We explore a lightweight framework that adapts frozen large language models to analyze longitudinal clinical data. The approach integrates patient history and context within the language model space to generate accurate forecasts without model fine-tuning. Applied to neuropsychological assessments, it achieves accurate and reliable performance even with minimal training data, showing promise for early-stage Alzheimer's monitoring.

Accurate and interpretable survival analysis remains a core challenge in oncology. With growing multimodal data and the clinical need for transparent models to support validation and trust, this challenge increases in complexity. We propose an interpretable multimodal AI framework to automate survival analysis by integrating clinical variables and computed tomography imaging. Our MultiFIX-based framework uses deep learning to infer survival-relevant features that are further explained: imaging features are interpreted via Grad-CAM, while clinical variables are modeled as symbolic expressions through genetic programming. Risk estimation employs a transparent Cox regression, enabling stratification into groups with distinct survival outcomes. Using the open-source RADCURE dataset for head and neck cancer, MultiFIX achieves a C-index of 0.838 (prediction) and 0.826 (stratification), outperforming the clinical and academic baseline approaches and aligning with known prognostic markers. These results highlight the promise of interpretable multimodal AI for precision oncology with MultiFIX.

Accurate prognosis of non-small cell lung cancer (NSCLC) patients undergoing immunotherapy is essential for personalized treatment planning, enabling informed patient decisions, and improving both treatment outcomes and quality of life. However, the lack of large, relevant datasets and effective multi-modal feature fusion strategies pose significant challenges in this domain. To address these challenges, we present a large-scale dataset and introduce a novel framework for multi-modal feature fusion aimed at enhancing the accuracy of survival prediction. The dataset comprises 3D CT images and corresponding clinical records from NSCLC patients treated with immune checkpoint inhibitors (ICI), along with progression-free survival (PFS) and overall survival (OS) data. We further propose a cross-modality masked learning approach for medical feature fusion, consisting of two distinct branches, each tailored to its respective modality: a Slice-Depth Transformer for extracting 3D features from CT images and a graph-based Transformer for learning node features and relationships among clinical variables in tabular data. The fusion process is guided by a masked modality learning strategy, wherein the model utilizes the intact modality to reconstruct missing components. This mechanism improves the integration of modality-specific features, fostering more effective inter-modality relationships and feature interactions. Our approach demonstrates superior performance in multi-modal integration for NSCLC survival prediction, surpassing existing methods and setting a new benchmark for prognostic models in this context.

In vitro fertilization-embryo transfer (IVF-ET) stands as one of the most prevalent treatments for infertility. During an IVF-ET cycle, the time interval between trigger shot and oocyte pickup (OPU) is a pivotal period for follicular maturation, which determines mature oocytes yields and impacts the success of subsequent procedures. However, accurately predicting this interval is severely hindered by the variability of clinicians'experience that often leads to suboptimal oocyte retrieval rate. To address this challenge, we propose ILETIA, the first machine learning-based method that could predict the optimal trigger-OPU interval for patients receiving progestin-primed ovarian stimulation (PPOS) protocol. Specifically, ILETIA leverages a Transformer to learn representations from clinical tabular data, and then employs gradient-boosted trees for interval prediction. For model training and evaluating, we compiled a dataset PPOS-DS of nearly ten thousand patients receiving PPOS protocol, the largest such dataset to our knowledge. Experimental results demonstrate that our method achieves strong performance (AUROC = 0.889), outperforming both clinicians and other widely used computational models. Moreover, ILETIA also supports premature ovulation risk prediction in a specific OPU time (AUROC = 0.838). Collectively, by enabling more precise and individualized decisions, ILETIA has the potential to improve clinical outcomes and lay the foundation for future IVF-ET research.

Breast cancer remains a significant global health challenge, with prognosis and treatment decisions largely dependent on clinical characteristics. Accurate prediction of patient outcomes is crucial for personalized treatment strategies. This study employs survival analysis techniques, including Cox proportional hazards and parametric survival models, to enhance the prediction of the log odds of survival in breast cancer patients. Clinical variables such as tumor size, hormone receptor status, HER2 status, age, and treatment history were analyzed to assess their impact on survival outcomes. Data from 1557 breast cancer patients were obtained from a publicly available dataset provided by the University College Hospital, Ibadan, Nigeria. This dataset was preprocessed and analyzed using both univariate and multivariate approaches to evaluate survival outcomes. Kaplan-Meier survival curves were generated to visualize survival probabilities, while the Cox proportional hazards model identified key risk factors influencing mortality. The results showed that older age, larger tumor size, and HER2-positive status were significantly associated with an increased risk of mortality. In contrast, estrogen receptor positivity and breast-conserving surgery were linked to better survival outcomes. The findings suggest that integrating these clinical variables into predictive models improvesthe accuracy of survival predictions, helping to identify high-risk patients who may benefit from more aggressive interventions. This study demonstrates the potential of survival analysis in optimizing breast cancer care, particularly in resource-limited settings. Future research should focus on integrating genomic data and real-world clinical outcomes to further refine these models.

Machine learning for early syndrome diagnosis aims to solve the intricate task of predicting a ground truth label that most often is the outcome (effect) of a medical consensus definition applied to observed clinical measurements (causes), given clinical measurements observed several hours before. Instead of focusing on the prediction of the future effect, we propose to directly predict the causes via time series forecasting (TSF) of clinical variables and determine the effect by applying the gold standard consensus definition to the forecasted values. This method has the invaluable advantage of being straightforwardly interpretable to clinical practitioners, and because model training does not rely on a particular label anymore, the forecasted data can be used to predict any consensus-based label. We exemplify our method by means of long-term TSF with Transformer models, with a focus on accurate prediction of sparse clinical variables involved in the SOFA-based Sepsis-3 definition and the new Simplified Acute Physiology Score (SAPS-II) definition. Our experiments are conducted on two datasets and show that contrary to recent proposals which advocate set function encoders for time series and direct multi-step decoders, best results are achieved by a combination of standard dense encoders with iterative multi-step decoders. The key for success of iterative multi-step decoding can be attributed to its ability to capture cross-variate dependencies and to a student forcing training strategy that teaches the model to rely on its own previous time step predictions for the next time step prediction.

Renal cell carcinoma represents a significant global health challenge with a low survival rate. This research aimed to devise a comprehensive deep-learning model capable of predicting survival probabilities in patients with renal cell carcinoma by integrating CT imaging and clinical data and addressing the limitations observed in prior studies. The aim is to facilitate the identification of patients requiring urgent treatment. The proposed framework comprises three modules: a 3D image feature extractor, clinical variable selection, and survival prediction. The feature extractor module, based on the 3D CNN architecture, predicts the ISUP grade of renal cell carcinoma tumors linked to mortality rates from CT images. A selection of clinical variables is systematically chosen using the Spearman score and random forest importance score as criteria. A deep learning-based network, trained with discrete LogisticHazard-based loss, performs the survival prediction. Nine distinct experiments are performed, with varying numbers of clinical variables determined by different thresholds of the Spearman and importance scores. Our findings demonstrate that the proposed strategy surpasses the current literature on renal cancer prognosis based on CT scans and clinical factors. The best-performing experiment yielded a concordance index of 0.84 and an area under the curve value of 0.8 on the test cohort, which suggests strong predictive power. The multimodal deep-learning approach developed in this study shows promising results in estimating survival probabilities for renal cell carcinoma patients using CT imaging and clinical data. This may have potential implications in identifying patients who require urgent treatment, potentially improving patient outcomes. The code created for this project is available for the public on: \href{https://github.com/Balasingham-AI-Group/Survival_CTplusClinical}{GitHub}

Deep-learning-based clinical decision support using structured electronic health records (EHR) has been an active research area for predicting risks of mortality and diseases. Meanwhile, large amounts of narrative clinical notes provide complementary information, but are often not integrated into predictive models. In this paper, we provide a novel multimodal transformer to fuse clinical notes and structured EHR data for better prediction of in-hospital mortality. To improve interpretability, we propose an integrated gradients (IG) method to select important words in clinical notes and discover the critical structured EHR features with Shapley values. These important words and clinical features are visualized to assist with interpretation of the prediction outcomes. We also investigate the significance of domain adaptive pretraining and task adaptive fine-tuning on the Clinical BERT, which is used to learn the representations of clinical notes. Experiments demonstrated that our model outperforms other methods (AUCPR: 0.538, AUCROC: 0.877, F1:0.490).

Abstract: The coronavirus pandemic has been going on since the year 2019, and the trend is still not abating. Therefore, it is particularly important to classify medical CT scans to assist in medical diagnosis. At present, Supervised Deep Learning algorithms have made a great success in the classification task of medical CT scans, but medical image datasets often require professional image annotation, and many research datasets are not publicly available. To solve this problem, this paper is inspired by the self-supervised learning algorithm MAE and uses the MAE model pre-trained on ImageNet to perform transfer learning on CT Scans dataset. This method improves the generalization performance of the model and avoids the risk of overfitting on small datasets.

FDA has been promoting enrollment practices that could enhance the diversity of clinical trial populations, through broadening eligibility criteria. However, how to broaden eligibility remains a significant challenge. We propose an AI approach to Cohort Optimization (AICO) through transformer-based natural language processing of the eligibility criteria and evaluation of the criteria using real-world data. The method can extract common eligibility criteria variables from a large set of relevant trials and measure the generalizability of trial designs to real-world patients. It overcomes the scalability limits of existing manual methods and enables rapid simulation of eligibility criteria design for a disease of interest. A case study on breast cancer trial design demonstrates the utility of the method in improving trial generalizability.