Vascular Function in Chronic Kidney Disease and in Renovascular Disease

Cardiovascular mortality is 15 to 30 times higher in patients with chronic kidney disease than in the age-adjusted general population. Even minor renal dysfunction predicts cardiovascular events and death in the general population. In patients with atherosclerotic renovascular disease the annual cardiovascular event and death rate is even higher. The abnormalities in coronary and peripheral artery function in the different stages of chronic kidney disease and in renovascular disease are still poorly understood, nor have the cardiac effects of renal artery revascularization been well characterized, although considered to be beneficial. This study was conducted to characterize myocardial perfusion and peripheral endothelial function in patients with chronic kidney disease and in patients with atherosclerotic renovascular disease. Myocardial perfusion was measured with positron emission tomography (PET) and peripheral endothelial function with brachial artery flow-mediated dilatation. It has been suggested that the poor renal outcomes after the renal artery revascularization could be due to damage in the stenotic kidney parenchyma; especially the reduction in the microvascular density, changes mainly evident at the cortical level which controls almost 80% of the total renal blood flow. This study was also performed to measure the effect of renal artery stenosis revascularization on renal perfusion in patients with renovascular disease. In order to do that a PET-based method for quantification of renal perfusion was developed. The coronary flow reserve of patients with chronic kidney disease was similar to the coronary flow reserve of healthy controls. In renovascular disease the coronary flow reserve was, however, markedly reduced. Flow-mediated dilatation of brachial artery was decreased in patients with chronic kidney disease compared to healthy controls, and even more so in patients with renovascular disease. After renal artery stenosis revascularization, coronary vascular function and renal perfusion did not improve in patients with atherosclerotic renovascular disease, but in patients with bilateral renal artery stenosis, flow-mediated dilatation improved. Chronic kidney disease does not significantly affect coronary vascular function. On the contrary, coronary vascular function was severely deteriorated in patients with atherosclerotic renovascular disease, possibly because of diffuse coronary artery disease and/or diffuse microvascular disease. The peripheral endothelial function was disturbed in patients with chronic kidney disease and even more so in patient with atherosclerotic renovascular disease. Renal artery stenosis dilatation does not seem to offer any benefits over medical treatment in patients with renovascular disease, since revascularization does not improve coronary vascular function or renal perfusion.

Generating competitive advantage through competitor information systems

This pro gradu –thesis discusses generating competitive advantage through competitor information systems. The structure of this thesis follows the structure of the WCA model by Alter (1996). In the WCA model, business process is influenced by three separate but connected elements: information, technology, and process participants. The main research question is how competitor information can be incorporated into or made into a tool creating competitive advantage. Research subquestions are: How does competitor information act as a part of the business process creating competitive advantage? How is a good competitor information system situated and structured in an organisation? How can management help information generate competitive advantage in the business process with participants, information, and technology? This thesis discusses each of the elements separate, but the elements are connected to each other and to competitive advantage. Information is discussed by delving into competitor information and competitor analysis. Competitive intelligence and competitor analysis requires commitment throughout the organisation, including top management, the desire to perform competitive intelligence and the desire to use the end products of that competitive intelligence. In order to be successful, systematic competitive intelligence and competitor analysis require vision, willingness to strive for the goals set, and clear strategies to proceed. Technology is discussed by taking a look into the function of the competitor information systems play and the place they occupy within an organization. In addition, there is discussion about the basic infrastructure of competitor information systems, and the problems competitor information systems can have plaguing them. In order for competitor information systems to be useful and worthy of the resources it takes to develop and maintain them, competitor information systems require on-going resource allocation and high quality information. In order for competitor information systems justify their existence business process participants need to maintain and utilize competitor information systems on all levels. Business process participants are discussed through management practices. This thesis discusses way to manage information, technology, and process participants, when the goal is to generate competitive advantage through competitor information systems. This is possible when information is treated as a resource with value, technology requires strategy in order to be successful within an organization, and process participants are an important resource. Generating competitive advantage through competitor information systems is possible when the elements of information, technology, and business process participants all align advantageously.