Contemporary Surgical Management of Colorectal Liver Metastases.

Colorectal cancer is the third most common cancer in the United States and the second most common cause of cancer-related death. Approximately 20-30% of patients will develop hepatic metastasis in the form of synchronous or metachronous disease. The treatment of colorectal liver metastasis (CRLM) has evolved into a multidisciplinary approach, with chemotherapy and a variety of locoregional treatments, such as ablation and portal vein embolization, playing a crucial role. However, resection remains a core tenet of management, serving as the gold standard for a curative-intent therapy. As such, the input of a dedicated hepatobiliary surgeon is paramount for appropriate patient selection and choice of surgical approach, as significant advances in the field have made management decisions extremely nuanced and complex. We herein aim to review the contemporary surgical management of colorectal liver metastasis with respect to both perioperative and operative considerations.

The Effect of Ipsilateral Carotid Revascularization on Contralateral Carotid Duplex Parameters in Patients with Bilateral Carotid Stenosis.

BACKGROUND: Duplex-derived velocity measurements are often used to determine the need for carotid revascularization. There is evidence that severe ipsilateral carotid stenosis can cause artificially elevated velocities in the contralateral carotid artery, which may decrease following ipsilateral revascularization. The objective of this study was to determine if contralateral carotid artery duplex velocities decrease following ipsilateral carotid endarterectomy or stenting procedures. METHODS: This is a single institutional retrospective study of prospectively collected data on all patients who underwent carotid revascularization from 2013 to 2021. Patients with immediate preoperative and first postoperative Duplex scan within 4 months of carotid revascularization at our vascular laboratory were included for analysis. Patients with contralateral occlusion were excluded. Duplex criteria used to define moderate (50-69%) and severe (>70%) stenosis were systolic velocity ≥125 cm/sec and ≥230 cm/sec, respectively. RESULTS: Between 2013 and 2021, 129 patients with bilateral carotid stenosis underwent either carotid endarterectomy (98) or a stenting procedure (31). The majority of patients (90%) underwent intervention for severe stenosis. Preoperatively, the contralateral artery was categorized as severe in 30.4% patients. After ipsilateral carotid revascularization, 86 patients (67.2%) saw a decrease in the contralateral artery peak systolic velocity (PSV), while the remaining remained stable or increased. Fifty-four patients had a change in designated stenosis severity in the contralateral artery. Between the carotid endarterectomy and stenting cohorts, there was no significant difference in the proportion of patients whose contralateral velocity decreased (69.4% vs. 61.3%, P = 0.402). Patients with coronary artery disease and diabetes were significantly less likely to experience a decrease in the contralateral artery PSV after ipsilateral intervention (P = 0.018 and P = 0.033). CONCLUSIONS: In patients with bilateral carotid disease, ipsilateral revascularization can change the contralateral artery velocity and perceived disease severity. Most patients were noted to have a decrease in the contralateral artery PSV, although almost one-third either stayed stable or increased. On multivariable analysis, patients with coronary artery disease and diabetes were less likely to see a decrease in the contralateral artery PSV after intervention. Patients who are at risk for artificial elevation of the contralateral artery may warrant a re-evaluation of the contralateral artery after ipsilateral intervention. These patients are potentially better assessed with axial imaging, although further research is needed.

Effect of dimensions on function: A 2-dimensional sonographic assessment to correlate facial muscle and smile type.

OBJECTIVE: The aim of this study was to measure the dimensions of the select facial muscles and correlate them with different types of smiles. METHODS: The study group included 30 South Asian adults (17 men and 13 women) aged between 24 and 30 years divided into 3 groups of 10 subjects each according to Rubin's classification of smile. The zygomaticus major, levator labii superioris, depressor anguli oris, and mentalis muscles were ultrasonographically evaluated. The length and thickness of the muscles were measured bilaterally. The data obtained were analyzed statistically. RESULTS: The maximum mean value thickness of the zygomaticus major was found in the canine smile group. The maximum mean value thickness of the depressor anguli oris and mentalis was seen in the full denture smile group. However, the thickness of the levator labii superioris muscle was similar between the different smile groups. There was no significant difference in the measurements of the length of the muscles between the right and the left sides. CONCLUSIONS: This study did not find any statistically significant correlation between the type of smiles described in Rubin's classification and the dimensions of the associated facial muscle.

Photographic Evaluation, Analysis and Comparison of Aesthetically Pleasing Smiles: A Prospective Study.

OBJECTIVE: To evaluate the differences in aesthetically pleasing smiles and compare the smile arc parameters in males and females by dental specialists using photographs. METHODS: The study was conducted on 500 North Indian subjects (Indo-Aryan race; 212 males and 288 females) aged 17-25 years (mean age, males=21.1 years; females=23.4 years), with reasonably pleasing smiles. The facial photographs were taken using a DSLR camera. The standardized photographs were shown to 30 judges for evaluation and rated using the visual analog scale. The smiles were categorized into attractive, fair, and average. The quantification of the smile characteristics was done by using an objective method that involved identifying consonant and non-consonant smiles. RESULTS: The association between smile arc and smile attractiveness was significant (p=0.018) in females. The buccal corridor width was higher among those with fair to attractive smiles as compared with those with an average smile (p=0.018). Most subjects with an attractive smile had a smile arc parallel to the upper lip as compared with most subjects with a fair or average smile who did not have the smile arc in parallel (p=0.006). CONCLUSION: Most females were in the fair to attractive category whereas most males were in the average to fair category. The buccal corridor width was found to be higher among those with a fair to attractive smile as compared with those with an average smile. There was an association between smile arc and smile attractiveness in females.

New Zealand ophthalmologists' opinions and behaviours on climate, carbon and sustainability.

IMPORTANCE: Ophthalmology faces imperatives to improve sustainability, but there is uncertainty about how to respond. BACKGROUND: We sought New Zealand ophthalmologists' opinions on climate change, sustainability and the role of ophthalmologists in responding to these issues, as well as information on the extent that ophthalmology practices are acting on sustainability. DESIGN: Anonymous online survey of New Zealand fellows and trainees (178) of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) was conducted. PARTICIPANTS: Forty-seven respondents (response rate 26%) were included in the study. METHODS: Respondents were asked their level of agreement with statements on climate, health and sustainability and invited to comment. Current sustainability activities were collected from clinical leaders and directors of hospital departments and private practices. MAIN OUTCOME MEASURE: Distribution of agreement scores was the main outcome measure. RESULTS: Agreement with mainstream positions on climate change was as expected. A minority of up to 19% expressed the opinion that climate change was not due to human activity, and did not require mitigation. Younger ophthalmologists tended to have greater agreement with the need for broad-based political action on climate mitigation than those aged over 50 years. Most practices had room to improve on reducing waste, travel and carbon footprints. CONCLUSIONS AND RELEVANCE: The majority of New Zealand ophthalmologists are concerned about anthropogenic climate change. Currently, sustainability is not a performance indicator for New Zealand district health boards, so there is limited incentive to drive improvements. These data form a reference point to compare future opinions and ophthalmology carbon footprinting.

Canine retraction: A systematic review of different methods used.

Canine retraction is a very important step in treatment of patients with crowding, or first premolar extraction cases. In severe crowding cases until, the canines have been distilized to relive the crowding, space to correctly align the incisors will not be available. Correct positioning of the canines after retraction is of great importance for the function, stability, and esthetics. The aim of this systematic review was to examine, in an evidence-based way, which kinds of canine retraction methods/techniques are most effective and which have the least side effects. A literature survey was performed by applying the Medline Database (Entrez PubMed) and Science Direct database covering the period from 1985 to 2014, to find out efficient ways to accomplish canine retraction. Randomized controlled trials (RCTs), prospective and retrospective controlled studies, and clinical trials were included. Two reviewers selected and extracted the data independently and assessed the quality of the retrieved studies. The search strategy resulted in 324 articles, of which 22 met the inclusion criteria. Due to the vast heterogeneity in study methods, the scientific evidence was too weak to evaluate retraction efficiency during space closure. The data so far reviewed proved that elastomeric power chains, elastic threads, magnets, NiTi coil springs, corticotomies, distraction osteogenesis, and laser therapy, all are able to provide optimum rate of tooth movements. All the methods were nearly similar to each other for retraction of canines Most of the techniques lead to anchorage loss in various amounts depending on the methods used. Most of the studies had serious problems with small sample size, confounding factors, lack of method error analysis, and no blinding in measurements. To obtain reliable scientific evidence, controlled RCT's with sufficient sample sizes are needed to determine which method/technique is the most effective in the respective retraction situation. Further studies should also consider patient acceptance and cost analysis as well as implants and minor surgeries for canine retraction.

Comment on "Computed Tomography Evaluation of Craniomandibular Articulation in Class II Division 1 Malocclusion and Class I Normal Occlusion Subjects in North Indian Population".

Clear statement of objective, appropriate location of landmarks and removal of subjective bias in measurement is essential in all kinds of research, especially, orthodontics. The research design should be rationalistic, purposeful, and in accordance with the objectives of the study. In this communication, we highlight the errors in research design, measurement, analysis, and inferences drawn with the help of a published article as the primary source to explain these simple but useful points.

Comments on: Cardoso, C.F.; Drummond, A.F.; Lages, E.M.B.; Pretti, H.; Ferreira, E.F.; Abreu, M.H.N.G. The Dental Aesthetic Index and Dental Health Component of the Index of Orthodontic Treatment Need as Tools in Epidemiological Studies. Int. J. Environ. Res. Public Health 2011, 8, 3277-3286.

In regard to the article entitled "The Dental Aesthetic Index and Dental Health Component of the Index of Orthodontic Treatment Need as Tools in Epidemiological Studies" by Cardoso et al. [1] which checks the validity and agreement of two scales for orthodontic treatment need, we would like to draw your attention to a number of discrepancies in the design and methodology which have affected the results. [...].