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Background Ionocytes are rare cells in airway epithelium characterized by a high expression of CFTR. Objectives To investigate the morphology and distribution of ionocytes and the function of CFTR in the nasal mucosal epithelium of children. Methods The exfoliated cells of nasal mucosa from 101 children were detected using flow cytometry to analyze the number of ionocytes and CFTR and the difference of CFTR function. Nasal mucosa and polyps were collected from 10 children with CRSwNP. The RNAscope of FOXI1 and CFTR was detected in pathological paraffin sections. The expression and distribution of ionocytes and CFTR in nasal mucosa and polyp epithelium were observed. Results In CRS patients, the number of ionocytes in the nasal epithelium was lower and the number of ionocytes that did not express CFTR was higher, and the function of CFTR was also decreased. The expression of CFTR in the nasal mucosa of CRS showed the characteristics of local dense distribution and increased as the inflammation expanded. The ionocytes were “tadpole-shaped” in the epithelium and gathered in the area of high CFTR expression, the intracellular CFTR was expanded in clusters. Ionocytes that did not express CFTR was more common in the nasal polyps. Conclusions The number of ionocytes and the function of CFTR in nasal mucosa of CRS patients decreased. With the expansion of inflammation, CFTR and ionocytes showed more obvious dense distribution. Some ionocytes lost the expression of CFTR and did not show the "tadpole" shape, which may be related to the occurrence of polyps.

In order to comprehensively consider the impact of human activities on runoff simulation and improve the accuracy of runoff simulation, so as to make a more accurate prediction of the future runoff of the Hanjiang River Basin, this study improved the reservoir module of the Wespa model, adding two parts: reservoir inflow data correction and water storage and outflow data calculation without measured data. Use the improved model to verify its applicability to the Hanjiang River Basin, then, choose the ones who has the most familiar trend with the historical data in the future climate model data (CMIP6). Put the selected data in the model to predict the runoff of Hanjiang River from 2021 to 2060. By analyzing the future runoff trend of Ankang, Huangjiagang and Huangzhuang in the Hanjiang River Basin from 2021 to 2060 and the changes of average runoff, seasonal runoff and monthly runoff compared with the historical period (1981-2020), the conclusions drawn are as follows: (1) The improved Wetspa model has good applicability in the Hanjiang River Basin; (2) The future runoff of Ankang section is decreasing, while that of Huangjiagang and Huangzhuang sections is increasing; (3) Compared with the reference period, the average runoff of the three sections in the future shows an increasing trend, which indicates that there will be flood risk in the future; (4) Compared with the reference period, the runoff proportion of the three sections will increase in spring and winter, and decrease in autumn. Attention should be paid to the risk of drought in autumn. In terms of months, the proportion of runoff from April to June increases, decreases from September to November, and increases and decreases in other months are uncertain.

The hydrological conditions are key factors in ensuring the health of water ecosystems. The lack of runoff data constrains the assessment of the basin's evolutionary pattern of the eco-hydrological conditions. The Yongding River Basin (YDRB) is a typical water-scarce basin in northern China, where the changing environment has led to widespread water scarcity and ecosystem degradation problems. In response to the shortage of information at the upper reaches of the YDRB at the Xiangshuibao gauging station, this study adopted a distributed hydrological model, WetSpa, to simulate the daily runoff data in this station from 1960 to 2019. Then, Indicators of Hydrologic Alteration (IHA) was used to identify the most ecologically relevant hydrological indicators (ERHIs) and further determine the "true" eco-hydrological variation point in the basin. Finally, the evolution rule of the eco-hydrological conditions in the basin was analyzed and the overall hydrological alteration degree of the Xiangshuibao Section was determined. The results showed that the rising rate, decline rate, annual maximum 1-day flow, annual minimum 1-day flow, annual maximum flow occurrence time, and July flow were the ERHIs. The variation period was from 1980 to 1986. Except for the annual maximum 1-day flow and decline rate were moderate variation indicators, all others were low variation indicators. The overall hydrological variability of the Xiangshuibao section was low. The results of this study were intended to provide a reference for ecological management construction in the YDRB and other similar areas.

ObjectivesThis study aims to explore clinicians’ practices and attitudes regarding advance care planning (ACP) in mainland China.MethodsThis study was a multicenter cross-sectional survey. Clinicians from tertiary hospitals in Beijing, Guangxi, and Inner Mongolia were invited to participate in the study. A questionnaire was formulated based on related literature to obtain information including demographic characteristics, and practices and attitudes toward ACP.ResultsThe total number of participants included 285 clinicians. The data response rate was 84.57%. Most of the clinicians had an inadequate understanding of ACP. Only a few clinicians had experience in participating or witnessing an ACP or related end-of-life discussions. Among 285 clinicians, 69.82% of clinicians were willing to introduce ACP to patients. Two hundred and thirty-eight (83.51%) clinicians wanted more education on ACP. Almost all clinicians believed that patients had the right to know about their diagnosis, prognosis, and available care options. Most clinicians (82.11%) regarded that ACP was partially feasible in mainland China. If clinicians had a serious illness, almost everyone was willing to find out their true health status and decide for themselves, and 81.40% wanted to institute an ACP for themselves. The biggest barriers to the use of ACP in mainland China were cultural factors. Statistical analysis revealed that some or good understanding level (P = 0.0052) and practical experience (P = 0.0127) of ACP were associated with the positive willingness.Significance of resultsACP is still in its infancy in mainland China. Clinicians had inadequate understanding and minimal exposure to ACP. Most clinicians recognized the value and significance of ACP and had a positive attitude toward ACP. Clinicians need to be provided with education and training to promote their ACP practices. Culturally appropriate ACP processes and documents need to be developed based on Chinese culture and Chinese needs.

Background Engaging in anal sexual intercourse markedly increases the risk of developing HIV among men who have sex with men (MSM); oral sexual activities tend to uniquely introduce gut-derived microbes to salivary microbiota, which, combined with an individual’s positive HIV status, may greatly perturb oral microecology. However, till date, only a few published studies have addressed this aspect. Based on 16S rRNA sequencing data of bacterial taxa, MicroPITA picks representative samples for metagenomic analysis, effectively revealing how the development and progression of the HIV disease influences oral microbiota in MSM. Therefore, we collected samples from 11 HIV-negative and 44 HIV-positive subjects (stage 0 was defined by HIV RNA positivity, but negative or indeterminate antibody status; stages 1, 2, and 3 were defined by CD4+ T lymphocyte counts ≥ 500, 200–499, and ≤ 200 or opportunistic infection) and selected 25 representative saliva samples (5 cases/stage) using MicroPITA. DNA extraction, library construction, and metagenomic sequencing analysis were performed to explore whether a positive HIV status changes oral microbiota KEGG functional composition in MSM. Results The core functions of oral microbiota were maintained across each of the five groups, including metabolism, genetic and environmental information processing. All HIV-positive groups displayed KEGG functions of abnormal proliferation, most prominently at stage 0, and others related to metabolism and human disease. Clustering relationship analysis tentatively identified functional relationships between groups, with bacterial function being more similar between stage 0-control groups and stage 1–2 groups, whereas the stage 3 group exhibited large functional changes. Although we identified most metabolic pathways as being common to all five groups, several unique pathways formed clusters for certain groups; the stage 0 group had several, while the stage 2 and 3 groups had few, such clusters. The abundance of K03046 was positively correlated with CD4 counts. Conclusions As HIV progresses, salivary bacterial function in MSM progressively changes as HIV promotes abnormal energy metabolism and exacerbates pathogen virulence. Further, infection and drug resistance of acute stage and immune cell destruction of AIDS stage were abnormally increased, predicting an increased risk for MSM individuals to develop systemic and oral diseases.

Background: Gastric cancer (GC) is one of the most common cancers and the main cause of tumor-related death worldwide. Moreover, the incidence of gastric cardiac cancer (GCC) has increased obviously, with the potentially different prognosis from other sites of GC (non-gastric cardiac cancer, NGCC). We will analyze the prognosis between GCC and NGCC, and set up an effective prognostic model based on neural network for GCC. Methods: In the population-based cohort study, we firstly enrolled the clinical features from the Surveillance, Epidemiology and End Results (SEER) data (n=31397) as well as the public Chinese data from different hospitals (n=1049). Then according to the diagnostic time, the SEER data were then divided into two cohorts, the train cohort (patients were diagnosed as GCC in 2010-2014, n=4414) and the test cohort (diagnosed in 2015, n=957). Age, sex, pathology, tumor, node, and metastasis (TNM) stage, tumor size, surgery or not, radiotherapy or not, chemotherapy or not and history of malignancy were chosen as the predictive clinical features. Results: The prognosis of GCC patients in SEER database was worse than that of NGCC patients, while it was not worst in the Chinese data. The total of 5371 patients were used to conduct the development model, following inclusion and exclusion criteria. Neural network-based prognostic predictive model had a satisfactory performance for GCC overall survival (OS) prediction, which owned 0.7431 AUC in the train cohort (95% confidence intervals, CIs, 0.7423-0.7439) and 0.7419 in the test cohort (95% CIs, 0.7411-0.7428). Conclusion: GCC patients indeed have the different survival time compared with NGCC patients. And this neural network-based prognostic predictive tool is a novel and promising software for the outcome of GCC patients.

ObjectivesThe early diagnosis of tuberculous pleural effusion (TPE) is challenging due to the difficulty of isolating Mycobacterium tuberculosis, and pleural biomarkers are an optional choice. Recent studies showed that interleukin-27 (IL-27) appears to be a new accurate biomarker for TPE in adults and no related studies were reported in children. In this study, we aimed to evaluate the potential value of IL-27 in pediatric tuberculous pleurisy by detecting its levels in pleural fluid and serum.MethodsA total of 48 children with TPE and 64 children with severe Mycoplasma pneumoniae (MP) pneumonic effusion (SMPPE) were enrolled in this study. IL-27 concentrations were measured in serum and pleural fluid. The diagnostic yield of IL-27 was evaluated using receiver operating characteristic (ROC) curves.ResultsThe level of p-IL-27 in TPE showed statistically no significant difference when compared with SMPPE (p > 0.05). However, pleural fluid IL-27 (p-IL-27) / serum IL-27 (s-IL-27) ratio in TPE were significantly much higher than those in SMPPE (p < 0.05). By the analysis of the ROC curves, the diagnostic sensitivity and specificity of the p-IL-27/s-IL-27 ratio were 100% and 48.44%, respectively (cutoff value of 1.0280). The area under the ROC curve for p-IL-27/s-IL-27 was 0.7295.ConclusionPleural fluid IL-27 alone was not accurate in distinguishing pediatric TPE from SMPPE, which was different from the diagnostic value of IL-27 in adult studies due to the different disease spectra between children and adults. Our results implied that the p-IL-27/s-IL-27 ratio had a potential value in distinguishing TPE from SMPPE. However, the specificity of IL-27 was relatively lower and it is necessary to find a more specific marker in tuberculous pleurisy of children.

Background Mesenchymal stromal cells (MSCs) are heterogeneous populations. Heterogeneity exists within the same tissue and between different tissues. Some studies have found enormous heterogeneity in immunomodulatory function among MSCs derived from different tissues. Moreover, the underlying mechanism of heterogeneity in immunomodulatory abilities is still unclear. Methods Foreskin mesenchymal stromal cells (FSMSCs) and human umbilical cord mesenchymal stromal cells (HuMSCs) were isolated and cultured until the third passage. According to the International Association for Cell Therapy standard, we confirmed the cell type. Then, FSMSCs and HuMSCs were cocultured with human peripheral blood mononuclear cells (PBMCs) stimulated by lipopolysaccharide (LPS) in vitro. Furthermore, the supernatant was sampled for an enzyme-linked immunosorbent assay to investigate the secretion of IL-1β, IL-6, IL-10, TNF-α, and TGF-β1. Finally, we performed single-cell RNA sequencing (scRNA-seq) of FSMSCs and HuMSCs. Results We successfully identified FSMSCs and HuMSCs as MSCs. When cocultured with LPS pretreated PBMCs, FSMSCs and HuMSCs could effectively reduced the secretion of IL-1β and TNF-α. However, FSMSCs stimulated the PBMCs to secrete more IL-10, TGF-β1, and IL-6. Furthermore, 4 cell subsets were identified from integrated scRNA-seq data, including proliferative MSCs (MKI67+, CD146low+, NG2+, PDGFRB−), pericytes (CD146high+, PDGFRB+, MKI67−, CD31−, CD45−, CD34−), immune MSCs (CXCL12high+, PTGIShigh+, PDGFRB+, CD146−, MKI67−) and progenitor proliferative MSCs (CXCL12low+, PTGISlow+, PDGFRB+, CD146−, MKI67−). Among them, we found that immune MSCs with strengthened transcriptional activity were similar to pericytes with regard to the degree of differentiated. Various of immune-related genes, gene sets, and regulons were also enriched in immune MSCs. Moreover, immune MSCs were determined to be close to other cell subsets in cell–cell communication analysis. Finally, we found that the proportion of immune MSCs in foreskin tissue was highest when comparing the subset compositions of MSCs derived from different tissues. Conclusions FSMSCs show better immunomodulatory capacity than HuMSCs in vitro. Moreover, immune MSCs may play a vital role in the heterogeneity of immunoregulatory properties. This study provides new insights suggesting that immune MSCs can be isolated to exert stable immunoregulatory functions without being limited by the heterogeneity of MSCs derived from different tissues.

The early diagnosis of tuberculous pleural effusion (TPE) is challenging due to the difficulty of isolatingA total of 48 children with TPE and 64 children with severeThe level of p-IL-27 in TPE showed statistically no significant difference when compared with SMPPE (Pleural fluid IL-27 alone was not accurate in distinguishing pediatric TPE from SMPPE, which was different from the diagnostic value of IL-27 in adult studies due to the different disease spectra between children and adults. Our results implied that the p-IL-27/s-IL-27 ratio had a potential value in distinguishing TPE from SMPPE. However, the specificity of IL-27 was relatively lower and it is necessary to find a more specific marker in tuberculous pleurisy of children.

The hydrodynamics and water quality of a lake in response to human activities is an important yet poorly understood issue. In this study, the responses of flow field, water level, and water quality of the Hongze Lake to changes in land use, project operation, and pollution accident were investigated using the 2D hydrodynamic model, water quality model, and hydrological model. The results show that project operations have more significant effects on the hydrodynamics and water quality of the Hongze Lake than changes in land use. In addition, the construction and operation of various water conservancy projects could increase pollutant diffusion and water exchange, thus contributing to improve the water quality of the Hongze Lake, but there is a need to solve the problem of rising water level in the Lihe depression lake area. The increase of urban and farmland area can significantly affect the flow of the Hongze Lake that could increase the flood risk. The simulations of the loosely coupled model imply that the coupling among the hydrodynamic model, water quality model, and SWAT model for the lake basin is feasible. Furthermore, a model based on the space grid was proposed in the study and combined with the verified loosely coupled model to assess the flood risk in the Hongze Lake, which could improve water resources and flood retarding basin operations.

This paper used a long series of daily flow data of Ankang section from 1960 to 2020 to diagnose eco-hydrological variations in the upper reaches of the Hanjiang River. Aiming at the problems of the single hydrological variable used in watershed hydrological variation diagnosis, a method for extracting the most Ecologically Relevant Hydrologic Indicators (ERHIs) based on sensitive indicators of similar years and diagnosing the variation period was proposed. In this method, 32 hydrological indexes in the IHA index system were used to diagnose hydrological variation instead of the traditional single index, and the IHA index were refined into wet season index and dry season index based on different hydrological characteristics. Ten years were randomly selected from the long series flow data as the sample years and ten similar years corresponding to each sample year were selected for the determination of ERHIs. The indexes with strong variation were selected from ERHIs to diagnose hydrological variation. Through comprehensive variation diagnosis calculation, the indexes with strong variation were the annual average duration index of low flow and the annual minimum 1-day flow index, with the period of variation from 1973 to 1977, and from 1973 to 1986, respectively. Combined with the climate change and human activities in the past 60 years, it is found that the time period of climate change and water conservancy project construction is consistent with the time period diagnosed in this paper. Therefore, the variation period from 1973 to 1986 is reasonable. Through this study, it can be concluded that the method has strong practicability in the diagnosis of hydrological variation, and the conclusion is consistent with the practice, which can fully reflect the characteristics of hydrological changes in the Hanjiang River Basin.

Background Tuberculous pleural effusion (TPE) is often misdiagnosed as severe Mycoplasma pneumoniae pneumonic effusion (SMPPE) in children at early stage. The aim of this study was to develop a predictive model based on clinical and laboratory indices to make accurate differential diagnosis. Methods Patients included in this study were 167 children (83 patients with TPE and 84 with SMPPE), containing 117 patients for predictive model development and 50 patients for external validation. Multivariate logistic regression analysis was conducted to select potentially useful characteristics for discrimination of TPEs. External validation was performed for model evaluation. Results Multivariate analysis revealed that blood neutrophils and serum lactate dehydrogenase were significant independent factors to discriminate between TPEs and SMPPEs. The results indicated that blood neutrophils ≤69.6% and concentration of serum lactate dehydrogenase ≤297 U/L were the extremely important discrimination factors of TPEs. The area under the receiver operating characteristic curve of the model was 0.9839. The accuracy rate, sensitivity and specificity of the model were 94.02%, 98.28% and 89.83%, respectively. Meanwhile, the accuracy rate of the external validation from the 50 patients was 94.0%. Conclusions Applying a predictive model with clinical and laboratory indices can facilitate the differential diagnosis of TPE from SMPPE in children, which seems helpful when a microbiologic or histologic diagnosis of pleural tuberculosis could not be established.

Salivary virome is important for oral ecosystem, but there are few reports on people living with HIV. We performed metagenomic sequencing to compare composition and functional genes of salivary virobiota between one HIV-negative and four HIV-positive groups in which participants were all men who have sex with men (MSM) with different immunosuppression statuses (five samples per group) to find the evidence that salivary virobiota plays a role in the pathogenesis of oral disease. Acute-stage subjects achieved a positive result of HIV RNA, but HIV antibody negative or indeterminate, whereas individuals with mild, moderate, and severe immunosuppression exhibited CD4+ T-lymphocyte counts of at least 500, 200–499, and less than 200 cells/μL or opportunistic infection, respectively. The results showed the composition of salivary virus genera in subjects with mild immunosuppression was the most similar to that in healthy people, followed by that in the acute stage; under severe immunosuppression, virus genera were suppressed and more similar to that under moderate immunosuppression. Furthermore, abnormally high abundance of Lymphocryptovirus was particularly obvious in MSM with HIV infection. Analysis of KEGG Pathway revealed that Caulobacter cell cycle, which affects cell duplication, became shorter in HIV-positive subjects. It is worth noting that in acute-stage participants, protein digestion and absorption related to the anti-HIV-1 activity of secretory leukocyte protease inhibitor was increased. Moreover, in the severely immunosuppressed subjects, glutathione metabolism, which is associated with the activation of lymphocytes, was enhanced. Nevertheless, the ecological dysbiosis in HIV-positive salivary virobiota possibly depended on the changes in blood viral load, and salivary dysfunction of MSM infected with HIV may be related to CD4 counts. Ribonucleoside diphosphate reductase subunit M1 in purine metabolism was negatively correlated, though weakly, to CD4 counts, which may be related to the promotion of HIV-1 DNA synthesis in peripheral blood lymphocytes. 7-Cyano-7-deazaguanine synthase in folate biosynthesis was weakly positively correlated with HIV viral load, suggesting that this compound was produced excessively to correct oral dysfunction for maintaining normal cell development. Despite the limited number of samples, the present study provided insight into the potential role of salivary virome in the oral function of HIV infected MSM.

In recent years, a growing number of researchers have attempted to overcome the constraints of size and scope in different medical studies to find out the overall treatment effects. As a widespread technique to combine results of multiple studies, commonly used meta-analytic approaches for continuous outcomes demand sample means and standard deviations of primary studies, which are absent sometimes, especially when the outcome is skewed. Instead, the median, the extrema, and/or the quartiles are reported. One feasible solution is to convert the preceding order statistics to demanded statistics to keep effect measures consistent. In this article, we propose new methods based on maximum likelihood estimation for known distributions with unknown parameters. For unknown underlying distributions, the Box–Cox transformation is applied to the reported order statistics so that the techniques for normal distribution can be utilized. Two approaches for estimating the power parameter in Box–Cox transformation are provided. Both simulation studies and real data analysis indicate that in most cases, the proposed methods outperform the existing methods in estimation accuracy.

Background: Mesenchymal stromal cells (MSCs) and fibroblasts show similar morphology, surface marker expression, and proliferation, differentiation, and immunomodulatory capacities. These similarities not only blur their cell identities but also limit their application.Methods: We performed single-cell transcriptome sequencing of the human umbilical cord and foreskin MSCs (HuMSCs and FSMSCs) and extracted the single-cell transcriptome data of the bone marrow and adipose MSCs (BMSCs and ADMSCs) from the Gene Expression Omnibus (GEO) database. Then, we performed quality control, batch effect correction, integration, and clustering analysis of the integrated single-cell transcriptome data from the HuMSCs, FMSCs, BMSCs, and ADMSCs. The cell subsets were annotated based on the surface marker phenotypes for the MSCs (CD105+, CD90+, CD73+, CD45−, CD34−, CD19−, HLA-DRA−, and CD11b−), fibroblasts (VIM+, PECAM1−, CD34−, CD45−, EPCAM−, and MYH11−), and pericytes (CD146+, PDGFRB+, PECAM1−, CD34−, and CD45−). The expression levels of common fibroblast markers (ACTA2, FAP, PDGFRA, PDGFRB, S100A4, FN1, COL1A1, POSTN, DCN, COL1A2, FBLN2, COL1A2, DES, and CDH11) were also analyzed in all cell subsets. Finally, the gene expression profiles, differentiation status, and the enrichment status of various gene sets and regulons were compared between the cell subsets.Results: We demonstrated 15 distinct cell subsets in the integrated single-cell transcriptome sequencing data. Surface marker annotation demonstrated the MSC phenotype in 12 of the 15 cell subsets. C10 and C14 subsets demonstrated both the MSC and pericyte phenotypes. All 15 cell subsets demonstrated the fibroblast phenotype. C8, C12, and C13 subsets exclusively demonstrated the fibroblast phenotype. We identified 3,275 differentially expressed genes, 305 enriched gene sets, and 34 enriched regulons between the 15 cell subsets. The cell subsets that exclusively demonstrated the fibroblast phenotype represented less primitive and more differentiated cell types.Conclusion: Cell subsets with the MSC phenotype also demonstrated the fibroblast phenotype, but cell subsets with the fibroblast phenotype did not necessarily demonstrate the MSC phenotype, suggesting that MSCs represented a subclass of fibroblasts. We also demonstrated that the MSCs and fibroblasts represented highly heterogeneous populations with distinct cell subsets, which could be identified based on the differentially enriched gene sets and regulons that specify proliferating, differentiating, metabolic, and/or immunomodulatory functions.

Accurate assessments of potassium intake in children are important for the early prevention of CVD. Currently, there is no simple approach for accurate estimation of potassium intake in children. We aim to evaluate the accuracy of 24-h urinary potassium excretion (24UKV) estimation in children using three common equations: the Kawasaki, Tanaka and Mage formulas, in a hospital-based setting. A total of 151 participants aged 5–18 years were initially enrolled, and spot urine samples were collected in the whole 24-h duration to measure the concentrations of potassium and creatinine. We calculated the mean difference, absolute and relative difference and misclassification rate between measured 24UKV and the predicted ones using Kawasaki, Tanaka and Mage formulas in 129 participants. The mean measured 24UKV was 1193·3 mg/d in our study. Mean differences between estimated and measured 24UKV were 1215·6, −14·9 and 230·3 mg/d by the Kawasaki, Tanaka and Mage formulas, respectively. All estimated 24UKV were significantly different from the measured values in all the time point (all P < 0·05), except for the predicted values from Tanaka formula using morning, afternoon and evening spot urine. The proportions with relative differences over 40 % were 87·2%, 32·5% and 47·3 % for Kawasaki, Tanaka and Mage formulas, respectively. Misclassification rates were 91·5 % for Kawasaki, 44·4 % for Tanaka and 58·9 % for Mage formula at the individual level. Our findings showed that misclassification could occur on the individual level when using Kawasaki, Tanaka and Mage formulas to estimate 24UKV from spot urine in the child population.

Background: Mesenchymal stromal cells (MSCs) could be applied for the treatment of immune-related diseases. However, some studies have found there is enormous heterogeneity in immunomodulatory function of MSCs isolated from different tissue. At present, the underlying mechanism of heterogeneity in immunoregulatory function is still unclear. Methods: In this study, the foreskin mesenchymal stromal cells (FSMSCs) and human umbilical cord mesenchymal stromal cells (HuMSCs) were isolated and cultured to the 3rd passage. Cell types were confirmed according to the standard of International Association for Cell Therapy. Then, FSMSCs and HuMSCs were co-cultured with human peripheral blood mononuclear cells (PBMC) stimulated by lipopolysaccharides (LPS) in viro respectively. And the supernatant was sampled for enzyme-linked immunosorbent assay to investigate the secretion of IL-1β, IL-6, IL-10, TNF-α and TGF-β. Finally, single cell transcriptome sequencing was performed in order to elucidate the mechanism for the difference of immunomodulatory function.Results: FSMSCs and HuMSCs are successfully identified as MSCs. When co-cultured with LPS pre-treated PBMC, FSMSCs and HuMSCs could effectively reduce the secretion of IL-1β and TNF-α. But FSMSCs were able to stimulate the PBMC to secrete more IL-10, TGF-β and IL-6. Furthermore, 4 MSCs subsets in integrated data were identified, including Proliferative MSCs , Pericyte, Immune MSCs and Progenitor Proliferative MSCs. Among them, the proportions of Immune MSCs in FSMSCs and HUMSCs were 56% and 10% respectively. Varieties of immune-related genes, gene sets and regulons were enriched in Immune MSCs. And Immune MSCs with powful transcriptional activity were found to be near to Pericyte at the degree of differentiation and closed to other cell subsets. Finally, the foreskin tissue might be an ideal source of isolating Immune MSCs when comparing the subset composition of MSCs derived from adipose tissue and bone marrow from public database. Conclusions: Immune MSCs may play a key role in the heterogeneity of immunoregulatory function. It is a new insight that Immune MSCs could be isolated and better applied for the treatment of immune-related diseases without being limited by the heterogeneity of immunomodulatory function derived from different tissues.

Background:No previous study explored the association between serum calcium levels and dyslipidemia in children. This study aimed to explore this relationship in children, based on a multicenter cross-sectional study population in China.Methods:Cross-sectional data was derived from the Pediatric Reference Intervals in China (PRINCE) study conducted between 2017 and 2018 involving 5,252 males and 5,427 females with a mean age of 10.0 ± 4.6 years. Multivariable logistic regression models were applied to calculate odds ratios (ORs), with 95% confidence intervals (CIs), for dyslipidemia of each serum calcium level and albumin-corrected calcium levels, which were sorted into quartiles. The restricted cubic spline model was fitted for the dose-response analysis. An L-shaped dose-response relation between calcium levels and the probability of dyslipidemia was found after the adjustment for multiple potential confounding factors,pfor non-linear < 0.001.Results:Using the middle category of calcium level as the reference, multivariable-adjusted ORs and 95% CIs of the lowest and the highest quartile categories were 0.96 (0.82–1.12) and 1.29 (1.12–1.48), respectively, for total serum calcium levels and 1.06 (0.91–1.23) and 1.39 (1.21–1.60) for albumin-corrected calcium levels.Conclusions:Individuals with higher levels of serum calcium were associated with increased risk of dyslipidemia in a sample of a healthy Chinese pediatric population. The association between serum calcium levels and dyslipidemia needs to be examined prospectively in future studies.

Water resources are crucial for maintaining daily life and a healthy ecological environment. In order to gain a harmonious development among water resources and economic development in Lake Watershed, it is urgent to quantify the lake inflow. However, the calculation of inflow simulations is severely limited by the lack of information regarding river runoff. This paper attempts calculated inflow in an ungauged stream through use of the coupling water balance method and the Xin’anjiang model, applying it to calculate the inflow in the Chaohu Lake Basin, China. Results show that the coupled model has been proved to be robust in determining inflow in an ungauged stream. The error of daily inflow calculated by the water balance method is between 1.4 and −19.5%, which is within the standard error range (±20%). The calibration and verification results of the coupled model suggest that the simulation results are best in the high inflow year (2016), followed by the normal inflow year (2007) and the low inflow year (1978). The Nash-Sutcliffe efficiencies for high inflow year, normal inflow year, and low inflow year are 0.82, 0.72, and 0.63, respectively, all of which have reached a satisfactory level. Further, the annual lake inflow simulation in the normal inflow year is 19.4 × 108 m3, while the annual average land surface runoff of the study area is 18.9 × 108 m3, and the relative error is −2.6% by the two ways. These results of the coupled model offer a new way to calculate the inflow in lake/reservoir basins.

Inter-basin water transfer projects play an important role in allocating water resources that vary both in temporal and spatial scale while supporting regional development. In the practical operation of inter-basin water transfer projects, high water level and less inflow runoff would result in water supply destruction, while low water level and more inflow runoff would cause abandoned water. How to play the compensation roles of hydrological characteristics and storage capacities of multi-reservoirs to maximize the utilization efficiency of water resources, the key is to select the basis for the decision-making of starting water transfer process. In this paper, we selected the “Datong-Huangshui” water transfer project as the research subject, analyzed the composition of the inter-basin water transfer system, and constructed a dispatching rule extraction model including water transfer rules, water diversion rules, and water supply rules. Then the NSGA-II was used to solve the multi-objective optimization model to obtain the Pareto frontier solution set of the dispatching rules. Finally, the optimal operation scheme was determined and discussed according to the scheduling scheme decision model. The model itself was based on the gray target model and prospect theory. We found that: (1) The optimal target frontier obtained by the two-dimensional scheduling diagram and the hedging rules for water supply was closer to the theoretical optimal frontier of the multi-objective problem. This result indicated that the two-dimensional scheduling diagram and the hedging rules for water supply could better guide the water diversion operation of inter-basin water transfer projects. (2) Based on the multi-objective optimal operation schemes set, the OPT scheme obtained by the scheduling scheme decision model using gray target model and prospect theory could generate 359 million Kwh. At the same time, it could guarantee 90% of municipal and industrial water supply and 85% of agricultural water supply.

The variation of hydrological conditions in the basin affects the original stable state of the basin, and the change of eco-hydrological conditions also plays a decisive role in the stability of the basin. In this manuscript, Indicators of Hydrologic Alteration (IHA) was used to diagnose watershed variation from the eco-hydrological perspective, and a new diagnostic method was proposed in the current study, which was the extraction method of the most relevant eco-hydrological indicators based on a similar year sensitive index and the diagnosis method of variation period. This method used the sensitivity of statistical characteristics between similar years to provide the basis for the selection of the most ecologically-relevant hydrogeological indicators (ERHIs), then selected the strong variation indicators from the most relevant eco-hydrological indicators, and finally used the strong variation indicators to diagnose the watershed variation. The runoff data (1960 to 2020) in the Ankang gauging station of the Hanjiang River were analyzed, and the results showed that the indicators of high variation were the average duration index of low discharge in a year and the minimum discharge index of one day in a year. The variation period was from 1973 to 1986. It was concluded that the diagnosis results from the perspective of eco-hydrology were consistent with the actual hydrological situation changes, and this method had certain reliability.

The prediction of surface water resources in the Danjiangkou Basin is of great significance for the design of the water transfer plans for the South-to-North Water Diversion Project. However, it is difficult to obtain high-precision simulations for mid- and long-term hydrological forecasting. Based on the thought of extended streamflow prediction (ESP) and distributed hydrological models, this paper proposed a set of forecasting systems for predicting the annual surface water resources in the Danjiangkou Basin. Firstly, the Wetspa model was established to forecast the inflow of Danjiangkou reservoir. The Nash efficiency coefficients of the monthly average runoff during the calibration period (2006-2012) and verification period (2013-2016) were 0.97 and 0.95, respectively. Secondly, it was assumed that the rainfall of 2017 could be predicted by the rainfall forecasting model, then the rainfall process was obtained based on the ESP and the runoff process of the basin outlet was calculated through the Wetspa model. Finally, the predicted surface water resources of the Danjiangkou Basin in 2017 was 45.448 billion m3, and the actual surface water resources is 40.395 billion m3, with a relative error of 12.51%. The results showed that the prediction of surface water resources in Danjiangkou Basin based on ESP and distributed hydrological model could provide a certain reference for the design of water transfer plans of the Danjiangkou Reservoir.Key words: Water resources prediction; ESP; Wetspa model; Nash coefficient

In order to improve the accuracy of the inflow forecasting of Shiquan Reservoir in the Han River Basin, this paper compared the application effects of Xin'anjing model and Wetspa model. The study collected the rainfall and runoff data from 2009 to 2015, as well as the DEM, land use and soil data with 1000´1000m grid size. The model calibration and verification periods were from 2009 to 2012 and from 2013 to 2015, respectively. In addition to using the runoff depth and the determination coefficient to evaluate the accuracy of the two models, the flow relative error CR1, model confidence coefficient CR2, Nash-Sutcliffe efficiency CR3, logarithmic version of Nash-Sutcliffe efficiency CR4 for low flow, improved Nash-Sutcliffe efficiency CR5 for high flow were adopted to analyze the simulation results of the two models. The results showed that the simulation results of the Wetspa model could be used as a supplement to the simulation results of the Xin'anjiang model, providing high-precision flood forecasting results for the scheduling decisions of Shiquan Reservoir in terms of time and space.

Background The delayed diagnosis of neuroblastoma (NB) is common in China, which results in the prognosis of NB in China lagging behind that in developed countries. Methods A referral flowchart for suspected NB was implemented in nononcology clinics at Beijing Children's Hospital (BCH). Patients with symptoms of suspected NB were referred from nononcology clinics in BCH to oncology clinics and confirmed NB cases were regarded as referral group. The control group comprised patients initially diagnosed with NB who came directly to oncology clinics in BCH from other regions nationwide. The age at NB diagnosis was compared as primary outcome, and the 5-year overall survival (OS) and event-free survival (EFS) were compared via the Kaplan-Meier method and log-rank tests. Results In total, 3337 children with suspected NB were screened consecutively from 687 070 pediatric patients. Through examination of urine vanillylmandelic acid and homovanillic acid, or B-ultrasound, 102 of 3337 patients were referred to oncologists for comprehensive evaluations. Eventually, 29 referred patients were diagnosed as NB and the hospital-based diagnosis rate of NB was 4.2 per 100 000 visits. The median age at diagnosis in the referral group was 21.0 months, which was 9 months earlier than that of the control group (30.0 months, P = .026). The 5-year OS rate was 72.4% in the referral group, which was higher than that of the control group (66.7%) but without statistical significance (P = .664). Conclusion Delayed NB detection could be avoided by training pediatricians in nononcology clinics to detect suspected NB and refer these patients to oncologists.

Although retinoblastoma (Rb) is considered to have a good prognosis, economical stress is still a huge problem for patients' families. Besides, doctors, the government, and social foundation staff do not precisely know how much is truly required for complete Rb therapy, especially the non-medical costs and indirect costs. This study was conducted to estimate the economic burden of Rb patients.This was a retrospective study. Fifty Rb patients were finally enrolled in the study. The questionnaire survey was conducted with surviving Rb patient' main family caregivers to collect the information on costs during illness through the phone. Costs included direct and indirect cost; direct costs included medical and non-medical costs. Medical costs include drug costs, surgery costs, treatment fees, lab tests, non-lab tests costs, and medical consumptive stuff costs (including hospital expenses and outpatient fees).The total direct cost was $27,814.62 ± 15,137.73, and the average medical cost was $15,034.48 ± 8,224.19 ($3,963.99-36,826.53). The total non-medical expenses averaged $12,252.93 ± 9,872.64 ($728.86-48,104.95). The average reduced working time was 11.50 ± 8.06 months, and the average lost income was $13,512.23 ± 11,545.83. Among the non-medical expenses, the average non-medical expenses for children in Beijing and surrounding areas was $6,557.68 ± 6,385.42, and the average non-medical expenses for children in other provinces and was $14,502.29 ± 10,484.86,Children with Rb have a heavy economic burden. Direct non-medical expenses are higher. Getting medical treatment nearby can help reduce the economic burden of the disease. Besides, work-related issues are also a major financial problem for families with Rb, and the government should properly provide economic subsidies. Simplifying the national health insurance process and purchasing commercial supplementary medical insurance will increase the family's ability to afford the cost of cancer treatment.

Modeling the effects of atmospheric deposition on the water quality of the middle route of the South-to-North Water Diversion Project (MR-SNWDP) can provide a basis for scientific protection and optimal allocation of water resources. Considering the total nitrogen (TN) as a representative water quality index, this study analyzed the water quality variations along the MR-SNWDP and in the Miyun Reservoir under atmospheric deposition, using the hydrodynamic and environmental numerical models. The results in 2016 revealed that the atmospheric deposition significantly affected the water quality of the MR-SNWDP, and the effects of atmospheric deposition on the water quality of the middle route and Miyun Reservoir showed different variation rules. However, the clearer water from the MR-SNWMP would significantly deteriorate after storage in the Miyun Reservoir as the TN concentration increased significantly. Based upon the scenario analysis, it was found that the constant water diversion scheme helped reduce the effects of atmospheric deposition. Further, it is recommended that the storage amounts in the Miyun Reservoir should be as low as possible.

From 15 to 20 September 2016, precipitation extremes occurred in the middle and lower reaches of the Jinsha River, causing immense direct economic losses due to floods. The current research on extreme climate characteristics and the relationship between climate extremes and runoff extremes are based on a single data source. This is due to the uneven distribution of precipitation and temperature stations, which make it difficult to fully capture extreme climate events. In this paper, various internationally popular reanalysis datasets were introduced. Extreme climate indexes were computed using the merged datasets versus the meteorological station observations. The results showed that: (1) Comparative analysis of the extreme climate indexes of the reanalysis dataset and the data of traditional meteorological observation stations showed that most of the extreme precipitation indexes calculated by the various reanalysis of combined data exhibited good performances. Among the reanalyzed combined products, CMPA-H, CMADS, and GPM (IMERG) exhibited good performance while the performance of TRMM (TMPA) was slightly worse. The extreme temperature indexes, TXx and TNn, calculated based on the reanalysis of combined data showed a better consistency than the indexes calculated based on the observational data of meteorological stations. The CMADS temperature dataset exhibited a higher consistency with the data obtained from meteorological stations as well as the best accuracy (84% of the stations with the error value of TXx calculated from the CMADS dataset and observed data less than 3 °C). (2) The response of typical flood events to precipitation extremes were analyzed and evaluated; the spatial distribution of the precipitation in the combined dataset was used to quantitatively analyze the response of occurrence of typical flood events to precipitation extremes, and the typical flood events were found to be mainly caused by certain factors, such as lagging flood propagation in the upstream of the basin outlet. This study indicates that it is feasible to use the reanalyzed combined data products to calculate the extreme climate indexes of the Jinsha River Basin, especially in the upper reaches of the Yangtze River where there is a lack of meteorological observation stations.

Summary We investigated changes in anastomotic stricture indexes (SIs) and stricture diameter (SD) between before and 6 months after the first dilatation in children with anastomotic stricture after esophageal atresia (EA) repair and identified predictors of medium-term dilatation success (success for at least 3 months). We retrospectively reviewed the records and measurement indexes of patients who underwent post-EA repair endoscopic balloon dilatation between November 2017 and August 2019 in our hospital. We identified diagnostic and performance indicators that predicted medium-term dilatation success by univariate and multivariate analyses and receiver operator characteristic (ROC) curve analysis. Sixty patients (34 boys and 26 girls) showed post-EA repair anastomotic stricture. Paired sample t-tests showed that SD (P

Neuroblastoma (NB) is notorious in childhood cancer because of its high incidence and poor prognosis. The Children's Oncology Group reported that the 3-year OS in the high-risk (HR) group is 50%, and the HR-NB with bone marrow metastasis in our center is 43.1%. Thousands of families in China suffer from the cost of NB, but the true costs of therapy are unknown; to date, no study has ever performed a detailed therapy costs analysis for NB. The objective of this study was to assess the economic burden of NB treatment in children to the family, to ultimately reduce related expenses for patients and promote the establishment of NB management policy.Data in this cross-sectional study were collected via questionnaires completed by parents at the outpatient clinic and was verified via a computer system. Therapy costs of children with NB of differing risks were analyzed through descriptive statistics (1 CNY ≈ 0.1412 USD).Median direct medical costs of low risk (LR), middle risk (MR), and HR NB during treatment were 180.0 (120.0, 300.0), 200.0 (166.0, 300.0), and 650.0 (415.5, 850.0) thousand Chinese yuan (CNY), respectively. Direct non-medical costs including transportation, food, and accommodation were 60.0 (37.0, 100.0), 80.0 (60.0, 120.0), and 100.0 (80.0, 157.5) thousand CNY in the LR, MR, and HR groups, respectively. Additionally, parents accrued work absences to attend treatment, and lost a total of 100.0 (50.0, 150.0) thousand CNY in indirect costs.Families whose children had relapsed or died were excluded from this analysis and therefore limited the conclusions drawn. Parents were asked to recall costs since initial diagnosis (1-6 years in the past), but this extended time period may have introduced recall bias.Direct non-medical and indirect costs play an important role in the total treatment costs of NB. Children with NB treated in local hospitals and followed up in hospital specialized in childhood oncology may save many unnecessary expenses. China's healthcare system should establish mechanisms and provide financial support for children with NB.

Background Neuroblastoma (NB) tumor rupture is a rare oncology emergency with a poor prognosis. We aimed to evaluate patient clinical characteristics and risk factors for ruptured NB. Methods A retrospective study of 47 patients with confirmed NB rupture between January 2009 and January 2019 at Beijing Children’s Hospital was conducted. To identify tumor rupture risk factors in high-risk NB patients, we included 93 consecutive non-ruptured high-risk NB patients from January 2017 to January 2019. Results The median age at presentation was 29 months (adrenal and retroperitoneum origin) for 47 ruptured NB patients. Spontaneous tumor rupture occurred in 22 cases; 18 cases occurred during or after the first chemotherapy cycle, and 7 occurred after core needle biopsy. Five patients died of tumor rupture, and 17 patients’ parents refused further antitumor therapy. Among the 25 remaining patients, 6 survived without disease, 5 received ongoing treatment and achieved stable disease, and 14 died. According to multivariate logistic regression analysis, a maximum primary tumor diameter > 13.20 cm and MYCN gene amplification were independent risk factors for tumor rupture within high-risk NB. Conclusions Tumor rupture is an uncommon, life-threatening event for NB patients; these patients are most likely to have poor outcomes due to tumor recurrence or rapid progression. Several treatment modalities, including symptomatic support therapy and chemotherapy, are important for saving lives and for developing NB risk-based treatment in the future.

Background: Spiritual support should be offered to all patients and their families regardless of their affiliated status with an organized religion. Aim: To understand nonreligious theistic parents’ spirituality and to explore how parents discuss death with their terminally ill children in mainland China. Design: Qualitative study. Setting/participants: This study was conducted in the hematology oncology center at Beijing Children’s Hospital. Participants in this study included 16 bereaved parents. Results: Participants described themselves as nonreligious but showed a tendency toward a particular religion. Parents sought religious support in the face of the life-threatening conditions that affected their child and regarded the religious belief as an important way to get psychological and spiritual comfort after experiencing the death of their child. Religious support could partially address parents’ spiritual needs. Parents’ spiritual needs still require other supports such as bereavement services, death education, and family support groups. Some parents stated that it was difficult to find a way to discuss death with their children. For patients who come from nonreligious theistic families, their understanding of death was more complex and may be related to atheism. Conclusion: Religious support could be an element of spiritual support for nonreligious theistic parents of terminally ill children. Multiple strategies including religious supports and nonreligious supports should be rationally integrated into spiritual support of nonreligious theistic family. Patient’s personal belief in death should be assessed before discussing death with them.

Additional file 3: Supplementary Table 1. Multivariate logistic regression analysis.

Additional file 4: Supplementary Table 2. Comparison of clinical characteristics and prognosis between different causes of ruptured neuroblastoma groups.

Rare diseases have a low morbidity, include a wide variety of diseases, and involve a large number of people. However, because of the small sample size, high heterogeneity, and difficulty in recruiting, the research of rare diseases is difficult to carry out. This dilemma results in the lack of effective treatments for many rare diseases and the lack of high-quality efficacy and safety evidence of limited treatments. Therefore, it is of great significance to explore the design methods of clinical trials of rare disease. Recently, the breakthrough in methodology and the generation of new design methods provide a new clue for the clinical trials of rare diseases. The purpose of this paper is to introduce the innovative methods suitable for the clinical trials of rare diseases. We introduce four design methods according to their characteristics for researchers’ reference.

Pattern recognition receptors (PRRs) are employed in insects to defend against infectious pathogens by triggering various immune responses. Peptidoglycan recognition proteins (PGRPs), a vital family of PRRs, are widely distributed and highly conserved from vertebrates to invertebrates. To date, five PGRP genes have been identified in Antheraea pernyi , but their biochemical roles still remain unknown. In this study, we focused on the immune functions of PGRP-SA in A. pernyi ( Ap PGRP-SA), which was confirmed to be immune-related according to its significantly up-regulated expression level post microbial injection. In addition, the binding properties of Ap PGRP-SA were investigated using a recombinant protein produced in a prokaryotic expression system, revealing that r Ap PGRP-SA displayed a multi-binding ability to various microbes, including the Gram-positive bacteria Staphylococcus aureus and Micrococcus luteus , Gram-negative bacteria Escherichia coli and Pseudomonas aeruginosa , and fungus Candida albicans, together with their surface pathogen associated molecular patterns (PAMPs). Further studies showed that after recognition, the mixture of r Ap PGRP-SA/PAMP remarkably stimulated prophenoloxidase (PPO) activation in the hemolymph of A. pernyi in vitro , while the ds-PGRP-SA-treated hemolymph exhibited a lower sensitivity to PAMPs in comparison to the native sample. Moreover, the transcriptional level of the three antimicrobial peptides was also decreased in PGRP-SA knock-down larvae in response to immune-challenge. In summary, we conclude that Ap PGRP-SA is a novel identified PGRP in A. pernyi that might act as a broad-spectrum pattern recognition receptor and is involved in the PPO activation system as well as antimicrobial peptide production.

Background This study aims to explore the diagnostic accuracy of the combination of gamma-glutamyl transferase (GGT) and liver stiffness measurement (LSM) for biliary atresia (BA) screening at different ages. Methods Our retrospective study involved 282 infants under the age of 120 days with jaundice who were admitted into Beijing Children’s Hospital between January 2016 to December 2018. The GGT and LSM levels of infants were obtained. A parallel test was used, and ROC curve was created to obtain cutoff values of GGT and LSM for BA infants at different ages. Results Of the 282 infants, 135 were diagnosed with BA and 147 were non-BA infants. In all age groups (A: ≤60 days; B: 61–90 days; C: 91–120 days), the LSM and GGT levels of the BA group were significantly higher than that of the non-BA group, P Conclusions Cutoff values of GGT and LSM to screen BA increased with age. Parallel testing of GGT and LSM in infants who are younger than 90 days old can decrease the rate of BA misdiagnosis.

Importance: Childhood solid tumors account for the highest proportion of childhood cancers and are one of the leading causes of death in childhood. However, their pathogenesis is unclear. Objective: To explore prenatal and perinatal risk factors for solid malignancies in children. Methods: We enrolled 71 consecutive pediatric patients (44 boys and 27 girls; median age, 30 months) with solid tumors who were diagnosed and treated at our center from January 2013 to December 2016 as the case group. We also enrolled 211 age- and residence-matched healthy children (ratio of approximately 3:1 with the case group) as the control group. We conducted a questionnaire-based survey with the parents of these 282 children. Univariate and multivariate conditional logistic regression analyses of the collected data were performed. Results: Confirmed solid malignancies included neuroblastoma (n = 32), rhabdomyosarcoma (n = 18), retinoblastoma (n = 7), renal tumors (n = 3), and other tumors (n = 11). Risk factors for solid childhood tumors in the univariate analysis were the parents’ age, gravidity, parity, abortion history, vaginal bleeding, family history of malignancy, and prenatal use of folic acid or hematinics/iron supplements (P < 0.05), and those in the multivariate analysis were higher parity (odds ratio [OR], 2.482; 95% confidence interval [CI], 1.521–4.048), family history of malignancy (OR, 3.667; 95% CI, 1.679–8.009), and prenatal use of hematinics/iron supplements (OR, 2.882; 95% CI, 1.440–5.767). In contrast, use of prenatal folic acid was protective (OR, 0.334; 95% CI, 0.160–0.694). Interpretation: A family history of malignancy, use of prenatal hematinics/iron supplements, and higher parity are risk factors for solid childhood tumors, whereas use of prenatal folic acid is a protective factor. Key words: Case-control study; Children; Maternal; Perinatal; Risk factors; Solid malignancies

A kind of nitrogen-doped activated microporous carbon sphere/sulfur composite (NAMCS/S) is deliberately designed and prepared via a controllable solvothermal method and a liquid phase in-situ sulfur deposition technology. The structure characteristic and composition analysis of samples are conducted with X-ray photoelectron spectroscopy (XPS), elemental analysis (EA), field-emission scanning electron microscopy (FESEM) and high resolution transmission electron microscope (HRTEM). The electrochemical performances are characterized by galvanostatic charge-discharge (GCD), cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS) measurements. The results show that the nitrogen-doped activated microporous carbon spheres (NAMCS) present uniform spherical morphology, abundant nitrogen content of 9.64 wt%, and large specific surface areas of 1578.6 m2/g. Compared with the activated microporous carbon sphere/sulfur (AMCS/S) composite, the NAMCS/S composite with same sulfur loading of 64 wt% can deliver a higher initial capacity of 1004.6 mAh/g and a stable capacity retention of 79.1% after 100 cycles at 0.1 C rate as well as a remarkable Coulombic efficiency of 93% and relative low capacity decay of 0.2% per cycle. These effective improvements are attributed to the change of surface physicochemical property, chemical interaction between nitrogen functionality and polysulfides and the physical adsorption of abundant microporous structure.