No abstract

ObjectiveEsophagogastroduodenoscopy (EGD) is the pivotal procedure in the diagnosis of upper gastrointestinal lesions. However, there are significant variations in EGD performance among endoscopists, impairing the discovery rate of gastric cancers and precursor lesions. The aim of this study was to construct a real-time quality improving system, WISENSE, to monitor blind spots, time the procedure and automatically generate photodocumentation during EGD and thus raise the quality of everyday endoscopy.DesignWISENSE system was developed using the methods of deep convolutional neural networks and deep reinforcement learning. Patients referred because of health examination, symptoms, surveillance were recruited from Renmin hospital of Wuhan University. Enrolled patients were randomly assigned to groups that underwent EGD with or without the assistance of WISENSE. The primary end point was to ascertain if there was a difference in the rate of blind spots between WISENSE-assisted group and the control group.ResultsWISENSE monitored blind spots with an accuracy of 90.40% in real EGD videos. A total of 324 patients were recruited and randomised. 153 and 150 patients were analysed in the WISENSE and control group, respectively. Blind spot rate was lower in WISENSE group compared with the control (5.86% vs 22.46%, p<0.001), and the mean difference was −15.39% (95% CI −19.23 to −11.54). There was no significant adverse event.ConclusionsWISENSE significantly reduced blind spot rate of EGD procedure and could be used to improve the quality of everyday endoscopy.Trial registration numberChiCTR1800014809; Results.

Highlights d A three-dimensional architecture of the HNS with high resolution was reconstructed d Magnocellular neuroendocrine cells collaterally projected to extrahypothalamic areas d Activation of Magno-OXT neurons promoted social behavior and peripheral OXT release d Inhibition of Magno-OXT neurons elicited opposite effects

The hypothalamo-neurohypophysial system (HNS), comprising hypothalamic magnocellular neuroendocrine cells (MNCs) and the neurohypophysis, plays a pivotal role in regulating reproduction and fluid homeostasis by releasing oxytocin and vasopressin into the bloodstream. However, it remains incompletely understood on its structure and whether it contributes to the central actions of oxytocin and vasopressin.Using viral tracing and whole brain imaging, we reconstructed the three-dimensional architecture of the HNS and uncovered that subsets of MNCs collaterally project to multiple extrahypothalamic regions. Moreover, selective activation of magnocellular oxytocin neurons promoted peripheral oxytocin release and facilitated central oxytocinmediated social interactions. Further, MNCs-released oxytocin in the caudate putamen enhanced locomotion to orchestrate social investigation. Our work reveals the previously unrecognized complexity of the HNS and provides structural and functional evidence for MNCs in coordinating both peripheral and central oxytocin-mediated actions, which will shed light on the mechanistic understanding of oxytocin-related psychiatric diseases.