Uterine myomas treated with microwave ablation: the agreement between ablation volumes obtained from contrast-enhanced sonography and enhanced MRI.

PURPOSE: This study explores the agreement between ablated uterine myoma volumes obtained from contrast-enhanced sonography and enhanced magnetic resonance imaging (MRI) after microwave ablation therapy. MATERIALS AND METHODS: Twenty uterine myomas in 18 patients (average size: 5.56 ± 1.26 cm) were successfully treated by microwave ablation. Contrast-enhanced sonography and enhanced MRI were performed within 7 days after the treatment. The ablation range of uterine myomas was observed and the ablation volume was calculated. By using the intraclass correlation coefficient (ICC) and Bland-Altman regression analysis, the agreement between ablated uterine myoma volumes obtained from contrast-enhanced sonography and enhanced MRI after microwave ablation therapy was analysed. RESULTS: The ablated volume ranged from 13.66 to 135.27 cm(3) after ablation, and the mean volume was 66.59 ± 35.71 cm(3) by using contrast-enhanced sonography. Respectively, the ablated volume ranged from 10.88 to 137.83 cm(3), and the mean volume was 66.81 ± 35.45 cm(3) by using enhanced MRI. The limits of agreement between the two methods were (-10.83 cm(3), 8.39 cm(3)), ICC was 0.991 (F = 209.61, P < 0.05), and 95% confidence interval is (0.976, 0.996). The results revealed a good agreement between the two examination methods of contrast-enhanced sonography and enhanced MRI. CONCLUSIONS: Contrast-enhanced sonography and enhanced MRI can be used interchangeably in observing the ablation range of uterine myomas treated with microwave ablation. Contrast-enhanced sonography can be used as a preferred non-invasive examination and for follow-up. Meanwhile, enhanced MRI can be used to comprehensively determine the relationships among uterine myomas, the entire uterus, and surrounding tissues.

Evaluation of a medication monitor-based treatment strategy for drug-sensitive tuberculosis patients in China: study protocol for a cluster randomised controlled trial.

BACKGROUND: Treatment for drug-sensitive tuberculosis (TB) is taken for at least 6 months and problems with adherence are common. Therefore, there is substantial interest in the possible use of eHealth interventions to support patients to take their treatment. Electronic medication monitors have been shown to improve adherence to TB medication, but the impact on clinical outcomes is unknown. We aim to evaluate the impact of a medication monitor-based treatment strategy for drug-sensitive TB patients on a composite poor outcome measured over 18 months from start of TB treatment. METHODS/DESIGN: We will conduct an open, pragmatic, cluster randomised superiority trial, with 24 counties/districts in three provinces in China, randomised 1:1 to implement the intervention or standard of care. Adults (aged ≥ 18 years) with a new episode of GeneXpert-positive and rifampicin-sensitive pulmonary TB, who plan to be in the study area for the next 18 months, and will receive daily fixed-dose combination tablets for 6 months of treatment are eligible. The intervention is centred around a medication monitor that holds a 1-month supply of medication and has three key functions: as an audio and visual reminder for patients to take their daily medication; reminds patients of upcoming monthly visit; and records date and time whenever the box is opened. At the monthly follow-up visit, the doctor downloads these data to generate a graphical display of the last month's adherence record for discussion with the patient and potentially to switch the patient to more intensive management. The primary outcome is a composite poor outcome measured over 18 months from start of TB treatment, defined as either of poor outcome at the end of treatment (death, treatment failure, or loss to follow-up) or subsequent recurrence (culture positive for TB at 12 or 18 months or re-starting TB treatment in the follow-up period). An economic evaluation will also be conducted as part of this study. DISCUSSION: This trial will assess whether a medication monitor-based treatment strategy can improve clinical outcomes for TB patients. Several trials of other eHealth interventions for TB treatment are ongoing and are summarised in this paper. This trial will provide an important part of the emerging evidence base for the potential of eHealth to improve TB treatment outcomes. TRIAL REGISTRATION: This trial was registered with Current Controlled Trials (identifier: ISRCTN35812455 ). Registered on May 19, 2016.