Many cardiovascular surgeons are well aware of the importance of non-technical skills but don't know what behaviors with high quality non-technical skills are in the operating room. The Non-Technical Skills for Surgeons (NOTSS) system was developed to be used as a debriefing tool for supervisors to assess the non-technical skills of trainee surgeons and provide feedback immediately after surgery. The NOTSS system has the four categories containing three elements respectively, with "good behavior" and "bad behavior" indicated for each element. The purpose of this column is to introduce the NOTSS and to provide an opportunity to think about how cardiovascular surgeons should behave in the operating room. Jpn. J. Cardiovasc. Surg. 53(3): U1-U4 (2024)

Serum lipid levels in female handball players were studied. A group of well trained female handball players, in comparison with a group of less active females, had a significantly lower level of triglyceride, higher levels of HDL-cholesterol and HDL₂-Cholesterol subfractions, and higher apolipoprotein A-I and LCAT activities. The ratio of apolipoprotein B/apolipoprotein A-I, as an atherogenic index, was also significantly lower in the handball players. These results suggest that prolonged regular exercise such as handball training may produce favorable changes in serum lipids, thus helping to prevent and reduce the incidence of atherosclerosis.

  One patient was intervened by our palliative care team (PCT) to relieve neuropathic pain due to postoperative recurrence of rectal cancer. The dosage controlled-release oxycodone was increased, analgesic adjuvant drugs were changed and the administration of betamethasone were started. Furthermore, the number of times the patient took controlled-release oxycodone increased two to three times a day. These changes in medication resulted in relief of symptoms. Cetuximab therapy was given twice during the course. The other patient was intervened by the PCT for right upper limb pain and dyspnea due to postoperative recurrence of breast cancer. Morphine sulfate hydrate and analgesic adjuvant were additionally given. As pain increased three days after the administeration of transdermal fentanyl patches, the patches were changed every other day, instead of every three days. FEC100 therapy was given twice during the course. In the present two cases, the PCT was intervened with great zeal and rapid relief of symptoms resulted. In the meantime chemotherapy proceeded uneventfully. We thought that trust of the chief doctor in the PCT was most important for effective intervention.

OBJECTIVESPolyamines have long been known to have an insulin-like action, but their antiglycating effect has only recently attracted the attention of researchers. The aim of our investigation was to determine the whole blood polyamine concentration in a healthy population in order to examine its relationship with glycemic profiles.

METHODSThe study cohort comprised 622 men aged 40-59 who participated in a health checkup program conducted in 1997, when they underwent measurements of fasting plasma glucose (FPG), insulin (FPI), and fructosamine as glycemic indices. Colorimetric assay methods using oat and barley seedling polyamine oxidase were used to determine total polyamine (spermidine + spermine) and spermine concentrations in the whole blood, respectively. Polyamine concentrations adjusted for hemoglobin were quartiled for the analysis of covariance to assess the association with glycemic indices.

RESULTSA significant association was demonstrated between the FPG and total polyamine concentrations. In the trend test, FPG and fructosamine levels increased in accordance with the shift of quartiles of total polyamine concentrations from low to high. In contrast, the association between the spermine and glycemic indices was not statistically significant based on the test for difference of multivariate-adjusted means or trend for linearity.

CONCLUSIONSThis is the first epidemiological study to reveal that the concentrations of blood polyamines are related with either FPG or fructosamine level in a healthy population. There may be some feedback mechanism for the elevation of circulating polyamines to quench the glycation reaction under hyperglycemic conditions. In addition, total polyamines, rather than spermine alone, seem to be a sensitive biomarker representing the antiglycation effect of polyamines.

Background: Mental assessment for patients in a palliative care unit with no regular psychiatrist tends to depend on subjective judgments by other health professionals. We introduced the 9-item Patient Health Questionnaire (PHQ-9) to screen major depression from patients in a palliative care unit and assessed the usefulness of the questionnaire. Methods: The subjects were all patients who were admitted to a palliative care unit. Each patient was asked to answer the PHQ-9 on admission and then was interviewed by a psychiatrist. When PHQ-9 score was of 10 points and above, the case was judged to be positive for depressive disorder. A psychiatrist diagnosed according to Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). Results: A total of 83 patients were hospitalized between January 2016 and October 2016. 50 patients completed PHQ-9 and psychiatrist’s interview. Nine cases were positive by PHQ-9 and diagnosed as depressive disorder by a psychiatrist. Seven cases were positive by the PHQ-9 but not diagnosed as depressive disorder. Although 34 cases were judged to be negative by the PHQ-9, 2 cases of them were diagnosed as depressive disorder. The sensitivity and specificity of the PHQ-9 were 81.8% and 82.1% respectively. Conclusion: We found that the PHQ-9 was useful screening test for depression even in palliative care settings.