Hydromorphone precipitating serotonin syndrome

Opioid medications are an underappreciated cause of serotonin syndrome. Fentanyl, meperidine, and methadone are more commonly associated with this potentially life-threatening side effect. Here, we present the case of a 60-year-old man taking duloxetine, oxycodone as needed, and long-acting hydromorphone for chronic pain, who developed serotonin syndrome two days after his hydromorphone dose was increased. Due to severe agitation he required intubation and his course was notable for marked adrenergic instability. Eventually, he improved after treatment with benzodiazepines and cyproheptadine. This case highlights a rare synergistic effect from the combination of hydromorphone, duloxetine, and oxycodone resulting in serotonin syndrome.Includes bibliographical reference

Critical phenomena in gravitational collapse of Husain-Martinez-Nunez scalar field

We construct analytical models to study the critical phenomena in gravitational collapse of the Husain-Martinez-Nunez massless scalar field. We first use the cut-and-paste technique to match the conformally flat solution ($c=0$ ) onto an outgoing Vaidya solution. To guarantee the continuity of the metric and the extrinsic curvature, we prove that the two solutions must be joined at a null hypersurface and the metric function in Vaidya spacetime must satisfy some constraints. We find that the mass of the black hole in the resulting spacetime takes the form $M\propto (p-p^*)^\gamma$, where the critical exponent $\gamma$ is equal to $0.5$. For the case $c\neq 0$, we show that the scalar field must be joined onto two pieces of Vaidya spacetimes to avoid a naked singularity. We also derive the power-law mass formula with $\gamma=0.5$. Compared with previous analytical models constructed from a different scalar field with continuous self-similarity, we obtain the same value of $\gamma$. However, we show that the solution with $c\neq 0$ is not self-similar. Therefore, we provide a rare example that a scalar field without self-similarity also possesses the features of critical collapse.Comment: 14 pages, 6 figure

Alignments of dark matter halos with large-scale tidal fields: mass and redshift dependence

Large scale tidal field estimated directly from the distribution of dark matter halos is used to investigate how halo shapes and spin vectors are aligned with the cosmic web. The major, intermediate and minor axes of halos are aligned with the corresponding tidal axes, and halo spin axes tend to be parallel with the intermediate axes and perpendicular to the major axes of tidal field. The strengths of these alignments generally increase with halo mass and redshift, but the dependencies are only through the peak height, {\nu}. The scaling relations of the alignment strengths with the value of {\nu} indicate that the alignment strengths remain roughly constant when the structures within which the halos reside are still in quasi-linear regime, but decreases as nonlinear evolution becomes more important. We also calculate the alignments in projection so that our results can be compared directly with observations. Finally, we investigate the alignments of tidal tensors on large scales, and use the results to understand alignments of halo pairs separated at various distances. Our results suggest coherent structure of the tidal field is the underlying reason for the alignments of halos and galaxies seen in numerical simulations and in observations

Aerobic exercise training at maximal fat oxidation intensity improves body composition, glycemic control, and physical capacity in older people with type 2 diabetes

Background: Aerobic training has been used as one of the common treatments for type 2 diabetes; however, further research on the individualized exercise program with the optimal intensity is still necessary. The purpose of this study was to investigate the effects of supervised exercise training at the maximal fat oxidation (FATmax) intensity on body composition, glycemic control, lipid profile, and physical capacity in older people with type 2 diabetes. Methods: Twenty-four women and 25 men with type 2 diabetes, aged 60–69 years. The exercise groups trained at the individualized FATmax intensity for 1 h/day for 3 days/week over 16 weeks. No dietary intervention was introduced during the experimental period. Whole body fat, abdominal fat, oral glucose tolerance test, lipid profile, and physical capacity were measured before and after the interventions. Results: FATmax intensity was at 41.3 ± 3.2% VO2max for women and 46.1 ± 10.3% VO2max for men. Exercise groups obtained significant improvements in body composition, with a special decrease in abdominal obesity; decreased resting blood glucose concentration and HbA1c; and increased VO2max, walking ability, and lower body strength, compared to the non-exercising controls. Daily energy intake and medication remained unchanged for all participants during the experimental period. Conclusion: Beside the improvements in the laboratory variables, the individualized FATmax training can also benefit daily physical capacity of older people with type 2 diabetes

Soccer training: an effective exercise mode to prevent and treat childhood obesity?

Exercise training has been recognized as an effective treatment for childhood obesity. Clinical experience has shown that great efforts are needed to train children around 10 years old when using traditional aerobic exercise modes, such as walking and running. To seek more attractive training methods for children, in this paper, we review the current literature to evaluate the effectiveness of soccer training on childhood obesity prevention and treatment. Future research direction and sport injury prevention are also discussed