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  1. This week's New Research includes 168 newly published academic research papers and government NGO reports on matters of climate change, gathered and classified for easy access via one convenient location.

    Featured:

    * Rapid Increase in Geogenic CO2 Emissions from Antarctic Permafrost

    * Experimental evidence of threshold-driven gas breakthrough in thawing permafrost

    * Palaeoclimate constraints narrow uncertainty in future Arctic winter sea ice projections

    * Resolving short-term meteorological variability amplifies projected glacier loss and sea-level rise

    * The Myth of “Baseload” Power in Modern Power Grids

    * Emissions Gap Report 2026: The point of return – Urgent emissions cuts needed to come back from overshoot of 1.5°C

    skepticalscience.com/new_resea

    #ClimateChange

  2. During a pre-install check on a GBase Database(GBase 8a MPP Cluster) environment running Kylin V10, I found a familiar configuration issue: Transparent Huge Pages (THP) was still set to always.

    The services could start, but bulk-load performance was inconsistent. With three machines configured differently, the slowest node became the first place to investigate.

    THP was one potential factor worth checking before spending hours troubleshooting database performance.

    What Is Transparent Huge Pages?


    Linux Transparent Huge Pages allows the kernel to use larger memory pages, commonly 2 MB instead of 4 KB, without requiring applications to manage huge pages explicitly.

    The potential benefit is fewer Translation Lookaside Buffer (TLB) misses. However, THP can also introduce memory compaction, allocation latency, and background activity that affect latency-sensitive workloads.

    For analytical databases such as GBase Database(GBase 8a), large memory allocations may occur during operations such as hash aggregation, sorting, and bulk loading. Depending on the kernel and workload, THP-related activity can contribute to performance variability.

    This does not mean THP always slows down a database. It means the setting should be validated against the database's deployment requirements and workload.

    1. Check the Current THP Configuration


    Inspect the active settings:

    cat /sys/kernel/mm/transparent_hugepage/enabled
    cat /sys/kernel/mm/transparent_hugepage/defrag

    Example output:

    always madvise

    [never]The value inside square brackets is the active setting. In this example, THP is set to never.

    If you see:

    [always] madvise never

    THP is configured to always.

    Check whether huge pages are being used during a workload:

    grep -E 'AnonHugePages|ShmemHugePages|FileHugePages' /proc/meminfo

    Compare the values before and during bulk loading. AnonHugePages can help indicate anonymous memory backed by huge pages, but it does not independently prove that THP caused a performance issue.

    2. Disable THP Temporarily for Validation


    If the GBase Database installation guide for your release recommends disabling THP, you can apply the change at runtime:

    echo never > /sys/kernel/mm/transparent_hugepage/enabled
    echo never > /sys/kernel/mm/transparent_hugepage/defrag

    These commands require root privileges. The settings generally do not survive a reboot.

    After applying the change, verify the active values again:

    cat /sys/kernel/mm/transparent_hugepage/enabled
    cat /sys/kernel/mm/transparent_hugepage/defrag

    Then compare the database's behavior under the same workload and conditions. Check load duration, latency variation, memory utilization, and relevant system logs rather than assuming that a configuration change guarantees a performance improvement.

    3. Make the Configuration Persistent


    For a persistent configuration, use the method supported by your Linux distribution and kernel.

    Some environments support systemd services, boot scripts, kernel command-line parameters, or tuned profiles. Their behavior and syntax vary.

    For example, on a system where /etc/rc.d/rc.local is supported and executed during boot, the following commands may be used:

    # Add to /etc/rc.d/rc.local
    echo never > /sys/kernel/mm/transparent_hugepage/enabled
    echo never > /sys/kernel/mm/transparent_hugepage/defrag

    If necessary, make the script executable:

    chmod +x /etc/rc.d/rc.local

    Do not assume this method works on every distribution. Validate the boot mechanism and check whether another service or tuned profile overrides the setting.

    After rebooting, confirm the active configuration again. Repeat the check after changing system profiles or applying OS updates.

    4. Validate Every Node in the GBase Database Cluster


    A configuration that is correct on one machine may be wrong on another.

    For a multi-node GBase Database deployment, include THP validation in the pre-install checklist and provisioning automation.

    At minimum, check:

    • Active THP settings on every node.
    • Consistency of kernel and OS versions.
    • Whether system profiles override the setting.
    • Memory behavior during representative workloads.
    • Database-specific recommendations for the installed release.

    Explicit Huge Pages are a separate configuration choice. They require appropriate memory reservation and database configuration, so do not enable them without checking the product documentation and operating system requirements.

    Final Takeaway


    Transparent Huge Pages is a small OS setting with potentially significant implications for database performance consistency.

    For GBase Database(GBase 8a MPP Cluster), the practical lesson is to validate THP before installation, keep cluster nodes consistent, and measure the impact under a representative workload.

    A repeatable pre-install check is more reliable than discovering configuration differences during production troubleshooting.

    TIL question: Do you disable THP by default for database servers, or do you benchmark it separately for each workload?

    Keywords: GBase Database, GBase 8a, Transparent Huge Pages, THP Linux, database performance tuning, Kylin V10, Linux pre-install checks#gbase #database #数据库 #todayilearned #software #coding #development #engineering #inclusive #community
    TIL: Why GBase Database Deployment Often Requires Disabling Transparent Huge Pages

  3. DATE: October 22, 2026 at 12:00PM
    SOURCE: PSYPOST.ORG

    ** Research quality varies widely from fantastic to small exploratory studies. Please check research methods when conclusions are very important to you. **
    -------------------------------------------------

    TITLE: Higher progesterone is linked to blurrier brain signals for emotional control, study finds

    URL: psypost.org/higher-progesteron

    Young women with higher natural levels of the hormone progesterone tend to show less distinct brain activity patterns when they must override their automatic emotional impulses, according to a new neuroimaging study published in Psychological Medicine. The findings suggest that progesterone may blur the neural signals that help the brain regulate emotional actions. Reduced precision in a frontal brain region also accounted for an indirect statistical pathway linking higher progesterone to worse recent mood.

    In everyday life, people naturally gravitate toward positive or rewarding things and pull away from threats or unpleasant situations. Psychologists refer to this automatic habit as approach-avoidance behavior. Overriding these instincts, such as stepping toward an angry person or walking away from something appealing, requires active emotional control.

    This regulatory process relies heavily on the lateral frontal pole, a brain structure located at the very front of the cerebral cortex just behind the forehead. A 2020 neuroimaging study indicated that the lateral frontal pole plays a key role in overriding automatic impulses when people have to make these kinds of emotional choices. When this region fails to properly guide behavior, people tend to struggle with emotional regulation, as seen in a 2023 study covered by PsyPost showing that highly anxious individuals have difficulty recruiting the lateral frontal pole and must rely on other brain regions instead.

    Scientists have also found that sex hormones can influence these exact brain circuits. For example, a study covered by PsyPost in 2023 indicated that high levels of the hormone testosterone are associated with reduced activity in the anterior prefrontal cortex during emotional control in adulthood. Far less is known about how the female ovarian hormones estradiol and progesterone shape these regulatory networks.

    “Historically, neuroscience research has disproportionately focused on men, partly because hormonal fluctuations across the menstrual cycle were considered a source of unwanted variability,” study author Macià Buades-Rotger, an associate professor of clinical psychology and psychobiology at the University of Barcelona, told PsyPost. “As a result, we still know surprisingly little about how naturally occurring changes in ovarian hormones influence the brain and behavior.”

    “At the same time, the relationship between female hormones and emotions is surrounded by sexist stereotypes and assumptions that often have little scientific basis,” Buades-Rotger added. “I was interested in moving beyond these simplistic narratives to investigate what hormones actually do in the brain, particularly how they might influence the mechanisms that allow us to control our automatic emotional responses.”

    Both estradiol and progesterone fluctuate naturally throughout the menstrual cycle, and shifts in these hormones are frequently tied to changes in emotional well-being. The authors of a 2020 review argued that progesterone can act like a double-edged sword: one of its chemical byproducts has proven useful for treating depression after childbirth, yet the hormone may trigger negative symptoms in women with premenstrual syndrome or premenstrual dysphoric disorder, a severe form of premenstrual mood disturbance. Meanwhile, a 2019 neuroimaging study of naturally cycling women found that during the cycle phase when progesterone is high, frontal and striatal regions tended to be more active during mental tasks.

    Most earlier brain imaging studies looked only at whether entire brain regions became more or less active overall in response to hormones. Buades-Rotger and his colleagues wanted to look deeper by examining whether estradiol and progesterone relate to fine-grained patterns of brain activity during emotional control, and whether those patterns connect to recent mood.

    To investigate this in a preregistered study, the researchers recruited 116 healthy, naturally cycling women between the ages of 18 and 35. None of the participants were using hormonal contraceptives or had a history of neurological, hormonal, or recent psychiatric disorders. Before entering the brain scanner, each participant provided a saliva sample (stimulated by chewing gum) so the researchers could measure their current levels of estradiol and progesterone.

    Participants also completed questionnaires measuring their typical emotion regulation habits and their mood over the preceding seven days. The mood survey assessed feelings of friendliness, vigor, fatigue, anger, tension, and depression, which the researchers combined into a single overall mood score. All testing sessions took place between 4 p.m. and 7 p.m. to minimize natural daily fluctuations in hormone levels.

    Inside a functional magnetic resonance imaging scanner, which tracks brain activity by measuring changes in blood flow, the women completed a 240-trial approach-avoidance task. During the task, they viewed photographs of actors displaying happy or angry facial expressions. Depending on the instructions for each block of trials, participants pressed buttons to either “approach” a face, which made the image grow larger as if looming closer, or “avoid” a face, which made the image shrink as if receding.

    In half of the trials, the instructions matched natural human instincts: approaching happy faces and avoiding angry ones. In the other half, the instructions went against those instincts, requiring participants to approach angry faces and avoid happy ones. After excluding six participants with unusually high error rates, the researchers analyzed the behavioral responses of 110 women.

    As expected, overriding automatic emotional tendencies took more effort. When participants had to approach angry faces, their average reaction time was 0.782 seconds with an error rate of 1.52 percent, compared to 0.663 seconds and a 0.55 percent error rate when approaching happy faces. Similarly, avoiding happy faces took an average of 0.762 seconds with a 1.36 percent error rate, compared to 0.684 seconds and a 0.64 percent error rate when avoiding angry faces.

    Next, the researchers examined the brain scans of 106 participants, after excluding four additional women who moved too much in the scanner. Instead of just measuring overall blood flow in a given brain area, the team used a machine learning technique called multivoxel pattern analysis. A voxel is a tiny three-dimensional unit of brain tissue, similar to a three-dimensional pixel.

    The computer algorithm looked at the detailed grid of activity across thousands of voxels during odd-numbered trials and tried to predict which task condition the participant was performing during even-numbered trials. If the computer could accurately tell whether a participant was overriding their instincts or following them based on a region’s activity pattern, it meant that brain area was distinctly encoding the rules of emotional control.

    The algorithm had to sort each trial into one of the four task conditions, so guessing would be right 25 percent of the time. Activity patterns in several regions allowed it to beat that chance level, including the lateral frontal pole, the striatum (a cluster of neurons deep beneath the cortex that helps manage movement and reward), the central insula (a region involved in processing internal bodily states and emotions), the primary visual cortex, the cerebellum, and the periaqueductal gray (a brainstem area involved in threat responses). The amygdala, a threat-processing region the researchers had planned in advance to examine, did not distinguish between the conditions. The algorithm mainly succeeded at telling instinct-opposing trials apart from instinct-matching ones, while often confusing the two conditions within each type.

    When the researchers combined the brain data, hormone levels, and mood scores for the 101 participants who had complete data across all measures, they found a consistent link with progesterone. Women with higher concentrations of salivary progesterone showed lower classification accuracy in both the lateral frontal pole (r = −0.25) and the striatum (r = −0.26). In other words, in women with higher progesterone, the brain activity patterns representing emotional control in these two regions were less distinct and harder for the algorithm to tell apart.

    “In everyday life, we constantly encounter situations in which our automatic emotional reactions conflict with what we actually need to do,” Buades-Rotger explained. “Imagine needing to ask a grumpy colleague for help: your instinct might be to avoid them, but achieving your goal requires approaching them instead. Our findings suggest that higher progesterone levels may make the brain’s representation of these competing emotional demands less clear, potentially making it harder to distinguish when to follow an instinctive reaction and when to override it. This could be one way in which natural hormonal fluctuations subtly influence how we navigate emotionally challenging situations.”

    Sharper activity patterns in the lateral frontal pole were also associated with better mood over the past week (r = 0.26). Even without a direct correlation between progesterone and mood reported in the study, a preregistered mediation analysis found a small indirect pathway: higher progesterone was linked to less distinct frontal patterns, which were in turn linked to worse recent mood. The model explained 7.1 percent of the variation in mood scores, and a reversed version that swapped the roles of progesterone and the brain patterns produced a weaker effect that was not statistically significant.

    Contrary to the researchers’ initial expectations, estradiol levels were not linked to brain decoding accuracy or to mood. In addition, neither estradiol nor progesterone correlated with how quickly or accurately participants pressed the buttons during the behavioral task. When the researchers divided participants into early and late stages of the menstrual cycle based on self-reported cycle length, they found higher progesterone in the late phase as expected, but cycle phase by itself was not linked to differences in mood, task performance, or brain decoding accuracy.

    “What surprised me most was the absence of comparable effects for estradiol,” Buades-Rotger noted. “Both estradiol and progesterone are known to influence brain function, and we had good reasons to expect that either hormone might be associated with how emotional control is represented in the brain. Instead, the associations we identified were specific to progesterone. This does not mean that estradiol has no role in emotional regulation, but it suggests that the two hormones may influence these processes through different mechanisms.”

    The authors suggest that progesterone may make brain activity patterns more diffuse across frontal and striatal circuits. While this blurring of emotional signals might make it harder to actively regulate mood and impulses, the researchers note that a slight blunting of emotional representations could be helpful in other ways, such as reducing sensitivity to physical pain during the second half of the menstrual cycle.

    As with all research, there are some caveats to consider when interpreting these findings. Because the researchers collected only a single saliva sample and brain scan from each woman at one point in time, the study cannot prove that higher progesterone directly causes changes in brain patterns or mood. In addition, the 101 participants included in the correlation analyses fell short of the preregistered target of 120, leaving the study with 71 percent statistical power to detect effects of the observed size. Tracking the same individuals across multiple days of their menstrual cycles in future studies will be necessary to separate temporary hormonal states from stable personal traits.

    “One important misconception would be that higher progesterone necessarily makes women more emotional or less capable of controlling their behavior,” Buades-Rotger emphasized. “That is not what our study shows. We examined statistical associations between naturally occurring hormone levels, patterns of brain activity, and mood in healthy young women; we did not experimentally manipulate progesterone or demonstrate that these neural differences cause changes in emotional behavior. It is also important to remember that hormonal effects vary considerably between individuals, and many women experience little or no noticeable mood changes across the menstrual cycle.”

    Methodological factors may have also introduced measurement noise that masked potential effects of estradiol. The researchers used chewing gum to help participants produce saliva, which is known to alter measured concentrations of steroid hormones, and salivary estradiol is a poor marker of menstrual cycle phase. In this sample, estradiol did not differ between the early and late phases of the cycle, while progesterone did. Finally, the pathway linking progesterone, frontal brain patterns, and mood accounted for just over 7 percent of the variation in mood among participants, meaning most of the differences in how participants felt were explained by other factors.

    “The associations we observed were relatively modest, which is unsurprising given that mood and emotional regulation depend on many interacting biological, psychological, and environmental factors,” Buades-Rotger said. “Progesterone is certainly not a master switch that determines how someone feels or behaves. The significance of our findings lies primarily in identifying a potential brain mechanism linking hormonal variation to mood, rather than demonstrating a large or immediately noticeable effect on everyday behavior.”

    Looking ahead, the researchers hope to test these hormonal pathways more directly over time. “An important next step would be to follow the same women across different phases of the menstrual cycle to determine whether changes in progesterone are accompanied by corresponding changes in neural representations of emotion control,” Buades-Rotger said. “Pharmacological studies that experimentally manipulate progesterone levels or the activity of its neuroactive metabolites would provide a more direct test of causality. Ultimately, understanding these mechanisms could help explain why some women are particularly sensitive to hormonal fluctuations, including those who experience premenstrual dysphoria, and potentially inform future approaches to treatment.”

    “I think our findings also illustrate the value of looking beyond conventional measures of brain activation,” Buades-Rotger concluded. “This allowed us to investigate how information about emotional control is represented in the brain. More broadly, the study highlights why hormonal state should be taken seriously as a meaningful source of variation in neuroscience, rather than simply treated as a nuisance variable.”

    The study, “Endogenous progesterone blurs frontostriatal representations of emotion control in healthy young women,” was authored by Macià Buades-Rotger, Rosamunde Hendricks, Beatrice Roncarati, Marta Calderón-García, Kaja Bergmann, and Francisco José Pérez-Cano.

    URL: psypost.org/higher-progesteron

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  4. Il paradosso dell’ossicodone e la protesi articolare

    Quando l’analgesico preoperatorio diventa un predittore di esito sfavorevole

    Il problema del dolore cronico pre-chirurgico

    L’osteoartrite grave di anca e ginocchio è una delle principali indicazioni alla chirurgia protesica, ma il percorso che conduce la sala operatoria è spesso lastricato di anni di terapia antidolorifica. Tra i farmaci più frequentemente impiegati in questa fase pre-chirurgica figurano gli oppioidi forti, in primis l’ossicodone, prescritto per controllare un dolore cronico da moderato a severo che i FANS o il paracetamolo non riescono più a contenere.

    Il paradosso emerge con forza dalla letteratura degli ultimi anni: il paziente che assume ossicodone o altri oppioidi nelle settimane e nei mesi precedenti l’artroprotesi — al fine di migliorare la propria qualità di vita in attesa dell’intervento — si trova dopo la chirurgia in una posizione significativamente più svantaggiata rispetto a chi non ha mai assunto oppioidi. Più dolore nel postoperatorio, più complicanze, più consumo di farmaci, esiti funzionali inferiori e un rischio sensibilmente più alto di dipendenza cronica da oppioidi.

    Dimensioni del fenomeno: quanti pazienti arrivano all’intervento già in terapia oppioide?

    I dati nordamericani, i più robusti disponibili, sono eloquenti. In uno studio su 84.932 pazienti sottoposti a artroprotesi totale di ginocchio (TKR), il 41,4% risultava in trattamento con oppioidi nei tre mesi precedenti l’intervento; i tre principi attivi più prescritti erano idrocodone/paracetamolo, ossicodone/paracetamolo e ossicodone in monoterapia. In un’analisi su 66.950 pazienti con TKR, il 34,8% di coloro che assumevano oppioidi preoperatoriamente diveniva utilizzatore cronico nel follow-up, contro il 5,0% del gruppo naive agli oppioidi — un rapporto di quasi 7 a 1.

    In Europa, e in Italia in particolare, i tassi di utilizzo preoperatorio di oppioidi forti sono storicamente inferiori rispetto al Nord America, ma la tendenza è in crescita, trainata dall’invecchiamento della popolazione, dalla maggiore durata delle liste d’attesa chirurgiche e dalla progressiva — seppur ancora cauta — apertura culturale verso la terapia con oppioidi nel dolore non oncologico.

    Il paradosso in numeri: outcome peggiori su più fronti

    La letteratura converge su un quadro coerente e preoccupante. I pazienti con uso preoperatorio di oppioidi — inclusi quelli in terapia con ossicodone — presentano, rispetto ai pazienti naive:

    • Punteggi di outcome riferiti dal paziente (PRO) significativamente peggiori nel postoperatorio: una metanalisi su 7.356 pazienti sottoposti a TKR o THR ha documentato una differenza standardizzata delle medie (SMD) di −0,53 (IC 95%: −0,75; −0,32, p < 0,0001), indicativa di un danno clinicamente rilevante in termini di dolore e funzione.
    • Maggiore tasso di complicanze: infezioni della protesi, necessità di revisione chirurgica, ritardo nella guarigione della ferita, più lunghe degenze ospedaliere e tassi di riammissione più elevati.
    • Rischio aumentato di uso prolungato di oppioidi nel postoperatorio: il pregresso utilizzo è il singolo più forte predittore di dipendenza oppioide a lungo termine dopo artroprotesi.
    • Più alti livelli di dolore postoperatorio e maggiore consumo di analgesici nelle prime settimane dopo l’intervento, con implicazioni per la riabilitazione e il recupero funzionale.
    • Maggiori costi sanitari complessivi legati alle complicanze e alle riammissioni.

    Perché accade? I meccanismi fisiopatologici

    Il deterioramento degli esiti post-chirurgici nei pazienti pretrattati con oppioidi non è casuale né imputabile esclusivamente al profilo di comorbidità — sebbene i pazienti in terapia oppioide tendano ad avere più condizioni concomitanti. I meccanismi biologici identificati includono:

    • Iperalgesia indotta da oppioidi (OIH): l’esposizione cronica agli agonisti μ produce una paradossale ipersensibilità al dolore, mediata da fenomeni di neuroplasticità a livello spinale e sopraspinale. Il paziente in OIH percepisce il dolore postoperatorio con un’intensità amplificata rispetto al paziente naive.
    • Tolleranza farmacologica: le dosi standard di analgesici oppioidi nel postoperatorio risultano spesso insufficienti nei pazienti pretrattati, rendendo necessari regimi analgesici più aggressivi o combinazioni multimodali più complesse.
    • Sensibilizzazione centrale: l’input nocicettivo cronico, combinato con l’esposizione prolungata agli oppioidi, modifica l’elaborazione del dolore a livello del sistema nervoso centrale, peggiorando la risposta funzionale all’intervento chirurgico.
    • Effetti immunosoppressori degli oppioidi: l’ossicodone, come altri agonisti μ, esercita effetti immunomodulanti che possono favorire le infezioni periprotesiche e ritardare la guarigione tissutale.
    • Effetti sul microbiota intestinale e sulla motilità: la stipsi oppioide-indotta e le alterazioni del microbioma intestinale possono influenzare la risposta infiammatoria perioperatoria.

    Ossicodone in ortopedia: da soluzione a problema?

    L’ossicodone ha una lunga storia nell’analgesia perioperatoria ortopedica. Studi italiani e internazionali hanno documentato l’efficacia della formulazione a rilascio prolungato (CR) e dell’associazione ossicodone/naloxone nel controllo del dolore postoperatorio da artroprotesi di ginocchio e anca, con un profilo gastrointestinale migliorato dall’azione periferica del naloxone. Il farmaco è indicato per il dolore da moderato a severo e la sua efficacia analgesica — con un rapporto morfina equivalente di circa 1:1,5 per via orale — è ben documentata.

    Il problema non è l’ossicodone in sé: usato appropriatamente nel perioperatorio, o nella gestione del dolore postoperatorio acuto a breve termine, mantiene un profilo rischio/beneficio accettabile. Il paradosso emerge quando l’oppioide viene impiegato per mesi nel preoperatorio, come misura di ‘ponte’ in attesa dell’intervento, in un contesto in cui le liste d’attesa chirurgiche si allungano e il dolore cronico dell’osteoartrite avanzata diventa ingestibile con i soli analgesici di primo livello.

    Implicazioni cliniche: cosa fare prima dell’intervento?

    Le linee guida dell’American Society for Enhanced Recovery (ASER) e le consensus statement perioperatorie convergono su alcune raccomandazioni chiave per i pazienti in terapia oppioide cronica candidati ad artroprotesi:

    • Stratificazione del rischio: identificare sistematicamente i pazienti in terapia oppioide preoperatoria e considerarli ad alto rischio per complicanze e dipendenza postoperatoria.
    • Riduzione preoperatoria degli oppioidi: dove clinicamente fattibile, avviare un programma strutturato di tapering preoperatorio dell’ossicodone nelle settimane precedenti l’intervento. Studi specifici hanno mostrato che la riduzione preoperatoria del carico oppioide migliora gli esiti funzionali.
    • Ottimizzazione dell’analgesia multimodale non oppioide: sfruttare al massimo il potenziale di paracetamolo, FANS/COX-2 inibitori (in assenza di controindicazioni), gabapentinergici e terapie topiche nel preoperatorio per ridurre il fabbisogno di oppioidi.
    • Blocchi locoregionali: l’utilizzo di tecniche anestetiche locoregionali (blocco del nervo femorale, adductor canal block, blocco perinervoso della spalla) riduce significativamente il consumo di oppioidi perioperatori e può essere pianificato anche nella fase preoperatoria.
    • Counseling informato: il paziente deve essere chiaramente informato che l’uso preoperatorio di oppioidi può ridurre i benefici attesi dall’artroprotesi in termini di dolore e funzione, favorendo una partecipazione attiva alle strategie di riduzione.
    • Nuovi analgesici come alternativa: farmaci come suzetrigine (bloccante selettivo di Nav1.8), attualmente in fase di valutazione regolatoria, potrebbero offrire in futuro un’alternativa analgesica perioperatoria efficace senza i rischi degli oppioidi.

    Il contesto italiano: liste d’attesa, oppioidi e il nodo irrisolto

    In Italia, il paradosso dell’ossicodone preoperatorio si inserisce in un contesto ulteriormente complicato dalle lunghe liste d’attesa per le artroprotesi nel Servizio Sanitario Nazionale. Un paziente con osteoartrite severa di ginocchio che attende anche 18-24 mesi per l’intervento si trova spesso nella condizione di dover scegliere tra tollerare un dolore invalidante o ricorrere a una terapia oppioide che, come emerge dai dati, potrebbe compromettere il risultato dell’intervento tanto atteso.

    La Legge 38/2010 sul diritto alla terapia del dolore ha ampliato significativamente l’accesso agli oppioidi in Italia, con effetti positivi innegabili per i pazienti oncologici e per molti con dolore cronico non oncologico. Tuttavia, la governance clinica dell’uso preoperatorio degli oppioidi in ortopedia rimane un ambito poco esplorato: mancano percorsi strutturati per la gestione e la riduzione del carico oppioide nelle settimane che precedono l’artroprotesi, e la comunicazione tra il medico di base o il reumatologo — che prescrivono l’analgesico — e il chirurgo ortopedico è spesso carente.

    Commento editoriale

    Il ‘paradosso dell’ossicodone e della protesi articolare’ non è una critica al farmaco in sé, né alla legittima esigenza di controllare il dolore nei mesi che precedono la chirurgia. È un monito contro la gestione frammentata del percorso terapeutico del paziente ortopedico: la prescrizione dell’oppioide e la pianificazione dell’intervento avvengono spesso in silos separati, senza che il rischio del pretrattamento oppioide venga esplicitamente discusso e gestito come variabile modificabile.

    La letteratura è chiara: il paziente che arriva all’artroprotesi pretrattato con ossicodone ha outcome peggiori, e questo è in parte un risultato prevenibile. Il chirurgo ortopedico, il medico di medicina generale, l’algologo e il reumatologo devono lavorare in un’ottica integrata, identificando per tempo i pazienti a rischio e implementando strategie di riduzione preoperatoria del carico oppioide che, pur complesse, hanno dimostrato di migliorare i risultati chirurgici. La lista d’attesa, in questo senso, può paradossalmente diventare un’opportunità terapeutica: il tempo che separa la diagnosi dall’intervento andrebbe utilizzato non solo per aspettare, ma per preparare il paziente in modo ottimale — anche farmacologicamente.

    Bedard, N. A., Pugely, A. J., Westermann, R. W., Duchman, K. R., Glass, N. A., & Callaghan, J. J. (2017). Opioid use after total knee arthroplasty: trends and risk factors for prolonged use. The Journal of Arthroplasty, 32(8), 2390–2394. https://doi.org/10.1016/j.arth.2017.03.014

    Smith, S. R., Bido, J., Collins, J. E., Yang, H., Katz, J. N., & Losina, E. (2017). Impact of preoperative opioid use on total knee arthroplasty outcomes. The Journal of Bone and Joint Surgery, 99(10), 803–808. https://doi.org/10.2106/JBJS.16.01200

    Pivec, R., Issa, K., Naziri, Q., Kapadia, B. H., Bonutti, P. M., & Mont, M. A. (2014). Opioid use prior to total hip arthroplasty leads to worse clinical outcomes. International Orthopaedics, 38(6), 1159–1165. https://doi.org/10.1007/s00208-013-2033-z

    Goplen, C. M., Verbeek, W., Kang, S., Jones, C. A., Voaklander, D. C., Churchill, T. A., & Beaupre, L. A. (2019). Preoperative opioid use is associated with worse patient outcomes after total joint arthroplasty: a systematic review and meta-analysis. BMC Musculoskeletal Disorders, 20, 234. https://doi.org/10.1186/s12891-019-2619-y

    Chapman, C. R., & Vierck, C. J. (2017). The transition of acute postoperative pain to chronic pain: an integrative overview of research on mechanisms. The Journal of Pain, 18(4), 359.e1–359.e38. https://doi.org/10.1016/j.jpain.2016.11.004

    Richebé, P., Capdevila, X., & Rivat, C. (2018). Persistent postsurgical pain: pathophysiology and preventative pharmacologic considerations. Anesthesiology, 129(3), 590–607. https://doi.org/10.1097/ALN.0000000000002238

    Cherubino, P., Raucci, U., Valentini, G., & Colombo, M. (2015). Il ruolo dell’associazione ossicodone/naloxone nella gestione del dolore in ortopedia. Giornale Italiano di Ortopedia e Traumatologia, 41(Suppl. 1), S40–S48.

    Wick, E. C., Grant, M. C., & Wu, C. L. (2017). Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: a review. JAMA Surgery, 152(7), 691–697. https://doi.org/10.1001/jamasurg.2017.0898

    Gritsenko, K., Khelemsky, Y., Kaye, A. D., Vadivelu, N., & Urman, R. D. (2014). Multimodal therapy in perioperative analgesia. Best Practice & Research Clinical Anaesthesiology, 28(1), 59–79. https://doi.org/10.1016/j.bpa.2014.03.001

    Salaffi, F., Stancati, A., Silvestri, C. A., Ciapetti, A., & Grassi, W. (2004). Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. European Journal of Pain, 8(4), 283–291. https://doi.org/10.1016/j.ejpain.2003.09.004

    #analgesiaPerioperatoria #artroprotesi #chirurgiaOrtopedica #doloreCronico #farmacologia #iperalgesia #medicinaInterna #oppioidi #ossicodone #osteoartrite #protesiArticolare #terapiaDelDolore
  5. The queer fox jumps over the lazy dragon! @post2hotbox

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