At the time of writing, the ICH E9 Note for Guidance entitled "Statistical principles for clinical trials" has been in force in Europe, Japan and the U.S.A. for almost a year. The purpose of this paper is to review the initial progress of E9 in terms of its degree of acceptance and also in terms of any early problems which have emerged. A different means of exploring these questions has been adopted in each of the three regions. From Europe there is a regulatory perspective on statistical issues which have been found to be incompletely covered within E9 and which have been important for specific regulatory decisions. From the U.S. there is a report of the results of a survey of U.S. pharmaceutical industry opinion concerning the effect of E9 on statistical practice in drug development. From Japan there is a discussion of the shortage of qualified statisticians in Japan and the difficulties that this causes when trying to implement E9. Some overall conclusions are drawn.

Clinical Trials as Topic↗

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Development of an immunoassay for the COOH-terminal region of the gamma chains of human fibrin.

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Amino Acids↗

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The preferential release of beta-endorphin from the anterior pituitary lobe by corticotropin releasing factor (CRF).

Although a number of investigators have shown that release of ACTH is accompanied by the release of Beta-endorphin (beta-End) and Beta-lipotropin (beta-LPH), the proportion of the latter two peptides released with stress or by CRF is unclear. To evaluate directly the release of beta-End versus beta-LPH from the anterior lobe, we used molecular sieving of plasma and subsequent radioimmunoassay to measure release of both beta-End and beta-LPH into plasma after thirty minutes of inescapable intermittent footshock. We found a substantial increase in circulating beta-End which appears to be of anterior lobe origin. The beta-End does not appear to represent peripheral conversion of beta-LPH to beta-End since the ratio of beta-LPH:beta-End released remained constant between five and thirty minutes of stress, and the rate of disappearance of beta-LPH is slower than the rate of disappearance of beta-End following the termination of stress. Further confirmation of these findings was obtained by examining the POMC derived peptides released by pituitary cell suspensions in the presence and absence of oCRF. While unstimulated release consisted of equal proportions of beta-End and beta-LPH, stimulation of the anterior lobe cell suspensions with oCRF resulted in the release of two-fold more beta-End than beta-LPH.

Animals↗

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The effects of iron oxides on proton relaxivity.

The magnetic properties and relaxivities of superparamagnetic, ferromagnetic and paramagnetic iron oxides are presented and compared. The iron in colloids of ferromagnetic iron oxide has a large spin-spin relaxivity and a small spin-lattice relaxivity. The iron in colloids of paramagnetic iron oxide has a low spin-spin and spin-lattice relaxivity. The iron in colloids of highly dispersed superparamagnetic iron oxides has a large spin-spin relaxivity and a large spin-lattice relaxivity. Superparamagnetic colloids with various particle sizes in solution have been made by varying the number of superparamagnetic iron oxide crystals per particles in solution. Superparamagnetic colloids of larger solution particle size have a lower spin-lattice relaxivity than colloids comprised of smaller solution particle sizes.

Chemical Phenomena↗

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Beta blockade during and after myocardial infarction: an overview of the randomized trials.

Long-term beta blockade for perhaps a year or so following discharge after an MI is now of proven value, and for many such patients mortality reductions of about 25% can be achieved. No important differences are clearly apparent among the benefits of different beta blockers, although some are more convenient than others (or have slightly fewer side effects), and it appears that those with appreciable intrinsic sympathomimetic activity may confer less benefit. If monitored, the side effects of long-term therapy are not a major problem, as when they occur they are easily reversible by changing the beta blocker or by discontinuation of treatment. By contrast, although very early IV short-term beta blockade can definitely limit infarct size, more reliable information about the effects of such treatment on mortality will not be available until a large trial (ISIS) reports later this year, with data on some thousands of patients entered within less than 4 hours of the onset of pain. Our aim has been not only to review the 65-odd randomized beta blocker trials but also to demonstrate that when many randomized trials have all applied one general approach to treatment, it is often not appropriate to base inference on individual trial results. Although there will usually be important differences from one trial to another (in eligibility, treatment, end-point assessment, and so on), physicians who wish to decide whether to adopt a particular treatment policy should try to make their decision in the light of an overview of all these related randomized trials and not just a few particular trial results. Although most trials are too small to be individually reliable, this defect of size may be rectified by an overview of many trials, as long as appropriate statistical methods are used. Fortunately, robust statistical methods exist--based on direct, unweighted summation of one O-E value from each trial--that are simple for physicians to use and understand yet provide full statistical sensitivity. These methods allow combination of information from different trials while avoiding the unjustified direct comparison of patients in one trial with patients in another. (Moreover, they can be extended of such data that there is no real need for the introduction of any more complex statistical methods that might be more difficult for physicians to trust.) Their robustness, sensitivity, and avoidance of unnecessary complexity make these particular methods an important tool in trial overviews.

Adrenergic beta-Antagonists↗

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Different forms of bone grafts.

Successful incorporation of a bone graft depends on a number of factors. The source, size, function, and form of the bone graft necessary will influence decision making. This article presents the various forms of bone grafts, along with their applications in foot and ankle surgery.

Ankle↗