In this report, a 69-year-old man with fever, thrombocytopenia, and hepatic and renal dysfunction presented to our hospital. His disease progression was rapid, and he became unconscious. The patient was diagnosed with severe fever with thrombocytopenia syndrome (SFTS). However, his inflammation markers continued to rise until a mixed fungal infection was detected. Metagenomic next-generation sequencing of blood detected elevated sequence numbers for Actinomucor elegans and Aspergillus fumigatus. The culture of the bronchoalveolar lavage fluid were positive for Aspergillus fumigatus and Escherichia coli. Infection was controlled after adjusting the antifungal regimens against Actinomucor elegans. The patient's condition gradually improved. This patient was diagnosed with possible mucormycosis. Reports of Mucorales infection associated with SFTS are rare. We hope that this case report will draw the attention of physicians in the area where SFTS occurs to figure out if patients with SFTS are susceptible to mucormycosis.

N6-methyladenosine (m6A) modification and m6A-related RNA-binding proteins (RBPs) play vital roles in various aspects of circRNA metabolism. Hsa_circRNA_103820 is implicated in the pathogenesis of multiple cancers, including lung cancer (LC). Moreover, bioinformatics analysis has suggested that hsa_circRNA_103820 possesses potential peptide-coding ability. Thus, we aimed to investigate the function and peptide-coding potential of hsa_circRNA_103820 in this study. Cell viability, apoptosis rate, and migratory and invasive abilities were assessed using CCK-8, flow cytometry, and transwell assays, respectively. Hsa_circRNA_103820 level was measured using RT-qPCR assay, and the interaction between hsa_circRNA_103820 and IGF2BP3 was examined through RIP and RT-qPCR assays. The coding ability of hsa_circRNA_103820 and protein levels were determined through western blot assay. The results showed that hsa_circRNA_103820 reduced cell viability, attenuated cell migratory and invasive abilities, and promoted cell apoptosis in LC. IGF2BP3 negatively regulated hsa_circRNA_103820 expression and interacted with it. Hsa_circRNA_103820 knockdown alleviated si-IGF2BP3-mediated anti-viability, anti-migration, anti-invasion, and pro-apoptosis effects in LC cells. Moreover, a 188-amino acid (aa) peptide encoded by hsa_circRNA_103820 decreased cell viability, facilitated cell apoptosis, and inhibited cell migration and invasion in LC. Collectively, hsa_circRNA_103820, regulated by IGF2BP3, encodes a 188-aa peptide and inhibits the malignant progression of LC cells by inhibiting the AKT pathway.

Lung cancer is the leading cause of cancer-related death. In particular, non-small cell lung cancer (NSCLC) accounts for approximately 85% of all lung cancer cases. Due to tumor resistance and the toxicity of chemotherapeutic agents, it is increasingly critical to discover novel, potent antitumorigenic drugs for treating NSCLC. Lutein, a carotenoid, has been reported to exert toxic effects on cells in several tumor types. However, the detailed functions and underlying mechanisms of lutein in NSCLC remain elusive. The present study showed that lutein significantly and dose-dependently inhibited cell proliferation, arrested the cell cycle at the G0/G1 phase, and induced apoptosis in NSCLC cells. RNA-sequencing analysis revealed that the p53 signaling pathway was the most significantly upregulated in lutein-treated A549 cells. Mechanistically, lutein exerted antitumorigenic effects by inducing DNA damage and subsequently activating the ATR/Chk1/p53 signaling pathway in A549 cells. In vivo, lutein impeded tumor growth in mice and prolonged their survival. In conclusion, our findings demonstrate the antitumorigenic potential of lutein and reveal its molecular mechanism of action, suggesting that lutein is a promising candidate for clinical NSCLC treatment.

Lung cancer patients tend to have strong intratumoral and intertumoral heterogeneity and complex tumor microenvironment, which are major contributors to the efficacy of and drug resistance to immunotherapy. From a new perspective, single-cell techniques offer an innovative way to look at the intricate cellular interactions between tumors and the immune system and help us gain insights into lung cancer and its response to immunotherapy. This article reviews the application of single-cell techniques in lung cancer, with focuses directed on the heterogeneity of lung cancer and the efficacy of immunotherapy. This review provides both theoretical and experimental information for the future development of immunotherapy and personalized treatment for the management of lung cancer.

BACKGROUND:Although immune checkpoint blockade (ICB) therapy has shown remarkable benefits in cancers, a subset of patients with cancer exhibits unresponsiveness or develop acquired resistance due to the existence of abundant immunosuppressive cells. Tumor-associated macrophages (TAMs), as the dominant immunosuppressive population, impede the antitumor immune response; however, the underlying mechanisms have not been fully elucidated yet.METHODS:Single-cell RNA sequencing analysis was performed to portray macrophage landscape and revealed the underlying mechanism of component 1q (C1q)+ TAMs. Malignant pleural effusion (MPE) of human and mouse was used to explore the phenotypes and functions of C1q+ TAMs.RESULTS:C1q+ TAMs highly expressed multiple inhibitory molecules and their high infiltration was significantly correlated with poor prognosis. C1q+ TAMs promote MPE immunosuppression through impairing the antitumor effects of CD8+ T cells. Mechanistically, C1q+ TAMs enhance fatty acid binding protein 5 (FABP5)-mediated fatty acid metabolism, which activate transcription factor peroxisome proliferator-activated receptor-gamma, increasing the gene expression of inhibitory molecules. A high-fat diet increases the expression of inhibitory molecules in C1q+ TAMs and the immunosuppression of MPE microenvironment, whereas a low-fat diet ameliorates these effects. Moreover, FABP5 inhibition represses the expression of inhibitory molecules in TAMs and tumor progression, while enhancing the efficacy of ICB therapy in MPE and lung cancer.CONCLUSIONS:C1q+ TAMs impede antitumor effects of CD8+ T cells promoting MPE immunosuppression. Targeting C1q+ TAMs effectively alleviates the immunosuppression and enhances the efficacy of ICB therapy. C1q+ TAMs subset has great potential to be a therapeutic target for cancer immunotherapy.

Background Lung cancer is a highly aggressive disease and the leading cause of cancer-related deaths. Lung adenocarcinoma (LUAD) is the most common histological subtype of lung cancer. As a type of programmed cell death, anoikis serves a key role in tumor metastasis. However, as few studies have focused on anoikis and prognostic indicators in LUAD, in this study, we constructed an anoikis-related risk model to explore how anoikis could influence the tumor microenvironment (TME), clinical treatment, and prognosis in LUAD patients; we aimed to provide new insight for future research. Methods Using patient data from Gene Expression Omnibus (GEO) and The Cancer Genome Atlas (TCGA), we utilized the ‘limma’ package to select differentially expressed genes (DEGs) associated with anoikis and then they were divided into 2 clusters with consensus clustering. Risk models were constructed with least absolute shrinkage and selection operator (LASSO) Cox regression (LCR). Kaplan-Meier (KM) analysis and receiver operating characteristic (ROC) curves were performed to assess the independent risk factors for different clinical characteristics, including age, sex, disease stage, grade, and their associated risk scores. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and gene set enrichment analysis (GSEA) were performed to explore the biological pathways in our model. The effectiveness of clinical treatment was detected according to tumor immune dysfunction and exclusion (TIDE), The Cancer Immunome Atlas (TCIA), and IMvigor210. Results Our model was found to divide LUAD patients into high- and low-risk groups well, in which high risk groups had poor overall survival (OS), indicating that risk score could be an independent risk factor to predict the prognosis of LUAD patients. Interestingly, we found that anoikis could not only influence the extracellular organization but also play great roles in immune infiltration and immunotherapy, which might provide a new insight for future research. Conclusions The risk model constructed in this study can benefit to predict patient survival. Our results provided new potential treatment strategies.

Background: Twenty-four-hour oscillations of circadian rhythms control comprehensive biological processes in the human body. In lung adenocarcinoma (LUAD), chronic circadian rhythm disruption is positively associated with tumorigenesis. However, few studies focus on circadian clock gene signatures (CGSs) for prognosis evaluation of patients with early-stage LUAD.Methods: In this study, we aimed to construct a robust prognostic circadian rhythm-related biomarker from multiple public databases, including the Gene Expression Omnibus database and The Cancer Genome Atlas database. The least absolute shrinkage and selection operator (LASSO)-penalized Cox regression model was performed to select optimal circadian clock gene pairs. Bioinformatic analyses were performed to estimate the abundance of different immune cells and immunohistochemical analyses were conducted to validate the differential proportion of tumor-infiltrating lymphocytes in different groups.Results: Results demonstrated that the CGS could accurately identify patients with early-stage LUAD at a high risk in the training dataset [hazard ratio (HR) =3.06; 95% confidence interval (CI): 2.47-3.78; P<0.001], testing dataset (HR =2.44; 95% CI: 1.74-3.43; P<0.001), and validation dataset (HR =2.09, 95% CI: 1.09-4.00; P=0.023). Bioinformatic and immunohistochemical analyses demonstrated that the abundance of tumor-infiltrating CD4+ T cells was higher in the low-CGS groups. Integration of the CGS and clinical characteristics improved the accuracy of the CGS in predicting overall survival (OS) of patients with early stage LUAD.Conclusions: In conclusion, the CGS was an independent immune-related circadian biomarker that could identify early-stage LUAD patients with different OS.

Background: Overproduction of endothelial extracellular vesicles (eEVs) is correlated with pulmonary hypertension progression, but the precise mechanism remains largely unclear. Methods: MicroRNA-chip and real-time polymerase chain reaction were conducted to screen and validate microRNA profiles in blood plasma eEVs of rats and human with or without cigarette smoking. Pulmonary artery smooth muscle cells were cultured to study signaling pathways. Pulmonary hypertension phenotypes were evaluated in wild-type and calcium-sensing receptor knockout rats to identify the pathophysiological significance of the microRNA pathway. Results: MicroR-1249 was predominant highly expressed in eEVs from plasma of rats exposed to cigarette smoking, and confirmed in eEVs from plasma of human smokers as well as in eEVs from cigarette smoke extract-treated pulmonary artery endothelial cells, but not in cigarette smoke extract-treated pulmonary artery smooth muscle cells. In cultured pulmonary artery smooth muscle cells, microR-1249 downregulated the expression of histone deacetylase 10, which in turn enhanced the acetylated form of NFκB (nuclear factor κB) level and its nuclear translocation leading to increased expression of calcium-sensing receptor. In rats, the repression of microR-1249 in eEVs by microR-1249 inhibitor, histone deacetylase 10 overexpression, or calcium-sensing receptor knockout profoundly inhibited the proliferative capacities and diminished apoptosis-resistance of pulmonary artery smooth muscle cells and pulmonary hypertension development in rats intravenously administrated with eEVs preparation from cigarette smoke extract-treated pulmonary artery endothelial cells. Conclusions: Cigarette smoke–enriched microR-1249 in endothelial extracellular vesicles facilitates the hyperproliferative and antiapoptotic status of pulmonary artery smooth muscle cells promoting pulmonary hypertension evolution through the inhibition of histone deacetylase 10–NFκB–calcium-sensing receptor cascade.

Activation of the CaSR (extracellular calcium-sensing receptor) has been recognized as a critical mediator of hypoxia-induced pulmonary hypertension. Preventive targeting of the early initiating phase as well as downstream events after CaSR activation remains unexplored. As a representative of the G protein-coupled receptor family, CaSR polymerizes on cell surface upon stimulation. Immunoblotting together with MAL-PEG technique identified a reactive oxygen species-sensitive CaSR polymerization through its extracellular domain in pulmonary artery smooth muscle cells upon exposure to acute hypoxia. Fluorescence resonance energy transfer screening employing blocking peptides determined that cycteine129/131 residues in the extracellular domain of CaSR formed intermolecular disulfide bonds to promote CaSR polymerization. The monitoring of intracellular Ca2+ signal highlighted the pivotal role of CaSR polymerization in its activation. In contrast, the blockade of disulfide bonds formation using a peptide decreased both CaSR and hypoxia-induced mitogenic factor expression as well as other hypoxic-related genes in vitro and in vivo and attenuated pulmonary hypertension development in rats. The blocking peptide did not affect systemic arterial oxygenation in vivo but inhibited acute hypoxia-induced pulmonary vasoconstriction. Pharmacokinetic analyses revealed a more efficient lung delivery of peptide by inhaled nebulizer compared to intravenous injection. In addition, the blocking peptide did not affect systemic arterial pressure, body weight, left ventricular function, liver, or kidney function or plasma Ca2+ level. In conclusion, a peptide blocking CaSR polymerization reduces its hypoxia-induced activation and downstream events leading to pulmonary hypertension and represents an attractive inhaled preventive alternative worthy of further development.

BACKGROUND Rhizopus microsporus (R. microsporus) lung infection is an invasive fungal disease with high mortality that is increasingly common in immunocompromised patients. However, it is very rare in immunocompetent patients. Here, we present the case of a 19-year-old girl who developed R. microsporus lung infection without any known immunodeficiency. CASE SUMMARY The patient presented to our hospital because of hemoptysis and irritative cough without expectoration. She was first treated for community-acquired pneumonia until the detection of R. microsporus in bronchoalveolar lavage fluid by metagenomics next-generation sequencing (mNGS). After a combination therapy of intravenous inhalation and local airway perfusion of amphotericin B, she eventually recovered, with significant absorption of lung infections. CONCLUSION Early diagnosis and treatment are very important for pulmonary mucormycosis. Compared to fungal culture, mNGS is a relatively precise and convenient method to obtain pathogenic results. A combination therapy of intravenous inhalation and local airway perfusion of amphotericin B may be a promising strategy for the treatment of pulmonary mucormycosis in the future.

2020年初,一场突如其来的新冠肺炎疫情,彻底摧毁了人们对病毒感染的认知.一旦遭遇发热、咳嗽、头昏、肌痛等症状,大家再也无法像以前那样保持镇定. “我是不是得了新冠?”这来自内心的恐惧,就像一层乌云笼罩在心头.

The aim of this study was to compare ribavirin therapy versus supportive therapy only for patients with severe coronavirus disease 2019 (COVID-19). A total of 115 patients with laboratory-confirmed COVID-19 were retrospectively analysed. All patients received supportive care as well as regular laboratory and clinical monitoring. The 115 patients comprised 44 patients who received intravenous ribavirin (treatment group) and 71 who did not (control group). Baseline laboratory and clinical characteristics were similar between the two groups. The negative conversion time for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR in the ribavirin group was 12.8 ± 4.1 days compared with 14.1 ± 3.5 days in the control group (P = 0.314). Moreover, 7/41 patients (17.1%) in the ribavirin group died compared with 17/69 (24.6%) in the control group (P = 0.475). Adverse effects were similar between the two groups. In conclusion, in patients with severe COVID-19, ribavirin therapy is not associated with improved negative conversion time for SARS-CoV-2 test and is not associated with an improved mortality rate. Further assessment in designed randomised controlled trials is recommended.

Abstract Background: Immune checkpoint inhibitors (ICIs) have shown remarkable antitumor effects in non-small cell lung cancer (NSCLC), however, only a subset of patients show a response. Therefore, more accurate biomarkers are highly needed. The aim of this study was to examine the prevalence of INPP4B and its association with response to ICIs among patients with NSCLC. Methods: Formalin-fixed, paraffin-embedded (FFPE) tumor and matched blood samples of 3433 NSCLC patients from OrigiMed were collected for targeted next-generation sequencing (NGS) panel sequencing from December 2017 to January 2019. Genomic alterations (GAs) including single nucleotide variations, short and long insertions/deletions, copy number variations, and gene rearrangements were assessed. PD-L1 expression positive was defined as ≥1% of tumor cells with membranous staining (22C3, DAKO). Genomic data and ICIs treatment outcome of a cohort of 240 NSCLC patients were derived from cBioPortal (MSKCC, J Clin Oncol 2018). Results: INPP4B GAs were found in 1% of patients (33/3433) in the OrigiMed database and 3.75% of patients (9/240) in the MSKCC database. Sites of INPP4B mutations were found scattered throughout the gene, and no significant difference was observed in the frequency of INPP4B GAs between age, stage, and histologic subtype. INPP4B GAs were associated with a significantly higher tumor mutational burden (TMB) compared with wild-type (WT) INPP4B (14.7 vs. 4.6 muts/Mb, respectively, p<0.001). PD-L1 expression was detected in 20.9% of patients (718/3433), including 9 patients with INPP4B GAs. INPP4B GAs were significantly associated with higher PD-L1 expression compared with WT (66.7% vs 29.1%, respectively, p=0.006). Survival analysis from the MSKCC cohort confirmed that patients with INPP4B GAs had a remarkable clinical benefit to ICIs compared to WT patients in both progression free survival (PFS) (13.17 months vs 3.23 months, respectively, p=0.041) and durable clinical benefit (DCB) (50% vs 29.7%, respectively, p=0.25). Furthermore, INPP4B GAs were independent risk factors of PFS (HR: 0.34, 95%CI: 0.134-0.86, p=0.023). Conclusion: This study's findings suggest that the GAs of INPP4B occur in a subgroup of patients with NSCLC and are associated with an increased TMB and response to ICIs, suggesting that GAs of INPP4B may have implications as a biomarker for guiding ICI treatment. Keywords: non-small cell lung cancer, INPP4B, tumor mutational burden, immunotherapy Citation Format: Zhuojian Shen, Hongbiao Wang, Jianjiang Xie, Yuan Su, Shiyue zhang, Jiqiang He, Hui Chen, Shaohua Yuan, Xiaowei Dong. INPP4B mutation as a novel biomarker for immunotherapy in patients with non-small cell lung cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4287.

BAckground Severe COVID-19 patients account for most of the mortality of this disease. Early detection of severe cases of the disease remains a major challenge. Here, we performed clinical and laboratory profiling of COVID-19 to explore the early warning indicators of severe cases. Methods An analysis of the evolution during the hospitalization of clinical and laboratory findings from 78 confirmed COVID-19 patients and the associated risk factors. Results Of the 78 patients who were classified as un-severe at admission, 60 patients(stable group) were stable as mild cases until discharge, and the remaining 18 patients progressed to severe cases(exacerbated group) during hospitalization. Compared with stable patients, exacerbated patients exhibited older, higher BMI values and higher proportion of smokers. In the exacerbated patients, the median time from onset to deterioration was 7.5 days. Before the time point(days 0–7 from onset), we observed higher-levels of White blood cells(WBC), neutrophil, Neutrophi-Lymphocyte-Ratio(NLR), Lactose-dehydrogenase(LDH), D-dimer, and lower-levels of albumin in the exacerbated group, compared with the stable group. In the second week after the time point, the exacerbated patients displayed lower numbers of lymphocytes, CD3 + , and CD8 + T-cells, and higher-levels of C-reactive protein(CRP), erythrocyte-sedimentation-rate(ESR), Alanine-aminotransferase(ALT),Aspartate-aminotransferase(AST), and Interleukin-6. In the third week, the highest temperature and the proportion of febrile patients declined. All of the laboratory indicators gradually improved. Conclusions Advanced age and smoking history could be risk factors for COVID-19 progression. In the early stage, high-levels of WBC and neutrophils, with noticeably increased LDH and D-dimer, could be early indicators of the disease’s conversion from mild to severe, followed by elevated inflammatory markers, liver enzymes, and decreased T-lymphocytes in the next week.

Increased cholinergic activity has been highlighted in the pathogenesis of airway hyperresponsiveness, and alternations of mitochondrial structure and function appear to be involved in many lung diseases including airway hyperresponsiveness.It is crucial to clarify the cause-effect association between mitochondrial dysfunction and cholinergic hyperactivity in the pathogenesis of airway hyperresponsiveness.Male SD rats and cultured airway epithelial cells were exposed to cigarette smoke plus lipopolysaccharide administration; mitochondria isolated from airway epithelium were delivered into epithelial cells in vitro and in vivo.Both the cigarette smoke plus lipopolysaccharide-induced cholinergic hyperactivity in vitro and the airway hyperresponsiveness to acetylcholine in vivo were reversed by the transplantation of exogenous mitochondria.The rescue effects of exogenous mitochondria were imitated by the elimination of excessive reactive oxygen species or blockage of muscarinic M 3 receptor, but inhibited by M receptor enhancer.Mitochondrial transplantation effectively attenuates cigarette smoke plus lipopolysaccharide-stimulated airway hyperresponsiveness through the inhibition of ROS-enhanced epithelial cholinergic hyperactivity.

Monocrotaline has been widely used to establish an animal model of pulmonary hypertension, most frequently in rats. An important feature of this model resides in the selectivity of monocrotaline injury toward the pulmonary vascular endothelium versus the systemic vasculature when administrated at standard dosage. The toxic metabolite of monocrotaline, monocrotaline pyrrole, is transported by erythrocytes. This study aimed to reveal whether partial pressure of oxygen of blood determined the binding and release of monocrotaline pyrrole from erythrocytes in rats with one subcutaneous injection of monocrotatline at the standard dosage of 60 mg/kg. Our experiments demonstrated that monocrotaline pyrrole bound to and released from erythrocytes at the physiological levels of partial pressure of oxygen in venous and arterial blood, respectively, and then aggregated on pulmonary artery endothelial cells. Monocrotaline pyrrole-induced damage of endothelial cells was also dependent on partial pressure of oxygen. In conclusion, our results demonstrate the importance of oxygen partial pressure on monocrotaline pyrrole binding to erythrocytes and on aggregation and injury of pulmonary endothelial cells. We suggest that these mechanisms contribute to pulmonary selectivity of this toxic injury model of pulmonary hypertension.

Objective This study aims to determine whether and how the enriched metabolites of endothelial extracellular vesicles (eEVs) are critical for cigarette smoke-induced direct injury of endothelial cells and the development of pulmonary hypertension, rarely explored in contrast to long-investigated mechanisms secondary to chronic hypoxemia. Approach and Results Metabonomic screen of eEVs from cigarette-smoking human subjects reveals prominent elevation of sperminea polyamine metabolite with potent agonist activity for the extracellular CaSR (calcium-sensing receptor). CaSR inhibition with the negative allosteric modulator Calhex231 or CaSR knockdown attenuates cigarette smoke-induced pulmonary hypertension in rats without emphysematous changes in lungs or chronic hypoxemia. Cigarette smoke exposure increases the generation of spermine-positive eEVs and their spermine content. Immunocytochemical staining and immunogold electron microscopy recognize the spermine enrichment not only within the cytosol but also on the outer surface of eEV membrane. The repression of spermine synthesis, the inhibitory analog of spermine, N-1-dansyl-spermine, Calhex231, or CaSR knockdown profoundly suppresses eEV exposure-mobilized cytosolic calcium signaling, pulmonary artery constriction, and smooth muscle cell proliferation. Confocal imaging of immunohistochemical staining demonstrates the migration of spermine-positive eEVs from endothelium into smooth muscle cells in pulmonary arteries of cigarette smoke-exposed rats. The repression of spermine synthesis or CaSR knockout results in attenuated development of pulmonary hypertension induced by an intravascular administration of eEVs. Conclusions Cigarette smoke enhances eEV generation with spermine enrichment at their outer surface and cytosol, which activates CaSR and subsequently causes smooth muscle cell constriction and proliferation, therefore, directly leading to the development of pulmonary hypertension.

目的 探讨临床药师在风湿性心脏病二尖瓣置换术后合并肺部感染患者药物治疗中的作用.方法 临床药师在参与1例二尖瓣置换术后合并肺部感染患者的治疗过程中,积极协助医师制定合理的抗凝和抗感染治疗方案.结果 兼顾了抗凝与抗感染治疗,避免了药物相互作用引起的不良事件.患者症状缓解,疗效满意.结论 临床药师可通过关注药物相互作用、抓住监护要点、优化治疗方案等,有效促进二尖瓣置换术后合并肺部感染患者安全合理用药.

BackgroundMonocrotaline has been widely used to establish an animal model of pulmonary hypertension. The molecular target underlying monocrotaline‐induced pulmonary artery endothelial injury and pulmonary hypertension remains unknown. The extracellular calcium–sensing receptor (CaSR) and particularly its extracellular domain hold the potential structural basis for monocrotaline to bind. This study aimed to reveal whether monocrotaline induces pulmonary hypertension by targeting the CaSR. Methods and ResultsNuclear magnetic resonance screening through WaterLOGSY (water ligand‐observed gradient spectroscopy) and saturation transfer difference on protein preparation demonstrated the binding of monocrotaline to the CaSR. Immunocytochemical staining showed colocalization of monocrotaline with the CaSR in cultured pulmonary artery endothelial cells. Cellular thermal shift assay further verified the binding of monocrotaline to the CaSR in pulmonary arteries from monocrotaline‐injected rats. Monocrotaline enhanced the assembly of CaSR, triggered the mobilization of calcium signaling, and damaged pulmonary artery endothelial cells in a CaSR‐dependent manner. Finally, monocrotaline‐induced pulmonary hypertension in rats was significantly attenuated or abolished by the inhibitor, the general or lung knockdown or knockout of CaSR. ConclusionsMonocrotaline aggregates on and activates the CaSR of pulmonary artery endothelial cells to trigger endothelial damage and, ultimately, induces pulmonary hypertension.

Put forward the idea of " leading medical curriculum reform with the concept of integration ", analyse current situation of medical course integration both at home and abroad, take Medical Education in Huazhong University of Science and Technology Affliated Union Medical College as an example, in view of the "problem centered" teaching system, probes into the research and experience about continuous improvement of integrated curriculum reform in recent years. To provide a reference to a suitable integrated curriculum reform for national conditions for domestic institutions.