Computer planning of stereotactic iodine-125 seed brachytherapy for recurrent malignant gliomas

At St Thomas' Hospital, we have developed a computer program on a Titan graphics supercomputer to plan the stereotactic implantation of iodine-125 seeds for the palliative treatment of recurrent malignant gliomas. Use of the Gill-Thomas-Cosman relocatable frame allows planning and surgery to be carried out at different hospitals on different days. Stereotactic computed tomography (CT) and positron emission tomography (PET) scans are performed and the images transferred to the planning computer. The head, tumour and frame fiducials are outlined on the relevant images, and a three-dimensional model generated. Structures which could interfere with the surgery or radiotherapy, such as major vessels, shunt tubing etc., can also be outlined and included in the display. Catheter target and entry points are set using a three-dimensional cursor controlled by a set of dials attached to the computer. The program calculates and displays the radiation dose distribution within the target volume for various catheter and seed arrangements. The CT co-ordinates of the fiducial rods are used to convert catheter co-ordinates from CT space to frame space and to calculate the catheter insertion angles and depths. The surgically implanted catheters are after-loaded the next day and the seeds left in place for between 4 and 6 days, giving a nominal dose of 50 Gy to the edge of the target volume. 25 patients have been treated so far.

The utility of serum CA-125 in predicting extra-uterine disease in apparent early stage endometrial cancer

Objectives: To evaluate the clinical value of pre-operative serum CA125 in predicting the presence of extra-uterine disease in patients with apparent early stage endometrial cancer. Methods: Between October 6, 2005 and June 17, 2010, 760 patients were enrolled in an international, multicentre, prospective randomized trial (LACE) comparing laparotomy with laparoscopy in the management of endometrial cancer apparently confined to the uterus. This study is based on data from 657 patients with endometrial adenocarcinoma who had a pre-operative serum CA125 value, and was undertaken to correlate pre-operative serum CA125 with final stage. Results: Using a pre-operative CA-125 cutpoint of 30U/ml was associated with the smallest misclassification error (14.5%) using a multiple cross-validation method. Median pre-operative serum CA-125 was 14U/ml, and using a cutpoint of 30U/ml, 14.9% of patients had elevated CA-125 levels. Of 98 patients with elevated CA-125 level, 36 (36.7%) had evidence of extra-uterine disease. Of the 116 patients (17.7%) with evidence of extra-uterine disease, 31.0% had elevated CA-125 level. In univariate and multivariate logistic regression analysis, only pre-operative CA-125 level was found to be associated with extra-uterine spread of disease. Utilising a cutpoint of 30U/ml achieved a sensitivity, specificity, positive predictive value and negative predictive value of 31.0%, 88.5%, 36.7% and 85.7% respectively. Overall, 326/657 (49.6%) of patients had full surgical staging involving lymph node dissection. When analysis was limited to patients that had undergone full surgical staging, the outcomes remained essentially unchanged. Conclusions: Elevated CA-125 above 30U/ml in patients with apparent early stage disease is associated with a sensitivity of 31.0% and specificity of 88.5% in detecting extra-uterine disease. Pre-operative identification of this risk factor may assist to triage patients to tertiary centres and comprehensive surgical staging.

A preference-based semantics for CTD reasoning

In [8] the authors developed a logical system based on the definition of a new non-classical connective ⊗ capturing the notion of reparative obligation. The system proved to be appropriate for handling well-known contrary-to-duty paradoxes but no model-theoretic semantics was presented. In this paper we fill the gap and define a suitable possible-world semantics for the system for which we can prove soundness and completeness. The semantics is a preference-based non-normal one extending and generalizing semantics for classical modal logics.

125 GeV Higgs state in the context of four generations with two Higgs doublets

We interpret the recent discovery of a 125 GeV Higgs-like state in the context of a two-Higgs-doublet model with a heavy fourth sequential generation of fermions, in which one Higgs doublet couples only to the fourth-generation fermions, while the second doublet couples to the lighter fermions of the first three families. This model is designed to accommodate the apparent heaviness of the fourth-generation fermions and to effectively address the low-energy phenomenology of a dynamical electroweak-symmetry-breaking scenario. The physical Higgs states of the model are, therefore, viewed as composites primarily of the fourth-generation fermions. We find that the lightest Higgs, h, is a good candidate for the recently discovered 125 GeV spin-zero particle, when tan beta similar to O(1), for typical fourth-generation fermion masses of M-4G = 400-600 GeV, and with a large t-t' mixing in the right-handed quark sector. This, in turn, leads to BR(t' -> th) similar to O(1), which drastically changes the t' decay pattern. We also find that, based on the current Higgs data, this two-Higgs-doublet model generically predicts an enhanced production rate (compared to the Standard Model) in the pp -> h -> tau tau channel, and reduced rates in the VV -> h -> gamma gamma and p (p) over bar /pp -> V -> hV -> Vbb channels. Finally, the heavier CP-even Higgs is excluded by the current data up to m(H) similar to 500 GeV, while the pseudoscalar state, A, can be as light as 130 GeV. These heavier Higgs states and the expected deviations from the Standard Model din some of the Higgs production channels can be further excluded or discovered with more data.

Implication of a Higgs boson at 125 GeV within the stochastic superspace framework

We revisit the issue of considering stochasticity of Grassmannian coordinates in N = 1 superspace, which was analyzed previously by Kobakhidze et al. In this stochastic supersymmetry (SUSY) framework, the soft SUSY breaking terms of the minimal supersymmetric Standard Model (MSSM) such as the bilinear Higgs mixing, trilinear coupling, as well as the gaugino mass parameters are all proportional to a single mass parameter xi, a measure of supersymmetry breaking arising out of stochasticity. While a nonvanishing trilinear coupling at the high scale is a natural outcome of the framework, a favorable signature for obtaining the lighter Higgs boson mass m(h) at 125 GeV, the model produces tachyonic sleptons or staus turning to be too light. The previous analyses took Lambda, the scale at which input parameters are given, to be larger than the gauge coupling unification scale M-G in order to generate acceptable scalar masses radiatively at the electroweak scale. Still, this was inadequate for obtaining m(h) at 125 GeV. We find that Higgs at 125 GeV is highly achievable, provided we are ready to accommodate a nonvanishing scalar mass soft SUSY breaking term similar to what is done in minimal anomaly mediated SUSY breaking (AMSB) in contrast to a pure AMSB setup. Thus, the model can easily accommodate Higgs data, LHC limits of squark masses, WMAP data for dark matter relic density, flavor physics constraints, and XENON100 data. In contrast to the previous analyses, we consider Lambda = M-G, thus avoiding any ambiguities of a post-grand unified theory physics. The idea of stochastic superspace can easily be generalized to various scenarios beyond the MSSM. DOI: 10.1103/PhysRevD.87.035022

Role of supersymmetric heavy Higgs boson production in the self-coupling measurement of 125 GeV Higgs boson at the LHC

Measurement of the self-coupling of the 125 GeV Higgs boson is one of the most crucial tasks for a high luminosity run of the LHC, and it can only be measured in the di-Higgs final state. In the minimal supersymmetric standard model, heavy CP even Higgs (H) can decay into a lighter 125 GeV Higgs boson (h) and, therefore, can influence the rate of di-Higgs production. We investigate the role of single H production in the context of measuring the self-coupling of h. We have found that the H -> hh decay can change the value of Higgs (h) self-coupling substantially, in a low tan beta regime where the mass of the heavy Higgs boson lies between 250 and 600 GeV and, depending on the parameter space, it may be seen as an enhancement of the self-coupling of the 125 GeV Higgs boson.