Alpha2-Adrenoceptor-mediated vascular responses induced by dexmedetomidine

Alpha2-Adrenoceptors are cell-surface G protein coupled receptors that mediate many of the effects of the catecholamines noradrenaline and adrenaline. The three human α2-adrenoceptor subtypes are widely expressed in different tissues and organs, and they mediate many different physiological and pharmacological effects in the central and peripheral nervous system and as postsynaptic receptors in target organs. Previous studies have demonstrated that α2-adrenoceptors mediate both vascular constriction and dilatation in humans. Large inter-individual variation has been observed in the vascular responses to α2-adrenoceptor activation in clinical studies. All three receptor subtypes are potential drug targets. It was therefore considered important to further elucidate the details of adrenergic vascular regulation and its genetic variation, since such knowledge may help to improve the development of future cardiovascular drugs and intensive care therapies. Dexmedetomidine is the most selective and potent α2-adrenoceptor agonist currently available for clinical use. When given systemically, dexmedetomidine induces nearly complete sympatholysis already at low concentrations, and postsynaptic effects, such vasoconstriction, can be observed with increasing concentrations. Thus, local infusions of small doses of dexmedetomidine into dorsal hand veins and the application of pharmacological sympathectomy with brachial plexus block provide a means to assess drug-induced peripheral vascular responses without interference from systemic pharmacological effects and autonomic nervous system regulation. Dexmedetomidine was observed to have biphasic effects on haemodynamics, with an initial decrease in blood pressure at low concentrations followed by substantial increases in blood pressure and coronary vascular resistance at high concentrations. Plasma concentrations of dexmedetomidine that significantly exceeded the recommended therapeutic level did not reduce myocardial blood flow below the level that is observed with the usual therapeutic concentrations and did not induce any evident myocardial ischaemia in healthy subjects. Further, it was demonstrated that dexmedetomidine also had significant vasodilatory effects through activation of endothelial nitric oxide synthesis, and thus when the endothelial component of the blood vessel response to dexmedetomidine was inhibited, peripheral vasoconstriction was augmented. Hand vein constriction responses to α2-adrenoceptor activation by dexmedetomidine were only weakly associated with the constriction responses to α1-adrenoceptor activation, pointing to independent cellular regulation by these two adrenoceptor classes. Substantial inter-individual variation was noted in the venous constriction elicited by activation of α2-adrenoceptors by dexmedetomidine. In two study populations from two different continents, a single nucleotide polymorphism in the PRKCB gene was found to be associated with the dorsal hand vein constriction response to dexmedetomidine, suggesting that protein kinase C beta may have an important role in the vascular α2-adrenoceptor signalling pathways activated by dexmedetomidine.

Space–Time Block Codes and the Complexity of Sphere Decoding

In wireless communications the transmitted signals may be affected by noise. The receiver must decode the received message, which can be mathematically modelled as a search for the closest lattice point to a given vector. This problem is known to be NP-hard in general, but for communications applications there exist algorithms that, for a certain range of system parameters, offer polynomial expected complexity. The purpose of the thesis is to study the sphere decoding algorithm introduced in the article On Maximum-Likelihood Detection and the Search for the Closest Lattice Point, which was published by M.O. Damen, H. El Gamal and G. Caire in 2003. We concentrate especially on its computational complexity when used in space–time coding. Computer simulations are used to study how different system parameters affect the computational complexity of the algorithm. The aim is to find ways to improve the algorithm from the complexity point of view. The main contribution of the thesis is the construction of two new modifications to the sphere decoding algorithm, which are shown to perform faster than the original algorithm within a range of system parameters.

Distributed ControlArchitecture of Power Electronics Building-Block-Based Frequency Converters

The increasing power demand and emerging applications drive the design of electrical power converters into modularization. Despite the wide use of modularized power stage structures, the control schemes that are used are often traditional, in other words, centralized. The flexibility and re-usability of these controllers are typically poor. With a dedicated distributed control scheme, the flexibility and re-usability of the system parts, building blocks, can be increased. Only a few distributed control schemes have been introduced for this purpose, but their breakthrough has not yet taken place. A demand for the further development offlexible control schemes for building-block-based applications clearly exists. The control topology, communication, synchronization, and functionality allocationaspects of building-block-based converters are studied in this doctoral thesis. A distributed control scheme that can be easily adapted to building-block-based power converter designs is developed. The example applications are a parallel and series connection of building blocks. The building block that is used in the implementations of both the applications is a commercial off-the-shelf two-level three-phase frequency converter with a custom-designed controller card. The major challenge with the parallel connection of power stages is the synchronization of the building blocks. The effect of synchronization accuracy on the system performance is studied. The functionality allocation and control scheme design are challenging in the seriesconnected multilevel converters, mainly because of the large number of modules. Various multilevel modulation schemes are analyzed with respect to the implementation, and this information is used to develop a flexible control scheme for modular multilevel inverters.

Ankle-brachial index, high-sensitivity C-reactive protein and endothelial function in a cardiovascular risk population

Atherosclerotic vascular disease is the leading cause of death in the Western world. Its main three manifestations are coronary heart disease, cerebrovascular disease, and peripheral arterial disease. Asymptomatic peripheral arterial disease is usually diagnosed using the ankle brachial index, and values ≤ 0.90 are used to determine the diagnosis. The classical risk factors of peripheral arterial disease, such as smoking and diabetes, are well known and early interventions are mandatory to improve the prognosis. What is not well known is the role of inflammation as a risk factor. Yet, a novel approach to cardiovascular diseases is the measurement of endothelial function. In this thesis, we studied the ankle-brachial index, C-reactive protein and endothelial function in a cardiovascular risk population. A total of 2856 subjects were invited to the study and 2085 (73%) responded. From these subjects, a cohort of 1756 risk persons was screened. We excluded the subjects with previously known cardiovascular disease or diabetes, because they were already under systematic follow-up. Out of the study subjects, 983 (56%) were women and 773 (44%) men. The ankle brachial index and high-sensitivity C-reactive protein were measured from 1047 subjects. Endothelial function was assessed by measuring reactive hyperemia pulse amplitude tonometry from 66 subjects with borderline peripheral arterial disease. In this study, smoking was a crucial risk factor for peripheral arterial disease. Subclinical peripheral arterial disease seems to be more common in hypertensive patients even without comorbidities. The measurement of the ankle brachial index is an efficient method to identify patients at an increased cardiovascular risk. High-sensitivity C-reactive protein did not correlate with the ankle brachial index or peripheral arterial disease. Instead, it correlated with measures of obesity. In a cardiovascular risk population with borderline peripheral arterial disease, nearly every fourth subject had endothelial dysfunction. This might point out a subgroup of individuals in need of more intensive treatment for their risk factors.