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Drug utilization of clarithromycin for gastrointestinal disease treatment

World Journal of Gastroenterology 2008年第39期14卷 6065-6071页

作者： Quan Zhou Ling-Ling Zhu Xiao-Feng Yan wen-sheng pan Su Zeng Department of Clinical Pharmacy the 2nd Affiliated Hospital School of Medicine Zhejiang University Zhejiang Province 310009 China Geriatric Ward the 2nd Affiliated Hospital School of Medicine Zhejiang University Zhejiang Province 310009 China Department of gastroenterology the 2nd Affiliated Hospital School of Medicine Zhejiang University Zhejiang Province 310009 China Department of Pharmaceutical Analysis & Drug Metabolism College of Pharmaceutical Sciences Zhejiang University Zhejiang Province 310058 China

AIM： To evaluate the patterns of use of clarithromycin for gastrointestinal disease treatment and promote its rational use.METHODS： Using a structured pro forma, we conducted a two-month survey of the electronic prescriptions containing immediate-release （IR） or sustained-release （SR） product of clarithromycin for outpatients with gastrointestinal diseases in a 2200-bed general hospital. Suitability of the prescription was audited retrospectively. RESULTS： One hundred and sixty-four prescriptions of SR product and 110 prescriptions of IR product were prescribed for gastrointestinal disease treatment. Among prescriptions for anti-Helicobacter pylori （H pylori） therapy, triple therapy take the dominant position （91.8%）, followed by quadruple therapy （4.3%） and dual therapy （3.9%）. Amoxicillin was the most frequently co-prescribed *** and levofloxacin are used more widely than metronidazole or tinidazole. Clarithromycin SR was administered at inappropriate time points in all prescriptions. Fifty percent of all prescriptions of clarithromycin SR, and 6.4% of prescriptions of clarithromycin IR, were prescribed at inappropriate dosing intervals. Surprisingly, disconcordance between diagnoses and indications was observed in all prescriptions of clarithromycin SR which has not been approved for treating Hpy/ori infection although off-label use for this purpose was reported in literature. On the contrary, only one prescription （0.9%） of clarithromycin IR was prescribed for unapproved indication （i.e. gastro-oesophageal reflux disease）. 1.4% of prescriptions for chronic gastritis or peptic ulcer treatment were irrational in that clarithromycin was not co-prescribed with gastric acid inhibitors. Clinical significant CYP3A based drug interactions with clarithromycin were identified. CONCLUSION： There is a great scope to improve the quality of clarithromycin prescribing in patients with gastrointestinal disease, especially with regard to administration

关键词： Clarithromycin Drug utilization Prescriptions Helicobacter pylori Gastrointestinal Diseases Drug administration schedule Drug interactions Polypharmacy

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

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World Journal of Gastroenterology 2007年第42期13卷 5618-5628页

作者： Quan Zhou Xiao-Feng Yan Zhong-Miao Zhang wen-sheng pan Su Zeng Department of Clinical Pharmacology & Clinical Pharmacy the 2^nd AffiliatedHospital School of Medicine Zhejiang University Hangzhou310009 Zhej iang Province China Department of Gastroenterology the 2^nd Affiliated Hospital School of Medicine Zhejiang UniversityHangzhou 310009 Zhejiang Province China Department of Pharmaceutical Analysis & Drug Metabolism College of Pharmaceutical Sciences ZhejiangUniversity Hangzhou 310058 Zhejiang Province China

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 ***:Relevant literature was identified by performing MEDLINE/Pubmed searches covering the period from 1988 to ***: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 *** 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 ***: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 *** relevant CYP knowledgehelps clinicians to enhance the management of patients with gastrointestinal disease who may require treatment with polytherapeutic regimens.

关键词： Cytochrome P450 Pharmacokinetics Drugmetabolism Genotype Polymorphism Drug interaction Pharmacotherapy Gastrointestinal diseases

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Is the required therapeutic effect always achieved by racemic switch of proton-pump inhibitors?

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World Journal of Gastroenterology 2008年第16期14卷 2617-2619页

作者： Quan Zhou Xiao-Feng Yan wen-sheng pan Su Zeng Department of Clinical Pharmacy The 2nd Affiliated Hospital School of Medicine Zhejiang University Hangzhou 310009 Zhejiang Province China Department of Gastroenterology the 2nd Affiliated Hospital School of Medicine Zhejiang University Hangzhou 310009 Zhejiang Province China Department of Pharmaceutical Analysis & Drug Metabolism College of Pharmaceutical Sciences Zhejiang University Hangzhou 310058 Zhejiang Province China

Many of the drugs currently used in medical practice are racemates. The enantiomers of a racemic drug differ in pharmacodynamics and/or pharmacokinetics, thus in some cases it is preferable to develop pure enantiomers by racemic switch. In a recent study by Pai et al, dexrabeprazole [R(+)-rabeprazole] (10 mg) was found to be more effective than rabeprazole (20 mg) in the treatment of gastroesophageal reflux disease. We read with great interest in this study and discussed whether such racemic switch would be applicable to other proton-pump inhibitors (PPIs). A literature review indicates that stereoselective pharmacokinetics, rather than stereoselective pharmacological activity, is the main cause of differences in clinical efficacy between pure enantiomer and racemic PPI. Racemic switches of PPI provide the therapeutic advantages such as reducing metabolic load on the body, simplifying pharmacokinetics, providing benefit to the non-responders to standard dose of racemate, more homogenous response to treatment and better efficacy with equal safety. Further studies in quantitative structure-activity relationships (QSARs) are needed to address the fact that the preferred enantiomer of PPI is not always in the same absolute configuration, i.e., S-form is for omeprazole, pantoprazole and tenatoprazole whereas R-form is for lansoprazole and rabeprazole.

关键词： Proton-pump inhibitors Enantiomer Racemate Stereoisomerism Racemic switch Pharmacokinetics Pharmacodynamics Cytochrome P450 Genotype

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Spontaneous expulsion of a duodenal lipoma after endoscopic biopsy: A case report

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World Journal of Gastroenterology 2022年第34期28卷 5086-5092页

作者： Zhi-Hao Chen Li-Hong Lv wen-sheng pan Yi-Miao Zhu Department of Gastroenterology Zhejiang Provincial People’s HospitalHangzhou 310014Zhejiang ProvinceChina Affiliated Hospital People’s Hospital of Hangzhou Medical CollegeHangzhou 310014Zhejiang ProvinceChina Department of Gastroenterology Xianju County People’s HospitalTaizhou 317300Zhejiang ProvinceChina

BACKGROUND Gastrointestinal(GI)lipomas are benign submucosal tumors of mature adipocytes that arise mainly in the colon and stomach,sometimes in the ileum and jejunum,and rarely in the *** with symptomatic lipomas require endoscopic or surgical *** expulsion of lipomas after biopsy is a rare condition that has limited case *** SUMMARY A 56-year-old man presented to our hospital with intermittent postprandial epigastric ***(EGD)revealed a 10-mm soft yellowish submucosal lesion with the“pillow sign,”located in the second portion of *** ultrasonography(EUS)using a 12-MHz catheter probe showed a hyperechoic,homogenous,and round solid lesion(OLYMPUS EUS EUME2,UM-DP12-25R,12-MHz radial miniprobe,Olympus Corporation,Tokyo,Japan).Deep biopsy was performed using the bite-on-bite technique with *** examination was compatible with submucosal *** lesion spontaneously expelled 12 d after the ***-up EUS performed after 2 mo confirmed this *** Deep biopsy could lead to spontaneous GI lipoma *** might be the first step in lipoma diagnosis and treatment.

关键词： Lipoma Duodenal neoplasms Spontaneous expulsion Endoscopic biopsy Adipose tissue Case report

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Diagnostic efficacy of the Japan Narrow-band-imaging Expert Team and Pit pattern classifications for colorectal lesions: A meta-analysis

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World Journal of Gastroenterology 2020年第40期26卷 6279-6294页

作者： Yu Zhang Hui-Yan Chen Xiao-Lu Zhou wen-sheng pan Xin-Xin Zhou Hang-Hai pan Department of Gastroenterology Zhejiang Provincial People’s HospitalPeople’s Hospital of Hangzhou Medical CollegeHangzhou 310014Zhejiang ProvinceChina School of Laboratory Medicine and Life Sciences Wenzhou Medical UniversityWenzhou 325035Zhejiang ProvinceChina Department of Medical College The Medical College of Qingdao UniversityQingdao 266071Shandong ProvinceChina Department of Gastroenterology The First Affiliated HospitalZhejiang UniversityHangzhou 310003Zhejiang ProvinceChina

BACKGROUND Pit pattern classification using magnifying chromoendoscopy is the established method for diagnosing colorectal lesions. The Japan Narrow-band-imaging(NBI) Expert Team(JNET) classification is a novel NBI magnifying endoscopic classification that focuses on the vessel, and surface *** To determine the diagnostic efficacy of each category of the JNET and Pit pattern classifications for colorectal *** A systematic literature search was performed using PubMed, Embase, the Cochrane Library, and Web of Science databases. The pooled sensitivity, specificity, diagnostic odds ratio, and area under the summary receiver operating characteristic curve of each category of the JNET and Pit pattern classifications were *** A total of 19227 colorectal lesions in 31 studies were included. The diagnostic performance of the JNET classification was equivalent to the Pit pattern classification in each corresponding category. The pooled sensitivity, specificity,and area under the curve(AUC) for each category of the JNET classification were as follows: 0.73(95%CI: 0.55-0.85), 0.99(95%CI: 0.97-1.00), and 0.97(95%CI: 0.95-0.98), respectively, for Type 1;0.88(95%CI: 0.78-0.94), 0.72(95%CI: 0.64-0.79), and 0.84(95%CI: 0.81-0.87), respectively, for Type 2 A;0.56(95%CI: 0.47-0.64), 0.91(95%CI: 0.79-0.96), and 0.72(95%CI: 0.68-0.76), respectively, for Type 2 B;0.51(95%CI: 0.42-0.61), 1.00(95%CI: 1.00-1.00), and 0.90(95%CI: 0.87-0.93), respectively, for Type *** This meta-analysis suggests that the diagnostic efficacy of the JNET classification may be equivalent to that of the Pit pattern classification. However, due to its simpler and clearer clinical application, the JNET classification should be promoted for the classification of colorectal lesions, and to guide the treatment strategy.

关键词： Colorectal neoplasms Colonoscopy Chromoendoscopy Japan Narrow-band-imaging Expert Team Pit pattern Meta-analysis

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Resveratrol alleviates intestinal mucosal barrier dysfunction in dextran sulfate sodium-induced colitis mice by enhancing autophagy

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World Journal of Gastroenterology 2020年第33期26卷 4945-4959页

作者： Hang-Hai pan Xin-Xin Zhou Ying-Yu Ma wen-sheng pan Fei Zhao Mo-Sang Yu Jing-Quan Liu Department of Gastroenterology Zhejiang Provincial People's HospitalPeople's Hospital of Hangzhou Medical CollegeHangzhou 310014Zhejiang ProvinceChina Department of Gastroenterology The First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003Zhejiang ProvinceChina Key Laboratory of Gastroenterology of Zhejiang Province Zhejiang Provincial People's HospitalPeople's Hospital of Hangzhou Medical CollegeHangzhou 310014Zhejiang ProvinceChina Critical Care Unit Zhejiang Provincial People's HospitalPeople's Hospital of Hangzhou Medical CollegeHangzhou 310014Zhejiang ProvinceChina

BACKGROUND Intestinal mucosal barrier dysfunction plays an important role in the pathogenesis of ulcerative colitis(UC).Recent studies have revealed that impaired autophagy is associated with intestinal mucosal dysfunction in the mucosa of colitis *** exerts anti-inflammatory functions by regulating *** To investigate the effect and mechanism of resveratrol on protecting the integrity of the intestinal mucosal barrier and anti-inflammation in dextran sulfate sodium(DSS)-induced ulcerative colitis *** Male C57BL/6 mice were divided into four groups:negative control group,DSS model group,DSS+resveratrol group,and DSS+5-aminosalicylic acid *** severity of colitis was assessed by the disease activity index,serum inflammatory cytokines were detected by enzyme-linked immunosorbent *** tissues were stained with haematoxylin and eosin,and mucosal damage was evaluated by mean histological *** expression of occludin and ZO-1 in colon tissue was evaluated using immunohistochemical *** addition,the expression of autophagy-related genes was determined using reverse transcription-polymerase chain reaction and Western-blot,and morphology of autophagy was observed by transmission electron *** The resveratrol treatment group showed a 1.72-fold decrease in disease activity index scores and 1.42,3.81,and 1.65-fold decrease in the production of the inflammatory cytokine tumor necrosis factor-α,interleukin-6 and interleukin-1β,respectively,in DSS-induced colitis mice compared with DSS group(P<0.05).The expressions of the tight junction proteins occludin and ZO-1 in DSS model group were decreased,and were increased in resveratrol-treated colitis *** also increased the levels of LC3B(by 1.39-fold compared with DSS group)and Beclin-1(by 1.49-fold compared with DSS group)(P<0.05),as well as the number of autophagosomes,which implies that the resveratrol may alleviate intestinal mucosal barrier dysfuncti

关键词： Resveratrol Ulcerative colitis Autophagy Intestinal mucosal barrier Dextran sulfate sodium-induced colitis Intestinal inflammation

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Nomogram based on clinical characteristics for predicting overall survival in gastric cancer patients with preoperative anemia

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World Journal of Gastrointestinal Surgery 2023年第7期15卷 1375-1387页

作者： Yan Long Xiao-Lu Zhou Cheng-Long Zhang Ya-Nan Wang wen-sheng pan Department of Gastroenterology Zhejiang Provincial People’s HospitalAffiliated People’s HospitalHangzhou Medical CollegeHangzhou 310014Zhejiang ProvinceChina Department of Traumatology the Affiliated Hospital of Qingdao UniversityQingdao 266003Shandong ProvinceChina College of Biotechnology and Bioengineering Zhejiang University of TechnologyHangzhou 310014Zhejiang ProvinceChina

BACKGROUND Preoperative anemia is associated with increased postoperative morbidity and mortality and increased perioperative transfusion *** surgical patients,this affects physical and cognitive ability and quality of life,but it is an important and modifiable risk *** To determine the effect of preoperative anemia on the prognosis of gastric cancer(GC)patients and generate a prognostic nomogram to predict the postoperative overall survival(OS)of GC patients with preoperative *** Clinicopathological and follow-up data of GC patients treated at Zhejiang Provincial People's Hospital(China)from 2010 to 2015 were *** prognostic factors were screened by univariate and multivariate Cox regression ***,these factors were used to construct a nomogram to predict 1-,3-,and 5-year postoperative OS in preoperative anemic GC *** nomogram was assessed by calibration curves,receiver operating characteristic(ROC)curves,and decision curve analysis(DCA).RESULTS Nine hundred and sixty GC patients were divided into two groups(preoper atively anemic and nonanemic),and postoperative survival analysis was performed on both groups,yielding a shorter postoperative survival for preoperatively anemic patients than for nonanemic patients.A total of 347 GC patients with preoperative anemia were ***,preoperative alpha-fetoprotein level,monocyte count,lymphocyte count,clinicopathological stage,liver metastasis,and GC type were identified as independent prognostic factors for *** area under the ROC curve(AUC)of the nomogram for predicting 1-,3-,and 5-year OS was 0.831,0.845,and 0.840,respectively,for the training cohort,and the corresponding AUC values in the validation cohort were 0.827,0.829,and 0.812,*** curves and DCA indicated good performance of the *** In all,we have successfully produced and verified a useful nomogram for predicting OS in GC patients with preoperative *** no

关键词： Anemia Gastric cancer Nomogram Overall survival

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Immunotherapy in combination with chemotherapy for Peutz-Jeghers syndrome with advanced cervical cancer:A case report

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World Journal of Gastrointestinal Surgery 2023年第3期15卷 480-487页

作者： Xiang-Cheng Hu Chen-Xiao Gan Hui-Min Zheng Xue-Ping Wu wen-sheng pan Department of Gastroenterology Bengbu Medical CollegeBengbu 233000Anhui ProvinceChina Department of Gastroenterology Zhejiang Provincial People’s hospitalHangzhou 310014Zhejiang ProvinceChina

BACKGROUND Peutz-Jeghers syndrome(PJS)is a rare autosomal dominant disorder,and female patients may develop gynecologic *** prognosis for such patients is poor and the specific pathogenesis remains ***,there are currently no uniform treatment *** SUMMARY Herein,we introduce the case of a 45-year-old female who was diagnosed with PJS for 45 years and cervical cancer for 3 *** pathological examination showed metastases in the right external iliac lymph *** patient was initially treated with a combination of doxorubicin and carboplatin chemotherapy and pelvic magnetic resonance showed that the metastases had ***,we performed whole exome sequencing in this patient and identified the relevant causative *** addition to the chemotherapy regimen,sindilizumab was administered and the patient was followed *** 4 cycles of treatment,the metastases were substantially reduced and were not enlarged after six months of *** case report suggests that patients with PJS combined with cervical cancer may have a sustained response to immunecombination chemotherapy *** Clinicians should be aware of the importance of immunotherapy in patients with PJS combined with advanced cervical cancer.

关键词： Peutz-Jeghers syndrome Cervical cancer Programmed cell death protein 1 Chemotherapy Case report

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Intestinal natural killer/T-cell lymphoma presenting as a pancreatic head space-occupying lesion:A case report

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World Journal of Gastrointestinal Oncology 2023年第1期15卷 195-204页

作者： Ya-Nan Wang Yi-Miao Zhu Xiao-Ju Lei Yuan Chen Wan-Mao Ni Zheng-Wei Fu wen-sheng pan College of Biotechnology and Bioengineering Zhejiang University of TechnologyHangzhou 310032Zhejiang ProvinceChina Department of Gastroenterology Zhejiang Provincial People’s HospitalPeople’s Hospital of Hangzhou Medical CollegeHangzhou 310014Zhejiang ProvinceChina Department of Endoscopy Center Zhejiang Provincial People’s HospitalPeople’s Hospital of Hangzhou Medical CollegeHangzhou 310014Zhejiang ProvinceChina Department of Pathology Zhejiang Provincial People’s HospitalPeople’s Hospital of Hangzhou Medical CollegeHangzhou 310014Zhejiang ProvinceChina Cancer Center Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang ProvinceZhejiang Provincial People’s HospitalHangzhou Medical CollegeHangzhou 310014Zhejiang ProvinceChina Molecular Diagnosis Laboratory Zhejiang Provincial People's HospitalPeople's Hospital of Hangzhou Medical CollegeHangzhou 310014Zhejiang ProvinceChina

BACKGROUND Intestinal natural killer/T-cell lymphoma(NKTCL)is a rare and aggressive non-Hodgkin’s lymphoma,and its occurrence is closely related to Epstein-Barr virus *** addition,the clinical symptoms of NKTCL are not obvious,and the specific pathogenesis is still *** NKTCL may occur in any segment of the intestinal tract,its distinct location in the periampullary region,which leads clinicians to consider mimics of a pancreatic head mass,should also be ***,there remain huge challenges in the diagnosis and treatment of intestinal *** SUMMARY In this case,we introduce a male who presented to the clinic with edema of both lower limbs,accompanied by diarrhea,and abdominal *** ultrasound(EUS)showed well-defined homogeneous hypoechoic lesions with abundant blood flow signals and compression signs in the head of the *** the guidance of EUS-fine needle biopsy(FNB)with 19 gauge or 22 gauge needles,combined with multicolor flow cytometry immunophenotyping(MFCI)helped us diagnose *** treatments,the patient was prescribed the steroid(dexamethasone),methotrexate,ifosfamide,L-asparaginase,and etoposide chemotherapy ***,he died of leukopenia and severe septic shock in a local *** Clinicians should enhance their understanding of *** key factors,including EUS characteristics,the right choice of FNB needle,and combination with MFCI,are crucial for improving the diagnostic rate and reducing the misdiagnosis rate.

关键词： Intestinal natural killer/T-cell lymphoma Endoscopic ultrasound-guided fine-needle biopsy Multicolor flow cytometry immunophenotyping Diagnosis Case report

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Ultrasound-guided percutaneous catheter drainage in early treatment of severe acute pancreatitis

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World Journal of Emergency Medicine 2010年第1期1卷 45-48页

作者： Xin-bo Ai Xiao-ping Qian wen-sheng pan Jun Xu, Liang-qing Wu Wan-jun Zhang An Wang Department of Gastroenterology Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou 310009 China Department of Gastroenterology Zhuhai People's Hospital Third Affiliated Hospital of Jinan University School of Medicine Zhuhai 519000 China Department of Radiology Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou 310009 China Department of Ultrasonography Second Affiliated Hospital of Zhejiang University School of Medicme Hangzhou 310009 China

Percutaneous catheter drainage （PCD） is a minimally invasive intervation for severe acute pancreatitis （SAP）. This study was undertaken to compare the results of surgery and ultrasound-guided PCD in the treatment of 32 patients with SAP, and to direct clinicians to the most optimal approach for SAP. In the 32 patients, 19 were proved to have deteriorated clinical signs or symptoms, extensive fluid exudation, and necrosis confirmed by computed tomography （CT） and they underwent operative debridement and drainage. For extensive fluid exudation or necrosis, complete liquefaction and safe catheter implantation, the other 13 patients were given PCD. The mortality rate of the surgery group was 26.3%, much higher than that of the PCD group （0%）. There was a significant difference between the two groups （P=0.044）. The mean time for recovery of the serum C-reactive protein （CRP） level was 43.8 days in the surgery group, which was significantly longer than that of the PCD group （23.8 days）（P=0.034）. Early PCD guided by ultrasound could decrease the mortality of patients with severe acute pancreatitis, alleviate life-threatening inflammatory complications, and avoid unnecessary emergency operation.

关键词： Percutaneous catheter drainage Operation Severe acute pancreatitis Clinicalefficacy

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