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Abstract Acute respiratory distress syndrome (ARDS) in COVID‐19 is associated with high mortality. Mesenchymal stem cells are known to exert immunomodulatory and anti‐inflammatory effects and could yield beneficial effects in COVID‐19 ARDS. The objective of this study was to determine safety and explore efficacy of umbilical cord mesenchymal stem cell (UC‐MSC) infusions in subjects with COVID‐19 ARDS. A double‐blind, phase 1/2a, randomized, controlled trial was performed. Randomization and stratification by ARDS severity was used to foster balance among groups. All subjects were analyzed under intention to treat design. Twenty‐four subjects were randomized 1:1 to either UC‐MSC treatment (n = 12) or the control group (n = 12). Subjects in the UC‐MSC treatment group received two intravenous infusions (at day 0 and 3) of 100 ± 20 × 106 UC‐MSCs; controls received two infusions of vehicle solution. Both groups received best standard of care. Primary endpoint was safety (adverse events [AEs]) within 6 hours; cardiac arrest or death within 24 hours postinfusion). Secondary endpoints included patient survival at 31 days after the first infusion and time to recovery. No difference was observed between groups in infusion‐associated AEs. No serious adverse events (SAEs) were observed related to UC‐MSC infusions. UC‐MSC infusions in COVID‐19 ARDS were found to be safe. Inflammatory cytokines were significantly decreased in UC‐MSC‐treated subjects at day 6. Treatment was associated with significantly improved patient survival (91% vs 42%, P = .015), SAE‐free survival (P = .008), and time to recovery (P = .03). UC‐MSC infusions are safe and could be beneficial in treating subjects with COVID‐19 ARDS.

Introduction Youth firearm violence has been a growing problem in the USA. Several programs across the country aimed at reducing recurrent gun violence in this vulnerable population have published recidivism rates of 40% to 50%. For the past 18 years, the Juvenile Weapons Offenders Program (JWOP) in Miami-Dade County has provided a unique multidisciplinary intervention encompassing 100 hours of violence education, behavioral modification, and social mentoring. The present study defines its outcomes as a national model for youth firearm recidivism prevention.Methods Retrospective analysis of Florida Juvenile Justice Department records from 2008 to 2016 defined a group of youths convicted of firearm-related crimes and subsequently enrolled in the program. Cohorts were those who demonstrated successful completion of the JWOP program versus those who partially completed the program. At 6 and 12 months after release, records were cross-referenced with Florida Department of Justice criminal record system to prospectively capture rates of new all-comer and firearm-specific criminal charges.Results 215 youth were included in the prospectively followed cohort at 6 months and 163 youth followed at 12 months after release. The 6-month recidivism rate for any criminal charge was 20.1% for program completers versus 32.9% for those who did not complete the program (p=0.047). When excluding unarmed criminal offenses, the recidivism rate dropped to 10.1% versus 22.4%, respectively (p=0.008). At 12 months, all-comers recidivism was 33.6% for the GATE program completion cohort versus 50% for the incomplete cohort (p=0.045). When excluding unarmed offenses, the recidivism rates were 18.6% versus 33.9%, respectively (p=0.035).Conclusion The JWOP program has one of the lowest recidivism rates for reoffense for firearm and non-firearm-related offenses. Further investigation into details of the program’s efficacy and its applicability for expansion to other state and national jurisdictions should serve a model for decreasing youth gun violence across the country.

Enrique Ginzburg1, Alvin Lin2, Michael Sigler1, Denise Olsen2, Nancy Klimas1, Alan Mintz21University of Miami Miller School of Medicine, Miami, Florida, USA; 2Cenegenics® Medical Institute, Las Vegas, Nevada, USABackground: Age-related declines in testosterone and growth hormone (GH) are associated with increased adiposity and decreases in lean mass and bone mineral density (BMD). A long-term retrospective study examined the effects of testosterone and/or GH supplementation on body composition and quality of life (QoL).Methods: A database survey assessed the records of 91 men and 97 women (ages 25–82) in treatment groups based on their hormonal status: dehydroepiandrosterone but no hormonal supplementation (control); testosterone only (Tes); GH only (GH); and testosterone plus GH (Tes+GH). Pre- and post-treatment assessments recorded changes in fat and lean mass, BMD, and QoL.Results: After an average of 3 years of treatment, weight decreased in women in the control and Tes+GH groups but remained stable in men in all groups. Tes and Tes+GH produced statistically significant increases in lean mass, reductions in fat mass, and improvements in BMD in both sexes; GH produced similar changes in women. QoL and mood improved in all groups. Treatments were generally safe and well tolerated.Conclusions: In this retrospective survey, treatment with testosterone and/or GH was associated with favorable effects in men and women across a wide age range.Keywords: testosterone, growth hormone, body composition, quality of life

Massive splenic infarction (MSI) is a rare phenomenon that results from compromised blood flow to more than half of the spleen. Causes of MSI include hematological disorders, coagulopathies, infection, and embolization, and, rarely, MSI is spontaneous. The mainstay of treatment is splenectomy. We report the case of a 50-year-old man with a history of renal transplant who presented with diffuse abdominal pain and rapidly developed septic shock. A computed tomographic study (CT scan) of the abdomen demonstrated MSI. The surgical team was consulted for splenectomy but conservative management was maintained and immune function preserved. The patient’s clinical condition was resolved over a three-week period. This report demonstrates successful nonoperative management of a spontaneous MSI most likely secondary to hypoperfusion and a hypercoagulable state from both septic shock and renal transplant.

Venous thromboembolic event after traumatic brain injury represents a unique clinical challenge. Physicians must balance appropriate timing of chemoprophylaxis with risk of increased cerebral hemorrhage. Despite an increase in the literature since the 1990s, there are clear disparities in treatment strategies. This review discusses the prominent studies and subsequent findings regarding the topic with an attempt to establish recommendations using the existing evidence-based literature.