Blood Glucose Regulation for Post-Operative Patients with Diabetics and Hypertension Continuum: A Cascade Control-Based Approach.

Management of glycemic level in post-operative condition is critical for hypertensive patients and the post-operative stress may results in hyperglycemia, hyper insulin and osmotic diuresis. Recent medical research shows that diabetic and hypertension hands together in a significant overlap in its etiology and its disease mechanism. It is clear that there is a call for monitoring in the parameter and controlling the glucose level particularly in the presence of hypertension. This paper proposes the novel complex (cascade) control system to control the insulin infusion level particularly in the presence of hypertension. Based on the requirements the structure has been designed and the simulation results indicates that the proposed control strategy shows better results and may achieve potentially better glycemic control to the hypersensitive diabetic patients.

Prevalence and aetiology of anaemia in lymphoid malignancies.

BACKGROUND: We prospectively studied the prevalence, type and causes of anaemia in newly diagnosed patients with lymphoid malignancies. METHODS: Between January 2007 and June 2008, a total of 316 newly diagnosed, consecutive patients (aged 15 years or above) of Hodgkin lymphoma, non-Hodgkin lymphoma and chronic lymphocytic leukaemia with anaemia (haemoglobin <11 g/dl), were analysed to determine the prevalence and a subgroup of 46 patients was analysed for the cause of anaemia. RESULTS: Hodgkin lymphoma, non-Hodgkin lymphoma and chronic lymphocytic leukaemia were the diagnoses in 81 (25.8%), 203 (64.7%) and 30 (9.6%) patients, respectively. Anaemia was present in 134 patients (42.4%). Anaemia of chronic disease was present in 33/46 (71.7%) and iron deficiency in 18/46 (39.1%) patients. Vitamin B12 and/or folate deficiency was detected in 10/46 (21.7%) patients (B12 deficiency alone in 7, folate deficiency alone in 1 and combined B12 and folate deficiency in 2). Autoimmune haemolytic anaemia was detected in 5/46 (10.9%) although direct Coombs test was positive in 17/46 (37%) patients. Among patients with Hodgkin lymphoma and non-Hodgkin lymphoma, anaemia due to bone marrow involvement was present in 16/40 (40%). In most patients with bone marrow involvement, anaemia was due to other causes. In only 3 patients, anaemia was attributable to bone marrow involvement alone. Anaemia was multifactorial in 18/46 (39.1%) patients. Nutritional deficiency alone or in combination was present in 22/46 (47.8%) patients. CONCLUSION: Anaemia is common in lymphoid malignancies at initial presentation. Besides managing anaemia of chronic disease and bone marrow involvement, nutritional and autoimmune causes should be ruled out.

Liver fat analysis using optimized support vector machine with support vector regression.

BACKGROUND: Fatty liver disease is a common condition caused by excess fat in the liver. It consists of two types: Alcoholic Fatty Liver Disease, also called alcoholic steatohepatitis, and Non-Alcoholic Fatty Liver Disease (NAFLD). As per epidemiological studies, fatty liver encompasses 9% to 32% of the general population in India and affects overweight people. OBJECTIVE: An Optimized Support Vector Machine with Support Vector Regression model is proposed to evaluate the volume of liver fat by image analysis (LFA-OSVM-SVR). METHOD: The input computed tomography (CT) liver images are collected from the Chennai liver foundation and Liver Segmentation (LiTS) datasets. Here, input datasets are pre-processed using Gaussian smoothing filter and bypass filter to reduce noise and improve image intensity. The proposed U-Net method is used to perform the liver segmentation. The Optimized Support Vector Machine is used to classify the liver images as fatty liver image and normal images. The support vector regression (SVR) is utilized for analyzing the fat in percentage. RESULTS: The LFA-OSVM-SVR model effectively analyzed the liver fat from CT scan images. The proposed approach is activated in python and its efficiency is analyzed under certain performance metrics. CONCLUSION: The proposed LFA-OSVM-SVR method attains 33.4%, 28.3%, 25.7% improved accuracy with 55%, 47.7%, 32.6% lower error rate for fatty image classification and 30%, 21%, 19.5% improved accuracy with 57.9%, 46.5%, 31.76% lower error rate for normal image classificationthan compared to existing methods such as Convolutional Neural Network (CNN) with Fractional Differential Enhancement (FDE) (CNN-FDE), Fully Convolutional Networks (FCN) and Non-negative Matrix Factorization (NMF) (FCN-NMF), and Deep Learning with Fully Convolutional Networks (FCN) (DL-FCN).

Optimize an effective triboelectric nanogenerator surface morphology to harvest the human wrist pulse pressure: A numerical study on finite element method.

This paper presents the optimized surface morphology to enhance transferred charge between the mental and dielectric of the modelled triboelectric nanogenerator. The structured shape of the dielectric layer is a vital factor in enhancing the output performance of the triboelectric nanogenerator. In this study, flat, cone, circular and rectangular shapes are structured on the dielectric surface of TENG. Its output performance is examined by conducting a numerical study on the finite element method in COMSOL Multiphysics software. Among the above stated structured surface TENGs, the structured rectangular surface triboelectric nanogenerator produces an improved output open-circuit voltage of 26 V for an externally given 3K Pascal pulse pressure as input. Hence, the result indicates that the structured surface TENGs can make a portable self-powered healthcare device such as heart rate, respiratory rate, and blood pressure measurement.

Serum ferritin as a predictive biomarker in COVID-19. A systematic review, meta-analysis and meta-regression analysis.

Ferritin is a known inflammatory biomarker in COVID-19. However, many factors and co-morbidities can confound the level of serum ferritin. This current metaanalysis evaluates serum ferritin level in different severity levels in COVID-19. Studies evaluating serum ferritin level in different clinical contexts (COVID-19 vs. control, mild to moderate vs. severe to critical, non-survivor vs. survivor, organ involvement, ICU and mechanical ventilation requirement) were included (total 9 literature databases searched). Metaanalysis and metaregression was carried out using metaphor "R" package. Compared to control (COVID-19 negative), higher ferritin levels were found among the COVID-19 patients [SMD -0.889 (95% C.I. -1.201, -0.577), I2 = 85%]. Severe to critical COVID-19 patients showed higher ferritin levels compared to mild to moderate COVID-19 patients [SMD 0.882 (0.738, 1.026), I2 = 85%]. In meta-regression, high heterogeneity was observed could be attributed to difference in "mean age", and "percentage of population with concomitant co-morbidities". Non-survivors had higher serum ferritin level compared to survivors [SMD 0.992 (0.672, 1.172), I2 = 92.33%]. In meta-regression, high heterogeneity observed could be attributed to difference in "mean age" and "percentage of male sex". Patients requiring ICU [SMD 0.674 (0.515 to 0.833), I2 = 80%] and mechanical ventilation [SMD 0.430 (0.258, 0.602), I2 = 32%] had higher serum ferritin levels compared to those who didn't. To conclude, serum ferritin level may serve as an important biomarker which can aid in COVID-19 management. However, presence of other co-morbid conditions/confounders warrants cautious interpretation.

An extensive study on the COVID-19 pandemic, an emerging global crisis: Risks, transmission, impacts and mitigation.

A number of unexplained cases of pneumonia have been recorded since November 2019 in China. It is officially named the new corona virus (2019-nCov) by the World Health Organization on 12 January 2020. WHO officially named it COVID-19 on 11 February. COVID-19 is a highly transmitted and pathogenic viral infection that has been developed and spread across the world in Wuhan, China, caused by extreme acute respiratory syndrome corona-virus 2 (SARS-CoV-2). Genomic analysis showed that bats may also be a primary reservoir of SARS-CoV-2 phylogenetically associated with severe acute respiratory syndrome-like viruses (SARS). However, the rapid human to human transition has been generally reported. Intermediate source of origin and human transition is unknown. Clinically approved COVID-19 antiviral medication or vaccine is not available. In clinical trials, however, few broad-based COVID-19 antiviral medicinal drugs were tested, resulting in clinical recovery. This analysis summarizes the pathogenicity of COVID-19 and aims to raise awareness of COVID-19 among the population and to continually boost the detection, monitoring, diagnosis and care level. Over 50 COVID-19 scientific publications were included in this systematic analysis. We found that fever (87.0%), cough (65.9%) and malaise/tiredness (35%) were the most common symptoms of COvida-19. However, COVID-19 clinical signs and symptoms were not necessarily obvious. The transmission of COVID-19 in comparison to SARS was more specific. The rate of death of COVID-19 was 2,7% and the pathological characteristics of COVID-19 are very similar to ARDS. There are also discussions on the latest epidemiological changes, clinical manifestations, auxiliary examination and COVID-19 pathological characteristics.

Clinically effective CK-MB reporting: how to do it?

The clinical utility of measuring the Muscle Brain (MB) isoenzyme of creatine kinase (CK) in the diagnosis of myocardial injury is well established. CK/CK-MB measurement in combination or CK-MB alone is widely used and reporting the results of CK-MB in absolute unit is the common current practice. CK-MB is widely measured by "Immunoinhibition" in India, which gives falsely elevated CK-MB results in the following circumstances: Central nervous system damage, childbirth, macro CK-immunoglobulin complex, in patients with carcinoma of various organs, such as prostate carcinoma and other adenocarcinomas. But, reporting %CK-MB rather than the absolute CK-MB results assists in detection of macroCK (or CK variants), associated proliferative and autoimmune pathologies and their prognosis.

Urate crystal deposition, prevention and various diagnosis techniques of GOUT arthritis disease: a comprehensive review.

Gout is described as difficult in joint sore, uttermost ordinarily in the principal metatarsophalangeal joint, attend from formation of urate monosodium crystallization in a joint space. Analysis might be affirmed by recognizable proof of urate monosodium precious stones in synovial liquid of the influenced joint. There has been expanded enthusiasm for gout in common scholarly and clinical practice settings. The pervasiveness of both hyperuricemia and gout has ascended as most recent decade of time in created nations and in this way weight of gout as expanded. The relationship of hyperuricemia and gout with cardio results for chance of added advantages in mediation on hyperuricemia was featured in this audit. Imaging procedures have ended up being helpful for location of urate statement, even before the primary clinical indications, empowering the assessment of the degree of testimony and giving target estimation of precious stone exhaustion amid urate-bringing down treatment. In advancement, the indication defines the pre diagnostic of gout and associated commodities is advised to prevent the inflammation, that image procedures will assess the weight on statement as well reaction to urinary bringing down clinical procedure in chose patients, lastly amongst last key goal on social insurance for clinical evaluation with gout is to totally project urate gem stores. In spite of the fact that the formal determination is defined with arthrocentesis and resulting examination, CT and ultrasound discoveries on addition of evaluation and execution of infection administration. The standard therapy methodology is available for the patients and whose disease is refractory to standard therapy.

Investigation on uric acid biosensor model for enzyme layer thickness for the application of arthritis disease diagnosis.

Uric acid biosensors for arthritis disease has been developed for the specific selection of uricase enzyme film thickness coated over the TiO2-CeO2 nano-composite matrix is modelled mathematically. This model is purely based on R-diffusion conditions with irreversible first-order catalytic reactions. By arithmetical method, the impact of the thickness of enzyme layer on the current response of the biosensor was explored. This article displays a structure for choice of the enzyme layer thickness, guaranteeing the adequately stable sensitivity of a biosensor in a required extent of the maximal enzymatic rate. The numerical outcomes showed subjective and sensible quantitative information for oxidation current due to uric acid also shows the maximum change in the biosensor current response due to the change in membrane thickness, which will be more suitable for uric acid biosensor for the application of arthritis disease diagnosis.

Evolution of blood pressure control identification in lieu of post-surgery diabetic patients: a review.

The blood pressure disparity is the major problem in post-operative surgery especially diabetic patients, because there is substantial interrelation between diabetic and hypertension and this abnormality creates complicated problems and needs to be controlled by continuous monitoring based on the severity. To overcome this problem, implementation of automatic drug infusion is required for critical patients, by which workload of the clinical staffs are reduced. Most commonly the sodium nitroprusside (SNP) is used to reduce the blood pressure in fast action based on the prescribed level. In this paper three different types of estimation techniques (PID, IMC and MPC) are uses to identify the valuation. The strength of the projected controller performance is evaluated under different types of patients such as sensitive, and normal along with insensitive patients. Therefore, this paper review the validation results based on the optimized SNP infusion rate for persistent Blood pressure control compare then the reviewed methods. The MATLAB simulation is used to evaluate the efficiency of the proposed work and obtain the results based on the projected values.

The Impact of Cardiac Radiation Dosimetry on Survival After Radiation Therapy for Non-Small Cell Lung Cancer.

PURPOSE: The heart receives high radiation doses during radiation therapy of advanced-stage lung cancer. We have explored associations between overall survival, cardiac radiation doses, and electrocardiographic (ECG) changes in patients treated in IDEAL-CRT, a trial of isotoxically escalated concurrent chemoradiation delivering tumor doses of 63 to 73 Gy. METHODS AND MATERIALS: Dosimetric and survival data were analyzed for 78 patients. The whole heart, pericardium, AV node, and walls of left and right atria (LA/RA-Wall) and ventricles (LV/RV-Wall) were outlined on radiation therapy planning scans, and differential dose-volume histograms (dDVHs) were calculated. For each structure, dDVHs were approximated using the average dDVH and the 10 highest-ranked structure-specific principal components (PCs). ECGs at baseline and 6 months after radiation therapy were analyzed for 53 patients, dichotomizing patients according to presence or absence of "any ECG change" (conduction or ischemic/pericarditis-like change). All-cause death rate (DR) was analyzed from the start of treatment using Cox regression. RESULTS: 38% of patients had ECG changes at 6 months. On univariable analysis, higher scores for LA-Wall-PC6, Heart-PC6, "any ECG change," and larger planning target volume (PTV) were significantly associated with higher DR (P=.003, .009, .029, and .037, respectively). Heart-PC6 and LA-Wall-PC6 represent larger volumes of whole heart and left atrial wall receiving 63 to 69 Gy. Cardiac doses ≥63 Gy were concentrated in the LA-Wall, and consequently Heart-PC6 was highly correlated with LA-Wall-PC6. "Any ECG change," LA-Wall-PC6 scores, and PTV size were retained in the multivariable model. CONCLUSIONS: We found associations between higher DR and conduction or ischemic/pericarditis-like changes on ECG at 6 months, and between higher DR and higher Heart-PC6 or LA-Wall-PC6 scores, which are closely related to heart or left atrial wall volumes receiving 63 to 69 Gy in this small cohort of patients.

The positive feedback role of arachidonic acid in the platelet-derived growth factor-induced signaling in lens epithelial cells.

PURPOSE: Platelet-derived growth factor (PDGF)-stimulated cell proliferation has been associated with reactive oxygen species (ROS)-mediated redox signaling. This study examined the role of arachidonic acid (AA) in PDGF-stimulated ROS generation in human lens epithelial B3 cells (HLE B3). METHODS: PDGF (1 ng/ml)-stimulated ROS generation was examined using dichlorofluorescein (DCFH)-activated fluorescence by laser confocal microscopy while AA (30-150 muM)-stimulated superoxide anion production was measured using lucigenin-amplified chemiluminescence in serum-starved HLE B3 cells. PDGF-stimulated AA release was quantified by cells prelabeled with (3)H-AA with and without the presence of cytosolic phospholipase A(2) (cPLA(2)) inhibitor (AACOCF(3)) and mitogen-activated protein (MAP) kinases (MEK) inhibitor (U0126). Western blot analysis was used to characterize the activated MAP kinase components in cell lysates or protein kinase C (PKC) translocation in isolated cytosolic and membrane fractions. Specific inhibitors to various enzymes were used in the study, including GF109203X for pan protein kinase C (PKC), AACOCF3 for cytosolic phospholipase A2 (cPLA(2)), U0126 for MEK, and DPI for NADPH oxidase. Inhibitors for AA metabolism were also used to examine the role of AA in PDGF-stimulated ROS generation, including CDC and NDGA for pan lipoxygenase, AA861 for 5-lipoxygenase, indomethacin for cycloxygenase, and ketoconazole for cytochrome p450. RESULTS: We found that PDGF-stimulated ROS was eradicated by inhibitors to MEK, cPLA(2), 5-lipoxygenase, NADPH oxidase, or PKC. PDGF-stimulated AA release depended on both active cPLA(2) and ERK1/2. Exogenous AA showed a concentration-dependent ROS generation via NADPH oxidase activation that was insensitive to MEK inhibitor, but sensitive to PKC inhibitor, and could be attenuated by superoxide dismutase (SOD), mannitol, or DPI. This effect of AA was specific as other long chain fatty acids (leinoleic acid, stearic acid), or AA derivatives (eicosa-11Z, 14Z, 17Z-trienoic acid (20:3) and eicosa-11Z, 14Z-dienoic acid (20:2)) were ineffective. Inhibitor to lipoxygenase, in particular the 5-isoform, but not cycloxygenase or cytochrome p450, could diminish AA-stimulated luminescence generation. Western blot analysis showed that AA-treated cells transiently activated ERK1/2 and JNK, but not p38, in a time- and dose-dependent manner that was similar to that of PDGF. Finally, PDGF-stimulated PKC translocation depended on AA release while AA-stimulated PKC translocation was eradicated by lipoxygenase inhibition. CONCLUSIONS: We conclude that PDGF signaling in HLE B3 cells is mediated by AA and its lipoxygenase metabolites, which provide a positive feedback loop for PDGF action, as AA and its metabolites can mobilize PKC and other factors needed for NADPH oxidase assembly and activation for ROS generation to facilitate cell proliferation. We further propose the role of AA in PDGF signaling.

5-HT4 receptor agonists enhance both cholinergic and nitrergic activities in human isolated colon circular muscle.

Previous studies have demonstrated mixed inhibitory and facilitatory effects of 5-hydroxytryptamine-4 (5-HT(4)) receptor agonists on electrical field stimulation (EFS)-induced responses in human isolated colon. Here we report three types of responses to EFS in human isolated colon circular muscle: monophasic cholinergic contraction during EFS, biphasic response (nitrergic relaxation during EFS followed by cholinergic contraction after termination of EFS) and triphasic response (cholinergic contraction followed by nitrergic relaxation during EFS and a tachykininergic contraction after EFS). The effects of two 5-HT(4) receptor agonists, prucalopride and tegaserod were then investigated on monophasic responses only. Each compound inhibited contractions during EFS in a concentration-dependent manner. In the presence of N(omega)-nitro-l-arginine methyl ester (l-NAME) however, prucalopride and tegaserod enhanced the contractions in a concentration-dependent manner. In strips where the tone was elevated with substance-P and treated with scopolamine, EFS-induced relaxations were enhanced by the two agonists. The above observed effects by the two agonists were abolished by 5-HT(4) receptor antagonist SB-204070. The two agonists did not alter the tone raised by substance-P in the presence of scopolamine and l-NAME and did not affect carbachol-induced contractions in the presence of tetrodotoxin. These results suggest that in the circular muscle of human colon, 5-HT(4) receptor agonists simultaneously facilitate the activity of neurones which release the inhibitory and excitatory neurotransmitters, nitric oxide and acetylcholine respectively.

The big finger: the second to fourth digit ratio is a predictor of sporting ability in women.

BACKGROUND: The second to fourth finger length ratio (2d:4d) is thought to be related to diverse traits including cognitive ability, disease susceptibility, and sexuality. OBJECTIVE: To examine the relationship between 2d:4d and sports ability in women. METHODS: Hand radiographs from 607 women (mean age 54 years) were used to estimate 2d:4d. Ranking of sports ability was on a scale (1-5). RESULTS: The highest achieved level of participation in any sport was significantly negatively associated with 2d:4d (b = -4.93, p = 0.01) as was the relationship between 2d:4d and running level (b = -6.81, p = 0.034). Ability in other sports also showed a negative relationship albeit non-significant. CONCLUSIONS: These results suggest that a low 2d:4d ratio is related to increased female sports ability. It can be postulated that this ratio may predict potential sports ability. Understanding the mechanisms underpinning this relationship may give important insights into musculoskeletal fitness, health and disease.

IgM anti-GM1 antibody titers in patients with monomelic amyotrophy.

BACKGROUND: Monomelic amyotrophy (MMA) is a benign motor neuron disorder, which particularly affects young people and the etiology is still unknown. Gangliosides are located on the outer surface of motor neurons. Anti-GM1 antibodies have been found to be elevated in multi-focal motor neuropathy with conduction block and other neurological diseases, which may have therapeutic implication. AIM: To evaluate IgM anti-GM1 antibody titers in patients of monomelic amyotrophy. SETTING AND DESIGN: prospective controlled study. MATERIALS AND METHODS: Forty-six clinically and electrophysiologically diagnosed cases of MMA were assessed for IgM anti-GM1 antibody titers by enzyme-linked immunosorbent assay (ELISA) method and compared with titers in healthy controls, cases of amyotrophic lateral sclerosis (ALS) and acute inflammatory demyelinating polyneuropathy (AIDP). Titer of 800 units was taken as upper limit of normal (Buhlmann Laboratories AG, Switzerland). STATISTICAL ANALYSIS USED: one-way ANOVA. RESULTS: The mean age of 46 patients with MMA was 24.5 (+/- 7.3) years, with male female ratio of 44:2. The mean age of 19 healthy controls was 24.1 (+/- 3) years with male: female ratio of 18:1. Five (26%) individuals in the healthy control group, 22 (48%) patients of MMA, four (30%) of ALS and five (50%) of AIDP had high titers of IgM anti-GM1 antibody (P> 0.05). CONCLUSIONS: Although larger number of patients with MMA had higher IgM anti-GM1 antibody titers, the difference was not statistically significant from titers of healthy individuals and of patients in the ALS and AIDP group.

Natural abundance 2H NMR spectra of molecules oriented in liquid crystals.

It has been demonstrated that the natural abundance 2H NMR spectra of molecules dissolved in liquid crystals can be obtained easily with the help of present-day high-resolution FT NMR spectrometers. Such spectra obtained in the case of benzene and chloroform dissolved in liquid crystals are reported. These experiments could serve as valuable aids for the analysis of the complex proton NMR spectra of oriented molecules.

Cross-reaction of human chorionic gonadotrophin in Immulite 2000 luteinizing hormone assay.

BACKGROUND AND METHOD: The cross-reactivity of human chorionic gonadotrophin (hCG) in the new DPC Immulite 2000 luteinizing hormone immunoassay was studied using sera from healthy pregnant women and pooled serum spiked with hCG standard IRP 75/537. RESULTS AND CONCLUSION: Significant positive bias was seen in sera from pregnant women and in IRP 75/537 spiked serum.

Evidence for the presence of phosphoinositide cycle and its involvement in cellular signal transduction in the rabbit lens.

In the lens, free inositol is present at high concentrations. The lens transports inositol from the extracellular source but can also synthesize inositol from glucose via inositol-1-phosphate. The inositol containing phospholipid (phosphoinositides) constitutes only 10% of the total phospholipid in the membrane and was suggested to play some key role in the cellular differentiation. Recently, one of the phosphoinositides, PIP2, was located in the epithelial cells but not in fiber cells. Prostaglandin, which uses one of the phosphoinositide metabolites, diacylglycerol, as a precursor in its biosynthesis was also found in the lens. The evidence, although scanty, do provide some clues to the possibility that lens may contain a phosphoinositide cycle similar to retina and cornea. In this study we demonstrated that rabbit lens epithelial cells could incorporate 3H-inositol into the membrane and the label accumulated in all three phosphoinositides, PI, PIP and PIP2 with PI as the predominant form. Both PI Kinase and PIP Kinase were found in the lens epithelial homogenate which incorporated (gamma-32P) ATP into PI and PIP to form their respective product, PIP and PIP2. The membrane bound PI Synthase was also demonstrated by using a cell free system. The lens cells showed distinctive response to some agonists such as Ca2+, EGF, glucagon, serotonin but not the others such as insulin, FGF. It is therefore concluded that lens epithelium cells, like other cell types has a complete and functional phosphoinositide cycle.

Beam angle manipulation to reduce cardiac dose during breast radiotherapy.

OBJECTIVE: Standard tangential radiotherapy techniques after breast conservative surgery (BCS) often results in the irradiation of the tip of the left ventricle and the left anterior descending coronary artery (LAD), potentially increasing cardiovascular morbidity. The importance of minimising radiation dose to these structures has attracted increased interest in recent years. We tested a hypothesis that in some cases, by manipulating beam angles and accepting lower-than-prescribed doses of radiation in small parts of the breast distant from the surgical excision site, significant cardiac sparing can be achieved compared with more standard plans. METHODS: A sample of 12 consecutive patients undergoing radiotherapy after left-sided BCS was studied. All patients were planned with a 6 MV tangential beam, beam angles were manipulated carefully and if necessary lower doses were given to small parts of the breast distant from the surgical excision site to minimise cardiac irradiation ("institutional" plan). Separate "hypothetical standard" plans were generated for seven patients using set field margins that met published guidelines. RESULTS: In seven patients, the institutional plans resulted in lower doses to the LAD and myocardium than the hypothetical standard plans. In the other five patients, LAD and myocardial doses were deemed minimal using the hypothetical standard plan, which in these patients corresponded to the institutional plan (the patients were actually treated using the institutional plans). CONCLUSION: Much attention has been devoted to ways of minimising cardiac radiation dose. This small sample demonstrates that careful manipulation of beam angles can often be a simple, but effective technique to achieve this.