Advancing Open Science

Background: Central venous occlusive disease is a major challenge in hemodialysis patients who have exhausted conventional vascular access options and may lead to long-term dependence on tunneled central venous catheters. The Hemodialysis Reliable Outflow (HeRO) graft provides an alternative by bypassing obstructed central veins and enabling catheter-free upper-extremity vascular access. Case presentation: We report the first HeRO graft implantation in Lithuania in a 78-year-old woman with end-stage kidney disease and extensive central venous occlusive disease. Previous arteriovenous fistulas had failed because of thrombosis and severe venous hypertension, while prolonged catheter dependence was complicated by recurrent infections, dislodgements, and multiple catheter exchanges. The HeRO venous outflow component was implanted through the existing tunneled catheter access and positioned in the right atrium. It was connected to an early-cannulation expanded polytetrafluoroethylene graft anastomosed to the brachial artery. Completion fistulography demonstrated unobstructed flow through the system into the right atrium. The procedure was technically successful, and the graft was successfully cannulated for hemodialysis 24 h after implantation, avoiding the need for temporary catheter placement. Conclusions: The HeRO graft may provide a valuable catheter-sparing option for carefully selected hemodialysis patients with severe central venous occlusive disease and no feasible conventional upper-extremity access. This case demonstrates its technical feasibility in a complex vascular access setting and highlights the potential role of an early-cannulation graft when immediate catheter removal is necessary.

Obstructive sleep apnea (OSA) is highly relevant among professional drivers; however, self-reported symptoms may not reflect the objective disease burden. This cross-sectional study examined the relationship between subjective sleep complaints and the objectively measured OSA burden in 207 professional metropolitan public transport drivers undergoing respiratory polygraphy. Daytime sleepiness, insomnia symptoms, sleep quality, and OSA risk were assessed using the Epworth Sleepiness Scale (ESS), Athens Insomnia Scale (AIS), Pittsburgh Sleep Quality Index (PSQI), and STOP–BANG questionnaire. The objective OSA burden was assessed using the apnea–hypopnea index (AHI) and the sleep apnea-specific hypoxic burden (SASHB). Moderate-to-severe OSA (AHI ≥ 15 events/h) was identified in 65.2% of participants, whereas excessive daytime sleepiness was reported by only 2.4%. The ESS, AIS, and PSQI scores were correlated with one another but not with the AHI or SASHB. A model combining these subjective measures showed limited discrimination for moderate-to-severe OSA (area under the curve [AUC] = 0.533), whereas a model including age and body mass index (BMI) showed modest discrimination (AUC = 0.637), with BMI independently associated with the outcome. Subjective sleep complaints were poorly associated with the objectively measured OSA burden, supporting the use of clinical risk assessment and objective sleep evaluation when indicated.

Impact investing requires the assessment of social and environmental outcomes alongside financial returns, yet impact measurement remains methodologically fragmented and heterogeneous in purpose and use. This systematic review synthesizes the scholarly literature treating impact measurement as a central object of study within impact investing. Following PRISMA 2020 guidelines, records were identified through Scopus and Web of Science, screened at title/abstract and full-text stages, and appraised using design-specific quality criteria. The final corpus comprised 69 studies published between 2012 and 2026. Findings were synthesized narratively and complemented by descriptive bibliometric analysis. Four recurring themes emerged: persistent standardization efforts alongside methodological fragmentation; the growing role of ex-ante assessment; the organizational and relational functions of measurement; and contextual, institutional and organizational variation. The review further shows that impact measurement involves not only technical choices but also causal reasoning. Remaining evidence gaps concern the validation of ex-ante approaches, the use of impact information in actual investment decisions, external validation of measurement frameworks, and comparative evidence across institutional contexts.

Background/Objectives: Stenotrophomonas maltophilia is a common cause of lower respiratory tract infection (LRTI) in critically ill patients, but differences between ventilator-associated tracheobronchitis (VAT) and ventilator- or hospital-acquired pneumonia (VAP/HAP) remain unclear. We aimed to compare clinical outcomes between VAT and VAP/HAP and, secondarily, to explore antimicrobial treatment patterns and their association with treatment failure. Methods: We conducted a retrospective two-center cohort study of adults admitted to intensive care units (ICUs) in Madrid, Spain, between August 2021 and December 2025 with clinically significant S. maltophilia VAT, VAP, or HAP. The primary analysis included only the first (index) episode per patient. Results: Sixty-seven patients contributed 90 episodes. Among index episodes, therapeutic failure was more frequent in VAP/HAP than in VAT (40.6% vs. 14.3%; absolute risk difference, 26.3 percentage points; 95% confidence interval [CI], 5.0–45.2; p = 0.026). In a parsimonious Firth’s penalized logistic regression, VAP/HAP remained associated with therapeutic failure (adjusted odds ratio, 4.06; 95% CI, 1.32–14.25; p = 0.014). Results were consistent after adjustment for SOFA score at infection onset and when the analysis was restricted to VAP. ICU mortality was numerically higher in VAP/HAP (46.9% vs. 25.7%). In an exploratory Firth’s model, laboratory-reported in vitro active antimicrobial therapy was associated with lower odds of failure (adjusted odds ratio, 0.19; 95% CI, 0.05–0.72; p = 0.014); however, this exposure was susceptible to time-dependent bias, and empirical anti-S. maltophilia therapy, defined at treatment initiation, was not associated with failure (26.7% vs. 26.9%). Conclusions: The clinical and prognostic significance of respiratory S. maltophilia infection appears to differ by syndrome. VAP/HAP was associated with more therapeutic failure than VAT. The association between in vitro active therapy and lower failure was exploratory and requires confirmation, and no comparative effectiveness conclusions can be drawn for individual antimicrobial agents.

Acute lung injury (ALI) is a severe inflammatory pulmonary disorder with high morbidity and limited treatment options available in clinical settings. Mogrosides, natural products derived from Siraitia grosvenorii, have been shown to exhibit protective effects against ALI, but structural optimization of their aglycone moiety, mogrol, may provide opportunities to improve pharmacological efficacy. In this study, oxidized mogrol derivatives (MG-COOH and MG-CHO) were synthesized, and their anti-inflammatory activities were initially compared with those of natural mogrosides in lipopolysaccharide (LPS)-stimulated MH-S cells. MG-COOH exhibited pronounced anti-inflammatory activity and was designated for comprehensive analysis of its protective potential and underlying mechanisms in the LPS-induced ALI model. MG-COOH effectively alleviated LPS-induced injury in lung, decreased pro-inflammatory cytokine release, and reduced oxidative stress, showing a tendency toward greater efficacy relative to natural mogrosides at equimolar doses. Transcriptomic analysis indicated that MG-COOH modulated genes involved in the HIF-1, JAK-STAT, MAPK, PI3K-Akt, NF-κB, NOD-like receptor, and Toll-like receptor signaling pathways. Furthermore, MG-COOH reduced the expression of NLRP3, ASC, caspase-1, and IL-1β mRNA and protein in lung. In conclusion, the oxidized mogrol derivative MG-COOH exhibits pronounced anti-ALI activity, which is associated with reduced NLRP3 inflammasome-related inflammatory responses in the lung, which serves as a pivotal node in multiple inflammatory signaling cascades.

Two series of co-precipitated FeO_x@MO_y catalysts with variation of the second component (M = silica, alumina, ceria, zirconia) prepared using CTMABr or Pluronic 123 templates were investigated to assess the effect of the composition and synthesis in CO₂ hydrogenation reaction to C₂₊ hydrocarbons. Alumina- or silica-modified samples were prepared by the CTMABr-assisted route, and alumina-, silica-, ceria-, or zirconia-modified samples were obtained using Pluronic 123. All samples demonstrated uniform component distribution over the surface (by SEM–EDX) with a ratio close to the target value, and the predominant phase in most samples was maghemite with crystallite sizes reaching 17 nm (by XRD). All samples had a mostly mesoporous structure with a small amount of micropores. The highest catalytic activity was achieved for samples containing alumina and zirconia additives in the range of 25 to 50%. The decrease in zirconia content from 25 to 1 wt% did not affect the CO₂ conversion rate but led to a decrease in methane selectivity from 34 to 21%, while the C₂₊ selectivity remained constant 21%. The highest CO₂ conversion rates at 340 °C and 20 atm (12.3 and 12.9 mol(CO₂) × kg_cat⁻¹ × h⁻¹) were achieved with Fe¹/Al¹ P123 and Fe³/Zr¹ P123 samples. The highest C₂₊ selectivity (26%) at the same temperature and pressure was achieved for the monometallic Fe P123 sample, but its CO₂ conversion rate was 5.4 mol(CO₂) × kg_cat⁻¹ × h⁻¹.

This study examines the acoustic correlates of accentedness and comprehensibility in Cantonese checked syllables produced by Mandarin-speaking learners. Forty learners produced four checked syllables (luk6, cat1, baat3, and sap6), which were evaluated by native Cantonese listeners. Generalized additive mixed models (GAMMs) were used to examine potentially non-linear associations between listener ratings and acoustic measures of vowel quality, pitch contour, duration, and voice quality. Results show that while listener ratings of accentedness and comprehensibility were highly correlated, their acoustic correlates varied substantially across syllables. After correction for multiple comparisons, vowel duration was the only acoustic measure significantly associated with listener ratings, with effects observed for both perceptual dimensions in luk6 and baat3. For luk6, relatively prolonged realizations were associated with lower ratings on both perceptual dimensions, whereas for baat3, longer realizations were associated with higher ratings. No acoustic measure remained significant for cat1 or sap6. These findings suggest that the relationship between acoustic properties and listener evaluations of Cantonese checked syllables is strongly syllable-specific rather than governed by a common hierarchy of acoustic cues. More broadly, they highlight the importance of examining fine-grained acoustic–perceptual relationships at the level of individual phonological items in L2 tonal speech.

Rainfall-induced surface erosion of aeolian loess slopes in open-pit coal mines threatens slope stability and ecological reclamation, whereas conventional rigid protection and ordinary soil stabilizers can hardly reconcile soil reinforcement, impermeabilization, and vegetation compatibility. Here, poly(diallyldimethylammonium chloride) (PDADMAC) was compounded with nano-SiO₂, carboxymethyl cellulose, sodium bentonite, and sodium lignosulfonate into a modified PDADMAC-based composite (MPDC). An L₁₈(3⁷) orthogonal array optimized the mix proportion (0.80, 0.50, 0.15, 1.60, and 0.10 wt.% of dry soil for PDADMAC, nano-SiO₂, CMC, bentonite, and lignosulfonate, respectively), which was evaluated by shear and permeability tests, scanning electron microscopy, a 480 min rainfall test on a 38° slope model, and six-month field monitoring. The optimum mixture raised cohesion from 18.5 to 41.8 kPa and the friction angle from 26.8° to 32.7°, and cut saturated hydraulic conductivity by 74.3%. Under 480 min of rainfall, sediment loss and erosion ratio were 142.3 g m⁻² and 4.7%, i.e., 88.7% and 88.8% below untreated loess, and cumulative infiltration fell by 85.4%. After six months, the treated 0–5 cm layer retained 46.6 kPa cohesion and a 2.2% fissure ratio (versus 20.8%); after 48 h of scouring, soil loss and sliding area were only 5.3 kg m⁻² and 1.5 m² per 100 m², with Medicago sativa survival above 91.3%. MPDC thus couples soil reinforcement, seepage control, and ecological restoration.