arXiv subjects

Mengling Feng

Publications and source records attributed to Mengling Feng.

At least 19 recordsLinked to original sources

arXiv2026

What Is Missing in Surgical Risk Stratification and Outcome Prediction: A Scoping Review of End-to-End Machine Learning Approaches

Postoperative adverse events, including mortality and morbidity, remain a major global burden, many of which are preventable through early identification of high-risk patients and targeted perioperative care. Accurate risk stratification is therefore essential. With the growing availability of large-scale electronic health records (EHRs), machine learning (ML) provides a data-driven approach to model complex clinical patterns. However, existing studies vary widely in design, and methodological practices remain fragmented. This scoping review characterizes ML pipelines for surgical risk stratification and outcome prediction using EHR data. We reviewed 190 studies covering the ML workflow, including data preprocessing, algorithm selection, model evaluation, and explainability. Most studies relied on single-center private datasets with limited data modalities, while the scarcity of open-access surgical datasets constrained reproducibility and generalizability. Reporting of key preprocessing steps, including missing data handling, feature selection, and class imbalance, was often incomplete. Conventional ML models and simple neural networks predominated, whereas deep learning and multimodal approaches remained uncommon. Benchmark datasets and standardized evaluation protocols were largely absent, hindering cross-study comparisons. Only about one-third of studies incorporated explainability methods. This review identifies methodological gaps limiting clinically robust postoperative ML tools and provides a structured reference to support more rigorous, reproducible, and clinically meaningful ML development for perioperative care.

cs.LG↗

arXiv2026

Semantic-Anchored Evidential Fusion for Domain-Robust Whole-Slide Survival Analysis

Whole-slide images (WSIs) are widely used for computational cancer prognosis. However, most existing methods primarily focus on in-domain performance and fail to generalize across clinical centers. This limitation stems from their reliance on pixel-derived representations that are highly susceptible to domain-specific artifacts caused by staining protocols and scanner hardware. We hypothesize that high-level pathology semantics, such as tumor grade and micro-environmental architecture, provide a domain-invariant semantic representation that mirrors the robust diagnostic logic of human pathologists. Therefore, we propose a Semantic-Anchored Evidential Fusion Survival (SAEFS) framework, where SAEFS derives semantic anchors from WSIs via Visual Question Answering (VQA), employs a dual-stream WSI evidence extraction architecture, uses Dirichlet-based Subjective Logic to model uncertainty, and fuses semantic and visual evidence through a cautious conjunction rule to avoid overconfident fusion from correlated sources. Trained exclusively on one source domain and evaluated zero-shot across four unseen domains, SAEFS consistently outperforms state-of-the-art models both in prediction accuracy and reliability, improving the average C-index by 10.2%. Quantitative analyses further show that VQA-derived semantic features exhibit significantly lower cross-center divergence than pixel-derived features, highlighting their robustness for cross-center clinical applications.

cs.CV↗

arXiv2026

Evidential Fusion Network for Multimodal Survival Prediction under Missing Modalities

Recent multimodal survival prediction models have demonstrated strong predictive performance by leveraging complementary information across modalities. However, such models generally assume data completeness and exhibit limited robustness toward missing modalities, which are frequently encountered in real-world clinical settings. We propose the Evidential Missing Modality Survival Fusion (EMMS) model for multimodal survival prediction under missing modalities. EMMS offers a straightforward, computationally effective approach to survival analysis without requiring a generative phase for missing data. By employing Dempster-Shafer theory and Gaussian Random Fuzzy Numbers for multimodal decision fusion, it considers both aleatoric and epistemic uncertainty alongside modality reliability for fusion. Moreover, the model treats missing modalities as vacuous evidence, preventing interference with available inputs and naturally reflecting increased uncertainty and calibrated predictions. Extensive experiments on four cancer datasets demonstrate state-of-the-art performance while providing calibrated and interpretable uncertainty estimates under incomplete multimodal observations, without introducing additional computational overhead.

cs.LG↗

arXiv2026

Bridging the Modality Bottleneck in Pathology MIL through Virtual Molecular Staining

Multiple instance learning (MIL) is the dominant framework for whole-slide image analysis in computational pathology, typically combining a frozen patch encoder, a projection layer, and a slide-level aggregator. While encoders and aggregators have been extensively studied, the projection layer remains a largely morphology-only bottleneck. This limits endpoints such as biomarker status and survival, which are governed by a molecular state that is not fully captured by H&E morphology. We introduce Molecularly Informed Staining Transform (MIST), a plug-in replacement for the MIL projection layer that uses paired spatial transcriptomics only during training to construct virtual molecular stains. MIST clusters gene expression profiles into cross-modal prototypes, anchors them in the frozen foundation model feature space, and uses them to reorganize H&E patch features along molecularly guided axes. It requires no transcriptomics at inference and can be inserted before standard MIL aggregators. We evaluate MIST across 23 downstream tasks and 8 MIL aggregators. MIST improves 240 of 256 configurations over the standard projection layer, with an average gain of +3.5%, observed consistently across endpoint types: +5.2% on survival prediction, +3.3% on tissue subtyping, and +2.6% on biomarker prediction. Ablations confirm that gene-derived prototypes are the primary source of the gains, while spatial, biological, and pathological analyses show that cross-modal prototype affinities capture spatially coherent molecular programs from H&E alone.

q-bio.QM↗

arXiv2026

Beyond Semantics: An Evidential Reasoning-Aware Multi-View Learning Framework for Trustworthy Mental Health Prediction

Automated mental health prediction using textual data has shown promising results with deep learning and large language models. However, deploying these models in high-stakes real-world settings remains challenging, as existing approaches largely rely on semantic representations and often produce overconfident predictions under ambiguous, noisy, or shifted data. Moreover, most methods lack reliable uncertainty estimation, undermining trust in risk-sensitive mental health applications. To address these limitations, we formulate the task as a multi-view learning problem that integrates semantic information from encoder-only models with higher-level reasoning information from decoder-only models, where reasoning-aware representations and uncertainty modeling are obtained in a trustworthy manner. To ensure reliable fusion, we adopt an evidential learning framework based on Subjective Logic to explicitly model uncertainty and introduce an evidential fusion strategy that balances complementary views while discounting unreliable evidence. Benchmarking on three real-world datasets, Dreaddit, SDCNL, and DepSeverity, reports accuracies of 0.835, 0.731, and 0.751, respectively, demonstrating its potential for reliable mental health prediction. Additional experiments on robustness to noise and case studies for interpretability confirm that our proposed framework not only improves predictive performance but also provides trustworthy uncertainty estimates and human-understandable reasoning signals, making it suitable for risk-sensitive applications in mental health assessment.

cs.CL↗

arXiv2026

Learning Preference-Based Objectives from Clinical Narratives for Dynamic Sepsis Treatment

Designing reward functions for reinforcement learning (RL) in healthcare remains challenging because clinically meaningful outcomes are sparse, delayed, and difficult to explicitly specify. Although structured clinical data capture physiologic states, they often fail to reflect broader aspects of patient trajectories such as treatment response, recovery dynamics, and intervention burden. Clinical narratives, by contrast, encode longitudinal clinician assessments of disease progression, treatment effectiveness, and recovery, providing a potential source of trajectory-level supervision beyond predefined outcome metrics. We propose Clinical Narrative-informed Preference Rewards (CN-PR), a framework that learns reward functions directly from discharge summaries by treating clinical narratives as scalable supervision for trajectory-level preferences. Using a large language model, we derive trajectory quality scores and construct pairwise preferences between patient trajectories to learn rewards through preference-based optimization. To account for variability in narrative informativeness, we incorporate a task relevance signal that weights supervision according to its relevance to the downstream decision-making task. We evaluate CN-PR in dynamic sepsis treatment using offline RL. The learned reward demonstrated strong monotonic alignment with trajectory quality scores and produced policies associated with improved recovery-related outcomes, including increased organ support-free days and faster shock resolution, while maintaining mortality performance comparable to outcome-based reward baselines. These findings were preserved under external validation. Our results suggest that clinical narratives provide a scalable and expressive source of supervision for reward learning in dynamic treatment regimes.

cs.AI↗

arXiv2026

Toward a Multi-View Brain Network Foundation Model: Cross-View Consistency Learning Across Arbitrary Atlases

Brain network analysis provides an interpretable framework for characterizing brain organization and has been widely used for neurological disorder identification. Recent advances in self-supervised learning have motivated the development of brain network foundation models. However, existing approaches are often limited by atlas dependency, insufficient exploitation of multiple network views, and weak incorporation of anatomical priors. In this work, we propose MV-BrainFM, a multi-view brain network foundation model designed to learn generalizable and scalable representations from brain networks constructed with arbitrary atlases. MV-BrainFM explicitly incorporates anatomical distance information into Transformer-based modeling to guide inter-regional interactions, and introduces an unsupervised cross-view consistency learning strategy to align representations from multiple atlases of the same subject in a shared latent space. By jointly enforcing within-view robustness and cross-view alignment during pretraining, the model effectively captures complementary information across heterogeneous network views while remaining atlas-aware. In addition, MV-BrainFM adopts a unified multi-view pretraining paradigm that enables simultaneous learning from multiple datasets and atlases, significantly improving computational efficiency compared to conventional sequential training strategies. The proposed framework also demonstrates strong scalability, consistently benefiting from increasing data diversity while maintaining stable performance across unseen atlas configurations. Extensive experiments on more than 20K subjects from 17 fMRI datasets show that MV-BrainFM consistently outperforms 14 existing brain network foundation models and task-specific baselines under both single-atlas and multi-atlas settings.

cs.CV↗

arXiv2026

MedForge: Interpretable Medical Deepfake Detection via Forgery-aware Reasoning

Text-guided image editors can now manipulate authentic medical scans with high fidelity, enabling lesion implantation/removal that threatens clinical trust and safety. Existing defenses are inadequate for healthcare. Medical detectors are largely black-box, while MLLM-based explainers are typically post-hoc, lack medical expertise, and may hallucinate evidence on ambiguous cases. We present MedForge, a data-and-method solution for pre-hoc, evidence-grounded medical forgery detection. We introduce MedForge-90K, a large-scale benchmark of realistic lesion edits across 19 pathologies with expert-guided reasoning supervision via doctor inspection guidelines and gold edit locations. Building on it, MedForge-Reasoner performs localize-then-analyze reasoning, predicting suspicious regions before producing a verdict, and is further aligned with Forgery-aware GSPO to strengthen grounding and reduce hallucinations. Experiments demonstrate state-of-the-art detection accuracy and trustworthy, expert-aligned explanations.

cs.AI↗

arXiv2026

SCOPE: Structured Prototype-Guided Adaptation for EEG Foundation Models with Limited Labels

Electroencephalography (EEG) foundation models (EFMs) have shown strong potential for transferable representation learning, yet their adaptation in realistic settings remains challenging when only a few labeled subjects are available. We show that this challenge stems from a structural mismatch between noisy, limited supervision and the highly plastic parameter space of EFMs, reflected in three key failure modes: overconfident miscalibration, prediction collapse, and representation drift caused by unconstrained parameter updates. To address these challenges, we propose SCOPE, a Structured COnfidence-aware Prototype-guided framework for label-limited EFM adaptation. SCOPE first constructs cohort-level external supervision to provide persistent guidance and further derives confidence-aware pseudo-labels to select reliable unlabeled samples for adaptation. Building on the constructed external supervision, SCOPE introduces ProAdapter, a lightweight prototype-conditioned adapter that modulates frozen EFMs to preserve pretrained representations. Experiments across 50 label-limited adaptation settings, covering 6 EEG tasks, 5 EFM backbones, and 5%-50% training labeled-subject ratios, show that SCOPE consistently achieves strong performance and efficiency.

cs.LG↗

arXiv2026

medR: Reward Engineering for Clinical Offline Reinforcement Learning via Tri-Drive Potential Functions

Reinforcement Learning (RL) offers a powerful framework for optimizing dynamic treatment regimes (DTRs). However, clinical RL is fundamentally bottlenecked by reward engineering: the challenge of defining signals that safely and effectively guide policy learning in complex, sparse offline environments. Existing approaches often rely on manual heuristics that fail to generalize across diverse pathologies. To address this, we propose an automated pipeline leveraging Large Language Models (LLMs) for offline reward design and verification. We formulate the reward function using potential functions consisted of three core components: survival, confidence, and competence. We further introduce quantitative metrics to rigorously evaluate and select the optimal reward structure prior to deployment. By integrating LLM-driven domain knowledge, our framework automates the design of reward functions for specific diseases while significantly enhancing the performance of the resulting policies.

cs.LG↗

arXiv2026

S3-CoT: Self-Sampled Succinct Reasoning Enables Efficient Chain-of-Thought LLMs

Large language models (LLMs) equipped with chain-of-thought (CoT) achieve strong performance and offer a window into LLM behavior. However, recent evidence suggests that improvements in CoT capabilities often come with redundant reasoning processes, motivating a key question: Can LLMs acquire a fast-thinking mode analogous to human System 1 reasoning? To explore this, our study presents a self-sampling framework based on activation steering for efficient CoT learning. Our method can induce style-aligned and variable-length reasoning traces from target LLMs themselves without any teacher guidance, thereby alleviating a central bottleneck of SFT-based methods-the scarcity of high-quality supervision data. Using filtered data by gold answers, we perform SFT for efficient CoT learning with (i) a human-like dual-cognitive system, and (ii) a progressive compression curriculum. Furthermore, we explore a self-evolution regime in which SFT is driven solely by prediction-consistent data of variable-length variants, eliminating the need for gold answers. Extensive experiments on math benchmarks, together with cross-domain generalization tests in medicine, show that our method yields stable improvements for both general and R1-style LLMs. Our data and model checkpoints can be found at https://github.com/DYR1/S3-CoT.

cs.CL↗

arXiv2026

From Latent Signals to Reflection Behavior: Tracing Meta-Cognitive Activation Trajectory in R1-Style LLMs

R1-style LLMs have attracted growing attention for their capacity for self-reflection, yet the internal mechanisms underlying such behavior remain unclear. To bridge this gap, we anchor on the onset of reflection behavior and trace its layer-wise activation trajectory. Using the logit lens to read out token-level semantics, we uncover a structured progression: (i) Latent-control layers, where an approximate linear direction encodes the semantics of thinking budget; (ii) Semantic-pivot layers, where discourse-level cues, including turning-point and summarization cues, surface and dominate the probability mass; and (iii) Behavior-overt layers, where the likelihood of reflection-behavior tokens begins to rise until they become highly likely to be sampled. Moreover, our targeted interventions uncover a causal chain across these stages: prompt-level semantics modulate the projection of activations along latent-control directions, thereby inducing competition between turning-point and summarization cues in semantic-pivot layers, which in turn regulates the sampling likelihood of reflection-behavior tokens in behavior-overt layers. Collectively, our findings suggest a human-like meta-cognitive process-progressing from latent monitoring, to discourse-level regulation, and to finally overt self-reflection. Our analysis code can be found at https://github.com/DYR1/S3-CoT.

cs.CL↗

arXiv2025

Robust Multimodal Sentiment Analysis via Double Information Bottleneck

Multimodal sentiment analysis has received significant attention across diverse research domains. Despite advancements in algorithm design, existing approaches suffer from two critical limitations: insufficient learning of noise-contaminated unimodal data, leading to corrupted cross-modal interactions, and inadequate fusion of multimodal representations, resulting in discarding discriminative unimodal information while retaining multimodal redundant information. To address these challenges, this paper proposes a Double Information Bottleneck (DIB) strategy to obtain a powerful, unified compact multimodal representation. Implemented within the framework of low-rank Renyi's entropy functional, DIB offers enhanced robustness against diverse noise sources and computational tractability for high-dimensional data, as compared to the conventional Shannon entropy-based methods. The DIB comprises two key modules: 1) learning a sufficient and compressed representation of individual unimodal data by maximizing the task-relevant information and discarding the superfluous information, and 2) ensuring the discriminative ability of multimodal representation through a novel attention bottleneck fusion mechanism. Consequently, DIB yields a multimodal representation that effectively filters out noisy information from unimodal data while capturing inter-modal complementarity. Extensive experiments on CMU-MOSI, CMU-MOSEI, CH-SIMS, and MVSA-Single validate the effectiveness of our method. The model achieves 47.4% accuracy under the Acc-7 metric on CMU-MOSI and 81.63% F1-score on CH-SIMS, outperforming the second-best baseline by 1.19%. Under noise, it shows only 0.36% and 0.29% performance degradation on CMU-MOSI and CMU-MOSEI respectively.

cs.AI↗

arXiv2025

Med-Banana: Learning Quality-Controlled Medical Image Editing from Success-and-Failure Trajectories

Text-guided medical image editing must satisfy the requested pathology while preserving anatomy, modality-specific appearance, and clinical plausibility. However, existing datasets largely supervise editors with final accepted edits and discard the failed attempts produced during generation. We argue that these failures provide essential supervision for quality control: they specify what should be rejected, why an edit is medically or visually invalid, and how the instruction should be revised. We present Med-Banana, a trajectory-supervised framework for quality-controlled medical image editing. We introduce Med-Banana-80K, a large-scale resource of success-and-failure editing trajectories with candidate images, verification outcomes, rejection reasons, and prompt refinements. Building on it, Med-Banana jointly trains an editor, verifier, and refiner, enabling edit--verify--refine inference from accepted and rejected attempts. Experiments across MLLM judges, blind expert assessment, source-preservation and real--synthetic separability probes demonstrate consistent improvements over open medical image editors. Code and data are publicly available.

cs.CV↗

arXiv2025

DeepEN: A Deep Reinforcement Learning Framework for Personalized Enteral Nutrition in Critical Care

Objective: Enteral nutrition (EN) delivery in the ICU remains suboptimal due to limited personalization and uncertainty regarding appropriate calorie, protein, and fluid targets under dynamic metabolic demands. We introduce DeepEN, a reinforcement learning (RL) framework for personalized EN optimization using electronic health record data. Methods: DeepEN was trained on over 11,000 ICU patients from MIMIC-IV to generate 4-hourly, patient-specific caloric, protein, and fluid targets. The state representation incorporated demographics, comorbidities, vital signs, laboratory values, and recent interventions. A physiologically aligned reward framework balanced biomarker stability with long-term survival. Policy learning employed a dueling double deep Q-network with Conservative Q-Learning regularization to enable safe offline training. Results: DeepEN achieved the highest estimated policy value ($V^\pi = 9.48$) and the lowest calibrated mortality (18.8 +/- 1.0%), representing a 4.0 percentage-point absolute reduction compared with clinician practice (22.8%). The policy also demonstrated superior metabolic stability, achieving the highest proportion of glucose, phosphate, and sodium values within target range. Furthermore, deviation from the DeepEN policy was independently associated with increased mortality and biomarker instability, whereas deviation from a random policy showed no such association. Interpretability analyses further indicated that recommendations were conditioned on physiologically relevant markers of organ function and metabolic status rather than static dosing heuristics. Conclusion: DeepEN demonstrates the feasibility of conservative offline RL for safe, individualized EN optimization, highlighting the potential of data-driven personalization to complement guideline-based approaches in critical care.

cs.LG↗

arXiv2025

DPsurv: Dual-Prototype Evidential Fusion for Uncertainty-Aware and Interpretable Whole-Slide Image Survival Prediction

Pathology whole-slide images (WSIs) are widely used for cancer survival analysis because of their comprehensive histopathological information at both cellular and tissue levels, enabling quantitative, large-scale, and prognostically rich tumor feature analysis. However, most existing methods in WSI survival analysis struggle with limited interpretability and often overlook predictive uncertainty in heterogeneous slide images. In this paper, we propose DPsurv, a dual-prototype whole-slide image evidential fusion network that outputs uncertainty-aware survival intervals, while enabling interpretation of predictions through patch prototype assignment maps, component prototypes, and component-wise relative risk aggregation. Experiments on five publicly available datasets achieve the highest mean concordance index and the lowest mean integrated Brier score, validating the effectiveness and reliability of DPsurv. The interpretation of prediction results provides transparency at the feature, reasoning, and decision levels, thereby enhancing the trustworthiness and interpretability of DPsurv.

eess.IV↗

arXiv2025

Anchoring Refusal Direction: Mitigating Safety Risks in Tuning via Projection Constraint

Instruction Fine-Tuning (IFT) has been widely adopted as an effective post-training strategy to enhance various abilities of Large Language Models (LLMs). However, prior studies have shown that IFT can significantly compromise LLMs' safety, particularly their ability to refuse malicious instructions, raising significant concerns. Recent research into the internal mechanisms of LLMs has identified the refusal direction (r-direction) in the hidden states, which plays a pivotal role in governing refusal behavior. Building on this insight, our study reveals that the r-direction tends to drift during training, which we identify as one of the causes of the associated safety risks. To mitigate such drift, our proposed ProCon method introduces a projection-constrained loss term that regularizes the projection magnitude of each training sample's hidden state onto the r-direction. Our initial analysis shows that applying an appropriate constraint can effectively mitigate the refusal direction drift and associated safety risks, but remains limited by overall performance barriers. To overcome this barrier, informed by our observation of early-stage sharp drift and a data-driven perspective, we introduce a warm-up strategy that emphasizes early-stage strong constraints and broaden the data distribution to strengthen constraint signals, leading to an enhanced ProCon method. Experimental results under various datasets, scenarios, and LLMs demonstrate that our method can significantly mitigate safety risks posed by IFT while preserving task performance gains. Even compared with strong baselines, our method consistently delivers superior overall performance. Crucially, our analysis indicates that ProCon can contribute to stabilizing the r-direction during training, while such an interpretability-driven exploration of LLMs' internal mechanisms lays a solid foundation for future safety research.

cs.CL↗

arXiv2025

Toward Clinically Explainable AI for Medical Diagnosis: A Foundation Model with Human-Compatible Reasoning via Reinforcement Learning

The clinical adoption of artificial intelligence (AI) in medical diagnostics is critically hampered by its black-box nature, which prevents clinicians from verifying the rationale behind automated decisions. To overcome this fundamental barrier, we introduce DeepMedix-R1, a foundation model (FM) for chest X-ray (CXR) interpretation that generates not only accurate diagnoses but also a transparent, step-by-step reasoning process grounded in specific visual evidence. Our methodology employs a sequential training strategy, beginning with instruction fine-tuning, followed by a cold-start phase to elicit reasoning capabilities. Critically, we then implement reinforcement learning with grounded rewards to meticulously refine the model, aligning both its diagnostic outputs and its reasoning pathways with clinical plausibility. Quantitative assessments show that DeepMedix-R1 substantially outperforms advanced FMs, achieving improvements in report generation and visual question answering tasks. We also introduce Report Arena, a novel LLM-based benchmark that ranks DeepMedix-R1 first among competing models for output quality. Most significantly, a formal review by clinical experts reveals a profound preference for DeepMedix-R1's generated reasoning over the broadly adopted Qwen2.5-VL-7B model, confirming its superior interpretability and clinical utility.

cs.AI↗