Targeting cell death in NAFLD: mechanisms and targeted therapies.

Nonalcoholic fatty liver disease (NAFLD) is a group of chronic liver disease which ranges from simple steatosis (NAFL) to non-alcoholic steatohepatitis (NASH) and is characterized by lipid accumulation, inflammation activation, fibrosis, and cell death. To date, a number of preclinical studies or clinical trials associated with therapies targeting fatty acid metabolism, inflammatory factors and liver fibrosis are performed to develop effective drugs for NAFLD/NASH. However, few therapies are cell death signaling-targeted even though the various cell death modes are present throughout the progression of NAFLD/NASH. Here we summarize the four types of cell death including apoptosis, necroptosis, pyroptosis, and ferroptosis in the NAFLD and the underlying molecular mechanisms by which the pathogenic factors such as free fatty acid and LPS induce cell death in the pathogenesis of NAFLD. In addition, we also review the effects of cell death-targeted therapies on NAFLD. In summary, our review provides comprehensive insight into the roles of various cell death modes in the progression of NAFLD, which we hope will open new avenues for therapeutic intervention.

Cascade-responsive size/charge bidirectional-tunable nanodelivery penetrates pancreatic tumor barriers.

The pancreatic tumor microenvironment presents multiple obstacles for polymer-based drug delivery systems, limiting tumor penetration and treatment efficacy. Here, we engineer a hyaluronidase/reactive oxygen species cascade-responsive size/charge bidirectional-tunable nanodelivery (btND, G/R@TKP/HA) for co-delivery of gemcitabine and KRAS siRNA, capable of navigating through tumor barriers and augmenting anticancer efficiency. When penetrating the tumor stroma barrier, the hyaluronic acid shell of the nanodelivery undergoes degradation by hyaluronidase in an extracellular matrix, triggering size tuning from large to small and charge tuning from negative to positive, thereby facilitating deeper penetration and cellular internalization. After endocytosis, the nanodelivery protonizes in the endo/lysosome, prompting rapid endo/lysosomal escape, effectively overcoming the lysosome barrier. Intracellular ROS further disrupt the nanodelivery, inducing its size tuning again from small to large and a positive charge decrease for high tumor retention and controlled drug release. The btND shows remarkable antitumor activity in pancreatic cancer mouse models, highlighting the efficacy of this approach in penetrating tumor barriers and enhancing anticancer outcomes.

Exploration on cold adaptation of Antarctic lichen via detection of positive selection genes.

Lichen as mutualistic symbiosis is the dominant organism in various extreme terrestrial environment on Earth, however, the mechanisms of their adaptation to extreme habitats have not been fully elucidated. In this study, we chose the Antarctic dominant lichen species Usnea aurantiacoatra to generate a high-quality genome, carried out phylogenetic analysis using maximum likelihood and identify genes under positive selection. We performed functional enrichment analysis on the positively selected genes (PSGs) and found that most of the PSGs focused on transmembrane transporter activity and vacuole components. This suggest that the genes related to energy storage and transport in Antarctic U. aurantiacoatra were affected by environmental pressure. Inside of the 86 PSGs screened, two protein interaction networks were identified, which were RNA helicase related proteins and regulator of G-protein signaling related proteins. The regulator of the G-protein signaling gene (UaRGS1) was chosen to perform further verification by the lichen genetic manipulation system Umbilicaria muhlenbergii. Given that the absence of UmRgs1 resulted in elevated lethality to cold shock, the role for UaRgs1 in Antarctic U. aurantiacoatra resistance to cold can be inferred. The investigation of lichen adaptation to extreme environments at the molecular level will be opened up.

Geriatric nutritional risk index predicts postoperative delirium in elderly: A meta-analysis.

OBJECTIVES: To review current evidence on using the geriatric nutritional risk index (GNRI) in predicting postoperative delirium (POD) in elderly patients. METHODS: The literature search was performed in core databases to include all the cohort studies on the association between GNRI and risk of POD for further meta-analysis. RESULTS: A total of 6 studies with 4242 patients underwent this meta-analysis, which showed that the risk of POD was higher in patients with moderate and high GNRI than the ones with low GNRI (odds ratio [OR]=2.04, 95% confidence interval [CI] [1.58, 2.64], p<0.001), and moderate and high GNRI significantly increased the risk of POD in patients of 60 to 75 years or above [OR=1.98, 95%CI (1.49, 2.62), p<0.001; OR=2.79, 95%CI (1.38, 5.64), p=0.004, respectively]. CONCLUSION: Therefore, moderate and high GNRI increased the risk of POD in elderly patients.

Improved the physicochemical properties and bioactivities of oligosaccharides by degrading self-extracting/commercial ginseng polysaccharides.

Degradation of polysaccharides is an effective method to improve the physicochemical properties and biological activities. In this study, self-extracting ginseng oligosaccharides (SGOs) and commercial ginseng oligosaccharides (CGOs) were compared with self-extracting ginseng polysaccharides (SGPs) and commercial ginseng polysaccharides (CGPs). The four saccharides were composed of different types and proportions of monosaccharides. And the molecular weight (Mw) size order was SGP > CGP > CGO > SGO. The SGO and CGO had better solubility with smaller particle size, 97.63 ± 0.42 % and 96.23 ± 1.12 %, respectively. Fourier transform infrared, nuclear magnetic resonance, and X-ray diffraction spectroscopy characterized the structures of four saccharides. It was found that the structural features of saccharides did not change after enzymatic hydrolysis. The results of bioactivities showed that SGO and CGO had better antioxidant, hypoglycemic, and hypolipidemic activities. Compared with polysaccharides, oligosaccharides could significantly promote the proliferation and phagocytic ability of RAW 264.7 cells. Oligosaccharides induced RAW 264.7 cells to produce more NO and had better immune activity. Pearson's correlation coefficient analysis confirmed the bioactivities were negatively correlated with the Mw of ginseng saccharides. This study suggests that reducing the Mw of saccharides is an effective strategy to enhance their bioactivities.

N2H4Zn(HC3N3O3): exceptionally strong second harmonic generation and ultra-long phosphorescence.

The discovery and designed synthesis of multifunctional materials is a leading pursuit in materials science. Herein, we report a novel hydro-isocyanurate, N2H4Zn(HC3N3O3), which combines strong second harmonic generation (SHG) and ultra-long room-temperature phosphorescence (RTP). The SHG intensity is the highest within the cyanurate system (13 × KDP), and RTP lifetime extends up to 448 ms, accompanied by a long-lasting afterglow visible to the naked eye for 1.2 s, surpassing most of the current metal-organic complexes. This advancement holds promise for the development of multifunctional optoelectronic devices, particularly leveraging second-harmonic generation (SHG) processes.

Highly sensitive detection of carbendazim in agricultural products using colorimetric and photothermal lateral flow immunoassay based on plasmonic gold nanostars.

The wide use and high toxicity of carbendazim (CBD) in agriculture pose unprecedented demands for convenient, sensitive, and cost-effective on-site monitoring. Herein, we propose a novel colorimetric and photothermal dual-mode lateral flow immunoassay (LFIA) based on plasmonic gold nanostars (AuNSs) for CBD detection in agricultural products. The AuNSs were synthesized via a rapid seed-mediated growth method (with growth time of ∼5 s). A stable immunoprobe was formed by adsorbing CBD antibodies onto AuNSs. This immunoprobe exhibited high conversion efficiency and sensitivity in photothermal detection with a low limit of detection (LOD) of 0.28 ng mL-1. The LOD of the colorimetric mode was higher (0.48 ng mL-1). The results of CBD detection in various agricultural products aligned well with ultra-performance liquid chromatography tandem mass spectrometry. Overall, our LFIA shows excellent sensitivity, specificity, reproducibility, and rapidness in CBD detection, and thus is a highly potential on-site platform in resource-limited environments.

The de Winter pattern in a single precordial lead caused by high-grade stenosis of the proximal left anterior descending artery with plaque rupture: A case report.

The de Winter electrocardiogram (ECG) pattern indicates severe stenosis or occlusion of the left anterior descending artery (LAD). We present a 72-year-old female with 1.5-h chest pain. Angiography and optical coherence tomography (OCT) revealed 90 % LAD stenosis with plaque rupture, but no ST-segment elevation in the precordial leads. The de Winter pattern, characterized by upsloping ST-segment depression in V1-V6, appeared only in lead V2. Following successful percutaneous coronary intervention (PCI), the de Winter pattern disappeared. This case underscores the significance of the de Winter pattern in one precordial lead, necessitating prompt angiography and PCI for improved patient outcomes.

The discriminatory capability of anthropometric measures in predicting reproductive outcomes in Chinese women with PCOS.

OBJECTIVE: Obesity is a common feature in women with polycystic ovary syndrome (PCOS) and potentially significantly influences reproductive function. However, opinions are divided as to which factor is a more appropriate obesity predictor of reproductive outcomes. The aim of this study was to investigate the discriminatory capability of anthropometric measures in predicting reproductive outcomes in Chinese women with PCOS. METHODS: A total of 998 women with PCOS from PCOSAct were included. Logistic regression models were used to compute the odds ratios (ORs) and 95% confidence interval (95% CIs) to assess the effect of anthropometric measures, including body mass index (BMI), waist circumference (WC), hip circumference (HC), the waist‒hip ratio (WHR) and the waist‒height ratio (WHtR), on reproductive outcomes. The discrimination abilities of the models were assessed and compared based on the area under the receiver operating characteristic curve (AUC), Akaike's information criterion (AIC) and integrated discrimination improvement (IDI). RESULTS: Among PCOS women, there was a graded association between anthropometric measures and predicted reproductive outcomes across quintiles of anthropometric measures, including a linear association among WHR, BMI and reproductive outcomes and among waist circumference, WHtR and live birth, pregnancy, and ovulation. However, only a linear association was noted between the hip and ovulation. C-statistic comparisons and IDI analyses revealed a trend towards a significant superiority of BMI for ovulation and WHR for live birth, pregnancy and conception in the models. Combining obesity variables improved discrimination in the multivariable models for reproductive outcomes. CONCLUSIONS: Our findings support that BMI is a better predictor of ovulation and that the WHR is a better predictor of live birth, pregnancy and conception, whereas the combination of obesity variables contributes to the discrimination of reproduction.

Occupational support following arthroplasty of the lower limb (OPAL): trial protocol for a UK-wide phase III randomised controlled trial.

BACKGROUND: In the UK, one in four patients are in work at the time of their hip or knee replacement surgery. These patients receive little support about their return to work (RTW). There is a need for an occupational support intervention that encourages safe and sustained RTW which can be integrated into National Health Service practice. We developed a two-arm intervention trial, based on a feasibility study, to assess whether an occupational support intervention (the OPAL (Occupational support for Patients undergoing Arthroplasty of the Lower limb) intervention) is effective in supporting a reduced time to full, sustained RTW compared with usual care in patients undergoing hip and knee replacement. METHODS AND ANALYSIS: This is a multicentre, individually randomised controlled superiority trial comparing the OPAL intervention to usual care. 742 working adults listed for elective primary hip or knee replacement, who intend to RTW, will be randomised to the OPAL intervention or usual care. The intervention comprises: (1) multimedia information resources; and (2) support from a designated RTW coordinator. The primary outcome is time until 'full' sustained RTW without sick leave for a consecutive 4-week period. Secondary outcomes are: time to any RTW, measures of functional recovery, number of 'sick days' between surgery and 'full' sustained RTW and the use of workplace modifications to facilitate their return. A health economic evaluation and a mixed methods process evaluation will assess cost-effectiveness and the implementation, fidelity and acceptability of the intervention, respectively. Outcomes will be collected at baseline, 3, 6, 9 and 12-month follow-up time points, as well as a monthly RTW questionnaire. ETHICS AND DISSEMINATION: Dissemination will focus on supporting the wider adoption and implementation of the intervention (if effective) and will target groups for whom the results will be relevant. This trial was approved by West Midlands-Edgbaston REC 23/WM/0013. TRIAL REGISTRATION NUMBER: ISRCTN13694911.

SGLT2 inhibitors ameliorate NAFLD in mice via downregulating PFKFB3, suppressing glycolysis and modulating macrophage polarization.

Sodium-glucose co-transporter 2 (SGLT2) inhibitor (SGLT2i) is a novel class of anti-diabetic drug, which has displayed a promising benefit for non-alcoholic fatty liver disease (NAFLD). In this study, we investigated the protective effects of SGLT2i against NAFLD and the underlying mechanisms. The db/db mice and western diet-induced NAFLD mice were treated with dapagliflozin (1 mg·kg-1·d-1, i.g.) or canagliflozin (10 mg·kg-1·d-1, i.g.) for 8 weeks. We showed that the SGLT2i significantly improved NAFLD-associated metabolic indexes, and attenuated hepatic steatosis and fibrosis. Notably, SGLT2i reduced the levels of pro-inflammatory cytokines and chemokines, downregulated M1 macrophage marker expression and upregulated M2 macrophage marker expression in liver tissues. In cultured mouse bone marrow-derived macrophages and human peripheral blood mononuclear cell-derived macrophages, the SGLT2i (10, 20 and 40 µmol/L) significantly promoted macrophage polarization from M1 to M2 phenotype. RNA sequencing, Seahorse analysis and liquid chromatography-tandem mass spectrometry analysis revealed that the SGLT2i suppressed glycolysis and triggered metabolic reprogramming in macrophages. By using genetic manipulation and pharmacological inhibition, we identified that the SGLT2i targeted PFKFB3, a key enzyme of glycolysis, to modulate the macrophage polarization of M1 to M2 phenotype. Using a co-culture of macrophages with hepatocytes, we demonstrated that the SGLT2i inhibited lipogenesis in hepatocytes via crosstalk with macrophages. In conclusion, this study highlights a potential therapeutic application for repurposing SGLT2i and identifying a potential target PFKFB3 for NAFLD treatment.

Understanding the amylose biosynthesis and regulation mechanisms in Tartary buckwheat by the endosperm transcriptome.

Starch serves as a crucial energy source for both plants and humans, predominantly synthesized and stored in endosperms, tubers, rhizomes, and cotyledons. Given the significant role of amylose in determining the quality of starchy crops, optimizing its content has become a key objective in current crop breeding efforts. Tartary buckwheat, a dicotyledonous plant, notably accumulates high levels of amylose in its endosperm, surpassing common cereals like rice and maize. However, the mechanisms underlying amylose accumulation, distribution, and regulation in Tartary buckwheat remain unclear. Here, amylose content was determined across various tissues and organs of Tartary buckwheat, identifying with the endosperm as the primary site for its biosynthesis and accumulation. RNA sequencing analysis of endosperms from different developmental stages identified 35 genes potentially involved in starch biosynthesis, with 13 genes showing high endosperm-specific expression, suggesting crucial roles in starch biosynthesis. Additionally, the transcription factor FtNF-YB2, which was specifically highly expressed in the endosperm, was discovered to enhance amylose synthesis. Moreover, promoters with potential endosperm-specific activity were identified, advancing our understanding of amylose regulation. Additionally, this study also demonstrates that brassinosteroids (BR) positively influence amylose biosynthesis in Tartary buckwheat endosperm. These findings provide essential insights into the mechanisms of understanding amylose biosynthesis, accumulation and regulation in Tartary buckwheat, offering significant implications for future breeding strategies.

Ultralong room temperature phosphorescence with multicolor afterglow achieved in a harsh polymeric viscous flow state.

Polymer-based ultralong room temperature phosphorescence (RTP) is more attractive than that of organic small molecules. However, the intrinsic contradictions between the motion of the chain and the stability of phosphors' triplet excitons make achieving ultralong lifetime in polymeric systems a big challenge. Herein, we have achieved ultralong RTP emission in a polymeric viscous flow state with free chain motion through a facile B-O click reaction among boric acid, polyvinyl alcohol, and hydroxyl silicone oil. The yielded RTP putties (RTPPs) exhibited long lifetimes under ambient conditions (up to 2.39 s), surpassing those of all reported elastic RTP polymers and most glassy RTP polymers. Furthermore, multi-color afterglow can be achieved in RTPPs using the triplet-to-singlet Förster resonance energy transfer strategy. Impressively, utilizing viscous liquid features combined with RTP performance, RTPPs can be easily applied in complex models, handiwork, and anti-counterfeiting. Therefore, this progress, achieving a long phosphorescence lifetime in a viscous flow state, greatly expands the application scope of polymeric RTP materials and further compels a conceptual advance of polymeric RTP.

Acetylcholine regulates the melanogenesis of retinal pigment epithelia cells via a cAMP-dependent pathway: A non-neuronal function of cholinergic system in retina.

The turnover rate of melanogenesis in retinal pigment epithelium (RPE) and its molecular signaling remain unclear. This study aimed to investigate the role of cholinergic signaling in the process of melanogenesis of cultured RPE cells. Here, a human retinal pigment epithelia cell line, ARPE-19 cell, was used to study the process of melanogenesis. The mRNA and protein expressions of cholinergic molecules, e.g., acetylcholinesterase (AChE), butyrylcholinesterase (BChE), and melanogenic molecules i.e., tyrosinase (TYR), microphthalmia-associated transcription factor (MITF), and melanin pigment were measured during melanogenesis of cultured ARPE-19 cells. Forskolin (a cAMP inducing agent), acetylcholine (ACh) and bethanechol (Bch; a muscarinic AChR agonist) were used to induce melanogenesis in the cultures. Muscarinic acetylcholine receptor (mAChR) antagonists were employed to identify the receptor subtype. During melanogenesis of ARPE-19 cells, the mRNA and protein expressions of cholinergic molecules, e.g., AChE and BChE, were increased along with melanogenic molecules, i.e., TYR, MITF and melanin pigment. Forskolin, ACh, and Bch induced an upregulation of melanogenesis in cultured ARPE-19 cultures: the induction was parallel to an increase of AChE expression. The Bch-induced enzymatic activities and mRNA levels of AChE and TYR were fully blocked by the treatments of gallamine (a M2 specific antagonist), tropicamide (a M4 specific antagonist) and atropine (non-specific antagonist for mAChRs). Cholinergic signaling via M2/M4 mAChRs regulates melanogenesis in cultured ARPE-19 cells through a cAMP-dependent pathway. This study provides insights into the regulation of RPE cell melanogenesis via a non-neuronal function of cholinergic system.

Stearic acid alleviates aortic medial degeneration through maintaining mitochondrial dynamics homeostasis via inhibiting JNK/MAPK signaling.

Aortic dissection is characterized pathologically by aortic medial degeneration (AMD) where disturbance of mitochondrial dynamics may be involved. Stearic acid (SA) can promote mitochondrial fusion and improve mitochondrial function. Here, we established an AMD mouse model through oral administration of ß-aminopropionitrile (BAPN) and a cellular model by treating primary vascular smooth muscle cells (VSMCs) with Angiotensin-II to explore the potential role of SA in AMD. Our results showed SA reduced AMD and prolonged survival of BAPN-treated mice. Excessive mitochondrial fission was observed during AMD both in vivo and in vitro, and SA reduced mitochondrial fission and increased fusion. Additionally, SA promoted expression of contractile phenotype markers of VSMCs. At the molecular level, SA reduced AMD by inhibiting JNK/MAPK signaling. Our study suggests SA can promote mitochondrial fusion and increase the contractile phenotype of VSMCs by inhibiting JNK/MAPK signaling, thereby reducing AMD formation and possibly the consequent risk of aortic dissection.

Gut microbiota-derived indole-3-propionic acid alleviates diabetic kidney disease through its mitochondrial protective effect via reducing ubiquitination mediated-degradation of SIRT1.

INTRODUCTION: Gut microbes and their metabolites play crucial roles in the pathogenesis of diabetic kidney disease (DKD). However, which one and how specific gut-derived metabolites affect the progression of DKD remain largely unknown. OBJECTIVES: This study aimed to investigate the potential roles of indole-3-propionic acid (IPA), a microbial metabolite of tryptophan, in DKD. METHODS: Metagenomic sequencing was performed to analyze the microbiome structure in DKD. Metabolomics screening and validation were conducted to identify characteristic metabolites associated with DKD. The protective effect of IPA on DKD glomerular endothelial cells (GECs) was assessed through in vivo and in vitro experiments. Further validation via western blot, immunoprecipitation, gene knockout, and site-directed mutation elucidated the mechanism of IPA on mitochondrial injury. RESULTS: Alterations in gut microbial community structure and dysregulated tryptophan metabolism were evident in DKD mice. Serum IPA levels were significantly reduced in DKD patients and correlated with fasting blood glucose, HbA1c, urine albumin-to-creatinine ratio (UACR), and estimated glomerular filtration rate (eGFR). IPA supplementation ameliorated albuminuria, bolstered the integrity of the glomerular filtration barrier, and mitigated mitochondrial impairments in GECs. Mechanistically, IPA hindered SIRT1 phosphorylation-mediated ubiquitin-proteasome degradation, restoring SIRT1's role in promoting PGC-1α deacetylation and nuclear translocation, thereby upregulating genes associated with mitochondrial biosynthesis and antioxidant defense. CONCLUSION: Our findings underscore the potential of the microbial metabolite IPA to attenuate DKD progression, offering novel insights and potential therapeutic strategies for its management.

Sustainable H2O2 production via solution plasma catalysis.

Clean production of hydrogen peroxide (H2O2) with water, oxygen, and renewable energy is considered an important green synthesis route, offering a valuable substitute for the traditional anthraquinone method. Currently, renewable energy-driven production of H2O2 mostly relies on soluble additives, such as electrolytes and sacrificial agents, inevitably compromising the purity and sustainability of H2O2. Herein, we develop a solution plasma catalysis technique that eliminates the need for soluble additives, enabling eco-friendly production of concentrated H2O2 directly from water and O2. Screening over 40 catalysts demonstrates the superior catalytic performance of carbon nitride interacting with discharge plasma in water. High-throughput density functional theory calculations for 68 models, along with machine learning using 29 descriptors, identify cyano carbon nitride (CCN) as the most efficient catalyst. Solution plasma catalysis with the CCN achieves concentrated H2O2 of 20 mmol L-1, two orders of magnitude higher than photocatalysis by the same catalyst. Plasma diagnostics, isotope labeling, and COMSOL simulations collectively validate that the interplay of solution plasma and the CCN accounts for the significantly increased production of singlet oxygen and H2O2 thereafter. Our findings offer an efficient and sustainable pathway for H2O2 production, promising wide-ranging applications across the chemical industry, public health, and environmental remediation.

Plant-based diet indices and their interaction with ambient air pollution on the ovarian cancer survival: A prospective cohort study.

BACKGROUND: Ambient air pollution might serve as a prognostic factor for ovarian cancer (OC) survival, yet the relationships between plant-based diet indices (PDIs) and OC survival remain unclear. We aimed to investigate the associations of comprehensive air pollution and PDIs with OC survival and explored the effects of air pollution-diet interactions. METHODS: The present study encompassed 658 patients diagnosed with OC. The overall plant-based diet index (PDI), the healthful PDI (hPDI), and the unhealthful PDI (uPDI) were evaluated by a self-reported validated food frequency questionnaire. In addition, an air pollution score (APS) was formulated by summing the concentrations of particulate matter with a diameter of 2.5 microns or less, ozone, and nitrogen dioxide. Cox proportional hazard models were applied to calculate hazard ratios (HRs) and 95 % confidence intervals (CIs). The potential interactions of APS with PDIs in relation to overall survival (OS) were assessed on both multiplicative and additive scales. RESULTS: Throughout a median follow-up of 37.60 (interquartile: 24.77-50.70) months, 123 deaths were confirmed. Comparing to the lowest tertiles, highest uPDI was associated with lower OS of OC (HR = 2.06, 95 % CI = 1.30, 3.28; P-trend < 0.01), whereas no significant associations were found between either overall PDI or hPDI and OC survival. Higher APS (HR for per interquartile range = 1.27, 95 % CI = 1.01, 1.60) was significantly associated with worse OC survival, and the association was exacerbated by adherence to uPDI. Notably, an additive interaction was identified between combined air pollution and uPDI (P < 0.005 for high APS and high uPDI). We also found that adherence to overall PDI aggravated associations of air pollution with OC survival (P-interaction = 0.006). CONCLUSIONS: Joint exposure to various ambient air pollutants was significantly associated with lower survival among patients with OC, particularly for those who predominantly consumed unhealthy plant-based foods.

Rethinking masked image modelling for medical image representation.

Masked Image Modelling (MIM), a form of self-supervised learning, has garnered significant success in computer vision by improving image representations using unannotated data. Traditional MIMs typically employ a strategy of random sampling across the image. However, this random masking technique may not be ideally suited for medical imaging, which possesses distinct characteristics divergent from natural images. In medical imaging, particularly in pathology, disease-related features are often exceedingly sparse and localized, while the remaining regions appear normal and undifferentiated. Additionally, medical images frequently accompany reports, directly pinpointing pathological changes' location. Inspired by this, we propose Masked medical Image Modelling (MedIM), a novel approach, to our knowledge, the first research that employs radiological reports to guide the masking and restore the informative areas of images, encouraging the network to explore the stronger semantic representations from medical images. We introduce two mutual comprehensive masking strategies, knowledge-driven masking (KDM), and sentence-driven masking (SDM). KDM uses Medical Subject Headings (MeSH) words unique to radiology reports to identify symptom clues mapped to MeSH words (e.g., cardiac, edema, vascular, pulmonary) and guide the mask generation. Recognizing that radiological reports often comprise several sentences detailing varied findings, SDM integrates sentence-level information to identify key regions for masking. MedIM reconstructs images informed by this masking from the KDM and SDM modules, promoting a comprehensive and enriched medical image representation. Our extensive experiments on seven downstream tasks covering multi-label/class image classification, pneumothorax segmentation, and medical image-report analysis, demonstrate that MedIM with report-guided masking achieves competitive performance. Our method substantially outperforms ImageNet pre-training, MIM-based pre-training, and medical image-report pre-training counterparts. Codes are available at https://github.com/YtongXie/MedIM.