Purpose: Early confirmation or ruling out biliary atresia (BA) is essential for infants with delayed onset of jaundice. In the current practice, percutaneous liver biopsy and intraoperative cholangiography (IOC) remain the golden standards for diagnosis. In Taiwan, the diagnostic methods are invasive and can only be performed in selective medical centers. However, referrals from primary physicians and local pediatricians are often delayed because of lacking clinical suspicions. Ultrasounds (US) are common screening tools in local hospitals and clinics, but the pediatric hepatobiliary US particularly requires well-trained imaging personnel. The meaningful comprehension of US is highly dependent on individual experience. For screening BA through human observation on US images, the reported sensitivity and specificity were achieved by pediatric radiologists, pediatric hepatobiliary experts, or pediatric surgeons. Therefore, this research developed a tool based on deep learning models for screening BA to assist pediatric US image reading by general physicians and pediatricians. Methods: De-identified hepatobiliary US images of 180 patients from Taichung Veterans General Hospital were retrospectively collected under the approval of the Institutional Review Board. Herein, the top network models of ImageNet Large Scale Visual Recognition Competition and other network models commonly used for US image recognition were included for further study to classify US images as BA or non-BA. The performance of different network models was expressed by the confusion matrix and receiver operating characteristic curve. There were two methods proposed to solve disagreement by US image classification of a single patient. The first and second methods were the positive-dominance law and threshold law. During the study, the US images of three successive patients suspected to have BA were classified by the trained models. Results: Among all included patients contributing US images, 41 patients were diagnosed with BA by surgical intervention and 139 patients were either healthy controls or had non-BA diagnoses. In this study, a total of 1,976 original US images were enrolled. Among them, 417 and 1,559 raw images were from patients with BA and without BA, respectively. Meanwhile, ShuffleNet achieved the highest accuracy of 90.56% using the same training parameters as compared with other network models. The sensitivity and specificity were 67.83% and 96.76%, respectively. In addition, the undesired false-negative prediction was prevented by applying positive-dominance law to interpret different images of a single patient with an acceptable false-positive rate, which was 13.64%. For the three consecutive patients with delayed obstructive jaundice with IOC confirmed diagnoses, ShuffleNet achieved accurate diagnoses in two patients. Conclusion: The current study provides a screening tool for identifying possible BA by hepatobiliary US images. The method was not designed to replace liver biopsy or IOC, but to decrease human error for interpretations of US. By applying the positive-dominance law to ShuffleNet, the false-negative rate and the specificities were 0 and 86.36%, respectively. The trained deep learning models could aid physicians other than pediatric surgeons, pediatric gastroenterologists, or pediatric radiologists, to prevent misreading pediatric hepatobiliary US images. The current artificial intelligence (AI) tool is helpful for screening BA in the real world.

Our report is the first example describing the successful synthesis of magnetic Fe₃O₄ nanoparticles (NPs), for which we used pulsed-laser induced photolysis (PLIP). Compared with the previous method of using pulsed-laser ablation of a target, or strong energy of pulsed-laser light to decompose precursors in generating a solvated-ion reaction, the PLIP method used here is dependent on hydrogen peroxide (H₂O₂) to generate a hydrolysis reaction. Energy-dispersive X-ray spectroscopy (EDS) and X-ray diffraction (XRD) were used to demonstrate the Fe₃O₄ crystalline structure of the synthesized NPs. Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) images revealed that the average size of the NPs was about 20–50 nm. Regarding their magnetic characteristics, the synthesized NPs exhibited a saturation magnetization of 5.62 emu/g, remanence of 3.82 emu/g, and coercive force of 49.8 Oe. The photocatalytic experiments confirmed that the synthesized magnetic Fe₃O₄ NPs have visible light-degradation effects based on their ability to photocatalytically degrade methylene blue (MB). The MB degradation efficiency was 60–80% under white-light exposure for 180 min. This study presents a new route for synthesizing magnetic Fe₃O₄ NPs for their potential use in photocatalysis.

Gold nanoparticles conjugated with collagen molecules and fibers have been proven to improve structure strength, water and enzyme degradation resistance, cell attachment, cell proliferation, and skin wound healing. In this study, high-power impulse magnetron sputtering (HiPIMS) was used to deposit ultrathin gold films (UTGF) and discontinuous island structures on type I collagen substrates. A long turn-off time of duty cycle and low chamber temperature of HiPIMS maintained substrate morphology. Increasing the deposition time from 6 s to 30 s elevated the substrate surface coverage by UTGF up to 91.79%, as observed by a field emission scanning electron microscope. X-ray diffractometry analysis revealed signature low and wide peaks for Au (111). The important surface functional groups and signature peaks of collagen substrate remained unchanged according to Fourier transform infrared spectroscopy results. Multi-peak curve fitting of the Amide I spectrum revealed the non-changed protein secondary structure of type I collagen, which mainly consists of α-helix. Atomic force microscopy observation showed that the roughness average value shifted from 1.74 to 4.17 nm by increasing the deposition time from 13 s to 77 s. The uneven surface of collagen substrate made quantification of thin film thickness by AFM difficult. Instead, UTGF thickness was measured using simultaneously deposited glass specimens placed in an HiPIMS chamber with collagen substrates. Film thickness was 3.99 and 10.37 nm at deposition times of 13 and 77 s, respectively. X-ray photoelectron spectroscopy showed preserved substrate elements on the surface. Surface water contact angle measurement revealed the same temporary hydrophobic behavior before water absorption via exposed collagen substrates, regardless of deposition time. In conclusion, HiPIMS is an effective method to deposit UTGF on biomedical materials such as collagen without damaging valuable substrates. The composition of two materials could be further used for biomedical purposes with preserved functions of UTGF and collagen.

Parenteral nutrition (PN) in children with short bowel syndrome is crucial and lifesaving. Taking care of such patients requires interprofessional practice and multiple team resource management. Home PN (HPN) usage allows patients and families to live regular lives outside hospitals. We share our experiences for the last two decades and identify the risk factors for complications and mortality. A retrospective study of HPN patients was conducted between January 2000 and February 2022. Medical records of age, body weight, diagnosis, length of residual intestines, HPN period, central line attempts, complications, weaning, and survival were collected and analyzed. The patients were classified as HPN free, HPN dependent, and mortality groups. A total of 25 patients received HPN at our outpatient clinic, and one was excluded for the adult age of disease onset. There were 13 patients (54.1%) who were successfully weaned from HPN until the record-enroled date. The overall mortality rate was 20.8% (five patients). All mortality cases had prolonged cholestasis, Child Class B or C, and a positive Pediatric End-Stage Liver Disease (PELD) score. For HPN dependence, extended resection and multiple central line placement were two significant independent factors. Cholestasis, Child Class B or C, and positive PELD score were the most important risk factors for mortality. The central line-related complication rate was not different in all patient groups. The overall central line infection rate was 1.58 per 1000 catheter days. Caution should be addressed to prevent cholestasis and intestinal failure-associated liver disease during the HPN period, to prevent mortality. By understanding the risks of HPN dependence and mortality, preventive procedures could be addressed earlier.

Rationale: Foreign body ingestion is more common in children than adults and occurs most frequently between the ages of 6 months and 6 years. While most foreign bodies pass spontaneously, retention in the appendix is rare and can lead to serious complications such as appendicitis or perforation. Patient concerns: We report the case of a 2-year 10-month-old boy referred to our pediatric gastroenterology division due to a witnessed ingestion of a screw, which remained in the gastrointestinal tract for 2 months. Diagnoses: Abdominal computed tomography revealed a screw-shaped metallic foreign body located near the ileocecal valve, with mild dilatation of the small bowel. Interventions: Given the prolonged presence of the foreign body in the right lower abdomen, a laparoscopic appendectomy was performed. Pathology confirmed early acute appendicitis. Outcomes: The patient recovered uneventfully and was discharged on postoperative day 5 without complications. Lessons: Although rare, appendicitis can result from foreign body ingestion. Serial abdominal X-rays or abdominal 3-dimensional computed tomography scans can assist in diagnosis. Management options include endoscopic retrieval or surgical removal, such as laparoscopic appendectomy.