This discovery could dramatically alter the way that chronic pain can be identified and managed. Dr. Miguel Pappolla, UTMB professor of neurology, said that although the discovery is very preliminary, it may lead to a revolutionary shift on how fibromyalgia and related forms of chronic pain are treated. The new approach has the potential to save billions of dollars to the health care system and decrease many peoples’ dependence on opiates for pain management.

The UTMB team of researchers, along with collaborators from across the U.S., including the National Institutes of Health, were able for the first time, to separate patients with fibromyalgia from normal individuals using a common blood test for insulin resistance, or pre-diabetes. They then treated the fibromyalgia patients with a medication targeting insulin resistance, which dramatically reduced their pain levels. The study was recently published in PlosOne.

Fibromyalgia is one of the most common conditions causing chronic pain and disability. The global economic impact of fibromyalgia is enormous — in the U.S. alone and related health care costs are about $100 billion each year. Despite extensive research the cause of fibromyalgia is unknown, so there’s no specific diagnostics or therapies for this condition other than pain-reducing drugs.

“Earlier studies discovered that insulin resistance causes dysfunction within the brain’s small blood vessels. Since this issue is also present in fibromyalgia, we investigated whether insulin resistance is the missing link in this disorder,” Pappolla said. “We showed that most — if not all — patients with fibromyalgia can be identified by their A1c levels, which reflects average blood sugar levels over the past two to three months.”

Pre-diabetics with slightly elevated A1c values carry a higher risk of developing central (brain) pain, a hallmark of fibromyalgia and other chronic pain disorders.”

The researchers identified patients who were referred to a subspecialty pain medicine clinic to be treated for widespread muscular/connective tissue pain. All patients who met the criteria for fibromyalgia were separated into smaller groups by age. When compared with age-matched controls, the A1c levels of the fibromyalgia patients were significantly higher.

“Considering the extensive research on fibromyalgia, we were puzzled that prior studies had overlooked this simple connection,” said Pappolla. “The main reason for this oversight is that about half of fibromyalgia patients have A1c values currently considered within the normal range. However, this is the first study to analyze these levels normalized for the person’s age, as optimal A1c levels do vary throughout life. Adjustment for the patients’ age was critical in highlighting the differences between patients and control subjects.”

For the fibromyalgia patients, metformin, a drug developed to combat insulin resistance was added to their current medications. They showed dramatic reductions in their pain levels.

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Each summer, a climatic shift brings persistent wind and rain to much of Southeast Asia, in the form of a seasonal monsoon. The general cause of the monsoon is understood to be an increasing temperature difference between the warming land and the comparatively cool ocean. But for the most part, the strength and timing of the monsoon, on which millions of farmers depend each year, is incredibly difficult to predict.

Now MIT scientists have found that an interplay between atmospheric winds and the ocean waters south of India has a major influence over the strength and timing of the South Asian monsoon.

Their results, published today in the Journal of Climate, show that as the summertime sun heats up the Indian subcontinent, it also kicks up strong winds that sweep across the Indian Ocean and up over the South Asian land mass. As these winds drive northward, they also push ocean waters southward, much like a runner pushing against a treadmill’s belt. The researchers found these south-flowing waters act to transport heat along with them, cooling the ocean and in effect increasing the temperature gradient between the land and sea.

They say this ocean heat transporting mechanism may be a new knob in controlling the seasonal South Asian monsoon, as well as other monsoon systems around the world.

“What we find is, the ocean’s response plays a huge role in modulating the intensity of the monsoon,” says John Marshall, the Cecil and Ida Green Professor of Oceanography at MIT. “Understanding the ocean’s response is critical to predicting the monsoon.”

Marshall’s co-authors on the paper are lead author Nicholas Lutsko, a postdoc in MIT’s Department of Earth, Atmospheric, and Planetary Sciences, and Brian Green, a former graduate student in Marshall’s group who is now at the Univeristy of Washington.

Damps and shifts

Scientists have traditionally focused on the Himalayas as a key influencer of the South Asian monsoon. It’s thought that the massive mountain ridge acts as a barrier against cold winds blowing in from the north, insulating the Indian subcontinent in a warm cocoon and enhancing the summer time temperature difference between the land and the ocean.

“Before, people thought the Himalayas were necessary to have a monsoon system,” Lutsko says. “When people got rid of them in simulations, there was no monsoon. But these models were run without an ocean.”

Lutsko and Marshall suspected that if they were to develop a model of the monsoon that included the ocean’s dynamics, these effects would lessen the monsoon’s intensity. Their hunch was based on previous work in which Marshall and his colleagues found that wind-driven ocean circulation minimized shifts in the Inter Tropical Convergence Zone, or ITCZ, an atmospheric belt near the equator that typically produces dramatic thunderstorms over large areas. This wide zone of atmospheric turbulence is known to shift seasonally between the northern and southern hemispheres, and Marshall found the ocean plays a role in corraling these shifts.

“Based on the idea of the ocean damping the ITCZ shifts, we thought that the ocean would also damp the monsoon,” Marshall says. “But it turns out it actually strengthens the monsoon.”

Seeing past a mountain

The researchers came to this unexpected conclusion after drawing up a simple simulation of a monsoon system, starting with a numerical model that simulates the basic physics of the atmosphere over an “aqua planet” — a world covered entirely in an ocean. The team added a solid, rectangular mass to the ocean to represent a simple land mass. They then varied the amount of sunlight across the simulated planet, to mimic the seasonal cycles of insolation, or sunlight, and also simulated the winds and rains that result from these seasonal shifts in temperature.

They carried out these simulations under different scenarios, including one in which the ocean was static and unmoving, and another in which the ocean was allowed to circulate and respond to atmospheric winds. They observed that winds blowing toward the land prompted ocean waters to flow in the opposite direction, carrying heat away from waters closest to the land. This wind/ocean interaction had a significant effect on any monsoon that formed over the land: the stronger this interplay, or coupling between winds and ocean, the wider the difference in land and sea temperature, and the stronger the intensity of the ensuing monsoon.

Interestingly, their model did not include any sort of Himalayan structure; nevertheless, they were still able to produce a monsoon simply from the effect of the ocean and winds.

“We initially had a picture that we couldn’t make a monsoon without the Himalayas, which was the established wisdom,” Lutsko says. “But in our model, we had no such barrier, and we were still able to generate a monsoon, and we were excited about that.”

Ultimately, their work may help to explain why the South Asian monsoon is one of the strongest monsoon systems in the world. The combination of the Himalayas to the north, which act to warm up the land, and the ocean to the south, which takes heat away from nearby waters, sets up an extreme temperature gradient for one of the most intense, persistent monsoons on the planet.

“One reason the South Asian monsoon is so strong is there’s this big barrier to the north keeping the land warm, and there’s an ocean to the south that’s cooling, so it’s perfectly situated to be really strong,” Lutsko says.

In future work, the researchers plan to apply their newfound observations of the ocean’s role to help interpret variations in monsoons much farther back in time.

“What’s interesting to me is, during times when the northern hemisphere was much colder, you see a collapse of the monsoon system,” Lutsko says. “People don’t know why that happens. But we feel we can explain this, using our minimal model.”

The researchers also believe their new, ocean-based explanation for generating monsoons may help climate modelers to predict how, for example, the monsoon cycle may change in response to ocean warming due to climate change.

“We’re saying you have to understand how the ocean is responding if you want to predict the monsoon,” Lutsko says. “You can’t just focus on the land and the atmosphere. The ocean is key.”

This research is supported in part by the National Science Foundation and the National Oceanic and Atmospheric Administration.

Their work is published in Monthly Notices of the Royal Astronomical Society.

Type Ia supernovae play a crucial role in helping astronomers understand the universe. Their brilliance allows them to be seen across great distances and to be used as cosmic mile-markers, which garnered the 2011 Nobel Prize in Physics. Furthermore, their violent explosions synthesize many of the elements that make up the world around us, which are ejected into the galaxy to generate future stars and stellar systems.

Although hydrogen is the most-abundant element in the universe, it is almost never seen in Type Ia supernova explosions. In fact, the lack of hydrogen is one of the defining features of this category of supernovae and is thought to be a key clue to understanding what came before their explosions. This is why seeing hydrogen emissions coming from this supernova was so surprising.

Type Ia supernovae originate from the thermonuclear explosion of a white dwarf that is part of a binary system. But what exactly triggers the explosion of the white dwarf — the dead core left after a Sun-like star exhausts its nuclear fuel — is a great puzzle. A prevailing idea is that, the white dwarf gains matter from its companion star, a process that may eventually trigger the explosion, but whether or not this is the correct theory explaining these supernovae has been hotly debated for decades.

This led the research team behind this paper to begin a major survey of Type Ia supernovae — called 100IAS — that was launched when Kollmeier was discussing the origin of these supernovae with study co-authors Subo Dong of Peking University and Doron Kushnir of the Weizmann Institute of Science who, along with Weizmann colleague Boaz Katz, put forward an new theory for Type Ia explosions that involves the violent collision of two white dwarfs.

Astronomers eagerly study the chemical signatures of the material ejected during these explosions in order to understand the mechanism and players involved in creating Type Ia supernovae.

In recent years, astronomers have discovered a small number of rare Type Ia supernovae that are cloaked in large amount of hydrogen — maybe as much as the mass of our Sun. But in several respects, ASASSN-18tb is different from these previous events.

“It’s possible that the hydrogen we see when studying ASASSN-18tb is like these previous supernovae, but there are some striking differences that aren’t so easy to explain,” said Kollmeier.

First, in all previous cases these hydrogen-cloaked Type Ia supernovae were found in young, star-forming galaxies where plenty of hydrogen-rich gas may be present. But ASASSN-18tb occurred in a galaxy consisting of old stars. Second, the amount of hydrogen ejected by ASASSN-18tb is significantly less than that seen surrounding those other Type Ia supernovae. It probably amounts to about one-hundredth the mass of our Sun.

“One exciting possibility is that we are seeing material being stripped from the exploding white dwarf’s companion star as the supernova collides with it,” said Anthony Piro. “If this is the case, it would be the first-ever observation of such an occurrence.”

“I have been looking for this signature for a decade!” said co-author Josh Simon. “We finally found it, but it’s so rare, which is an important piece of the puzzle for solving the mystery of how Type Ia supernovae originate.”

Nidia Morrell was observing that night, and she immediately reduced the data coming off the telescope and circulated them to the team including PhD student Ping Chen, who works on 100IAS for his thesis and Jose Luis Prieto of Universidad Diego Portales, a veteran SNe observer. Mr. Chen was the first to notice that this was not a typical spectrum. All were completely surprised by what they saw in ASASSN-18tb’s spectrum. “I was shocked, and I thought to myself ‘could this really be hydrogen?'” recalled Morrell.

Morrell met with team member Mark Phillips, who is a pioneer in establishing the relationship — informally named after him — that allows Type Ia supernovae to be used as standard rulers to discuss the observation. Phillips was convinced: It is hydrogen you’ve found; no other possible explanation.”

“This is an unconventional supernova program, but I am an unconventional observer — a theorist, in fact” said Kollmeier. “It’s an extremely painful project for our team to carry out. Observing these things is like catching a knife, because by definition they get fainter and fainter with time! It’s only possible at a place like Carnegie where access to the Magellan telescopes allow us to do time-intensive and sometimes arduous, but extremely important cosmic experiments. No pain, no gain.”

This research was supported in part by the NSFC.