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Background: Continuous advancements in interventional and diagnostic radiological techniques are mandatory to meet the increasing demands of patients and health care professionals. This thesis aims to contribute to the development of more effective interventional and diagnostic radiological methods for pelvic diseases. Ultimately, these advancements can lead to improved patient outcomes, optimised treatment strategies, and enhanced precision in diagnosing and managing conditions affecting the uterus and prostate. Aim: The overarching aim of this thesis is to investigate both interventional and diagnostic radiological methods for pelvic diseases, and specifically for the uterus and the prostate. Specifically, we aim to address the feasibility, usability and effectiveness of a new degradable starch microsphere (DSM) intended for use in transarterial embolisation of the uterus and prostate (papers I and II), and prostate MRI features with applications on estimations of tumour aggressiveness and prostate volume (papers III and IV). Methods: The experimental trial of papers I and II was performed on sheep that underwent transarterial uterine artery embolisation with either a DSM or a permanent commercially available permanent sphere, trisacryl gelatine microspheres (TGMS) in a blinded randomised controlled trial. Two weeks after embolisation, a follow-up angiogram was performed to assess recanalisation, and thereafter the animals were euthanised, and organs were collected for histopathology. The primary outcome measures were the occurrence of recanalisation of the embolised arteries and the presence of ischaemic changes in the embolised organs. Papers III and IV were retrospective cohort studies of men diagnosed with prostate cancer who had an MRI prior to prostatectomy. In paper III, we evaluated the correlation of absolute tumour apparent diffusion coefficient (ADC) and ADC ratios with pathology-based tumour aggressiveness in terms of ISUP grade group according to the

I vår studie har vi undersökt hur delaktiga eleverna är i fritidshemmets verksamhet och att se likheter och olikheter mellan två skolor i Uppsala. Våra frågeställningar fokuserar på att få fram vilka arenor, vilka frågor, hur personalen skapar förutsättningar samt vilka hinder det finns för att öka elevernas delaktighet inom fritidshemmet. Intervjuer med rektorer, fritidshemslärare samt elever på båda skolorna har utförts för att sedan analyseras och jämförs med tidigare forskning. I tidigare forskning lyfts olika sätt för att öka elevers delaktighet på fritidshemmet genom fritidsråd, förslagslåda men även via samtal med eleverna. De teoretiska begrepp som vi har använt oss av i analysen är olika syn på ledarstilar, maktperspektiv samt teorier relationer och interkulturalitet. I elevsamtalen lade vi stor vikt i att möta eleverna i en mer naturlig del igenom att vara delaktiga i deras aktivitet på fritidshemmet. Eleverna har svårt att förstå vad de får och inte får vara med att bestämma över, de har en grundinställning att de inte får vara med att bestämma alls. I slutanalysen lyfter vi fram olika framgångsfaktorer för att öka elevernas delaktighet och inflytande. Resultatet visar att det är olika förutsättningar för fritidshemslärarna på de båda skolorna samt att likheterna är att närvaron till eleverna är en stark framgångsfaktor.

Background: The purpose of this study was to investigate whether treatment of a depressive episode with intermittent theta burst stimulation (iTBS) over the dorsomedial prefrontal cortex (DMPFC) had any effects on heart rate variability (HRV). We also investigated if changes in HRV covaried with symptom change after iTBS and if HRV could predict symptom change. Methods: We included 49 patients with a current depressive episode. All were randomized to receive a double-blind treatment course with active or sham iTBS over the DMPFC. HRV data were obtained from 1 h of night data before and after the iTBS. The standard deviation of the RR interval (SDNN) was chosen as primary outcome measure. Depressive, negative, and anxiety symptoms as well as self-rated health were assessed by clinicians or by self-report. Results: The group×time linear mixed model revealed no effect of iTBS on SDNN (estimate = −1.8, 95% confidence interval [CI]: −19.9 to 16.2). There were neither correlations between HRV and depressive, negative, or anxiety symptom change after iTBS nor with self-assessed health. No predictive value of HRV was found. Conclusions: Treatment for depression with dorsomedial iTBS had neither negative nor positive effects on the cardiac autonomic nervous system., Title in thesis list of papers: No effects on heart rate variability after a treatment course of dorsomedial prefrontal intermittent theta burst stimulation in depression

Negative symptoms comprise anhedonia, avolition, and blunted affect. Although first described in schizophrenia, these symptoms share phenomenology with the depressive state. Pharmacological treatment has not been successful in reducing negative symptoms. Repetitive transcranial magnetic stimulation (rTMS) is a non-pharmacological treatment option for moderate to severe depression. There have also been attempts to treat negative symptoms in both schizophrenia and depression with rTMS. Cardiovascular disease is common in schizophrenia and depression. Heart rate variability (HRV) is an established proxy for cardiac autonomic functioning and numerous studies have found lower HRV in patients with schizophrenia and depression. The impact of psychopharmacological treatment on HRV has been extensively studied and anticholinergic compounds have been found to decrease HRV. Lastly, since the most commonly used rTMS depression targets are also the brain regions involved in central autonomic regulation, there is reason to consider a potential effect of rTMS on HRV. The overall aim of this thesis was to investigate negative symptoms, rTMS, and HRV in schizophrenia and depression. Study I was a validation study of a Swedish translation of the Clinical Assessment Interview for Negative Symptoms (CAINS). Thirty-four patients with schizophrenia were interviewed and it was concluded that the Swedish version of the CAINS exhibited acceptable psychometric properties. Study II was a double-blind randomized controlled trial of rTMS for negative symptoms in schizophrenia and depression. There was a significant decrease of negative symptoms in the depression group, but not in the schizophrenia group. There were no effects on overall depressive symptoms in either group. Study III assessed determinants of HRV in schizophrenia, depression, and healthy controls. The results indicated lower HRV in both patient groups, even after controlling for several factors, and also that anticholinergic burd

PURPOSE: The Clinical Assessment Interview for Negative Symptoms (CAINS) was developed in order to advance the assessment of negative symptoms. The aim of this study was to validate the Swedish version of the CAINS. MATERIALS AND METHODS: Thirty-four out-patients with a schizophrenia spectrum disorder were recruited. All patients were videotaped while interviewed with the CAINS and the Brief Psychiatric Rating Scale (BPRS). Another rater watched the video recordings in the reverse order, enabling a blinded design. The patients also filled in self-reported measures of depression, quality of life, and social and vocational functioning. We calculated inter-rater agreement and internal consistency for the CAINS. We also calculated validity measures by correlating the subscales Motivation and Pleasure (CAINS-MAP) and Expression (CAINS-EXP) to subscales of the BPRS. RESULTS: The blinded inter-rater agreement for the CAINS total score was high (ICC = 0.92) but slightly lower for the expression subscale (ICC = 0.76). Cronbach's alpha was 0.84 for the total score. Convergent validity with the negative symptoms subscale of BPRS was different for the blinded and the unblinded data, with a CAINS-MAP correlation of 0.10 (p = 0.580) and a CAINS-EXP correlation of 0.48 (p = 0.004) in the blinded data. The unblinded data had a CAINS-MAP correlation of 0.38 (p = 0.026) and a CAINS-EXP correlation of 0.87 (p < 0.001). Self-rated measures of anhedonia correlated to CAINS-MAP with a coefficient of 0.68 (p < 0.001), while the CAINS-EXP only had a correlation of 0.16 (p = 0.366) to these measures. CONCLUSION: The Swedish version of the CAINS displays adequate psychometric properties in line with earlier validation studies.

Background & Aims: Magnetic resonance cholangiopancreatography (MRCP) is used for the diagnosis and follow-up of individuals with primary sclerosing cholangitis (PSC). The aim of our study is to develop an MRCP-score based on chol-angiographic findings previously associated with outcomes and assess its reproducibility and prognostic value in PSC. Methods: The score (DiStrict score) was developed based on the extent and severity of cholangiographic changes of intra-hepatic and extrahepatic bile ducts (range 0-8) on 3D-MRCP. In this retrospective, multicentre study, three pairs of radiol-ogists with different levels of expertise from three tertiary centres applied the score independently. MRCP examinations of 220 consecutive individuals with PSC from a prospectively collected PSC-cohort, with median follow-up of 7.4 years, were reviewed. Inter-reader and intrareader agreements were assessed via intraclass correlation coefficient (ICC). After consensus, the prognostic value of the score was assessed using Cox-regression and outcome-free survival rates were assessed via Kaplan-Meier estimates. Harrell's C-statistic was calculated. Results: Forty patients developed outcomes (liver transplantation or liver-related death). Inter-reader agreement between experienced radiologists was good (ICC 0.82; 95% CI 0.74-0.87, and ICC 0.81; 95% CI 0.70-0.87, respectively) and better than the agreement for the pair of experienced/less-experienced radiologists (ICC 0.48; 95% CI 0.05-0.72). Agreement between radiologists from the three centres was good (ICC 0.76; 95% CI 0.57-0.89). Intrareader agreement was good to excellent (ICC 0.85-0.93). Harrell's C was 0.78. Patients with a DiStrict score of 5-8 had 8.2-fold higher risk (hazard ratio 8.2; 95% CI 2.97-22.65) of developing outcomes, and significantly worse survival (p <0.001), compared to those with a DiStrict score of 1-4. Conclusions: The novel DiStrict score is reproducible and strongly associated with outcomes, indicating i