Targeting the NTRK Fusion Gene in Pancreatic Acinar Cell Carcinoma: A Case Report and Review of the Literature.

Pancreatic acinar cell carcinoma (PACC) is a rare pancreatic exocrine malignancy. Compared with the more common pancreatic ductal adenocarcinoma (PDAC), PACC is more common in younger White men, has earlier stages and a lower mean age (56 vs 70 years) at the time of presentation, and has a better prognosis. In addition to differences in demographic, histologic, and clinical characteristics, PACC has a genomic profile distinct from PDAC, with only rare mutations in TP53, KRAS, and p16 that are commonly found in PDAC. This case report presents a man aged 81 years who presented with a pancreatic body mass with peripancreatic lymph node enlargement. Biopsy of the mass showed acinar cell carcinoma. The patient underwent upfront surgical resection, followed by one cycle of adjuvant gemcitabine, with stoppage of therapy due to poor tolerance. Lower-dose gemcitabine was reintroduced after disease progression 6 months later. Nab-paclitaxel was added to gemcitabine after 6 cycles because of a continued increase in the size of peripancreatic lymph nodes. Combination chemotherapy was stopped after 4 cycles because of further disease progression with new liver metastasis. Molecular testing showed the presence of an SEL1L-NTRK1 fusion. Targeted therapy was started with the oral neurotrophic tropomyosin receptor kinase (NTRK) inhibitor larotrectinib at a dosage of 100 mg twice daily. At the time of writing, the patient has been on therapy for 13 months with an exceptional radiographic response and has not experienced any grade 3 adverse effects. To our knowledge, this is the first clinical report of an NTRK gene fusion in a patient with PACC. This case study highlights the significance of tumor molecular profiling in patients with pancreatic tumors, especially rare histologies.

Oral lichen nitidus case report.

This case report aims to increase awareness that lichen nitidus may affect the mouth and therefore supports multidisciplinary management, particularly between dermatologists and dental professionals.

Developing, piloting and evaluating a Medicines Safety School Programme to be delivered by student pharmacists.

INTRODUCTION: This project aimed to develop content, pilot delivery, and evaluate effectiveness of an innovative Medicines Safety School Programme delivered by student pharmacists to primary school pupils. METHODS: A collaborative approach between academic staff and a primary school guided programme content. The interactive workshop focused on benefits of medicines when used correctly and harmful effects associated with misuse. Delivery was piloted by academic staff in this same school. Following the pilot, student pharmacists delivered the programme to primary school children. A post-placement online survey explored student pharmacists' views on how involvement supported their professional development. RESULTS: The pilot was delivered to 72 pupils between eight- and nine-years-old. Results from pre- and post-workshop surveys completed by pupils showed an increased understanding post-workshop of the benefits and potential risks associated with medicines. Post-workshop evaluations completed by class teachers rated the workshop as excellent in aspects such as presentation of the topic and effective linking to school and national curricula. Seventy-seven student pharmacists were involved in delivering the programme to 296 primary school children. Results of a post-placement online survey showed that student pharmacists felt that completing this placement had benefited their professional development and increased their confidence when interacting with young children. CONCLUSIONS: The Medicines Safety School Programme has been well received by the pupils, school staff, and student pharmacists involved in the pilot study. Development of the programme is ongoing and is now progressing to embed this innovative educational initiative into the pharmacy undergraduate curriculum.

Safe use of paracetamol and high-dose NSAID analgesia in dentistry during the COVID-19 pandemic.

With dental services currently altered, dentists are being asked to provide advice, analgesia and antibiotics in situations where they would normally be offering operative care. Dentists are familiar with using analgesia for short courses for their patients, but using higher-dose regimes and for periods of over two weeks brings special challenges. This paper reviews the areas where special precautions are needed when using analgesia in the current situation.

Vaccine-Induced Protection Against Furunculosis Involves Pre-emptive Priming of Humoral Immunity in Arctic Charr.

With respect to salmonid aquaculture, one of the most important bacterial pathogens due to high mortality and antibiotic usage is the causative agent of typical furunculosis, Aeromonas salmonicida spp. salmonicida (Asal). In Atlantic salmon, Salmo salar, the host response during infections with Asal is well-documented, with furunculosis outbreaks resulting in significant mortality in commercial settings. However, less is known about the host-pathogen interactions in the emerging aquaculture species, Arctic charr Salvelinus alpinus. Furthermore, there is no data on the efficacy or response of this species after vaccination with commonly administered vaccines against furunculosis. To this end, we examined the immunological response of S. alpinus during infection with Asal, with or without administration of vaccines (Forte Micro®, Forte Micro® + Renogen®, Elanco Animal Health). Artic charr (vaccinated or unvaccinated) were i.p.-injected with a virulent strain of Asal (106 CFUs/mL) and tissues were collected pre-infection/post-vaccination, 8, and 29 days post-infection. Unvaccinated Arctic charr were susceptible to Asal with 72% mortalities observed after 31 days. However, there was 72-82% protection in fish vaccinated with either the single or dual-vaccine, respectively. Protection in vaccinated fish was concordant with significantly higher serum IgM concentrations, and following RNA sequencing and transcriptome assembly, differential expression analysis revealed several patterns and pathways associated with the improved survival of vaccinated fish. Most striking was the dramatically higher basal expression of complement/coagulation factors, acute phase-proteins, and iron hemostasis proteins in pre-challenged, vaccinated fish. Remarkably, following Asal infection, this response was abrogated and instead the transcriptome was characterized by a lack of immune-stimulation compared to that of unvaccinated fish. Furthermore, where pathways of actin assembly and FcγR-mediated phagocytosis were significantly differentially regulated in unvaccinated fish, vaccinated fish showed either the opposite regulation (ForteMicro®), or no impact at all (ForteMicro®Renogen®). The present data indicates that vaccine-induced protection against Asal relies on the pre-activation and immediate control of humoral immune parameters that is coincident with reduced activation of apoptotic (e.g., NF-κB) and actin-associated pathways.

Exploring a Problem-Based Learning Approach in Pharmaceutics.

OBJECTIVE: The basis of this study was to explore the impact of the initiation of a Problem-Base Learning (PBL) approach within a second-year pharmaceutics degree on a Master of Pharmacy programme, introduced as a way of improving deep learning and to foster independent learning. DESIGN: A semi-structured interview was used to seek feedback from the students, and feedback from staff was secured though a focus group. A thematic approach was used for the analysis, once data saturation had been reached. Exam pass-rate statistics were also analysed. ASSESSMENT: Five parent themes were identified from the student interviews: Module structure, Promoting lifelong learning, Integration and future practice, Outcomes and Student experience. The third year exam pass rate improved by 12% in the year following the introduction of PBL in second year. CONCLUSIONS: Various recommendations were proposed to further improve the module, based on the findings of this study. These include improving feedback and support through tutorials, reducing the volume of directed study, as well as highlighting the relevance of pharmaceutics to the pharmacy degree. A long-term review would be needed to assess the full implications of PBL teaching within this course.