Background and objectivesDuring the coronavirus disease 2019 outbreak, the treatment of families with children on long-term KRT is challenging. This study was conducted to identify the current difficulties, worries regarding the next 2 months, and mental distress experienced by families with children on long-term KRT during the coronavirus disease 2019 outbreak and to deliver possible management approaches to ensure uninterrupted treatment for children on long-term KRT.Design, setting, participants, & measurementsA multicenter online survey was conducted between February 10 and 15, 2020, among the families with children on long-term KRT from five major pediatric dialysis centers in mainland China. The primary caregivers of children currently on long-term KRT were eligible and included. Demographic information, severe acute respiratory syndrome coronavirus 2 infection status, current difficulties, and worries regarding the next 2 months were surveyed using a self-developed questionnaire. The Patient Health Questionnaire-9 and the General Anxiety Disorder Scale-7 were used to screen for depressive symptoms and anxiety, respectively.ResultsAmong the children in the 220 families included in data analysis, 113 (51%) children were on dialysis, and the other 107 (49%) had kidney transplants. No families reported confirmed or suspected cases of coronavirus disease 2019. Overall, 135 (61%) and 173 (79%) caregivers reported having difficulties now and having worries regarding the next 2 months, respectively. Dialysis supply shortage (dialysis group) and hard to have blood tests (kidney transplantation group) were most commonly reported. A total of 29 (13%) caregivers had depressive symptoms, and 24 (11%) had anxiety. After the survey, we offered online and offline interventions to address their problems. At the time of the submission of this paper, no treatment interruption had been reported.ConclusionsThe coronavirus disease 2019 outbreak has had physical, mental, logistical, and financial effects on families with children on long-term KRT.

Background The high prevalence of erectile dysfunction (ED) in patients with type 2 diabetes mellitus (DM2) is a challenging clinical problem. Researches on extracellular vesicles from urine‐derived stem cells (USC‐EVs) have shown that they have significant therapeutic effects in a variety of diseases by injection including ED. Hyaluronic acid (HA) is especially useful for delivering bioactive molecules. This study investigated the effects and related mechanisms of local administration of human USC‐EVs combined with HA (USC‐EVs‐HA) on a rat model of DM2ED. Methods UCSs were extracted from human urine samples and identified for preparation of the corresponding USC‐EVs. The effects of high glucose and USC‐EVs on human umbilical vein endothelial cells (HUVECs) were assessed in vitro using a CCK‐8 assay to determine cell proliferation and pick the most appropriate concentration for subsequent experiments. Scratch and tube formation assays were performed to assess the function of HUVECs. Quantitative real‐time polymerase chain reaction (PCR) was used to detect the expression of genes such as B‐cell lymphoma‐2 (Bcl‐2), Bcl‐2‐associated X protein (BAX), and superoxide dismutase‐2 (SOD2). HA, USC‐EVs, and USC‐EVs‐HA were prepared at concentrations and then administered topically to DM2ED rats multiple times. Intracavernous pressure and mean arterial pressure were measured to assess erectile function in rats. Masson, Tunel, Immunohistochemistry, and Western blot analysis were performed to assess the fibrosis and endothelial function in corpus cavernosum, respectively. Results Compared with the control group, the proliferation, migration ability, and tube‐forming ability of HUVECs decreased in high glucose environment, while USC‐EVs could optimize the function of HUVECs, reverse the expression of apoptotic genes, and enhance the antioxidant capacity. USC‐EVs‐HA showed improvement in ED compared to the HA and USC‐EVs groups, and the 10‐dose group was better than the 5‐dose group. Histologically, the USC‐EVs‐HA group significantly improved apoptosis, angiogenesis, and smooth muscle regeneration in the corpus cavernosum compared to the HA group. Conclusions The topical application of USC‐EVs‐HA in the treatment of DM2ED rats has been proved effective. The potential mechanism might to promote the proliferation of endothelial cells and smooth muscle in the corpus cavernosum, which leads to the remodeling of erectile function. And multiple dosing at intervals may make the effect more pronounced.

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Based on published research on the combined cognitive behavioral therapy (CBT) versus drug therapy alone in children with attention deficit/hyperactivity disorder (ADHD), we systematically reviewed and analyzed the efficacy of two treatment methods in children with ADHD. The literature as at the end of 10 July 2017 in multiple databases was systematically searched. Standardized mean differences (SMD) and 95% confidence intervals (CIs) were calculated. The results indicated that combined CBT therapy was efficacious in reducing symptoms of ADHD (SDM [Formula: see text]0.48, 95% CI [Formula: see text]0.80 to [Formula: see text]0.17). The executive function scores were not improved more in the combined CBT (SMD [Formula: see text]0.34; 95% CI [Formula: see text]0.71 to 0.03). This study suggests that combined CBT seems more efficacious in some domains affecting children with ADHD, but further evaluation is needed.