Medical large language models and agents show strong single-encounter question answering and evidence interpretation but struggle to accumulate and govern experience across encounters. We present HealthJev, an open-source agent separating shared safety rules and medical knowledge from a private longitudinal memory and distilling lessons from completed cases. To filter out erroneous lessons before they affect future behaviour, we self-train JevGate, a lightweight System-One model that decides which lessons enter memory; each decision takes a median of 86 milliseconds and about 1,000 input tokens, sustaining experience accumulation at negligible run-time overhead. On a longitudinal benchmark of 90-day simulated daily interactions for 20 users built from real MIMIC-IV trajectories, HealthJev outperformed a memory-free ReAct agent and three memory-augmented frameworks, with all paired comparisons significant. Across six tasks spanning clinical records, medical imaging, genomics and clinical text, HealthJev improved every task with a mean gain of 13.3 percentage points over the base condition, surpassing all baselines. The frozen library transferred to six further backbones with macro-average gains of 6.8 to 15.1 percentage points, and one task's library brought gains on other tasks. These results indicate that governed, self-evolving memory supports longitudinal personal health management beyond single encounters. HealthJev is publicly available at https://github.com/HC-Guo/Self-Evolving_HealthJev.
Zhen Yu, Yang Liu, Jianfeng Feng, Xiahai Zhuang, Qingchao Chen
Foundation models hold promise for generalizable analysis of structural brain magnetic resonance imaging (MRI) scans across diverse populations and imaging conditions. However, existing models typically rely on centralized pretraining using data pooled across cohorts, which is constrained by privacy and data-governance requirements. Moreover, larger cohorts can dominate optimization, underutilizing anatomical information from smaller cohorts and limiting generalization. Here we present BrainFedFM, a structural brain MRI foundation model federatively pretrained on 164,707 three-dimensional scans drawn from diverse real-world data distributions and organized across 42 federated sites. BrainFedFM uses dual-priority federated pretraining, in which spatial-priority masking emphasizes informative anatomical regions during local training, while site-priority aggregation adaptively weights contributions during global aggregation. Across 20 downstream datasets spanning 17 classification, regression and segmentation tasks, BrainFedFM achieved the state-of-the-art performance across seven foundation models, including four centralized models, while showing consistent advantages in classification and regression tasks and strong robustness under underrepresented populations and challenging imaging conditions. These findings demonstrate the generalizability of BrainFedFM and highlight federated pretraining as a practical strategy for developing neuroimaging foundation models from distributed data without pooling raw images.
Large language models (LLMs) are advancing in multimodal understanding and reasoning, accelerating medical model development. Traditional Chinese medicine (TCM) uses evidence from the four examinations to determine disease location and nature, differentiate syndromes and guide treatment. This diagnostic process constitutes a complete chain of reasoning. We present Fu-TCM, a multimodal TCM LLM trained on data retained after cleaning and filtering an initial collection of approximately 7.12 million examples derived from classical texts, textbooks, medical images, clinical cases and publicly available datasets. The model was further optimized using Bianzheng-Grounded Policy Optimization (BGPO), which explicitly targets syndrome differentiation through rewards for response format, intermediate TCM reasoning fields and final syndrome predictions. Fu-TCM-27B led all six benchmarks spanning TCM reasoning, text and vision, achieving a macro-average accuracy of 81.01% and surpassing the strongest reference model with complete results across all six benchmarks by 7.13 percentage points. Its largest margin was 11.90 points on Fu-bianzheng. Case-level analyses further showed a positive association between intermediate-field accuracy and final syndrome-selection accuracy in most evaluated models. These findings suggest that TCM syndrome differentiation may be computationally learnable and that structured reasoning supervision can improve performance across TCM tasks.