Reliable medical image understanding requires models to connect clinical language and visual reasoning with pixel-level grounding. Yet medical vision-language models often lack precise localization, whereas medical segmenters typically rely on explicit target categories or precise spatial prompts. This divide is reinforced by a supervision mismatch: segmentation datasets provide precise masks but little language supervision, whereas medical vision-language data rarely pair language with dense spatial annotations. To address this gap, we present MedPixel, a unified medical pixel-language model built around a shared language--mask interface. To provide scalable supervision, we introduce MedPLG-440K, comprising approximately 440K pixel-language task samples constructed through a clinically motivated synthesis process without external LLM annotation. MedPixel is trained with joint multi-task supervised fine-tuning followed by Pixel-Level Preference Optimization, which uses ground-truth masks as offline verifiers to derive response preferences from mask quality. MedPixel supports a broad spectrum of tasks spanning explicit grounding, implicit reasoning, spatial interaction, grounded explanation, and medical VQA. Across this task spectrum, MedPixel achieves strong performance in both pixel-level prediction and response generation, together with effective zero-shot transfer to external grounding benchmarks and robustness to imperfect spatial prompts. Code and model checkpoints will be released at https://github.com/yhy-whu/Medpixel.
Haoyu Yang, Meixing Shi, Zengjie Chen et al.· 0 citations
Musculoskeletal diseases are among the leading causes of disability and drive the greatest global need for rehabilitation. Because recovery, remodelling and degeneration of bones, joints and related tissues unfold over months to years, care requires longitudinal management rather than isolated decisions. Clinicians must repeatedly integrate evolving patient evidence, medical knowledge and stage-specific functional goals, yet evidence is often fragmented across visits, departments and hospital systems, disrupting continuous, individualised management. Here we report OrthoPilot, a clinical artificial intelligence (AI) system powered by a large language model (LLM) that integrates hospital data streams with authoritative external knowledge for continuous musculoskeletal care. It autonomously retrieves real-time imaging, laboratory, pathology and order data and translates evolving patient states into evidence-based decisions from admission diagnosis through rehabilitation planning. We established a specialist-validated benchmark from real-world electronic health records (EHRs) spanning 1,000 disease codes. In a full-pathway reader study against 81 orthopaedic physicians, OrthoPilot outperformed experts with 25 years of experience in diagnostic reasoning, clinical decision-making and management planning. This advantage generalised across 60 external clinical centres, where OrthoPilot surpassed all evaluated intelligent systems. In a prospective physician decision-making study of 1,870 complex cases, OrthoPilot improved full-chain management success by 10.6%. In a randomised deployment involving 8,240 inpatients, integration into routine care increased cumulative cases per bed by 9.7% and improved patient-reported access to health information. These results move clinical AI from predicting isolated events toward executing longitudinal management across complete musculoskeletal care pathways.
Wenjie Li, Yu-Jie Zhang, Fanrui Zhang et al.· 0 citations
Agentic engineering systems have shown strong performance on general-purpose benchmarks, yet their effectiveness in enterprise resource planning (ERP) domain-specific languages (DSLs) remains underexplored. We introduce BC-Bench, a benchmark designed to evaluate agentic engineering on real-world tasks in AL, the DSL for Microsoft Dynamics 365 Business Central. BC-Bench comprises 101 manually curated tasks extracted from two Microsoft-owned production repositories, reflecting authentic ERP development workflows. Adapting the SWE-Bench methodology, we address the unique constraints of the AL ecosystem---including limited public resources and complex environment provisioning. Beyond generating functional code, BC-Bench evaluates test generation and supports multimodal problem statements where visual context is commonly present. We evaluate multiple frontier models across two agent harnesses, utilizing multi-run metrics to account for nondeterminism. In the Bug Fixing category, under our evaluated settings, between-model differences in resolution rate are larger than differences between the two evaluated agent harnesses, and improvements reported on general-purpose benchmarks do not consistently transfer to AL. These results highlight the need for domain-specific evaluation.
Results show that the evaluation framework captures execution-relevant requirements for autonomous wet-lab automation, and that ProtoPilot can meet them by converting protocol and code generation into validated execution and feedback-guided revision.
Yankai Jiang, Wei Tang, Haoran Sun et al.· arXiv.org· 0 citations