German Red Cross

Scrub typhus and murine typhus, caused by Orientia tsutsugamushi and Rickettsia typhi, respectively, are important causes of febrile illness in Laos. Although several studies have assessed rickettsial infection in selected provinces, the nationwide distribution remains unclear. This study aimed to estimate exposure to scrub typhus group (STG) and typhus group (TG) across twelve provinces of Laos and identify potential hotspots. We screened 1,200 serum samples from blood donors (100 per province) for STG and TG IgG antibodies using enzyme-linked immunosorbent assays (ELISA). Samples with optical density ≥ 0.5 were confirmed by immunofluorescence assays (IFA). Overall seroprevalence was 7.26% (95%CI:5.93-8.87) for STG and 4.09% (95% CI:3.11-5.37) for TG. STG seroprevalence was highest in Huaphan (27%), Oudomxay (19%) and Xiangkhuang (17%), all in northern Laos. TG seroprevalence was 10% in both Oudomxay (north) and Attapue (south). Compared with Vientiane Capital, these provinces had significantly higher seropositivity. No significant association was observed with age group. STG seropositivity was higher in males, whereas TG seropositivity was higher in females. Rickettsial infections are widespread in Laos, with STG seroprevalence concentrated in the north and TG seroprevalence present in both the north and south, guiding future research priorities and informing targeted public health interventions.

Background Real-world evidence concerning the cardiovascular (CV) risk of umeclidinium (UMEC) monotherapy or UMEC/vilanterol (VI) is scarce. This real-world study investigated CV risk in new users of UMEC or UMEC/VI versus new users of tiotropium (TIO) in patients with chronic obstructive pulmonary disease (COPD). Methods This prospective, observational, multinational, cohort study enrolled patients ≥18 years with COPD who initiated UMEC, UMEC/VI or TIO between 2 February 2016 and 31 January 2023. Non-inferiority (95% confidence interval [CI] upper bound <2.0) of UMEC and UMEC/VI to TIO was compared for the time-to-first event (hazard ratio [HR] over 24 months) of a composite CV endpoint of myocardial infarction, stroke, heart failure or sudden cardiac death. Stabilised inverse probability of treatment weighting adjusted for differences in baseline covariate balance between groups. Incidence rates for the composite CV endpoint were calculated. Results In total, 6606 patients were enrolled; 6165 were included in the analysis. Both UMEC (n=1246) and UMEC/VI (n=2448) were non-inferior to TIO (n=2471) for the risk of the composite CV endpoint (adjusted HR [95% CI]: UMEC versus TIO: 1.254 [0.830–1.896]; UMEC/VI versus TIO: 1.352 [0.952–1.922]). Unadjusted composite CV incidence rates were low across cohorts (incidence rate [95% CI] per 100 person-years: UMEC: 1.157 [0.814–1.594]; UMEC/VI: 1.287 [1.034–1.584]; TIO: 0.924 [0.716–1.174]). Conclusions Both UMEC and UMEC/VI were non-inferior to TIO for composite CV risk, suggesting that physicians may consider escalating patients to dual bronchodilator therapy if COPD symptoms are not effectively managed with monotherapy.

The integration of artificial intelligence (AI), the rise of mega‐journals, and the manipulation of impact factors present challenges to scientific integrity. These trends threaten the core principles of objectivity, reproducibility, and transparency. This editorial highlights two categories of threats: (1) external pressures, such as AI misuse and metric‐driven publishing models, and (2) internal systemic flaws, including the ‘publish or perish’ culture and methodological fragility. Mega‐journals, characterized by high‐volume publishing and broad interdisciplinary scopes, improve accessibility and accelerate dissemination. However, the emphasis on publication volume might weaken the rigor of peer review. To navigate these challenges, the authors propose a balanced approach that harnesses innovation without compromising scientific integrity. Proposed solutions include mandating AI transparency through frameworks like CONSORT‐AI, and redefining impact metrics to emphasize reproducibility, mentorship, and societal impact alongside citations. Scientific journals should promote career opportunities less on publication quantity and more on quality. Global cooperation, via initiatives like the San Francisco Declaration on Research Assessment (DORA) and the Committee on Publication Ethics (COPE), is essential to standardize ethics and address resource disparities. This editorial proposes solutions for researchers, journals, and policymakers to realign academic incentives and uphold the ethical foundation of the science. By fostering transparency, accountability, and equity, the scientific community can preserve its ethical foundations while embracing transformative tools—ultimately advancing knowledge and serving society.Level of EvidenceLevel V.

BackgroundBeing of older age is associated with chronic conditions and multimorbidity, which may lead to complex care needs of the persons affected. Residents in care homes are more often hospitalised than older adults living at home, and hospitalisations are often unplanned. It not sufficiently clear, how processes preceding unplanned hospitalisations are characterised, who is involved, what their decisions and competencies are, and what is needed to prevent such situations. We aimed to identify major causal factors for unplanned hospitalisations, potential fields of actions and goals for care.MethodsWe conducted a multiple case study including a root-cause analysis based on cases of residents in care homes with unplanned acute care incidents as key events. We extracted data from 5 care home residents’ records and interviewed 18 involved parties (health professionals, residents, relatives) in two facilities. We analysed data from 8 weeks preceding the key event on case base with event flow diagrams and qualitative content analysis of case-related interviews. Based on causal factors for gaps in care we derived fields of action and goals for care.ResultsAcross cases, major causal factors were insufficient management of chronic diseases, disrupted interprofessional collaboration processes, and lack of individualised protocol application. We developed 31 fields of action with goals for care and clustered these into 7 overarching meta-themes: geriatric nursing processes; interprofessional collaboration; empowerment of residents; health promotion and prevention; communication processes; management; values, standards and guidelines.ConclusionsCaring for residents with complex care needs in long-term care requires nurses with expanded skills in clinical nursing, cooperation and communication. The results of this study contribute to the development of a new role profile for these nurses in German long-term care homes and specify relevant fields of action and goals for care.Patient or public contributionAn advisory board including resident representatives discussed and supported the project in repeated consultation meetings throughout the research process.Trial registrationThe study was positively evaluated by the ethics committee of the University of Lübeck (file number 21–301) and registered prospectively at the German register for clinical trials (DRKS00025773).Clinical trial registrationGerman Register for clinical trials: DRKS00025773. Registered prospectively on 20th of August 2021.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12912-025-04206-2.

In vitro red blood cell (RBC) production offers a promising complement to conventional blood donation, particularly for patients with rare blood types. Previously, we developed imBMEP-A, the first erythroid cell line derived from reticulocyte progenitors, which maintains robust hemoglobin expression and erythroid differentiation in the presence of erythropoietin (EPO) despite its immortalized state. However, clinical translation remains hindered by the inability to scale up production due to impaired in vitro enucleation of RBC progenitor cell lines. Enhancing enucleation efficiency in imBMEP-A cells involved CRISPR/Cas9-mediated knockout (K.O.) of miR-30a-5p, a key enucleation inhibitor, moderately increasing rates to 3.3 ± 0.4%- 8.9 ± 1.7%. Further investigation of enucleation inefficiencies led to transcriptome and proteome comparisons between imBMEP-miR30a-K.O. cells and hematopoietic stem cells (HSCs). These analyses revealed altered gene expression and protein abundances linked to metabolic transitions, apoptosis promotion, and cytoskeletal regulation. Notably, forced expression of the proto-oncogene c-Myc, required for cell immortalization, emerged as a key driver of these physiological changes. Counteracting these effects required optimization of imBMEP-A cells by activating BCL-XL transcription and knocking out SCIN, which encodes the actin-severing protein scinderin. While BCL-XL is upregulated in normal erythropoiesis, it is downregulated in imBMEP-A. Conversely, SCIN, typically absent in erythroid cells, is highly expressed in imBMEP-A, disrupting actin organization. These interventions improved viability, restored actin network formation, and increased terminal erythropoiesis, yielding 22.1 ± 1.7% more orthochromatic erythroblasts. These findings establish a foundation for optimizing imBMEP-A cells for therapeutic use and advancing the understanding the pathophysiology of erythroleukemia.