Grade 2 gliomas are malignant brain tumours affecting otherwise healthy adults. Although the long-term prognosis is poor, many patients are well and may have a high quality of life for several years. There is, however, a large variability in the natural course of the disease which makes it essential to identify patients who might benefit from early surgery or radio-therapy. The aim of the present thesis was to define new and clinically useful prognostic markers that may assist in the initial treatment decision and in patient follow-up. A retrospective study of 189 patients with gliomas WHO grade 2 showed no advantage in survival of early tumour resection or radiotherapy, and confirmed that histological subtype and patient age are the most important predictors of survival (I). In 89 patients, the pre-treatment uptake of 11C-methionine (MET) measured with positron emission tomography (PET) was identified as a prognostic marker for survival (II). At the time of tumour progression, irradiated tumours demonstrated signs of a residual radiotherapeutic effect that correlated with the pre-treatment uptake of MET (III). Pre-treatment uptake of MET may, therefore, be important both in predicting the natural course of the disease and the response after treatment. Immunohistochemical staining of 40 tumour samples showed an inverse association between the number of tumour cells expressing platelet-derived growth factor alpha receptor (PDGFRa) and survival (IV). Also, a reduction was observed in the number of receptor-positive cells after malignant transformation, supporting the prognostic value of PDGFRa. Lumbar puncture was performed in eight patients with newly diagnosed low-grade gliomas to identify three important growth factors in tumour development. Neither PDGF nor vascular endothelial growth factor (VEGF) were detected in the cerebrospinal fluid (CSF), and fibroblast growth factor 2 (FGF-2) was measurable at extremely low concentrations in two of the patients (V). A proteome screening of the CSF, using two-dimensional gel electrophoresis and mass spectrometry, detected alpha 2-HS glycoprotein at significantly higher concentrations than in a control group (VI). This glycoprotein emerges as a novel substance in glioma research and may be of great interest because of its suggested involvement in the embryonic development of the neocortex.

Im Ergebnis der Arbeit kann eine Einbeziehung von Haldenerzen anstelle von Tagebauerzen unter Beibehaltung der wirtschaftlichen Kennzahlen wie z. B. Rentabilität und Gewinn durchgeführt werden. Dafür wurden entsprechende Einbeziehungskriterien für das Haldenerz entwickelt. Bei der Einbeziehung wird ein Teil der Tagebaugeräte freigesetzt, welche für den Abbau von zusätzlichem Abraum verwendet werden können. Diese Maßnahme bietet die Möglichkeit des Abbaues von Abraumspitzen und der Kostensteuerung. Letztere sieht eine Erhöhung der Abraumförderung in den Perioden hoher Preise und eine Verringerung bei niedrigeren Preisen vor. Für die Preisänderungen wurden Einbeziehungskriterien entwickelt, die den Kapitalwert bzw. Gewinn maximieren. Dabei wurden die Einbeziehungskriterien so modifiziert, dass eine Stilllegung der Tagebaue während der Einbeziehung vermieden werden kann.

A disease has consequences not only for the afflicted person but also for those who interact with him or her. A low-grade glioma is a brain tumour whose regarding its psychosocial implications for adult patients and their next of kin has received little attention in the literature. In the light of this the overall aim of the present thesis was to provide increased knowledge about how patients with low-grade glioma and their next of kin experience and deal with everyday life. The methods of the studies were mainly qualitative. Thirty-nine patients and 28 next of kin were interviewed and all except one next of kin completed a quality of life questionnaire. The onset of low-grade glioma was described from the patients’ perspective as a process, either rapid (up to a few months) or prolonged over several years. This phase of low-grade glioma encompassed repeated visits to physicians and care institutions. The onset of low-grade glioma was accompanied by stress, anxiety and uncertainty in the case of both the patients and those nearest. The symptoms and problems the patients experienced covered a broad range of consequences, physical, psychological and social. The patients presented a wide range of ways to cope with illness-related problems. The next of kin were often deeply involved in the patients’ situation and many of them experienced extremely stressful emotions mainly in the early period of the illness. They had experience of positive encounters in health care but more often they had had a sense both of powerlessness and of being invisible and neglected. Relations and roles changed in ways that mostly were experienced as negative. Enabling strength in everyday life had to do with alleviation of strain and having a positive outlook upon life. By means of the questionnaire Subjective estimation of Quality of Life (SQoL) the patients and those nearest estimated their quality of life as being comparatively high. Only one variable, among the patients the absence of work/meaningful occupation and among the next of kin the absence of own children, being estimated at below 60% of the maximum score.

No description available.

Comprendre comment le cerveau humain engendre les formes les plus élaborées de comportements est profondément lié à nos connaissances générales sur son organisation anatomique et fonctionnelle. Jusqu'à récemment encore, on pensait que les fonctions cognitives n'étaient rien d'autre que le sous-produit de l'activité neurale de régions corticales discrètes et hyper-fonctionnalisées. Les découvertes majeures obtenues ces dix dernières années dans le champ de la neuro-imagerie, et plus particulièrement de la connectomique, invitent cependant à complexifier nos représentations sur les liens qu'entretiennent structures et fonctions cérébrales. Le cerveau semble en effet être organisé en systèmes neurocognitifs complexes, hautement distribués et plastiques. C'est dans cet esprit qu'a été réalisé ce travail de thèse dont l'ambition première a été de repenser les modèles actuels de la cognition sociale, et en particulier ceux ayant trait à la fonction de mentalisation, à travers l'étude comportementale des patients porteurs d'un gliome diffus de bas-grade. Cette tumeur neurologique rare constitue un excellent modèle physiopathologique en vue du démasquage des structures maîtresses des systèmes cognitifs complexes, en ce qu'elle induit des phénomènes majeurs de réorganisation fonctionnelle, et s'infiltre préférentiellement le long de la connectivité axonale associative. Des corrélations anatomo-cliniques ont été réalisées suivant une approche topologique classique (analyse de groupe en régions d'intérêt, cartographie voxel-based lesion-symptom, stimulation électrique corticale intra-opératoire) mais également hodologique (degré de déconnection des faisceaux d'association, stimulation électrique de la connectivité axonale). Les résultats principaux de nos différents travaux nous permettent de jeter les premières bases d'un modèle à double voie dynamique (plastique) et hodotopique (contraint par la réalité anatomique) de l'organisation anatomo-fonctionnelle des processus de mentalisation. Spécifiquement, une voie dorsale, interconnectant le aires corticales fronto-pariétales « miroirs » via le système périsylvien de substance blanche associative (faisceau arqué et faisceau longitudinal supérieur latéral), sous-tendrait les processus perceptifs de « bas-niveau » nécessaires à l'identification préréflexive des états mentaux ; une voie cingulo-médiane, interconnectant les régions préfrontales médiales et rostro-cingulaires aux régions pariétales postérieures médiales via le faisceau cingulaire, sous-tendrait les processus de «haut-niveau » nécessaires aux inférences mentalistiques conscientes. Ces découvertes constituent une avancée substantielle en neurosciences sociales, ont des implications importantes pour la prise en charge clinique des patients, et peuvent permettre de mieux comprendre certaines psychopathologies caractérisées à la fois par un trouble de la mentalisation et des anomalies structurales de la connectivité associative (troubles du spectre autistique). / Understanding how the brain produces sophisticated behaviours strongly depends of our knowledge on its anatomical and functional organization. Until recently, it was believed that high-level cognition was merely the by-product of the neural activity of discrete and highly specialized cortical areas. Major findings obtained in the past decade from neuroimaging, particularly from the field of connectomics, prompt now researchers to revise drastically their conceptions about the links between brain structures and functions. The brain seems indeed organized in complex, highly distributed and plastic neurocognitive networks. This is in this state of mind that our work has been carried out. Its foremost ambition was to rethink actuals models of social cognition, especially mentalizing, through the behavioural study of patients harbouring a diffuse low-grade glioma. Because this rare neurological tumour induces major functional reorganization phenomena and migrates preferentially along axonal associative connectivity, it constitutes an excellent pathophysiological model for unmasking the core structures subserving complex cognitive systems. Anatomo-clinical correlations were conducted according to both a classical topological approach (region of interest analyses, voxel-based lesion-symptom mapping, intraoperative cortical electrostimulation) and a hodological approach (degree of disconnection of associative white matter fasciculi, intraoperative axonal connectivity mapping). The main results of our different studies enable us to lay the foundation of a dynamic (plastic) and hodotopical (connectivity) dual-stream model of mentalizing. Specifically, a dorsal stream, interconnecting mirror frontoparietal areas via the perisylvian network (arcuate fasciculus and lateral superior longitudinal fasciculus), may subserve low-level perceptual processes required in rapid and pre-reflective identification of mental states; a cingulo-medial stream, interconnecting medial prefrontal and rostro-cingulated areas with medial posterior parietal areas via the cingulum, may subserve higher-level processes required in reflective mentalistic inferences. These original findings represents a great step in social neuroscience, have major implications in clinical practice, and opens new opportunities in understanding certain pathological conditions characterized by both mentalizing deficits and aberrant structural connectivity (e.g. autism spectrum disorders).

L’objectif de cette thèse est d’étudier le comportement du soufre dans des fluides hydrothermaux soumis à un métamorphisme de bas grade. Elle est séparée en trois études interconnectées couplant étude naturelle et expérimentale : i) une étude du cycle du soufre dans les évaporites carniennes de la "Nappe des Gypses" des Alpes françaises comme cas d’étude naturelle a été réalisée, ii) une étude de la spéciation du soufre dans les inclusions fluides associées à ces évaporites triasiques, et iii) une étude expérimentale du rôle de la spéciation du soufre sur le mécanisme de la Thermo-Réduction des Sulfates (TSR) et l’altération des hydrocarbures associée. La première étude repose sur le couplage d’une approche pétrographique classique et d’une étude détaillée des inclusions fluides, des isotopes stable (δ34S, δ33S, δ36S, Δ33S, Δ36S, δ13C et δ18O) et de la matière organique dans la "Nappe des Gypses". Ces études couplées ont permis d’identifier le processus de TSR comme la réaction contrôlant le comportement du soufre dans cette formation en système fermé. La seconde étude repose sur une nouvelle approche analytique couplant spectroscopie Raman in-situ et platine microthermométrique permettant de réchauffer jusqu’à 300°C les échantillons (naturel et synthétique). Ainsi, à température >100°C la présence de l’ion radicalaire S3- et d’autres espèces polymériques du soufre (Snx) a été mise en évidence dans la “Nappe des Gypses”. Cette étude confirme le rôle indispensable à la TSR de l’ion S3- et des Snx dans les fluides naturels. Cette étude naturelle a été complétée par une étude expérimentale préliminaire qui a permis de mettre en place de nouveaux protocoles expérimentaux en autoclave et en capillaires de silice couplés à des analyses spectroscopiques et isotopiques. Ceci afin de mieux comprendre le rôle de la spéciation du soufre dans les interactions entre une phase aqueuse et un fluide hydrocarboné lors de la TSR. Cette thèse conduit à une meilleure compréhension du rôle de la spéciation du soufre et son lien avec des composés organiques lors de la TSR en condition métamorphique de bas grade. Cela ouvre de nouvelles perspectives de compréhension des formations géologiques basées sur le couplage d’études géologiques classiques et d’études géochimiques plus fines / The aim of this thesis is to study the sulfur behavior in hydrothermal fluids subjected to low grade metamorphism. It is separated into three interconnected studies linking natural and experimental study: i) a study of the sulfur cycle in the Carnian evaporites of the "Nappe des Gypses" from the French Alps as a natural case study is performed, ii) a study of the sulfur speciation in fluid inclusions associated to these Triassic evaporites, and iii) an experimental study of the role of sulfur speciation on the Thermochemical Sulfate Reduction (TSR) mechanisms and the associated hydrocarbons alteration. The first study is based on the coupling of a classical petrographic approach associated to a detailed study of fluid inclusions, stable isotopes (δ34S, δ33S, δ36S, Δ33S, Δ36S, δ13C and δ18O) and organic matter in the “Nappe des Gypses”. The coupling study allows to identify the TSR process as the reaction controlling the behavior of sulfur in this formation in a closed system. The second study is based on a new analytical approach coupling in-situ Raman spectroscopy and microthermometric stage. This technique allows to heat up to 300°C samples (natural and synthetic). Thus, at temperature >100°C, the presence of the radical ion S3- and other polymeric sulfur species (Snx) is demonstrated in the “Nappe des Gypses”. This study confirms the essential role in the TSR process of S3- and Snx species in natural fluids. This study natural was completed by a preliminary experimental study allowed to set up new experimental protocols in autoclave and fused silica capillaries coupled to spectroscopic and isotopic analyses. This to better understood the role of sulfur speciation in the interactions between an aqueous phase and a hydrocarbons fluid during the TSR. This thesis leads to a better understanding of the role of sulfur speciation and its link with organic compounds during TSR under low grade metamorphic conditions. This opens new perspectives to understand geological formations based on coupling of classical geological studies and finer geochemical studies

[pt] No presente trabalho são avaliados os fatores físicos e químicos que influenciam o processamento do minério sulfetado de mais baixo teor de ouro conhecido no mundo. A amostra de minério estudada é proveniente da Rio Paracatu Mineração S.A - RPM e é identificada como minério Calha Brava Cl-4, pertencente ao Banco 716, Bloco 508-B da mina. Alguns circuitos de beneficiamento de minérios auríferos incluem processos de concentração gravítica e flotação visando atingir máximas recuperações de ouro e, conseqüentemente, elevada produção a baixo custo. A seleção das técnicas de processamento do minério depende, basicamente, da mineralogia e distribuição das partículas minerais no minério, do tamanho da partícula de ouro ou dos minerais e outros metais associados ao minério. A distribuição do teor de ouro nas diferentes frações granulométricas do minério Calha Brava Cl-4 revelam que 80,4 por cento do ouro encontra-se na fração acima de 104 um e 25 por cento encontram-se na fração fina (< 28 um). A recuperação total de ouro, enxofre e arsênio obtida nos ensaios de concentração gravítica por meio do concentrador centrífugo Knelson e flotação foram 80,44 por cento, 64,9 por cento e 58,22 por cento, respectivamente. A recuperação em massa dessa etapa foi 10,14 por cento. A recuperação total de ouro, enxofre e arsênio obtidos na concentração de jigagem e flotação foi 88,91 por cento, 86,82 por cento e 49,07 por cento, respectivamente. A recuperação em massa do concentrado recuperado foi de 19,5 por cento. Nos ensaios de flotação direta, a maior recuperação de ouro (87 por cento) foi obtida para o minério cominuído a uma granulometria com P80 = 86 um e recuperado por flotação na presença de 30 g/t do coletor amil xantato de potássio (AXP), 20 g/t de metil isobutil carbinol (MIBC), pH 6,3 e potencial de polpa 0,209 V vs Eh, em relação ao eletrodo de hidrogênio. A recuperação em massa do concentrado obtida foi 4 por cento. No caso das partículas grossas do minério (P80 = 130 um), constatou-se a necessidade de maiores concentrações do coletor. A maior recuperação de ouro (85,33 por cento) foi obtida com a concentração de 60 g/t para o AXP, pH 6,3 e potencial de polpa de 0,218 V vs Eh. A recuperação em massa do concentrado foi de 9 por cento. / [en] The work involves the evaluation of physical and chemical factors that influence the processing of sulphide ores, with the lowest grade of gold known in the world. The studied sample is from Rio Paracatu Mining S.A. and is described as Calha Brava Cl-4, belonging to the 716 bench, block 508-B in the mine. Some industrial processing of gold include gravity concentration and flotation processes in order to reach the maximum gold recovery, aiming at raising production levels with lower costs. The selection of the mineral processing depends on several factors as mineralogy, particle size distribution and other minerals associated with the ore. The distribution of gold grades to the different size fractions in the studied ore, reveals that 80.48 percent of gold occur in the particle size fraction above 104 um, and 25 percent of gold occur in the fine fraction (< 28 um). The global gold, sulphur and arsenic recoveries, obtained by centrifuge gravity concentration (Knelson)and flotation tests, were 80.44 percent, 64.90 percent and 58.22 percent, respectively. To these processes, the mass recovery was 10.14 percent. The total gold, sulphur and arsenic recoveries obtained in concentration processes by jig and flotation techniques were 88.91 percent, 86.82 percent and 49.07 percent, respectively. The mass recovery was 19.5 percent. In the flotation tests, the maximum gold recovery (87 percent) was obtained with the grounded ore (P80 = 86 um), using 30 g/t collector potassium amyl xanthate (PAX), 20 g/t methyl isobuthyl carbinol (MIBC), pH = 6.3 and potential of pulp 0.209 V vs Eh. The mass recovery was approximately 4 percent. When coarse particles (P80 = 130 um) were floated, the need of am increase in the collector concentration was observed. The maximum ore recovery (85.33 percent) was obtained at concentration of 60 g/t PAX, pH = 6.3 and potential of pulp 0.218 V vs Eh. The mass recovery was 9 percent.

Abstract Alopecia has been suggested to be associated with coronary artery diseases (CAD). However, the mechanism underlying this association has remained unclear. The purpose of the present study was to examine the relationships between metabolic syndrome-related risk factors, cardiovascular diseases (CVD) and alopecia among Finnish population. In addition, health-related quality of life (HRQOL) was studied in respect of alopecia among both genders. The data come from the national Finrisk survey alopecia sub-study (4 066 men aged 25–74 years old) and two community samples of men and women (aged 55 and 63 years) living in the city of Oulu in 2001 and 1998, respectively. The degree of alopecia was assessed using the Norwood-Hamilton classification scale for men and the Ludwig scale for women. This study showed a high prevalence of alopecia in the general male Finnish population varying from 17% to 73% among men aged 25–74 years, and its association with CVD particularly in age-groups older than 55 years. In addition, insulin resistance, as a metabolic syndrome-related risk factor, was associated with alopecia in middle-aged men. Among men younger than 35 years, low-grade inflammation was associated with alopecia, especially combined with central obesity. Further, in middle-aged general Finnish population, obesity associated most closely with low-grade inflammation, which is in line with the findings among young men with alopecia. Compared to subjects with no alopecia, HRQOL dimension scores (RAND-36) were significantly lower in physical functioning, role limitations due to physical health and general health among women with alopecia, and in physical functioning and social functioning among men with alopecia. Regression analyses of HRQOL-related factors revealed that alopecia was associated with role limitations due to physical health in women but not in men. An association between alopecia and CVD was strengthened in this study. In addition, low-grade inflammation and insulin resistance were associated with alopecia, especially with early onset alopecia. In elderly women, alopecia seemed to be associated with morbidity in vascular diseases. In the future, recognition of the risk factors for cardiovascular disease among subjects with alopecia is a challenge for primary health care that may prevent the development of arterial diseases. / Tiivistelmä Hiustenlähdön yhteys sydän- ja verisuonisairauksiin on ollut tiedossa jo pitkään, mutta yhteyden taustalla olevat patofysiologiset mekanismit ovat edelleenkin epäselviä. Tässä väitöskirjatyössä tutkittiin hiustenlähdön yhteyksiä metaboliseen oireyhtymään ja siihen liittyviin riskitekijöihin suomalaisessa väestössä yleisesti. Lisäksi tutkittiin elämänlaadun yhteyttä hiustenlähtöön 63-vuotiailla miehillä ja naisilla. Tutkimukseen käytettiin kolmea aineistoa; kansallisen Finrisk 2002 tutkimuksen alopecia (hiustenlähtö) alaotos (4066 iältään 25–74-vuotiasta miestä) ja kaksi aineistoa Oulun kaupungista (Oulussa asuneet 55- ja 63-vuotiaat miehet ja naiset vuonna 2001 ja 1998). Hiustenlähdön laajuus määriteltiin miehillä Norwood-Hamiltonin ja naisilla Ludwigin luokitteluasteikon mukaan. Hiustenlähdön esiintyvyys suomalaisessa miesväestössä vaihteli 17 %:sta (25–34-vuotiaat) 73 %:iin (65–74-vuotiaat) ja se näytti liittyvän sydän- ja verisuonisairauksiin 55-vuotiailla ja sitä vanhemmilla miehillä. Lisäksi alentunut insuliiniherkkyys metabolisen oireyhtymän merkkinä oli yhteydessä hiustenlähtöön keski-ikäisillä miehillä. Varhain alkanut hiustenlähtö (alle 35-vuotiaat) liittyi matala-asteiseen tulehdukseen erityisesti keskivartalolihavilla kaljuuntuvilla nuorilla miehillä. Samansuuntainen tulos tuli esille myös väestötutkimuksessa 55-vuotiailla oululaisilla miehillä ja naisilla, jonka mukaan matala-asteinen tulehdus oli yhteydessä erityisesti yleiseen lihavuuteen eikä pelkästään vyötärölihavuuteen. Terveyteen liittyvän elämänlaadun osa-alueiden pisteet (RAND-36) 63-vuotialla hiustenlähdöstä kärsivillä naisilla olivat merkittävästi matalampia kolmella osa-alueella; fyysiset toiminnot, fyysisen terveydentilan aiheuttamat muutokset roolitoiminnoissa ja yleinen terveys. Samanikäisillä kaljuuntuvilla miehillä merkittävästi matalammat terveyteen liittyvät elämänlaadun osakomponentit olivat fyysisten ja sosiaalisten toimintojen alueella. Tilastollisessa regressioanalyysissä ilmeni, että hiustenlähtö selitti fyysisen terveydentilan aiheuttamia rajoituksia roolitoimintoihin erityisesti kaljuuntuvilla naisilla, mutta ei miehillä. Hiustenlähdön yhteys eri sydän- ja verisuonisairauksiin vahvistui tässä tutkimuksessa. Varhainen hiustenlähtö on ilmeisesti merkki sekä matala-asteisesta tulehduksesta että alentuneesta insuliiniherkkyydestä. Myös naisilla hiustenlähtö näyttäisi liittyvän suurempaan sairastavuuteen. Terveydenhuollon tulisi jatkossa tarkemmin paneutua sydän- ja verisuonisairauksien riskin kartoittamiseen hiustenlähdöstä kärsivien potilaiden kohdalla.

Un nouveau procédé de trigénération thermo-hydraulique fonctionnant à partir d'énergie thermique basse température (80 à 110 °C) a été étudié pour assurer les différents besoins du secteur résidentiel. Le terme "thermo-hydraulique" se réfère à l'utilisation d'un liquide incompressible qui permet de transférer le travail hydrauliquement entre différents composants ou sous-systèmes, permettant d'améliorer l'efficacité de la chaine de conversion énergétique. Un modèle quasi-statique a été développé pour évaluer les performances énergétiques des différentes variantes du procédé. Ces calculs ont permis de définir parmi un large choix, quels fluides de travail étaient les plus appropriés. Ces calculs ont été complétés par une étude quasi-dynamique et dynamique permettant un meilleur dimensionnement du procédé. Enfin, une étude de fonctionnement annuel a été réalisée à partir du modèle quasi-statique pour évaluer l'évolution des performances ainsi que sa production d'énergie sur une année complète de fonctionnement. Ces études montrent que le couple fluide R1234yf/R1233zd semble le plus approprié à un fonctionnement en climat méditerranéen. L'étude annuelle montre qu'en considérant les données climatiques de la ville de Perpignan, le procédé permet d'amplifier l'énergie solaire collectée d'un facteur de 1,32 en moyenne et permet d'atteindre un COP solaire de 0,24 en mode rafraichissement. Quand les besoins thermiques sont satisfaits, l'intégralité de l'énergie solaire captée est valorisée pour produire de l'électricité avec un rendement moyen annuel de 4,2%. / A new process based on thermal-hydraulic conversion actuated by low-grade thermal energy (80–110 °C) is investigated and aims at providing trigeneration energy features for the residential sector. "Thermo-hydraulic" term refers to a process involving an incompressible fluid used as an intermediate medium to transfer work hydraulically between different thermal operated components or sub-systems allowing to improve the efficiency of the energy conversion chain. A model, assuming steady-state operations, is developed to assess the energy performances of different variants of this thermo-hydraulic process as well as various pairs of working fluids. These calculations were completed by a quasi-dynamic and dynamic models allowing a better sizing of the process. Finally, an annual study was realized from the quasi-static model in order to estimate the evolution of the performances as well as its power production over a complete year of functioning. For instance, in the frame of a single-family home, located in the Mediterranean region, the working fluid pair (R1234yf/R1233zd) is investigated in detail in order to estimate the annual performances. For domestic houses, the process aims at amplifying the solar energy collected by a factor of 1.32 for heating purpose, provides a cold production with a solar COP of 0.24 and generates electricity from the remaining solar energy with an efficiency of 4.2%.

Abstract Cardiovascular diseases (CVD), and especially atherosclerotic vascular diseases (ASVD), are the largest cause of morbidity and premature death worldwide. Coronary heart disease (CHD) and cerebrovascular disease (stroke) are common and severe manifestations of ASVD. Atherosclerosis is a chronic inflammatory disease and lipoprotein metabolism disorder. If the regulation of inflammatory process is disturbed, the systemic release of pro-inflammatory mediators, including matrix metalloproteinases (MMPs), may lead to a low-grade systemic inflammation, which is a risk factor for CVDs. MMPs are enzymes that are responsible for the degradation of the extracellular matrix (ECM) during growth and tissue renewal but also in many pathological conditions. These ECM degrading proteases and their regulators play an important role in atherogenesis and subsequent plaque rupture, leading to acute cardiovascular manifestations. The pivotal role of MMPs in atherosclerosis has raised interest in the development of drug therapies targeting these proteases. Doxycycline has inhibitory effects on some MMPs in addition to its antimicrobial properties. The main objective of this thesis project was to investigate the potential of these inflammatory mediators as biomarkers, risk factors, and therapeutic targets in CVD. The special focus was on MMP-8 and its main regulator, tissue inhibitor of matrix metalloproteinase (TIMP)-1. The results of this study show that a high serum MMP-8 concentration indicates an acute cardiac condition and predicts a future CVD event. In addition to MMP-8, MMP-7 is a potential biomarker for incident CVD. The balance between these MMPs and their tissue inhibitor may indicate vulnerability to plaque rupture. Measurement of serum MMP-8 concentration is reliable, anti-invasive and inexpensive and can be done in hospital settings. We also show that regular-dose doxycycline decreases the systemic inflammatory burden in patients with earlier myocardial infarction and is a promising anti-inflammatory therapy in the prevention of CVDs with relatively minor side effects. In conclusion, MMP-8 and TIMP-1 can be considered inflammatory risk markers of CVD events and death, and they can be utilized both for diagnostic and screening purposes. The inhibition of MMP-8 by doxycycline may reduce the systemic inflammatory burden in patients with myocardial infarction. / Tiivistelmä Sydän- ja verisuonisairaudet, erityisesti ateroskleroottiset valtimosairaudet, ovat maailman yleisin sairastuvuuden ja ennenaikaisen kuoleman syy. Sepelvaltimotauti ja aivohaveri ovat ateroskleroottisen valtimosairauden yleisiä ja vakavia ilmenemismuotoja. Ateroskleroosi on krooninen tulehduksellinen sairaus ja lipoproteiiniaineenvaihdunnan häiriö. Jos tulehdustapahtuma häiriintyy, elimistöön vapautuvat tulehdusvälittäjäaineet, kuten matriksin metalloproteinaasit (MMP), voivat aiheuttaa elimistön matala-asteisen tulehduksen, joka on sydän- ja verisuonisairauksien riskitekijä. MMP:t ovat entsyymejä, jotka pilkkovat solunväliainetta kasvun ja kudosten uusiutumisen mutta myös monien tautitilojen yhteydessä. Nämä soluväliainetta hajottavat proteaasit ja niiden säätelijät ovat tärkeässä roolissa ateroskleroottisen plakin muodostumisessa ja repeämisessä, joka johtaa äkillisiin sydäntautitapahtumiin. Matriksin metalloproteinaasien keskeinen rooli ateroskleroosissa on herättänyt kiinnostusta niihin kohdistuvan lääkehoidon kehittämiseen. Doksisykliinillä on joidenkin MMP-entsyymien toimintaa estävä vaikutus antimikrobiaalisten ominaisuuksiensa lisäksi. Tämän väitöskirjatutkimuksen päätavoitteena oli tutkia näiden tulehdusvälittäjäaineiden mahdollisuuksia biomarkkereina, riskitekijöinä ja lääkehoidon kohteena sydän- ja verisuonisairauksissa. Erityinen kiinnostuksen kohde oli MMP-8 ja sen pääsäätelijä ja kudosestäjä, tissue inhibitor of matrix metalloproteinase (TIMP)-1. Tämän tutkimuksen tulokset osoittavat, että seerumin korkea MMP 8 pitoisuus viittaa akuuttiin sydäntautiin ja ennakoi tulevaa sydäntautitapahtumaa. MMP-8:n lisäksi MMP-7 on lupaava sydäntapahtuman biomarkkeri. Näiden matriksin metalloproteinaasien ja niiden kudossäätelijä TIMP-1:n välinen tasapaino voi liittyä ateroskleroottisen plakin haurauteen. Seerumin MMP-8:n mittaus on luotettavaa, kajoamatonta ja edullista, ja mahdollista toteuttaa myös sairaalaolosuhteissa. Näytämme myös, että doksisykliini vähentää elimistön tulehdustaakkaa sydäninfarktin sairastaneilla potilailla ja että se on sydäntautien ehkäisyssä lupaava anti-inflammatorinen lääke, jolla on suhteellisen vähän sivuvaikutuksia. Johtopäätöksenä on, että MMP-8:aa ja TIMP-1:tä voidaan pitää lupaavina sydän- ja verisuonitautien sekä kuoleman biomarkkereina sekä diagnostiikka- että seulontakäytössä. Lisäksi tutkimustulokset osoittavat, että MMP-8:n esto doksisykliinillä voi vähentää elimistön tulehdustaakkaa sydänkohtauksen sairastaneilla potilailla.