Surg-R1: A Hierarchical Reasoning Foundation Model for Scalable and Interpretable Surgical Decision Support with Multi-Center Clinical Validation

Surgical scene understanding demands not only accurate predictions but also interpretable reasoning that surgeons can verify against clinical expertise. However, existing surgical vision-language models generate predictions without reasoning chains, and general-purpose reasoning models fail on compositional surgical tasks without domain-specific knowledge. We present Surg-R1, a surgical Vision-Language Model that addresses this gap through hierarchical reasoning trained via a four-stage pipeline. Our approach introduces three key contributions: (1) a three-level reasoning hierarchy decomposing surgical interpretation into perceptual grounding, relational understanding, and contextual reasoning; (2) the largest surgical chain-of-thought dataset with 320,000 reasoning pairs; and (3) a four-stage training pipeline progressing from supervised fine-tuning to group relative policy optimization and iterative self-improvement. Evaluation on SurgBench, comprising six public benchmarks and six multi-center external validation datasets from five institutions, demonstrates that Surg-R1 achieves the highest Arena Score (64.9%) on public benchmarks versus Gemini 3.0 Pro (46.1%) and GPT-5.1 (37.9%), outperforming both proprietary reasoning models and specialized surgical VLMs on the majority of tasks spanning instrument localization, triplet recognition, phase recognition, action recognition, and critical view of safety assessment, with a 15.2 percentage point improvement over the strongest surgical baseline on external validation.

USTC-KXDIGIT System Description for ASVspoof5 Challenge

This paper describes the USTC-KXDIGIT system submitted to the ASVspoof5 Challenge for Track 1 (speech deepfake detection) and Track 2 (spoofing-robust automatic speaker verification, SASV). Track 1 showcases a diverse range of technical qualities from potential processing algorithms and includes both open and closed conditions. For these conditions, our system consists of a cascade of a frontend feature extractor and a back-end classifier. We focus on extensive embedding engineering and enhancing the generalization of the back-end classifier model. Specifically, the embedding engineering is based on hand-crafted features and speech representations from a self-supervised model, used for closed and open conditions, respectively. To detect spoof attacks under various adversarial conditions, we trained multiple systems on an augmented training set. Additionally, we used voice conversion technology to synthesize fake audio from genuine audio in the training set to enrich the synthesis algorithms. To leverage the complementary information learned by different model architectures, we employed activation ensemble and fused scores from different systems to obtain the final decision score for spoof detection. During the evaluation phase, the proposed methods achieved 0.3948 minDCF and 14.33% EER in the close condition, and 0.0750 minDCF and 2.59% EER in the open condition, demonstrating the robustness of our submitted systems under adversarial conditions. In Track 2, we continued using the CM system from Track 1 and fused it with a CNN-based ASV system. This approach achieved 0.2814 min-aDCF in the closed condition and 0.0756 min-aDCF in the open condition, showcasing superior performance in the SASV system.