Coupled Graph--Policy Distillation for Personalized Medication Safety in Older Adults with Multimorbidity

Large language model (LLM) agents can support medication review between clinical visits, but safe choices for older adults with multimorbidity depend on conditions, medications, and geriatric risks that users may omit. We introduce ATLAS, a coupled graph--policy distillation framework for patient-adaptive medication safety. ATLAS structures guideline evidence as a medication-safety graph. Targeted questions update the patient state and distill relevant relations into a patient-specific medication conflict graph (PMCG). A risk-first multi-agent policy uses the PMCG to screen contraindications, assess cautions and monitoring needs, identify safer alternatives, and verify the final medication plan. We also introduce GeriMedBench, an interactive benchmark that tests safety-critical information acquisition and evidence-based decision revision. Across a European non-interactive multimorbidity benchmark, an Asian interactive multimorbidity benchmark, and an Asian non-interactive cross-guideline benchmark, ATLAS achieves the strongest complete-decision performance among the compared systems. On the European non-interactive multimorbidity benchmark, it exceeds the strongest proprietary LLM baseline by 53.73 points in Strict Success Rate and 14.63 points in overall safety reasoning score (OSRS), with no unsafe recommendations under the automated evaluator. A blinded clinician evaluation gives ATLAS higher mean ratings across all five criteria and flags potentially unsafe recommendations in one ATLAS case and two Gemini cases.

LGE-Guided Cross-Modality Contrastive Learning for Gadolinium-Free Cardiomyopathy Screening in Cine CMR

Cardiomyopathy, a principal contributor to heart failure and sudden cardiac mortality, demands precise early screening. Cardiac Magnetic Resonance (CMR), recognized as the diagnostic 'gold standard' through multiparametric protocols, holds the potential to serve as an accurate screening tool. However, its reliance on gadolinium contrast and labor-intensive interpretation hinders population-scale deployment. We propose CC-CMR, a Contrastive Learning and Cross-Modal alignment framework for gadolinium-free cardiomyopathy screening using cine CMR sequences. By aligning the latent spaces of cine CMR and Late Gadolinium Enhancement (LGE) sequences, our model encodes fibrosis-specific pathology into cine CMR embeddings. A Feature Interaction Module concurrently optimizes diagnostic precision and cross-modal feature congruence, augmented by an uncertainty-guided adaptive training mechanism that dynamically calibrates task-specific objectives to ensure model generalizability. Evaluated on multi-center data from 231 subjects, CC-CMR achieves accuracy of 0.943 (95% CI: 0.886-0.986), outperforming state-of-the-art cine-CMR-only models by 4.3% while eliminating gadolinium dependency, demonstrating its clinical viability for wide range of populations and healthcare environments.