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The validation of surrogate endpoints has been studied by Prentice, who presented a definition as well as a set of criteria that are equivalent if the surrogate and true endpoints are binary. Freedman et al. supplemented these criteria with the so-called proportion explained. Buyse and Molenberghs proposed to replace the proportion explained by two quantities: (1). the relative effect, linking the effect of treatment on both endpoints, and (2). the adjusted association, an individual-level measure of agreement between both endpoints. In a multiunit setting, these quantities can be generalized to a trial-level measure of surrogacy and an individual-level measure of surrogacy. In this paper, we argue that such a multiunit approach should be adopted because it overcomes difficulties that necessarily surround validation efforts based on a single trial. These difficulties are highlighted.

Dichotomous noise appears in a wide variety of physical and mathematical models. It has escaped attention that the standard results for the long time properties cannot be applied when unstable fixed points are crossed in the asymptotic regime. We show how calculations have to be modified to deal with these cases and present as a first application full analytic results for hypersensitive transport.

In renal ischemia, tubular obstruction induced by swelling of epithelial cells might be an important mechanism for reduction of the glomerular filtration rate. We investigated ischemic cell swelling by examining volume regulation of A6 cells during metabolic inhibition (MI) induced by cyanide and 2-deoxyglucose. Changes in cell volume were monitored by recording cell thickness (T(c)). Intracellular pH (pH(c)) measurements were performed with the pH-sensitive probe 5-chloromethyl-fluoresceine diacetate. T(c) measurements showed that MI increases cell volume. Cell swelling during MI is proportional to the rate of Na(+) transport and is not followed by a volume regulatory response. Furthermore, MI prevents the regulatory volume decrease (RVD) elicited by a hyposmotic shock. MI induces a pronounced intracellular acidification that is conserved during a subsequent hypotonic shock. A transient acidification induced by a NH(4)Cl prepulse causes a marked delay of the RVD in response to a hypotonic shock. On the other hand, acute lowering of external pH to 5, simultaneously with the hypotonic shock, allowed the onset of RVD. However, this RVD was completely arrested approximately 10 min after the initiation of the hyposmotic challenge. The inhibition of RVD appears to be related to the pronounced acidification that occurred within this time period. In contrast, when external pH was lowered 20 min before the hyposmotic shock, RVD was absent. These data suggest that internal acidification inhibits cellular volume regulation in A6 cells. Therefore, the intracellular acidification associated with MI might at least partly account for the failure of volume regulation in swollen epithelial cells.

Objective: To study the relative contribution of osteoporosis and falls to the occurrence of symptomatic fractures in postmenopausal women., Design: Retrospective survey of current osteoporosis in relation to falls and fractures in the preceding year., Setting: Patients of general practitioners of the area around a Belgian university., Participants: A total of 2649 consecutive postmenopausal women (mean age, 61y; range, 45-91y)., Interventions: Not applicable., Main Outcome Measures: Current bone density measurements (single-photon absorptiometry in the forearm) were analyzed in relation to self-reported incidence of falls and fractures in the preceding year., Results: Osteoporosis was found in 15% of the patients, 19% reported 1 or more falls during the preceding year, and 1.8% had a fracture during the preceding year. The age-adjusted risk for a fracture in the past 12 months for a 1 standard deviation decrease in bone density was 1.9 (95% confidence interval [CI], 1.4-2.5; P<.01). Adjusted risk for age, bone density, and body mass index (BMI) for a fracture in the past 12 months in patients who reported a fall was 6.0 (95% CI, 3.1-11.5; P<.001). Compared with women without osteoporosis and without a fall, women with osteoporosis without a fall had an age- and BMI-adjusted fracture risk of 2.8 (95% CI, 0.6-12.8; P<.10), and women with osteoporosis and a fall had an adjusted-fracture risk of 24.8 (95% CI, 6.9-88.6; P<.0001)., Conclusions: Falls are a major contributing factor to the occurrence of symptomatic fractures in postmenopausal women, independent of and additive to the risk attributable to age and osteoporosis., (Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation)

Sequestration of Pb by synthetic chelates has been reported to increase bioavailability, uptake, and translocation of this metal in plants. In this work the potential phytotoxic effects of Pb-EDTA were investigated in Phaseolus vulgaris L. cv. Limburgse vroege plants grown on hydroponics. Addition of 50 microM Pb-EDTA to the nutrient solution caused a significant induction of syringaldazine peroxidase (SPOD; EC 1.11.1.7) in roots and primary leaves and guaiacol peroxidase (GPOD; EC 1.11.1.7) in leaves. Addition of 100 microM Pb-EDTA further exacerbated ascorbate peroxidase (APOD; EC 1.11.1.11), GPOD, dehydroascorbate reductase (DHAR; EC 1.8.5.1), glutathione reductase (GR; EC 1.6.4.2) and malic enzyme (ME; EC 1.1.1.40) in roots and APOD and ME in primary leaves. Addition of 200 microM Pb-EDTA also induced DHAR in leaves. This induction of peroxidases (SPOD, GPOD, APOD), enzymes of the ascorbate-glutathione cycle (DHAR, GR in roots) and of an NADP+ reducing enzyme in roots and primary leaves indicates that oxidative stress has been initiated. At 200 microM Pb-EDTA, chlorophyll a and b content in leaves was significantly reduced while visible effects on root morphology and shoot length were observed, while no significant morphological effects were found in the leaves, confirming the sensitive character of the measured enzymes as plant stress indicators. Elevation of the Pb-EDTA concentration in the growth medium significantly reduced the content of Ca, Fe, Mn and Zn taken up by plants, probably due to ion leakage as a result of observed toxicity. Addition of up to 200 microM EDTA increased chelation of divalent cations in nutrient solution resulting in reduced plant uptake of Zn, Cu, Fe and Mn. This did not result in phytotoxicity.

We present the exact analytic solution for the model of directed transport induced by nonequilibrium state occupation, introduced by Porto [Eur. Phys. J. B 25, 345 (2002)].

The gas-phase internal elimination (E(i)) reaction of the sulfoxide (-SO-CH(3)) precursors of ethylene and model oligomers of PPV and PITN has been investigated by means of Hartree-Fock, Møller-Plesset (second and fourth order), and Density Functional Theory (B3LYP, MPW1K) calculations. Considerable differences between the obtained ground state and transition state geometries and the calculated activation energies are observed from one approach to the other, justifying first a careful calibration against the results of a benchmark CCSD(T) study of the E(i) reaction leading to ethylene. In comparison with the CCSD(T) results, as well as with available experimental data, DFT calculations along with the MPW1K functional are found to be a very appropriate choice for describing the E(i) pathway. The leading conformations of the precursors, the relevant transition state structures, and the energy barriers encountered along the lowest energy path to unsubstituted, alpha and beta chloro-, methoxy-, and cyano-substituted ethylene, styrene, stilbene in its cis and trans forms, and at last trans-biisothianaphthene have therefore been identified and characterized in detail employing DFT (MPW1K). Depending on the substituents attached to the C(alpha) and C(beta) atoms, different reaction mechanisms are observed.

Whereas most models for incomplete longitudinal data are formulated within the selection model framework, pattern-mixture models have gained considerable interest in recent years (Little, 1993, 1994). In this paper, we outline several strategies to fit pattern-mixture models, including the so-called identifying restrictions strategy. Multiple imputation is used to apply this strategy to realistic settings, such as quality-of-life data from a longitudinal study on metastatic breast cancer patients.

In evaluating the risk of mortality or development of opportunistic infections in HIV-infected patients, the number of CD4 lymphocyte cells per cubic millimetre of blood is widely recognized as one of the best available predictors of such future events. However, its usefulness is limited by the incompleteness and variability of such CD4 measurements during follow-up. Because of these limitations, analysis of such data requires the missing measurements to be 'filled in' or the patients without them to be excluded. We consider multiple imputation of CD4 values based partly on information from other health status measures such as haemoglobin, as well as on the event status of interest. These alternative health status measures are also considered as possible independent predictors of survival endpoints. Our work is motivated by a cohort of 1530 patients enrolled in two AIDS clinical trials. We compare our approach to other strategies such as basing evaluation of risk on baseline CD4, the last measured CD4 before an event, or a time-dependent covariate based on carrying the last CD4 value forward; we conclude with a strong recommendation for multiple imputation.

This work investigates whether techniques that are generally used for the validation of surrogate markers in clinical trials can be applied in the validation of psychiatric health measurements (often scales) and more generally to investigate relationships between treatment effects on different measurements. However, the categorical nature of some scales makes these techniques inapplicable in the way they were originally defined. In this work, we show a possible extension of this methodology to the setting in which one of the scales is an ordinal categorical variable. When psychiatric health measurements are either developed or used in a new population, reliability and validity must be investigated. Reliability, more specifically internal consistency, test-retest reliability, and inter-rater reliability, is focused on the reproducibility of the measurement. Validity is defined as the degree to which the scale measures what it purports to measure. This can be performed through the analysis of content, construct, and criterion validity. We argue that recent methodology, in particular developed to study surrogate endpoints, can be used to examine criterion validity, concurrent validity, and predictive validity. In concurrent validity, we correlate the measurement with a criterion measure, both of which are given at the same time. In predictive validity, the criterion will not be available to some point in time in the future. The surrogate methods were applied on pooled data from five trials in schizophrenia.

In multiple sclerosis (MS), T-cells are considered to be critical in coordinating an immunopathological cascade that results in myelin damage. We investigated whether clinical disease activity or brain inflammatory activity as measured by magnetic resonance imaging (MRI) was associated with changes in autoreactive T-cell reactivities in MS patients. To this end, a longitudinal study was performed in which T-cell-related immune parameters and clinical parameters (including MRI) were monitored in seven relapsing-remitting (RR) MS patients and two healthy controls with bimonthly intervals over a period of 18 months. The serial evaluation of antimyelin (MBP, PLP, MOG) T-cell responses revealed highly dynamic shifts and fluctuations from one pattern to another in a patient-dependent manner. In some of the patients, changes in T-cell-related immune variables were found to concur with MRI activity and generally preceded clinical relapses. These alterations include: increased number of myelin-reactive IFN-gamma secreting T-cells, detection of clonally expanded myelin-reactive T-cells, elevated proinflammatory and decreased antiinflammatory cytokine production, upregulation of ICAM-1 membrane expression and highly increased serum levels of soluble VCAM-1. However, not all exacerbations and MRI changes were associated with changes in antimyelin reactivity. Some of the observed immune alterations were also detected in the healthy controls, indicating that additional regulatory mechanisms-which may be defective in MS-play a role in the downregulation of potentially pathological T-cell responses. In conclusion, this study provides further support for an important role of myelin-reactive T-cells in the pathogenesis of MS. In addition, the observed dynamic changes in the antimyelin T-cell reactivity pattern may be a major obstacle for the development of antigen-specific immunotherapies.

Objective: To study T cell receptor (TCR) repertoire changes in synovial membrane over a 16 week period in patients with early rheumatoid arthritis (RA); and to study the influence of cyclosporin A (CSA) on TCR repertoire in a subgroup of these patients., Methods: Synovial tissue biopsies and paired blood samples were obtained from 12 patients with early RA at 2 time points. Seven patients were treated with CSA (Neoral-Sandimmun, 3 mg/kg/day) and 5 patients with placebo for 16 weeks. TCR V gene repertoires were analyzed by semiquantitative PCR-ELISA. CDR3 spectratyping and sequence analysis was used to compare TCR clonotype distributions., Results: TCR-specific mRNA was detected in all synovial tissue biopsies at the first sampling, but in only 8/12 biopsies 16 weeks later (4/7 CSA group, 4/5 placebo group). Overrepresented TCR BV genes were found in biopsies of 10/12 patients at the first time point, and in 7/12 patients after 16 weeks (3/7 CSA, 4/5 placebo). CDR3 sequence analysis revealed dynamic repertoire changes with only a few persisting clonotypes in the synovial tissue of placebo controls. Persisting T cell clonotypes were more frequently found in the synovial tissue of CSA treated patients compared to the placebo group., Conclusion: These data suggest a dynamic process of T cell recruitment in the joints of RA patients. This process, possibly due to activation and subsequent infiltration of new T cell clones, apparently is influenced by CSA treatment. Synovial tissue T cells were no longer detected after 16 weeks' CSA treatment in 3 patients. In the other CSA treated patients, new T cell clones infiltrated, while other clones were persistently represented in the joints. These data may have important consequences for the design of T cell targeted therapies for RA.

Autoreactive T lymphocytes are considered to play a crucial role in orchestrating a chronic inflammation in the central nervous system (CNS) of multiple sclerosis (MS) patients and in the joints of rheumatoid arthritis (RA) patients. However, it has been suggested that the majority of T cells in the immune infiltrate are nonspecifically recruited into the CNS and into the inflamed joint. In addition, several lines of evidence suggest an important role for interferon-gamma (IFN-gamma) in the pathogenesis of MS and RA. We have studied whether peripheral blood T cells from patients with autoimmune diseases are more susceptible to activation in the presence of IFN-gamma. The results indicate that IFN-gamma mediates a sustained elevated [Ca(2+)](i) in T cells of (active) MS and RA patients as compared to healthy controls and patients with common viral infections. No [Ca(2+)](i) increase was observed in Ca(2+)-free medium, excluding an effect of IFN-gamma on Ca(2+)-release from intracellular stores. Although the IFN-gamma-activated Ca(2+)-influx is insufficient to induce T cell proliferation in vitro, our data indicate a significantly augmented proliferation in response to suboptimal doses of PHA in the presence of IFN-gamma. This study suggests that the IFN-gamma-induced Ca(2+)-influx can act as a complementary mechanism in the activation of blood T lymphocytes from MS and RA patients.

We introduce simple non-Markovian modifications to the standard random walk resulting in absolute negative mobility, i.e., the response to an external force is always opposite to the direction of the force.

We revisit the mean-field model of globally and harmonically coupled parametric oscillators subject to periodic block pulses with initially random phases. The phase diagram of regions of collective parametric instability is presented, as is a detailed characterization of the motions underlying these instabilities. This presentation includes regimes not identified in earlier work [I. Bena and C. Van den Broeck, Europhys. Lett. 48, 498 (1999)]. In addition to the familiar parametric instability of individual oscillators, two kinds of collective instabilities are identified. In one the mean amplitude diverges monotonically while in the other the divergence is oscillatory. The frequencies of collective oscillatory instabilities in general bear no simple relation to the eigenfrequencies of the individual oscillators nor to the frequency of the external modulation. Numerical simulations show that systems with only nearest-neighbor coupling have collective instabilities similar to those of the mean-field model. Many of the mean-field results are already apparent in a simple dimer [M. Copelli and K. Lindenberg, Phys. Rev. E 63, 036605 (2001)].

Quality of Life (QL) is becoming an increasingly popular endpoint in phase III cancer clinical trials. However, there is still no agreement as to what is the optimal approach to analysis. In this paper we review some concepts which should be considered during a QL analysis. We present two modelling approaches that have been substantively developed in other research fields: selection models and pattern-mixture models. These models are compared using data from an EORTC clinical trial in poor-prognosis prostate cancer patients. It is illustrated that, although selection models and pattern mixture are probabilistically equivalent, they may shed completely different light on data from a modeller's point of view.

A screening method was developed to monitor the illegal use of synthetic corticosteroids in cattle. Diethyl ether extracts from spiked feces samples were cleaned-up by solid phase extraction followed by semipreparative reversed-phase chromatography (RPC). The fraction containing the corticosteroids was derivatized with ethoxyamine hydrochloride. The corresponding ethoximes were separated using silica-based C18 RPC and analyzed on-line in an ion trap mass spectrometer using atmospheric pressure positive chemical ionization. Ethoxime derivatives of dexamethasone and betamethasone were baseline resolved, allowing for the simultaneous mass spectrometric differentiation of both epimers in bovine feces by conventional non-chiral chromatography. At the lowest level tested (1 micro g/kg), corticosteroids (except triamcinolone) could be identified in compliance with the recent European criteria for residue identification. The quantitative performance of the method was best at residue levels > or = 2 micro g/kg., (Copyright 2002 John Wiley & Sons, Ltd.)

In this review, new insights into the immunopathogenesis of multiple sclerosis (MS) are discussed, with special focus on the potential mechanisms leading to neuroinflammation in MS--that is, the role of autoreactive T cells, infections, and neurodegenerative events. Oligodendrocytes are considered to be the target of autoimmune inflammation in the CNS of MS patients. Some important features of oligodendrocyte biology are discussed, together with the molecular mechanisms that are potentially involved in oligodendrocyte injury. These include injury mechanisms that might be executed by the adaptive and innate immune system, via cytokines and/or oligodendrocyte receptors, or as a consequence of nitrative and oxidative stress, and excitotoxicity. The mode of cell death of oligodendrocytes in MS is discussed, in addition to the mechanisms of axonal injury as observed in pathology- and imaging-based studies. Finally, recent progress in therapeutic strategies that may interfere with these pathological processes are reviewed, with a focus on repair strategies, such as gene therapy, antibody-mediated remyelination, and stem cell therapy.

We consider the one-dimensional stochastic flow x=f(x)+g(x)xi(t), where xi(t) is a dichotomous Markov noise, and use a simple procedure to identify the conditions under which the integro-differential equation satisfied by the total probability density P(x,t) of the driven variable can be reduced to a differential equation of finite order. This generalizes the enumeration of the "solvable" cases.

We investigated bacterial populations associated with the Zn hyperaccumulator Thlaspi caerulescens subsp. calaminaria grown in a soil collected from an abandoned Zn-Pb mine and smelter in Plombières, Belgium. The bacterial population of the nonrhizospheric soil consisted of typical soil bacteria, some exhibiting multiple heavy-metal resistance characteristics that often are associated with polluted substrates: 7.8% and 4% of the population survived in the presence of elevated levels of Zn (1 mM) and Cd (0.8 mM), respectively. For the bacterial population isolated from the rhizosphere, the comparable survival rates were 88 and 78%. This observation indicates a selective enrichment of the metal-resistant strains due to an increased availability of the metals in soils near the roots compared with nonrhizospheric soil. The endophytic inhabitants of the roots and shoots were isolated, identified, and characterized. Although similar endophytic species were isolated from both compartments, those from the rhizoplane and roots showed lower resistance to Zn and Cd than the endophytic bacteria isolated from the shoots. In addition, root endophytic bacteria had additional requirements. Contrary to the rootresiding inhabitants, the shoot represented a niche rich in metal-resistant bacteria and even seemed to contain species that were exclusively abundant there. These differences in the characteristics of the bacterial microflora associated with T. caerulescens might possibly reflect altered metal speciation in the different soils and plant compartments studied.

Analysing quality of life data (QOL) may be complicated for several reasons. Quality of life data not only involves repeated measures but is also usually collected on ordered categorical responses. In addition, it is evident that not all patients provide the same number of assessments, due to attrition caused by death or other medical reasons. In the recent statistical literature, increasing attention is given to methods which can handle non-continuous outcomes in the presence of missing data. The aim of this paper is to investigate the effect on statistical conclusions of applying different modelling techniques to QOL data generated from an EORTC phase III trial. Treatment effects and treatment differences are of major concern. First, a random-effects model is fitted, relating a binary longitudinal response (derived from the physical functioning scale of the QLQ-C30) to several covariates. In a second approach, marginal models are fitted, retaining the response variable and the mean structure used before. The fitted marginal models only differ with respect to the considered estimation procedure: generalized estimating equations (GEE); weighted generalized estimating equations (WGEE), and maximum likelihood (ML)., (Copyright 2001 John Wiley & Sons, Ltd.)

Objectives: To review the role of T lymphocytes in the pathogenesis of rheumatoid arthritis (RA) and discuss the relevance of the components of the trimolecular complex (synovial T cells, autoantigens, and antigen presenting cells) in the pathogenic autoimmune response in RA., Methods: Currently available experimental data are combined into a hypothetical pathway that may explain some of the events in the RA process. The literature regarding the potential therapeutic strategies that interfere with specific components of the trimolecular complex and other mediators are discussed briefly., Results: T cells are activated in the peripheral blood, cross the endothelial cell wall, and migrate into the joints. Once in the synovial joints, T cells are reactivated by cross-reactive antigens and clonally expand. Clonally expanded T cells accumulate in the diseased joint and secrete proinflammatory cytokines that attract and activate other cells, such as monocytes and macrophages. Treatment with anti-CD4 monoclonal antibodies or anticytokine agents that prevents antigen presentation and/or T-cell activation were effective in RA. Other therapies, such as T-cell vaccination and T-cell receptor peptide vaccination targeting autoreactive T cells, showed clinical improvement, suggesting a pathogenic role of these lymphocytes in disease progression., Conclusion: T cells appear to be actively involved in the pathogenesis of RA, but several parts of the pathway are hypothetical and further research is needed., (Copyright 2001 by W.B. Saunders Company)

A statistical definition of surrogate endpoints as well as validation criteria was first presented by Prentice. Freedman et al. supplemented these criteria with the so-called proportion explained. Buyse and Molenberghs pointed to inadequacies of these criteria and suggested a new definition of surrogacy based on (i) the relative effect linking the overall effect of treatment on both endpoints and (ii) an individual-level measure of agreement between both endpoints. Using data from a randomized trial, they showed how a potential surrogate endpoint can be studied using a joint model for the surrogate and the true endpoint. Whereas Buyse and Molenberghs restricted themselves to the fairly simple cases of jointly normal and jointly binary outcomes, we treat the situation where the surrogate is binary and the true endpoint is continuous, or vice versa. In addition, we consider the case of ordinal endpoints. Further, Buyse et al. extended the approach of Buyse and Molenberghs to a meta-analytic context. We will adopt a similar approach for responses of a mixed data type., (Copyright 2001 John Wiley & Sons, Ltd.)

Endocrine-disrupting chemicals are considered to be a possible cause of hormone-dependent cancers. In areas of high exposure to pesticides, people are concerned about the long lasting toxicity of pesticides, some of which are possibly hormonally active. We collected for each Belgian municipality (n = 589) the latest mortality statistics from breast and prostate cancer (period 1985-1994) and the latest data on crops and pesticides (1998). In addition, data on possible confounders such as population density, degree of urbanization, industrial activity and the presence of an incinerator were collected as well. The data were analysed with spatial statistics that takes into account the spatial nature of the data. There is a large variation in crops and pesticide exposure among the municipalities, the highest exposure being seen in the fruit production area. Apart from use of defoliants and potato cultivation, no consistent correlation was detected between crops, pesticides and mortality from breast and prostate cancer. Our data cannot support the hypothesis of a relationship between total and class-related pesticide use and breast and prostate cancer mortality. However, the increased mortality due to breast cancer and to a lesser extent due to prostate cancer in traditional potato-growing areas needs attention and more research.

We investigate the critical properties of a one-dimensional stochastic lattice model with n (permutation symmetric) absorbing states. We analyze the cases with n/=3 with exponents z=nu( ||)/nu( perpendicular)=2, nu( perpendicular)=1, and beta=1. These exponents coincide with those of the multispecies (bosonic) branching annihilating random walks. For n=3 we also show that, upon breaking the symmetry to a lower one (Z2), one gets a transition either in the directed percolation, or in the parity conserving class, depending on the choice of parameters.

A method for mutation detection in the alpha-1 antitrypsin gene (protease inhibitor 1; PI) has been developed using denaturing gradient gel electrophoresis of PCR amplified gene fragments. Using this experimental approach, all common phenotypes and mutations could be detected. Denaturing gradient gel electrophoresis (DGGE) was compared with standard isoelectric focusing (IEF) in 20 potential alpha1-antitrypsin deficient patients and their relatives. The genotype determined by DGGE was found to be more reliable in some cases than IEF, which is essential for a proper diagnosis of alpha-1 antitrypsin malfunctioning., (Copyright 2001 Wiley-Liss, Inc.)

The response of antioxidant enzymes to cyclic drought was studied in control non-transformed tobacco (Nicotiana tabacum L. cv. Petit Havana SR1) and two types of transgenic Pssu-ipt tobacco (grafted on wild rootstock and poorly rooted progeny of F1 generation) grown under different conditions of irradiation (greenhouse, referred as high light, versus growth chamber, referred as low light). Water stress cycles started with plants at two contrasting developmental stages, i.e., at the stage of vegetative growth (young) and at the onset of flowering (old). Drought reduced the growth of SR1 plants compared with transgenic ones, particularly, when treatment started in earlier stage of plant development. Relative leaf water content was significantly lower (below 70%) in all transgenic grafts and plants compared with the wild type, irrespective of age, drought, and growth conditions. The response of antioxidant enzymes was significantly dependent on plant type and plant age; nevertheless, growth conditions and water stress also affected enzyme activities. Contrary to non-transgenic tobacco, where about half of glutathione reductase activity was found in older plants, both transgenic types exhibited unchanged activities throughout plant development and stress treatment. No differences were found in catalase activity, although the growth in the greenhouse caused a moderate increase in all older plants. In contrast to non-transgenic and Pssu-ipt rooted plants, peroxidase activities (ascorbate, guaiacol, and syringaldazine peroxidase) in older Pssu-ipt grafts were up to four times higher, irrespective of growth and stress, nevertheless, the effect seemed to be age-dependent. Superoxide dismutase (SOD) activity was affected particularly by plant age but also by growth conditions. Unlike in older plants, water stress caused an increase of SOD activities in all younger plants. The differences observed in activities of enzymes of intermediary metabolism (i.e., malic enzyme and glucose-6-phosphate dehydrogenase) revealed that transgenic grafts probably compensated differently for a decrease of ATP and NADPH than control and transgenic rooted plants under stress.

Event histories play an increasingly important role in medical studies. Examples include times between recurrences of tumours, as with bladder cancer, and between repeated infections, as with chronic granulotomous disease. A general method for generating new distributions is proposed by introducing an intensity function into a density. This procedure yields, as special cases, several distributions already proposed in the literature. The families of distributions based on the Pareto distribution are of particular interest for event history analysis because of their relationship to the Laplace transform of a gamma distribution. They can yield multivariate distributions, with longitudinal (serial) dependence by a procedure similar to updating in the Kalman filter and with uniform dependence in a similar way to copulas. For longitudinal dependence, several such updating procedures are proposed., (Copyright 2001 John Wiley & Sons, Ltd.)

High-resolution (e,2e) measurements of the valence electronic structure and momentum-space electron density distributions of n-butane have been exhaustively reanalyzed in order to cope with the presence of two stable structures in the gas phase, namely the all-staggered and gauche conformers. The measurements are compared to a series of Boltzmann-weighted simulations based on the momentum-space form of Kohn-Sham (B3LYP) orbital densities, and to ionization spectra obtained from high-level [ADC(3)] one-particle Green's Function calculations. Indubitable improvements in the quality of the simulated (e,2e) ionization spectra and electron momentum profiles are seen when the contributions of the gauche form of n-butane are included. Both the one-electron binding energies and momentum distributions consistently image the distortions and topological changes that molecular orbitals undergo due to torsion of the carbon backbone, and thereby exhibit variations which can be traced experimentally. With regard to the intimate relation of (e,2e) cross sections with orbital densities, electron momentum spectroscopy can therefore be viewed as a very powerful, but up to now largely unexploited, conformational probe. The study also emphasizes the influence of thermal agitation in photoionization experiments of all kind.

Objective: Minimally invasive coronary artery bypass grafting (CABG), carried out on the warm beating heart, does not allow conventional myocardial protection. The objective was to investigate the possibility of enhancing tolerance to ischemia during short episodes of coronary artery occlusion, based on a pharmacological approach using a selective Na(+)/H(+)-exchange inhibitor (cariporide) or a serine protease inhibitor (aprotinin)., Methods: Four groups (n=6 in each group) of sheep were subjected to 20 min of normothermic regional ischemia (first lateral branch of the circumflex artery occlusion) followed by 1 h of reperfusion. Regional wall thickening was measured using sonomicrometry, and expressed as the percentage of thickening fraction compared with baseline. Group I was the control with no treatment, group II received cariporide (1 mg/kg administered over 2 min prior to ischemia), group III was treated with aprotinin (2.10(6) kallikrein inactivation units (KIU) load followed by 500.000 KIU/h). Group IV was treated with a combination of cariporide and aprotinin at the same concentrations as in groups II and III, respectively., Results: Wall thickening measurements showed that, compared with control, cariporide was largely able to suppress secondary loss of wall thickening after initial recovery during early reperfusion. Wall thickening in the ischemic/reperfused myocardial area improved from 10+/-31 to 51+/-17% at 1 h of reperfusion (P=0.002). Aprotinin improved wall thickening at the end of 1 h of reperfusion to 70+/-13% (P=0.0001). However, in this group, there was a transient loss of regional contractility similar in amplitude and time course to the one observed in the control group. A combination of cariporide and aprotinin suppressed transient contractile loss and resulted in improved wall thickening at the end of 1 h of reperfusion (65+/-22%, P=0.0002 vs. control). This value was not significantly different from the cariporide (P=0.263) or aprotinin (P=0.704) group., Conclusion: These data indicate that both Na(+)/H(+)-exchange inhibition and aprotinin administration are promising tools for cardioprotection during minimally invasive CABG. A combination of both treatments is able to adequately suppress loss of contractility during early reperfusion as a consequence of reperfusion injury, and results in significantly improved wall thickening at the end of 1 h of reperfusion.

We study the one-dimensional contact process in its quantum version using a recently proposed real-space renormalization technique for stochastic many-particle systems. Exploiting the duality and other properties of the model, we can apply the method for cells with up to 37 sites. After suitable extrapolation, we obtain exponent estimates that are comparable in accuracy with the best known in the literature.

In 1985-1986, a hepatitis B vaccination programme was conducted in a Belgian institution for the mentally handicapped. A group of 97 residents was followed up for 11 years in order to characterize the long-term persistence of hepatitis B antibodies after vaccination. This paper proposes the use of linear mixed-effects models to account for serial correlation and between-individual heterogeneity in the data, while adjusting the analysis for various individual characteristics and important risk factors in the response to vaccination. We propose several model building strategies and focus on the prediction of future levels of antibodies., (Copyright 2001 John Wiley & Sons, Ltd.)

We show that the dissipative Abelian sandpile on a graph L can be related to a random walk on a graph that consists of L extended with a trapping site. From this relation it can be shown, using exact results and a scaling assumption, that the correlation length exponent nu of the dissipative sandpiles always equals 1/d(w), where d(w) is the fractal dimension of the random walker. This leads to a new understanding of the known result that nu=1/2 on any Euclidean lattice. Our result is, however, more general, and as an example we also present exact data for finite Sierpinski gaskets, which fully confirm our predictions.

Formica polyctena antidiuretic factor (FopADF) was purified from a 15% trifluoroacetic acid (TFA) extract of the abdomens of 150,000 worker ants. After solid phase extraction of the crude extract and reversed-phase HPLC on two C(18) columns, an antidiuretic factor was isolated. Tested at a concentration of 1.0 ant-equivalents/µl (ant-eq/µl), the factor reversibly inhibited fluid secretion of isolated Malpighian tubules to 29+/-5% (mean+/-SE, n=24) of the control value. The same concentration of FopADF reversibly depolarized both the basolateral membrane potential (V(bl)), from -21+/-2 mV to -3+/-1 mV (n=5), and the apical membrane potential (V(ap)), from -65+/-5 mV to -20+/-5 mV (n=5). Similar effects on fluid secretion and V(ap) were caused by a TFA extract of the haemolymph of ants with non-secreting tubules. Unfortunately, further purification of FopADF on a C(4) column led to a loss of activity in the fluid secretion assay. This is the first time an endogenous antidiuretic factor acting directly on Malpighian tubules has been partially purified and shown to depolarize the tubule cell membranes.

Myelin proteins, including myelin basic protein (MBP), proteolipid protein (PLP) and myelin oligodendrocyte glycoprotein (MOG) are candidate autoantigens in MS. It is not clear whether MS patients show a predominant reactivity to one or several myelin antigens. We evaluated the IFN-gamma production induced by MBP and MOG and selected MBP-, MOG- and PLP-peptides in MS patients and healthy controls using the IFN-gamma ELISPOT assay. Most MS patients and healthy controls showed a heterogeneous anti-myelin T-cell reactivity. Interestingly in MS patients a positive correlation was found between the anti-MOG and anti-MBP T-cell responses. No myelin peptide was preferentially recognized among the peptides tested (MBP 84-102, 143-168, MOG 1-22, 34-56, 64-86, 74-96, PLP 41-58, 184-199, 190-209). In addition the frequency of IL2R+ MBP reactive T-cells was significantly increased in blood of MS patients as compared with healthy subjects, indicating that MBP reactive T-cells exist in an in vivo activated state in MS patients. Most of the anti-MBP T-cells were of the Th1-type because reactivity was observed in IFN-gamma but not in IL-4 ELISPOT-assays. Using Th1 (IL-12) and Th2 (IL-4) promoting conditions we observed that the cytokine secretion pattern of anti-MBP T-cells still is susceptible to alteration. Our data further indicate that precursor frequency analysis of myelin reactive T-cells by proliferation-based assays may underestimate the true frequency of myelin specific T-cells significantly., (Copyright 2001 Wiley-Liss, Inc.)

Background: Pericardial adhesions subject patients requiring reoperation to potential injuries to the heart, great vessels, and cardiac grafts during the re-sternotomy. These adhesions can severely complicate re-operations by making re-entry hazardous, impeding orientation and visibility, increasing the amount of blood loss, and prolonging the operation time. The efficacy of an in situ-forming polyethylene glycol (PEG) material, CoSeal surgical sealant (CoSeal), for inhibiting cardiac adhesions in an animal model is reported. It is currently estimated that 10-20% of patients undergoing aortic valve replacement and coronary artery bypass grafting (CABG) will require a second operation later in their lives. Successful clinical experience using CoSeal for sealing suture lines of the aorta and CABGs with the data reported here suggest that CoSeal may have multiple applications in cardiac surgery., Methods: In rabbits, a sternotomy and pericardiotomy were performed to expose the heart and the epicardium of the left ventricular surface. The epicardium was abraded for five minutes with dry gauze and cotton to develop punctate bleeding. In treated animals, CoSeal(R) or Tissucol(R) was applied directly to the abraded bleeding epicardium while retracting the pericardium. The pericardium was released, and the material over-sprayed to the cut edges of the pericardium. No material was applied in control animals., Results: At necropsy, CoSeal(R) was found to significantly reduce the formation of adhesions, the tenacity of the adhesions, and the percent of the abraded site with adhesions as compared to surgical control and Tissucol. Tissucol showed no significant difference from the surgical control in any adhesion parameter. CoSeal treated hearts showed re-establishment of the mesothelial layer and tissue morphology similar to a normal un-operated heart. During the clinical cardiac procedures, CoSeal was easily mixed and applied to the suture lines of the aorta and coronary artery grafts. No bleeding was found at the suture lines., Conclusions: In the rabbit cardiac adhesion model, CoSeal significantly reduced the formation of adhesions as compared to surgical control and Tissucol, and demonstrated good biocompatibility. In CoSeal treated patients undergoing cardiopulmonary bypass or vessel repair, sealing was achieved comparable to previous cases using Tissucol fibrin sealant. CoSeal effectively sealed the suture lines of the aorta and coronary artery bypass grafts.

Objective: Autoreactive T cells may contribute to the pathogenesis of rheumatoid arthritis (RA). We studied the T-cell receptor (TCR) V-gene repertoire in the blood and synovium of early and chronic RA patients using polymerase chain reaction-enzyme-linked immunosorbent assay to evaluate possible differences between these patient groups., Results: Over-represented TCR V genes were observed in the synovium, but not in the blood of all RA patients (n = 38). The number of over-represented V genes was higher in the synovium of chronic RA patients (n = 31) than in that of early RA patients (n = 7). The V-gene profile was different among patients, and similar in the two knees for patients with bilateral synovitis (n = 5). The clonal composition of over-represented TCR BV genes in a patient with early RA and a patient with chronic RA was further studied by CDR3 region sequence analysis. A high level of clonal diversity was found in the joints and the blood of the early RA patient, suggesting a polyclonal T-cell expansion. In the chronic RA patient, predominant clonal expansions were observed in the blood and synovium, and some expanded clones were still present 2 yr later., Conclusions: The observation of similar T-cell populations in both joints in patients with bilateral synovitis and the persistence of clonally expanded T cells for more than 2 yr in the joints of a chronic RA patient may indicate a pathogenic role for these cells in the disease process.

In a previous paper [I. Bena, M. Malek Mansour, and F. Baras, Phys. Rev. E 59, 5503 (1999)] the statistical properties of linearized Kolmogorov flow were studied, using the formalism of fluctuating hydrodynamics. In this paper the nonlinear regime is considered, with emphasis on the statistical properties of the flow near the first instability. The normal form amplitude equation is derived for the case of an incompressible fluid and the velocity field is constructed explicitly above (but close to) the instability. The relative simplicity of this flow allows one to analyze the compressible case as well. Using a perturbative technique, it is shown that close to the instability threshold the stochastic dynamics of the system is governed by two coupled nonlinear Langevin equations in Fourier space. The solution of these equations can be cast into the exponential of a Landau-Ginzburg functional, which proves to be identical to the one obtained for the case of an incompressible fluid. The theoretical predictions are confirmed by numerical simulations of the nonlinear fluctuating hydrodynamic equations.

We describe a simple method for obtaining functionally and morphologically intact primary cultures of cells from the medullary thick ascending limb of rabbit kidneys. After digesting dissected fragments of the inner stripe of the outer medulla with collagenase, a suspension of tubule fragments is obtained, the vast majority of which are medullary thick ascending limb (MTAL) segments. These are identified individually by their morphological appearance and large amounts are collected with a micropipette mounted on a micromanipulator. This ensures maximal homogeneity of the starting material. Monolayers of cells grow out of these MTAL segments after seeding them onto collagen-coated, permeable filter supports. During the week following confluence, the cultures exhibit an apical side-positive transepithelial potential difference. Electron microscopic examination shows a monolayer of polarised cells with characteristics of distal tubular cells. The primary cultures express Tamm-Horsfall protein at their apical surface. Additional evidence for their differentiation and polarisation is the net ammonium influx, which occurs at very high rates across the apical membrane and is much slower across the basolateral membrane, as judged by measurements of intracellular pH. Adenosine 3',5'-cyclic monophosphate (cAMP) production is stimulated by arginine-vasopressin, calcitonin or isoproterenol (all 1 micromol/l). Intracellular calcium signalling is observed after stimulation with 1 micromol/l adenosine, adenosine 5'-triphosphate (ATP) and bradykinin. In addition, we compared these characteristics with those of TALH-SVE cell monolayers, an established immortalised cell line of the same origin.

This report describes the technique and procedure for perfusing an isolated rabbit kidney with 25 ml heparinized autologous blood in a closed circuit including a pump and an oxygenator. The duration of the operative ischaemia was 5-8 min; the perfusion lasted 2.5 hours. An additional infusion was made to compensate for urinary losses. Renal blood flow increased progressively from 2.01+/-0.1 to 2.65+/-0.22* ml/g kidney weight (kw) per min (*P<0.05). Between the first (P1) and the last (P4) urine collection period the glomerular filtration rate (GFR) fell from 288+/-25 to 217+/-38* microl/g kw per min, urine flow from 5.58+/-1.13 to 4.91+/-0.75 microl/g kw per min, Na+ excretion from 1.07+/-0.19 to 0.63+/-0.12* micromol/g kw per min, K+ excretion from 0.46+/-0.03 to 0.28+/-0.05* micromol/g kw per min, P excretion from 2.5+/-0.2 to 2.0+/-0.5 microg/g kw per min, Ca excretion from 0.4+/-0.1 to 0.12+/-0.05* microg/g kw per min, creatinine excretion from 6.94+/-0.32 to 5.68+/-0.54 microg/g kw per min, glucose excretion from 18.2+/-3.2 to 1.6+/-0.5* microg/g kw per min, the free water clearance (CH2O) from -6.57+/-0.85 to -5.10+/-1.31 microl/g kw per min and urine osmolality from 600+/-52 to 590+/-105 mOsm/kg, urea excretion from 0.75+/-0.16 to 0.95+/-0.13 micromol/g kw per min. Excretion of glucose, P or Ca was observed only above a given plasma threshold value, and no transport maximum was found for glucose or P. Ca reabsorption paralleled the Na reabsorption. The proximal tubule pressure, measured within the 1st h of perfusion, was 12.5+/-1.1 mm Hg. Histological examination at the end of the perfusion showed dilatation of the tubules as in the non-perfused kidneys, and the presence of numerous bacteria. Hypertonic urine (380-1110 mOsm/kg) was observed in the presence of vasopressin, in the latter's absence the urine was hypotonic urine (206-278 mOsm/kg). There was no correlation between renal plasma flow and the GFR. CH2O increased with increasing filtered Na+ load. In conclusion, the blood-perfused, isolated rabbit kidney has a fairly constant functional capacity for approximately 2 h.

In this study, we have investigated the distribution of the enzyme nucleoside triphosphate diphosphohydrolase-1 (NTPDase1; EC 3.6.1.5) in a subset of pig tissues by biochemical activity and Western blotting with antibodies against porcine NTPDase1. The highest expression of this enzyme was found in vascular endothelium, smooth muscle, spleen and lung. The complete cDNA of NTPDase1 from aorta endothelial cells was sequenced using primer walking. The protein consists of 510 amino acids, with a calculated molecular mass of 57 756 Da. The amino-acid sequence indicated seven putative N-glycosylation sites and one potential intracellular cGMP- and cAMP-dependent protein kinase phosphorylation site. As expected, the protein has a very high homology to other known mammalian ATPDases and CD39 molecules, and includes all five apyrase conserved regions. Expression of the complete cDNA in COS-7 cells confirmed that NTPDase1 codes for a transmembrane glycoprotein with ecto-ATPase and ecto-ADPase activities. Two proteolytic products of NTPDase1, with molecular mass of 54 and 27 kDa, respectively, were consistently present in proteins from transfected COS-7 cells and in particulate fractions from different tissues. A trypsin cleavage site, giving rise to these two cleavage products, was identified. In order to remain enzymatically active, the two cleavage products have to interact by non-covalent interactions.

In secondary ion mass spectrometry, the detection of MCs+ clusters (with M an element of the specimen) under a Cs bombardment is frequently used for the quantification of major elements. Despite some very good results obtained by this method, some problems still remain. In order to gain some more insight into these problems, the formation mechanism of the MCs+ clusters is investigated using a Monte Carlo model. It is shown that the majority of the constituent particles of the formed clusters are initially first or second neighbor atoms at the surface and that the velocity distribution of the MCs+ clusters becomes broader and peaked at higher velocities with increasing surface binding energy of the M atom. In addition, it is demonstrated that the interaction potential between the M and Cs+ particle has no influence on the velocity distribution of the MCs+ clusters. On the other hand, the cluster formation probability, defined as the probability that a sputtered M and Cs+ particle will form a MCs+ cluster, is extremely sensitive to this interaction potential. It is also shown that the cluster formation probability decreases with increasing surface binding energy. Finally, a good correspondence is obtained between the calculated and experimental velocity distributions of MCs+ clusters sputtered from different monoatomic materials. As a consequence, the Monte Carlo model and the discussed results can be validated.

This study investigates the usefulness of lifetime measurements of Sodium Green for evaluating intracellular Na+ concentration ([Na+]i) in HeLa cells. Frequency-domain lifetime measurements are performed in HeLa cells and in different buffer solutions (with and without K+ and bovine serum albumin). In all cases, the fluorescence decays of Sodium Green are multiexponential, with decay times independent of [Na+]. Three relaxation times are found in the various buffer solutions. Binding of the indicator to albumin results in an increase in the long and intermediate decay times. For Sodium Green inside HeLa cells, the intensity decay can be approximated by a biexponential. The ratio of the fractional intensity of the long decay time (tau2 = 2.4 +/- 0.2 ns) to that of the short component (tau1 = 0.4 +/- 0.1 ns) increases with [Na+]i. The changes in fluorescence decay with [Na+] are significantly less pronounced in cells as compared with the buffer solutions. Similar values for the resting [Na+]i were estimated from lifetime measurements of Sodium Green and from ratiometric measurements using SBFI. Alternatively, [Na+]i can be monitored by measuring only the phase angle at the modulation frequency of 160 MHz. The usefulness of this latter approach is demonstrated by following the changes in [Na+]i induced by reversible inhibition of the Na+/K+ pump.

Membranes of pig kidney cortex tissue were solubilized in the presence of Triton X-100. Partial purification of ATP diphosphohydrolase (ATPDase) was achieved by successive chromatography on concanavalin A-Sepharose, Q-Sepharose Fast Flow, and 5'-AMP-Sepharose 4B. Monoclonal antibodies against ATPDase were generated. Further purification of the ATPDase was obtained by immunoaffinity chromatography with these monoclonal antibodies. NH(2)-terminal amino acid sequencing of the 78-kDa protein showed a sequence very homologous to mammalian CD39. The protein is highly glycosylated, with a nominal molecular mass of approximately 57 kDa. The purified enzyme hydrolyzed di- and triphosphates of adenosine, guanosine, cytidine, uridine, inosine, and thymidine, but AMP and diadenosine polyphosphates could not serve as substrates. All enzyme activities were dependent on divalent cations and were partially inhibited by 10 mM sodium azide. The distribution of the enzyme in pig kidney cortex was examined immunohistochemically. The enzyme was found to be present in blood vessel walls of glomerular and peritubular capillaries.

The behavior of the sodium indicator sodium-binding benzofuran isophthalate (SBFI) is investigated in HeLa cells by time-resolved fluorescence microscopy. The fluorescence relaxation of SBFI in HeLa cells can be described by a triexponential for intracellular sodium concentration ([Na(+)](i)) between 0 and 90 mM. Changes in [Na(+)](i) affect neither the fluorescence relaxation times (0.21, 0. 60, and 2.7 ns) nor the average decay time (2.2 ns). The preexponential factor of the shortest decay time is negative. However, the ratio of the fluorescence excitation signal at 340 nm to that at 380 nm increases with [Na(+)](i). To elucidate the behavior of SBFI in cells, experiments are performed on SBFI in buffer at various concentrations of sodium, potassium, and bovine serum albumin (BSA) and at various viscosities. The fluorescence decay is triexponential only in the presence of BSA. The relaxation times are independent of [Na(+)] and [BSA]. The preexponential factor of the shortest decay time is negative from a certain [BSA] on, which depends on [Na(+)]. The data indicate that interactions with intracellular components rather than microviscosity influence the SBFI behavior in cells. A model is suggested in which the fluorescence intensities are mainly determined by the signals from the Na(+) subsetSBFI and SBFI subsetprotein complexes., (Copyright 2000 Academic Press.)

The most commonly used models for categorical repeated measurement data are log-linear models. Not only are they easy to fit with standard software but they include such useful models as Markov chains and graphical models. However, these are conditional models and one often also requires the marginal probabilities of responses, for example, at each time point in a longitudinal study. Here a simple method of matrix manipulation is used to derive the maximum likelihood estimates of the marginal probabilities from any such conditional categorical repeated measures model. The technique is applied to the classical Muscatine data set, taking into account the dependence of missingness on previous observed values, as well as serial dependence and a random effect., (Copyright 2000 John Wiley & Sons, Ltd.)

Matching in case-control studies is a situation in which one wishes to make inferences about a parameter of interest in the presence of nuisance parameters. The usual approach is to apply a conditional likelihood. A bivariate latent class log-linear model for binomial responses is shown to yield a standard likelihood identical to the usual conditional one. This extension of the Rasch model for binary responses gives consistent estimates and a suitable likelihood function for cases matched with any fixed number of controls., (Copyright 2000 John Wiley & Sons, Ltd.)

Pathogenic autoreactive T cells can be targeted by T cell vaccination (TCV), a procedure in which patients are immunized with autologous attenuated pathogenic T cells. We reported previously that TCV with myelin basic protein (MBP) reactive T cell clones in multiple sclerosis (MS) patients induced T cell immune responses, resulting in a clonal depletion of MBP reactive T cells in all patients. Five years after TCV, MBP reactive T cells were observed in five out of nine MS patients. These clones had a different clonal origin from those isolated before vaccination. We have studied the cytokine profile, cytotoxicity and epitope specificity of these reappearing clones. Our data indicate that the clones express similar effector functions as those isolated before TCV, suggesting that they also could play a pathogenic role in the disease. We demonstrated that these clones can be depleted by an additional sequence of immunizations. These findings may be relevant to other T cell targeted immunotherapies for MS and other autoimmune diseases.

Recent cases of fraud in clinical trials have attracted considerable media attention, but relatively little reaction from the biostatistical community. In this paper we argue that biostatisticians should be involved in preventing fraud (as well as unintentional errors), detecting it, and quantifying its impact on the outcome of clinical trials. We use the term 'fraud' specifically to refer to data fabrication (making up data values) and falsification (changing data values). Reported cases of such fraud involve cheating on inclusion criteria so that ineligible patients can enter the trial, and fabricating data so that no requested data are missing. Such types of fraud are partially preventable through a simplification of the eligibility criteria and through a reduction in the amount of data requested. These two measures are feasible and desirable in a surprisingly large number of clinical trials, and neither of them in any way jeopardizes the validity of the trial results. With regards to detection of fraud, a brute force approach has traditionally been used, whereby the participating centres undergo extensive monitoring involving up to 100 per cent verification of their case records. The cost-effectiveness of this approach seems highly debatable, since one could implement quality control through random sampling schemes, as is done in fields other than clinical medicine. Moreover, there are statistical techniques available (but insufficiently used) to detect 'strange' patterns in the data including, but no limited to, techniques for studying outliers, inliers, overdispersion, underdispersion and correlations or lack thereof. These techniques all rest upon the premise that it is quite difficult to invent plausible data, particularly highly dimensional multivariate data. The multicentric nature of clinical trials also offers an opportunity to check the plausibility of the data submitted by one centre by comparing them with the data from all other centres. Finally, with fraud detected, it is essential to quantify its likely impact upon the outcome of the clinical trial. Many instances of fraud in clinical trials, although morally reprehensible, have a negligible impact on the trial's scientific conclusions., (Copyright 1999 John Wiley & Sons, Ltd.)

The multivariate power exponential distribution, a member of the multivariate elliptically contoured family, provides a useful generalization of the multivariate normal distribution for the modeling of repeated measurements. Both light and heavy tailed distributions are included. The covariance matrix retains its interpretation so that it can easily be structured for serial dependence and several levels of variance components. A crossover trial on insulin applied to rabbits, with a series of repeated measurements within each period, is analyzed by means of this distribution using autocorrelation and two levels of variance components.