Wearable Single-Lead ECG Detects Fine-Grained Structural Heart Disease Through Echo-Report Supervision

Structural heart disease (SHD) is a primary driver of heart failure and cardiovascular mortality, yet early detection remains constrained by the limited accessibility of echocardiography. While single-lead electrocardiogram (ECG) is ubiquitous through wearables, existing AI screening models often depend on 12-lead inputs, generalize poorly across institutions, or require massive, condition-specific labeled datasets. Recent work has demonstrated the feasibility of contrastive pre-training between single-lead ECGs and echocardiography reports within a single health system. Here, we present AnyECG-Echo, a framework that advance this paradigm toward clinical translation through three key developments: (1) evaluation in a geographically independent external cohort (n = 16,621); (2) diagnostic coverage of 13 fine-grained SHD subtypes spanning myocardial, chamber, valvular, and great-vessel pathologies; and (3) dual-axis mechanistic interpretability combining electrophysiology-grounded Shapley attribution with emergent correlations to quantitative measurements. Across validation cohorts totaling n = 25,222, the model demonstrated high AUROC for high-impact subtypes, including reduced left ventricular systolic function (AUROC 0.866-0.924), global heart enlargement (0.877-0.931), and mitral stenosis (0.836-0.906). Furthermore, we successfully validated the alignment of model outputs with established medical physiological traits, thereby enhancing interpretability. Notably, we discovered that AnyECG-Echo's outputs function as physiologically grounded digital biomarkers that accurately track objective metrics such as LVEF and myocardial wall thickness. These findings prove that wearable single-lead ECGs can effectively detect fine-grained structural heart disease, offering a practical solution for population-scale screening.

In-Hospital Stroke Prediction from PPG-Derived Hemodynamic Features

The absence of pre-hospital physiological data in standard clinical datasets fundamentally constrains the early prediction of stroke, as patients typically present only after stroke has occurred, leaving the predictive value of continuous monitoring signals such as photoplethysmography (PPG) unvalidated. In this work, we overcome this limitation by focusing on a rare but clinically critical cohort - patients who suffered stroke during hospitalization while already under continuous monitoring - thereby enabling the first large-scale analysis of pre-stroke PPG waveforms aligned to verified onset times. Using MIMIC-III and MC-MED, we develop an LLM-assisted data mining pipeline to extract precise in-hospital stroke onset timestamps from unstructured clinical notes, followed by physician validation, identifying 176 patients (MIMIC) and 158 patients (MC-MED) with high-quality synchronized pre-onset PPG data, respectively. We then extract hemodynamic features from PPG and employ a ResNet-1D model to predict impending stroke across multiple early-warning horizons. The model achieves F1-scores of 0.7956, 0.8759, and 0.9406 at 4, 5, and 6 hours prior to onset on MIMIC-III, and, without re-tuning, reaches 0.9256, 0.9595, and 0.9888 on MC-MED for the same horizons. These results provide the first empirical evidence from real-world clinical data that PPG contains predictive signatures of stroke several hours before onset, demonstrating that passively acquired physiological signals can support reliable early warning, supporting a shift from post-event stroke recognition to proactive, physiology-based surveillance that may materially improve patient outcomes in routine clinical care.

Addressing data annotation scarcity in Brain Tumor Segmentation on 3D MRI scan Using a Semi-Supervised Teacher-Student Framework

Accurate brain tumor segmentation from MRI is limited by expensive annotations and data heterogeneity across scanners and sites. We propose a semi-supervised teacher-student framework that combines an uncertainty-aware pseudo-labeling teacher with a progressive, confidence-based curriculum for the student. The teacher produces probabilistic masks and per-pixel uncertainty; unlabeled scans are ranked by image-level confidence and introduced in stages, while a dual-loss objective trains the student to learn from high-confidence regions and unlearn low-confidence ones. Agreement-based refinement further improves pseudo-label quality. On BraTS 2021, validation DSC increased from 0.393 (10% data) to 0.872 (100%), with the largest gains in early stages, demonstrating data efficiency. The teacher reached a validation DSC of 0.922, and the student surpassed the teacher on tumor subregions (e.g., NCR/NET 0.797 and Edema 0.980); notably, the student recovered the Enhancing class (DSC 0.620) where the teacher failed. These results show that confidence-driven curricula and selective unlearning provide robust segmentation under limited supervision and noisy pseudo-labels.

Mimic Human Cognition, Master Multi-Image Reasoning: A Meta-Action Framework for Enhanced Visual Understanding

While Multimodal Large Language Models (MLLMs) excel at single-image understanding, they exhibit significantly degraded performance in multi-image reasoning scenarios. Multi-image reasoning presents fundamental challenges including complex inter-relationships between images and scattered critical information across image sets. Inspired by human cognitive processes, we propose the Cognition-Inspired Meta-Action Framework (CINEMA), a novel approach that decomposes multi-image reasoning into five structured meta-actions: Global, Focus, Hint, Think, and Answer which explicitly modeling the sequential cognitive steps humans naturally employ. For cold-start training, we introduce a Retrieval-Based Tree Sampling strategy that generates high-quality meta-action trajectories to bootstrap the model with reasoning patterns. During reinforcement learning, we adopt a two-stage paradigm: an exploration phase with Diversity-Preserving Strategy to avoid entropy collapse, followed by an annealed exploitation phase with DAPO to gradually strengthen exploitation. To train our model, we construct a dataset of 57k cold-start and 58k reinforcement learning instances spanning multi-image, multi-frame, and single-image tasks. We conduct extensive evaluations on multi-image reasoning benchmarks, video understanding benchmarks, and single-image benchmarks, achieving competitive state-of-the-art performance on several key benchmarks. Our model surpasses GPT-4o on the MUIR and MVMath benchmarks and notably outperforms specialized video reasoning models on video understanding benchmarks, demonstrating the effectiveness and generalizability of our human cognition-inspired reasoning framework.

GPT-PPG: A GPT-based Foundation Model for Photoplethysmography Signals

This study introduces a novel application of a Generative Pre-trained Transformer (GPT) model tailored for photoplethysmography (PPG) signals, serving as a foundation model for various downstream tasks. Adapting the standard GPT architecture to suit the continuous characteristics of PPG signals, our approach demonstrates promising results. Our models are pre-trained on our extensive dataset that contains more than 200 million 30s PPG samples. We explored different supervised fine-tuning techniques to adapt our model to downstream tasks, resulting in performance comparable to or surpassing current state-of-the-art (SOTA) methods in tasks like atrial fibrillation detection. A standout feature of our GPT model is its inherent capability to perform generative tasks such as signal denoising effectively, without the need for further fine-tuning. This success is attributed to the generative nature of the GPT framework.

Foundation Models in Electrocardiogram: A Review

The electrocardiogram (ECG) is ubiquitous across various healthcare domains, such as cardiac arrhythmia detection and sleep monitoring, making ECG analysis critically essential. Traditional deep learning models for ECG are task-specific, with a narrow scope of functionality and limited generalization capabilities. Recently, foundation models (FMs), also known as large pre-training models, have fundamentally reshaped the scheme of model design and representation learning, enhancing the performance across a variety of downstream tasks. This success has drawn interest in the exploration of FMs to address ECG-based medical challenges concurrently. This survey provides a timely, comprehensive and up-to-date overview of FMs for large-scale ECG-FMs. First, we offer a brief background introduction to FMs. Then, we discuss the model architectures, pre-training methods, and adaptation approaches of ECG-FMs from a methodology perspective. Despite the promising opportunities of ECG-FMs, we also outline the challenges and potential future directions. Overall, this survey aims to provide researchers and practitioners with insights into the research of ECG-FMs on theoretical underpinnings, domain-specific applications, and avenues for future exploration.

Human Stone Toolmaking Action Grammar (HSTAG): A Challenging Benchmark for Fine-grained Motor Behavior Recognition

Action recognition has witnessed the development of a growing number of novel algorithms and datasets in the past decade. However, the majority of public benchmarks were constructed around activities of daily living and annotated at a rather coarse-grained level, which lacks diversity in domain-specific datasets, especially for rarely seen domains. In this paper, we introduced Human Stone Toolmaking Action Grammar (HSTAG), a meticulously annotated video dataset showcasing previously undocumented stone toolmaking behaviors, which can be used for investigating the applications of advanced artificial intelligence techniques in understanding a rapid succession of complex interactions between two hand-held objects. HSTAG consists of 18,739 video clips that record 4.5 hours of experts' activities in stone toolmaking. Its unique features include (i) brief action durations and frequent transitions, mirroring the rapid changes inherent in many motor behaviors; (ii) multiple angles of view and switches among multiple tools, increasing intra-class variability; (iii) unbalanced class distributions and high similarity among different action sequences, adding difficulty in capturing distinct patterns for each action. Several mainstream action recognition models are used to conduct experimental analysis, which showcases the challenges and uniqueness of HSTAG https://nyu.databrary.org/volume/1697.

Deep Learning for Personalized Electrocardiogram Diagnosis: A Review

The electrocardiogram (ECG) remains a fundamental tool in cardiac diagnostics, yet its interpretation traditionally reliant on the expertise of cardiologists. The emergence of deep learning has heralded a revolutionary era in medical data analysis, particularly in the domain of ECG diagnostics. However, inter-patient variability prohibit the generalibility of ECG-AI model trained on a population dataset, hence degrade the performance of ECG-AI on specific patient or patient group. Many studies have address this challenge using different deep learning technologies. This comprehensive review systematically synthesizes research from a wide range of studies to provide an in-depth examination of cutting-edge deep-learning techniques in personalized ECG diagnosis. The review outlines a rigorous methodology for the selection of pertinent scholarly articles and offers a comprehensive overview of deep learning approaches applied to personalized ECG diagnostics. Moreover, the challenges these methods encounter are investigated, along with future research directions, culminating in insights into how the integration of deep learning can transform personalized ECG diagnosis and enhance cardiac care. By emphasizing both the strengths and limitations of current methodologies, this review underscores the immense potential of deep learning to refine and redefine ECG analysis in clinical practice, paving the way for more accurate, efficient, and personalized cardiac diagnostics.

SiamQuality: A ConvNet-Based Foundation Model for Imperfect Physiological Signals

Foundation models, especially those using transformers as backbones, have gained significant popularity, particularly in language and language-vision tasks. However, large foundation models are typically trained on high-quality data, which poses a significant challenge, given the prevalence of poor-quality real-world data. This challenge is more pronounced for developing foundation models for physiological data; such data are often noisy, incomplete, or inconsistent. The present work aims to provide a toolset for developing foundation models on physiological data. We leverage a large dataset of photoplethysmography (PPG) signals from hospitalized intensive care patients. For this data, we propose SimQuality, a novel self-supervised learning task based on convolutional neural networks (CNNs) as the backbone to enforce representations to be similar for good and poor quality signals that are from similar physiological states. We pre-trained the SimQuality on over 36 million 30-second PPG pairs and then fine-tuned and tested on six downstream tasks using external datasets. The results demonstrate the superiority of the proposed approach on all the downstream tasks, which are extremely important for heart monitoring on wearable devices. Our method indicates that CNNs can be an effective backbone for foundation models that are robust to training data quality.

SQUWA: Signal Quality Aware DNN Architecture for Enhanced Accuracy in Atrial Fibrillation Detection from Noisy PPG Signals

Atrial fibrillation (AF), a common cardiac arrhythmia, significantly increases the risk of stroke, heart disease, and mortality. Photoplethysmography (PPG) offers a promising solution for continuous AF monitoring, due to its cost efficiency and integration into wearable devices. Nonetheless, PPG signals are susceptible to corruption from motion artifacts and other factors often encountered in ambulatory settings. Conventional approaches typically discard corrupted segments or attempt to reconstruct original signals, allowing for the use of standard machine learning techniques. However, this reduces dataset size and introduces biases, compromising prediction accuracy and the effectiveness of continuous monitoring. We propose a novel deep learning model, Signal Quality Weighted Fusion of Attentional Convolution and Recurrent Neural Network (SQUWA), designed to learn how to retain accurate predictions from partially corrupted PPG. Specifically, SQUWA innovatively integrates an attention mechanism that directly considers signal quality during the learning process, dynamically adjusting the weights of time series segments based on their quality. This approach enhances the influence of higher-quality segments while reducing that of lower-quality ones, effectively utilizing partially corrupted segments. This approach represents a departure from the conventional methods that exclude such segments, enabling the utilization of a broader range of data, which has great implications for less disruption when monitoring of AF risks and more accurate estimation of AF burdens. Our extensive experiments show that SQUWA outperform existing PPG-based models, achieving the highest AUCPR of 0.89 with label noise mitigation. This also exceeds the 0.86 AUCPR of models trained with using both electrocardiogram (ECG) and PPG data.