ClinicalReTrial: A Self-Evolving AI Agent for Clinical Trial Protocol Optimization

Clinical trial failure remains a central bottleneck in drug development, where minor protocol design flaws can irreversibly compromise outcomes despite promising therapeutics. Although cutting-edge AI methods achieve strong performance in predicting trial success, they are inherently reactive for merely diagnosing risk without offering actionable remedies once failure is anticipated. To fill this gap, this paper proposes ClinicalReTrial, a self-evolving AI agent framework that addresses this gap by casting clinical trial reasoning as an iterative protocol redesign problem. Our method integrates failure diagnosis, safety-aware modification, and candidate evaluation in a closed-loop, reward-driven optimization framework. Serving the outcome prediction model as a simulation environment, ClinicalReTrial enables low-cost evaluation of protocol modifications and provides dense reward signals for continuous self-improvement. To support efficient exploration, the framework maintains hierarchical memory that captures iteration-level feedback within trials and distills transferable redesign patterns across trials. Empirically, ClinicalReTrial improves 83.3% of trial protocols with a mean success probability gain of 5.7%, and retrospective case studies demonstrate strong alignment between the discovered redesign strategies and real-world clinical trial modifications.

Incentivizing Tool-augmented Thinking with Images for Medical Image Analysis

Recent reasoning based medical MLLMs have made progress in generating step by step textual reasoning chains. However, they still struggle with complex tasks that necessitate dynamic and iterative focusing on fine-grained visual regions to achieve precise grounding and diagnosis. We introduce Ophiuchus, a versatile, tool-augmented framework that equips an MLLM to (i) decide when additional visual evidence is needed, (ii) determine where to probe and ground within the medical image, and (iii) seamlessly weave the relevant sub-image content back into an interleaved, multimodal chain of thought. In contrast to prior approaches limited by the performance ceiling of specialized tools, Ophiuchus integrates the model's inherent grounding and perception capabilities with external tools, thereby fostering higher-level reasoning. The core of our method is a three-stage training strategy: cold-start training with tool-integrated reasoning data to achieve basic tool selection and adaptation for inspecting key regions; self-reflection fine-tuning to strengthen reflective reasoning and encourage revisiting tool outputs; and Agentic Tool Reinforcement Learning to directly optimize task-specific rewards and emulate expert-like diagnostic behavior. Extensive experiments show that Ophiuchus consistently outperforms both closed-source and open-source SOTA methods across diverse medical benchmarks, including VQA, detection, and reasoning-based segmentation. Our approach illuminates a path toward medical AI agents that can genuinely "think with images" through tool-integrated reasoning. Datasets, codes, and trained models will be released publicly.

SpectralAdapt: Semi-Supervised Domain Adaptation with Spectral Priors for Human-Centered Hyperspectral Image Reconstruction

Hyperspectral imaging (HSI) holds great potential for healthcare due to its rich spectral information. However, acquiring HSI data remains costly and technically demanding. Hyperspectral image reconstruction offers a practical solution by recovering HSI data from accessible modalities, such as RGB. While general domain datasets are abundant, the scarcity of human HSI data limits progress in medical applications. To tackle this, we propose SpectralAdapt, a semi-supervised domain adaptation (SSDA) framework that bridges the domain gap between general and human-centered HSI datasets. To fully exploit limited labels and abundant unlabeled data, we enhance spectral reasoning by introducing Spectral Density Masking (SDM), which adaptively masks RGB channels based on their spectral complexity, encouraging recovery of informative regions from complementary cues during consistency training. Furthermore, we introduce Spectral Endmember Representation Alignment (SERA), which derives physically interpretable endmembers from valuable labeled pixels and employs them as domain-invariant anchors to guide unlabeled predictions, with momentum updates ensuring adaptability and stability. These components are seamlessly integrated into SpectralAdapt, a spectral prior-guided framework that effectively mitigates domain shift, spectral degradation, and data scarcity in HSI reconstruction. Experiments on benchmark datasets demonstrate consistent improvements in spectral fidelity, cross-domain generalization, and training stability, highlighting the promise of SSDA as an efficient solution for hyperspectral imaging in healthcare.

Versatile and Risk-Sensitive Cardiac Diagnosis via Graph-Based ECG Signal Representation

Despite the rapid advancements of electrocardiogram (ECG) signal diagnosis and analysis methods through deep learning, two major hurdles still limit their clinical adoption: the lack of versatility in processing ECG signals with diverse configurations, and the inadequate detection of risk signals due to sample imbalances. Addressing these challenges, we introduce VersAtile and Risk-Sensitive cardiac diagnosis (VARS), an innovative approach that employs a graph-based representation to uniformly model heterogeneous ECG signals. VARS stands out by transforming ECG signals into versatile graph structures that capture critical diagnostic features, irrespective of signal diversity in the lead count, sampling frequency, and duration. This graph-centric formulation also enhances diagnostic sensitivity, enabling precise localization and identification of abnormal ECG patterns that often elude standard analysis methods. To facilitate representation transformation, our approach integrates denoising reconstruction with contrastive learning to preserve raw ECG information while highlighting pathognomonic patterns. We rigorously evaluate the efficacy of VARS on three distinct ECG datasets, encompassing a range of structural variations. The results demonstrate that VARS not only consistently surpasses existing state-of-the-art models across all these datasets but also exhibits substantial improvement in identifying risk signals. Additionally, VARS offers interpretability by pinpointing the exact waveforms that lead to specific model outputs, thereby assisting clinicians in making informed decisions. These findings suggest that our VARS will likely emerge as an invaluable tool for comprehensive cardiac health assessment.

Utilizing Training Data to Improve LLM Reasoning for Tabular Understanding

Automated tabular understanding and reasoning are essential tasks for data scientists. Recently, Large language models (LLMs) have become increasingly prevalent in tabular reasoning tasks. Previous work focuses on (1) finetuning LLMs using labeled data or (2) Training-free prompting LLM agents using chain-of-thought (CoT). Finetuning offers dataset-specific learning at the cost of generalizability. Training-free prompting is highly generalizable but does not take full advantage of training data. In this paper, we propose a novel prompting-based reasoning approach, Learn then Retrieve: LRTab, which integrates the benefits of both by retrieving relevant information learned from training data. We first use prompting to obtain CoT responses over the training data. For incorrect CoTs, we prompt the LLM to predict Prompt Conditions to avoid the error, learning insights from the data. We validate the effectiveness of Prompt Conditions using validation data. Finally, at inference time, we retrieve the most relevant Prompt Conditions for additional context for table understanding. We provide comprehensive experiments on WikiTQ and Tabfact, showing that LRTab is interpretable, cost-efficient, and can outperform previous baselines in tabular reasoning.

Mitigating Hallucination of Large Vision-Language Models via Dynamic Logits Calibration

Large Vision-Language Models (LVLMs) have demonstrated significant advancements in multimodal understanding, yet they are frequently hampered by hallucination-the generation of text that contradicts visual input. Existing training-free decoding strategies exhibit critical limitations, including the use of static constraints that do not adapt to semantic drift during generation, inefficiency stemming from the need for multiple forward passes, and degradation of detail due to overly rigid intervention rules. To overcome these challenges, this paper introduces Dynamic Logits Calibration (DLC), a novel training-free decoding framework designed to dynamically align text generation with visual evidence at inference time. At the decoding phase, DLC step-wise employs CLIP to assess the semantic alignment between the input image and the generated text sequence. Then, the Relative Visual Advantage (RVA) of candidate tokens is evaluated against a dynamically updated contextual baseline, adaptively adjusting output logits to favor tokens that are visually grounded. Furthermore, an adaptive weighting mechanism, informed by a real-time context alignment score, carefully balances the visual guidance while ensuring the overall quality of the textual output. Extensive experiments conducted across diverse benchmarks and various LVLM architectures (such as LLaVA, InstructBLIP, and MiniGPT-4) demonstrate that DLC significantly reduces hallucinations, outperforming current methods while maintaining high inference efficiency by avoiding multiple forward passes. Overall, we present an effective and efficient decoding-time solution to mitigate hallucinations, thereby enhancing the reliability of LVLMs for more practices. Code will be released on Github.

Comorbidity-Informed Transfer Learning for Neuro-developmental Disorder Diagnosis

Neuro-developmental disorders are manifested as dysfunctions in cognition, communication, behaviour and adaptability, and deep learning-based computer-aided diagnosis (CAD) can alleviate the increasingly strained healthcare resources on neuroimaging. However, neuroimaging such as fMRI contains complex spatio-temporal features, which makes the corresponding representations susceptible to a variety of distractions, thus leading to less effective in CAD. For the first time, we present a Comorbidity-Informed Transfer Learning(CITL) framework for diagnosing neuro-developmental disorders using fMRI. In CITL, a new reinforced representation generation network is proposed, which first combines transfer learning with pseudo-labelling to remove interfering patterns from the temporal domain of fMRI and generates new representations using encoder-decoder architecture. The new representations are then trained in an architecturally simple classification network to obtain CAD model. In particular, the framework fully considers the comorbidity mechanisms of neuro-developmental disorders and effectively integrates them with semi-supervised learning and transfer learning, providing new perspectives on interdisciplinary. Experimental results demonstrate that CITL achieves competitive accuracies of 76.32% and 73.15% for detecting autism spectrum disorder and attention deficit hyperactivity disorder, respectively, which outperforms existing related transfer learning work for 7.2% and 0.5% respectively.

OrderChain: A General Prompting Paradigm to Improve Ordinal Understanding Ability of MLLM

Despite the remarkable progress of multimodal large language models (MLLMs), they continue to face challenges in achieving competitive performance on ordinal regression (OR; a.k.a. ordinal classification). To address this issue, this paper presents OrderChain, a novel and general prompting paradigm that improves the ordinal understanding ability of MLLMs by specificity and commonality modeling. Specifically, our OrderChain consists of a set of task-aware prompts to facilitate the specificity modeling of diverse OR tasks and a new range optimization Chain-of-Thought (RO-CoT), which learns a commonality way of thinking about OR tasks by uniformly decomposing them into multiple small-range optimization subtasks. Further, we propose a category recursive division (CRD) method to generate instruction candidate category prompts to support RO-CoT automatic optimization. Comprehensive experiments show that a Large Language and Vision Assistant (LLaVA) model with our OrderChain improves baseline LLaVA significantly on diverse OR datasets, e.g., from 47.5% to 93.2% accuracy on the Adience dataset for age estimation, and from 30.0% to 85.7% accuracy on the Diabetic Retinopathy dataset. Notably, LLaVA with our OrderChain also remarkably outperforms state-of-the-art methods by 27% on accuracy and 0.24 on MAE on the Adience dataset. To our best knowledge, our OrderChain is the first work that augments MLLMs for OR tasks, and the effectiveness is witnessed across a spectrum of OR datasets.

Biomedical Foundation Model: A Survey

Foundation models, first introduced in 2021, are large-scale pre-trained models (e.g., large language models (LLMs) and vision-language models (VLMs)) that learn from extensive unlabeled datasets through unsupervised methods, enabling them to excel in diverse downstream tasks. These models, like GPT, can be adapted to various applications such as question answering and visual understanding, outperforming task-specific AI models and earning their name due to broad applicability across fields. The development of biomedical foundation models marks a significant milestone in leveraging artificial intelligence (AI) to understand complex biological phenomena and advance medical research and practice. This survey explores the potential of foundation models across diverse domains within biomedical fields, including computational biology, drug discovery and development, clinical informatics, medical imaging, and public health. The purpose of this survey is to inspire ongoing research in the application of foundation models to health science.

A Survey on Ordinal Regression: Applications, Advances and Prospects

Ordinal regression refers to classifying object instances into ordinal categories. Ordinal regression is crucial for applications in various areas like facial age estimation, image aesthetics assessment, and even cancer staging, due to its capability to utilize ordered information effectively. More importantly, it also enhances model interpretation by considering category order, aiding the understanding of data trends and causal relationships. Despite significant recent progress, challenges remain, and further investigation of ordinal regression techniques and applications is essential to guide future research. In this survey, we present a comprehensive examination of advances and applications of ordinal regression. By introducing a systematic taxonomy, we meticulously classify the pertinent techniques and applications into three well-defined categories based on different strategies and objectives: Continuous Space Discretization, Distribution Ordering Learning, and Ambiguous Instance Delving. This categorization enables a structured exploration of diverse insights in ordinal regression problems, providing a framework for a more comprehensive understanding and evaluation of this field and its related applications. To our best knowledge, this is the first systematic survey of ordinal regression, which lays a foundation for future research in this fundamental and generic domain.