MedCL-Bench: Benchmarking stability-efficiency trade-offs and scaling in biomedical continual learning

Medical language models must be updated as evidence and terminology evolve, yet sequential updating can trigger catastrophic forgetting. Although biomedical NLP has many static benchmarks, no unified, task-diverse benchmark exists for evaluating continual learning under standardized protocols, robustness to task order and compute-aware reporting. We introduce MedCL-Bench, which streams ten biomedical NLP datasets spanning five task families and evaluates eleven continual learning strategies across eight task orders, reporting retention, transfer, and GPU-hour cost. Across backbones and task orders, direct sequential fine-tuning on incoming tasks induces catastrophic forgetting, causing update-induced performance regressions on prior tasks. Continual learning methods occupy distinct retention-compute frontiers: parameter-isolation provides the best retention per GPU-hour, replay offers strong protection at higher cost, and regularization yields limited benefit. Forgetting is task-dependent, with multi-label topic classification most vulnerable and constrained-output tasks more robust. MedCL-Bench provides a reproducible framework for auditing model updates before deployment.

HeartAgent: An Autonomous Agent System for Explainable Differential Diagnosis in Cardiology

Heart diseases remain a leading cause of morbidity and mortality worldwide, necessitating accurate and trustworthy differential diagnosis. However, existing artificial intelligence-based diagnostic methods are often limited by insufficient cardiology knowledge, inadequate support for complex reasoning, and poor interpretability. Here we present HeartAgent, a cardiology-specific agent system designed to support a reliable and explainable differential diagnosis. HeartAgent integrates customized tools and curated data resources and orchestrates multiple specialized sub-agents to perform complex reasoning while generating transparent reasoning trajectories and verifiable supporting references. Evaluated on the MIMIC dataset and a private electronic health records cohort, HeartAgent achieved over 36% and 20% improvements over established comparative methods, in top-3 diagnostic accuracy, respectively. Additionally, clinicians assisted by HeartAgent demonstrated gains of 26.9% in diagnostic accuracy and 22.7% in explanatory quality compared with unaided experts. These results demonstrate that HeartAgent provides reliable, explainable, and clinically actionable decision support for cardiovascular care.

To Reason or Not to: Selective Chain-of-Thought in Medical Question Answering

Objective: To improve the efficiency of medical question answering (MedQA) with large language models (LLMs) by avoiding unnecessary reasoning while maintaining accuracy. Methods: We propose Selective Chain-of-Thought (Selective CoT), an inference-time strategy that first predicts whether a question requires reasoning and generates a rationale only when needed. Two open-source LLMs (Llama-3.1-8B and Qwen-2.5-7B) were evaluated on four biomedical QA benchmarks-HeadQA, MedQA-USMLE, MedMCQA, and PubMedQA. Metrics included accuracy, total generated tokens, and inference time. Results: Selective CoT reduced inference time by 13-45% and token usage by 8-47% with minimal accuracy loss ($\leq$4\%). In some model-task pairs, it achieved both higher accuracy and greater efficiency than standard CoT. Compared with fixed-length CoT, Selective CoT reached similar or superior accuracy at substantially lower computational cost. Discussion: Selective CoT dynamically balances reasoning depth and efficiency by invoking explicit reasoning only when beneficial, reducing redundancy on recall-type questions while preserving interpretability. Conclusion: Selective CoT provides a simple, model-agnostic, and cost-effective approach for medical QA, aligning reasoning effort with question complexity to enhance real-world deployability of LLM-based clinical systems.

LongCat-Flash-Thinking-2601 Technical Report

We introduce LongCat-Flash-Thinking-2601, a 560-billion-parameter open-source Mixture-of-Experts (MoE) reasoning model with superior agentic reasoning capability. LongCat-Flash-Thinking-2601 achieves state-of-the-art performance among open-source models on a wide range of agentic benchmarks, including agentic search, agentic tool use, and tool-integrated reasoning. Beyond benchmark performance, the model demonstrates strong generalization to complex tool interactions and robust behavior under noisy real-world environments. Its advanced capability stems from a unified training framework that combines domain-parallel expert training with subsequent fusion, together with an end-to-end co-design of data construction, environments, algorithms, and infrastructure spanning from pre-training to post-training. In particular, the model's strong generalization capability in complex tool-use are driven by our in-depth exploration of environment scaling and principled task construction. To optimize long-tailed, skewed generation and multi-turn agentic interactions, and to enable stable training across over 10,000 environments spanning more than 20 domains, we systematically extend our asynchronous reinforcement learning framework, DORA, for stable and efficient large-scale multi-environment training. Furthermore, recognizing that real-world tasks are inherently noisy, we conduct a systematic analysis and decomposition of real-world noise patterns, and design targeted training procedures to explicitly incorporate such imperfections into the training process, resulting in improved robustness for real-world applications. To further enhance performance on complex reasoning tasks, we introduce a Heavy Thinking mode that enables effective test-time scaling by jointly expanding reasoning depth and width through intensive parallel thinking.

MeCaMIL: Causality-Aware Multiple Instance Learning for Fair and Interpretable Whole Slide Image Diagnosis

Multiple instance learning (MIL) has emerged as the dominant paradigm for whole slide image (WSI) analysis in computational pathology, achieving strong diagnostic performance through patch-level feature aggregation. However, existing MIL methods face critical limitations: (1) they rely on attention mechanisms that lack causal interpretability, and (2) they fail to integrate patient demographics (age, gender, race), leading to fairness concerns across diverse populations. These shortcomings hinder clinical translation, where algorithmic bias can exacerbate health disparities. We introduce \textbf{MeCaMIL}, a causality-aware MIL framework that explicitly models demographic confounders through structured causal graphs. Unlike prior approaches treating demographics as auxiliary features, MeCaMIL employs principled causal inference -- leveraging do-calculus and collider structures -- to disentangle disease-relevant signals from spurious demographic correlations. Extensive evaluation on three benchmarks demonstrates state-of-the-art performance across CAMELYON16 (ACC/AUC/F1: 0.939/0.983/0.946), TCGA-Lung (0.935/0.979/0.931), and TCGA-Multi (0.977/0.993/0.970, five cancer types). Critically, MeCaMIL achieves superior fairness -- demographic disparity variance drops by over 65% relative reduction on average across attributes, with notable improvements for underserved populations. The framework generalizes to survival prediction (mean C-index: 0.653, +0.017 over best baseline across five cancer types). Ablation studies confirm causal graph structure is essential -- alternative designs yield 0.048 lower accuracy and 4.2x times worse fairness. These results establish MeCaMIL as a principled framework for fair, interpretable, and clinically actionable AI in digital pathology. Code will be released upon acceptance.

AMO-Bench: Large Language Models Still Struggle in High School Math Competitions

We present AMO-Bench, an Advanced Mathematical reasoning benchmark with Olympiad level or even higher difficulty, comprising 50 human-crafted problems. Existing benchmarks have widely leveraged high school math competitions for evaluating mathematical reasoning capabilities of large language models (LLMs). However, many existing math competitions are becoming less effective for assessing top-tier LLMs due to performance saturation (e.g., AIME24/25). To address this, AMO-Bench introduces more rigorous challenges by ensuring all 50 problems are (1) cross-validated by experts to meet at least the International Mathematical Olympiad (IMO) difficulty standards, and (2) entirely original problems to prevent potential performance leakages from data memorization. Moreover, each problem in AMO-Bench requires only a final answer rather than a proof, enabling automatic and robust grading for evaluation. Experimental results across 26 LLMs on AMO-Bench show that even the best-performing model achieves only 52.4% accuracy on AMO-Bench, with most LLMs scoring below 40%. Beyond these poor performances, our further analysis reveals a promising scaling trend with increasing test-time compute on AMO-Bench. These results highlight the significant room for improving the mathematical reasoning in current LLMs. We release AMO-Bench to facilitate further research into advancing the reasoning abilities of language models. https://amo-bench.github.io/

Automating Expert-Level Medical Reasoning Evaluation of Large Language Models

As large language models (LLMs) become increasingly integrated into clinical decision-making, ensuring transparent and trustworthy reasoning is essential. However, existing evaluation strategies of LLMs' medical reasoning capability either suffer from unsatisfactory assessment or poor scalability, and a rigorous benchmark remains lacking. To address this, we introduce MedThink-Bench, a benchmark designed for rigorous, explainable, and scalable assessment of LLMs' medical reasoning. MedThink-Bench comprises 500 challenging questions across ten medical domains, each annotated with expert-crafted step-by-step rationales. Building on this, we propose LLM-w-Ref, a novel evaluation framework that leverages fine-grained rationales and LLM-as-a-Judge mechanisms to assess intermediate reasoning with expert-level fidelity while maintaining scalability. Experiments show that LLM-w-Ref exhibits a strong positive correlation with expert judgments. Benchmarking twelve state-of-the-art LLMs, we find that smaller models (e.g., MedGemma-27B) can surpass larger proprietary counterparts (e.g., OpenAI-o3). Overall, MedThink-Bench offers a foundational tool for evaluating LLMs' medical reasoning, advancing their safe and responsible deployment in clinical practice.

Uncertainty-Aware Large Language Models for Explainable Disease Diagnosis

Explainable disease diagnosis, which leverages patient information (e.g., signs and symptoms) and computational models to generate probable diagnoses and reasonings, offers clear clinical values. However, when clinical notes encompass insufficient evidence for a definite diagnosis, such as the absence of definitive symptoms, diagnostic uncertainty usually arises, increasing the risk of misdiagnosis and adverse outcomes. Although explicitly identifying and explaining diagnostic uncertainties is essential for trustworthy diagnostic systems, it remains under-explored. To fill this gap, we introduce ConfiDx, an uncertainty-aware large language model (LLM) created by fine-tuning open-source LLMs with diagnostic criteria. We formalized the task and assembled richly annotated datasets that capture varying degrees of diagnostic ambiguity. Evaluating ConfiDx on real-world datasets demonstrated that it excelled in identifying diagnostic uncertainties, achieving superior diagnostic performance, and generating trustworthy explanations for diagnoses and uncertainties. To our knowledge, this is the first study to jointly address diagnostic uncertainty recognition and explanation, substantially enhancing the reliability of automatic diagnostic systems.

Retrieval-augmented in-context learning for multimodal large language models in disease classification

Objectives: We aim to dynamically retrieve informative demonstrations, enhancing in-context learning in multimodal large language models (MLLMs) for disease classification. Methods: We propose a Retrieval-Augmented In-Context Learning (RAICL) framework, which integrates retrieval-augmented generation (RAG) and in-context learning (ICL) to adaptively select demonstrations with similar disease patterns, enabling more effective ICL in MLLMs. Specifically, RAICL examines embeddings from diverse encoders, including ResNet, BERT, BioBERT, and ClinicalBERT, to retrieve appropriate demonstrations, and constructs conversational prompts optimized for ICL. We evaluated the framework on two real-world multi-modal datasets (TCGA and IU Chest X-ray), assessing its performance across multiple MLLMs (Qwen, Llava, Gemma), embedding strategies, similarity metrics, and varying numbers of demonstrations. Results: RAICL consistently improved classification performance. Accuracy increased from 0.7854 to 0.8368 on TCGA and from 0.7924 to 0.8658 on IU Chest X-ray. Multi-modal inputs outperformed single-modal ones, with text-only inputs being stronger than images alone. The richness of information embedded in each modality will determine which embedding model can be used to get better results. Few-shot experiments showed that increasing the number of retrieved examples further enhanced performance. Across different similarity metrics, Euclidean distance achieved the highest accuracy while cosine similarity yielded better macro-F1 scores. RAICL demonstrated consistent improvements across various MLLMs, confirming its robustness and versatility. Conclusions: RAICL provides an efficient and scalable approach to enhance in-context learning in MLLMs for multimodal disease classification.

EPEE: Towards Efficient and Effective Foundation Models in Biomedicine

Foundation models, including language models, e.g., GPT, and vision models, e.g., CLIP, have significantly advanced numerous biomedical tasks. Despite these advancements, the high inference latency and the "overthinking" issues in model inference impair the efficiency and effectiveness of foundation models, thus limiting their application in real-time clinical settings. To address these challenges, we proposed EPEE (Entropy- and Patience-based Early Exiting), a novel hybrid strategy designed to improve the inference efficiency of foundation models. The core idea was to leverage the strengths of entropy-based and patience-based early exiting methods to overcome their respective weaknesses. To evaluate EPEE, we conducted experiments on three core biomedical tasks-classification, relation extraction, and event extraction-using four foundation models (BERT, ALBERT, GPT-2, and ViT) across twelve datasets, including clinical notes and medical images. The results showed that EPEE significantly reduced inference time while maintaining or improving accuracy, demonstrating its adaptability to diverse datasets and tasks. EPEE addressed critical barriers to deploying foundation models in healthcare by balancing efficiency and effectiveness. It potentially provided a practical solution for real-time clinical decision-making with foundation models, supporting reliable and efficient workflows.