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Tsukasa Kuwana, Kosaku Kinoshita, Marina Hirabayashi, Shingo Ihara, Nami Sawada, Tomokazu Mutoh, Junko Yamaguchi Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo, JapanCorrespondence: Kosaku KinoshitaDivision of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamichou Itabashi-ku, Tokyo, JapanTel +81-3-3972-8111Fax +81-3-5995-1069Email kinoshita.kosaku@nihon-u.ac.jpAbstract: Hypercytokinemia induced by coronavirus disease-19 (COVID-19) is associated with severe pulmonary involvement, which may lead to respiratory failure. These conditions play an important role in the worsening of clinical symptoms in patients with severe COVID-19. There is no established treatment for hypercytokinemia. We report on two patients whose clinical symptoms improved after direct hemoperfusion using polymyxin B-immobilized fiber column (PMX-DHP), following the administration of the anti-inflammatory agent tocilizumab. Case A was a 70-year-old man diagnosed with COVID-19 pneumonia. Despite treatment with ciclesonide and favipiravir, supplemental oxygen was administered due to the worsening of dyspnea with tachypnea. Although tocilizumab was started on day 6, the patient deteriorated into deoxygenation, presenting with the PaO2/FIO2 (P/F) ratio of 92. On days 8 and 10, the patient received PMX-DHP therapy. On day 11, his dyspnea improved. On day 13, his P/F ratio began to improve, and oxygen therapy was discontinued on day 18. The patient recovered without requiring mechanical ventilation. Case B was a 70-year-old man diagnosed with COVID-19 pneumonia and treated with favipiravir, starting on day 0. Despite starting ciclesonide inhalation and tocilizumab on day 2, his P/F ratio was 53. On day 5, he received PMX-DHP therapy. On day 6, his dyspnea improved, as did his P/F ratio, reaching 81 on day 8. Finally, his clinical symptoms resolved, and he was discharged from the intensive care unit without requiring mechanical ventilation. These cases indicate that PMX-DHP therapy might be a suitable treatment option for dyspnea and deoxygenation in COVID-19 pneumonia, especially in cases where an anti-inflammatory agent, such as tocilizumab, has failed to achieve the desired effect.Keywords: blood cytokine, hypercytokinemia, P/F ratio, respiratory failure, tocilizumab

Matthew Hirabayashi,1,2 Gurpal Virdi,1 Joshua King,1 Dayeong Lee,1 Van Nguyen,1,2 Jella An1,2 1School of Medicine, University of Missouri, Columbia, MO, USA; 2Mason Eye Institute, Department of Ophthalmology, University of Missouri, Columbia, MO, USACorrespondence: Jella AnMason Eye Institute, Department of Ophthalmology, University of Missouri, 3215 Wingate Court, Columbia, MO 65201, USATel +1 573-884-1311Fax +1 573-884-3330Email anja@health.missouri.eduPurpose: To determine the effect of Kahook Dual Blade goniotomy with phacoemulsification (Phaco-KDB) compared to phacoemulsification alone (Phaco) on surgically induced astigmatism (SIA).Design: Prospective study.Participants: Forty eyes of 28 patients treated with Phaco-KDB and 20 eyes of 13 patients treated with Phaco between 12/27/16 and 7/23/19 with a minimum 1 month follow-up were prospectively enrolled.Methods: Corneal astigmatism was assessed pre- and post-operatively using the simulated K (simK) values from the Pentacam Holladay report.Main Outcome Measures: SIA was compared between Phaco-KDB and Phaco groups using mean magnitude SIA, rate of ≥ 0.50 D SIA, and SIA centroids.Results: The difference in mean magnitude SIA was not statistically significant between Phaco-KDB and Phaco (mean = 0.28 D and 0.25 D, respectively, P = 0.621). The difference in the rate of ≥ 0.50 D SIA was not statistically significant between Phaco-KDB and Phaco (11.6% and 10.0%, respectively, P = 1.00). The SIA centroid for Phaco-KDB was 0.05 D @ 51° ± 0.40 D and 0.07 D @ 3° ± 0.32 D for Phaco.Conclusion: Neither the mean magnitude SIA nor the rate of astigmatic change ≥ 0.50 D was significantly different between Phaco-KDB and Phaco groups. SIA centroids between groups showed comparable and negligible effect on corneal astigmatism. KDB combined with phacoemulsification may not significantly affect SIA compared to phacoemulsification alone based on postoperative topography and is likely an astigmatically neutral procedure.Keywords: KDB, astigmatism, MIGS, surgically induced astigmatism

Dayeong Lee,1 Joshua King,1 Samuel Thomsen,1,2 Matthew Hirabayashi,1 Jella An1,2 1School of Medicine, University of Missouri School of Medicine, Columbia, MO, USA; 2Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, MO, USACorrespondence: Jella AnMason Eye Institute - University Eye Institute East, 3215 Wingate Court, Columbia, MO 65201, USATel +1573-529-1077Fax +1573-884-4868Email anja@health.missouri.eduPurpose: To compare 6-month surgical outcomes of patients who underwent phacoemulsification (Phaco) combined with iStent implantation (iStent) versus excisional goniotomy using Kahook Dual Blade (KDB).Methods: Retrospective comparative case series of 58 iStent-Phaco eyes and 44 KDB-Phaco eyes operated upon by a single surgeon between 2016 and 2018. Preoperative, intraoperative, and postoperative intraocular pressure (IOP) and IOP-lowering medication data were collected. The primary outcome was the proportion of eyes using ≥1 fewer IOP-lowering medication at Month 6 while maintaining IOP ≤ 18 mmHg.Results: Baseline IOP was 17.2 (standard error 0.7) in the KDB-Phaco group using a mean of 1.9 (0.2) medications; at Month 6, mean IOP was 14.8 mmHg P=0.002) on 1.0 (0.2) medications (P0.05). Significantly more KDB-Phaco eyes than iStent-Phaco eyes (43.2% vs 17.2%, P=0.004) were using ≥1 fewer medications while maintaining IOP ≤18 mmHg at Month 6. Adverse events were uncommon and similar in nature and frequency between groups with the exception that more KDB-Phaco eyes than iStent-Phaco eyes (8 [18.2%] versus 1 [1.7%]) experienced an IOP elevation presumed to be related to steroid use.Conclusion: KDB-Phaco and iStent-Phaco provided comparable IOP and medication reductions. The proportion of eyes able to discontinue 1 or more medications while maintaining IOP ≤ 18 mmHg was significantly greater in eyes undergoing KDB-Phaco.Keywords: glaucoma, intraocular pressure, minimally invasive glaucoma surgery, iStent, Kahook Dual Blade

Quantifying the ejecta thickness distribution from complex craters is key to understanding surface‐evolving processes on Ceres. Using the Park et al. (2019, https://doi.org/10.1016/j.icarus.2018.10.024) shape model, we estimated the ejecta thickness of five complex craters located in Ceres' equatorial region by analyzing 1,778 smaller, simple craters in their continuous ejecta deposits. In addition, we constrained their rim‐crest ejecta thickness following Sharpton (2014, https://doi.org/10.1002/2013JE004523). The ejecta thicknesses range from ∼3 to 73 m and ∼96–223 m around complex craters and at their rim crest localities, respectively. We find that ejecta thicknesses on Ceres are thinner than those on the Moon. Meltwater likely facilitates thin ejecta deposits on Ceres, given that fluid pressure conditions allow transient liquid water stability at shallow depths (∼1.8 m). Such water must be short‐lived because the atmospheric pressure on Ceres is too low (≳2.09 × 10−8 Pa) to allow a stable liquid phase. Our findings are consistent with previous work that ascribes fluidized appearing ejecta morphologies to the melting of subsurface water ice. Plain Language Summary: Understanding how thin ejecta are deposited and redistributed is important to provide insights into crater erasure processes that occur throughout Ceres' geological history. Using high‐resolution surface elevation data, we estimated the thickness of ejecta deposits from five complex craters around Ceres' equator. Comparing our results with cases estimated for ejecta deposits on the Moon suggests that ejecta deposits are thinner on Ceres. Water ice present at depth may be melted upon impact, which causes ejecta to act as a fluid and form thin deposits. This is possible given that on Ceres, pressures allow stable conditions for liquid water at shallow depths. Meltwater present at shallow depths is short‐lived because surface atmospheric pressures are too low to allow a stable liquid phase. Key Points: On Ceres, ejecta thickness ranges from ∼3 to 73 m on ejecta deposits and ∼96–223 m at crater rimsBased on both covariance ellipse statistical analysis and outcrop measurements, ejecta deposits are thinner compared to the MoonFluidization of ejecta causes thin deposits due to transient meltwater stability at shallow‐depth (∼2 m‐deep) fluid pressure conditions (611 Pa) [ABSTRACT FROM AUTHOR]

Lunar water is redistributed by various processes. Topographic diffusion affects the transport of water and contributes to its preservation in subsurface layers. Here, we analyze 16 complex craters (∼3.2 – ∼4.2 Ga) larger than 20 km in diameter near the lunar south pole to quantify their degradation states. The results show that the diffusive rates of late Imbrian craters are similar to those of similarly aged simple craters, while Nectarian and pre‐Nectarian craters are degraded less efficiently. Within a complex crater, the mass accumulation by topographic diffusion and ejecta blankets from other complex craters preserves water, ranging up to 1 wt% on average. However, impact mixing and internal heat further limit the stability of ancient water to subsurface regions with ages younger than 3.9 Ga and at depth from a few meters to 10s of meters. Plain Language Summary: Water in lunar shadowed regions is redistributed by various processes. When small craters form on a large crater's wall, its topography gradually erodes. Surface materials and deposited water move downhill, leading to a mixture of these materials and accumulations on the complex crater's floor. Here, we analyze 16 complex craters older than 3.2 Ga and larger than 20 km in diameter near the lunar south pole to investigate how fast these complex craters are topographically eroded. The results show that the speeds of topographic degradation of craters with an age of ∼3.2 Ga are comparable to those of similarly aged simple craters, while older craters experience significant degradation but are diffused inefficiently. On a complex crater, water may be stored in accumulated mass by topographic diffusion and large ejecta blankets for a long time. Such accumulated regions may host water, ranging up to 1 wt%. However, impact mixing and internal heat compete against the water supply and storage, limiting the water existence in subsurface layers at 10s of meters but a few meters below the surface and younger than 3.9 Ga. Key Points: Topographic degradation of 16 complex craters near the lunar south pole significantly varies with surface age and crater sizeMass wasting by topographic diffusion and ejecta blanketing mixes water with regolith, giving a water mass fraction of up to 1 wt%Impact mixing and internal heat limit the existence of unaffected ancient water at 10s of meters in depth and younger than 3.9 Ga [ABSTRACT FROM AUTHOR]

Aims: To investigate the usefulness of ultrasound biomicroscopy for evaluating changes in the ciliary body in patients with Vogt-Koyanagi-Harada disease. Methods: Ultrasound biomicroscopy was used to evaluate 14 eyes of [...]

Crater morphology and surface age of asteroid (162173) Ryugu are characterized using the high‐resolution images obtained by the Hayabusa2 spacecraft. Our observations reveal that the abundant boulders on and under the surface of the rubble‐pile asteroid affect crater morphology. Most of the craters on Ryugu exhibit well‐defined circular depressions, unlike those observed on asteroid Itokawa. The craters are typically outlined by boulders remaining on the rim. Large craters (diameter > 100 m) host abundant and sometimes unproportionally large boulders on their floors. Small craters (<20 m) are characterized by smooth circular floors distinguishable from the boulder‐rich exterior. Such small craters tend to have dark centers of unclear origin. The correlation between crater size and boulder number density suggests that some processes sort the size of boulders in the shallow (<30 m) subsurface. Furthermore, the crater size‐frequency distributions (CSFDs) of different regions on Ryugu record multiple geologic events, revealing the diverse geologic history on this 1‐km asteroid. Our crater‐counting analyses indicate that the equatorial ridge is the oldest structure of Ryugu and was formed 23–30 Myr ago. Then, Ryugu was partially resurfaced, possibly by the impact that formed the Urashima crater 5–12 Myr ago. Subsequently, a large‐scale resurfacing event formed the western bulge and the fossae 2–9 Myr ago. Following this process, the spin of Ryugu slowed down plausibly due to the YORP effect. The transition of isochrons in a CSFD suggests that Ryugu was decoupled from the main belt and transferred to a near‐Earth orbit 0.2–7 Myr ago. Plain Language Summary: Japan's asteroid explorer Hayabusa2 visited the carbon‐rich, 1‐km asteroid named Ryugu. One of the onboard cameras took many pictures of asteroid's surface. In order to know the history of this asteroid, we estimate the age of different geologic units by counting craters. We also documented how the craters on this asteroid look, to help understand the geology of the carbon‐rich world. We found that the mountain range running along the equator formed 23‐30 million years ago. About 5–12 million years ago, the meteorite impact that formed the biggest crater on this asteroid likely scattered soil around, erasing nearby craters that existed before. Then, about 2–9 million years ago, the western half of this asteroid was wiped out by a large‐scale movement of rocks and pebbles that build this asteroid, because the asteroid was spinning fast and unstable at that time. Then, sometime between 0.2 and 7 million years ago, this asteroid left the home of asteroids located between Mars and Jupiter orbits, and came to the orbit passing near the Earth. During its journey to the near‐Earth orbit, the spin of the asteroid slowed down because of the very weak but effective force by heat radiation from surface rocks. Key Points: Craters on asteroid Ryugu are documented and counted based on the high‐resolution images obtained with Hayabusa2's telescopic cameraCrater morphology on Ryugu ranges from distinct >100‐m circular depressions to <10 m smooth texture outlined by bouldersCrater chronology reveals multiple resurfacing events on each hemisphere 2–12 Myr ago and Ryugu's departure from the main belt <7 Myr ago [ABSTRACT FROM AUTHOR]

We update an analytic impact gardening model (Costello et al., 2018, https://doi.org/10.1016/j.icarus.2018.05.023) to calculate the depth gardened by impactors on the Moon and Mercury and assess the implications of our results for the age, extent, and source of water ice deposits on both planetary bodies. We show that if the water presently on the Moon has a primordial origin, it may have been 4–15 m thick. If ice deposits are buried, they may be as shallow as 3 cm or as deep as 10 m and provide a gradient of probability for ice gardened into a column. Our calculations for gardening on Mercury show that thermal lag deposits will be reworked into the background over 200 Myr, and, thus, the most recent large‐scale deposition of ice on Mercury must have occurred no more than 200 Myr ago. We also find that gardening mixes incremental layers of ice with underlying regolith and prevents the growth of pure ice deposits by continuous supply. We conclude that ice deposits on the Moon and Mercury are likely the result of sudden and voluminous deposition. Plain Language Summary: The Moon and Mercury have water ice in permanently shadowed regions at their poles; however, while Mercury's poles are rich in water ice, the Moon's are relatively sparse. Impact cratering mixes surface material, bringing buried ice upward to a relatively hostile surface in a process called "impact gardening." We apply a revised impact gardening model to investigate the depth from which ice is mixed upward by impacts as a function of time and discover the following: (1) Ice on the Moon may have been mixed with underlying regolith or buried under many meters of dry regolith; (2) the most recent large‐scale delivery of water to Mercury happened no more than 200 Myr ago; (3) what ice exists at the poles of the Moon and Mercury was probably delivered suddenly and voluminously; and (4) the differences between the abundance of water ice on the Moon and Mercury will only become more pronounced with time as impact gardening destroys surface ice on the Moon and only scratches the surface of Mercury's extensive deposits. Key Points: Secondary cratering dominates impact gardening in the top few metersWater ice on the Moon may be billions of years oldWater ice on Mercury is no more than 200 million years old [ABSTRACT FROM AUTHOR]

The Hayabusa2 spacecraft arrived at the near-Earth carbonaceous asteroid 162173 Ryugu in 2018. We present Hayabusa2 observations of Ryugu’s shape, mass, and geomorphology. Ryugu has an oblate “spinning top” shape, with a prominent circular equatorial ridge. Its bulk density, 1.19 ± 0.02 grams per cubic centimeter, indicates a high-porosity (>50%) interior. Large surface boulders suggest a rubble-pile structure. Surface slope analysis shows Ryugu’s shape may have been produced from having once spun at twice the current rate. Coupled with the observed global material homogeneity, this suggests that Ryugu was reshaped by centrifugally induced deformation during a period of rapid rotation. From these remote-sensing investigations, we identified a suitable sample collection site on the equatorial ridge. [ABSTRACT FROM AUTHOR]

Background: Trappin‐2/pre‐elafin is an endogenous inhibitor of human neutrophil elastase involved in inflammation, innate immunity and vascular remodelling, which consist of the complex pathological process of systemic sclerosis (SSc). Objectives: To clarify the potential role of trappin‐2 in SSc. Methods: Serum trappin‐2 levels were determined by enzyme‐linked immunosorbent assay in 51 SSc and 18 healthy subjects. Trappin‐2 expression was evaluated in SSc lesional skin and cultured endothelial cells treated with FLI1 siRNA by immunohistochemistry, reverse transcription‐real‐time PCR and/or immunoblotting. Friend leukaemia virus integration 1 (Fli1) binding to the PI3 promoter was assessed by chromatin immunoprecipitation. Results: Since serum trappin‐2 levels inversely correlated with estimated glomerular filtration rate in SSc patients with renal dysfunction, SSc patients with normal renal function were analysed. Although serum trappin‐2 levels were comparable between diffuse cutaneous SSc, limited cutaneous SSc and control subjects, the prevalence of digital ulcers or elevated right ventricular systolic pressure (RVSP) was significantly higher in SSc patients with elevated serum trappin‐2 levels than in those with normal levels. Furthermore, serum trappin‐2 levels were significantly increased in SSc patients with digital ulcers or elevated RVSP compared to those without. Moreover, serum trappin‐2 levels positively correlated with RVSP values in SSc patients. Importantly, trappin‐2 expression was enhanced in small vessels of SSc lesional skin. In cultured endothelial cells, trappin‐2 expression was elevated by gene silencing of FLI1 at mRNA and protein levels and Fli1 occupied the PI3 promoter. Conclusions: Endothelial trappin‐2 up‐regulation partially due to Fli1 deficiency can be associated with the development of SSc vasculopathy. [ABSTRACT FROM AUTHOR]

This paper investigates the plausible mass shedding from the surface of Didymos A, the primary of Near-Earth binary asteroid 65803 Didymos, and the subsequent orbital evolution of the shedding debris. Shedding conditions are derived semi-analytically. The unstable surface area on Didymos A is determined by combining the analyses and numeric results of SSDEM simulations. We show the observation-based model gives a highly unstable surface for Didymos A. In particular, most of the equatorial ridge is unattachable for cohesionless regolith, and an active region emerges along the ridge, in which extensive avalanches that cause surface mass shedding seem likely to happen. We track the ballistic motion of shedding debris from the unstable area. Month-long simulations show the diverse evolutions of sample particles with different sizes, due to the varying magnitude of solar radiation pressure. Statistics on the dynamical fates of shedding debris give clues on the current development of this binary system. Depending on the observation-based reference model, we find a vast majority of the shedding mass is finally transferred to Didymos B and thus leads to a cumulative growth. The cumulated mass may cause a spiralling-in motion of Didymos B, and the spiralling-in speed depends on the frequency and magnitude of mass shedding. A topography dependence of the mass shedding/transfer is also noticed that the cumulated mass mostly originates from highly elevated regions of the ridge areas. Long term it suggests that the shedding processes prefer to erode the bulges first and force the equatorial ridge to evolve into good roundness. [ABSTRACT FROM AUTHOR]