arXiv:2603.08321v1 Announce Type: new Abstract: Large language models (LLMs) show significant potential for clinical decision support (CDS), yet their black-box nature -- characterized by untraceable reasoning and probabilistic hallucinations -- poses severe challenges in acupuncture, a field demanding rigorous interpretability and safety. To address this, we propose CORE-Acu, a neuro-symbolic framework for acupuncture clinical decision support that integrates Structured Chain-of-Thought (S-CoT) with knowledge graph (KG) safety verification. First, we construct the first acupuncture Structured Reasoning Trace dataset and a schema-constrained fine-tuning framework. By enforcing an explicit causal chain from pattern identification to treatment principles, treatment plans, and acupoint selection, we transform implicit Traditional Chinese Medicine (TCM) reasoning into interpretable generation constraints, mitigating the opacity of LLM-based CDS. Furthermore, we construct a TCM safety knowledge graph and establish a ``Generate--Verify--Revise'' closed-loop inference system based on a Symbolic Veto Mechanism, employing deterministic rules to intercept hallucinations and enforce hard safety boundaries. Finally, we introduce the Lexicon-Matched Entity-Reweighted Loss (LMERL), which corrects terminology drift caused by the frequency--importance mismatch in general optimization by adaptively amplifying gradient contributions of high-risk entities during fine-tuning. Experiments on 1,000 held-out cases demonstrate CORE-Acu's superior entity fidelity and reasoning quality. Crucially, CORE-Acu achieved 0/1,000 observed safety violations (95\% CI: 0--0.37\%), whereas GPT-4o exhibited an 8.5\% violation rate under identical rules. These results establish CORE-Acu as a robust neuro-symbolic framework for acupuncture clinical decision support, guaranteeing both reasoning auditability and strict safety compliance.

arXiv:2603.04191v1 Announce Type: new Abstract: Large Language Models (LLMs) are increasingly serving as personal assistants, where users share complex and diverse preferences over extended interactions. However, assessing how well LLMs can follow these preferences in realistic, long-term situations remains underexplored. This work proposes RealPref, a benchmark for evaluating realistic preference-following in personalized user-LLM interactions. RealPref features 100 user profiles, 1300 personalized preferences, four types of preference expression (ranging from explicit to implicit), and long-horizon interaction histories. It includes three types of test questions (multiple-choice, true-or-false, and open-ended), with detailed rubrics for LLM-as-a-judge evaluation. Results indicate that LLM performance significantly drops as context length grows and preference expression becomes more implicit, and that generalizing user preference understanding to unseen scenarios poses further challenges. RealPref and these findings provide a foundation for future research to develop user-aware LLM assistants that better adapt to individual needs. The code is available at https://github.com/GG14127/RealPref.