkalemia or acidemia due to SHV and unfavorable functional neurologic outcome at two weeks and six months. In addition, the severity of SHV was also closely linked to both the short-term and long-term outcomes of patients with a cerebellar hematoma. However, the mechanism by which SHV affects the prognosis remains unclear. Many studies have found an adverse effect of hyperventilation in patients with a TBI, and these findings could help to explain unfavorable outcomes in cerebellar hemorrhage patients ,8. Hypocembranes . Carrera finding .Even though our study clarified an important clinical feature that had a significant association with the poor functional neurologic outcomes of patients with cerebellar hemorrhage, no evidence showed that correcting hyperventilation could improve the prognosis of a cerebellar hematoma. The opportunity for and methods of SHV treatment should also be taken into consideration. Thus, further investigation is still needed.Several limitations should be considered when interpreting the results. First, due to the inclusion and exclusion criteria, sample selection bias may be present, leading to a bias in the results of the study. However, the design of the cohort study and the statistical analysis minimized the change in conclusions caused by this deviation. Second, the monitoring of hyperventilation or hypocapnia in this study was not performed dynamically or in real time, and the results were selected, but the duration of the situation and the sampling time had an impact on the patient’s test results. Third, the sample size of this study is limited, and our conclusions need to be further verified in a larger patient population.In this retrospective analysis, we found that spontaneous hyperventilation was common and that its severity was associated with the functional outcome in cerebellar hemorrhage patients. As little attention has been paid to the manifestation of this clinical characteristic in spontaneous cerebellar hemorrhage patients, it is important to present our initial findings for further investigation and ultimately improve the prognosis of such patients.