INTRODUCTION: Antenatal exercise can reduce gestational weight gain, backache; pregnancy induced medical disorders, caesarean section rates, and improves pregnancy outcomes. American College of Obstetrics and Gynecology (ACOG) recommends prenatal exercise, which is associated with minimal risk and has been shown to be beneficial for pregnancy outcomes, although some exercise routines may need to be modified. Consequently, this meta-analysis is intended to verify the pooled practice of antenatal exercise in Africa using available primary articles. METHODS: Genuine search of the research articles was done via PubMed, Scopes, Cochrane library, the Web of Science; free Google databases search engines, Google Scholar, and Science Direct databases. Published and unpublished articles were searched and screened for inclusion in the final analysis and Studies without sound methodologies, and review and meta-analysis were not included in this analysis. The Newcastle-Ottawa scale was used to assess the risk of bias. If heterogeneity exceeded 40%, the random effect method was used; otherwise, the fixed-effect method was used. Meta-analysis was conducted using STATA version 14.0 software. Publication bias was checked by funnel plot and Egger test. RESULTS: This review analyzed data from 2880 women on antenatal care contact from different primary studies. The overall pooled effect estimate of antenatal exercise in Africa was 34.50(32.63-36.37). In the subgroup analysis for pooled antenatal exercise practice by country, it was 34.24 (31.41-37.08) in Ethiopia and 37.64(34.63-40.65) in Nigeria. CONCLUSION: The overall pooled effect estimate of antenatal exercise in Africa was low compared to other continent. As it was recommended by ACOG antenatal exercise to every patient in the absence of contraindications, it should be encouraged by professionals providing antenatal care service.

BACKGROUND: Autism is a normal part of cognitive diversity, resulting in communication and sensory processing differences, which can become disabling in a neurotypical world. Autistic people have an increased likelihood of physical and mental co-occurring conditions and die earlier than neurotypical peers. Inaccessible healthcare may contribute to this. Autism Health Passports (AHPs) are paper-based or digital tools which can be used to describe healthcare accessibility needs; they are recommended in UK clinical guidance. However, questions remained as to the theoretical underpinnings and effectiveness of AHPs. METHODS: We undertook a systematic literature search identifying studies focused on AHPs for adults (aged over 16 years) from five databases. Included literature was subjected to realist evaluation. Data were extracted using a standardised form, developed by the research team, which considered research design, study quality for realist review and the Context, Mechanisms and Outcomes (CMOs) associated with each AHP tool. FINDINGS: 162 unique records were identified, and 13 items were included in the review. Only one item was considered high quality. Contextual factors focused on the inaccessibility of healthcare to Autistic patients and staff lack of confidence and training in supporting Autistic needs. Interventions were heterogeneous, with most sources reporting few details as to how they had been developed. The most frequently included contents were communication preferences. Mechanisms were often not stated or were inferred by the reviewers and lacked specificity. Outcomes were included in four studies and were primarily focused on AHP uptake, rather than Outcomes which measured impact. CONCLUSION: There is insufficient evidence to conclude that AHPs reduce the health inequalities experienced by Autistic people. Using an AHP tool alone in a healthcare Context that does not meet Autistic needs, without the inclusion of the local Autistic community developing the tool, and a wider intervention to reduce known barriers to health inequality, may mean that AHPs do not trigger any Mechanisms, and thus cannot affect Outcomes.

Extracellular vesicles (EVs) (exossomes, microvesicles and apoptotic bodies) have been well acknowledged as mediators of intercellular communications in prokaryotes and eukaryotes. Lipids are essential molecular components of EVs but at the moment the knowledge about the lipid composition and the function of lipids in EVs is limited and as for now none lipidomic studies in Giardia EVs was described. Therefore, the focus of the current study was to conduct, for the first time, the characterization of the polar lipidome, namely phospholipid and sphingolipid profiles of G. lamblia trophozoites, microvesicles (MVs) and exosomes, using C18-Liquid Chromatography-Mass Spectrometry (C18-LC-MS) and Tandem Mass Spectrometry (MS/MS). A total of 162 lipid species were identified and semi-quantified, in the trophozoites, or in the MVs and exosomes belonging to 8 lipid classes, including the phospholipid classes phosphatidylcholine (PC), phosphatidylethanolamine (PE), phosphatidylglycerol (PG), phosphatidylinositol (PI), cardiolipins (CL), the sphingolipid classes sphingomyelin (SM) and ceramides (Cer), and cholesterol (ST), and 3 lipid subclasses that include lyso PC (LPC), lyso PE (LPE) and lyso PG (LPG), but showing different abundances. This work also identified, for the first time, in G. lamblia trophozoites, the lipid classes CL, Cer and ST and subclasses of LPC, LPE and LPG. Univariate and multivariate analysis showed clear discrimination of lipid profiles between trophozoite, exosomes and MVs. The principal component analysis (PCA) plot of the lipidomics dataset showed clear discrimination between the three groups. Future studies focused on the composition and functional properties of Giardia EVs may prove crucial to understand the role of lipids in host-parasite communication, and to identify new targets that could be exploited to develop novel classes of drugs to treat giardiasis.

Diet is a contributor to the pathogenesis of many non-communicable diseases. Among contributors to poor diet is high added sugar consumption, which is unfortunately on the rise nowadays. The recommended sugar intake by The American Heart Association (AHA) is 24g/day and 36g/day for women and men, respectively. The study's aim is to assess added sugar intake among adults in Saudi Arabia. A cross-sectional study design was used via an online survey among adults in Saudi Arabia using convenience sampling, and social media platforms were used to collect the data. The authors conducted descriptive statistics to present demographic variables using Chi-square χ2 tests for categorical and t-tests for continuous variables. All statistical tests used a 95% confidence interval with a two-sided P-value <0.05 as significance level. A total of 1163 respondents were included in the study. The study has shown an overall added sugar intake average of 73 g/day. There was a significant difference in means of overall added sugar intake across genders for the age group 18-30 and the age group >60. Equivalently, there was a statistically significant difference in means of added sugar intake food across gender (P-value 0.008). Females tended to consume more added sugar in their food than males. The highest consumption was in the Northern region (123.71 g/day), followed by the Southern region (98.52 g/day), the Western region (86.14 g/day), and lastly, the Central and Eastern regions (66.95 and 62.02 g/day, respectively). The total added sugar intake of added sugar is extremely high in Saudi Arabia. Poor dietary habits lead to many adverse health consequences, including obesity and diabetes. Healthcare providers and public health officials are highly encouraged to shed light on added sugar consumption and create opportunities to promote healthy dietary patterns. The Saudi population is recommended to abide by the added sugar dietary recommendations to avoid future chronic medical conditions.

The ability of governments and nations to handle crises and protect the lives of citizens is heavily dependent on the public's trust in their governments and related social institutions. The aim of the present research was to understand public trust in government during a time of crisis, drawing on interview data (N = 56) collected during the COVID-19 pandemic (2021). In addition to the general public (n = 11), participants were sampled to obtain diversity as it relates to identifying as First Nations, Métis, and Inuit (n = 7), LGBT2SQ+ (n = 5), low-income (n = 8), Black Canadians (n = 7), young adult (n = 8), and newcomers to Canada (n = 10). Data were coded in consideration of social theories of trust, and specifically the nature of trust between individuals and institutions working with government in pandemic management. Canadians' trust in government was shaped by perceptions of pandemic communication, as well as decision-making and implementation of countermeasures. Data suggest that although participants did not trust government, they were accepting of measures and messages as presented through government channels, pointing to the importance of (re)building trust in government. Perhaps more importantly however, data indicate that resources should be invested in monitoring and evaluating public perception of individuals and institutions generating the evidence-base used to guide government communication and decision-making to ensure trust is maintained. Theoretically, our work adds to our understanding of the nature of trust as it relates to the association between interpersonal and institutional trust, and also the nature of trust across institutions.

Polyalanine (polyA) disease-causative proteins with an expansion of alanine repeats can be aggregated. Although curative treatments for polyA diseases have not been explored, the dissociation of polyA aggregates likely reduces the cytotoxicity of polyA. Mid-infrared free electron laser (FEL) successfully dissociated multiple aggregates. However, whether the FEL dissociates polyA aggregates like other aggregates has not been tested. Here, we show that FEL at 6.1 μm experimentally weakened the extent of aggregation of a peptide with 13 alanine repeats (13A), and the irradiated 13A exerted lesser cytotoxicity to neuron-like cells than non-irradiated 13A. Then, we applied molecular dynamics (MD) simulation to follow the dissociation process by FEL. We successfully observed how the intermolecular β-sheet of polyA aggregates was dissociated and separated into monomers with helix structures upon FEL irradiation. After the dissociation by FEL, water molecules inhibited the reformation of polyA aggregates. We recently verified the same dissociation process using FEL-treated amyloid-β aggregates. Thus, a common mechanism underlies the dissociation of different protein aggregates that cause different diseases, polyA disease and Alzheimer's disease. However, MD simulation indicated that polyA aggregates are less easily dissociated than amyloid-β aggregates and require longer laser irradiation due to hydrophobic alanine repeats.

AIM: The aim of this literature review was to identify, summarize, and critically appraise available empirical articles on the knowledge, attitudes, and practices towards childhood fever management among South-East and East Asian parents. DESIGN: A literature review following PRISMA. METHODS: Articles were limited to those available in the English language. Articles had to be empirical studies that used a qualitative or quantitative research design with full-text available; focus on parental knowledge, attitudes, and practices towards fever; and be published in South-East and East Asia. Searches were conducted with CINAHL, PubMed and Scopus from inception to June 2022, and eleven articles were included after removing duplicates and excluding irrelevant articles. RESULTS: Narrative synthesis was conducted according to four themes: source of fever information, knowledge level, attitudes, and practices towards childhood fever. Parents showed different fever knowledge needs and various information-seeking behaviors. A low level of fever knowledge was revealed in terms of temperature, fever causes, potential harms and influencing factors. South-East and East Asian parents mainly reported anxiety, concerns and fever phobia. Fever assessment methods and fever management strategies varied based on parents' cultural background and beliefs. CONCLUSIONS: The findings of this review highlight that inadequacy of fever knowledge and negative attitudes towards childhood fever exist in South-East and East Asian parents. Parents have diverse cultural practices during their children's febrile episodes. However, some of them conflict with current medical guidelines, as they prioritize fever and body temperature reduction. This raises questions about their effectiveness and safety. Although some of them are medically discouraged, there are others that have been proven beneficial for the symptomatic relief of childhood fever. The results indicate an urgent need to develop a cultural-sensitive educational intervention for childhood fever management among South-East and East Asian parents. Unified educational interventions are needed to address parental concerns and fever-related knowledge needs.

Recreational angling is a very popular outdoor activity that is weather-dependent, although investigations of this relationship are rare. This study used weekly fishing effort (2015-2021) estimates throughout coastal Louisiana to understand how effort changed in response to weather conditions. Although we found evidence for some effect of all the weather variables, temperature reported the greatest number of monthly effects, along with an overall declining effect throughout the year. We also examined how tropical storms and hurricanes reduce fishing effort, but that effort recovers rapidly after the storm. Finally, we examined fishing effort during the first year of the pandemic (2020) compared to previous years and found some monthly increases exceeding 100% of normal effort. Understanding angler motivations remains an important part of fishery management, and in a future with changes to weather, hurricanes, and global health crises, we can now know more about how environmental factors change angling effort.

Extreme acidophiles thrive in harsh environments characterized by acidic pH, high concentrations of dissolved metals and high osmolarity. Most of these microorganisms are chemolithoautotrophs that obtain energy from low redox potential sources, such as the oxidation of ferrous ions. Under these conditions, the mechanisms that maintain homeostasis of proteins (proteostasis), as the main organic components of the cells, are of utmost importance. Thus, the analysis of protein chaperones is critical for understanding how these organisms deal with proteostasis under such environmental conditions. In this work, using a bioinformatics approach, we performed a comparative genomic analysis of the genes encoding classical, periplasmic and stress chaperones, and the protease systems. The analysis included 35 genomes from iron- or sulfur-oxidizing autotrophic, heterotrophic, and mixotrophic acidophilic bacteria. The results showed that classical ATP-dependent chaperones, mostly folding chaperones, are widely distributed, although they are sub-represented in some groups. Acidophilic bacteria showed redundancy of genes coding for the ATP-independent holdase chaperones RidA and Hsp20. In addition, a systematically high redundancy of genes encoding periplasmic chaperones like HtrA and YidC was also detected. In the same way, the proteolytic ATPase complexes ClpPX and Lon presented redundancy and broad distribution. The presence of genes that encoded protein variants was noticeable. In addition, genes for chaperones and protease systems were clustered within the genomes, suggesting common regulation of these activities. Finally, some genes were differentially distributed between bacteria as a function of the autotrophic or heterotrophic character of their metabolism. These results suggest that acidophiles possess an abundant and flexible proteostasis network that protects proteins in organisms living in energy-limiting and extreme environmental conditions. Therefore, our results provide a means for understanding the diversity and significance of proteostasis mechanisms in extreme acidophilic bacteria.

Interleukin-6 (IL-6) is a pleiotropic cytokine that coordinates host immune responses to infection. Though essential to the acute phase response, prolonged IL-6-mediated recruitment of mononuclear cells has been implicated in chronic inflammatory diseases such as rheumatoid arthritis, psoriasis, and Crohn's disease. Accordingly, identifying novel therapeutics that diminish circulating IL-6 levels could benefit individuals suffering from chronic inflammation. In immunocompetent hosts, bacterial lipopolysaccharide (LPS) recognition by toll-like receptor 4 (TLR4) activates the transcription factor NF-κB, driving macrophage production of IL-6. Interestingly, both citrate-stabilized and 'green' synthesized gold nanoparticles (AuNPs) have been shown to modulate the cytokine responses of LPS-activated macrophages. Here we demonstrate that AuNPs, synthesized with commercial and locally sourced honey, downregulate LPS-induced macrophage secretion of IL-6. Compared to LPS-only controls, inhibition of IL-6 levels was observed for all three types of honey AuNPs. The effect was likely driven by honey AuNP-mediated perturbation of the TLR4/NF-κB signaling pathway, as evidenced by a reduction in the phosphorylation of IκB. Further investigation into the anti-inflammatory properties of honey AuNPs may yield novel therapeutics for the treatment of chronic inflammation.

Ineffective coping is a risk factor for burnout among physicians, in whom the prevalence of burnout is high and has also increased in recent years. We examined in a cross-sectional study whether physicians with burnout show different coping styles compared with healthy controls. Male physicians (n = 60) were recruited into two groups (burnout vs. healthy). The Coping Inventory for Stressful Situations (CISS) and the Maslach Burnout Inventory (MBI) were applied. Wilcoxon rank-sum test showed group differences in two of the three coping styles, task-oriented and emotion-oriented, and also in one of the two subscales of the avoidance-oriented coping: social-diversion-oriented coping. Multiple binomial logistic regression, controlling for age, showed that lower task-oriented coping (OR = 0.38 (0.13 - 0.93), p = 0.048, d = 0.534) and lower social-diversion-oriented coping (OR = 0.33 (0.11 - 0.80), p = 0.024, d = 0.611) significantly predicted the burnout group. The findings suggest that male physicians with burnout differ from healthy controls in terms of less frequent utilization of effective coping styles. These findings could be explored for their utility in preventing burnout in future studies.

Antimicrobial resistance is a great public health concern that is now described as a "silent pandemic". The global burden of antimicrobial resistance requires new antibacterial treatments, especially for the most challenging multidrug-resistant bacteria. There are various mechanisms by which bacteria develop antimicrobial resistance including expression of β-lactamase enzymes, overexpression of efflux pumps, reduced cell permeability through downregulation of porins required for β-lactam entry, or modifications in penicillin-binding proteins. Inactivation of the β-lactam antibiotics by β-lactamase enzymes is the most common mechanism of bacterial resistance to these agents. Although several effective small-molecule inhibitors of β-lactamases such as clavulanic acid and avibactam are clinically available, they act only on selected class A, C, and some class D enzymes. Currently, none of the clinically approved inhibitors can effectively inhibit Class B metallo-β-lactamases. Additionally, there is increased resistance to these inhibitors reported in several bacteria. The objective of this study is to use the Resonant Recognition Model (RRM), as a novel strategy to inhibit/modulate specific antimicrobial resistance targets. The RRM is a bio-physical approach that analyzes the distribution of energies of free electrons and posits that there is a significant correlation between the spectra of this energy distribution and related protein biological activity. In this study, we have used the RRM concept to evaluate the structure-function properties of a group of 22 β-lactamase proteins and designed 30-mer peptides with the desired RRM spectral periodicities (frequencies) to function as β-lactamase inhibitors. In contrast to the controls, our results indicate 100% inhibition of the class A β-lactamases from Escherichia coli and Enterobacter cloacae. Taken together, the RRM model can likely be utilized as a promising approach to design β-lactamase inhibitors for any specific class. This may open a new direction to combat antimicrobial resistance.

BACKGROUND: Almost 10% of the population develop depression or anxiety disorder during their lifetime. Considering that people who are exposed to high stress are more likely to develop mental disorders, it is important to detect and remove mental stress before depression or anxiety disorder develops. We aimed to develop an objective screening test that quantifies mental stress in workers so that they can recognize and remove it before the disorder develops. METHODS: We obtained urine specimens from 100 healthy volunteers (49 men and 51 women; age = 48.2 ± 10.8 years) after they received medical checks and answered the Brief Job Stress Questionnaire (BJSQ). Participants were divided into high- and low- stress groups according to their total BJSQ scores. We further analyzed six urinary neurotransmitters (dopamine, serotonin, 5-hydoroxyindoleacetic acid, gamma-aminobutyric acid, homovanillic acid, and vanillylmandelic acid) using liquid chromatography-mass spectrometry to compare their levels between the two groups. RESULTS: We obtained the concentrations of the six analytes from 100 examinees and revealed that the levels of urinary dopamine (p = 0.0042) and homovanillic acid (p = 0.020) were significantly lower in the high-stress group than those in the low-stress group. No biases were observed between the two groups in 36 laboratory items. The stress index generated from the six neurotransmitter concentrations recognized high-stress group significantly. Moreover, we discovered that the level of each urinary neurotransmitter changed depending on various stress factors, such as dissatisfaction, physical fatigue, stomach and intestine problems, poor appetite, poor working environments, sleep disturbance, isolation, worry, or insecurity. CONCLUSION: We revealed that urinary neurotransmitters could be a promising indicator to determine underlying mental stress. This study provides clues for scientists to develop a screening test not only for workers but also for patients with depression.

As a crucial component of internal corporate governance, remuneration controls possess the potential to influence the cash holdings of firms. However, identifying the causal relationship between these controls and such holdings presents a considerable challenge. To address this research gap, this paper leverages the implementation of China's Guidance on Further Regulating the Remuneration Management of Heads of Central Enterprises as a quasi-natural experiment to investigate the relationship between executive remuneration controls and firms' cash holdings, utilizing a double-difference approach. Based on an analysis of a sample of listed companies from 2007-2012, the results indicate that firms subject to regulated executive compensation exhibit lower cash holdings. To ensure the robustness of these findings, various statistical techniques such as parallel trend tests, variable replacement, propensity score matching, and placebo tests were employed. Additionally, a mechanism test was conducted, whereby the mediating effect of executive compensation controls on firms' cash holdings was examined, revealing a reduction in internal agency costs. Finally, the analysis of heterogeneity demonstrated that the impact of executive compensation controls on firms' cash holdings was more pronounced in companies with high-quality internal controls, stronger management oversight, and lower information asymmetry.

This study develops the Omega model integrated with momentum and reversal strategies using high-frequency data on the component stocks of the S&P 500 Index and the NASDAQ 100. The Omega model based on the momentum strategy (M_Omega), the reversal strategy (R_Omega), and both strategies (M_R_Omega) are designed to simulate trading over three periods. The portfolio is rebalanced every transaction day to optimize asset allocation by incorporating intraday winners or losers' information and trading cost. The study finds that the proposed models generate positive returns (net of trading costs), in spite of fact that intraday trading frequently erodes profits. The M_Omega and R_Omega models produce a higher return than that of the S&P 500 index or NASDAQ 100 index, considering the intraday trading cost. The performance of the Omega model integrated with the momentum or reversal strategy is more profitable in a volatile market or period. The M_Omega and R_Omega reach the highest final market value from 2020 to 2021, when COVID 19 pandemic emerged. The rebalancing of the momentum or reversal strategy is suitable for the short term but not recommended in the long term for intraday trading as the trading costs become increasingly significant over time.

COI1-mediated perception of jasmonate is critical for plant development and responses to environmental stresses. Monocots such as rice have two groups of COI genes due to gene duplication: OsCOI1a and OsCOI1b that are functionally equivalent to the dicotyledons COI1 and OsCOI2 whose function remains unclear. In order to assess the function of OsCOI2 and its functional redundancy with COI1 genes, we developed a series of rice mutants in the 3 genes OsCOI1a, OsCOI1b and OsCOI2 by CRISPR Cas9-mediated editing and characterized their phenotype and responses to jasmonate. Characterization of OsCOI2 uncovered its important roles in root, leaf and flower development. In particular, we show that crown root growth inhibition by jasmonate relies on OsCOI2 and not on OsCOI1a nor on OsCOI1b, revealing a major function for the non-canonical OsCOI2 in jasmonate-dependent control of rice root growth. Collectively, these results point to a specialized function of OsCOI2 in the regulation of plant development in rice and indicate that sub-functionalisation of jasmonate receptors has occurred in the monocot phylum.

For a transparent well with a known volume capacity, changes in fluid level result in predictable changes in magnification of an overhead light source. For a given well size and fluid, the relationship between volume and magnification can be calculated if the fluid's index of refraction is known or in a naive fashion with a calibration procedure. Light source magnification can be measured through a camera and processed using computer vision contour analysis with OpenCV. This principle was applied in the design of a 3D printable sensing device using a raspberry pi zero and a camera.

Some health concerns are often not identified until late into clinical development of drugs, which can place participants and patients at significant risk. For example, the United States Food and Drug Administration (FDA) labeled the xanthine oxidase inhibitor febuxostat with a"boxed" warning regarding an increased risk of cardiovascular death, and this safety risk was only identified during Phase 3b clinical trials after its approval. Thus, better preclinical assessment of drug efficacy and safety are needed to accurately evaluate candidate drug risk earlier in discovery and development. This study explored whether an in vitro vascular model incorporating human vascular cells and hemodynamics could be used to differentiate the potential cardiovascular risk associated with molecules that have similar on-target mechanisms of action. We compared the transcriptomic responses induced by febuxostat and other xanthine oxidase inhibitors to a database of 111 different compounds profiled in the human vascular model. Of the 111 compounds in the database, 107 are clinical-stage and 33 are FDA-labelled for increased cardiovascular risk. Febuxostat induces pathway-level regulation that has high similarity to the set of drugs FDA-labelled for increased cardiovascular risk. These results were replicated with a febuxostat analog, but not another structurally distinct xanthine oxidase inhibitor that does not confer cardiovascular risk. Together, these data suggest that the FDA warning for febuxostat stems from the chemical structure of the medication itself, rather than the target, xanthine oxidase. Importantly, these data indicate that cardiovascular risk can be evaluated in this in vitro human vascular model, which may facilitate understanding the drug candidate safety profile earlier in discovery and development.

The post-COVID-19 era presents a looming threat of global debt, elevating concerns regarding sovereign credit ratings worldwide. This study develops a new index system, divides the rating variables into long- and short-term factors, performs rating fitting and prediction, and investigates the fairness of China and relevant countries. Our findings reveal that sovereign credit ratings have a deterrent effect on the global financial market due to the ceiling effect and quasi-public goods characteristics. A high and stable credit rating demands long-term enhancements in economic fundamentals, budget balances, external surpluses, and overall solvency. Concurrently, effective short-term debt management strategies, including reduction, repayment, and swaps, are essential. Moreover, we introduce the concept of a "rating gap" to assess rating fairness, revealing both undervaluation and overvaluation among countries. Notably, China's sovereign rating was underestimated between 2009 and 2011 and overestimated between 2013 and 2016. These findings underscore the criticality of government vigilance in monitoring sovereign debt and credit ratings to navigate potential post-COVID-19 sovereign debt crises.

Spontaneous pneumothorax occurs predominantly in young males and older adults, often as a secondary condition, and can be refractory and fatal. This study aimed to investigate the mortality and prognostic factors for pneumothorax in older patients. We retrospectively cohort studied patients with pneumothorax aged ≥65 years who visited our department from October 2012 to January 2019. Data on sex, age, medical history, smoking history, underlying lung disease, treatment, and prognosis were extracted from medical records. Cox proportional hazards regression analysis was used to investigate pneumothorax mortality and prognostic factors. In total, 239 patients were included. Among them, 36 (15%) died during hospitalization. Respiratory disease was the direct cause of death in 30 patients (83.3%), and 211 (88.3%) patients had underlying lung disease. The incidence of pneumonia in our hospital was 22.6% (54 cases). On admission, the mortality rate was 33% (18/54) in patients with concomitant pneumonia; univariate analysis showed significant differences in the Charlson Comorbidity Index (CCI), activities of daily living (ADL), and concomitant pneumonia. In the Cox proportional hazards analysis of ADL (p = 0.09), CCI (p = 0.05), and concomitant pneumonia on admission (p = 0.02), concomitant pneumonia on admission was found to be an independent predictor of in-hospital mortality. This study suggests that concomitant pneumonia at admission may be a mortality risk factor for pneumothorax.