Johannes Wesling Klinikum Minden

This work-in-progress paper addresses the transition gap between visual, text-based, and complex programming skills in early computer science education. We present a multi-level workshop concept designed to provide a coherent and motivating learning progression across different programming stages. The workshops integrate narrative-driven gameplay with progressively challenging programming tasks in a custom-developed 2D dungeon crawler framework, aiming to support learners in progressing from block-based coding to text-based and open code manipulation. The concept was implemented in collaboration with regional schools and industry partners and evaluated in six workshops with 92 participants. Initial results from pre- and post-surveys indicate high acceptance and a positive trend in programming interest, particularly among female students.

Psoriasis vulgaris, palmoplantar pustulosis, acne and hidradenitis suppurativa in various forms are independent dermatological conditions that usually require extensive treatment; however, these dermatological entities also occur coincidentally with the rheumatological diseases of adult chronic non-bacterial osteomyelitis (CNO) and SAPHO syndrome. In the latter case the dermatological entities acne and palmoplantar pustulosis are actually indicative for the diagnosis, for the lettersA and P in the acronym SAPHO, even though SAPHO has been used in routine clinical practice without dermatological manifestations. According to the new consensus recommendations, however, SAPHO syndrome is now only listed as asubtype of adult CNO [1]. The similarity of the rheumatological clinical picture of adult CNO to the aforementioned dermatological entities requires adifferentiated presentation of the diagnosis, diagnostic classification and interdisciplinary treatment planning from adermatological perspective, which are presented in this article.

Targeted therapies (TT) improve outcomes in BRAF-mutant melanoma. Pre-clinical data suggest that anticoagulation (AC) and platelet aggregation inhibition (PAI) may have antitumoral effects. We evaluated the impact of concomitant AC or PAI on outcomes in patients receiving TT. We analyzed 1296 patients with unresectable stage III-IV BRAF-mutant melanoma treated with BRAF plus MEK inhibitors (2016-2024) in the prospective multicenter ADOReg registry. Patients were categorized as receiving no antithrombotic therapy (ATT; n = 1125), PAI (n = 73; acetylsalicylic acid or clopidogrel), or AC (n = 98; direct oral anticoagulants, low-molecular-weight heparin, or vitamin K antagonists). Median follow-up was 1.3 years. Compared with patients without ATT, those receiving AC had significantly improved 12-month progression-free survival (PFS; HR 0.55, 95 % CI 0.39-0.78, p = 0.001) and overall survival (OS; HR 0.35, 95 % CI 0.19-0.64, p = 0.001). Direct oral anticoagulants showed the most pronounced PFS benefit (HR 0.40, 95 % CI 0.25-0.64, p < 0.001). PAI was not associated with a significant difference in PFS, but multivariable Cox regression indicated a reduced hazard of death (HR 0.48, 95 % CI 0.27-0.87, p = 0.015). Concomitant AC, particularly factor Xa-inhibiting direct oral anticoagulants, was associated with improved survival in melanoma patients undergoing TT. These findings support prospective trials evaluating AC as concomitant therapy in advanced melanoma.

This study examines the influence of supraglottic airway (SGA) devices versus tracheal intubation (TI) on key ventilation parameters during intra-arrest-ventilation using volume-controlled-ventilation (VCV) in adult out-of-hospital cardiac arrest (OHCA). This cohort study is based on real-world data obtained from the emergency medical service of the Gütersloh district, Germany. Ventilation data were extracted in March 2024 from emergency ventilators and combined with patient-level information from the German Resuscitation Registry. Adult OHCA cases receiving intra-arrest-ventilation 01/2019-08/2023 with VCV via either SGA or TI were included. Collected parameters included the airway device used, set tidal volume (VTset), measured expiratory tidal volume (VTe), and leakage volume (VLeak). The primary outcome was the difference between VTset-VTe. Patients were grouped according to the airway management strategy used (SGA vs. TI). Potential differences in outcomes between these groups were assessed using linear mixed regression models. VCV was performed in n=27 individuals (682min) using SGA in n=13 (330min) vs. TI in n=14 (352min). The mean total VTset was 562.8±58.0ml (TI=573.9±62.5ml; SGA=550.9±50.1ml). The mean VTe totaled 270.7±205.5ml (TI=348.1±215.6ml; SGA=188.2±156.6ml). The mean VLeak was 23.3±27.4% (TI=5.5±7.0%; SGA=42.3±28.4%). Compared to SGA, TI was associated with smaller VTset-VTe (regression coefficient: -128.3ml; 95%-CI: [-252.3ml; -4.3ml]; p=0.0427) as well as for a lower VLeak (regression coefficient: -32.3%; 95%-CI: [-46.1%; -18.4%]; p<0.0001) for TI. In OHCA cases receiving mechanical intra-arrest-ventilation with VCV, TI was associated with higher delivered VTe, less deviation from VTset, and significantly lower VLeak compared to SGA.

Patients with advanced melanoma progressing after immune checkpoint inhibition (ICI) and BRAF/MEK inhibition have limited therapeutic options. In the LEAP-004 trial, pembrolizumab plus lenvatinib demonstrated activity in PD-1-refractory melanoma. The combination has emerged as a potential option when approved therapies have been exhausted; however, real-world evidence regarding its efficacy remains limited. This retrospective, multicenter DeCOG study included patients with advanced melanoma treated with anti-PD-1 plus lenvatinib after failure of anti-PD-1-based therapy at 11 major skin-cancer centers in Germany and Switzerland between October 2020 and March 2025. Overall, 120 patients were analyzed (median age 59 years); 70 % were male and 38 % had an ECOG performance status > 1. Most patients had ≥ 3 metastatic sites (69 %), brain metastases (42 %), and elevated LDH (58 %). Median follow-up was 13.4 months. Patients received a median of two prior systemic therapy lines; 98 % had been pretreated with ipilimumab/nivolumab, and 66 % exhibited primary resistance to prior ICI. The objective response rate was 23 %, with a median duration of response of 10 months; disease control rate was 47 %. Median progression-free survival (mPFS) was 4 months and median overall survival (mOS) was 10 months, with 12-month PFS and OS rates of 17 % and 42 %, respectively. Durable disease control beyond six months was observed in 23 % of patients, with mPFS of 21 months. Grade ≥ 3 treatment-related adverse events occurred in 21 % of patients. In this real-world cohort, anti-PD-1 plus lenvatinib demonstrated meaningful efficacy in a subset of heavily pretreated patients, predominantly in those with BRAF wild-type melanoma.

Between 1/15,000–1/50,000 passengers suffer in-flight medical emergencies (IFME) with cardiac arrest accounting for 0.3 %. Confined space can have a negative impact on quality of chest compressions during cardiopulmonary resuscitation (CPR), thus we have conducted a randomized controlled study to find the most effective approach of performing CPR in a one – vs. two-rescuer method in a simulated airliner cabin. We randomized 20 healthcare professionals to perform a set of 10 min Basic Life Support (BLS, chest compressions and bag-mask-ventilation) in a one- vs. two-rescuer scenario and in confined space vs. open space in a randomized order using a full-body manikin. The primary outcome was compression depth as sensitive marker for differences in CPR-quality. The study was registered on clinicaltrials.gov (NCT02002481). Mixed ANOVAs with post-hoc false-discovery-rate adjusted pairwise comparisons indicated that one- vs. two-rescuer method showed differences in no-flow-time (confined: 8.05 ± 0.17 vs. 24.25 ± 1.05 s/2min and open space: 7.51 ± 0.02 vs. 21.31 ± 0.43 s/2min; p < 0.001) and missing releases (confined: 27.09 ± 5.55 vs. 46.64 ± 9.66 number/10 minutes and open space: 27.09 ± 2.44 vs. 43.36 ± 6.4 number/10minutes; p < 0.001). A confined space significantly elevated no-flow-time in the two-rescuer-method vs. the one-rescuer-method (24.24 ± 1.06 s/2min vs. 21.26 ± 0.44 s/2min; p < 0.001), whereas compression frequency and compression depth were different but still within the current recommendations of ERC/AHA in both methods per condition. Limited space in an airliner cabin has significant impact on no-flow-time in a two-rescuer-method. In case of CPR and limited access to the patient, we recommend a one-rescuer-method as first approach to ensure early and high-quality CPR for experienced personnel.

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BACKGROUNDThe use of sodium-glucose cotransporter 2 (SGLT2) inhibitor in heart failure (HF) patients is increasing significantly, regardless of whether they have a history of diabetes. The effects of SGLT2 inhibitor on HF are likely mediated through multiple mechanisms, including suppression of the renin-angiotensin-aldosterone system (RAAS), reduction in oxidative stress leading to enhanced myocardial efficiency, and attenuation of adverse cardiac remodeling by preventing fibrosis. These pathways are fundamental to reducing mortality, improving patients' quality of life, and alleviating the burden on the United States healthcare system by decreasing HF-related hospitalizations.AIMTo evaluate SGLT2 inhibitor effects on HF, focusing on hospitalization for HF (HHF), cardiovascular (CV) deaths, and all-cause mortality.METHODSA comprehensive search was conducted in PubMed for randomized controlled trials (RCTs) evaluating the effects of SGLT2 inhibitor in HF patients compared to placebo, covering the period from January 1, 2014, to January 1, 2025. The primary outcomes assessed were HHF, CV deaths, and all-cause mortality. RevMan Web 5.4.1 was used to assess the risk of bias heterogeneity and to perform the statistical analyses. A random-effects model was employed for all statistical evaluations.RESULTSA total of nine RCTs were included in this analysis: DELIVER, DECLARE-TIMI 58, DAPA-HF, EMPA-REG OUTCOME, EMPEROR-Reduced, EMPEROR-Preserved, SOLOIST-WHF, EMPULSE, and VERTIS-CV. For HHF, eight trials (excluding the SOLOIST-WHF; n = 25906) were pooled, while CV deaths were assessed using data from eight trials (excluding the EMPULSE; n = 26598). Compared to placebo, SGLT2 inhibitor significantly reduced the risk of HHF (relative risk: 0.74; 95%CI: 0.71-0.77; P < 0.00001) and CV death (odds ratio: 0.88; 95%CI: 0.83-0.92; P = 0.0006). All nine trials (n = 27128) were included in the analysis of all-cause mortality. SGLT2 inhibitor were associated with a statistically significant reduction in all-cause mortality compared to placebo (OR: 0.91; 95%CI: 0.84-0.98; P = 0.02).CONCLUSIONThese results suggest that SGLT2 inhibitor significantly reduce the risk of hospitalization for HF, CV deaths, and all-cause mortality.