Changes in patient-reported pain interference after surgical treatment of painful lower extremity neuromas

PURPOSE: Painful neuromas commonly cause neuropathic pain, in up to 1 in 20 cases of traumatic or iatrogenic nerve injury. Despite the multiple surgical treatment types that reduce pain, no type has been universally accepted. METHODS: We performed a retrospective cohort study by administering follow-up surveys to all surgical patients treated in our department for lower-extremity neuroma from September 1, 2015, to October 22, 2021, that could be contacted, excluding those with Morton neuroma. In addition to the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) questionnaire, survey questions covered the time to pain reduction, use of physical or occupational therapy, and characteristics of the pain. When available, previously collected preoperative and postoperative PROMIS PI data were used for patients who could not be contacted for the telephone survey. Paired-sample nonparametric testing was used to compare preoperative and postoperative PROMIS PI scores. RESULTS: Initial query in the medical record by Current Procedural Terminology codes yielded 1,812 patients for chart review, of whom 33 were eligible to call. In total, 9 (27%) patients completed both preoperative and postoperative PROMIS PIs: 6 (18.2%) completed full telephone surveys and 3 (9.1%) had preoperative and postoperative PROMIS PI data in the chart review but could not be contacted for the full telephone survey. Four of the 6 telephone-survey respondents reported pain reduction within 12 months of their surgery. Wilcoxon signed-rank testing demonstrated a moderate but nonstatistically significant reduction in PROMIS PI scores, with a median difference of -4.85 ( CONCLUSIONS: There were notable improvements in our cohort, but larger studies are needed to determine whether surgical treatment of lower-extremity neuroma results in a clinically important and significant difference in PROMIS PI scores, as well as to discern the advantages each treatment. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV

Supernova Simulations with Boltzmann Neutrino Transport: A Comparison of Methods

Accurate neutrino transport has been built into spherically symmetric simulations of stellar core collapse and postbounce evolution. The results of such simulations agree that spherically symmetric models with standard microphysical input fail to explode by the delayed, neutrino-driven mechanism. Independent groups implemented fundamentally different numerical methods to tackle the Boltzmann neutrino transport equation. Here we present a direct and detailed comparison of such neutrino radiation-hydrodynamical simulations for two codes, Agile-Boltztran of the Oak Ridge-Basel group and Vertex of the Garching group. The former solves the Boltzmann equation directly by an implicit, general relativistic discrete angle method on the adaptive grid of a conservative implicit hydrodynamics code with second-order TVD advection. In contrast, the latter couples a variable Eddington factor technique with an explicit, moving-grid, conservative high-order Riemann solver with important relativistic effects treated by an effective gravitational potential. The presented study is meant to test both neutrino radiation-hydrodynamics implementations and to provide a data basis for comparisons and verifications of supernova codes to be developed in the future. Results are discussed for simulations of the core collapse and post-bounce evolution of a 13 solar mass star with Newtonian gravity and a 15 solar mass star with relativistic gravity.Comment: 23 pages, 13 figures, revised version, to appear in Ap

Few body Calculation of Neutrino Neutral Inelastic scattering on 4He

The inelastic neutral reaction of neutrino on 4He is calculated using two modern nucleon--nucleon potentials. Full final state interaction among the four nucleons is considered, via the Lorentz integral transform (LIT) method. The effective interaction hyperspherical-harmonic (EIHH) approach is used to solve the resulting Schrodinger like equations. A detailed energy dependent calculation is given in the impulse approximation.Comment: 4 pages; talk at 18th International Conference on Few-Body Problems in Physics (FB18), Santos, SP, Brazil, August 200

Electron Neutrino Pair Annihilation: A New Source for Muon and Tau Neutrinos in Supernovae

We show that in a supernova core the annihilation process nu_e nu_e-bar -> nu_{mu,tau} nu_{mu,tau}-bar is always more important than the traditional reaction e^+ e^- -> nu_{mu,tau} nu_{mu,tau}-bar as a source for muon and tau neutrino pairs. We study the impact of the new process by means of a Monte Carlo transport code with a static stellar background model and by means of a self-consistent hydrodynamical simulation with Boltzmann neutrino transport. Nucleon bremsstrahlung NN -> NN nu_{mu,tau} nu_{mu,tau}-bar is also included as another important source term. Taking into account nu_e nu_e-bar -> nu_{mu,tau} nu_{mu,tau}-bar increases the nu_mu and nu_tau luminosities by as much as 20% while the spectra remain almost unaffected. In our hydrodynamical simulation the shock was somewhat weakened. Elastic nu_{mu,tau} nu_e and nu_{mu,tau} nu_e scattering is not negligible but less important than nu_{mu,tau} e^+ or e^- scattering. Its influence on the nu_{mu,tau} fluxes and spectra is small after all other processes have been included.Comment: 11 pages, 9 eps-figs, submitted to Ap

Composition of the Innermost Core Collapse Supernova Ejecta

With presently known input physics and computer simulations in 1D, a self-consistent treatment of core collapse supernovae does not yet lead to successful explosions, while 2D models show some promise. Thus, there are strong indications that the delayed neutrino mechanism works combined with a multi-D convection treatment for unstable layers. On the other hand there is a need to provide correct nucleosynthesis abundances for the progressing field of galactic evolution and observations of low metallicity stars. The innermost ejecta is directly affected by the explosion mechanism, i.e. most strongly the yields of Fe-group nuclei for which an induced piston or thermal bomb treatment will not provide the correct yields because the effect of neutrino interactions is not included. We apply parameterized variations to the neutrino scattering cross sections and alternatively, parameterized variations are applied to the neutrino absorption cross sections on nucleons in the ``gain region''. We find that both measures lead to similar results, causing explosions and a Ye>0.5 in the innermost ejected layers, due to the combined effect of a short weak interaction time scale and a negligible electron degeneracy, unveiling the proton-neutron mass difference. We include all weak interactions (electron and positron capture, beta-decay, neutrino and antineutrino capture on nuclei, and neutrino and antineutrino capture on nucleons) and present first nucleosynthesis results for these innermost ejected layers to discuss how they improve predictions for Fe-group nuclei. The proton-rich environment results in enhanced abundances of 45Sc, 49Ti, and 64Zn as requested by chemical evolution studies and observations of low metallicity stars as well as appreciable production of nuclei in the mass range up to A=80.Comment: 13 pages, 8 figures. Final versio

A Finite Difference Representation of Neutrino Radiation Hydrodynamics in Spherically Symmetric General Relativistic Space-Time

We present an implicit finite difference representation for general relativistic radiation hydrodynamics in spherical symmetry. Our code, Agile-Boltztran, solves the Boltzmann transport equation for the angular and spectral neutrino distribution functions in self-consistent simulations of stellar core collapse and postbounce evolution. It implements a dynamically adaptive grid in comoving coordinates. Most macroscopically interesting physical quantities are defined by expectation values of the distribution function. We optimize the finite differencing of the microscopic transport equation for a consistent evolution of important expectation values. We test our code in simulations launched from progenitor stars with 13 solar masses and 40 solar masses. ~0.5 s after core collapse and bounce, the protoneutron star in the latter case reaches its maximum mass and collapses further to form a black hole. When the hydrostatic gravitational contraction sets in, we find a transient increase in electron flavor neutrino luminosities due to a change in the accretion rate. The muon- and tauon-neutrino luminosities and rms energies, however, continue to rise because previously shock-heated material with a non-degenerate electron gas starts to replace the cool degenerate material at their production site. We demonstrate this by supplementing the concept of neutrinospheres with a more detailed statistical description of the origin of escaping neutrinos. We compare the evolution of the 13 solar mass progenitor star to simulations with the MGFLD approximation, based on a recently developed flux limiter. We find similar results in the postbounce phase and validate this MGFLD approach for the spherically symmetric case with standard input physics.Comment: reformatted to 63 pages, 24 figures, to be published in ApJ

Precise quasielastic neutrino/nucleon cross section

Quasielastic antineutrino/proton and neutrino/neutron scatterings can be well approximated by simple formulae, valid around MeV or GeV energies. We obtain a single expression valid in the whole range, and discuss its relevance for studies of supernova neutrinos, which reach intermediate energies.Comment: 12 pages. Version 2: comparison with various approximations expanded. To appear on Phys. Lett.

The Neutrino Signal in Stellar Core Collapse and Postbounce Evolution

General relativistic multi-group and multi-flavor Boltzmann neutrino transport in spherical symmetry adds a new level of detail to the numerical bridge between microscopic nuclear and weak interaction physics and the macroscopic evolution of the astrophysical object. Although no supernova explosions are obtained, we investigate the neutrino luminosities in various phases of the postbounce evolution for a wide range of progenitor stars between 13 and 40 solar masses. The signal probes the dynamics of material layered in and around the protoneutron star and is, within narrow limits, sensitive to improvements in the weak interaction physics. Only changes that dramatically exceed physical limitations allow experiments with exploding models. We discuss the differences in the neutrino signal and find the electron fraction in the innermost ejecta to exceed 0.5 as a consequence of thermal balance and weak equilibrium at the masscut.Comment: 8 pages, 4 figures. Proceedings of the Nuclear Physics in Astrophysics Conference, Debrecen, Hungary, 2002, to appear in Nuc. Phys. A. Color figures added and reference actualize