SummaryAldosterone production causes vascular injury and may occur despite the long-term administration of angiotensin converting enzyme-inhibitors (ACE-I) (ie, aldosterone breakthrough). The angiotensin II receptor blocker (ARB) telmisartan can function as a ligand for peroxisome proliferator-activated receptor (PPAR) γ. Stimulation of PPAR γ has been demonstrated to raise adiponectin production and suppress angiotensin II type 1 receptor expression. Thus, we investigated the effect of the ACE-I perindopril erbumin (perindopril) and the ARB telmisartan on plasma levels of aldosterone and adiponectin.Patients with essential hypertension were randomly assigned to receive 48 weeks of perindopril (2-8 mg/d) or telmisartan (20-80 mg/d). We measured adiponectin, aldosterone, angiotensin II, and renin at weeks 0, 8, 24, and 48.A total of 53 subjects were randomized. Data on 51 subjects (25 in the perindopril group and 26 in the telmisartan group; mean age, 65.1 years) were available for analyses. Plasma aldosterone decreased significantly in both the telmisartan (69.9 ± 5.6 to 58.1 ± 5.4 pg/mL) and perindopril (74.1 ± 4.7 to 64.7 ± 5.3 pg/mL) groups at 8 weeks, but returned toward the baseline in the perindopril group (67.9 ± 4.1 pg/mL) at 24 weeks. Plasma glycated hemoglobin levels or urine albumin did not change significantly after the treatment in either group.Telmisartan seemed to be more effective at suppressing aldosterone and raising adiponectin levels than perindopril; however, improvements in insulin sensitivity and albuminuria were not detected. These results are consistent with the idea that the use of an ARB with PPAR γ stimulating activity is equivalent to ACE-I for the treatment of hypertension. (Int Heart J 2009; 50: 501-512)

The da Vinci Surgical System provides a high-resolution stereoscopic image and allows remote, tremor-free, and scaled control of endoscopic surgical instruments with seven degrees of freedom. Computer-enhanced ITA harvesting was performed safely with excellent results.

There has been great progress in robotic surgical technology in recent years. The aim of this study was to objectively quantify robot-enhanced dexterity. To evaluate three-dimensional monitoring and non-dominant hand maneuverability using the da Vinci Surgical System, five surgeons were asked to thread the needle through all 11 holes on the model with handling robotic instrument. Three types of suturing were carried out. In task 1, sutures were placed using the dominant hand under 3D imaging; in task 2, suturing was performed using the dominant hand under 2D imaging; and in task 3, suturing was done with the non-dominant hand under 3D imaging. Each surgeon placed three sutures in completing each task. The time to successful completion, accuracy, and the opinion of the level of difficulty were recorded. All 45 tasks were completed. The time required to place each suture (mean ± SD) was as follows: 211.7 ± 50.5 s for task 1, 331.1 ± 121.2 s for task 2, and 237.1 ± 95.7 s for task 3. Task 1 took less time than task 2 (P = 0.02). There were no differences in the times between task 1 and task 3 (P = 0.19). Robotic suturing under 3D imaging is significantly faster than under 2D imaging, and robotic suturing using the non-dominant hand does not need significantly more time than with the non-dominant hand. Technology for robotic surgery could increase the manipulative abilities.

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