An update on COPD prevention, diagnosis, and management: The 2024 GOLD Report.

ABSTRACT: Chronic obstructive pulmonary disease (COPD) is one of the top three causes of death throughout the world. Because of the preventable and treatable nature of the disease along with its prevalence, COPD represents a major public health challenge. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report provides a review of the most current evidence for prevention of COPD as well as the assessment, diagnosis, and treatment of people with the disease. The purpose of this article is to provide a summary of the 2024 revised GOLD Report and current best practices in accordance with the evidence.

Intention understanding over T: a neuroimaging study on shared representations and tennis return predictions.

Studying the way athletes predict actions of their peers during fast-ball sports, such as a tennis, has proved to be a valuable tool for increasing our knowledge of intention understanding. The working model in this area is that the anticipatory representations of others' behaviors require internal predictive models of actions formed from pre-established and shared representations between the observer and the actor. This model also predicts that observers would not be able to read accurately the intentions of a competitor if the competitor were to perform the action without prior knowledge of their intention until moments before the action. To test this hypothesis, we recorded brain activity from 25 male tennis players while they performed a novel behavioral tennis intention inference task, which included two conditions: (i) one condition in which they viewed video clips of a tennis athlete who knew in advance where he was about to act/serve (initially intended serves) and (ii) one condition in which they viewed video clips of that same athlete when he did not know where he was to act/serve until the target was specified after he had tossed the ball into the air to complete his serve (non-initially intended serves). Our results demonstrated that (i) tennis expertise is related to the accuracy in predicting where another server intends to serve when that server knows where he intends to serve before (but not after) he tosses the ball in the air; and (ii) accurate predictions are characterized by the recruitment of both cortical areas within the human mirror neuron system (that is known to be involved in higher-order (top-down) processes of embodied cognition and shared representation) and subcortical areas within brain regions involved in procedural memory (caudate nucleus). Interestingly, inaccurate predictions instead recruit areas known to be involved in low-level (bottom-up) computational processes associated with the sense of agency and self-other distinction.

Does the baricity of bupivacaine influence intrathecal spread in the prolonged sitting position before elective cesarean delivery? A prospective randomized controlled study.

BACKGROUND: Difficulties in inserting an epidural catheter while performing combined spinal-epidural anesthesia for cesarean delivery may lead to undue delays between the spinal injection of the local anesthetic mixture and the adoption of the supine position with lateral tilt. We hypothesized that this delay may affect the intrathecal distribution of local anesthetic of different baricities such that hypobaric local anesthetic would lead to a higher sensory block level. METHODS: Healthy parturients with uncomplicated pregnancies undergoing elective cesarean delivery under combined spinal-epidural anesthesia were enrolled in this prospective double-blind randomized controlled trial. The subjects were allocated to receive hyperbaric (hyperbaric group), isobaric (isobaric group), or hypobaric (hypobaric group) spinal bupivacaine 10 mg. After the spinal injection, the subjects remained in the sitting position for 5 minutes (to simulate difficulty in inserting the epidural catheter) before being helped into the supine lateral tilt position. The primary outcome was the sensory block level during the 25 minutes after the spinal injection. Other end points included motor block score, maternal hypotension, and vasopressor requirements. RESULTS: Data from 89 patients were analyzed. Patient characteristics were similar in all groups. The median [interquartile range] (95% confidence interval) sensory levels after spinal injection were significantly higher with decreasing baricity: hyperbaric T10 [T11-8] (T10-9), isobaric T9 [T10-7] (T9-7), and hypobaric T6 [T8-4] (T8-5) (P < 0.001, Cuzick trend). All patients in the hypobaric group reached a sensory block level of T4 at 25 minutes after spinal injection compared with 80% of the patients in both the isobaric and hyperbaric groups (P = 0.04; difference 20%, 95% confidence interval of difference 4%-33%). Significantly more patients in the hypobaric group had complete lower limb motor block (Bromage score = 4) (hyperbaric 43%, isobaric 63%, and hypobaric 90%; P < 0.001). The incidences of maternal hypotension and nausea and vomiting were similar among groups, although the ephedrine requirements were significantly increased in the isobaric and hypobaric groups by factors of 1.83 and 3.0, respectively, compared with the hyperbaric group (P < 0.001, Cuzick trend). CONCLUSIONS: We demonstrated that when parturients undergoing cesarean delivery were maintained in the sitting position for 5 minutes after spinal injection of the local anesthetic, hypobaric bupivacaine resulted in sensory block levels that were higher compared with isobaric and hyperbaric bupivacaine, respectively, during the study period.

Neuroimaging of love: fMRI meta-analysis evidence toward new perspectives in sexual medicine.

INTRODUCTION: Brain imaging is becoming a powerful tool in the study of human cerebral functions related to close personal relationships. Outside of subcortical structures traditionally thought to be involved in reward-related systems, a wide range of neuroimaging studies in relationship science indicate a prominent role for different cortical networks and cognitive factors. Thus, the field needs a better anatomical/network/whole-brain model to help translate scientific knowledge from lab bench to clinical models and ultimately to the patients suffering from disorders associated with love and couple relationships. AIM: The aim of the present review is to provide a review across wide range of functional magnetic resonance imaging (fMRI) studies to critically identify the cortical networks associated with passionate love, and to compare and contrast it with other types of love (such as maternal love and unconditional love for persons with intellectual disabilities). METHODS: Retrospective review of pertinent neuroimaging literature. MAIN OUTCOME MEASURES: Review of published literature on fMRI studies of love illustrating brain regions associated with different forms of love. RESULTS: Although all fMRI studies of love point to the subcortical dopaminergic reward-related brain systems (involving dopamine and oxytocin receptors) for motivating individuals in pair-bonding, the present meta-analysis newly demonstrated that different types of love involve distinct cerebral networks, including those for higher cognitive functions such as social cognition and bodily self-representation. CONCLUSIONS: These metaresults provide the first stages of a global neuroanatomical model of cortical networks involved in emotions related to different aspects of love. Developing this model in future studies should be helpful for advancing clinical approaches helpful in sexual medicine and couple therapy.

New electroencephalogram (EEG) neuroimaging methods of analyzing brain activity applicable to the study of human sexual response.

INTRODUCTION: Electroencephalogram (EEG) combined with brain source localization algorithms is becoming a powerful tool in the neuroimaging study of human cerebral functions. AIM: The present article provides a tutorial on the various EEG methods currently used to study the human brain activity, notably during sexual response. MAIN OUTCOME MEASURES: Review of published literature on standard EEG waveform analyses and most recent electrical neuroimaging techniques (microstate approach and two methods of brain source localization). METHODS: Retrospective overview of pertinent literature. RESULTS: Although the standard EEG waveform analyses enable millisecond time-resolution information about the human sexual responses in the brain, less is clear about their related spatial information. Nowadays, the improvement of EEG techniques and statistical approaches allows the visualization of the dynamics of the human sexual response with a higher spatiotemporal resolution. Here, we describe these enhanced techniques and summarize along with an overview of what we have learned from them in terms of chronoarchitecture of sexual response in the human brain. Finally, the speculation on how we may be able to use other enhanced approaches, such as independent component analysis, are also presented. CONCLUSIONS: EEG neuroimaging has already been proven as a strong worthwhile research tool. Combining this approach with standard EEG waveform analyses in sexual medicine may provide a better understanding of the neural activity underlying the human sexual response in both healthy and clinical populations.

Suprasternal Doppler estimation of cardiac output: standard versus sequential combined spinal epidural anesthesia for cesarean delivery.

BACKGROUND: Sequential (Seq) combined spinal epidural (CSE) may provide better cardiovascular stability than standard (Std) CSE for cesarean delivery. We compared the cardiovascular stability of both techniques using suprasternal Doppler. METHODS: Healthy women (n = 40) scheduled for elective cesarean delivery were randomized into two groups; Std or Seq CSE. Serial measures of cardiac output indices, including minute distance, stroke distance, stroke volume, peak velocity, and corrected flow time, were recorded before and after intravascular fluid administration and after CSE. Women received either hyperbaric bupivacaine 10 mg (Std) or 5 mg (Seq) with intrathecal fentanyl 15 microg. An epidural top-up with bupivacaine 0.5% w/v (5 mL at 20 min in the Std group and 10 mL at 15 min followed by 5 mL at 25 min in the Seq group) was given if predefined sensory targets were not met. Data were collected every 5 min after intrathecal injection. Hypotension was treated with ephedrine. Statistical analyses included repeated measures analysis of variance, analysis of covariance and Student's t-test. P < 0.05 denoted significance. RESULTS: Results showed no difference in cardiac output, minute distance, stroke distance, stroke volume, peak velocity, or corrected flow time between groups over the first 20 min after spinal injection. For whole measurement periods, mean lowest values for these same measures showed no group differences. CONCLUSION: We therefore found no benefit in terms of cardiovascular stability of Seq to Std CSE for elective cesarean delivery in the healthy pregnant population.