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01.
arXiv (CS.AI) 2026-06-16

Graphical-Probabilistic Modeling of Generative Flows in LLM-Native Software Systems

arXiv:2606.15943v1 Announce Type: cross Abstract: Engineering LLM-native software remains a challenging and immature field. Current practice is largely exploratory, relying on experimentation and heuristic techniques such as prompting and context engineering. These, however, are low-level and lack the principled structure needed to support design-level reasoning or analysis. In contrast, traditional software engineering leverages modularity and abstraction to communicate and analyze system behavior. To bring similar rigor to LLM-native development, we propose methods for documenting generative flows and for stating properties of LLM-based software designs. Such methods must account for the stochastic, prompt-dependent behavior of large language models while remaining expressive enough to capture emergent phenomena. Our initial approach is based on graphical probabilistic models, tailored to capture phenomena characteristic of LLM-native systems. This framework – what we term Generation Networks – aims to provide a foundation for principled reasoning about generative interactions and system-level properties in LLM-centric software architectures.

02.
arXiv (CS.CL) 2026-06-16

Scaling LLM Reasoning from Minimal Labels: A Semi-Supervised Framework with a Lightweight Verifier

For the development of Large language models (LLMs), recent approaches to generating pseudo intermediate reasoning have shown remarkable progress. But they typically rely on large numbers of correctly annotated answers to assess reasoning quality. This paper presents a semi-supervised framework that scales reasoning learning from minimal supervision, turning reasoning verification itself into a data creation mechanism. We train a lightweight reasoning-correctness classifier on only a few labeled samples, which judges whether intermediate reasoning traces generated by an LLM are valid. Furthermore, an entropy-based confidence threshold filters out unreliable samples, and the remaining high-confidence reasoning traces are used to fine-tune the model. Experiments on Verifiable Math Problems (Orca-Math subset) and Question Answering on Image Scene Graphs (GQA) with Visual Programming show that our method achieves accuracy comparable to using 10-15x more labeled data. Ablation analyses confirm that both the classifier and entropy filtering are essential for scalable and noise-resistant pseudo-labeling. By replacing expensive answer-level supervision with lightweight reasoning verification, our method provides a practical path toward constructing large-scale reasoning resources and paves the way for future autonomous reasoning systems that learn from minimal human input.

03.
arXiv (CS.AI) 2026-06-16

LLM-WikiRace Benchmark: How Far Can LLMs Plan over Real-World Knowledge Graphs?

arXiv:2602.16902v5 Announce Type: replace Abstract: We introduce LLM-Wikirace, a benchmark for evaluating planning, reasoning, and world knowledge in large language models (LLMs). In LLM-Wikirace, models must efficiently navigate Wikipedia hyperlinks step by step to reach a target page from a given source, requiring look-ahead planning and the ability to reason about how concepts are connected in the real world. We evaluate a broad set of open- and closed-source models, including Gemini-3, GPT-5, and Claude Opus 4.5, which achieve the strongest results on the easy level of the task and demonstrate superhuman performance. Despite this, performance drops sharply on hard difficulty: the best-performing model, Gemini-3, succeeds in only 23\% of hard games, highlighting substantial remaining challenges for frontier models. Our analysis shows that world knowledge is a necessary ingredient for success, but only up to a point, beyond this threshold, planning and long-horizon reasoning capabilities become the dominant factors. Trajectory-level analysis further reveals that even the strongest models struggle to replan after failure, frequently entering loops rather than recovering. LLM-Wikirace is a simple benchmark that reveals clear limitations in current reasoning systems, offering an open arena where planning-capable LLMs still have much to prove. Our code and leaderboard available at https:/llmwikirace.github.io.

04.
arXiv (quant-ph) 2026-06-12

Path integral control of open quantum systems

arXiv:2410.18635v4 Announce Type: replace Abstract: We investigate open-loop quantum state preparation for a class of open quantum systems whose dynamics follow a Gorini-Kossakowski-Lindblad-Sudarshan (GKLS) master equation that admits a trajectory-based stochastic representation. The deterministic control objective is reformulated as a stochastic optimal control problem – interpreting stochasticity as a methodological tool akin to stochastic Schrödinger equation unravelings – which situates the problem within the path integral control framework. For the class of GKLS generators under consideration, this reformulation leads to an explicit expression for the optimal control as a weighted average over stochastic quantum trajectories, thereby eliminating the need for gradient evaluations. Building on this theoretical result, we derive a control update rule for piecewise-constant control pulses and demonstrate that adaptive importance sampling progressively enhances the control estimator during optimization, culminating in the algorithm we term Path integral Quantum Control (PiQC). We further introduce an annealed variant of PiQC, wherein a synthetic noise schedule gradually steers open-system trajectories toward closed-system dynamics, enabling high-fidelity unitary state preparation. Numerical studies on a dissipative single-qubit system and a multi-qubit Nuclear Magnetic Resonance model verify that PiQC yields precise open-loop controls and displays robustness to Hamiltonian perturbations. We propose PiQC as a trajectory-based alternative to gradient-based approaches, which might offer a viable solution in quantum control problems where gradient computation is infeasible or computationally demanding.

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

Learning Earthquake Wave Arrival Time Picking from Labels with Inaccuracies

arXiv:2606.15377v1 Announce Type: cross Abstract: Inaccurately labeled training data, or "label noise", poses a significant threat to the integrity of supervised machine learning models. This corruption directly degrades performance by teaching the model erroneous mappings between features and labels, which leads to poor generalization and reduced accuracy on properly labeled validation and test data. Current seismological applications mainly rely on large-scale training sets or data augmentation to reduce the label-noise impact, which can be labor-intensive and costly. Here, we introduce a Label Noise-Contrastive Robust Learning (LaNCoR) approach that can effectively handle noisy labels in seismic signal processing tasks, without requiring large-scale training datasets. In this approach, the input waveform feature and label representation distributions are aligned in the feature space to correct mislabeling and reduce its impact on the training process. We present LaNCoR's performance on the task of P-phase arrival-time picking of real microseismic data using two baseline models and training approaches. Our results indicate that LaNCoR can improve performance by up to 28.8% across performance metrics. This approach holds great promise for model training in seismology and geosciences.

06.
arXiv (quant-ph) 2026-06-11

Enhancing Many-Body Chaos via Entropy Injection from Environment

arXiv:2606.11784v1 Announce Type: new Abstract: In closed quantum systems, local information spreads throughout the entire system and becomes highly complex under unitary evolution. In contrast, when the system is embedded in an environment, system-environment coupling can transfer information from the system into the environment, thereby reducing the rate of complexity growth within the system. This leads to the environment-induced scrambling transition established in previous works. In this work, we identify entropy injection from the environment as a different physical process that instead enhances many-body chaos. Our setup consists of coupling a system that is already in equilibrium with one environment to another environment, which serves as an entropy reservoir and drives the system into a non-equilibrium state. When entropy flows into the system through either heat transfer or particle transfer, the effective Hilbert space explored by the system enlarges, a mechanism that can enhance many-body chaos. We explicitly demonstrate this idea by constructing a solvable complex Brownian SYK model, in which both the relaxation toward the steady state and the steady-state quantum Lyapunov exponent can be computed analytically. Our results provide a controllable mechanism for tuning quantum scrambling through entropy flow in quantum many-body systems coupled to environments.

07.
arXiv (CS.LG) 2026-06-18

On Local Population-Risk Certificates

作者:

arXiv:2606.19147v1 Announce Type: cross Abstract: This paper develops local certificates for population-risk increments around a current model. For a local candidate set \(\mathcal D\), the certificate is a two-sided confidence band for \(P({\ell_{\theta+v}-\ell_\theta})\) over \(v\in\mathcal D\). As an application, the upper endpoint of this band yields a risk-controlled update rule: an update is accepted only when its certified upper endpoint is nonpositive; otherwise the current model is retained.

08.
arXiv (quant-ph) 2026-06-12

Roto-Reflection Geometry of Pure Two-Qubit Entanglement

arXiv:2606.12637v1 Announce Type: new Abstract: Pure two-qubit entanglement is usually characterized by scalar quantities such as concurrence. Here we show that it also has a natural geometric form. In the Pauli correlation tensor, maximally entangled states appear as improper orthogonal maps between two local Bloch spheres. These maps are roto-reflections. For partially entangled pure states, the same roto-reflection geometry is recovered after separating the contraction associated with concurrence. We call the corresponding geometric object the Entanglement Roto-Reflection Plane (ERRP). It organizes the maximally correlated directions of the two-qubit state and provides a covariant geometric complement to the scalar magnitude of entanglement.

09.
arXiv (CS.LG) 2026-06-11

Higher-Order Token Interactions via Quantum Attention

arXiv:2606.11673v1 Announce Type: cross Abstract: Standard dot-product self-attention computes, in a single layer, only pairwise (order-2) interactions between tokens; representing a generic order-$k$ interaction is known to require either super-quadratic resources in one layer or composition across depth. We introduce Quantum Higher-Order Attention (QHA), a shallow, hardware-realizable quantum attention head that, via data re-uploading and an all-to-all non-Clifford entangler, synthesizes order-$k$ token interactions inside the circuit and exposes them through a local single-qubit read-out. We prove (i) an expressivity separation: any single standard self-attention layer with embedding dimension $m$, $H$ heads and $p$-bit precision satisfying $mHp=o(N/\log\log N)$ cannot represent the order-$k$ correlation family that one QHA head represents with circuit depth $O(\log k)$ ($O(k)$ two-qubit gates); and (ii) a trainability guarantee for its local-design instantiation: with a local read-out and $O(\log n)$ depth the gradient variance is $\Omega(1/\mathrm{poly}(n))$ (no barren plateau), which we confirm empirically – while being explicit that the more expressive all-to-all instantiation we benchmark is trained empirically and shows exponentially decaying gradients. Empirically, at a $6.5\times$ smaller parameter budget, QHA generalizes hidden-subset parity of every order $k\le6$ from disjoint inputs, whereas the larger classical attention head collapses past order~2; consistent with theory, the size of the advantage tracks the target's Fourier degree - largest for parity and shrinking when low-order structure is present. As an application, QHA serves as a compact high-order interaction detector across three domains - genetic epistasis, learning-parity-with-noise, and graph triangle detection - reaching the noise ceiling at the smallest parameter budget where field-standard linear methods fail.

11.
arXiv (CS.AI) 2026-06-16

Synthetic Counteradaptation: A Principle of Human-AI Co-evolution

arXiv:2606.15503v1 Announce Type: new Abstract: In this paper, we introduce the concept of synthetic counteradaptation, a process where human and AI systems co-evolve by adapting to each other's strategies and behaviors. Synthetic counteradaptation occurs when AI systems develop novel strategies or social protocols, prompting humans to extract insights and adapt their own behaviors in response, leading to the emergence of new agent interaction dynamics. To illustrate these dynamics, we analyze examples from various contexts, including the game of Go, mixed-motive social interactions, and geopolitical simulations. By exploring these cases, we demonstrate how synthetic counteradaptation provides a framework for understanding the recursive and co-evolutionary nature of human-AI interactions in multi-agent environments.

12.
arXiv (CS.CV) 2026-06-11

CoVEBench: Can Video Editing Models Handle Complex Instructions?

While recent text-guided video editing models excel at elementary tasks (e.g., style transfer, object insertion), real-world user requests are highly compositional. A single prompt often demands multiple coupled edits, such as modifying subjects, actions, and camera views, while strictly preserving unrelated spatiotemporal content. Existing benchmarks, heavily constrained by isolated edits and coarse global metrics, fail to diagnose how models handle such complex workflows. To address this gap, we introduce CoVEBench, a compositional video editing benchmark comprising 416 curated source videos, 626 multi-point editing instructions, and 9,990 fine-grained checklist items. Covering diverse editing dimensions, CoVEBench evaluates models via MLLM-judged instruction compliance and video fidelity, alongside automated metrics for video quality. Extensive experiments reveal that compositional editing remains a profound challenge: current models frequently omit edits, violate preservation constraints, or introduce artifacts when handling multiple operations simultaneously. CoVEBench provides a challenging, diagnostic testbed to advance video editing toward realistic user workflows.

13.
arXiv (CS.CV) 2026-06-11

Seeing What Matters: Perceptual Wrapper with Common Randomness for 3D Gaussian Splatting

While 3D Gaussian Splatting (3DGS) achieves impressive real-time rendering, it frequently struggles to synthesize high-frequency textures, a limitation heavily exacerbated in memory-constrained and rate-distortion-optimized (RDO) pipelines. To address this, we propose a versatile 2D perceptual wrapper that enhances the rendered outputs of existing 3DGS representations in a content- and view-dependent manner. Our method leverages a lightweight synthesis network conditioned on pseudo-random Gaussian noise to synthesize perceptually plausible textures. Supervised by Wasserstein Distortion, the network learns to match local feature statistics rather than strictly enforcing pixel-wise reconstruction fidelity, effectively mitigating the blurriness inherent in standard frameworks. We demonstrate the broad applicability of our plug-and-play approach across vanilla, memory-constrained, and RDO 3DGS methods. Comprehensive subjective and objective experiments confirm that our method significantly improves over existing baselines, yielding superior perceptual quality at sharply reduced file or model sizes.

14.
arXiv (CS.CL) 2026-06-16

SAMark: A Self-Anchored Text Watermarking with Paragraph-Level Paraphrase Robustness

Semantic-level watermarking (SWM) improves robustness against text modifications by treating sentences as the basic unit. However, robustness to paragraph-level paraphrasing remains difficult because such attacks globally disrupt watermark signals by changing sentence order. In this work, we propose SAMark, a self-anchored watermarking framework that removes the dependency on sentence order by establishing a step-independent green region in semantic space. To improve detectability, we introduce a multi-channel hyperbolic scoring mechanism that amplifies watermark signals while suppressing noise from weakly aligned candidates. We further propose a diversity-aware filtering strategy that combines hard filtering with soft regularization, extending beyond simple n-gram repetition filters to address semantic redundancy. Experimental results show that SAMark achieves up to 90.2% TP@FP1% under typical paragraph-level paraphrasing attacks, outperforming the strongest prior baseline by more than 30% on average, while maintaining generation quality competitive with unwatermarked text and breaking the robustness-quality trade-off that limits prior methods.

15.
arXiv (CS.CV) 2026-06-11

The N-Body Problem: Parallel Execution from Single-Person Egocentric Video

Humans can intuitively parallelise complex activities, but can a model predict this from observing a single person? Given one egocentric video, we introduce the N-Body Problem: predicting how N individuals, can hypothetically perform the same set of tasks. The goal is to maximise speed-up, but naive assignment of video segments to individuals often violates real-world constraints, leading to physically impossible scenarios like two people using the same object or occupying the same space. To quantify this, we formalise the N-Body Problem and propose a suite of metrics to evaluate both performance (speed-up, task coverage) and feasibility (spatial collisions, object conflicts and causal constraints). As a proof of concept, we introduce a structured prompting strategy that guides a Vision-Language Model (VLM) to reason about the 3D environment, object usage, and temporal dependencies, producing a viable parallel execution. On 100 videos from EPIC-Kitchens and HD-EPIC, for $N = 2$, our structured prompt improves action coverage by 45% over a baseline prompt for Gemini 2.5 Pro, while simultaneously slashing collision rates, object and causal conflicts by 51%, 52% and 55% respectively.

16.
arXiv (quant-ph) 2026-06-12

Entanglement Detection by Approximate Entanglement Witnesses

arXiv:2402.14755v2 Announce Type: replace Abstract: The problem of determining whether a given quantum state is separable is known to be computationally difficult. We develop an approach to this problem based on approximations of convex polytopes in high dimensions. By showing that a convex polytope constructed from a finite number of hyperplanes approximates the Euclidean ball arbitrarily well in high dimensions, we find evidence that a finite set of approximate entanglement witnesses is potentially sufficient to determine the entanglement of a state with high probability.

17.
arXiv (CS.AI) 2026-06-16

Benign in Isolation, Harmful in Composition: Security Risks in Agent Skill Ecosystems

arXiv:2606.15242v1 Announce Type: cross Abstract: Skills are becoming the capability layer through which LLM agents turn plans into actions, but their use introduces security risks such as data leakage, unauthorized operations, and tool misuse. Existing vetting usually evaluates each skill in isolation, while real agent tasks often invoke multiple skills in a shared execution context. This creates Skill Composition Risk (SCR): a skill that appears benign alone can become harmful when its outputs, trust signals, authorization cues, or side effects influence later invocations along an activated path. We introduce SCR-Bench to evaluate this risk in controlled, sandboxed skill environments. Rather than relying only on textual intent or surface behavior, SCR-Bench records downstream state changes and path-level outcomes across composed skill executions. It contains three sub-benchmarks: SCR-CapFlow for capability-flow composition, SCR-TrustLift for trust-transfer composition, and SCR-AuthBlur for authorization-confusion composition. Across SCR-Bench, composed paths expose risks that are largely absent under isolated evaluation. In SCR-CapFlow, attack success rate reaches 33.6 percent under composition, compared with near-zero isolated baselines. In SCR-TrustLift, attack success rate exceeds 96.5 percent on four of five backends. In SCR-AuthBlur, the risky-approval rate increases by 71.8 percent relative to the L0 isolated baseline under the L1 context setting. These results show that agent skill security should be assessed at the level of activated paths rather than isolated artifacts. SCR and SCR-Bench provide a foundation for path-aware risk evaluation and defense in LLM agent skill ecosystems. Benchmark: https://github.com/saint-viperx/SCR_Bench.

19.
arXiv (CS.AI) 2026-06-11

Information bottleneck for learning the phase space of dynamics from high-dimensional experimental data

arXiv:2604.24662v2 Announce Type: replace-cross Abstract: Identifying the dynamical state variables of a system from high-dimensional observations is a central problem across physical sciences. The challenge is that the state variables are not directly observable and must be inferred from raw high-dimensional data without supervision. Here we introduce DySIB (Dynamical Symmetric Information Bottleneck) as a method to learn low-dimensional representations of time-series data by maximizing predictive mutual information between past and future observation windows while penalizing representation complexity. This objective operates entirely in latent space and avoids reconstruction of the observations. We apply DySIB to an experimental video dataset of a physical pendulum, where the underlying state space is known. The method, with hyperparameters of the learning architecture set self-consistently by the data, recovers a two-dimensional representation that matches the dimensionality, topology, and geometry of the pendulum phase space, with the learned coordinates aligning smoothly with the canonical angle and angular velocity. These results demonstrate, on a well-characterized experimental system, that predictive information in latent space can be used to recover interpretable dynamical coordinates directly from high-dimensional data.

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

OdysSim: Building Foundation Models for Human Behavior Simulation

Large language models are increasingly deployed as human simulators for interactive evaluation and social simulation. Yet helpfulness-driven post-training pulls them toward a homogeneous, overly agreeable assistant register, creating a behavioral Sim2Real gap. We present OdysSim, the largest open systematic investigation of behavioral foundation models, i.e., models trained to simulate human behavior at scale. We propose SOUL, a taxonomy of five capability axes (CONV, SS, COG, ROLE, EVAL) that unifies 62 datasets and 23 benchmark tasks under one framework. Specifically, we curate the OdysSim corpus (21.4M interactions, 10B tokens, retrofitted with back-generated social contexts), construct the SOUL-Index benchmark, and develop an end-to-end training recipe combining midtraining, task-specific RL, and expert distillation. The resulting open 8B OSim model ranks first or tied-first on 8 of 23 tasks, outperforming any individual frontier model by this count, with the strongest gains on conversational and social tasks. Its outputs are also more human-like in length, formatting, and word choice, and it transfers zero-shot to out-of-distribution user simulation on $\tau$-bench, nearly matching real users on reaction alignment (93.2 vs. 93.5). We further show that LLM-as-judge RL induces reward-hacking patterns, and that our detectors can mitigate them during post-training. Together, our findings suggest that behavioral foundation models require rethinking the LLM training paradigm. We release all artifacts to support future research.

21.
arXiv (CS.LG) 2026-06-19

Linear Mode Connectivity under Data Shifts for Deep Ensembles of Image Classifiers

arXiv:2511.04514v2 Announce Type: replace Abstract: The phenomenon of linear mode connectivity (LMC) links several aspects of deep learning, including training stability under noisy stochastic gradients, the smoothness and generalization of local minima (basins), the similarity and functional diversity of sampled models, and architectural effects on data processing. In this work, we experimentally study LMC under data shifts and identify conditions that mitigate their impact. We interpret data shifts as an additional source of stochastic gradient noise, which can be reduced through small learning rates and large batch sizes. These parameters influence whether models converge to the same local minimum or to regions of the loss landscape with varying smoothness and generalization. Although models sampled via LMC tend to make similar errors more frequently than those converging to different basins, the benefit of LMC lies in balancing training efficiency against the gains achieved from larger, more diverse ensembles. Code and supplementary materials are available at https://github.com/DLR-KI/LMC. This work has been submitted to the IEEE for possible publication. Copyright may be transferred without notice, after which this version may no longer be accessible.

22.
arXiv (quant-ph) 2026-06-15

Inhomogeneous Light-Matter Coupling as a Resource for Noiseless Quantum Memories

arXiv:2605.26783v3 Announce Type: replace Abstract: Inhomogeneous ensembles of two-level systems are central to both fundamental light-matter physics and quantum-network applications. Understanding and optimizing ensemble-based quantum memories and entanglement protocols requires a unified framework that describes how to store quantum states of light as collective matter excitations and retrieve them on demand. Here we develop such a framework, the waveguide model, by mapping the dark collective modes of the ensemble onto an effective waveguide with well-defined input-output relations, valid in both the weak-excitation regime and near population inversion. This model reveals that inhomogeneous coupling – often regarded as a limitation – is instead the physical origin of noisy-echo suppression by adiabatic pulses, a key ingredient for realizing noiseless quantum memories. For entanglement generation, the same mechanism exposes a previously unexplored shortcoming of robust control pulses and leads to a new composite-pulse protocol that overcomes it. These results establish the waveguide model as a practical bridge between fundamental collective physics and quantum-network protocol design, recasting inhomogeneous coupling from an obstacle into a control knob for collective emission.

23.
arXiv (CS.CV) 2026-06-17

Human-in-the-Loop Atlas-Based 3D Asset Segmentation for Interactive Content Workflows

Segmenting 3D assets into meaningful regions remains challenging, especially when segmentation criteria are application-dependent and require user control. We present a human-in-the-loop pipeline for generating a segmented 2D parameterized atlas from a 3D model for interactive media, game, and XR content workflows. Our method first selects a compact set of rendered views using a greedy set cover strategy over sampled surface points, and then supports interactive segmentation of these views with SAM~2 and Label Studio. The resulting masks are back-projected onto the model's UV parameterization to produce a unified segmented atlas that supports downstream production tasks such as segment-wise material assignment, style transfer, and semantic labeling. We assess the pipeline through a demonstration-based technical evaluation on eight cultural heritage objects. The results show that the approach can generate usable segmented atlases across diverse geometries while revealing recurring sources of manual correction, particularly fine structures, cavities, and weak appearance boundaries.

24.
arXiv (CS.CL) 2026-06-12

When Iterative RAG Beats Ideal Evidence: A Diagnostic Study in Scientific Multi-hop Question Answering

Retrieval-Augmented Generation (RAG) extends large language models (LLMs) beyond parametric knowledge, yet it is unclear when iterative retrieval-reasoning loops meaningfully outperform static RAG, particularly in scientific domains with multi-hop reasoning, sparse domain knowledge, and heterogeneous evidence. We provide the first controlled, mechanism-level diagnostic study of whether synchronized iterative retrieval and reasoning can surpass an idealized static upper bound (Gold Context) RAG. We benchmark eleven state-of-the-art LLMs under three regimes: (i) No Context, measuring reliance on parametric memory; (ii) Gold Context, where all oracle evidence is supplied at once; and (iii) Iterative RAG, a training-free controller that alternates retrieval, hypothesis refinement, and evidence-aware stopping. Using the chemistry-focused ChemKGMultiHopQA dataset, we isolate questions requiring genuine retrieval and analyze behavior with diagnostics spanning retrieval coverage gaps, anchor-carry drop, query quality, composition fidelity, and control calibration. Across models, Iterative RAG consistently outperforms Gold Context, with gains up to 25.6 percentage points, especially for non-reasoning fine-tuned models. Staged retrieval reduces late-hop failures, mitigates context overload, and enables dynamic correction of early hypothesis drift, but remaining failure modes include incomplete hop coverage, distractor latch trajectories, early stopping miscalibration, and high composition failure rates even with perfect retrieval. Overall, staged retrieval is often more influential than the mere presence of ideal evidence; we provide practical guidance for deploying and diagnosing RAG systems in specialized scientific settings and a foundation for more reliable, controllable iterative retrieval-reasoning frameworks.

25.
medRxiv (Medicine) 2026-06-11

Corticospinal tract risk modifies motor recovery after minimally invasive surgery for intracerebral hemorrhage: a secondary analysis of MISTIE-III

Objective: Outcome after surgical hematoma evacuation for intracerebral hemorrhage (ICH) depends on hematoma location. As corticospinal tract (CST) integrity affects motor recovery after stroke, we hypothesized that CST integrity drives heterogeneity in surgical outcomes and investigated this in a secondary analysis of MISTIE-III participants. Methods: Risk of CST injury was categorized into four levels, based on the interaction between the CST, the hematoma, and perihematomal edema (PHE) on automatically segmented stability CT: no risk, PHE infiltration, hematoma infiltration, and complete interruption of the CST. Associations with outcome were tested using multivariable linear regression for motor National Institutes of Health Stroke Scale (NIHSS) at day 180 and ordinal regression for modified Rankin Scale (mRS) at day 365, introducing an interaction term between CST risk and treatment group. Results: Day 180 motor NIHSS was significantly lower for 'no risk' ({beta}:-3.77, [95% confidence interval [CI]: -5.8 to -1.70], p=0.0003) and 'PHE infiltration' ({beta}:-2.3, [95%CI: -3.5 to -1.1]; p=0.0002) vs. 'complete interruption'. Surgery was associated with lower Day 180 motor NIHSS in participants with hematoma infiltration ({beta}:-2.07, [95%CI: -3.8 to -0.4], p=0.016). Compared to complete interruption, 'no risk' (adjusted odds ratio [aOR]:0.27, [95%CI: 0.10 to 0.74], p=0.01) and 'PHE infiltration' (aOR:0.41, [95%CI: 0.23 to 0.74]; p=0.003) were associated with lower odds of unfavorable day 365 mRS. Surgery was associated with lower mRS in participants with no risk (aOR:0.23, [95%CI: 0.05 to 0.97, p=0.045). Interpretation: Increasing CST risk is associated with worse motor recovery (day 180) and disability (day 365). CST risk modifies the effect of the MISTIE-III procedure on motor recovery and disability.