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PurposeThe purpose of this study is to examine the direct and indirect effects of organizational culture and quality improvement practices on the relationship between green practices and sustainability performances by using the structural equation modeling (SEM) approach.Design/methodology/approachStructured questionnaires were used to collect data from 330 full-time managerial employees in established businesses. The relationships depicted in the proposed conceptual model were tested through six hypotheses. IBM SPSS Statistics and SEM-AMOS were used to test the hypotheses.FindingsThe results supported proposed relationships in the model, except the one between organizational culture and green practices. The findings indicate that the more employees are aware of companies’ green practices, the more likely they are going to feel positive about the sustainability performance of the organization. Additionally, a strong organizational culture that supports the green movement and quality improvement practices lead to positive sustainability outcomes.Research limitations/implicationsA larger sample size in several major industries would allow the development of industry-specific sustainability strategies and best practices. In addition, a study based in a different geographical location in the USA or in a different country is recommended to see if the findings can be generalized across different industries, geographical locations or countries.Practical implicationsSustainability has undoubtedly become a major concern for many companies today. The findings of this study provide important guidelines for practitioners to balance the implementation of green practices, organizational culture, quality improvement practices and sustainability performance dimensions. Profitability and sustainability can be achieved together when companies are willing to continuously pay attention to environmental issues and strategically invest in initiatives that are cost-efficient and eco-friendly.Originality/valueThis study is one of the first that explores how organizational culture and quality improvement practices affect directly and indirectly the relationship between green practices and sustainability performance. The results imply that organizational culture and quality improvement practices significantly affect the relationship between green practices and the sustainability performance dimensions.

Late-onset asthma (LOA) differs from early-onset asthma (EOA) in terms of prognosis and the treatment response because it has a much worse prognosis and a poorer response to standard asthma treatment. This study sought to investigate the characteristics and clinical outcomes of asthma patients with phenotypes distinguished by age at onset and atopy status. We prospectively recruited patients with asthma who were registered in a pay-for-performance program operated by Taiwan’s National Health Insurance Administration (NHIA). These patients received regular outpatient treatment for at least 1 year at every outpatient clinic visit since 2019. Baseline characteristics and clinical outcomes were compared between patients with LOA (≥40 years) and those with EOA (

A desirable photographic reproduction method should have the ability to compress high-dynamic-range images to low-dynamic-range displays that faithfully preserve all visual information. However, during the compression process, most reproduction methods face challenges in striking a balance between maintaining global contrast and retaining majority of local details in a real-world scene. To address this problem, this study proposes a new photographic reproduction method that can smoothly take global and local features into account. First, a highlight/shadow region detection scheme is used to obtain prior information to generate a weight map. Second, a mutually hybrid histogram analysis is performed to extract global/local features in parallel. Third, we propose a feature fusion scheme to construct the virtual combined histogram, which is achieved by adaptively fusing global/local features through the use of Gaussian mixtures according to the weight map. Finally, the virtual combined histogram is used to formulate the pixel-wise mapping function. As both global and local features are simultaneously considered, the output image has a natural and visually pleasing appearance. The experimental results demonstrated the effectiveness of the proposed method and the superiority over other seven state-of-the-art methods.

Peritoneal dialysis (PD) is an important treatment method for patients with end stage renal disease. Since its introduction in 1975, clinical studies have shown that PD can improve patient survival, retain residual renal function, and lower the risk of infection. It can also reduce financial stress in the growing population with end stage renal disease. However, PD has limitations, mainly technique failures. Of these, catheterrelated infection is a major cause of catheter failure in PD. We reviewed the medical records of 986 PD patients from 2008 to 2018 at our hospital. The patients with intractable tunnel and exit site infection received exteriorization of the outer cuff and cuff shaving. The favourable outcomes observed recommend this treatment for PD patients whose catheter infection is not well controlled.

In the present work, we explored an economically feasible and environmentally friendly attempt to achieve tunable wettability of ceramic carbon substrates applicable in water splitting devices. It was found that by rationally controlling the surface functional groups, ceramic carbon substrates with different surface hydrophilicities, electroactive surface areas, and electrochemical behaviors could be achieved. Particularly, a hydrophilic ceramic carbon electrode (CCE) was obtained by using tetramethoxysilane as the modifier, which allowed uniform anchoring of an amorphous molybdenum sulfide (MoSx) hydrogen evolution electrocatalyst on its surface through a simple chemical vapor deposition method. The optimized CCE/MoSx exhibited promising hydrogen evolution reaction activity and good stability, with a small onset overpotential (∼250 mV) and a low Tafel slope (58 mV dec−1). The CCE/MoSx catalyst also showed reasonable stability under acidic conditions. Such promising electrochemical performance has been attributed to the strong chemical and electronic coupling between the conducting CCE and MoSx. This work paves a new way for the rational design and fabrication of an efficient composite electrode by selecting ceramic carbon as a durable high-conductivity substrate and the collaborative optimization of the catalyst and the substrate to achieve higher hydrogen evolution performance.

COVID-19 is a global pandemic infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The herbal formula, Ping An Fang Yu Yin (PAFYY), has been used to prevent respiratory viral infections for many years. This study aims to evaluate the effect of PAFYY on SARS-CoV-2 infection, oxidative stress, and inflammation via in vitro, investigate the chemical composition by full constituent quantitative analysis, and verify its anti-viral potential against SARS-CoV-2 using in silico. In this study, a total of eleven compounds, twenty amino acids, saccharide compositions, and trace elements were found and quantitatively determined by chromatographic techniques. PAFYY displayed free radical scavenging activity (DPPH, SC50: 1.24 ± 0.09 mg/mL), SOD activity (68.71 ± 1.28%), inhibition of lipoxygenase activity (75.96 ± 7.64 mg/mL) and interfered the interaction of SARS-CoV-2 spike protein and angiotensin-converting enzyme 2 (48.04 ± 3.18%). Furthermore, in-silico analysis results supported that liquiritin, 3,5-dicaffeoylquinic acid, and luteolin-7-O-glucoside with the highest affinity between SARS-CoV-2 RBD and human angiotensin-converting enzyme II (hACE2) receptor. Our findings suggest that PAFYY has the potential for anti-SARS-CoV-2 infection, anti-oxidation stress, and anti-inflammation, and may be used as supplements for amelioration or prevention of COVID-19 symptoms, as well as the representative compounds can be used for quality control of PAFYY in the future.

Background: Gut microbiota is thought to regulate immune homeostasis. The association between gut microbiota and the development of systemic lupus erythematosus remains unclear. This study aims to investigate the differential alteration of gut microbiota after the induction of lupus in a murine model with viral peptide of human cytomegalovirus (HCMV), which is an established murine model of induced lupus. Results: Specifically, we injected HCMVpp65 peptide in peritoneal space in NZB/W F1 mice to induce lupus. Three arms of animal treatment were prepared: intraperitoneal injection of HCMVpp65 peptide, intraperitoneal injection of adjuvant alone, and none injected. Feces of the study animals were collected before and every two weeks after the lupus induction for 16S rRNA sequencing. At 24 weeks of age, pathological investigation of renal tissue from sacrificed mice was conducted. Statistical analysis for dynamics and alteration of the fecal microbiota and lupus-like-activity-related functional prediction of bacterial communities was performed. HCMVpp65 peptide immunization induced lupus-like activities, with a higher level of anti-dsDNA antibodies, creatinine and proteinuria, and severe glomerular damage, compared to the mice treated with none or adjuvant only. A higher Simpson diversity value was measured in mice with injection of HCMVpp65 peptide than those with injection of adjuvant or none, but there have no difference in the species richness estimates, ACE and Chao1. Statistical Analysis of Metagenomic Profiles (STAMP) showed a higher relative abundance of the family (Saccharimonadaceae, Marinifiaceae, and Desulfovibrionaceae) and genera (Candidatus Saccharimonas, Roseburia, Odoribacter, and Desulfovibrio) that were found in HCMVpp65 peptide treated mice, compared to mice injected with adjuvant or none. The predicted metagenomic taxonomic profile showed statistically significant enrichment of flagellar assembly, bacterial motility, and chemotaxis. Conclusion: A significant correlation between increased related genera abundance (Candidatus Saccharimonas, Roseburia, Odoribacter, and Desulfovibrio) and HCMVpp65 peptide immunization induced lupus-like activities was observed. This study confirmed significant changes in gut microbiota after the onset of lupus in a murine animal model.

A fully inkjet-printed strain sensor based on carbon nanotubes (CNTs) was fabricated in this study for microstrain and microcrack detection. Carbon nanotubes and silver films were used as the sensing layer and conductive layer, respectively. Inkjet-printed CNTs easily undergo agglomeration due to van der Waals forces between CNTs, resulting in uneven films. The uniformity of CNT film affects the electrical and mechanical properties. Multi-pass printing and pattern rotation provided precise quantities of sensing materials, enabling the realization of uniform CNT films and stable resistance. Three strain sensors printed eight-layer CNT film by unidirectional printing, rotated by 180&deg, and 90&deg, were compared. The low density on one side of eight-layer CNT film by unidirectional printing results in more disconnection and poor connectivity with the silver film, thereby, significantly increasing the resistance. For 180&deg, rotation eight-layer strain sensors, lower sensitivity and smaller measured range were found because strain was applied to the uneven CNT film resulting in non-uniform strain distribution. Lower resistance and better strain sensitivity was obtained for eight-layer strain sensor with 90&deg, rotation because of uniform film. Given the uniform surface morphology and saturated sheet resistance of the 20-layer CNT film, the strain performance of the 20-layer CNT strain sensor was also examined. Excluding the permanent destruction of the first strain, 0.76% and 1.05% responses were obtained for the 8- and 20-layer strain sensors under strain between 0% and 3128 &micro, &epsilon, respectively, which demonstrates the high reproducibility and recoverability of the sensor. The gauge factor (GF) of 20-layer strain sensor was found to be 2.77 under strain from 71 to 3128 &micro, which is higher than eight-layer strain sensor (GF = 1.93) due to the uniform surface morphology and stable resistance. The strain sensors exhibited a highly linear and reversible behavior under strain of 71 to 3128 &micro, so that the microstrain level could be clearly distinguished. The technology of the fully inkjet-printed CNT-based microstrain sensor provides high reproducibility, stability, and rapid hardness detection.

Sarcandra glabra (Thunb.) Nakai (Chloranthaceae) is a medicinal plant used as herbal tea or food supplement to promote human health. We isolated 14 phenolic compounds from the n-butanol fraction of S. glabra and investigated their anti-inflammatory potential using lipopolysaccharide (LPS)-activated RAW264.7 macrophages. We demonstrated that methyl isorinate, a previously uncharacterized compound in S. glabra, is able to suppress NF-κB activation and reduce the expression of iNOS and COX-2 as well as the phosphorylation of IκB in LPS-treated RAW264.7 cells. In addition, the production of two inflammatory cytokines (IL-6 and TNF-α), as well as release of reactive oxygen species, in the LPS-stimulated macrophages was also inhibited by this compound. Furthermore, the structure-activity relationships of all of the isolated phenolic compounds present were analyzed. Overall, this study revealed several anti-inflammatory compounds that were present in S. glabra, and the results suggest that these diverse phenolic compounds are associated with the anti-inflammatory effects of S. glabra.

Background:Systemic lupus erythematosus (SLE) is a multifactorial disease. Gut microbiota is an important environmental factor for SLE1. The perturbation of gut microbiota is often observed at onset or during the disease course. The fragment of HCMV phosphoprotein 65422-439(HCMVpp65422-439) containing B cell epitopes has been reported to elicit humoral immunity and accelerate the autoimmune response in murine lupus2,3. However, little is there to know about the interplay between viral trigger for SLE and the change of gut microbiota during lupus progression.Objectives:By using a murine lupus model with NZB/W F1, we investigated the differential alteration in gut microbiota associated with the progression of lupus disease in HCMVpp65422-439immunized mice and control mice.Methods:Ten weeks-old NZB/W F1 mice were given or not given an intraperitoneal injection of 100-μg HCMVpp65422-439peptide biweekly for four times. Fecal samples, urine and blood of mice were collected once every two weeks followed by 16S rRNA genes sequencing and ELISA tests. The pathological investigation of renal tissue from sacrificed mice was conducted at 24 weeks of mice age. Statistical analysis for dynamics and alteration of the gut microbiota as well as functional prediction of bacterial communities related to the progression of lupus-like activity was performed.Results:HCMVpp65422-439immunization results in the onset of lupus-like activities in NZB/W F1 mice with a higher titer of anti-dsDNA antibody, creatinine and proteinuria, and severe glomerular damage (figure 1). Also, higher diversity and increased family abundance of several bacterial species were observed in HCMVpp65422-439immunized mice (Table 1 and Figure 2a). The predicted metagenomic taxonomic profile in NZB/W F1 mice showed statistically significant enrichment of flagellar assembly, bacterial motility, and chemotaxis (Figure 2b). Spearman’s correlation analysis revealed that a significant association between the increased relative family abundance forSaccharimonadaceae, Marinifilaceae, Desulfovibrionaceae,andRikenellaceaeand HCMVpp65422-439induced lupus-like activity in NZB/W F1 mice (Figure 2c).Table 1.Significant test of microbial community structure between two groupsMRPPAdonisAnosimGroupsE-ΔPR2PRPPre-disease vs. Control0.430.10.770.110.112Pre-disease vs. HCMVpp65422-4390.520.0070.550.0090.970.01Control vs. HCMVpp65422-4390.450.0130.350.0140.580.019Conclusion:Our results demonstrated that HCMVpp65422-439immunization induced the change in gut microbiota composition and suggested the association of gut microbiota alteration with lupus-like activity in NZB/W F1 mice.References:[1]Azzouz D, Omarbekova A, Heguy A, Schwudke D, Gisch N, Rovin BH, et al. Lupus nephritis is linked to disease-activity associated expansions and immunity to a gut commensal. Ann Rheum Dis. 2019;78(7):947-56.[2]Sebastiani GD, Iuliano A, Canofari C, and Bracci M. Cytomegalovirus infection in Systemic Lupus Erythematosus: report of four cases challenging the management of the disease, and literature review. Lupus. 2019;28(3):432-7.[3]HoHsieh A, Wang CM, Wu YJ, Chen A, Chang MI, and Chen JY. B cell epitope of human cytomegalovirus phosphoprotein 65 (HCMV pp65) induced anti-dsDNA antibody in BALB/c mice. Arthritis Res Ther. 2017;19(1):65Disclosure of Interests: :None declared

Flavonoids, widely present in medicinal plants and fruits, are known to exhibit multiple pharmacological activities. In this study, we isolated a flavonoid compound, pilloin, from Aquilaria sinensis and investigated its anti-inflammatory activity in bacterial lipopolysaccharide-induced RAW 264.7 macrophages and septic mice. Pilloin inhibited NF-&kappa, B activation and reduced the phosphorylation of I&kappa, B in LPS-stimulated macrophages. Moreover, pilloin significantly suppressed the production of pro-inflammatory molecules, such as TNF-&alpha, IL-6, COX-2 and iNOS, in LPS-treated RAW 264.7 macrophages. Additionally, pilloin suppressed LPS-induced morphological alterations, phagocytic activity and ROS elevation in RAW 264.7 macrophages. The mitogen-activated protein kinase-mediated signalling pathways (including JNK, ERK, p38) were also inhibited by pilloin. Furthermore, pilloin reduced serum levels of TNF-&alpha, (from 123.3 &plusmn, 7 to 46.6 &plusmn, 5.4 ng/mL) and IL-6 levels (from 1.4 &plusmn, 0.1 to 0.7 &plusmn, 0.1 ng/mL) in multiple organs of LPS-induced septic mice (liver: from 71.8 &plusmn, 3.2 to 36.7 &plusmn, 4.3, lung: from 118.6 &plusmn, 10.6 to 75.8 &plusmn, 11.9, spleen: from 185.9 &plusmn, 23.4 to 109.6 &plusmn, 18.4, kidney: from 160.3 &plusmn, 11.8 to 75 &plusmn, 10.8 pg/mL). In summary, our results demonstrate the anti-inflammatory potential of pilloin and reveal its underlying molecular mechanism of action.

Two new acylphloroglucinol derivatives, 13,14-didehydroxygarcicowin C (1) and 13,14-didehydroxyisoxanthochymol (2), have been isolated from the stems of Garcinia multiflora, together with seven known compounds (3–9). The structures of new compounds 1 and 2 were elucidated by MS and extensive 1D/2D NMR spectroscopic analyses. Among the isolates, 13,14-didehydroxy-isoxanthochymol (2) and sampsonione B (3) exhibited inhibition against lipopolysaccharide (LPS)-induced NF-κB activation in macrophages at 30 μM with relative luciferase activity values (inhibitory %) of 0.75 ± 0.03 (24 ± 4%) and 0.12 ± 0.03 (88 ± 4%), respectively. Additionally, sampsonione B (3) reduced LPS-induced nitric oxide (NO) production in murine RAW264.7 macrophages and did not induce cytotoxicity against RAW 264.7 cells after 24 h treatment. Compound 3 is worth further investigation and may be expectantly developed as an anti-inflammatory drug candidate.

Background Pregnancy involves adaptation to the immune system to prevent rejection of the foetus and this might have consequences on the activity of the rheumatoid arthritis (RA). Equally the aberrant immunity and disease activity of the RA might influence the pregnancy and foetal-neonatal outcomes. Objectives This study was designed to estimate the risk of adverse foetal-neonatal and maternal outcomes in pregnancies in women with RA. Methods We identified 2,350,339 singleton pregnancies using the Taiwan National Health Insurance database and birth registry between 2001 and 2012. Maternal history of RA, SLE, Sjogren’s syndrome, systemic sclerosis, vasculitis and poly/dermatomyositis were ascertained; among them, 845 individuals had RA. Odds ratios (ORs) and 95% confidence intervals (CIs) for pregnancy outcomes were estimated using an adjusted generalised estimating equation model. Results Pregnancies in women with RA were associated with an OR (95% CI) of 1.65 (1.37–1.98) for low birthweight ( Conclusions Pregnancies in women with RA were at a higher risk for multiple adverse foetal-neonatal outcomes, especially low birthweight ( References [1] Michet CJ Jr, McKenna CH, Elveback LR, Kaslow RA, Kurland LT. Epidemiology of systemic lupus erythematosus and other connective tissue diseases in Rochester, Minnesota, 1950 through 1979. Mayo Clin Proc1985;60(2):105–113. [2] Chiu YM, Lai CH. Nationwide population-based epidemiologic study of systemic lupus erythematosus in Taiwan. Lupus2010;19(10):1250–1255. [3] Rees F, Doherty M, Grainge M, Davenport G, Lanyon P, Zhang W. The incidence and prevalence of systemic lupus erythematosus in the UK, 1999–2012. Ann Rheum Dis2016;75(1):136–141. [4] See LC, Kuo CF, Chou IJ, Chiou MJ, Yu KH. Sex- and age-specific incidence of autoimmune rheumatic diseases in the Chinese population: A Taiwan population-based study. Semin Arthritis Rheum2013;43(3):381–386. [5] Cutolo M, Matucci-Cerinic M, Lockshin M, Ostensen M. Introduction: New trends in pregnancy and rheumatic diseases. Rheumatology (Oxford)2008;47(Suppl 3):iii1. Acknowledgements The authors would like to thank Centre for Big Data Analytics and Statistics in Chang Gung Memorial Hospital for statistical consultation. The sponsors of the study had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Disclosure of Interest None declared

Background Systemic antibiotics are a major cause of severe cutaneous adverse reactions (SCARs). The selection of alternative antibiotics and management for SCARs patients with underlying infections can be challenging. Methods We retrospectively analyzed 74 cases of SCARs, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug rash with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP), related to use of systemic antibiotics in Taiwan from January 2006 to January 2012. We analyzed the causative antibiotics, clinical features, organ involvements, and mortality. We also assessed patient tolerability to alternative antibiotics after the development of antibiotic-related SCARs. Results The most common causes of SCARs were penicillins and cephalosporins for SJS/TEN and AGEP; glycopeptides for DRESS. Fatality was more frequent in the SJS/TEN group. In patients with SJS/TEN, higher mortality was associated with old age and underlying sepsis before the development of SCARs. The majority of patients with penicillin- or cephalosporin-related SCARs were able to tolerate quinolones, glycopeptides, and carbapenems. Conclusions Complicated underlying conditions and infections may increase mortality in patients with antibiotic-related SCARs. The selection of structurally different alternative drugs is important to avoid recurrence.

Five new compounds, 9-O-angeloyl-8,10-dehydrothymol (1), 9-(3-methylbutanoyl)-8,10-dehydrothymol (2), eupatobenzofuran (3), 2-hydroxy-2,6-dimethylbenzofuran-3(2H)-one (4), and 1-(2-hydroxy-4-methylphenyl)propan-1,2-dione (5), have been isolated from the aerial part of Eupatorium cannabinum subsp. asiaticum, together with 16 known compounds (6-21). Compounds 6-8, 11, 13, and 15 exhibited inhibition (IC50 values≤18.4 μM) of superoxide anion generation by human neutrophils in response to formyl-L-methionyl-L-leucyl-L-phenylalanine/cytochalasin B (fMLP/CB). Compounds 2, 3, 10, 13, and 15 inhibited fMLP/CB-induced elastase release with IC50 values≤18.3 μM.