Neurophysiological evidence of impaired attention and working memory in untreated hematologic cancer patients.

OBJECTIVE: Neuroimaging studies of hematologic cancer patients report altered activity in dorsal attention and central executive networks. To determine the consequences of these altered brain networks, we evaluated neurophysiological correlates of attention and working memory in hematologic cancer patients prior to initiating treatment. METHODS: Hematologic cancer patients (19-80 years) were excluded for premorbid cognitive impairment, prior non-hematologic cancer diagnosis, and prior chemotherapy. Attention was manipulated by presenting an irrelevant spatial cue prior to visual search displays. Working memory was manipulated by presenting irrelevant distractors within memory displays. Electroencephalogram was recorded during task performance. RESULTS: Patients (n = 28) and controls (n = 15) were balanced on age, gender, and education. Spatial cues evoked larger N2pc amplitudes, a correlate of spatial attention, in patients than controls (p < .05; Cohen's d > 0.7). Memory distractors evoked larger contralateral delay activity amplitudes, a correlate of working memory load, in patients (p = .028; Cohen's d = 1.1) but not controls (p = .64). CONCLUSIONS: Prior to initiating treatment, hematologic cancer patients demonstrated poor control over spatial attention and working memory, consistent with altered dorsal attention and central executive network activity. SIGNIFICANCE: Hematologic cancer patients may be at a higher risk for selecting, processing, and storing distracting information that would compete with more immediate goal-related behaviors.

Virological response to protease inhibitor therapy in an HIV clinic cohort.

OBJECTIVE: New antiretroviral strategies aim to reduce plasma HIV RNA (viral load) to below the limits of detectability of assays with the objective of reducing viral replication in order to stop or reverse the pathogenic process and prevent development of drug resistance. First use of a protease inhibitor might offer the most realistic chance of achieving this aim. Our objective was to study the virological response to protease inhibitors in patients taking them for the first time. METHODS: A total of 901 patients from a large outpatient clinic were followed a mean of 15 months from the time of starting a protease inhibitor until 1 May 1998. Viral load and CD4 cell count measurements were made on average every 34 days. RESULTS: Overall there was a 79% [95% confidence interval (CI), 76-82] probability of the patients achieving a viral load < 500 copies/ml by 24 weeks after starting the protease inhibitor. In a multiple Cox regression model, those with lower initial viral load [relative hazard (RH), 0.72; P < 0.0001], higher CD4 cell count (RH, 1.07; P = 0.002), those starting other new drugs at same time as the protease inhibitor (RH, 1.46 for two versus none; P = 0.003), those who were antiretroviral-naive, and those using indinavir or nelfinavir were more likely to achieve such levels. In those 651 patients achieving viral load < 500 copies/ml within 24 weeks, there was an estimated 53% (95% CI, 51-55) probability of rebound of viral load to > 500 copies/ml by 52 weeks from the first undetectable value. Again, those who had started other new drugs at the same time as the protease inhibitor (RH, 0.57; P = 0.003 for starting two versus none) tended to experience a lower probability of viral load rebound, as did those with higher initial CD4 cell count (RH, 0.87 per 100 x 10(6)/l higher; P = 0.0007). Those who took saquinavir achieved less durable virological responses than those who took other protease inhibitors. CONCLUSIONS: Starting protease inhibitor therapy with two other new antiretroviral drugs simultaneously with protease inhibitor therapy offers a better best chance of achieving sustained viral load < 500 copies/ml than starting fewer new drugs.

Patterns of fatigue and activity and rest during adjuvant breast cancer chemotherapy.

PURPOSE/OBJECTIVES: To describe the patterns of fatigue and activity and rest and their relationship during adjuvant breast cancer chemotherapy. DESIGN: Prospective, descriptive, repeated measures. SETTING: Midwestern oncology clinics and subjects' homes. SAMPLE: 72 women, ages 30-69, who were receiving chemotherapy after surgery for stage I or II breast cancer. METHODS: The Piper Fatigue Scale was used to measure fatigue 48 hours after each treatment and at treatment cycle midpoints for three cycles. Wrist actigraphs were used to measure activity and rest cycles for 96 hours at each treatment and for 72 hours at each cycle midpoint. MAIN RESEARCH VARIABLES: Fatigue, activity and rest cycles, chemotherapy protocols (doxorubicin- or non-doxorubicin-based protocols). FINDINGS: Total and subscale fatigue scores were significantly different over time, with scores higher at treatments and lower at cycle midpoints. Activity levels were significantly different over time in a mirror-image pattern of fatigue. Fatigue was negatively correlated with activity levels at all times except the cycle 2 midpoint and positively correlated with awakenings at night only at the cycle 2 midpoint. Activity levels were significantly lower in women receiving doxorubicin-based protocols. CONCLUSIONS: Roller-coaster patterns of fatigue and activity have not been previously reported in this patient population. Examination of the inverse relationship between fatigue and activity will assist nurses in the development and testing of interventions to modify fatigue. IMPLICATIONS FOR NURSING PRACTICE: Women should be instructed to monitor the intensity of fatigue and encouraged to maintain activity levels balanced with efficient rest periods. Nurses can inform women that these patterns may be expected to be similar during the first three chemotherapy cycles.

Factors influencing oral cavity status during high-dose antineoplastic therapy: a secondary data analysis.

PURPOSE/OBJECTIVES: To identify factors associated with oral cavity status in patients receiving high-dose antineoplastic therapy. DESIGN: Descriptive, correlational secondary analysis. SETTING: Midwestern university oncology special care unit. SAMPLE: 50 males and females, ages 15-69. METHODS: The Oral Assessment Guide (OAG) was used to assess oral cavity status every shift throughout hospitalization. Additional data were collected by chart audit. Correlations and Cox regression analysis were performed. MAIN RESEARCH VARIABLES: Oral cavity status, absolute granulocyte count, blood urea nitrogen (BUN), creatinine, mean OAG score during the preparative regimen (prep-OAG), age, and total body irradiation (TBI). FINDINGS: Elevated BUN and creatinine, higher prep-OAG, older age, and TBI were associated with higher OAG scores. Cox analysis revealed that TBI was predictive of an OAG score > or = 16, and an OAG score > or = 18 was predictive of death by day +20. CONCLUSIONS: Patients who receive TBI and chemotherapy in combination are most likely to experience severely compromised oral cavity status. Those who are older, have poorer oral status, and have decreased renal function are at increased risk. IMPLICATIONS FOR NURSING PRACTICE: High-risk patients must be identified early, and oral assessments and care must be given consistently to decrease morbidity and potential mortality.

The influence of daytime inactivity and nighttime restlessness on cancer-related fatigue.

PURPOSE/OBJECTIVES: To identify indicators involving circadian activity/rest cycles associated with higher levels of cancer-related fatigue (CRF) during the first three chemotherapy cycles after surgery for stage I/II breast cancer. DESIGN: Prospective, descriptive, repeated measures. SETTING: Midwestern oncology clinics and subjects' homes. SAMPLE: 72 women, ages 33-69 and free of unstable chronic illnesses, entered the study. Complete data were obtained from 30-47 subjects at each time. METHODS: CRF was measured using the Piper Fatigue Scale at the start and midpoint of each chemotherapy cycle. Circadian activity/rest indicators were obtained using Mini-Motionlogger wrist actigraphs for 96 hours at the start of each treatment and for 72 hours at the midpoint of each chemotherapy cycle. MAIN RESEARCH VARIABLES: Fatigue and circadian activity/rest indicators. FINDINGS: Women who were less active and had increased night awakenings reported higher CRF levels at all three cycle midpoints, with the strongest association being number of night awakenings. During the third chemotherapy cycle, women who were less active during the day, took more naps, and spent more time resting during a 24-hour period experienced higher CRF. CONCLUSIONS: Women whose sleep is disrupted at cycle midpoints are at risk for CRF. The cumulative effects of less daytime activity, more daytime sleep, and night awakenings are associated with higher CRF levels. IMPLICATIONS FOR NURSING PRACTICE: Assessment of CRF and night awakenings at the midpoints of each chemotherapy cycle and development of nursing interventions to promote daytime activity and nighttime rest are key to managing fatigue and preventing loss of biologic rhythmicity.

Correlates of fatigue during and following adjuvant breast cancer chemotherapy: a pilot study.

PURPOSE/OBJECTIVES: To examine patterns of and relationships between activity, sleep, symptom distress, health status, and fatigue during and following adjuvant breast cancer chemotherapy with doxorubicin and cyclophosphamide. DESIGN: Prospective, descriptive, repeated measures. SETTING: Midwestern, urban, oncology clinics. SAMPLE: 14 women, ages 32-69 (X = 52.4), with stage I or II breast cancer receiving four cycles of chemotherapy. METHODS: Wrist actigraph, modified Morin Sleep Diary, Symptom Experience Scale, Medical Outcomes Study-Short Form 36, and Piper Fatigue Scale were used to collect data two days prior to and during the 21-day cycle 3, and for three days at three weeks and two months following treatment 4. MAIN RESEARCH VARIABLES: Activity, sleep, symptom distress, health status, and fatigue. FINDINGS: Fluctuating patterns of lowered activity, disturbed sleep, mild-to-moderate symptom distress, and moderate fatigue were identified. Mean activity levels ranged from 65%-80% of norms during and following treatments. Patterns of sleep (total rest, sleep latency, wake after sleep onset, and sleep efficiency) differed from established norms. Patients experienced the highest levels of fatigue and symptom distress during the first four days after treatment 3. Correlates of fatigue were greater symptom distress, lower activity, and poorer physical and social health status; variables representing disturbed sleep trended toward associations with fatigue. CONCLUSION: Activity, sleep, symptom distress, and health status cluster in patterns associated with either lower or higher fatigue. IMPLICATIONS FOR NURSING PRACTICE: Efforts to manage symptoms, remain active, and obtain quality sleep, especially in women with poorer health status, may assist in modifying fatigue.

The self-report of punitive childhood experiences of young adults and adolescents.

A questionnaire designed to assess childhood disciplinary experiences was administered to a large sample of university students. The responses of these subjects indicated many of these predominantly middle-class young adults had experienced disciplinary activities that could be considered abusive. The results provide prevalence data on child abuse histories in a nonclinical sample and were seen as supporting the idea that physical abuse of children is widespread and not restricted to groups identified on the basis of clinical service or social deviance. Regardless of the criterion for physical abuse applied to the data, most respondents who met a criterion for having been abused failed to label themselves as having been abused. Additionally, correlations between severe physical punishment and abuse-related domains were shown to obtain in these nonclinical samples in a manner consistent with descriptions of abusive families in the clinical literature. A second study conducted with truly abused and nonabused adolescents established the validity of the questionnaire approach used in this research, and the two studies indicated the feasibility of conducting research on physical child abuse in natural collectivities of nonclinical subjects.

State-of-the-art patient care. The impact of doctorally prepared clinical nurses.

Delivery of state-of-the-art patient care requires new models to foster the development of professional nurses and integrate practice, research, and education. The Chief Nursing Officer of University Hospital/Associate Dean of the College of Nursing at a tertiary health science center positioned doctorally prepared nurses in clinical practice settings to assist in actualizing a vision of state-of-the-art patient care. Strategic targets for performance improvement included building collaboration between the college and hospital, supporting advanced education for nurses, moving the nursing culture from one of co-dependence to one of professionalism, fostering research at the unit level, and capitalizing on the strengths of nurse leaders. Creating an environment where staff nurses use critical thinking skills and access their advanced practice nurse (APN) resources as they do their work has been a win-win-win situation for the patients, the hospital, and the college at the health science center.

Advanced practice roles for nurses in tomorrow's healthcare systems.

Advanced practice nurses (APNs) have traditionally been a diverse group in terms of titles, education, credentials, and roles. The classification of APN usually encompasses the nurse practitioner (NP), certified nurse midwife (CNM), certified registered nurse anesthetist (CRNA), and clinical nurse specialist (CNS). NP, CRNA, and CNM roles have been more clearly delineated than the CNS roles. In light of healthcare reform, the CNS roles have been critically reviewed and analyzed. Attempts have been made to clarify responsibilities and outcomes, and to quantify the financial impact of this role. In this article, seven APN roles clearly defined in terms of minimal qualifications and competencies critical to accomplishment of the duties, responsibilities, and expected outcomes are presented. Comparison of competency requirements are also presented. The roles presented are designed to facilitate healthcare institutions in meeting the demands for serving patients with increasingly complex needs, as well as cost-containment goals.

Human blood and marrow side population stem cell and Stro-1 positive bone marrow stromal cell numbers decline with age, with an increase in quality of surviving stem cells: correlation with cytokines.

Hematological deficiencies increase with aging leading to anemias, reduced hematopoietic stress responses and myelodysplasias. This study tested the hypothesis that side population hematopoietic stem cells (SP-HSC) would decrease with aging, correlating with IGF-1 and IL-6 levels and increases in bone marrow fat. Marrow was obtained from the femoral head and trochanteric region of the femur at surgery for total hip replacement (N=100). Whole trabecular marrow samples were ground in a sterile mortar and pestle and cellularity and fat content determined. Marrow and blood mononuclear cells were stained with Hoechst dye and the SP-HSC profiles acquired. Marrow stromal cells (MSC) were enumerated flow cytometrically employing the Stro-1 antibody, and clonally in the colony forming unit fibroblast (CFU-F) assay. Plasma levels of IGF-1 (ng/ml) and IL-6 (pg/ml) were measured by ELISA. SP-HSC in blood and bone marrow decreased with age but the quality of the surviving stem cells increased. MSC decreased non-significantly. IGF-1 levels (mean=30.7, SEM=2) decreased and IL-6 levels (mean=4.4, SEM=1) increased with age as did marrow fat (mean=1.2mmfat/g, SEM=0.04). There were no significant correlations between cytokine levels or fat and SP-HSC numbers. Stem cells appear to be progressively lost with aging and only the highest quality stem cells survive.

Regional white matter atrophy--based classification of multiple sclerosis in cross-sectional and longitudinal data.

BACKGROUND AND PURPOSE: The different clinical subtypes of multiple sclerosis (MS) may reflect underlying differences in affected neuroanatomic regions. Our aim was to analyze the effectiveness of jointly using the inferior subolivary medulla oblongata volume (MOV) and the cross-sectional area of the corpus callosum in distinguishing patients with relapsing-remitting multiple sclerosis (RRMS), secondary-progressive multiple sclerosis (SPMS), and primary-progressive multiple sclerosis (PPMS). MATERIALS AND METHODS: We analyzed a cross-sectional dataset of 64 patients (30 RRMS, 14 SPMS, 20 PPMS) and a separate longitudinal dataset of 25 patients (114 MR imaging examinations). Twelve patients in the longitudinal dataset had converted from RRMS to SPMS. For all images, the MOV and corpus callosum were delineated manually and the corpus callosum was parcellated into 5 segments. Patients from the cross-sectional dataset were classified as RRMS, SPMS, or PPMS by using a decision tree algorithm with the following input features: brain parenchymal fraction, age, disease duration, MOV, total corpus callosum area and areas of 5 segments of the corpus callosum. To test the robustness of the classification technique, we applied the results derived from the cross-sectional analysis to the longitudinal dataset. RESULTS: MOV and central corpus callosum segment area were the 2 features retained by the decision tree. Patients with MOV >0.94 cm(3) were classified as having RRMS. Patients with progressive MS were further subclassified as having SPMS if the central corpus callosum segment area was <55.12 mm(2), and as having PPMS otherwise. In the cross-sectional dataset, 51/64 (80%) patients were correctly classified. For the longitudinal dataset, 88/114 (77%) patient time points were correctly classified as RRMS or SPMS. CONCLUSIONS: Classification techniques revealed differences in affected neuroanatomic regions in subtypes of multiple sclerosis. The combination of central corpus callosum segment area and MOV provides good discrimination among patients with RRMS, SPMS, and PPMS.

Medulla oblongata volume: a biomarker of spinal cord damage and disability in multiple sclerosis.

BACKGROUND AND PURPOSE: While brain MR imaging is routinely performed, the MR imaging assessment of spinal cord pathology in multiple sclerosis (MS) is less frequent in clinical practice. The purpose of this study was to determine whether measurements of medulla oblongata volume (MOV) on routine brain MR imaging could serve as a biomarker of spinal cord damage and disability in MS. MATERIALS AND METHODS: We identified 45 patients with MS with both head and cervical spinal cord MR imaging and 29 age-matched and sex-matched healthy control subjects with head MR imaging. Disability was assessed by the expanded disability status scale (EDSS) and ambulation index (AI). MOV and upper cervical cord volume (UCCV) were manually segmented; semiautomated segmentation was used for brain parenchymal fraction (BPF). These measures were compared between groups, and linear regression models were built to predict disability. RESULTS: In the patients, MOV correlated significantly with UCCV (r = 0.67), BPF (r = 0.45), disease duration (r = -0.64), age (r = -0.47), EDSS score (r = -0.49) and AI (r = -0.52). Volume loss of the medulla oblongata was -0.008 cm(3)/year of age in patients with MS, but no significant linear relationship with age was found for healthy control subjects. The patients had a smaller MOV (mean +/- SD, 1.02 +/- 0.17 cm(3)) than healthy control subjects (1.15 +/- 0.15 cm(3)), though BPF was unable to distinguish between these 2 groups. MOV was smaller in patients with progressive MS (secondary- progressive MS, 0.88 +/- 0.19 cm(3) and primary-progressive MS, 0.95 +/- 0.30 cm(3)) than in patients with relapsing-remitting MS (1.08 +/- 0.15 cm(3)). A model including both MOV and BPF better predicted AI than BPF alone (P = .04). Good reproducibility in MOV measurements was demonstrated for intrarater (intraclass correlation coefficient, 0.97), interrater (0.79), and scan rescan data (0.81). CONCLUSION: MOV is associated with disability in MS and can serve as a biomarker of spinal cord damage.

An explanatory model of fatigue in women receiving adjuvant breast cancer chemotherapy.

BACKGROUND: Fatigue is the most common and disturbing complaint reported by women during adjuvant breast cancer chemotherapy, but little is known about the mechanisms influencing it. OBJECTIVES: To test an explanatory model of variables influencing fatigue in women during the first three cycles of adjuvant breast cancer chemotherapy and to determine the extent to which model variables explain fatigue at treatments and predict fatigue at cycle midpoints. METHODS: A prospective, correlational design with repeated measures was used. The sample included 60 women who received chemotherapy after surgery for Stage I or II breast cancer. Fatigue was measured by the Piper Fatigue Scale. Predictor variables and measures were health and functional status (MOS SF-36), chemotherapy protocol, health-promoting lifestyle behaviors (HPLPII), nutritional status (hematocrit [Hct] and body mass index [BMI]), symptom distress (MSDS), and initial reaction to the diagnosis of cancer (RDCQ). Multiple regression was used for path analyses. RESULTS: Trimmed models of influences on fatigue were identified. At treatments, direct influences on fatigue were symptom distress (beta = 0.45-0.76, p = 0.002-0.001), chemotherapy protocol (beta = 0.26, p = 0.02), and interpersonal relations (IPR) behaviors (beta = -0.28, p = 0.02); indirect influences were confronting reaction to the diagnosis through IPR behaviors and through symptom distress. At cycle midpoints, direct influences on fatigue were symptom distress from the previous treatment (beta = 0.36-0.43, p = 0.004-0.001), physical and social function (beta = -0.31-0.50, p = 0.02-0.001), and IPR behaviors (beta = -22, p = 0.05); an indirect influence was confronting reaction to the diagnosis (through IPR behaviors). Variance explained in fatigue ranged from 42% to 62% at treatments and from 40% to 56% at cycle midpoints. CONCLUSIONS: Further testing of the model is warranted. Findings suggest that interventions to reduce symptom distress and promote health and functional status need to be developed and evaluated for effectiveness in modifying fatigue during adjuvant breast cancer chemotherapy.

Economic feasibility evaluation of microfiltration of milk prior to cheesemaking.

A nonlinear programming optimization model was used to evaluate the net revenues and potential profit-ability of microfiltration (MF) prior to cheesemaking in the 3-year period 1998 to 2000, using monthly milk price and composition data. The model identifies the optimal mix of milk resources and determines if MF cheesemaking produces a higher net revenue than conventional cheesemaking that uses NDM and condensed milk for fortification. This study demonstrates the potential of this model to evaluate new technologies in cheese manufacture and improve decision making in the cheese industry. The use of MF produced higher net revenues in 30 out of the 36 mo for both Cheddar and low-moisture, part-skim mozzarella, leading to an appreciable increase in net revenue (vs. conventional cheesemaking) for both cheeses. The benefit from MF in net revenue was greater when the cream price was high. The use of 3X MF yielded the same net revenue as 2X MF. An estimate of manufacturing costs of MF vs. conventional cheesemaking was also made. To this end, the yields of products were calculated by the optimization model, while the production cost of each product was estimated from data of two economic engineering studies and a MF cheesemaking trial. The manufacturing cost of MF Cheddar was slightly higher than the manufacturing cost of conventional Cheddar. However, the benefit in net revenue from the use of MF was estimated to be higher than the difference in manufacturing costs. Moreover, some advantages in the new coproducts of MF Cheddar could outweigh its higher manufacturing cost. The relationships between prices and recoveries of coproducts required to render MF profitable were identified.

A nonlinear programming optimization model to maximize net revenue in cheese manufacture.

A nonlinear programming optimization model was developed to maximize net revenue in cheese manufacture and is described in this paper. The model identifies the optimal mix of milk resources together with the types of cheeses and co-products that maximize net revenue. It works in Excel while it takes the data specified by the user from a user-friendly interface created in Access. The user can specify any number of resources, cheese types, and co-products. To demonstrate the capabilities of the model, we determined the impact of variation in milk price and composition in the period 1998 to 2000 on the optimal mix of resources and optimal type of co-product for Cheddar and low-moisture, part-skim Mozzarella. It was also desired to determine the impact of variation in protein content of nonfat dry milk (NDM) on net revenue, and examine the effect of reconstitution of NDM with water versus milk on net revenue. The optimal mix of resources and the net revenue markedly varied as milk resource prices and composition varied. The net revenue for Mozzarella was much higher than for Cheddar when the price of cream was high. Cheese plants that did not optimize the use of resources in response to variations in prices and composition missed a significant profit opportunity. Whey powder was more profitable than 34% whey protein concentrate and lactose in most months. The use of high-protein NDM led to an appreciable increase in net revenue. When the value of the nonfat portion of raw milk was high, reconstitution of NDM with water rather than milk markedly raised net revenue.

Nosocomial infections in patients with central catheters.

Intensive care patients with central catheters were included in a month-long study to describe the usage of central catheters and determine factors associated with nosocomial infections. Eighty-seven patients had 130 catheters of five different types used for multiple purposes. All study variables were higher for the infected group. Significant differences were found between noninfected and infected groups in regard to number of single-lumen catheters, laboratory blood draws, intermittent infusions, heparin-locked ports, types of infused solutions, dressing changes, and hospitalized days. Total hospitalization days and total number of intermittent infusions were the best predictors of infection (P less than .05).

Effects of dietary propionate on hepatic glucose production, whole-body glucose utilization, carbohydrate and lipid metabolism in normal rats.

Increased intake of dietary fibres is associated with several beneficial effects on carbohydrate and lipid metabolism. The colonic fermentation of dietary fibres produces short-chain fatty acids (SCFA; acetate, propionate and butyrate). Some authors have suggested that SCFA could be partly responsible for the effects of dietary fibres. The purpose of the present study was to test the effects of one of the SCFA, propionate. The effects of moderate amounts of dietary propionate on insulin sensitivity and hepatic glucose production were studied in male Sprague-Dawley rats. Two groups of twenty-one adult rats were fed for 3 weeks on a diet containing 78 g propionate/kg (P) or 78 g/kg of a poorly fermentable cellulose (control group; C). Feed intake, body weight, fasting plasma glucose, insulin, free fatty acids, alanine, lactate, glycerol and beta-hydroxybutyrate levels were measured weekly in anaesthetized rats. At the end of the feeding period basal hepatic glucose production (BHGP) was measured with a primed continuous infusion of [3-3H]glucose and the in vivo insulin sensitivity in rats was quantified by the euglycaemic-hyperinsulinaemic clamp technique (0.6 and 2 U/kg per h). At that time fasting plasma glucose measured in anaesthetized rats was significantly lower in group P than in group C: 7.7 (SE 0.2) v. 8.5 (SE 0.2) mmol/l respectively (P < 0.002); plasma insulin levels were not significantly different. Neither the BHGP (mg/min per kg; C 14.8 (SE 1.3), P 15.1 (SE 1.3); n 7, not significant) nor the basal metabolic clearance (ml/min per kg; 8.9 (SE 0.8) v. 9.9 (SE 1.1); not significant) were different between treatments. Hepatic glucose production and glucose utilization at the two insulin concentrations (approximately 500 and 1500 mU/l respectively, n 7) did not differ significantly between the two groups. These results show that dietary propionate chronically ingested by normal rats could decrease fasting glycaemia, but from our findings, no effect on hepatic glucose production and whole-body glucose utilization could be clearly demonstrated.