Jiahe Qian

Yishu Wei, Hexin Dong, Yi Lin et al.

Objective: Survival analysis is central to medical prediction, yet large language models (LLMs) are rarely used as end-to-end survival models because censoring prevents straightforward supervised fine-tuning. Here we present LLMSurvival, a framework that enables censoring-aware survival analysis with unmodified LLMs operating directly on tabular clinical data. Materials and Methods: LLMSurvival reformulates time-to-event prediction as pairwise ranking among comparable subjects, and derives test-time risk by aggregating comparisons against anchor individuals from the training cohort. Results: Across two clinical tasks (ICU mortality prediction in MIMIC-IV and fragility fracture prediction in a NewYork-Presbyterian/Weill Cornell Medicine cohort), LLMSurvival improves overall concordance over Cox proportional hazards modeling by 3.1% for ICU mortality and 0.5% for fracture risk, 2.1% on average for ICU mortality and 2.8% for fracture risk over three established deep learning survival models. Discussion: The results show that survival modeling with censoring can be made compatible with LLM fine-tuning through comparison-based reformulation. The framework demonstrates high portability and superior performance over expert curated scores like SAPS-II and FRAX scores across diverse clinical context. Furthermore, the framework supports local deployment, as compact, publicly available base models provide sufficient performance. Conclusion: The LLMSurvival framework serves as a proof of concept for an integrated, censoring-conscious approach to survival analysis via LLMs.

Yaoyu Fang, Jiahe Qian, Xinkun Wang et al.

Spatial Transcriptomics (ST) provides spatially resolved gene expression profiles within intact tissue architecture, enabling molecular analysis in histological context. However, the high cost, limited throughput, and restricted data sharing of ST experiments result in severe data scarcity, constraining the development of robust computational models. To address this limitation, we present a Central-to-Local adaptive generative diffusion framework for ST (C2L-ST) that integrates large-scale morphological priors with limited molecular guidance. A global central model is first pretrained on extensive histopathology datasets to learn transferable morphological representations, and institution-specific local models are then adapted through lightweight gene-conditioned modulation using a small number of paired image-gene spots. This strategy enables the synthesis of realistic and molecularly consistent histology patches under data-limited conditions. The generated images exhibit high visual and structural fidelity, reproduce cellular composition, and show strong embedding overlap with real data across multiple organs, reflecting both realism and diversity. When incorporated into downstream training, synthetic image-gene pairs improve gene expression prediction accuracy and spatial coherence, achieving performance comparable to real data while requiring only a fraction of sampled spots. C2L-ST provides a scalable and data-efficient framework for molecular-level data augmentation, offering a domain-adaptive and generalizable approach for integrating histology and transcriptomics in spatial biology and related fields.

Yuhao Shen, Jiahe Qian, Shuping Zhang et al.

Multimodal large language models (LLMs) are increasingly used to generate dermatology diagnostic narratives directly from images. However, reliable evaluation remains the primary bottleneck for responsible clinical deployment. We introduce a novel evaluation framework that combines DermBench, a meticulously curated benchmark, with DermEval, a robust automatic evaluator, to enable clinically meaningful, reproducible, and scalable assessment. We build DermBench, which pairs 4,000 real-world dermatology images with expert-certified diagnostic narratives and uses an LLM-based judge to score candidate narratives across clinically grounded dimensions, enabling consistent and comprehensive evaluation of multimodal models. For individual case assessment, we train DermEval, a reference-free multimodal evaluator. Given an image and a generated narrative, DermEval produces a structured critique along with an overall score and per-dimension ratings. This capability enables fine-grained, per-case analysis, which is critical for identifying model limitations and biases. Experiments on a diverse dataset of 4,500 cases demonstrate that DermBench and DermEval achieve close alignment with expert ratings, with mean deviations of 0.251 and 0.117 (out of 5), respectively, providing reliable measurement of diagnostic ability and trustworthiness across different multimodal LLMs.

Jiahe Qian, Yaoyu Fang, Xinkun Wang et al.

For 3D spatial transcriptomics (ST), the high per-section acquisition cost of fully sampling every tissue section remains a significant challenge. Although recent approaches predict gene expression from histology images, these methods require large external datasets, which leads to high-cost and suffers from substantial domain discrepancies that lead to poor generalization on new samples. In this work, we introduce ST-DAI, a single-shot framework for 3D ST that couples a cost-efficient 2.5D sampling scheme with an intra-sample domain-adaptive imputation framework. First, in the cost-efficient 2.5D sampling stage, one reference section (central section) is fully sampled while other sections (adjacent sections) is sparsely sampled, thereby capturing volumetric context at significantly reduced experimental cost. Second, we propose a single-shot 3D imputation learning method that allows us to generate fully sampled 3D ST from this cost-efficient 2.5D ST scheme, using only sample-specific training. We observe position misalignment and domain discrepancy between sections. To address those issues, we adopt a pipeline that first aligns the central section to the adjacent section, thereafter generates dense pseudo-supervision on the central section, and then performs Fast Multi-Domain Refinement (FMDR), which adapts the network to the domain of the adjacent section while fine-tuning only a few parameters through the use of Parameter-Efficient Domain-Alignment Layers (PDLs). During this refinement, a Confidence Score Generator (CSG) reweights the pseudo-labels according to their estimated reliability, thereby directing imputation toward trustworthy regions. Our experimental results demonstrate that ST-DAI achieves gene expression prediction performance comparable to fully sampled approaches while substantially reducing the measurement burden.

Yaoyu Fang, Jiahe Qian, Xinkun Wang et al.

Spatial transcriptomics (ST) has revolutionized biomedical research by enabling high resolution gene expression profiling within tissues. However, the high cost and scarcity of high resolution ST data remain significant challenges. We present Single-shot Sparser-to-Sparse (S2S-ST), a novel framework for accurate ST imputation that requires only a single and low-cost sparsely sampled ST dataset alongside widely available natural images for co-training. Our approach integrates three key innovations: (1) a sparser-to-sparse self-supervised learning strategy that leverages intrinsic spatial patterns in ST data, (2) cross-domain co-learning with natural images to enhance feature representation, and (3) a Cascaded Data Consistent Imputation Network (CDCIN) that iteratively refines predictions while preserving sampled gene data fidelity. Extensive experiments on diverse tissue types, including breast cancer, liver, and lymphoid tissue, demonstrate that our method outperforms state-of-the-art approaches in imputation accuracy. By enabling robust ST reconstruction from sparse inputs, our framework significantly reduces reliance on costly high resolution data, facilitating potential broader adoption in biomedical research and clinical applications.

Jiahe Qian, Yaoyu Fang, Jinkui Hao et al.

Accurate segmentation of cell nuclei in histopathology images is essential for numerous biomedical research and clinical applications. However, existing cell nucleus segmentation methods only consider a single dataset (i.e., primary domain), while neglecting to leverage supplementary data from diverse sources (i.e., auxiliary domains) to reduce overfitting and enhance the performance. Although incorporating multiple datasets could alleviate overfitting, it often exacerbates performance drops caused by domain shifts. In this work, we introduce Adversarial Multi-domain Alignment of Segment Anything Model (AMA-SAM) that extends the Segment Anything Model (SAM) to overcome these obstacles through two key innovations. First, we propose a Conditional Gradient Reversal Layer (CGRL), a multi-domain alignment module that harmonizes features from diverse domains to promote domain-invariant representation learning while preserving crucial discriminative features for the primary dataset. Second, we address SAM's inherent low-resolution output by designing a High-Resolution Decoder (HR-Decoder), which directly produces fine-grained segmentation maps in order to capture intricate nuclei boundaries in high-resolution histology images. To the best of our knowledge, this is the first attempt to adapt SAM for multi-dataset learning with application to histology nuclei segmentation. We validate our method on several publicly available datasets, demonstrating consistent and significant improvements over state-of-the-art approaches.

Yuhao Shen, Jiahe Qian, Zhangtianyi Chen et al.

We present SkinGPT-R1, a dermatology focused vision language model that makes diagnostic chain of thought reasoning explicit, step by step, and verifiable. To support skin specific reasoning, we build DermCoT, a corpus of standardized dermatologic chain of thought narratives that combines 10,000 DermEval filtered training cases with 3,000 dermatologist scored certified cases, and we define DermEval as a physician aligned six dimensional evaluator and DermBench as the corresponding benchmark for dermatologic chain of thought quality. On DermBench, across 14 general, reasoning, and medical vision language models, SkinGPT-R1 achieves an average score of 4.031 out of 5 over the six clinician defined dimensions, ranks 1st among all systems, and improves the average score over Vision-R1 by about 41%. On three dermatology classification benchmarks, SkinGPT-R1 delivers stable accuracy gains over Vision-R1 and remains competitive among strong vision language models. Ablation results further show that DermCoT based chain of thought supervision provides substantial improvements over the base model and that adding dermatology aware visual distillation yields consistent additional gains in both narrative quality and recognition.

Ziqiao Weng, Yaoyu Fang, Jiahe Qian et al.

Spatial transcriptomics (ST) bridges gene expression and tissue morphology but faces clinical adoption barriers due to technical complexity and prohibitive costs. While computational methods predict gene expression from H&E-stained whole-slide images (WSIs), existing approaches often fail to capture the intricate biological heterogeneity within spots and are susceptible to morphological noise when integrating contextual information from surrounding tissue. To overcome these limitations, we propose HiFusion, a novel deep learning framework that integrates two complementary components. First, we introduce the Hierarchical Intra-Spot Modeling module that extracts fine-grained morphological representations through multi-resolution sub-patch decomposition, guided by a feature alignment loss to ensure semantic consistency across scales. Concurrently, we present the Context-aware Cross-scale Fusion module, which employs cross-attention to selectively incorporate biologically relevant regional context, thereby enhancing representational capacity. This architecture enables comprehensive modeling of both cellular-level features and tissue microenvironmental cues, which are essential for accurate gene expression prediction. Extensive experiments on two benchmark ST datasets demonstrate that HiFusion achieves state-of-the-art performance across both 2D slide-wise cross-validation and more challenging 3D sample-specific scenarios. These results underscore HiFusion's potential as a robust, accurate, and scalable solution for ST inference from routine histopathology.

Jiahe Qian, Yuhao Shen, Zhangtianyi Chen et al.

Medical visual question answering could support clinical decision making, yet current systems often fail under domain shift and produce answers that are weakly grounded in image evidence. This reliability gap arises when models attend to spurious regions and when retraining or additional labels are impractical at deployment time. We address this setting with CoTBox-TTT, an evidence-first test-time training approach that adapts a vision-language model at inference while keeping all backbones frozen. The method updates only a small set of continuous soft prompts. It identifies question-relevant regions through a visual chain-of-thought signal and encourages answer consistency across the original image and a localized crop. The procedure is label free, and plug and play with diverse backbones. Experiments on medical VQA show that the approach is practical for real deployments. For instance, adding CoTBox-TTT to LLaVA increases closed-ended accuracy by 12.3% on pathVQA.

Jiahe Qian, Yaoyu Fang, Ziqiao Weng et al.

Spatial transcriptomics aims to connect high-resolution histology images with spatially resolved gene expression. To achieve better performance on downstream tasks such as gene expression prediction, large-scale pre-training is required to obtain generalisable representations that can bridge histology and transcriptomics across tissues, protocols, and laboratories. Existing cross-modal pre-training approaches for spatial transcriptomics rely on either gene names or expression values in isolation, which strips the gene branch of essential semantics and breaks the association between each gene and its quantitative magnitude. In addition, by restricting supervision to image-text alignment, these methods ignore intrinsic visual cues that are critical for learning robust image features. We present CoMTIP, the first Contrastive Masked Text-Image Pretraining framework that jointly learns from images, gene names, and expression values while capturing fine-grained visual context for spatial transcriptomics. The vision branch uses Masked Feature Modeling to reconstruct occluded patches and learn context-aware image embeddings. The text branch applies a scalable Gene-Text Encoder that processes all gene sentences in parallel, enriches each gene and its numerical value with dedicated embeddings, and employs Pair-aware Adversarial Training (PAAT) to preserve correct gene-value associations. Image and text representations are aligned in a shared InfoNCE-optimised space. Experiments on public spatial transcriptomics datasets show that CoMTIP not only surpasses previous methods on diverse downstream tasks but also achieves zero-shot gene expression prediction, a capability that existing approaches do not provide.

Jingze Zhang, Jiahe Qian, Yiliang Zhou et al.

Fact-checking for health-related content is challenging due to the limited availability of annotated training data. In this study, we propose a synthetic data generation pipeline that leverages large language models (LLMs) to augment training data for health-related fact checking. In this pipeline, we summarize source documents, decompose the summaries into atomic facts, and use an LLM to construct sentence-fact entailment tables. From the entailment relations in the table, we further generate synthetic text-claim pairs with binary veracity labels. These synthetic data are then combined with the original data to fine-tune a BERT-based fact-checking model. Evaluation on two public datasets, PubHealth and SciFact, shows that our pipeline improved F1 scores by up to 0.019 and 0.049, respectively, compared to models trained only on the original data. These results highlight the effectiveness of LLM-driven synthetic data augmentation in enhancing the performance of health-related fact-checkers.