Academic Intelligence · Curated Daily

探索全球前沿学术脉络

AcademicHub 汇聚顶级期刊与预印本平台的实时文献。定制您的专属科研雷达,利用大语言模型自动生成交叉领域文献分析简报。

01.
arXiv (CS.LG) 2026-06-19

Optimal Deterministic Multicalibration and Omniprediction

arXiv:2606.20557v1 Announce Type: new Abstract: A model is multicalibrated on a collection of group weights $G$ if it is calibrated – i.e. unbiased even conditional on its prediction – not just overall, but also after reweighting contexts by each $g \in G$. It is a useful property for many downstream applications and is a basic desideratum of trustworthy machine learning. Before this work, all predictors known to attain the minimax-optimal $\widetilde O(\varepsilon^{-3})$ sample complexity rate for $\varepsilon$-multicalibration were randomized, while deterministic predictors were known only with substantially worse sample complexity. Whether randomization is necessary for optimal sample complexity in multicalibration was explicitly asked by [CLNR26] and implicitly in several prior works. We resolve this open problem by giving a minimax-optimal multicalibration algorithm that outputs a deterministic predictor. We then generalize the algorithm to produce optimal deterministic predictors that satisfy outcome indistinguishability (OI) with respect to finite or finitely covered collections of tests. As an application, this also gives deterministic omnipredictors and panpredictors with optimal sample complexity, resolving open problems posed by [OKK25] and [BHHLZ25].

02.
arXiv (CS.CV) 2026-06-24

Do Foundation Models See Biology? Evaluating Attention Coherence with Spatial Transcriptomics in Glioblastoma

Whether attention maps from pathology foundation models capture genuine biology remains unknown, yet this question is critical for clinical trust and regulatory approval. We propose a spatial transcriptomics-based framework for orthogonal, hypothesis-free evaluation of attention and apply it to five pathology foundation models (CONCH v1.5, UNI v2, Virchow2, GigaPath, H-Optimus-1) and a ResNet50 baseline. Using attention-based multiple instance learning, we train single-task and multi-task models to predict five molecular alterations in glioblastoma on the CPTAC cohort, validate on an independent TCGA cohort, and evaluate biological coherence of attention maps against 87 transcriptional signatures using co-registered Visium spatial transcriptomics data from 18 samples. Internally, no single encoder dominates across all tasks, and external validation inverts internal performance rankings. Attention maps show a five-fold enrichment gradient from pathways (Cohen's d=0.329) to individual genes (d=0.055), indicating that attention captures emergent multi-gene transcriptional programs rather than individual molecular events. Spatially smooth attention maps do not imply biological coherence, and different encoders attend to distinct biological compartments. Our framework provides objective, quantitative assessment of what foundation models learn from histopathology, moving the field beyond qualitative saliency map review.

03.
medRxiv (Medicine) 2026-06-19

Grey- and white-matter resilience to tau, cognition and sex in Alzheimer's disease

INTRODUCTION: Brain resilience to tau has been mainly studied in relation to grey matter, while its role in white matter remains unclear in Alzheimer's disease (AD). Sex may moderate associations between brain resilience and cognition. METHODS: We analyzed medial temporal lobe tau PET SUVR, entorhinal cortical thickness, cingulum-hippocampal mean diffusivity, and cognition in 205 amyloid-positive individuals from ADNI. Associations between grey- and white-matter resilience to tau and cognitive performance or decline were examined using linear and mixed-effects models, including sex interactions and stratified analyses. RESULTS: Higher grey-matter resilience to tau related to better cross-sectional memory and language performance (p

04.
arXiv (CS.AI) 2026-06-16

Cognitive Debt: AI as Intellectual Leverage and the Dynamics of Systemic Fragility

作者:

arXiv:2606.15078v1 Announce Type: new Abstract: We develop a formal theory of cognitive debt: the stock of unverified reasoning obligations that accumulates when individuals use AI as a substitute rather than a complement for first-principles cognition. The model features two state variables per agent, cognitive capital and cognitive debt, and a multiplicative production technology in which cognitive capital functions as collateral that determines the return to AI adoption. We establish six propositions. Rational agents incur positive cognitive debt because the costs are deferred, partially external, and masked by short-run productivity gains. Tranquil periods lower subjective risk assessments, raise AI substitution intensity, and compound leverage, generating a cognitive Minsky moment in which subjective risk falls while true systemic fragility rises. Expected crisis losses are convex in aggregate leverage. Post-crisis, output-target pressure can produce a false-correction loop in which agents patch AI failures with more AI. The decentralised equilibrium over-adopts substitutive AI relative to the social optimum because of systemic risk, cognitive public goods, and arms-race externalities. In a two-type heterogeneous-agent economy, high-cognitive-capital agents adopt AI more intensively and may eventually erode their unaided cognitive capital below that of initially lower-skilled agents.

05.
arXiv (CS.CV) 2026-06-16

Beyond Scalar Rewards by Internalizing Reasoning into Score Distributions

Reward models are central to text-to-image post-training, but visual preference is subjective and better represented as a distribution over rubric scores than as a deterministic scalar. Existing scalar, score-token, and pairwise reward models over-compress uncertainty and fine-grained score differences, while reasoning-based generative rewards provide stronger judgments but are costly to deploy and difficult to use as direct optimization signals. We propose Z-Reward, a teacher-student reward modeling framework that decouples reasoning-heavy judgment from efficient reward deployment. The teacher is a large VLM that uses reasoning to infer rubric-aligned score distributions, and is trained with Group-wise Direct Score Optimization (GDSO), which combines policy-gradient rewards from distribution expectations with direct pointwise and pairwise supervision on score distributions and score gaps. The student is trained with Reasoning-Internalized Score Distillation (RISD), which transfers the teacher's reasoning-conditioned score distribution into a compact VLM without requiring explicit reasoning chains at inference time. On our internally annotated evaluation set, the 27B GDSO teacher reaches 89.6% human preference accuracy, outperforming SFT, RewardDance, and GRPO, while the 9B RISD student reaches 88.6%, outperforming the OPD baseline and closely matching the larger teacher. We further show that Z-Reward can serve as a differentiable reward signal for text-to-image optimization, yielding a 41.3% net human-preference improvement over the SFT baseline.

06.
arXiv (quant-ph) 2026-06-12

Diffusive Dynamics of Nonstabilizerness

arXiv:2606.13606v1 Announce Type: new Abstract: Symmetries shape the quantum-information dynamics of many-body systems, but their effect on nonstabilizerness, the resource complementary to entanglement, is less understood. We compute the stabilizer Rényi entropy, a measure of nonstabilizerness, in $\mathrm{U}(1)$-symmetric one-dimensional random circuits. The disorder-averaged dynamics is captured by a four-replica tensor network, which we evaluate by $S_4$-adapted infinite time-evolving block decimation (iTEBD) directly in the thermodynamic limit. Together with a hydrodynamic argument, our results identify a diffusive universality class for the late-time approach of nonstabilizerness to its random-state value, with the stabilizer Rényi entropy gap closing as $1/t$. The same scaling is verified in an energy-conserving nonintegrable Ising chain. More broadly, our framework provides a hydrodynamic perspective on nonstabilizerness generation and offers insight into the design of approximate Haar-random states in Hamiltonian dynamics.

08.
medRxiv (Medicine) 2026-06-18

AlphaGenome identifies a deep intronic variant in a family with PLA2G6-associated neurodegeneration: Closing the diagnostic gap in rare genetic diseases

A molecular diagnosis remains out of reach for a substantial subset of patients with clinically recognizable Mendelian disorders, even after comprehensive next-generation sequencing. Causal variants in non-coding regions are difficult to detect and interpret using standard pipelines. Deep intronic variants that disrupt splicing are a known but underexplored source of pathogenic alleles, and systematic tools to evaluate them at scale have only recently emerged. We aimed to resolve an incomplete genetic diagnosis in two siblings with early-onset parkinsonism, prominent neuropsychiatric features, and autonomic dysfunction consistent with PLA2G6-associated neurodegeneration (PLAN), an autosomal recessive condition. Prior clinical exome sequencing, genome sequencing, Multiplex Ligation-dependent Probe Amplification (MLPA), and long-read sequencing had identified only a single heterozygous PLA2G6 missense variant, c.2132C>G (p.Pro711Arg). We used AlphaGenome to score 91 non-coding variants shared among the affected siblings and their father within 1 megabase of the PLA2G6 locus. The deep-learning model identified an intronic variant (c.2034+355G>A) that was predicted to create a cryptic splice acceptor site that could result in inclusion of a 160-bp cryptic exon. Tissue-specific predictions indicated the aberrant splicing would be detectable in blood, confirmed by junction-spanning RNA-seq reads from an unrelated carrier. This analysis completed a compound heterozygous PLAN diagnosis nearly two decades after symptom onset and demonstrates the utility of sequence-to-function models. Systematic integration of tools like AlphaGenome into rare disease workflows offers a practical, low-barrier route to closing the diagnostic gap for patients with compelling Mendelian phenotypes and incomplete genetic diagnoses.

09.
arXiv (CS.CL) 2026-06-12

Unraveling Syntax: Language Modeling and the Substructure of Grammars

While language models achieve impressive results, their learning dynamics are far from understood. Many domains of interest – such as natural language syntax, coding languages, arithmetic – are captured by context-free grammars (CFGs). In this work, we extend prior work on neural language modeling of CFGs in a novel direction: how language modeling behaves with respect to CFG substructure, namely subgrammars. We define subgrammars, and prove a set of fundamental theorems connecting language modeling and subgrammars. We show that language modeling loss recurses linearly over its top-level subgrammars; applied recursively, the loss decomposes into losses for "irreducible" subgrammars. Under additional assumptions, and empirically, parametrized models learn subgrammars in parallel, unlike children who first master simple substructures. We find that subgrammar pretraining can improve final performance, but only for tiny models relative to the grammar, while alignment analyses show that pretraining consistently leads to internal representations that better reflect the grammar's substructure.

10.
arXiv (CS.CL) 2026-06-24

Posterior Refinement: Fast Language Generation via Any-Order Flow Maps

Non-autoregressive generation offers a powerful paradigm for iterative refinement, allowing models to recursively critique, erase and regenerate arbitrary subsets of tokens. However, existing non-autoregressive models fail to realize this potential. Masked Diffusion Models (MDMs) suffer from factorization error, causing sample quality to collapse when generating multiple tokens simultaneously. Flow Map Language Models (FMLMs) circumvent this bottleneck via joint sequence transport for excellent few-step generation, but sacrifice the inference-time flexibility of MDMs. We introduce FMLM+, a framework that bridges this gap by equipping FMLM with masking-style noise schedules. While generating the full sequence in a single step, FMLM+ simultaneously scores the global consistency of each token a posteriori. We leverage this to introduce Posterior Refinement, a novel inference-time refinement strategy that enables the model to adaptively self-correct its outputs, matching the performance of discrete baselines with 32x fewer NFEs. Across diverse benchmarks, we demonstrate that FMLM+ with Posterior Refinement improves the speed–quality tradeoff over both MDM and FMLM families, providing a scalable foundation for high-fidelity language modeling.

11.
arXiv (math.PR) 2026-06-16

Free energy of non-convex multi-species spin glasses with centered Ising spins

arXiv:2606.16636v1 Announce Type: new Abstract: We identify the limit free energy of all multi-species spin glasses with centered $\pm 1$ spins. The result was previously known only under a convexity assumption on the covariance function of the Hamiltonian. We also obtain a one-species reduction of the formula for balanced multi-species models.

12.
bioRxiv (Bioinfo) 2026-06-11

Sequence-Based Therapeutic Peptide Classification with Augmented Negative Sampling

Therapeutic peptides offer high target specificity, low toxicity, and the ability to modulate protein-protein interactions, yet experimental functional characterization remains costly and slow. Computational prediction of therapeutic function directly from sequence could accelerate peptide screening and enable generative design pipelines, but requires reliable discrimination between therapeutic and non-therapeutic peptides. Existing multi-label predictors cover few functions, rely on limited datasets, and exhibit high glspl{fpr}, limiting their practical utility. We present a lightweight CNN classifier trained on the most comprehensive therapeutic peptide database to date (54,655 peptides, 48 functional categories). A key contribution is a statistically motivated negative sampling strategy using Markov models to generate diverse synthetic decoys at multiple difficulty levels. When evaluated on this controlled decoy benchmark, the FRP is reduced from over 60% for previous models to 2.1% for our approach. Our fine-tuned five-model ensemble achieves 78.9% Micro F1 and 54.6% Macro F1 while requiring only amino acid sequences as inputs. Analysis using a sparse L1-constrained variant of our model shows that convolutional filters capture conserved functional motifs and statistically improbable non-therapeutic patterns, with downstream layers combining these signals, providing mechanistic evidence that the network learns biologically meaningful structure. In a generalization task on the TPpred-LE benchmark, our model achieves 55.3% Micro F1 and 38.6% Macro F1, comparable to TPpred-LE trained on its native dataset (57.9%/38.1%) while predicting four times more therapeutic functions with four times fewer parameters. Code and models will be made available at https://github.com/terra-quantum-public/tq-therapep-ai.

13.
arXiv (CS.LG) 2026-06-16

Bayesian Tensor Decomposition with Diffusion Model Prior

arXiv:2606.03212v2 Announce Type: replace Abstract: Low-rank tensor decomposition (TD) is usually effective on clean, fully observed data, but it often degrades under severe missingness or noise. Low-rankness is itself a useful but limited structural prior, and additional handcrafted priors (e.g., sparsity or smoothness) still fall short of capturing the rich statistics of real-world data. To compensate for this weak inductive bias under heavy corruption, one would like to inject a learned, data-driven prior; however, the state-of-the-art diffusion models are not readily compatible with current TD and tractable posterior inference. To address these challenges, we introduce DiffBCP, a hybrid-prior Bayesian CP decomposition framework that couples a cumulative shrinkage process prior over the CP factors for automatic rank selection with an off-the-shelf pre-trained diffusion model as an implicit data prior on the reconstructed tensor. To make posterior inference tractable despite the coupling among the likelihood, low-rank constraint, and diffusion prior, we develop a split Gibbs sampler: CP factors admit conjugate updates, while the diffusion block is sampled via low-rank-guided denoising. A noise-adaptive coupling schedule further reduces sensitivity to hand-tuned annealing. Experiments on image inpainting and denoising, including high-resolution out-of-distribution images, show consistent gains over Bayesian, nonlinear, and plug-and-play TD baselines.

14.
arXiv (CS.CV) 2026-06-17

TivTok: Broadcasting Time-Invariant Tokens for Scalable Video Tokenization

Video tokenization is fundamental to scalable video generation, as the number of tokens directly determines the computational cost and the length of videos that can be modeled. Existing tokenizers mainly improve scalability by compressing videos into fewer tokens, but they often continue to represent persistent content, such as static backgrounds and consistent object appearances, repeatedly across frames and chunks. In this paper, we propose TivTok (Time-Invariant Tokenizer), a reuse-aware video tokenizer that makes persistent information reusable across time. TivTok represents a clip with Time-Invariant (TIV) tokens that encode information shared across frames and Time-Variant (TV) tokens that encode frame-specific residuals. To obtain this factorization, we introduce Scope-Induced Factorization (SIF), which assigns different attention scopes to the two token groups: TIV tokens attend to the full clip, whereas each TV token only accesses its corresponding frame together with the TIV tokens. In the decoder, Invariant Broadcasting (IB) reuses the same TIV tokens across frames and chunks for parallel reconstruction and long-video tokenization. Experiments show that TivTok achieves an rFVD of 12.65 on the standard $16{\times}256{\times}256$ benchmark and improves compression efficiency by 2.91$\times$ for 128-frame videos compared with the evaluated baselines, while using only 1.1\% of the tokens required by downsample-based tokenizers in our evaluation.

15.
arXiv (CS.AI) 2026-06-16

Calibrated Sampling-Free Uncertainty Estimation in Bayesian Deep Learning

arXiv:2606.16214v1 Announce Type: cross Abstract: Modern deep learning models remain notoriously prone to overconfidence, limiting their reliability in high-stakes applications. Bayesian methods aim to counter this by learning a distribution over model parameters, and recent advances now make this feasible for large-scale architectures at costs comparable to AdamW. However, a challenge remains at test time: predictions must be averaged across many forward passes with weights sampled from the posterior, which is prohibitively expensive. Variance propagation offers an efficient alternative, computing layer-wise analytical approximations of uncertainty in a single forward pass. While such techniques are effective for MLPs, their extension to modern architectures remains challenging, due to increased depth and diversity of layer types. To fill this gap, we propose Calibrated Variance Propagation (CVP), which introduces a new propagation method for normalization layers, combines it with recent techniques for handling activation functions, and absorbs residual error through a light calibration step. CVP yields comparably accurate uncertainty estimates to MC sampling across transformers and CNNs, at a fraction of the cost. Against prior variance propagation work, CVP improves coverage at $0.5\%$ risk from $8.2\%$ to $14.6\%$ with BEiT-3 on Visual Reasoning (NLVR2) and from $2.6\%$ to $10.8\%$ with ViLT on VQAv2, with gains extending to convolutional architectures.

16.
arXiv (CS.LG) 2026-06-16

Towards a Unified Generative Model for Scarce Time Series with Domain Experts

arXiv:2606.15172v1 Announce Type: new Abstract: Synthesizing realistic time series with generative models has wide-ranging applications in real-world scenarios. Despite recent progress, most existing methods are trained under the assumption of abundant training data, which substantially limits their effectiveness in data-scarce settings. In this paper, we propose TimeMoDE, a novel framework that integrates Diffusion Transformers with Mixture-of-Experts to exploit both domain adaptability and diffusion-stage awareness for time series generation under data scarcity. It is pre-trained on a large-scale collection of multi-domain datasets to extract domain-agnostic temporal representations and domain-specific information benefiting generalization during fine-tuning. We propose Domain Prompts to condition expert assignment for indistinguishable noised tokens, mitigating the limitations of capturing inter-dataset relationships. Moreover, we incorporate diffusion timestep signals to equip the experts with awareness of time series degradation variations, facilitating adaptive calibrate to stage-dependent denoising requirements. Extensive experiments demonstrate that TimeMoDE outperforms existing methods under diverse low-data settings. It establishes an innovative paradigm for advanced time series few-shot generation.

17.
arXiv (CS.AI) 2026-06-18

Benchmarking Action Spaces in Reinforcement Learning for Vision-based Robotic Manipulation

arXiv:2606.18594v1 Announce Type: cross Abstract: In real-world reinforcement learning (RL), the choice of action space can play a key role in shaping motion smoothness, safety, and overall task performance. In this study, we evaluate pose increment, pose velocity, joint position increment, and joint velocity across two vision-based manipulation tasks: object picking and pushing. We train policies in simulation and deploy them to the real world using sim-to-real transfer. We find that action-space representation indeed significantly affects sim-to-real performance. In particular, we find that the joint velocity action space is best for the vision-based picking and pushing tasks in terms of smoothness and final task performance. We also provide practical guidance for RL practitioners in choosing action spaces for both simulation and real-world experiments.

18.
arXiv (CS.LG) 2026-06-24

A Time-Reparameterized Cumulative Intensity Extrapolation Sampler for Discrete Flow Matching

arXiv:2606.24140v1 Announce Type: new Abstract: Discrete flow matching (DFM) provides a principled framework for generative modeling on discrete state spaces via continuous-time Markov chain dynamics. In practice, sampling for DFM commonly employs discretizations such as $\tau$-leaping, yet efficient sampling methods under a limited number of function evaluations (NFE) remain less studied. To address this gap, we propose the Time-Reparameterized Cumulative Intensity Extrapolation (TR-CIE) sampler, which aims to improve sampling quality when function evaluations are restricted. TR-CIE consists of two components. First, a schedule-based time reparameterization rescales the time grid according to the noise schedule. Under standard factorized DFM rate parameterizations, this transformation of variables absorbs the schedule-dependent growth term and mitigates stiffness near the terminal sampling stage. Second, we introduce a cumulative-intensity extrapolation updating rule. By reusing cached model outputs from the previous step as a history term, this improves the approximation of stepwise cumulative intensities on the resulting non-uniform time grid. We provide a theoretical analysis that bounds the local approximation error of cumulative intensities and establishes convergence results. The resulting sampler requires one NFE per step and introduces no additional model evaluations compared to the standard $\tau$-leaping sampler. Extensive experiments on synthetic tasks, text generation, and text-to-image benchmarks demonstrate that our method improves sampling quality under limited NFE.

19.
arXiv (CS.AI) 2026-06-15

Low-Burden LLM-Based Preference Learning: Personalizing Assistive Robots from Natural Language Feedback for Users with Paralysis

arXiv:2604.01463v2 Announce Type: replace-cross Abstract: Physically Assistive Robots require personalized behaviors to ensure user safety and comfort. However, traditional preference learning methods, like exhaustive pairwise comparisons, cause substantial physical and cognitive fatigue for users with severe motor impairments. To solve this, we propose a low-burden, offline framework that translates unstructured natural language feedback directly into deterministic robotic control policies. To safely bridge the gap between ambiguous human speech and robotic code, our pipeline uses Large Language Models (LLMs) grounded in the Occupational Therapy Practice Framework. This clinical reasoning decodes subjective user reactions into explicit physical and psychological needs, which are then mapped into transparent decision trees. Before deployment, an automated "LLM-as-a-Judge" verifies the code's structural safety. We validated this system in a simulated meal preparation study with 10 adults with paralysis. Results show our natural language approach significantly reduces user workload compared to traditional baselines. Additionally, occupational therapists confirmed the generated policies are safe and accurately reflect user preferences.

20.
arXiv (CS.LG) 2026-06-15

When Language Representations Interact: Separability and Cross-Lingual Effects in LLMs

arXiv:2606.14347v1 Announce Type: new Abstract: Large language models exhibit strong multilingual capabilities, however, their internal representations are difficult to interpret. Understanding these interactions is important for ensuring reliable behavior in multilingual systems. Recent work has shown that causal-geometric structure can explain how certain concepts are encoded as approximately linear and separable directions, but whether this framework extends to multilingual models, where language identity is correlated and hierarchical, is underexplored. We apply causal-geometric analysis to multilingual LLMs, studying 28 bilingual contrasts across three models, allowing us to analyze when languages behave as approximately independent factors and when structured dependencies persist. We find evidence that language concepts admit stable linear representations that are largely separable under a covariance-adjusted (causal) inner product, with structured deviations reflecting linguistic similarity. Moreover, languages within the same family (such as Germanic or Romance) exhibit a simplex-like geometric structure, suggesting hierarchical organization. These results extend causal-geometric interpretability to multilingual settings and provide insight into how separability and similarity may exist in multilingual LLM representations, motivating interpretability analyses that diagnose when and how structured dependencies between concepts can be anticipated. This has implications for trustworthy deployment, as residual structure between languages may lead to unintended cross-lingual effects when models are monitored or intervened upon.

21.
arXiv (CS.CV) 2026-06-12

Mana: Dexterous Manipulation of Articulated Tools

Articulated tool manipulation remains a major challenge in dexterous robotics due to the need to coordinate internal degrees of freedom and contact-rich interactions. While prior work has largely focused on rigid objects, articulated tool use remains underexplored because of its physical complexity and the difficulty of learning functional grasping and manipulation policies. We present Mana (Manipulation Animator), a general sim-to-real framework that reinterprets dexterous manipulation as an animation problem. Inspired by computer animation, Mana employs a coarse-to-fine pipeline that transforms procedurally-generated grasp keyframes into manipulation trajectories through motion planning and reinforcement learning. The data generation process is largely automatic, requiring only a few mouse clicks to specify functional affordances (

22.
arXiv (CS.AI) 2026-06-24

PHANTOM: A Large-Scale Dataset of Multimodal Adversarial Attacks for Vision-Language Models

arXiv:2606.24388v1 Announce Type: new Abstract: We introduce a large-scale, open-source dataset of pre-generated adversarial attacks for vision-language models (VLMs). The dataset is designed to be diverse, representative, and practical, extending existing benchmarks by covering 10 high-level categories and 55 subcategories of harmful intents. Our primary goal is to make adversarial data accessible to the research community, given the computational cost and complexity of generating large numbers of attacks. The dataset comprises 47 524 adversarial samples, generated using state-of-the-art attack strategies from recent literature. Our work complements existing efforts by consolidating and extending prior benchmarks from multiple established sources, resulting in 7 826 intents, and introduce an additional category to broaden coverage. This provides realistic evaluation resources for studying model robustness and alignment. Our dataset intends to enable researchers and practitioners to systematically evaluate the robustness and safety of VLMs, fine-tune attack-generation models, and develop or stress-test defensive guardrails under diverse adversarial conditions. By releasing this resource, we aim to lower the barrier to adversarial research and foster more reproducible, comprehensive, and comparable evaluations of VLM safety.

23.
medRxiv (Medicine) 2026-06-15

Anti-Platelet Factor 4 Antibody Clonal Heterogeneity and MGUS Status in HIT

Background Monoclonal gammopathy of thrombotic significance (MGTS) is a recently described chronic prothrombotic condition characterized by monoclonal anti-PF4 antibodies that are detected above the polyclonal antibody background in patient sera (i.e. present as monoclonal gammopathy of undetermined significance, MGUS). Due to conflicting data in the published literature on antibody clonality in heparin-induced thrombocytopenia (HIT), we evaluated clonality and abundance of anti-PF4 antibodies in HIT, including investigating whether an MGUS, if present in HIT, represents the causative anti-PF4 antibody. Methods Blood samples from 15 patients with HIT were subject to Platelet Factor 4-dependent antigen-based and functional tests. The unmanipulated serum antibody repertoire and isolated anti-PF4 antibodies were subjected to mass spectrometric evaluation. Results Two of the 15 HIT patients had an IgG MGUS. Notably, anti-PF4 antibodies were not synonymous with the MGUS antibody in either of the two patients. Eight of the 15 patients demonstrated monoclonal anti-PF4 antibodies, however, none of the anti-PF4 antibodies were detectable as an MGUS upon evaluation of the entire serum antibody repertoire, reflecting their low abundance. In the seven patients with multiple anti-PF4 antibodies, non-monoclonality was confirmed by analysis of deglycosylated antibody heavy chains. Conclusions Anti-PF4 HIT antibodies are monoclonal in approximately 50% of HIT patients, however, antibody abundance is low such that they are not detectable over the polyclonal IgG background (i.e. are MGUS-negative), differentiating HIT from MGTS. This observation helps explain the transient nature of HIT relative to the persistent prothrombotic state seen in MGTS.

24.
medRxiv (Medicine) 2026-06-22

Efficacy and safety of semaglutide for obesity and hyperphagia in adults with Prader-Willi syndrome

Context: Prader-Willi syndrome is a genetic neurodevelopmental disorder characterized by hyperphagia and early-onset obesity from hypothalamic dysfunction with endocrinopathies and learning disability. Management is challenging with strict control of the food environment needed. While newer glucagon-like peptide-1 receptor agonists, such as semaglutide, have efficacy in non-PWS obesity, there have been limited case reports in PWS. Objective/Design/Setting: Retrospective records review of 12 adults with PWS and overweight/obesity treated with semaglutide at a UK academic hospital centre specialist clinic. Patients: mean +/- SD age 28.3 +/- 10.1 years, 83% female, BMI 46.6 +/- 8.2kg/m2, 75% type 2 diabetes mellitus. Intervention: Median follow-up 17.2 months (range 8.7-36.1) with median semaglutide dose 2.4mg once weekly (1.0-2.4). Results: Although there was no significant weight loss on semaglutide, there was stabilisation of the weight gain prior to treatment over previous 12.4 months (7.6-23.0) (post -3.1 +/- 9.9% vs. pre +5.7 +/- 5.6%: d -0.72, P=0.037). There was a significant decrease in hyperphagia on semaglutide from hyperphagia questionnaire for clinical trials (n=11, -7.3 +/- 6.1 (max 36), d -1.19, P=0.003), having been stable before treatment. HbA1c improved in those with elevated baseline levels (n=6, -4.2 +/- 4.9%, d -0.74, P=0.13). Mild gastrointestinal side effects were seen in 25% but did not lead to discontinuation. Conclusions: In adults with PWS, semaglutide produced weight maintenance, reduced hyperphagia, and improved glycaemic control, with good tolerability. Larger placebo-controlled trials are needed to confirm these findings in adults and adolescents with PWS, especially in those without T2DM, where efficacy may be greater.

25.
medRxiv (Medicine) 2026-06-12

Mathematical analysis of the overall survival after chemoradiotherapy of limited-stage small cell lung cancer and the effect of dose/fractionation

The purpose of this work is to analyze the 2-year overall survival (OS2y) of limited-stage small cell lung cancer (LS-SCLC) treated with chemoradiotherapy (CRT), aiming at characterizing the response of LS-SCLC, and in particular the /{beta} value and proliferation parameters. Through a systematic analysis of the literature, we collated a dataset containing 57 entries (3363 patients) of response of LS-SCLC treated with CRT. Radiotherapy schedules ranged from hyper- to hypofractionation. Four radiobiological models to describe the OS2y were investigated, with progressive levels of complexity including the effect of radiotherapy, chemotherapy, treatment year and toxicity. The Akaike Information Criterion (AIC) was used to compare models, and the profile likelihood methodology to compute confidence intervals. Model 4, which includes the effect of radiotherapy, chemotherapy, treatment year and dose-dependent toxicity, provided the best fits of the experimental data (lowest AIC value). While being the best model, model 4 still fails to provide a good prediction of the OS2y, in particular failing to predict the survival of the schedules achieving the lower/higher survivals. The radiobiological analysis of the dose-response of LS-SCLC to CRT does not allow to narrowly constrain the value of response parameters. We attribute this limitation to the large heterogeneity of this disease. Nonetheless, our analysis shows a large /{beta} value (>9 Gy, 95% CI), which implies a low fractionation effect in the radiotherapy of LS-SCLC. and an accelerated proliferation of tumor cells, {lambda}' > 1.6 Gy/day (95% CI), after a kick-off time of ~4-5 weeks, which supports the use of accelerated protocols to avoid the effect of tumor proliferation on the clinical outcome.