A multinational, randomised, 12-week study comparing the effects of donepezil and galantamine in patients with mild to moderate Alzheimer's disease

To compare directly, in the same patient cohort, the ease of use and tolerability of donepezil and galantamine in the treatment of Alzheimer's disease (AD), and investigate the effects of both treatments on cognition and activities of daily living (ADL).

Effects of the novel (Pro(3))GIP antagonist and exendin(9-39)amide on GIP- and GLP-1-induced cyclic AMP generation, insulin secretion and postprandial insulin release in obese diabetic (ob/ob) mice: evidence that GIP is the major physiological incretin

AIMS/HYPOTHESIS: This study examined the biological effects of the GIP receptor antagonist, (Pro3)GIP and the GLP-1 receptor antagonist, exendin(9-39)amide.

METHODS: Cyclic AMP production was assessed in Chinese hamster lung fibroblasts transfected with human GIP or GLP-1 receptors, respectively. In vitro insulin release studies were assessed in BRIN-BD11 cells while in vivo insulinotropic and glycaemic responses were measured in obese diabetic ( ob/ ob) mice.

RESULTS: In GIP receptor-transfected fibroblasts, (Pro(3))GIP or exendin(9-39)amide inhibited GIP-stimulated cyclic AMP production with maximal inhibition of 70.0+/-3.5% and 73.5+/-3.2% at 10(-6) mol/l, respectively. In GLP-1 receptor-transfected fibroblasts, exendin(9-39)amide inhibited GLP-1-stimulated cyclic AMP production with maximal inhibition of 60+/-0.7% at 10(-6) mol/l, whereas (Pro(3))GIP had no effect. (Pro(3))GIP specifically inhibited GIP-stimulated insulin release (86%; p<0.001) from clonal BRIN-BD11 cells, but had no effect on GLP-1-stimulated insulin release. In contrast, exendin(9-39)amide inhibited both GIP and GLP-1-stimulated insulin release (57% and 44%, respectively; p<0.001). Administration of (Pro(3))GIP, exendin(9-39)amide or a combination of both peptides (25 nmol/kg body weight, i.p.) to fasted (ob/ob) mice decreased the plasma insulin responses by 42%, 54% and 49%, respectively (p<0.01 to p<0.001). The hyperinsulinaemia of non-fasted (ob/ob) mice was decreased by 19%, 27% and 18% (p<0.05 to p<0.01) by injection of (Pro3)GIP, exendin(9-39)amide or combined peptides but accompanying changes of plasma glucose were small.

CONCLUSIONS/INTERPRETATION: These data show that (Pro(3))GIP is a specific GIP receptor antagonist. Furthermore, feeding studies in one commonly used animal model of obesity and diabetes, (ob/ob) mice, suggest that GIP is the major physiological component of the enteroinsular axis, contributing approximately 80% to incretin-induced insulin release.

The contested notion of a pluralist School Ethos

Debates around the importance of school ethos have gathered pace in recent years. Whilst it is not clear why this concept has become increasingly important in the educational vernacular the marketisation of education seems to have had some effect. As schools are forced to compete they have become concerned to identify and promote their 'Unique Selling Points' as a means of attracting and maintaining a long term 'customer' base. Defining a school in terms of its particular 'ethos' therefore offers a useful means of identifying and encapsulating the particular strengths of the school. It is thus not uncommon for heads to market their schools on the basis of their endorsing a 'liberal ethos' a 'caring ethos' or a 'sporting ethos' (Gardner, 2003).

The purpose of this chapter is to use empirical evidence to explore the meaning of a 'pluralist ethos' or 'integrated ethos', within the integrated school context in Northern Ireland.

Mapping the Education System in Northern Ireland

In this chapter we provide a broad overview of the education system discussing both the system of schooling and the network of both statutory and voluntary bodies that are responsible for the administration and management of the system. We begin with an examination of the administrative structures. This network of statutory and non-statutory bodies has increased in number over recent years, illustrating the diversity of vested interests in the system. This is followed by an examination of the system of schooling and the chapter concludes by exploring the significance of changes that have taken place in terms of its implications for a more pluralist society where each is accorded parity of esteem and equality of opportunity.

Glucose-induced oxidative stress in mesangial cells.

Background: Hyperglycaemia is a well recognized pathogenic factor of long term complications in diabetes mellitus. Hyperglycaemia not only generates reactive oxygen species but also attenuates antioxidant mechanisms creating a state of oxidative stress. Methods: Porcine mesangial cells were cultured in high glucose (HG) for ten days to investigate the effects on the antioxidant defences of the cell. Results: Mesangial cells cultured in HG conditions had significantly reduced levels of glutathione (GSH) compared with those grown in normal glucose (NG). The reduced GSH levels were accompanied by decreased gene expression of both subunits of gamma-glutamylcysteine synthetase (gamma-GCS), the rate-limiting enzyme in de novo synthesis of GSH. Elevated levels of intracellular malondialdehyde (MDA) were found in cells exposed to HG conditions. HG also caused elevated mRNA levels of the antioxidant enzymes CuZn superoxide dismutase (SOD) and MnSOD. These changes were accompanied by increased mRNA levels of extracellular matrix proteins (ECM), fibronectin (FN) and collagen IV (CIV). Addition of antioxidants to high glucose caused a significant reversal of FN and CIV gene expression; alpha-lipoic acid also upregulated gamma-GCS gene expression and restored intracellular GSH and MDA levels. Conclusions: We have demonstrated the existence of glucose induced-oxidative stress in mesangial cells as evidenced by elevated MDA and decreased GSH levels. The decreased levels of GSH are as a result of decreased mRNA expression of gamma-GCS within the cell. Antioxidants caused a significant reversal of FN and CIV gene expression suggesting an aetiological link between oxidative stress and increased ECM protein synthesis.