Hamilton Health Sciences Corp.

Endometriosis is a serious multifocal condition that can involve various pelvic structures, with Pouch of Douglas (POD) obliteration being a significant clinical indicator for diagnosis. To circumvent the need for invasive diagnostic procedures like laparoscopy, research has increasingly focused on imaging-based methods such as transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI). The limited diagnostic accuracy achieved through manual interpretation of these imaging techniques has driven the development of automated classifiers that can effectively utilize both modalities. However, patients often undergo only one of these two examinations, resulting in unpaired data for training and testing POD obliteration classifiers, where TVUS models tend to be more accurate than MRI models, but TVUS scanning are more operator dependent. This prompts a crucial question: Can a model be trained with unpaired TVUS and MRI data to enhance the performance of a model exclusively trained with MRI, while maintaining the high accuracy of the model individually trained with TVUS? In this paper we aim to answer this question by proposing a novel multi-modal POD obliteration classifier that is trained with unpaired TVUS and MRI data and tested using either MRI or TVUS data. Our method is the first POD obliteration classifier that can flexibly take either the TVUS or MRI data, where the model automatically focuses on the uterus region within MRI data, eliminating the need for any manual intervention. Experiments conducted on our endometriosis dataset show that our method significantly improves POD obliteration classification accuracy using MRI from AUC=0.4755 (single-modal training and testing, without automatically focusing on the uterus region) to 0.8023 (unpaired multi-modal training and single modality MRI testing, with automatic uterus region detection), while maintaining the accuracy using TVUS with AUC=0.8921 (single modality TVUS testing using either an unpaired multi-modal training or a single-modality training).

Genetic disorders affecting amino acid metabolism are a significant subset of inherited metabolic disorders (IMDs). Plasma amino acid (PAA) analysis is used for the diagnosis and monitoring of these disorders in order to avoid development of severe symptoms. However, PAA assays are often lengthy in analysis time (>2h/sample) and some methods lack specificity and sensitivity. This project offers a novel solution through the optimization and clinical validation of the Kairos Amino Acid Kit by Waters Corp.

Using liquid chromatography with tandem mass spectrometry and 6-aminoquinolyl-N-hydroxysuccinimidyl carbamate derivatization, amino acid quantification has been achieved for 45 amino acids in 15 min of chromatography time per sample. The method utilizes reversed-phase chromatography via a high-strength silica C18 column. The optimized column chemistry enables strong hydrophobic retention, resolving all isobaric amino acids for individual mass-spectrometer quantification. Method validation protocols include linearity, sensitivity, precision, and bias.

Clinical validation has been performed, indicating high reproducibility and clinical applicability. Linearity results demonstrated 42/45 amino acids with R² > 0.975 over a linear range of at least 5-1000 µmol/L. Spiked plasma calibrators demonstrated high recovery with R² > 0.971. Twenty-day precision testing demonstrated total coefficient of variation < 15 % and sensitivity testing confirmed all analytes have limits of detection < 5 µmol/L, indicating high analytical sensitivity and precision. Method comparison to Waters' MassTrak Kit demonstrates acceptable bias and supports a future study to update reference intervals.

The clinical validation of the Kairos Amino Acid Kit for plasma amino acid monitoring highlights the potential of this novel method to enhance amino acid quantification in clinical laboratories for IMD management.

The objective of this study is to investigate safety and effectiveness of a fluoroscopy-guided high-intensity focused ultrasound (HIFU) system for thermal ablation of the lumbar medial branch nerves.

This dual center prospective cohort study enrolled 30 participants with lumbar zygapophyseal joint syndrome. Each participant previously had a positive response to either a single diagnostic analgesic block or radiofrequency ablation (RFA). The primary effectiveness outcome was individual responder rate, defined as a reduction of two points or more on the pain intensity numerical rating scale without an increase in opioid intake, or a reduction in opioid intake without an increase in pain at 6 months after the intervention. The primary safety outcome was procedure-related or device-related adverse events (AEs). Secondary outcome variables included MRI evidence of tissue ablation, Oswestry Disability Index, 12-Item Short Form Health Survey, Brief Pain Inventory, and Patient Global Impression of Change.

The individual responder rate was 89.7% at 2 days, 89.7% at 7 days, 72.4% at 14 days, 82.1% at 30 days, 59.3% at 90 days and 82.6% at 180 days. The average Numeric Rating Scale for pain severity decreased from 7.1 at baseline to 3.0 (N=29) after 2 days, 3.0 (N=29) after 7 days, 3.1 (N=29) after 14 days, 3.2 (N=28) after 30 days, 4.3 (N=27) after 90 days, and 3.3 (N=23) after 180 days. All participants tolerated the procedure well with no significant side effects or complications.

Fluoroscopy-guided HIFU neurotomy achieved clinical responses comparable with RFA, and there were no significant device-related or procedure-related AEs.

NCT04129034.