Cardiovascular diseases remain a major contributor to the global burden of healthcare, highlighting the importance of accurate and scalable methods for cardiac monitoring. Cardiac biosignals, most notably electrocardiograms (ECG) and photoplethysmograms, are essential for diagnosing, preventing and managing cardiovascular conditions across clinical and home settings. However, their acquisition varies substantially across scenarios and devices, whereas existing analytical models often rely on homogeneous datasets and static bespoke models, limiting their robustness and generalizability in diverse real-world contexts. Here we present a cardiac sensing foundation model (CSFM) that leverages transformer architectures and a generative masked pretraining strategy to learn unified representations from heterogeneous health records. CSFM is pretrained on a multimodal integration of data from various large-scale datasets, comprising cardiac signals from approximately 1.7 million individuals and their corresponding clinical or machine-generated text reports. The embeddings derived from CSFM act as effective, transferable features across diverse cardiac sensing scenarios, supporting a seamless adaptation to the varied input configurations and sensor modalities. Extensive evaluations across diagnostic tasks, demographic recognition, vital sign measurement, clinical outcome prediction and ECG question answering demonstrate that CSFM consistently outperforms traditional one-modal-one-task approaches. Notably, CSFM maintains favourable performance across both 12-lead and single-lead ECGs, as well as in scenarios involving ECG only, photoplethysmogram only or a combination of both. This highlights its potential as a versatile and scalable foundation for comprehensive cardiac monitoring.

The clinical translation of miniature medical devices (MMDs) for minimally invasive surgery promises transformative advances in biomedical engineering, offering enhanced precision, reduced patient trauma and faster recovery times. However, their effective deployment in complex anatomies under real-time X-ray guidance-a widely used surgical imaging modality-presents challenges such as low imaging quality and difficulties of spatial MMD control. Manual identification and operation are labour intensive and error prone. Meanwhile, deep learning-based automation is limited by the scarcity of annotated X-ray datasets of MMDs owing to costly data collection, laborious annotation and privacy constraints. Here we introduce MicroSyn-X, a framework for training computer vision models to enable robotic teleoperation of MMDs using synthesized high-fidelity, pixel-accurate, auto-labelled and domain-randomized X-ray images, eliminating manual data curation. Integrating MicroSyn-X into a teleoperated robotic system enables real-time localization and navigation of magnetic soft and magnetic liquid MMDs within both ex vivo and dynamic in vivo environments, demonstrating robustness under challenging imaging conditions of low contrast, high noise and occlusion. With these promises, we open source the X-ray MMD dataset to enable benchmarking. Addressing data scarcity and enabling real-time robotic navigation, this work advances MMD-assisted minimally invasive surgery towards next-generation precision interventions.

Abstract Deep learning models are usually trained with stochastic gradient descent-based algorithms, but these optimizers face inherent limitations, such as slow convergence and stringent assumptions for convergence. In particular, data heterogeneity arising from distributed settings poses significant challenges to their theoretical and numerical performance. Here we develop an algorithm called PISA (preconditioned inexact stochastic alternating direction method of multipliers). Grounded in rigorous theoretical guarantees, the algorithm converges under the sole assumption of Lipschitz continuity of the gradient on a bounded region, thereby removing the need for other conditions commonly imposed by stochastic methods. This capability enables the proposed algorithm to tackle the challenge of data heterogeneity effectively. Moreover, the algorithmic architecture enables scalable parallel computing and supports various preconditions, such as second-order information, second moment and orthogonalized momentum by Newton–Schulz iterations. Incorporating the last two preconditions in PISA yields two computationally efficient variants: SISA and NSISA. Comprehensive experimental evaluations for training or fine-tuning diverse deep models, including vision models, large language models, reinforcement learning models, generative adversarial networks and recurrent neural networks, demonstrate superior numerical performance of SISA and NSISA compared with various state-of-the-art optimizers.