Medical Large Vision-Language Models (Med-LVLMs) often exhibit suboptimal attention distribution on visual inputs, leading to hallucinated or inaccurate outputs. Existing methods primarily rely on inference-time interventions, which are limited in attention adaptation or require additional supervision. To address this, we propose A³Tune, a novel fine-tuning framework for Automatic Attention Alignment Tuning. ATune leverages zero-shot weak labels from SAM, refines them into prompt-aware labels using BioMedCLIP, and then selectively modifies visually-critical attention heads to improve alignment while minimizing interference. Additionally, we introduce a A³MoE module, enabling adaptive parameter selection for attention tuning across diverse prompts and images. Extensive experiments on medical VQA and report generation benchmarks show that A³Tune outperforms state-of-the-art baselines, achieving enhanced attention distributions and performance in Med-LVLMs.

This paper delves into a novel backdoor attack scenario, aiming to uncover potential security risks associated with Multimodal Large Language Models (MLLMs) during multi-round open-ended conversations with users. In the practical use of MLLMs, users have full control over the interaction process with the model, such as using their own collected photos and posing arbitrary open-ended questions. Traditional backdoor attacks that rely on adding external triggers are less applicable. To this end, we introduce a new shadow-activated backdoor attacking paradigm in this paper, wherein attacks implicitly inject malicious content into the responses of MLLMs when the responses explicitly relate to the shadowed object, i.e., without any triggers. To facilitate the shadow-activated backdoor attack, we present a novel framework named BadMLLM to achieve the desired behaviors by constructing a poisoned dataset using GPT-4 Vision and implementing an attention-regularized tuning strategy to address the semantic discontinuity between the original response and the inserted promotion. Extensive experimental results conducted on five MLLMs, three objects, and two types of promotion slogans have demonstrated impressive performance in achieving both efficacy and utility goals, thereby highlighting the significant potential risks concealed within MLLMs.

Parameter Efficient Fine-Tuning (PEFT) offers an efficient solution for fine-tuning large pretrained language models for downstream tasks. However, most PEFT strategies are manually designed, often resulting in suboptimal performance. Recent automatic PEFT approaches aim to address this but face challenges such as search space entanglement, inefficiency, and lack of integration between parameter budgets and search processes. To overcome these issues, we introduce a novel Budget-guided Iterative search strategy for automatic PEFT (BIPEFT), significantly enhancing search efficiency. BIPEFT employs a new iterative search strategy to disentangle the binary module and rank dimension search spaces. Additionally, we design early selection strategies based on parameter budgets, accelerating the learning process by gradually removing unimportant modules and fixing rank dimensions. Extensive experiments on public benchmarks demonstrate the superior performance of BIPEFT in achieving efficient and effective PEFT for downstream tasks with a low parameter budget.

Automatic International Classification of Diseases (ICD) coding plays a crucial role in the extraction of relevant information from clinical notes for proper recording and billing. One of the most important directions for boosting the performance of automatic ICD coding is modeling ICD code relations. However, current methods insufficiently model the intricate relationships among ICD codes and often overlook the importance of context in clinical notes. In this paper, we propose a novel approach, a contextualized and flexible framework, to enhance the learning of ICD code representations. Our approach, unlike existing methods, employs a dependent learning paradigm that considers the context of clinical notes in modeling all possible code relations. We evaluate our approach on six public ICD coding datasets and the experimental results demonstrate the effectiveness of our approach compared to state-of-the-art baselines.