A Robust Recurrent Neural Networks-Based Surrogate Model for Thermal History and Melt Pool Characteristics in Directed Energy Deposition.

In directed energy deposition (DED), accurately controlling and predicting melt pool characteristics is essential for ensuring desired material qualities and geometric accuracies. This paper introduces a robust surrogate model based on recurrent neural network (RNN) architectures-Long Short-Term Memory (LSTM), Bidirectional LSTM (Bi-LSTM), and Gated Recurrent Unit (GRU). Leveraging a time series dataset from multi-physics simulations and a three-factor, three-level experimental design, the model accurately predicts melt pool peak temperatures, lengths, widths, and depths under varying conditions. RNN algorithms, particularly Bi-LSTM, demonstrate high predictive accuracy, with an R-square of 0.983 for melt pool peak temperatures. For melt pool geometry, the GRU-based model excels, achieving R-square values above 0.88 and reducing computation time by at least 29%, showcasing its accuracy and efficiency. The RNN-based surrogate model built in this research enhances understanding of melt pool dynamics and supports precise DED system setups.

Percutaneous Biliary Interventions via the Modified Hutson Loop in Patients with Biliary-Enteric Anastomoses: A Retrospective Study.

PURPOSE: This study aimed to present the institutional experience and algorithm for performing biliary interventions in liver transplant patients using the modified Hutson loop access (MHLA) and the impact of percutaneous endoscopy via the MHLA on these procedures. METHODS: Over 13 years, 201 MHLA procedures were attempted on 52 patients (45 liver transplants; 24 living and 21 deceased donors) for diagnostic (e.g., cholangiography) and therapeutic (e.g., stent/drain insertion and cholangioplasty) purposes. The most common indications for MHLA were biliary strictures (60%) and bile leaks (23%). Percutaneous endoscopy was used to directly visualize the biliary-enteric anastomosis, diagnose pathology (e.g., ischemic cholangiopathy), and help in biliary hygiene (removing debris/casts/stones/stents) in 138/201 (69%) procedures. Technical success was defined as cannulating the biliary-enteric anastomosis and performing diagnostic/therapeutic procedure via the MHLA. RESULTS: The technical success rate was 95% (190/201). The failure rate among procedures performed with and without endoscopy was 2% (3/138) versus 13% (8/63) (P = 0.0024), and the need for new transhepatic access (to aid the procedure) was 12% (16/138) versus 30% (19/63) (P = 0.001). Despite endoscopy, failure in 2% of the cases resulted from inflamed/friable anastomosis (1/3) and high-grade stricture (2/3) obstructing retrograde cannulation of biliary-enteric anastomosis. Major adverse events (bowel perforation and injury) occurred in 1% of the procedures, with no procedure-related mortality. CONCLUSIONS: MHLA-based percutaneous biliary intervention is a safe and effective alternative to managing complications after liver transplant. Percutaneous endoscopy via the MHLA improves success rates and may reduce the need for new transhepatic access. Level of Evidence Level 4.

Social dysfunction relates to shifts within socioaffective brain systems among Schizophrenia and Alzheimer's disease patients.

Social dysfunction represents one of the most common signs of neuropsychiatric disorders, such as Schizophrenia (SZ) and Alzheimer's disease (AD). Perturbed socioaffective neural processing is crucially implicated in SZ/AD and generally linked to social dysfunction. Yet, transdiagnostic properties of social dysfunction and its neurobiological underpinnings remain unknown. As part of the European PRISM project, we examined whether social dysfunction maps onto shifts within socioaffective brain systems across SZ and AD patients. We probed coupling of social dysfunction with socioaffective neural processing, as indexed by an implicit facial emotional processing fMRI task, across SZ (N = 46), AD (N = 40) and two age-matched healthy control (HC) groups (N = 26 HC-younger and N = 27 HC-older). Behavioural (i.e., social withdrawal, interpersonal dysfunction, diminished prosocial or recreational activity) and subjective (i.e., feelings of loneliness) aspects of social dysfunction were assessed using the Social Functioning Scale and De Jong-Gierveld loneliness questionnaire, respectively. Across SZ/AD/HC participants, more severe behavioural social dysfunction related to hyperactivity within fronto-parieto-limbic brain systems in response to sad emotions (P = 0.0078), along with hypoactivity of these brain systems in response to happy emotions (P = 0.0418). Such relationships were not found for subjective experiences of social dysfunction. These effects were independent of diagnosis, and not confounded by clinical and sociodemographic factors. In conclusion, behavioural aspects of social dysfunction across SZ/AD/HC participants are associated with shifts within fronto-parieto-limbic brain systems. These findings pinpoint altered socioaffective neural processing as a putative marker for social dysfunction, and could aid personalized care initiatives grounded in social behaviour.

LSTMDD: an optimized LSTM-based drift detector for concept drift in dynamic cloud computing.

This study aims to investigate the problem of concept drift in cloud computing and emphasizes the importance of early detection for enabling optimum resource utilization and offering an effective solution. The analysis includes synthetic and real-world cloud datasets, stressing the need for appropriate drift detectors tailored to the cloud domain. A modified version of Long Short-Term Memory (LSTM) called the LSTM Drift Detector (LSTMDD) is proposed and compared with other top drift detection techniques using prediction error as the primary evaluation metric. LSTMDD is optimized to improve performance in detecting anomalies in non-Gaussian distributed cloud environments. The experiments show that LSTMDD outperforms other methods for gradual and sudden drift in the cloud domain. The findings suggest that machine learning techniques such as LSTMDD could be a promising approach to addressing the problem of concept drift in cloud computing, leading to more efficient resource allocation and improved performance.

A Retrospective Two-Year Review of the Outcomes of Surgical Rib Fixation Following Chest Wall Injury by the Multidisciplinary Chest Wall Injury Group in a Major Trauma Centre and the Change in Outcomes as the Service Has Developed.

Aims All English major trauma centres (MTCs) offer rib fixation, which the National Institute for Health and Care Excellence (NICE) guidance indicates in patients with multiple rib fractures or a flail segment; however, the data does not identify the appropriate patients. Our aims were to establish improvements in outcomes following rib fixation at our trust and then determine if the rib fixation service has improved. Methods We performed a matched cohort study whereby 32 patients who underwent rib fixation were independently matched with conservatively managed patients. We then performed a retrospective re-audit to compare outcomes with the matched cohort study. The outcomes analysed were mortality, critical care length of stay (LOS) and total hospital LOS. Results Our initial study revealed a 33.4% reduction in mortality in patients over 55 years. There was also a reduction in average total hospital LOS by 4.5 days in patients under 55 years when comparing rib fixation to conservative management. The results also revealed an average of 4.1 days from admission to operation, 12.7 days of critical care LOS and 29.1 days of total hospital LOS. The re-audit showed improvements in all outcomes. Time from admission to fixation was reduced to 2.1 days, critical care LOS was reduced to 7.5 days and total hospital LOS was reduced to 20.7 days. Conclusions Reduced mortality and LOS reinforce evidence that rib fixation improves outcomes. The re-audit shows that patients are identified for fixation sooner, which is important as the evidence has not identified optimal time for fixation. LOS further decreased in our re-audit, which indicates that earlier fixation results in patients avoiding the sequelae of rib fractures.

Acute Pancreatitis following Percutaneous Electrohydraulic Lithotripsy.

The gold-standard treatment of acute calculous cholecystitis is cholecystectomy. For patients not suitable for surgery, endoscopic or percutaneous techniques can be used for gallbladder decompression. The national percutaneous cholecystostomy rates have increased by 567% from 1994 to 2009*. Some of these patients are still not surgical candidates after the acute cholecystitis episode has resolved. Hence, it is crucial to have a management plan in place for such patients. There are several peroral endoscopic treatment options available, including ultrasound-guided transmural drainage, lithotripsy, and transpapillary stenting**. Furthermore, due to the advent of percutaneous biliary endoscopes, interventional radiology (IR) can now perform percutaneous lithotripsy and gallstone removal followed by cystic duct stenting. This method aims to internalize gallbladder drainage without the need for a long-term external cholecystostomy tube. Acute pancreatitis is a rare complication that can arise following interventions involving the biliary and cystic ducts. Acute pancreatitis can occur after retrograde ampullary manipulation during endoscopic retrograde cholangiopancreatography. However, this can sometimes happen after percutaneous antegrade interventions performed by IR. In this report, we will examine a rare complication that occurred in a patient with acute calculous cholecystitis: acute pancreatitis following percutaneous electrohydraulic lithotripsy with cystic duct stenting performed by IR.

Percutaneous sequential closure of an Abernethy malformation: A case report.

Abernethy malformation (congenital extrahepatic portosystemic shunt [CEPS]) is rare and is characterized by an aberrant connection between the portal and systemic veins, bypassing the liver. It can have varying presentations and can lead to severe complications if left untreated. It is usually diagnosed incidentally on abdominal imaging. Occlusion venography and measurement of portal pressures (pre- and postocclusion) is an important step in management. Complete occlusion of the malformation in cases where the portal veins in the liver are very small and the gradient is more than 10 mm Hg, can potentially lead to acute portal hypertensive complications, such as porto-mesenteric thrombosis. We report a case of Abernethy malformation diagnosed on an abdominal computed tomography scan that presented with neurological symptoms and was successfully managed by interventional radiology via endovascular closure through placement and sequential occlusion of 2 metal stents.

White Box Watermarking for Convolution Layers in Fine-Tuning Model Using the Constant Weight Code.

Deep neural network (DNN) watermarking is a potential approach for protecting the intellectual property rights of DNN models. Similar to classical watermarking techniques for multimedia content, the requirements for DNN watermarking include capacity, robustness, transparency, and other factors. Studies have focused on robustness against retraining and fine-tuning. However, less important neurons in the DNN model may be pruned. Moreover, although the encoding approach renders DNN watermarking robust against pruning attacks, the watermark is assumed to be embedded only into the fully connected layer in the fine-tuning model. In this study, we extended the method such that the model can be applied to any convolution layer of the DNN model and designed a watermark detector based on a statistical analysis of the extracted weight parameters to evaluate whether the model is watermarked. Using a nonfungible token mitigates the overwriting of the watermark and enables checking when the DNN model with the watermark was created.

Do Platelet-Rich Plasma Injections for Knee Osteoarthritis Work?

BACKGROUND: Recent evidence suggests a benefit in platelet-rich plasma injections (PRP) for the knee in the management of mild to moderate osteoarthritis (OA). There is a reported reduction in pain, stiffness, and improved function. However, there is very little level-one literature available that supports this practice and conclusively proves a benefit gained throughout the course. Three main randomized control trials (RCTs) conducted in North America are often referenced and cited to prove their efficacy. This study aimed to look at the outcomes of patients having undergone this treatment to determine if there was any benefit. AIMS: This study aimed to determine if PRP injections administered in patients with knee OA over a six to eight-week time period demonstrated any benefit. METHODS: The Western Ontario and McMaster Universities arthritis index (WOMAC) tool was used before each of the three PRP injections over the six to eight-week period, and six weeks after the final injection in 31 patients. Each injection was given spaced two to three weeks apart. The outcomes observed were pain, stiffness, and physical function, and the total WOMAC score was calculated. RESULTS: The third injection showed a reduction in total WOMAC score, pain, stiffness, and physical function by 16.36%, 16.37%, 5.12%, and 18.03%, respectively. However, all scores returned close to baseline at the sixth-week follow-up post treatment. CONCLUSION: Results showed a trend of reduction in the WOMAC score. However, they are overall indicative of a placebo effect from the injections. Further studies are needed to explore whether the grade of OA and patients' weight have a significant impact on the results.

Use of experimental medicine approaches for the development of novel psychiatric treatments based on orexin receptor modulation.

Despite progress in understanding the pathological mechanisms underlying psychiatric disorders, translation from animal models into clinical use remains a significant bottleneck. Preclinical studies have implicated the orexin neuropeptide system as a potential target for psychiatric disorders through its role in regulating emotional, cognitive, and behavioral processes. Clinical studies are investigating orexin modulation in addiction and mood disorders. Here we review performance-outcome measures (POMs) arising from experimental medicine research methods which may show promise as markers of efficacy of orexin receptor modulators in humans. POMs provide objective measures of brain function, complementing patient-reported or clinician-observed symptom evaluation, and aid the translation from preclinical to clinical research. Significant challenges include the development, validation, and operationalization of these measures. We suggest that collaborative networks comprising clinical practitioners, academics, individuals working in the pharmaceutical industry, drug regulators, patients, patient advocacy groups, and other relevant stakeholders may provide infrastructure to facilitate validation of experimental medicine approaches in translational research and in the implementation of these approaches in real-world clinical practice.

Percutaneous Cystic Duct Interventions and Drain Internalization for Calculous Cholecystitis in Patients Ineligible for Surgery.

PURPOSE: To evaluate the feasibility, effectiveness, and outcomes of percutaneous cholecystostomy drain internalization in patients with calculous cholecystitis who were not surgical candidates. MATERIALS AND METHODS: Percutaneous cystic duct interventions were attempted in 17 patients (with the intent to place dual cholecystoduodenal stents) who were deemed unfit for surgery and had previously undergone percutaneous cholecystostomies for acute calculous cholecystitis. Baseline demographics, technical success, time from percutaneous cholecystostomy to internalization (dual cholecystoduodenal stent placement), stent patency duration, and adverse event rates were evaluated. RESULTS: Fifteen (88%) of 17 procedures to cross the cystic duct were technically successful. Of these 17 patients, 13 (76%) underwent successful placement of dual cholecystoduodenal stents. Two of these 13 patients (who had successful dual cholecystoduodenal stent placement) needed repeat percutaneous cholecystostomy drains (1 patient had stent migration leading to recurrent cholecystitis, and the other had a perihepatic biloma). The 1-year patency rate was 77% (95% CI, 47%-100%). CONCLUSIONS: Dual cholecystoduodenal stent placement in nonsurgical patients is a technically feasible treatment option with the goal to remove percutaneous cholecystostomy drains.

How Endoscopic Guidance Augments Nonvascular Image-guided Interventions.

Endoscopy can improve guidance in nonvascular procedures performed by interventional radiologists (IRs). Historically, the major limiting factors preventing the widespread use of endoscopic tools by IRs were the large diameter (>20F) and length of the endoscopes. IRs had to significantly upsize their access into vascular organs such as the kidney and liver to allow endoscope placement. With the advent of newer endoscopes with sizes smaller than 11F (approximately 4 mm in diameter), percutaneous endoscopy has become more feasible than before. IRs routinely place percutaneous drains (eg, abscess drains, biliary drains, percutaneous nephrostomies, and percutaneous cholecystostomies). Once the drain is in position and the acute infection (if present) has resolved, the IR can use the percutaneous access to perform image-guided and endoscopically guided procedures, depending on the clinical situation. Most percutaneous image- and endoscopically guided interventions performed by IRs involve procedures for biliary and gallbladder pathologic conditions. Image-guided procedures with additional endoscopic guidance can also be used to manage urinary, gastrointestinal, and gynecologic pathologic conditions. The authors review the current applications and techniques of percutaneous endoscopy in interventional radiology. In unique situations, IRs can also perform endoscopy through natural orifices (eg, the urethra) or surgically created orifices (eg, urostomies). The authors also discuss the adjunctive techniques that are enhanced or made possible because of endoscopy in interventional radiology, including but not limited to endoscopic forceps biopsies, endobiliary ablation, laser stricturotomy, lithotripsy, and stone extraction. An invited commentary by Srinivasa is available online. Online supplemental material is available for this article. ©RSNA, 2022.

Impact of Portal Hypertension on Adverse Events after Splenic Arterial Aneurysm Embolization.

PURPOSE: To evaluate the outcomes of splenic artery aneurysm (SAA) embolization and compare adverse event (AE) rates after embolization in patients with and without portal hypertension (PHTN). MATERIALS AND METHODS: A retrospective review of all patients who underwent embolization of SAAs at 2 institutions was performed (34 patients from institution 1 and 7 patients from institution 2). Baseline demographic characteristics, preprocedural imaging, procedural techniques, and postprocedural outcomes were evaluated. Thirty-day postprocedural severe and life-threatening AEs were evaluated using the Society of Interventional Radiology guidelines. Thirty-day mortality and readmission rates were also evaluated. t test, χ2 test, and/or Fisher exact test were used for the statistical analysis. RESULTS: There was no statistically significant difference between patients with and without PHTN in the location, number, and size of SAA(s). All procedures were technically successful. There were 13 (32%) patients with and 28 (68%) patients without PHTN. The 30-day mortality rate (31% vs 0%; P = .007), readmission rates (61% vs 7%; P < .001), and severe/life-threatening AE rates (69% vs 0%; P < .001) were significantly higher in patients with PHTN than in those without PHTN. CONCLUSIONS: There was a significantly higher mortality and severe/life-threatening AE rate in patients with PHTN than in those without PHTN. SAAs in patients with PHTN need to be managed very cautiously, given the risk of severe/life-threatening AEs after embolization.

PKC isoforms activate LRRK1 kinase by phosphorylating conserved residues (Ser1064, Ser1074 and Thr1075) within the CORB GTPase domain.

Leucine-rich-repeat-kinase 1 (LRRK1) and its homolog LRRK2 are multidomain kinases possessing a ROC-CORA-CORB containing GTPase domain and phosphorylate distinct Rab proteins. LRRK1 loss of function mutations cause the bone disorder osteosclerotic metaphyseal dysplasia, whereas LRRK2 missense mutations that enhance kinase activity cause Parkinson's disease. Previous work suggested that LRRK1 but not LRRK2, is activated via a Protein Kinase C (PKC)-dependent mechanism. Here we demonstrate that phosphorylation and activation of LRRK1 in HEK293 cells is blocked by PKC inhibitors including LXS-196 (Darovasertib), a compound that has entered clinical trials. We show multiple PKC isoforms phosphorylate and activate recombinant LRRK1 in a manner reversed by phosphatase treatment. PKCα unexpectedly does not activate LRRK1 by phosphorylating the kinase domain, but instead phosphorylates a cluster of conserved residues (Ser1064, Ser1074 and Thr1075) located within a region of the CORB domain of the GTPase domain. These residues are positioned at the equivalent region of the LRRK2 DK helix reported to stabilize the kinase domain αC-helix in the active conformation. Thr1075 represents an optimal PKC site phosphorylation motif and its mutation to Ala, blocked PKC-mediated activation of LRRK1. A triple Glu mutation of Ser1064/Ser1074/Thr1075 to mimic phosphorylation, enhanced LRRK1 kinase activity ∼3-fold. From analysis of available structures, we postulate that phosphorylation of Ser1064, Ser1074 and Thr1075 activates LRRK1 by promoting interaction and stabilization of the αC-helix on the kinase domain. This study provides new fundamental insights into the mechanism controlling LRRK1 activity and reveals a novel unexpected activation mechanism.

Research Priorities in Percutaneous Image- and Endoscopy-Guided Interventions for Biliary and Gallbladder Diseases: Proceedings from the Society of Interventional Radiology Foundation Multidisciplinary Research Consensus Panel.

Recent technological advancements, including the introduction of disposable endoscopes, have enhanced the role of interventional radiology (IR) in the management of biliary and gallbladder diseases. There are unanswered questions in this growing field. The Society of Interventional Radiology Foundation convened a virtual research consensus panel consisting of a multidisciplinary group of experts to develop a prioritized research agenda regarding percutaneous image- and endoscopy-guided procedures for biliary and gallbladder diseases. The panelists discussed current data, opportunities for IR, and future efforts to maximize IR's ability and scope. A recurring theme throughout the discussions was to find ways to reduce the total duration of percutaneous drains and improve patients' quality of life. After the presentations and discussions, research priorities were ranked on the basis of their clinical relevance and impact. The research ideas ranked top 3 were as follows: (a) percutaneous multimodality management of benign anastomotic biliary strictures (laser vs endobiliary ablation vs cholangioplasty vs drain upsize protocol alone), (b) ablation of intraductal cholangiocarcinoma with and without stent placement, and (c) cholecystoscopy/choledochoscopy and lithotripsy in nonsurgical patients with calculous cholecystitis. Collaborative, retrospective, and prospective research studies are essential to answer these questions and improve the management protocols for patients with biliary and gallbladder diseases.

Investigating the Behavior of Waste Alumina Powder and Nylon Fibers for Eco-Friendly Production of Self-Compacting Concrete.

Self-compacting concrete (SCC) incorporating secondary raw materials has been extensively used around the globe due to its improved fresh, mechanical and durability properties. This study was planned to evaluate the suitability of locally available waste alumina powder (AP) and nylon textile fibers (NF) as a partial replacement for fine and coarse aggregates with the ultimate goal to locally produce SCC with desired properties. The used AP was acquired from a local market and NF was collected from a local textile factory. Various dosages of AP (10%, 20%, 30%, 40% and 50% by volume of fine aggregates) and NF (1% and 2% by volume of coarse aggregates) were studied. Tests including slump flow, V-funnel and J-ring tests were performed for examining the fresh properties of developed SCC. Results showed that the addition of AP has an insignificant effect on the superplasticizer dosage for maintaining a constant flow of 70 cm. However, a higher dosage of superplasticizer was required for a mixture with increasing dosages of NF to sustain a constant flow. Similarly, slump flow time (for a spread of 50 cm) and V-funnel time increased for mixtures with higher dosages of AP and NF. Tested SCC mixtures incorporating 40% and 50% of AP with 1% and 2% of NF showed an extreme blocking assessment due to their increased interparticle friction, the higher water absorption capacity of used AP and NF leading to increased flow resistance and hence, showed lower passing ability. The compressive strength was 16% higher for specimens incorporating 40% of AP due to the filling effect of AP which fills the micro-pores, leading to a more dense and compact internal micro-structure, confirmed through scanning electron microscopy analysis. An ultrasonic pulse velocity test conducted on hardened specimens verified the findings of the compressive strength results. Moreover, it was observed that NF has an insignificant effect on the compressive strength; however, flexural strength was increased due to the incorporation of NF, especially at higher dosages of AP.

Coded DNN Watermark: Robustness against Pruning Models Using Constant Weight Code.

Deep Neural Network (DNN) watermarking techniques are increasingly being used to protect the intellectual property of DNN models. Basically, DNN watermarking is a technique to insert side information into the DNN model without significantly degrading the performance of its original task. A pruning attack is a threat to DNN watermarking, wherein the less important neurons in the model are pruned to make it faster and more compact. As a result, removing the watermark from the DNN model is possible. This study investigates a channel coding approach to protect DNN watermarking against pruning attacks. The channel model differs completely from conventional models involving digital images. Determining the suitable encoding methods for DNN watermarking remains an open problem. Herein, we presented a novel encoding approach using constant weight codes to protect the DNN watermarking against pruning attacks. The experimental results confirmed that the robustness against pruning attacks could be controlled by carefully setting two thresholds for binary symbols in the codeword.

Cross-disorder and disorder-specific deficits in social functioning among schizophrenia and alzheimer's disease patients.

BACKGROUND: Social functioning is often impaired in schizophrenia (SZ) and Alzheimer's disease (AD). However, commonalities and differences in social dysfunction among these patient groups remain elusive. MATERIALS AND METHODS: Using data from the PRISM study, behavioral (all subscales and total score of the Social Functioning Scale) and affective (perceived social disability and loneliness) indicators of social functioning were measured in patients with SZ (N = 56), probable AD (N = 50) and age-matched healthy controls groups (HC, N = 29 and N = 28). We examined to what extent social functioning differed between disease and age-matched HC groups, as well as between patient groups. Furthermore, we examined how severity of disease and mood were correlated with social functioning, irrespective of diagnosis. RESULTS: As compared to HC, both behavioral and affective social functioning seemed impaired in SZ patients (Cohen's d's 0.81-1.69), whereas AD patients mainly showed impaired behavioral social function (Cohen's d's 0.65-1.14). While behavioral indices of social functioning were similar across patient groups, SZ patients reported more perceived social disability than AD patients (Cohen's d's 0.65). Across patient groups, positive mood, lower depression and anxiety levels were strong determinants of better social functioning (p's <0.001), even more so than severity of disease. CONCLUSIONS: AD and SZ patients both exhibit poor social functioning in comparison to age- and sex matched HC participants. Social dysfunction in SZ patients may be more severe than in AD patients, though this may be due to underreporting by AD patients. Across patients, social functioning appeared as more influenced by mood states than by severity of disease.

Percutaneous Biliary Neo-anastomosis or Neo-duct Creation Using Radiofrequency Wires.

BACKGROUND AND OBJECTIVE: This study aims to report a minimally invasive, percutaneous technique to cross complete biliary occlusions using a radiofrequency wire to create a biliary-enteric neo-anastomosis or biliary neo-duct. METHODS: All patients who underwent attempted creation of a neo-anastomosis/neo-duct using an RF wire were included in the study. Patients with non-malignant, complete and non-traversable biliary occlusion were considered for the creation of a neo-anastomosis (4 patients)/neo-duct (1 patient). RESULTS: Five patients (4 females, 1 male) with a mean age of 40 years (range: 10-69 years) were included in this study. Percutaneous bowel access was obtained in three of five patients and a snare was placed in the jejunal loop to serve as a target for RF wire advancement. In two patients, an enteral target was provided using a peroral endoscope in collaboration with gastroenterology. The procedure was technically successful in all cases and no intra-operative complications occurred. Patency of the neo-anastomosis was maintained in all patients, with follow-up ranging from 4 to 11 months. CONCLUSION: The RF wire was successfully used to create a biliary neo-anastomosis with a minimally invasive approach for the treatment of non-malignant complete biliary occlusion. This technique offers patients with complete biliary occlusion a safe, effective and durable treatment option which avoids the need for a permanent biliary drain and ultimately results in an improved quality of life.