286 p. : il; 21 cm

Background: Large language models have demonstrated strong performance on general medical examinations, but subspecialty clinical reasoning remains challenging due to rapidly evolving guidelines and nuanced evidence hierarchies. Methods: We evaluated January Mirror, an evidence-grounded clinical reasoning system, against frontier LLMs (GPT-5, GPT-5.2, Gemini-3-Pro) on a 120-question endocrinology board-style examination. Mirror integrates a curated endocrinology and cardiometabolic evidence corpus with a structured reasoning architecture to generate evidence-linked outputs. Mirror operated under a closed-evidence constraint without external retrieval. Comparator LLMs had real-time web access to guidelines and primary literature. Results: Mirror achieved 87.5% accuracy (105/120; 95% CI: 80.4-92.3%), exceeding a human reference of 62.3% and frontier LLMs including GPT-5.2 (74.6%), GPT-5 (74.0%), and Gemini-3-Pro (69.8%). On the 30 most difficult questions (human accuracy less than 50%), Mirror achieved 76.7% accuracy. Top-2 accuracy was 92.5% for Mirror versus 85.25% for GPT-5.2. Conclusions: Mirror provided evidence traceability: 74.2% of outputs cited at least one guideline-tier source, with 100% citation accuracy on manual verification. Curated evidence with explicit provenance can outperform unconstrained web retrieval for subspecialty clinical reasoning and supports auditability for clinical deployment.

16cm23cm, 244hlm:illu

Small open-source medical large language models (LLMs) offer promising opportunities for low-resource deployment and broader accessibility. However, their evaluation is often limited to accuracy on medical multiple choice question (MCQ) benchmarks, and lacks evaluation of consistency, robustness, or reasoning behavior. We use MCQ coupled to human evaluation and clinical review to assess six small open-source medical LLMs (HuatuoGPT-o1 (Chen 2024), Diabetica-7B, Diabetica-o1 (Wei 2024), Meditron3-8B (Sallinen2025), MedFound-7B (Liu 2025), and ClinicaGPT-base-zh (Wang 2023)) in pediatric endocrinology. In deterministic settings, we examine the effect of prompt variation on models' output and self-assessment bias. In stochastic settings, we evaluate output variability and investigate the relationship between consistency and correctness. HuatuoGPT-o1-8B achieved the highest performance. The results show that high consistency across the model response is not an indicator of correctness, although HuatuoGPT-o1-8B showed the highest consistency rate. When tasked with selecting correct reasoning, both HuatuoGPT-o1-8B and Diabetica-o1 exhibit self-assessment bias and dependency on the order of the candidate explanations. Expert review of incorrect reasoning rationales identified a mix of clinically acceptable responses and clinical oversight. We further show that system-level perturbations, such as differences in CUDA builds, can yield statistically significant shifts in model output despite stable accuracy. This work demonstrates that small, semantically negligible prompt perturbations lead to divergent outputs, raising concerns about reproducibility of LLM-based evaluations and highlights the output variability under different stochastic regimes, emphasizing the need of a broader diagnostic framework to understand potential pitfalls in real-world clinical decision support scenarios.

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Identifying type 2 diabetes mellitus can be challenging, particularly for primary care physicians. Clinical decision support systems incorporating artificial intelligence (AI-CDSS) can assist medical professionals in diagnosing type 2 diabetes with high accuracy. This study aimed to assess an AI-CDSS specifically developed for the diagnosis of type 2 diabetes by employing a hybrid approach that integrates expert-driven insights with machine learning techniques. The AI-CDSS was developed (training dataset: n = 650) and tested (test dataset: n = 648) using a dataset of 1298 patients with and without type 2 diabetes. To generate predictions, the algorithm utilized key features such as body mass index, plasma fasting glucose, and hemoglobin A1C. Furthermore, a clinical pilot study involving 105 patients was conducted to assess the diagnostic accuracy of the system in comparison to non-endocrinology specialists. The AI-CDSS showed a high degree of accuracy, with 99.8% accuracy in predicting diabetes, 99.3% in predicting prediabetes, 99.2% in identifying at-risk individuals, and 98.8% in predicting no diabetes. The test dataset revealed a 98.8% agreement between endocrinology specialists and the AI-CDSS. Type 2 diabetes was identified in 45% of 105 individuals in the pilot study. Compared with diabetes specialists, the AI-CDSS scored a 98.5% concordance rate, greatly exceeding that of nonendocrinology specialists, who had an 85% agreement rate. These findings indicate that the AI-CDSS has the potential to be a useful tool for accurately identifying type 2 diabetes, especially in situations in which diabetes specialists are not readily available.

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Convolutional Neural Networks play a key role in bone age assessment for investigating endocrinology, genetic, and growth disorders under various modalities and body regions. However, no researcher has tackled bone age progression/regression despite its valuable potential applications: bone-related disease diagnosis, clinical knowledge acquisition, and museum education. Therefore, we propose Bone Age Progression Generative Adversarial Network (BAPGAN) to progress/regress both femur/phalange X-ray images while preserving identity and realism. We exhaustively confirm the BAPGAN's clinical potential via Frechet Inception Distance, Visual Turing Test by two expert orthopedists, and t-Distributed Stochastic Neighbor Embedding.

This chapter describes the relationship between hormonal activity and metabolism, as well as the disorders that are associated with endocrine metabolism dysfunction. It discusses hormonal causes, epidemiology, physiology, diagnosis, and management for hypoglycaemia. It describes obesity and eating disorders, such as anorexia nervosa, in terms of hypothalamo-pituitary pathway dysfunction, associated hormones, nutritional status, imaging, and management. The chapter describes hormones’ role in sport performance, and methods of doping detection for hormones such as anabolic steroids, growth hormone, and erythropoietin. It also relates the symptoms of endocrine-related disorders, such as excessive flushing, sweating, and excessive tiredness, with possible causes in endocrine dysfunction.

This book aims to provide readers with a general as well as an advanced overview of the key trends in endocrine disorders. While covering a variety of topics ranging from thyroid carcinogenesis and pituitary adenomas to adrenal tumors and metabolic bone disease, this book also focuses on more specific issues not yet fully elucidated (e.g. the molecular pathways involved in thyrotropin beta gene regulation or monogenic phosphate balance disorders). Readers of different fields and background will have the opportunity to update their knowledge and more importantly to clarify areas of uncertainty and controversies in several topics of endocrine disorders

The field of women's endocrinology has trailed behind data-driven medical solutions, largely due to concerns over the privacy of patient data. Valuable datapoints about hormone levels or menstrual cycling could expose patients who suffer from comorbidities or terminate a pregnancy, violating their privacy. We explore the application of Federated Learning (FL) to predict the optimal drug for patients with polycystic ovary syndrome (PCOS). PCOS is a serious hormonal disorder impacting millions of women worldwide, yet it's poorly understood and its research is stunted by a lack of patient data. We demonstrate that a variety of FL approaches succeed on a synthetic PCOS patient dataset. Our proposed FL models are a tool to access massive quantities of diverse data and identify the most effective treatment option while providing PCOS patients with privacy guarantees.

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The paper deals with the estimation of a signal model in the form of the output of a continuous linear time-invariant system driven by a sequence of instantaneous impulses, i.e. an impulsive time series. This modeling concept arises in, e.g., endocrinology when episodic hormone secretion events and elimination rates are simultaneously estimated from sampled hormone concentration measurements. The pulsatile secretion is modeled with a train of Dirac impulses constituting the input to a linear plant, which represents stimulated hormone secretion and elimination. A previously developed one-step estimation algorithm effectively resolves the trade-off between data fit and impulsive input sparsity. The present work improves the algorithm so that it requires less manual tuning and produces more accurate results through the use of an information criterion. It is also extended to handle outliers and unknown basal levels that are commonly recognized issues in biomedical data. The algorithm performance is evaluated both theoretically and experimentally on synthetic and clinical data.

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Large Language Models (LLMs) constitute a breakthrough state-of-the-art Artificial Intelligence (AI) technology which is rapidly evolving and promises to aid in medical diagnosis either by assisting doctors or by simulating a doctor's workflow in more advanced and complex implementations. In this technical paper, we outline Cognitive Network Evaluation Toolkit for Medical Domains (COGNET-MD), which constitutes a novel benchmark for LLM evaluation in the medical domain. Specifically, we propose a scoring-framework with increased difficulty to assess the ability of LLMs in interpreting medical text. The proposed framework is accompanied with a database of Multiple Choice Quizzes (MCQs). To ensure alignment with current medical trends and enhance safety, usefulness, and applicability, these MCQs have been constructed in collaboration with several associated medical experts in various medical domains and are characterized by varying degrees of difficulty. The current (first) version of the database includes the medical domains of Psychiatry, Dentistry, Pulmonology, Dermatology and Endocrinology, but it will be continuously extended and expanded to include additional medical domains.

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Often linear regression is used to perform mediation analysis. However, in many instances, the underlying relationships may not be linear, as in the case of placental-fetal hormones and fetal development. Although, the exact functional form of the relationship may be unknown, one may hypothesize the general shape of the relationship. For these reasons, we develop a novel shape-restricted inference-based methodology for conducting mediation analysis. This work is motivated by an application in fetal endocrinology where researchers are interested in understanding the effects of pesticide application on birth weight, with human chorionic gonadotropin (hCG) as the mediator. We assume a practically plausible set of nonlinear effects of hCG on the birth weight and a linear relationship between pesticide exposure and hCG, with both exposure-outcome and exposure-mediator models being linear in the confounding factors. Using the proposed methodology on a population-level prenatal screening program data, with hCG as the mediator, we discovered that, while the natural direct effects suggest a positive association between pesticide application and birth weight, the natural indirect effects were negative.

Adrenocortical cancer (ACС) is a rare malignant endocrine tumor from cells of the adrenal cortex with an incidence of 0.7–2 cases per 1 million population per year. Due to difficulties in diagnosis, ACС is detected already at the stage of metastasis, which limits the possibilities of surgical intervention and implies an unfavorable prognosis. The composition of the tumor microenvironment is crucial for the development of strategies for immunotherapeutic treatment of cancer. One component of the tumor microenvironment is immune cells, the presence of which is often associated with a better prognosis for patients. The purpose of this review is to describe the current possibilities for predicting the course and treatment of patients with ACC, as well as to focus on the latest published data on the immune microenvironment of the tumor in order to give some ideas about the prospects for its use for personalized patient management.

Artificial intelligence (AI) in medical device software (MDSW) represents a transformative clinical technology, attracting increasing attention within both the medical community and the regulators. In this study, we leverage a data-driven approach to automatically extract and analyze AI-enabled medical devices (AIMD) from the National Medical Products Administration (NMPA) regulatory database. The continued increase in publicly available regulatory data requires scalable methods for analysis. Automation of regulatory information screening is essential to create reproducible insights that can be quickly updated in an ever changing medical device landscape. More than 4 million entries were assessed, identifying 2,174 MDSW registrations, including 531 standalone applications and 1,643 integrated within medical devices, of which 43 were AI-enabled. It was shown that the leading medical specialties utilizing AIMD include respiratory (20.5%), ophthalmology/endocrinology (12.8%), and orthopedics (10.3%). This approach greatly improves the speed of data extracting providing a greater ability to compare and contrast. This study provides the first extensive, data-driven exploration of AIMD in China, showcasing the potential of automated regulatory data analysis in understanding and advancing the landscape of AI in medical technology.

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With the advancements in computer technology, there is a rapid development of intelligent systems to understand the complex relationships in data to make predictions and classifications. Artificail Intelligence based framework is rapidly revolutionizing the healthcare industry. These intelligent systems are built with machine learning and deep learning based robust models for early diagnosis of diseases and demonstrates a promising supplementary diagnostic method for frontline clinical doctors and surgeons. Machine Learning and Deep Learning based systems can streamline and simplify the steps involved in diagnosis of diseases from clinical and image-based data, thus providing significant clinician support and workflow optimization. They mimic human cognition and are even capable of diagnosing diseases that cannot be diagnosed with human intelligence. This paper focuses on the survey of machine learning and deep learning applications in across 16 medical specialties, namely Dental medicine, Haematology, Surgery, Cardiology, Pulmonology, Orthopedics, Radiology, Oncology, General medicine, Psychiatry, Endocrinology, Neurology, Dermatology, Hepatology, Nephrology, Ophthalmology, and Drug discovery. In this paper along with the survey, we discuss the advancements of medical practices with these systems and also the impact of these systems on medical professionals.