Rational prescription of drugs within similar therapeutic or structural class for gastrointestinal disease treatment: Drug metabolism and its related interactions

AIM:To review and summarize drug metabolism and its related interactions in prescribing drugs within the similar therapeutic or structural class for gastrointestinal disease treatment so as to promote rational use of medicines in clinical practice.METHODS:Relevant literature was identified by performing MEDLINE/Pubmed searches covering the period from 1988 to 2006.RESULTS:Seven classes of drugs were chosen,including gastric proton pump inhibitors,histamine H2-receptor antagonists,benzamide-type gastroprokinetic agents,selective 5-HT3 receptor antagonists,fluoroquinolones,macrolide antibiotics and azole antifungals.They showed significant differences in metabolic profile(i.e.,the fraction of drug metabolized by cytochrome P450(CYP),CYP reaction phenotype,impact of CYP genotype on interindividual pharmacokinetics variability and CYP-mediated drug-drug interaction potential).Many events of severe adverse drug reactions and treatment failures were closely related to the ignorance of the above issues.CONCLUSION:Clinicians should acquaint themselves with what kind of drug has less interpatient variability in clearance and whether to perform CYP genotyping prior to initiation of therapy.The relevant CYP knowledgehelps clinicians to enhance the management of patients with gastrointestinal disease who may require treatment with polytherapeutic regimens.

A destructive field study on the behavior of piles under tension and compression

This paper involves a series of destructive full-scale load tests on long bored piles instrumented with strain gauges along the shafts,including two compression and two tension loading tests.The load-displacement response,axial force,skin friction,and the thresholds of the slip displacement for fully mobilizing the skin resistances in different soils are discussed.Moreover,the theoretical solution for estimating the pile tip settlement under compression was adopted to analyze the test results.It was found that the measured skin frictions for the piles under compression were about 6% to 42% higher than the estimated values of the cone penetration tests(CPTs),whereas the measured skin frictions in the uplift cases were about 16% to 50% smaller than the estimated values.In addition,the average limited skin frictions for the tension piles were about 0.36 to 0.78 times the average ultimate skin frictions for the piles under compression.It also can be indicated that the skin friction along the pile depth approached the limited state,and decreased from a peak value with increasing loads.

Influence of reaction piles on test pile response in a static load test

This work presents a new analytical method to analyze the influence of reaction piles on the test pile response in a static load test.In our method,the interactive effect between soil and pile is simulated using independent springs and the shear displacement method is adopted to analyze the influence of reaction piles on test pile response.Moreover,the influence of the sheltering effect between reaction piles and test pile on the test pile response is taken into account.Two cases are analyzed to verify the rationality and efficiency of the present method.This method can be easily extended to a nonlinear response of an influenced test pile embedded in a multilayered soil,and the validity is also demonstrated using centrifuge model tests and a computer program presented in the literature.The present analyses indicate that the proposed method will lead to an underestimation of the test pile settlement in a static load test if the influence of the presence of reaction piles on the test pile response is neglected.