Greifswald University Hospital

Ageing populations in high-income countries reduce the proportion of potential blood donors while increasing transfusion demand. Sustaining an adequate blood supply requires higher donor motivation among younger age groups. We analysed long-term trends in whole blood donations (WBDs) in one German federal state as an indicator for challenges that may arise in other high-income countries. In our prospective longitudinal study (starting 2005), we obtained the age and sex of the donors of all WBDs in the German federal state Mecklenburg-Western Pomerania in 2019 and 2020 and compared them with the data from 2005 to 2015. Population data from the German statistical office were used to predict future WBD in two models, population-based and population-based with behaviour-adjusted prediction. WBD decreased from 118,419 in 2005 to 83,871 in 2019 (-29.2%) and 76,912 in 2020 (-35.1%). Donation rates per 1000 inhabitants declined by 19.1% between 2005 and 2019, indicating a loss of donor motivation beyond demographic effects. Based on the donation numbers of 2019, we predict a further decline of WBD in 2030 by -12.7% (population-based projection) or -15.1% (behaviour-adjusted projection), respectively. The decline in blood donations is no longer solely driven by demographic changes but also by reduced motivation among younger donors. As ageing populations and changing donor behaviour are common to many high-income countries, these findings likely reflect an emerging international trend. Targeted strategies to recruit and retain young donors are urgently needed to ensure sustainable blood supplies in ageing societies.

Purpose To determine whether baseline clinical characteristics and cardiac MRI parameters predict major adverse cardiac events (MACEs) in participants with angiographically confirmed spontaneous coronary artery dissection (SCAD). Materials and Methods This prospective single-center study included participants with SCAD who were angiographically diagnosed between March 2018 and November 2023. Cardiac MRI was performed after a median of 4 days (IQR, 1.5-7) from symptom onset. SCAD types were classified according to the Yip-Saw system. Follow-up evaluation was performed at a median of 5.5 months after discharge, and MACEs were recorded. The primary outcome was the occurrence of MACEs. Secondary analyses included extent of late gadolinium enhancement (LGE). Statistical analysis included binary logistic and Cox proportional hazards regression. Results Overall, 59 participants (mean age, 49 years ± 10; 40 female participants [68%]) were included. ST-elevation myocardial infarction at presentation was diagnosed in 24 of 59 (41%). Angiographically, 41 of 59 (69.5%) were SCAD type 2. Baseline cardiac MRI demonstrated acute injury in 48 of 59 (81%) and LGE in 54 of 59 (93%), typically moderate (median, three segments [IQR, two to five]). In the adjusted model, ST-elevation myocardial infarction manifestation independently predicted greater LGE extent (P = .02; odds ratio, 7.00; 95% CI: 2.00, 24.00). After multivariable adjustment, SCAD type 1 was significantly associated with MACEs (P = .002; hazard ratio, 10.00; 95% CI: 2.00, 23.00), as was transmural LGE (P = .006; hazard ratio, 1.50; 95% CI: 1.10, 2.10). A threshold of greater than or equal to four LGE segments identified a critical risk zone. Conclusion In SCAD, SCAD type 1 and involvement of more than three transmural LGE segments at acute cardiac MRI independently predicted MACEs. Keywords: MR Perfusion, Cardiac, Arteries, Cardiomyopathies, Ischemia/Infarction Supplemental material is available for this article. © RSNA, 2026.

Rationale:Tuberculosis vaccines aim to elicit protective immunity, with IFNγ-producing CD4⁺ T cells considered central mediators of host defense. In murine models, IFNγ activates macrophages to induce inducible nitric oxide synthase (iNOS), resulting in nitric oxide–dependent control of Mycobacterium tuberculosis (Mtb).Objective:To define the relevance of IFNγ-induced iNOS activity in humans and other natural host of virulent mycobacterial species.Methods:We systematically compared IFNγ-induced effector responses in Mtb-infected myeloid cells across species. Using bulk RNA sequencing, functional infection assays, and nitric oxide measurements, we assessed IFNγ responsiveness in human and mouse macrophages. These analyses were extended to monocytes from seven mammalian species and complemented by reanalysis of publicly available single-cell RNA-sequencing datasets and spatial proteomic imaging of tuberculous granulomas.Measurements and Main Results:Single-cell transcriptomic reanalysis revealed minimal NOS2 expression in myeloid cells from human and non-human primate granulomas. In vitro, IFNγ pretreatment failed to induce NOS2 transcription, iNOS activity, or Mtb growth restriction in human macrophages, in stark contrast to murine cells. Across species, iNOS activity was largely restricted to mice, with limited induction in cattle monocytes. Instead, human respiratory epithelial cells consistently expressed NOS2, and multiplexed ion beam imaging localized iNOS protein to epithelial compartments adjacent to granulomatous lesions.Conclusion:IFNγ signaling is uncoupled from iNOS induction in primate myeloid cells and epithelial compartments represent dominant sources of iNOS in human tuberculosis. These findings, challenge murine macrophage–centric paradigms and IFNγ-based correlates used in TB vaccine development and central to pathophysiology of tuberculosis and other pneumonias.

The obesity paradox has been described in different cardiovascular conditions. Data on the association between obesity and outcomes in patients with Takotsubo syndrome (TTS) are lacking. The aim of this study was to determine the relationship between body weight and mortality in TTS patients. Patients enrolled in the International Takotsubo Registry from January 2011 to July 2021 and with available data on body mass index (BMI) were included in the analysis. Patients were stratified according to BMI (underweight, <18.5 kg/m2; normal weight, 18.5-24.9 kg/m2; overweight, 25.0-29.9 kg/m2; obese, 30.0-34.9 kg/m2; and very obese, ≥35.0 kg/m2). The primary endpoint was mortality at 1 year. Of the 2707 patients, 222 (8.2%) were underweight, 1340 (49.5%) of normal weight, 759 (28.0%) overweight, 268 (9.9%) obese and 118 (4.4%) very obese (p=0.02). Rates of mortality at 1 year were 11.3%, 6.9%, 5.5%, 4.9% and 9.3% in underweight, normal weight, overweight, obese and very obese patients (p=0.02). Being overweight or obese was significantly associated with a lower mortality rate at 1 year (HR 0.70, 95% CI 0.51 to 0.96, p=0.03), and this association remained significant after multivariable adjustments (adjusted HR 0.67, 95% CI 0.46 to 0.97, p=0.03). A U-shaped mortality curve across BMI categories was observed in TTS patients, with the highest mortality rates observed in underweight and the lowest rates observed in obese patients. These observations provide the first evidence for the existence of the obesity paradox in TTS. NCT01947621.

Plain Language SummaryLaser lithotripsy is more effective than pneumatic lithotripsy for the treatment of upper urinary tract urolithiasis (kidney and ureter) in adults as well as in children. Furthermore, laser lithotripsy is a safe procedure.

Hematophagous leeches rely on a broad diversity of bioactive factors that interfere with the host's defense systems to secure a successful blood meal. The most prominent examples of such factors are the antithrombotics that address either the primary hemostasis (the platelet aggregation) or the secondary hemostasis (the blood coagulation). Whereas the inhibitors of platelet aggregation mainly cause continuous blood flow, coagulation inhibitors mainly keep the blood fluid within the stomach of the leech. The critical dependency of hematophagous leeches on the accurate action of all antithrombotic factors may explain the presence of multiple genes for each type of these factors that is regularly observed in leech genomes. The genome of Hirudinaria manillensis Lesson, 1842, the Asian buffalo leech, contains five individual genes that encode variants of the coagulation inhibitor hirudin. However, no genes that encode putative decorsins, the archetype of leech-derived inhibitors of platelet aggregation, have been described to date. Here, we report the identification of one monomeric and four multimeric decorsin encoding genes in the genome of H. manillensis. A selection of the putative decorsins was expressed as recombinant proteins, purified and functionally characterized. All but one of these putative decorsins displayed platelet aggregation-inhibitory potencies. Furthermore, we provide a mathematical calculation based on the mechanism of alternative pre-mRNA splicing that illustrates the potential to generate an enormous variety of different factors from one single multimeric ornatin gene.

Impaired hearing is a frequent stressful experience in later life. However, not all individuals affected by hearing problems exhibit restrictions in mental or functional health; there may be psychosocial resources that buffer the detrimental impact of impaired hearing to some extent. We investigate whether positive self-perceptions of aging (SPA, i. e. perceptions of more ongoing development and perceptions of less physical and social losses) do in fact constitute a compensatory resource and moderate between-person and within-person associations of self-reported hearing problems with trajectories of mental and functional health. Our sample comprised n = 9,705 participants in the German Ageing Survey (mean age = 62.41 years, SD = 11.58, range 40-93 years) who were assessed up to five times between 2008 and 2021. Based on longitudinal multilevel regression models, controlling for socio-demographic variables, hearing aid use, and chronic diseases, we found that individuals with overall more hearing problems reported poorer mental health. Moreover, with regard to the within-person associations, on measurement occasions when individuals reported more hearing problems, their mental and functional health was poorer. The association of more hearing problems with poorer functional health was weaker among individuals with lower perceptions of physical loss at baseline (i.e., year 2008). Among chronologically older adults, the association of more hearing problems with poorer functional health was weaker for those with higher perceptions of ongoing development at baseline. Our findings suggest that SPA related to fewer physical losses and to more ongoing development may buffer the negative impact of hearing problems on functional health.