Purpose Elevated glycosylated hemoglobin (HbA1c) is often found in surgical patients with no history of diabetes. The purpose of this prospective observational study was to determine if elevated preoperative HbA1c is associated with postoperative hyperglycemia in non-diabetic surgical patients and to identify predictors of elevated HbA1c. Methods This study included 257 non-diabetic adults scheduled for inpatient surgery. Preoperatively, capillary blood glucose (CBG) and HbA1c were measured and patients completed the Canadian Diabetes Risk Questionnaire (CANRISK). Capillary blood glucose was measured for two days or until hospital discharge at the following time points: postoperatively, before all meals, and at 22:00 hr. The mean CBG and incidence of hyperglycemia were compared between HbA1c levels: Group I \ 6.0%, Group II 6.0-6.4%, and Group III C 6.5%. ResultsThe mean postoperative glucose levels at all time points were significantly higher in Group III compared with Groups I and II (P \ 0.01). At least one episode of hyperglycemia (CBG C 10.0 mMolÁL -1 ) occurred in 61% (11/18) of patients in Group III vs 11% (23/209) of patients in Group I (relative risk, 5.55; 95% confidence interval [CI], 3.26 to 9.47; P \ 0.001). Elevated glycosylated hemoglobin C 6.0% was found in 31% (33/107) of those with a high CANRISK score. The best predictors of postoperative hyperglycemia were preoperative CBG [ 6.9 mMolÁL -1 [diagnostic odds ratio (OR) (reference\6.0 mMolÁL -1 ), 4.16; 95% CI, 1.57 to 10.98; P = 0.004], HbA1c C 6.0% [OR (reference \ 6.0%), 3.00; 95% CI, 1.39 to 6.49; P = 0.005], and HbA1c C 6.5% [OR (reference \ 6.5%), 13.45; 95% CI, 4.78 to 37.84; P \0.001]. Conclusions Elevated HbA1c is associated with higher mean postoperative glucose levels in patients with no diabetic history. The CANRISK score is a strong predictor of elevated HbA1c, while CBG and HbA1c are both predictors of postoperative hyperglycemia. RésuméObjectif Une hémoglobine glycosylée (HbA1c) élevée est souvent observée chez des patients chirurgicaux sans antécédents de diabète. L'objectif de cette étude observationnelle prospective était de déterminer si une HbA1c préopératoire élevée est associée à une hyperglycémie post opératoire chez des patients chirurgicaux non diabétiques et d'identifier les facteurs prédictifs d'une HbA1c élevée. Méthodes Cette étude a inclus 257 adultes non diabétiques devant être hospitalisés pour chirurgie. La glycémie capillaire (CBG) et l'HbA1c ont été mesurées en

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Folic acid (FA) fortification and widespread supplemental use have significantly increased folate status in North America. Furthermore, >50% of colorectal cancer patients use FA supplement. The increased folate status may interfere with cancer chemotherapy. We investigated the effect of FA supplementation on chemosensitivity of human colon cancer cells to 5-fluorouracil (5-FU) using a xenograft model. Mice harboring human HCT116 colon cancer xenografts were randomized to receive the control, or 4× or 12.5× supplemental levels of FA. Within each diet group, mice were randomized to receive 5-FU+leucovorin or saline and xenograft growth and characteristics were determined. The expression of genes involved in folate metabolism and cancer treatment was determined. FA supplementation and 5-FU significantly interacted to influence xenograft growth (P < 0.007). At the control level, 5-FU significantly inhibited the growth of the xenografts (P < 0.0001). However, at the 4× supplemental level, 5-FU-treated xenografts grew faster than untreated xenografts (P = 0.048) while at the 12.5× supplemental level, 5-FU exhibited no effect. Cell proliferation, degree of necrosis, and expression of the selected genes did not significantly differ by the supplemental levels of FA. Our data suggest that FA supplementation may be detrimental to 5-FU chemotherapy of colon cancer and pose public health concern.

The Canadian Spine Society is a collaborative organization of spine surgeons advancing excellence in research, education and patient care.Accreditation: This event is an accredited group learning activity (Section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada, approved by The Canadian Orthopaedic Association. Course objectives:The Annual Scientific Conference of the Canadian Spine Society provides a contemporary review of spine surgery and spine care in Canada. The conference is a joint meeting of the Canadian Spine Society and the Canadian Paediatric Spine Society that encompasses a full range of spinal problems and current solutions. This year the focus ranged from the best means of triaging back pain patients to avoid unnecessary surgical intervention to the complication of postoperative spinal infection. Pediatric presentations included the ongoing study of home-based pain management following scoliosis surgery and the status of the national spine registry. The program offered a carefully constructed mix of didactic lectures, research updates and interactive symposia, and an opportunity to obtain valuable continuing medical education while engaging in a vibrant exchange of ideas and points of view Conflicts of interest: Available for all speakers who presented abstracts at the 16th Annual Scientific Conference of the Canadian Spine Society.1.03: Ontario's Inter-professional Spine Assessment and Education Clinics (ISAEC): patient, provider and system impact of an integrated model of care for the management of LBP.