And here comes our star-studded show train. The creation of American Railroads presents the musical play, Boys from Syracuse, by Richard Rogers and Lauren Park, starring Gordon McRae and his guest, Evelyn Kate. Our choir is out of the direction of Norman Luboff, and our music is prepared and conducted by Carmen Dragun.  And now here is our star, Gordon McRae. You never saw before in your life, came up to you in a strange town and insisted you were her brother. And that's the problem that Evelyn Kate and I are going to try to unravel in the Boys from Syracuse. And incidentally, that Syracuse in ancient Greece and not my hometown up in good old New York state. My name is Antipolis. I was separated from my family when I was scarcely more than a baby and grew up without ever having known them. When I had attained some measure of success in life, I searched all Greece for a trace of them, but in vain. Now on my way home to Syracuse, I stopped for refreshment in the town of Ephesus. And as I left the tavern. Romeo, Romeo, wait. I'm afraid you've made a mistake. My name is. Now, Romeo, I haven't any time for your pranks. Adriana is waiting for you, and she's practically beside herself. Adriana? Your wife, dear, remember? Well, no. As a matter of fact, I don't.  My sister will never forgive you. After all, you've been gone for months. I have. Romeo, what's wrong with you? I don't know. Maybe it's you. Do you often have this effect on people you just meet? You haven't just met me. That's funny. I feel as though I have. I was on my way to Syracuse, but if you're free for the evening. Free for the evening? Romeo, what's wrong with you? You're my sister's husband. I'd rather be yours. I'd rather be your wife, Romeo. I don't believe in love. Well, why on earth not? Perhaps because I've seen too many marriages like yours. I've learned a lot about love from you and Adriana, Romeo. I think very little of him. Then you'll see that I'm not Romeo. You've returned to me. Thank you, Luciana, for bringing him to me. Somebody's crazy. Maybe it's me. I've been so lonely all these weary months. Did you bring me the gold chain you promised me? Gold chain? Oh, Romeo, you promised. I did. Well, if I promised, I'll have to get one. I have a gift for you. I'll get it. It'll only take a moment. Well, Romeo? I don't understand any of this. My name isn't Romeo. I never saw that one before. And my whole life, for the only reason I haven't left already, is because I do care whether I see you again. Don't talk like that, Romeo. I can't listen. I mustn't listen. What did she call you? Luciana? You know that's my name. I don't know anything about you. Yet I know everything. The way you suddenly do know everything about someone you've been waiting to meet. You know, if I was married to you, I know just how it would be, Luciana. The shortest day of the year, has the longest night of the year. Listen to me. I am not Romeo. My name is Antipolis. I never was in this town before. I'm just one of the boys from Syracuse.  Well, one of us is mad. I know that. That doesn't matter. I'm in love with you. Do you understand that? I've never been in love in my life before. I was beginning to think I never would be. And then you came up calling me Romeo.  I was gone. How can we be in love under the circumstances? We're not in love. How do you know? I know how I feel. Well, how do you feel? I feel fine. Well, so do I. We both feel fine, so we're not in love. Adriana? Luciana, wait, don't go. I never want to see you again, Romeo. Is that clear? Oh, Luciana, and she was talking to a group of friends.   He must be Romeo's twin brother, the one who was lost in Syracuse when he was a baby. Your husband is my brother? I'm afraid so. And I must come along, Luciana. I'll rescue you from this upstart. Adriana, if you don't mind, I don't think I want to be rescued now. It's yourself. I'm going back to Romeo. You see? See, Luciana, I'm not Romeo. He's the brother I've been searching for. I'm really in no hurry. I'm in no hurry either. By the way, what did you say your name was? Antipolis from Syracuse. I'm very happy to meet you, Antipolis. Very happy to meet you. Right now, with summer just beginning, may seem like an odd time to be talking about next winter's fuel. But that's just what high government officials are talking about, in urging a nationwide program of summer fuel buying. The Secretary of the Interior urges, in the public interest, that all consumers of oil, liquefied petroleum gas and coal, build their own fuel stockpiles during the summer months. And the Defense Transport Administrator says that the wise consumer will lay in maximum fuel supplies during the off season in the fuel trades. The railroads, who are called upon to transport so much of the fuel you burn, join these government agencies in urging that you ensure your fuel needs for next winter by putting in as much of a supply as possible now. Here again is lovely Evelyn Case. I'm glad that my twin brother came home because you're the one I wanted to sing duets with all along. I wonder where your brother was. You suppose he might have been having a date with your next week's show? Well, it's possible, because next Monday, we're presenting the Mary widow, with Nadine Connor as our guest star, and Jack Kirkwood as an extra added attraction in the role of pop-off. Well, then I've got a date, a date to listen. Good night, Gordon. Good night, Evelyn, and thanks for a wonderful performance tonight. All aboard! Well, it looks as though we're ready to pull out. So until next week, this is Gordon Macrae saying goodbye.


Okay, welcome to the Bookmap Live Order Flow Advanced Analysis webinar. Risk disclaimer, trading equities and futures involves substantial risk of loss is not suitable for all investors. Past performance is not indicative of future results. And I gave the link out to some of the new traders for today to get a peek into this webinar and what you get with the trial. So welcome and let's take a look here. We'll dive right in. And first thing I want to take a look at is oil and because what I want to cover here on oil. Now, this was the day that we saw the big move to the downside, right? And I kept on looking for it to rebound and we did get that rebound a couple different times but then it failed and then went to the downside. I remember and what this is why I want to cover this is we saw so much absorption on the way down. All the way down through these areas and then we see the buying initiate down here yesterday and the move to the upside. So I recall all of that absorption that we saw on the way down was in this little area right in here. Just below 47-40. Where did we go to and this line has not changed. I kept it here for the last three days or so. We actually noticed it being important over in this area here on the 15th, which was what? That's Tuesday I guess. And that's where we saw a change in the order flow and yet again here and all of this absorption. So what we were witnessing in book map was not shorter term stuff. That's what I want to cover. This was larger players and we knew their position and we know that they're averaging in there on their cost on the way down and if they can get it back up into these areas here that's great. They can cover if they like. They're already out of profit. So you start to piece together the order flow here on a 30-minute candlestick chart. But you wouldn't be able to see that here unless you were looking at book map to understand that absorption like that into some of these areas. So anyway I just wanted to cover that because we get the question frequently regarding is this only for scalping or can it be used on intraday or not intraday, more swing trading. And there's a good example. We knew their position and we're looking for that anticipating that test of 47-40 and we got it in the overnight session last night. So oil, I want to take a quick look at oil. I've got both contracts up here and so I've got the V contract for October and then I've also, oh I don't have the other one, I had rhythmic earlier and I lost my data. I had both contracts earlier. I had the U contract as well as the V contract here in oil. And what I wanted to show was that both look very similar and they have high liquidity very close to price. Why is that? Why does it look like this? And what's going on is rollover. They're rolling over one contract into the next and you're seeing the volume switch to the new contract. So it's another thing that you're going to witness using book map. So when you start to see this kind of behavior here, you can start to understand what's going on. There's another thing that, using fundamentals and starting to understand risk in the fundamentals. So let's see if we have an example here. I don't. But during an economic release, you'll note how something changes. The book starts to really thin out and these areas will start to get really dark and that's because they don't want risk in the market so they'll pull the liquidity. So if you see some geopolitical type of activity or you don't know it's going to happen, those things can happen out of the blue. But book map can give you some insight to that too. If you start to see a lot of the algos turn off and a lot of the participants pull their liquidity and you'll see it all at once. In fact, the switch is kind of like this right here. This is kind of what it looks like. This area here, note how it got dark like that. In this little area, they all kind of basically started to pull at the same time. So you can also see that in book map to kind of give you clues to maybe some of the geopolitical or fundamentals out there. Okay. Good morning, Nisthan. Okay. Now welcome to the webinar. All right. Oh, I know, yeah, Guido, this is not what I'm talking about. It looks somewhat like this. You would see it on both sides with a fundamental release or geopolitical news or something. It's going to be the entire market, not just one side. Okay. All right. So due to the rollover, I don't want to look at oil and in fact, we were covering this earlier in the platform details webinar. A lot of really interesting price activity here in NASDAQ going on, all right? And saw some really nefarious stuff here, I thought. And I'm curious like how what maybe some of the governing bodies would think about some of this. Let's take a look at the NASDAQ here around this 10, 15. And you can see the move to the upside. Okay. You can see the high liquidity here, right, at 5,800. Okay. And we see they swept the book. They took all that liquidity and they continued on to the upside. Strong move through 5,800. Okay. Now as we cover every day, you know, we look for that sweep of the book and then we look for, and this is initiated buying here, okay? And we're looking for them to come back and support price from where we broke from, okay? And we'll usually get a retest of that area and you'll see the buyer support it just like this. Okay. In fact, we can draw in a trend line, okay? We can start to draw in some of the structure in some of these areas as well. Okay. You can draw in book map. And here's where we broke a structure. There's also a horizontal line, okay, right here. Okay. And we actually got a real retest of that horizontal line right here, okay? So this is what we're looking for, right, exactly what we're looking for. And we're looking for at least the high to get tested and maybe price, I would start to anticipate, you know, price discovery to the upside, okay? Now this is where it's pretty wicked stuff, okay? So we see high liquidity come back in here, right? And I'm looking for 5,800 trading above 5,800. Okay. Well, look what they did. Okay. They started to pull some liquidity here, okay? And some of it, they definitely, you know, you can see it, the trading took place right within this high liquidity area right here, okay? But look at the spoof on the other side, okay? You see the high liquidity here, okay? Short term, high liquidity, doesn't stay in the book for very long, and we get a nice stop run through all of this area here and right down into kind of like a, you know, it's going to be more or less like the POC of this range here, okay? And then you can see that then we found the buyers yet again, okay? And especially right in this area here, okay? Here's that initiated buying, okay, and then move to the upside. So wicked stuff, right? And here's another spoofing type of activity here, very, very high liquidity layered in here, three layers deep of high liquidity. Let's see, it's like 83, you know, 82 contracts or so. And although this is pretty far away from current price, usually, you know, it's quite close to current price and it'll skew that auction and then you'll see the price react to it. Nonetheless, this area here is very, very sensitive and we can see all sorts of, you know, pretty wicked stuff going on here, okay? In fact, we come back down into that area again here, okay? We see that then we get a bounce, okay? And then we see follow through to the downside here, okay? Now it looks like it wants to trade down below 5,800. So it's just banging around back and forth between that area here, okay? So let me go back here now. And okay, so let me zoom out a little bit so I'm kind of losing my place here, okay? All right, so, and again, very, very high liquidity here, but then they look at how they pulled, okay, as price is coming down. So did they have interest? No, these guys do not have interest to trade here at all, but we do see a retest back to structure yet again. So this is where we broke from right here, okay? And it's that 5,800 level again and we get a retest to it and this time we're accepting down below it, okay? So let me draw that one in as well. So here's our structure, here's our retest of it, okay? Here's our break from that structure, all right? Okay, good stuff. And what's nice about it too is we can start to read these flips in the order flow. I mean, it's really pretty clear. You know, look at the initiated buying here. We see sellers start to come in here again, but then we get the break of that structure like we covered and then you see, you know, continuation to the upside, okay? A nice cluster of volume of aggressive buying up here, but now we're starting to see on the other side. So this is getting, they're distributing out. This is a distribution pattern here and this is a head and shoulders, right? Or you can say, you know, complex head and shoulders or, you know, double top, whatever and it doesn't matter. What matters here is to understand their position, you know, what's going on with the majority of these traders, okay? We see the aggressor over here in the buying and then look how that starts to dry up, okay? And we start to see selling come in here, okay? This is what we look for in the order flow, all right? Selling again down here at some of these levels and, you know, it's still not really, to be honest, like I don't think this is, you're seeing it flip. You're seeing it starting to change over. I would like to see this down a little bit lower and a little bit more volume to, you know, on the downside here and, you know, we don't get that. We don't see that here but, you know, we did not hold above, we tested the high here again and look at the retest here and we're exhausting out and then that's where the sellers take control right in here. So this is where it starts to get good right in here, okay? And then they just continue to hit the bid, okay? All right. So, you know, we can go through and look at this again and again. You know, here's the order flow, nice volume to the downside here but then you see the buyers, you know, come in right in these areas here, again, trend line break or, you know, level broken here, move back up to where we broke from previously, okay? And then look at the selling here. So looking for, again, price discovery to the downside, okay? And the map, the heat map, the liquidity, it's finding some of those areas and then it continues to the downside, okay? This is looking like a flush to me, just a massive amount of volume here trading through and we'll see if, did we bounce after that or not? No, we continue down, okay? Okay. Yeah, you see, when you see that final flush like this, you can start to look for and you'll just see this massive amount of selling just like this and then it's like a V bottom and then you see the move right back up, okay? And then basically there's no more sellers, right? The sellers have dried up. Now we do get one more test of that area and we break the low here, okay? But and then the buyers step in though, all right? So all sorts of good stuff in this chart and, you know, after this kind of flush through and then this might have shaken you out a little bit but you can start to look for buyers to, the sellers to exhaust out and the buyers to step in, okay? After something like this and that's exactly what occurred, okay? Now we're above 5800, okay? And that's where the initiated buying, you can see it right in here. That's where they came in, all right? So great stuff here and very, very transparent, okay? Any of those sellers placing their stops maybe up in this area, okay? They just got stopped out, okay? So let's read it in the current market and what's going on now, okay? Wow, I mean it's both sides now, I mean we're seeing both buying and selling, okay? Big volume dots on both sides. So no real clarity on that, I mean I do like seeing the buying still here, okay? And here as well, okay? So let's see if we can step in and we can break structure again and then continue to the upside here, okay? So we want to go up to maybe 5806 or 7 and we want to see initiated buyers come right back in, okay? Here we are, here we are, just there. And they didn't step in and let's see if we get another rotation, okay? Where would I be targeting some of the higher liquidity up here, okay? So first stop would be like this 5808.5, 5810, 5812. Let's see a few questions. Yeah, Guido, I don't have ZB or ZN up, Istvan. Everybody set the CVP bars like I did, okay, that's really easy, okay, here we go, okay? So this is what we're looking for right here, right? And they started to pull that liquidity here instead, right? Boy, it's just moving back and forth and back and forth. I don't know what's going on here, I haven't really looked at the news. But anyway, yeah, I mean, still, I mean, we're moving lower now, but I don't see a lot of aggressive selling here, okay? I don't see clusters of activity here, hating the bid, okay? Let's see if maybe we can come into this area of high, there we go, right into that area of high liquidity just now, okay, at 5803. And now I'm looking for those buyers to step back in, okay, up to 06, okay? Still looks like there's more, you know, we just have more buy-in here in the overall. I mean, I'm not seeing what we're looking for in the order flow on that sell side. I'm looking, I'm seeing more volume trade, you know, aggressive buy-in at the higher highs. So due to that, I start to anticipate the move to the upside, okay, and we're getting it, okay? Now we're above that 5806 area here. We just broke that, okay? Still looking for $558.10 now. Boy, it's wicked, you know, another little flush through right here in this area, you know, just below the structure and then right back into the range. Let's see here. Okay, CVP column, sure. Let's go through that. This is very simple to set up. Let me zoom in a little bit closer. So CVP stands for Chart Range Volume Profile and it just gives me, I mean, look at the buy-in here on the upside. You know, I'm anticipating the move to the upside. I mean, we see the pressure here, okay? This is the way that I've got it set up as a profile here. You can split this out as well. You can right-click in the column, okay, and you can format the column, okay? Beautiful. $5810 just hit, okay? And our column gave us some nice insight on that right here, okay? You know, we can see, look at all the aggressive buy-in here, okay? So this is the way I've got it set up. I have it as bars and numbers. I like it for the CVPD bars and numbers. That's my personal choice. I have both bid and offer showing. I have a VWAP line, which is this white line right here, okay? And a lot of times though, I will also split out the data, too, because we can. We have both aggressors here.  Like right in this area here, look at that. You know, it gave us nice insight and we, you know, this was before this move to the upside just took place, okay? So we've been nailing it here with the order flow and, you know, reading it pretty nicely because it's displaying pretty nicely, right? It's just been displaying itself really nicely. You know, we can see the aggressor, all right? And we start to anticipate these kinds of moves to the upside, okay? So this is the kind of transparency that we're looking for in the marketplace. And today, the NASDAQ, although it's wippy, I mean, we're still reading it correctly, right? Down in this area here, I just didn't see the sellers stepping in. I didn't see this flip and order flow. Nice target, very nice target here with this high liquidity here. And we came right to it. And still, though, I didn't see a lot of selling come in. It still looked like more buying, okay? Here at 5806, this was giving us nice insight here, more volume, more buying at the higher high. Still, we got a quick move right back down to where we broke from here, a little lower as well. And then right back up with a nice cluster of volume trading up here, okay? And then you can start to anticipate that move, right? And we're getting it. So, yeah, 58010, just a little bit of a pause. And then it went right back up into high liquidity here at 5812. And it's trending pretty nicely at the moment, okay? All right, let's see. Any questions on the column there? Okay, now I'm pretty zoomed out right now, so you won't see the numbers. You know, it's been so wippy and we have so much volatility. If I zoom in a little bit, just with using my center mouse wheel, I can zoom in very quickly in and out, then the numbers will appear here, okay? Okay, so that's another way. A lot of traders really like to look at the column's data, and they like to have it split out just like this to see the aggressor, okay? Again, bid versus offer, who's winning the battle here, okay? And now, well, we can see that we see some selling as well now, okay? And we can just look at the dot and the color and the size and understand that as well, okay? In this area, in this area here, down here, it doesn't look too good. And actually now it still looks like buyers are in the game here, and we're still going up higher, okay? Now, another nice feature is resetting this column and the aggressor, okay? You can also just hover over the vertical, you know, the column line up here, and we can widen this out, okay? You can also just, you know, grab it and move the entire, just left click, hold and drag, you can move the entire column. So you can really build out a dome here very quickly, however you like. And let's get into some of the resetting here, because this is a nice feature. A lot of traders, they'd like to look at this, but now we have too much data here, so what we can do is we can come down here and we can go to reset, okay? And there's all sorts of configurations for resetting this, okay? So we can schedule a reset to happen every single minute or number of hours or seconds, or you can have it reset at a specific time as well, like 9.30 Eastern for the cash open, and then there's a conditional reset here too. So if it goes out of a range and then heads right back into that range, that data will not reset, okay, based on number of seconds here, all right? So let's get rid of the schedule reset, but I do want to show another one, which this is one of the features I use, is I like using the double click here, reset on double click, okay? So what I can do is just very quickly, I'll just double click in this column, and it's completely reset. So now I'm starting again, who's winning? Who's winning the battle? Which aggressor? What's the heat map look like? I see liquidity here at 13, and this is where we traded earlier at 13, right? There was high liquidity here earlier between 12 and 13, and they're showing up again, all right? And that looks like, I mean, we can see there's a little more selling pressure now, right? Okay, buyers come back in in this area here, but you know, they're the buyers, okay, there's our initiated buying again, okay? Let's hit 17, shy's away from 17, there we go, into 17, okay? Let's see if we can get back up to 20 now, okay? But you know, I'm reading it here, I mean, I'm seeing that selling coming in here now, right? Now initiated buying just came back in here, so this is getting a little more convoluted at the moment, okay? Let's see if we get our retest to where we broke from just right here at 17. Note how they were here on the offer, now they're on the bid, a little bit lower though, and let's see if we can break the highs into that 20 area, okay? That's the target, here we go, okay? 20 has reached, okay? These sellers here, they're going to be flipping out, and nice cluster of volume up here. Nadim, flip of the order flow, how do we see buyers, big green dots? Well, that's the aggressor, right? Market buys and sells, okay? So red dots, someone hit the market sell button, okay? They took liquidity, I'll zoom into this area here, okay? So they took liquidity here, for example, that was on the best bid, okay? The best bid at that point was, we see, you know, 10 contracts here. Okay? Now, we can also see an iceberg here, all right? Because we have 10 contracts here, but 38 traded. We have a trade here for 38, how is that possible? There's only 10, you can't trade more than what's here. They traded 28 contracts more than what was here on the bid. Well, that's because this is being absorbed here by an iceberg order, okay? So these 28 contracts here were hidden. They were not in the limit order book, but they did trade, all right? So then we tag it here, it's also this red number that you see here. But the red number in this column here, if this area gets retested, then this number is going to refresh, or the area will refresh. So that was the way we used to show the icebergs. We've enhanced it now to show it directly on the chart, which is fantastic. I really like it. I think it's really insightful. And then now it turns into 49 because we've just compressed our timeline and squeezed those trades together. And then we have an overall of 49 here, okay? Okay, some of the columns data here. So it's all initiated here with the right clicking. And the structure here, you can see some of these, just a little line right here, here, and here, and then also down here. So it's showing you different stuff here. The first one, the division here is just formatting that column, okay? Now for some of these data columns, you'll have more data than others, or more options here than others. So for this one, you have session accumulated or chart range accumulated. You can change the CVP to an SVP, okay? So let's right click again and let's change it back. And then let's right click, and we also have the reset options here. You're not going to get reset options with the COV column, for example, or some of the other ones, all right? And then we have another division here. And this area here, okay, are all the different data types, okay? COV, okay? That's our current order book column, okay? We're looking at a volume column right now. We can also look at a trades counter, okay? And what this is showing, let me format this into a profile, okay? And what this is showing now is CTC, okay? So it's a chart range, but it's showing the, not the volume, it's showing the number of trades that took place, okay? And then we can also look at the quotes that were refreshed, that came into the book and refreshed at certain areas. And we can also take a look at that data here, okay? We can also look at a quotes delta. What this is showing here is liquidity that was added and pulled, okay? The delta, okay? So if you see a negative number, that means liquidity was pulled. If you see a positive number, it was added, okay? We can also right-click here. We can look at a couple different notes columns. You can set your own notes, and you can also have a time in sales. Now, if you want to get rid of a column or insert a new column, that is done in this area here, okay? So I can insert a new column here, and a new one pops out to the right to where I was, from where I was. Same, it duplicates the column where I was, okay? And then now let's hide that column. So I'll right-click again, and then I'll change that to hide. There we go, okay? And then this changes back to volume, okay? Now, it's fun that it should be all available there in the basic. You should have those options, okay? The advanced is more about the different add-ons, okay? Not the column's data, though, okay? All right, let's go back to current price and see what's going on here. Okay, wow, all right? So basically, another just bashing these traders here to the other side, and by the breakout that I saw here, and noticing that I was starting to notice some selling coming in here, then I'm looking for this area up here, and I mentioned it as more of kind of like a stop-hunt area, okay? One more tap to the upside here, and let's view that area, and look at the buying here, okay? So this is where, again, we were reading the order flow, and today the order flow, well, we can look at the limit order book here as well, but the traded volume is showing us some really nice stuff here. And right in this area here, okay? So the buyers, again, they're drying up in this area here, and the sellers take control here, okay? We get below here, and the selling kicks in, okay? They want to sell, they want to try to get price below this swing here, and continue to the downside.  And then we see the move to the downside, okay? Now this area down here, look at the order flow down here, okay? So we see, look at the green, a lot of green, a lot of buyers starting to step in in this area here, okay? And look at the selling here, okay? That's not bad for the selling. Maybe I would look for maybe just to try to touch this high liquidity here, but we don't. Instead, they just sweep the book high to the upside here, and the buyers are back in the game. It's just all over the place. I mean, these are big moves. Nice, nice moves. I should be, I should be trading. Let's see, the, okay, so what I want to cover here is some of the liquidity that plays within the, basically the order flow that we're looking at today, but we'll see, you know, the difference here of little higher areas of liquidity and other examples, and we're not really seeing too much today. So, you know, these areas of high liquidity here, note how we're channeling between it, right? So it's giving that structure to the market, right? So, you know, and we're starting to, we can start to read it down here too. Look how, as price is coming down into this area, look how they started to come into the book, okay? They were down here, well, 5812 and 11.5 and 11.25, and then they kind of boosted it up here, okay? They were looking at 5812 and 12.5 here, and that's showing some, you know, it's not the most bullish, but it's more bullish than if they had stayed here and then added maybe higher liquidity down below, okay? So that's the distinction I'm trying to make here, right? So if they're adding as price is coming down, that's showing that they want to, you know, they're going to front run. They're trying to get in before these higher areas of liquidity are hit, okay? And instead, what happens right in this area here is they just, the aggressors just step right back in, okay? And now we're right back down there again, okay? Yeah, I'm looking for it to get tested now. Here we go. And let's see if the sellers will just sweep through 11 and 12 here. Okay, that doesn't look too good right now. The cluster of volume, I mean, we don't see a lot of volume trading here, okay? The cluster is up here at around 14, and the majority of it is buying too. So if we can sweep the book high yet again and get those buyers back in, then we'll see a nice move, I think, to the upside. At least, you know, first target would probably be, you know, see if they get back interested around this 18 level. If not, then 22. There they are. There we go. There's our move. Okay, all right. So another aspect I want to cover here, and showing it pretty nicely in our volume columns is, you know, in a trending day, okay, what that looks like. And, man, it's not, let's just look at the CVP then instead of maybe the SVP. But what you get on these trending days are nice multiple profiles, like this, okay? This is pretty muddled down here, but these two, this double distribution here is pretty nice, okay? And then Francisco is just pointing this out, you know, this is why these guys are providing high liquidity here between 11 and 12, so low volume node, okay? It's also a low volume node on our session range volume profile, okay? So you can play off of the two different columns here, right? And each one has a different VWAP as well. So there's all sorts of things to look for. You know, for example, right here, here's the point of control, okay? And we're trading above it now, okay? Fighting for that point of control. If we can get more buyers to step in here, then we'll get a retest, I think, of the high, right? It's going to be a battle for this point of control, the majority of the traders. Okay, we did get our test at 18, right? And that was our first area here. We did not see them jump in. Curiously enough, they did not jump in at all with high liquidity. There's a little bit maybe here. Let's see. Now, you know, if we can get both that point of control here and we get that initiated buy-in, we're looking for 22. Okay, showing interest here at 20.5. Okay, we're still above that point of control. So let's see if a buyer stepped back in right here, okay? This is where we had structure. Now, let's see maybe the sellers take over. Let's see here, more questions. The quotes counter is showing it's not the number of contracts. It's just, you know, the number of orders that are refreshed. Okay, so let's say I come in with, let's say I have 100 lots, but it's one order. Okay, the quotes counter is going to just tick one. Okay, even if I have one lot order and, you know, I want to be a buyer and then I pull it, well, the refresh will be one. Okay, and why would we want to look at that data? Why would we want to look at a trade counter as well, right, instead of a volume profile? Well, the reason being is that algorithmically here, a lot of these algos will disguise their size and position by breaking it up into several small orders. Okay, so you won't see those large block trades go through. You know, for, like, let's say for 100 in the NASDAQ, you wouldn't see that. I mean, you'll see some and we can filter for that as well. So let me show that. I'll show you how we can filter for that. But the point here is that why we want to look at quotes data as well as trade event data is because that 100 block order is going to go through instead as 100 orders for one each. Okay, and we were looking at it earlier. Let's zoom into an area and maybe we'll see. And you'll see the algorithmic activity, you know, and they'll very mechanically be, you know, lifting the offer or hitting the bid. Okay, maybe here. No, but look, yeah, this is getting a little bit, I really like to see it when it's very, very clear and mechanical. But anyway, that's my point. And why, you know, a lot of the algos will not, they're more reading events than they are necessarily the volume. Okay, because there's trade interest. It's like, you know, understanding and reading the number of or the interest at an area. Okay, we just traded into 22. All right. That was what we're looking for as a target here is 22. It still looks good. I think maybe 23 here. Let's see if we can get to 23. We had a retest here, but no volume here. Sellers starting to come in. Sellers. And there we go. Now we got 23. Okay, these sellers are getting squeezed. Okay, so that's why we'll have the quotes counter. You know, this is basically that pit noise.  They want to be buyers. They want to be sellers. And that's, that's, it's very similar here. So it's showing interest, you know, it's showing. They'll show really nice profiles here. And you know that there's a lot of interest down here at this area here at 5816. Okay, so if there's interest, you know, a lot of the algorithms are programmed to look for that and understand that it can trade at these areas here. So like, for example, and this is giving us, look at the profile here, you know, and look at the interest up in this area here. Right. It's really tapering off. Okay, I don't see a lot of refreshes up here. Okay, and if there's no interest, well, what's going to happen? Price is going to rotate to where it can trade. Okay, and then we'd be looking for maybe 18 again. Okay, 25 hit. No, that might be it right into the area here of high liquidity. Okay. And if there's a lack of interest up here, sellers are going to come in and we're going to charge to the downside. All right, so let's go through the filtering here and then we'll call it a week here. And you guys have a good weekend. I want to go through some of, because I haven't covered some of these things in quite a while. So, you know, we covered some of the automated strategies and I got a lot of questions yesterday from various traders and in support regarding that. So it's good to go through some of these things instead of just purely going through the order flow here. And as we are, you know, waiting for some of this stuff to unfold as well. So let's take a look at the volume dots here and there's ways of filtering for your volume. Okay. So I usually just leave it as the restore the default settings here. Okay. Now the dot size is a little too high for me with the default. So I'm going to bring this down. Okay. It's still showing strength. Wow. Jeez. It's just continuing. Anyway, so there's ways of the dot clustering. But the showing the block trades is what I want to go through. So that can be done here. Now the clustering is done with, you know, some of these, there's some different ways to do it. You can have it as none smart by time and by volume. Now by time is pretty, pretty straightforward. Okay. So like let's say every five minutes, I'm going to get a volume dot. Okay. Now note that the volume dot for this five minute period here, where that's being built right now, it'll end in just a few seconds here, is off of price. Okay. What it's showing here is a volume dot for this five minute period based on the VWAP. So that's why it's down here. So the VWAP of this five minute period is here at 25, 25 and a half. Okay. So that's how it displays it. Now if we can go, we can go with by volume here as well. Okay. And this input 500. So every dot that is painted here constitutes 500 trades or I'm sorry, 500 contracts. Okay. So all of these dots are going to be the same size unless someone traded for, you know, one order for more than 500, then it'll be a bigger size. Okay. So this period and this period here, 500 traded, 500 contracts. Okay. Now the smart cluster here, this is kind of a combination of time and volume and it will cluster it. Okay. So you're looking for the majority of the traders based on time and volume. All right. So now the block trades. Okay. Let's input 100 here. I wonder how many we'll get. None. No, there's one up here. Okay. Let's input 50. Okay. So a dot is going to appear when a trade, wow, there's only one. No, there's one down here. Let's put in 10. Okay. All right. We'll see quite a few more now. Okay. So and you can see that there's not a lot of these block trades that go through nowadays. Instead, they're going to break that up. Now, because they break it up that way, we can also filter for it and not look at block trades. Okay. Instead, we want to look at minimum accountable dot volume here. And what this means is you'll filter out some of these trade or some of these contracts here by inputting. Okay. So let's input 500. That's too much. Let's input 100. Okay. So what this means is within, you know, all that algorithmic activity that we saw, how these are broken up when we zoomed in, right? Well, we can only show so many events within the screen here. And one pixel right now is the smallest amount that we can show. Where the volume took place within that one pixel. And we just filtered out all of the rest of the volume here to show that within one vertical slice here pixel, paint a dot where there are 100 contracts that traded within that one little pixel. Okay. So that's how we're filtering for it. So let me take off the filter and then I'll zoom in here to this area. Okay. Okay.  But notice how when I zoom back out, okay, we consolidate all of that. Okay. It's just visually. I mean, all of the trade events are there. But we're just compressing the timeline on the bottom here, as you can see, as I'm zooming out. Okay. And as I'm zooming out, there were just, there were so many trades that took place here that we just painted as one big dot, you know, bigger dot. Okay. And so visually it's aggregated just graphically. Now, all of this other, you know, a lot of traders might think that there's too many dots. It's too much noise. They only want to look at the significant volume. So what you can do is we can filter for it here. Okay. So let's input actually something a little bit less, maybe 50 or maybe even 20. Okay. Now, so within that one pixel, 20 contracts traded here. Okay. Now you'll note here, okay, let's go into this little area right here. Okay. This dot. As I zoom in, that condition will no longer be true at a certain point there. Okay. Now it disappears. And why is that? Because those 20 events here or those 20 contracts are spread out now on more than just one pixel. Okay. So this is based on your zoom. All right. So if I zoom out, it, you know, it's not kind of a set and forget type of thing. It's based on your zoom. But you can filter for, you know, looking for more significant volume. If you, you know, a lot of traders like to do that because they, they just want to look for, you know, the majority of the trades. Okay. Not every single event. All right. Okay. All right. Well, interesting, interesting, great price action today. And great to, great to read the order flow. Again, same, same stuff. This is just higher timeframe. But we can, we can see here structure broken. Right. So we just created mine. And then, and now we're accepting above this area here. Okay. Looks like we're just about to get a retest of it now. Okay. And you can see that's why they're, they're, they're here with, you know, providing liquidity on the bid. Okay. Because, you know, this is, if this is the new value of this product, it's going to accept above this 21 level. So responsive buyers down here at 21. All right, guys. Yeah. Let's, let's call it a week. Thank you, Francisco. I really appreciate the comment there. Yeah. I, you know, we, this is just a, it's a fantastic tool. And it's offering really, you know, quite, quite a transparent view of the market. Okay. I mean, just putting these pieces together, you can see we do it, we do it all, you know, every day here. Today was a lot clearer than, than others. Okay. So coming down into the high liquidity here. So targeting that high liquidity. Okay. We also have our structure. Right. And, and we're right into it now. Let's see if, see if buyers start to step back in. Okay. All right. All right, guys. Yeah. Let's call it a week. Thanks for, thanks for coming. And we'll catch up with you on Monday. All right, guys. Yep. Okay. Take care. Bye-bye.


This is Think Tech Hawai'i. Community Matters here. Welcome. This is Craig Thomas, your host on Much More on Medicine, part of Think Tech Hawai'i's live stream series, assisted as always by Cindy and Rich, our engineers, and joined by my friend Vernon Anstale. Great. And thanks for coming. And just a little back story. Vernon, you're going to learn more about Soon, but he's a professor of tropical medicine. And years ago, like 25, I'm tempted to say, you and I went to Vanuatu together. And I vividly remember you, Dapper as always, commenting on the rat that had shared your pillow one morning.  So thanks for coming. Well, thanks for bringing that up again. Actually, I can barely remember the incident, but still. Well, you've been to many interesting places and are no doubt exposed to more interesting creatures than rats. And honestly, Vanuatu was a fascinating place. Before we dive into this, and I think it's both a timely and interesting topic, and I know that you're heading up a symposium and a board for what, at least a year, gathering the available information about this. But before we do that, I wanted to talk a little bit about a couple items in the news recently. And specifically, there's been quite a few different articles in the press relating the health benefits of exercise over pretty much anything else we can do, particularly if it's outdoors, and then looking at where states rank. And the benefits of outdoor exercise appear to be very high. And guess what? Hawaii has wonderful opportunities, and consequently, in a recent study, I had the highest average lifespan of any state at just over 81 years. I think that's fantastic. It's obviously one of the reasons it's great to live here. And in fact, I went for a little paddle this morning. It was fantastic. There is a disturbing piece to this also, Howard. And that is we live in a great state on a fantastic island. Access to many of the trails, and Cocoa Crater Trail, which is a really nice climb up if you haven't done it, and you can even make a great loop out of it, is in disarray. Sounds like there's a local group that is trying to own repairing and managing it, and I'm delighted about that.  And specifically, I know, and I thank you for it, that you've been leading the charge on the hiking stairs, which is probably the best trail in the entire state. You want to kind of tell us where that's at a little bit? Yeah. I mean, I think what you're saying, it's really disturbing. This list of hiking trails that are now forbidden, as it were, people can't enjoy them. And the list just seems to get longer and longer. And unfortunately, hike who stares is one of those situations. People cannot climb legally there. If they do try to sneak on and get caught, they can be fined up to $1,000. But this is such a fabulous experience that it needs to be reopened at some point for the general public to enjoy. I agree completely. I can't give you specifics, but let's just say I am fully aware of the joys on repeated occasions of climbing the hike who stares. So far, wallet is intact. In fact, he moved. Don't take your wallet. But it's a fantastic experience. I believe that things like the hike who stares, Cocoa Crater, Tom Tom Trail, if it could be safe enough, belong to us all. And that in truth, we should be expending some resource. In fact, I'll put out something else that's bugging me. You need a bike route over the Colows. The old poly highway works. It's closed off. So I would love to see recognition of the value of outdoor exercise and some support for infrastructure to make it happen. So I've admired you for years on this crusade. I hope that it works. And I'd love to help. Okay, so with that, we're going to switch gears a bit. Another item that's been in the news episodically, like every time somebody gets sick, for some years now, and is an issue on pretty much all the islands, I think, what you clue me up about that, but certainly both Oahu and Hilo, two islands I'm familiar, two areas I'm familiar with, is the whole rat lung disease, synophilic meningitis, whatever you want to call it thing. And it's a fascinating topic, honestly. And you're the world expert. I beg to differ on that. Well, you may not have been a year and a half ago, but I think you are now. Well, there's a whole core group of people who are now somewhat expert in the disease. And as you were saying, it's certainly present on the east side of Hawaii Island. Now they're getting cases on Maui, and we've had a handful of cases here recently on Oahu. So the potential, I think, is there for it to be on all the islands. Yeah, likely. And where else is it in the world? The main areas of infection are in Southeast Asia. So Thailand, China, Taiwan, they're seeing more cases. They're recognizing more cases in Vietnam and Laos. And then it's also been recognized on the mainland, the United States, and certainly in other countries in Africa and so on. So it's there. It's probably spreading. It'll probably spread more as with climate change. Climate change is a great uncontrolled experiment, sadly. And we're seeing, you know, we staff the winter side of the big island, and we're seeing more things longer than we have lefto, dengue. So anyway, yes, that will happen. My guess also is that, like most diseases, there's a big spectrum. And probably, you and I may have had it, we just didn't know it. And there's probably a whole lot of that or minor cases. And then, of course, the serious ones get real attention. So hopefully we can learn more about the true incidents. Let's talk about epidemiology of this a bit. Okay. Well, the basic life cycle is from rats to slugs and snails, and then back to rats. I think we have a picture of the slug and snail, and then I believe can also project an image of the whole deal. First of all, we don't need a picture of a rat. You're very familiar with rats. But if we could show our audience sort of what the slugs and snails look like, and then, Rich, if we could project the photo of the slugs and snails, or one of the two is up, and then we're going to switch to the life cycle. How does this work? So the basic life cycle is from rats to slugs and snails, and then back to rats. And that's the life cycle that the parasite would favor. That works best for the parasite. And interestingly, what you're just alluding to is that the parasites have their own life, and what they want to do is stick with the right host. So this is a little bit like the fish-tape worm thing. We are the wrong host. Bad for the fish-tape worm, they die. They could possibly make us sick and yonder. I mean, that's sort of the story here too, right? Yeah. So humans become infected as accidental hosts. And dogs and horses and other mammals can become infected as well. Again, accidental hosts. Interestingly, did you hear about the horses on the Big Island? I wonder. Yeah, yeah. I think a lot of things are possible, and it's probably not getting recognized too much in animals. Similar sort of problem to humans. It's an unusual disease. It's rare. But I think on the Big Island, it can be quite a problem. Yeah, it was, I think, a fairly isolated herd in the YPL Valley, which is certainly a place where this could be. Okay, so we're going to put up the actual life cycle, and maybe you can walk us through it. Bearing in mind, it's all aberrant for the long worm. Yeah, yeah. So again, basic life cycle is from rats to slugs and snails. Humans become infected in three made ways. One would be by deliberately eating a slug or a snail. Kids do that. And that happens. So do adult occasionally as a dare or a wager, and there have been cases of that. Let me guess, drunk men. Sorry, go on. I think often you're right, yeah. Another way of getting infected, and this is probably the most important way in Hawaii, is by inadvertently eating small slugs and snails that are contaminating green leafy vegetables, mainly sometimes fruits and things like that. So that's probably the main way that we get infected in Hawaii. And then the third way that's probably quite rare is through what they call transport hosts. So these are other creatures that can become infected, things like lizards, land crabs, frogs, shrimps and prawns.  Not much of a problem here as far as we can tell, but in some countries where they eat raw frogs or raw lizards, as almost like a routine thing, then people can become infected. Or raw filter feeders. You're the one who introduced me to the possibilities of filter feeders and the many cooking them is a good idea. Yes. I mean, I think if you cook these things, even if you cook slugs and snails, if you cook them well, they are safe to eat. You have any recipes? Never mind. And that's part of a problem in some countries like Thailand. As you probably know, if you cook a slug or a snail well, it becomes very rubbery. So not very attractive to eat. So in some countries, they may cook these creatures, but they tend to undercook them. So some of the infection maybe survives and can. And hence, that's why you traveled to Thailand a couple of times to learn more about both presentation, but also diagnostic and therapeutic evidence, which we'll talk a little bit about. There's world experts in Thailand. They see a lot of the disease there, especially up in the north. And so actually talking to people who've seen a lot of cases has proved very helpful. We wanted to talk to people there about diagnosis and treatment of the disease. They tend to see milder cases there, which kind of muddies the waters a bit, but it was useful information to help us when we worked on our guidelines. You think they're milder because they're diagnosed earlier. I'm aware that their diagnosis algorithm is a little different, or it's a different disease, or a different spectrum of the disease. I think it's a different spectrum of disease. They see very severe cases, but that's really very rare, apparently. They see much milder cases there. And I think it's mainly because they're eating these partially cooked snails. And the snails themselves tend to have a low level of infection. Unlike what we have here, we have a semi-slug that's notorious for spreading infection. And those semi-slugs tend to... they're very susceptible to infection, and when they get infected, they have very high larval load, so-called.  Got it. Well, after the break, we're going to talk more about how to get it, how to keep getting it, and a better what to do about it. So, thanks. And we'll see you soon. Good morning, guys. They told me they were making music. Do you watch my show on Tuesday? Comfort Zone. I sang this song to you because I think you either are cool or have the potential to be seriously cool. And I want you to come watch my show where I bring in experts who talk all about easy strategies to be healthier, happier, build better relationships, and make your life a success. So come sit with the cool kids at Out of the Comfort Zone on Tuesdays at 1 p.m. Welcome back. This is Much More on Medicine. We discussed part of Think Tech Hawaii's live stream series, and I'm here with Dr. Vernon Anstahl, Professor of Tropical Medicine at UH, absent, actually, which is the School of Medicine. And before the break, we were talking about sort of the life cycle of this parasite, the rat lungworm. You've been spending, I think, at least a year working on collecting all aspects of information, how this is spread, how it makes people sick, how you diagnose it, what you might do about it, and tell us a little about the process because it sounds pretty interesting. We formed a subcommittee, part of the governor's task force on rat lungworm disease, and the subcommittee was addressing diagnosis and treatment, which in a way are the most controversial or difficult areas. So we put together this group of mainly physicians, Tropical Medicine specialists, Infectious Disease specialists, parasitologists, a group of about 15 people, I think, altogether, and started really looking into diagnosis and treatment with the goal of coming up with guidelines. And at first, we spent time looking through the human literature, and there's a moderate amount of literature about this. Some of it is more reliable than others. So if I hear what you're saying, in my experience, when little is known about something, somebody kind of pulls something out of the air, often 50 years ago, and it becomes gospel. Is there anything like that in here? You're absolutely right. And one of the things was the use of anti-worm medicine.  I think there's a great temptation to think we have to kill it. Yes. But unfortunately, when the worm dies, it creates an inflammation, which itself can be quite dangerous and serious. So over decades, people have said, well, we don't know whether to use these anti-worm medicines because it's going to kill the worm, often all the worms at once, and create a lot of inflammation. So that keeps getting repeated. So it's like we reached a point where we need to fix this. We need to figure this out.  We are not their terminal host.  On the other hand, they get bigger over time, too.  It's my theory. Now, that's not based on science. I'll fully admit. So anyway, tell me about the process, what you've learned. You alluded to what you learned about the life cycle. What about how do you diagnose it? How do these cases present? Yeah, in terms of diagnosis, what would be ideal would be a simple blood test. So we could see a patient, we think might have it, just take a blood sample and make a diagnosis. I have a better idea. I have always wanted my patients to come in with on their forehead, I have appendicitis, or I have rat lung worms. Honestly, that would be just for dumb people like me, that would be perfect. But a blood test would be nice. A blood test would be nice. Unfortunately, the blood tests that are available are not the answer. We have a lot of what they call false positive tests. Somebody may have a positive test, but they don't actually have the disease right now. They may have had it years ago. There are all sorts of issues like that. So we have to resort to a spinal tap. And that's where we can actually do testing that will tell us to somebody have an active infection. Spinal taps are something that, it's been around for a long time. We've all done them. It's a pretty straightforward procedure, but it's the thought for a patient of having, people talk about lumbar punctures, or a lumbar puncture. But it's the right way to make the diagnosis. So this is a fascinating set of issues. The concept that tests, you think the test would say yes or no, and they'd never be wrong. And the truth is, a blood sugar determination, that's pretty much in that category. Almost none of the rest of our tests are. And some of them are bad enough that they're not very useful, as you've described. So in other words, if you have the disease, you want the test to say yes. And if it says no 30% of the time, it's not a very useful test. And again, if you don't have the disease, you want it to say no. And if, I don't know, 50% of the time it says yes, or even 20%, that's a real problem. Because you think the patient has something and they have something else. And then the last question of what do you have to do to perform the test? You're right. Lumbar punctures, honestly, well, I've never had one done on me. And so easy for me to say. But in truth, it's a routine test. It's really quite benign. But it's not a blood test either. And that's a barrier to both it being offered because it's a procedure. You have to fit it into your practice or refer them to somewhere where it can be done. And honestly, it's a procedure that it's very routine. It's not automatic. Sometimes they're harder to accomplish than they are technically tricky. And then the patient has to be okay with getting it done. So this is, I think, a significant challenge to diagnostics here. Yeah, I think spending time with the patient and explaining that it's critical to get this test. This is the only way I'm really going to be able to be able to make the diagnosis and plan a course of treatment for you. Yeah, and we call that shared decision making. Correct. You tell them, here's what I'm worried about. Here really seems to be the option to do it or not, the way to figure this out. Let's figure out together what a reasonable course it is. And then in the end, together you decide. Yeah. So, okay, so we've done that. Now, let's say my, I get my spinal tap. My test is positive. What lies ahead of me? Then it would be a course of treatment targeting this worm that's in the brain. And just simply doing a lumbar puncture action can relieve some of the pressure that's in the head and can help the severe headaches that these people have. But another way of relieving the inflammation that's there and relieving some of the pressure is corticosteroids. And so that's an important part of the treatment of the disease. Hidoscorticosteroids. But, and then the other arm, if you like, of treatment would be do we decide to treat the parasite, to kill the parasite or not? And as you mentioned earlier, when they're small, it sort of makes sense to kill them at that point, not let them thrive and grow to the point where when they finally do die, they're a much larger worm that's going to create more inflammation.  That's a good question. You can see them with the naked eye when they're mature. As mature as they're going to get, yeah. The goal of the parasite is, they would much rather be in a rat's brain. And their goal is to go from the brain, then the final step for them is to go into the lungs. Then the rats cough them up in the end, right? Yeah, they mate and the worms mate and release eggs and then larvae are produced and excreted. So that's what they want to do. It's actually very rare probably for the larvae to get to the human lungs.  Parasites are fascinating. They really are. As you allude to, there's some controversy about when or if and probably how much. I doubt so much how much. You use the anti-worm medicines. Is there likely to be a trial of this in the future, do you think? Well, in response really to all the work that we did, we realized we just don't have enough information. So we're hoping to put together a large multi-center trial which might involve working with people in Thailand and China and Taiwan, countries where they have a lot of disease because we just simply don't see enough cases here. It would take us 100 years to figure this out. Don't think that's helpful. But no, I hope that happens. That's exciting. You know, in the last minute or so, let's talk about what people can do to maintain a healthy diet because you don't want to eat a brown diet. A brown diet is something with no greens. But minimize your chances of this because honestly the risk of getting it is really low and the benefits from healthy diet is substantial. Yeah, so as I mentioned, one of the main ways that people in Hawaii seem to get infected is by inadvertently eating slugs and snails that are contaminating green leafy vegetables. So there's work being done looking at different ways of trying to wash these things off on green leafy vegetables. And it looks as if the best way is just simply pull off the leaves, inspect them, and wash them vigorously under running water. And if you do that, I mean sure it's a bit of a chore, but it seems to be a pretty effective way of making it safe to eat. You know, it must be pretty effective because the actual number of cases is very small. So a number of symptomatic cases, as one I should have said, is very small. And so I think we both want to leave the message of, sure, wash your stuff, then eat plenty of green things and fruits.  I appreciate you coming. And best wishes at the symposium next month when you present the findings back in Baltimore, is it? New Orleans. New Orleans. Oh, even better. That's better. Well, thanks. I hope you get to do this multi-center trial. I think that would be fantastic. Thank you. Thank you. Thanks for listening. We appreciate you joining us on Much More Medicine and our guest, Dr. Vernon Anstow. Thank you.


So, this is the demonstration of the liver the first point is about the location of the liver. So, you can see that the liver is located under the right dome of the diaphragm and it extends partly into the epigastrium and it spins over into the left hypochondrium. So, the main location is right hypochondrium little bit in the epigastrium and little bit in the left hypochondrium. You know to understand the parts of the liver we have to look at this ligament that we are holding up here. This is the falciform ligament and we can see that the falciform ligament is attached to one area of the liver here and this is what divides the liver into its component anatomical parts. The portion to the right is called the right anatomical lobe and this is the left anatomical lobe. This portion which is in contact with the under surface of the diaphragm where my finger is gone in this is known as the diaphragmatic surface it is also referred to as the anterior superior surface. And this surface where my finger is gone in this is the visceral surface because it is in related to the viscer of the abdomen and this is also referred to as the posterior inferior surface because my hand is going posterior inferior. So, these are the essential parts of the liver right anatomical lobe left anatomical lobe anterior superior surface and posterior inferior surface and separating them is this sharp margin that we see here. This is the inferior border or the inferior margin of the liver in a normal person in whom the liver is not this is not a normal case this is a patient with no micro nodular cirrhosis, but in a normal patient the inferior margin of the liver is just above the costal margin. So, we should not be able to feel the inferior margin of the liver in a normal person. However, if the liver is enlarged which is called hepatomegaly then we can feel it when we palpate the liver from below up. In children the liver inferior margin may be palpable one centimeter below the right costal margin which is not considered abnormal. There is one portion of the liver on the right side of the right anatomical lobe which is referred to as the right surface of the liver in some anatomical textbooks and this is the surface which is used to perform what is known as a liver biopsy through the ninth intercostal space in the mid axillary line. So, these are the parts of the liver come to the visceral relationships of the liver in order to understand the visceral relationships we will reflect the liver up. So, this is the visceral surface of the liver or the posterior inferior surface this is the cut portion of the stomach and this is the location of the esophagus. So, let us put the structures in the normal anatomical position on the left side going from above down we have the esophagus then we have the stomach and then we have the pyloric atrium and then further to the right we have the diodenum this is the diodenum then we have the kidney the right kidney and then we have the right supravenum. So, esophagus stomach pylorus diodenum kidney right supravenum. So, these are the six structures which are located to the visceral surface this was the location of the transverse colon. So, the transverse colon is located in relation to the inferior margin of the liver. So, these are the visceral relationships of the liver. Let us take a look at the ligament switcher attached to the liver this ligament which is being held up by my assistant here this is the falciform ligament the falciform ligament as the term implies is a sickle shaped triangular ligament. So, therefore, it has got two attached margins and one free margin this margin that you see here this is the margin which is attached to the inner surface of the abdominal wall when it goes to the liver it gets attached to the fisher between the anatomical right room and the left room this portion is a part of the falciform ligament which then splits to form the coronary ligament this is the other attached margin and finally, we see this margin here this is the free margin of the liver and this contains this structure here this structure is a combination of two things one of them is called the round ligament of liver which is a remnant of the umbilical vein and other structure which is present is the para umbilical vein and we can see the para umbilical vein here the round ligament of the liver carries oxygenated blood in fetal life from the umbilicus to the fetus and the para umbilical veins in adult life communicate the left branch of the portal vein with us weights on the umbilicus and they get engorged in a patient with cirrhosis with portal hypertension so these are the structures which have seen on this surface let's come back to where we saw the under surface of the diaphragm again to come back this is part of the falciform ligament and we can see that the falciform ligament is getting attached to the under surface of the diaphragm so therefore, this is an important structure which holds up the liver and going further posteriorly the falciform ligament splits into this layer here and this layer here this is the anterior leaf of the coronary ligament similarly we have something called the posterior leaf of the coronary ligament which we cannot see which also holds up the liver against the diaphragm now let's come to the fissures of the liver for that again we will turn the liver up we are looking at the visceral surface but here we are now not focusing on the visceral organs but we are focusing on the fissures straight away we can see one fissure here and another fissure here this is the cystic fissure or the fossa for the gallbladder and we can see that the gallbladder is attached to the in this region this is the region where the liver does not have visceral peytonium because it is covered by the gallbladder so this is the gallbladder fossa or the cystic fissure to the left of that we see yet another fissure this is the fissure for the round ligament of liver and we already mentioned the round ligament liver is a remnant of the umbilical vein further posteriorly if you trace the fissure for the round ligament we see yet another fissure here this is the fissure for the ligamentum venosum which contain the ductus venosis which connects the umbilical vein directly to the inferior venaecaeva posterior to the gallbladder fossa we have this structure here where my finger is located though it has not been dissected out that is the fissure for the inferior venaecaeva so therefore if we were to look at the whole thing in totality we see one continuous fissure here this is the fissure for the gallbladder and the fissure for the inferior venaecaeva which is on the right side then we have the fissure for the round ligament and the ductus venosis which is on the left side so this is the left sagittal fissure also known as the umbilical fissure this is the right sagittal fissure which will later form portal fissures in the surgical segments and finally connecting the two limbs of the fissure we have this segment here this is referred to as the porta hepatus so these are the fissures that we can see forming a rough edge structure on the visceral surface of the liver now let's come to the extra hepatic portal triad my finger has picked up some structures here this three structures are the extra hepatic portal triad so now let's take a look at them we have consistently separated them out to show the extra hepatic portal triad this one this is the common by duct the right anterior another anterior hepatic artery the hepatic artery starts as a common hepatic artery and after it gives the gastrodeodontal artery it becomes known as the hepatic artery proper so hepatic artery proper and posteriorly we have this structure here portal way so these three structures constitute the extra hepatic portal triad they are located within the two folds of petronium which is collectively referred to as the hepato-deodontal ligament and the hepato-deodontal ligament stretches from the first part of the deodontum which is here and gets attached to the margins of the portal triad these extra hepatic portal triad structures enter the liver or leave the liver the common by duct continues up and it gives off a cystic duct here and then it becomes known as the common hepatic duct and which enters the portal triad the hepatic artery also divides into a right and left right and the portal way also divides in the hepatic as the right and left portal veins my finger is in this space here behind the extra hepatic portal triad this is the epiploid for oven or the omen for oven or the which slows for oven so the anterior boundary is formed by the structures in the extra hepatic portal triad the posterior boundary is formed by the inferior vena cava and the right supra renal gland the superior boundary is formed by the liver and the inferior boundary is formed by the first part of the deodontum so this is a triangular shaped window which is called the epiploid for oven and which leads into this space here which is actually the space behind the stomach and that space is referred to as the lesser sac or the mental person so this is the epiploid for oven now let's take a look at the spatial around the liver there are three principal spaces around the liver the first space is where my finger hand is gone in this is the known as the sub phrenic recess because it is under the diaphragm sub phrenic means under the diaphragm and you could see the sub phrenic recess is divided into two parts a right part and a left part by the phalseiform ligament and the sub phrenic recess communicates with the rest of the paternal cavity the next space is on the under surface of the liver on the external surface of the liver this is referred to as the sub hepatic space and posterior continuation of the sub hepatic space is where my finger is gone in my finger has gone in very deep this is referred to as the hepato renal recess why is it called the hepato renal because this is the left kidney and this is the liver so therefore this is the hepato renal recess also referred to as the Morrison pouch let's come back to the sub phrenic space if i want to push my finger my hand does not go beyond a certain stage similarly on this side also my hand does not go beyond a particular stage what is blocking my hand the anterior layer of the coronary ligament is blocking my hand similarly if i want to push my hand in the hepato renal recess at a particular place my hand will not go any further so what is blocking my hand the posterior layer of the coronary ligament so these are the limits of the spaces and the hepato renal recess we can see very clearly here this is the hepato renal recess it is one of the two most dependent portions of the peritoneal cavity where abnormal fluid can collect when the patient is supine next so that brings me to the next that's the peritoneal spaces i've already referred to the lesser sag where my finger has gone in if the stomach was here then it would have been behind the stomach so the lesser sag is a space behind the lesser momentum the stomach this is the lesser sag it's a space between the stomach and the bed of the stomach so this lesser sag which is also referred to as the omenical bursar has got superior recess which also is going behind the liver but it is stopped by the posterior of the coronary ligament this lesser sag communicates through the omenical forearm where my fingers come and it communicates with the hepato renal recess and this lesser sag also communicates with the rest of the peritoneal cavity the rest of the peritoneal cavity is referred to as the greater sag there's a very important surgical correlation pertaining to the lesser sag the posterior boundary of the lesser sag is this structure here which is the pancreas in alcoholic or any other pancreatitis after the inflammation of the pancreas the subside fluid exudes and collects inside the lesser sag and it forms a big swelling behind the stomach and that is called the pseudo pancreatic cyst and when we have a patient with pseudo pancreatic cyst so any fluid collection what other surgical access do we have let me put back the colon here this was the location of the transverse colon and this is the greater incremental so this is a gastropolic ligament we can split the gastropolic ligament here and we can lift up this number and we can enter the lesser sag so this provides a surgical access to the lesser sag by splitting the gastropolic ligament now let's take a look at the rest of the peritoneal cavity which is the greater sag the portion above the transverse colon is called the supracolic compartment the portion below the transverse colon is the infracolic compartment and we can see that all of these spaces are in communication with each other fluid from the supracolic compartment and the interacolic compartment can travel on either side of the descending and descending colon and these depressions that we see here these are referred to as the paracolic cutters and from there they can track down and they can collect in the appendix when my finger is gone in so this is the second most dependent part of the peritoneal cavity the first being the epitoneal recess and the second being the peritoneal cavity so this is about the general peritoneal cavity and the peritoneal spaces and their intercommunications with each other now let's come to the port hepatitis port hepatitis is this structure the horizontal limb of the edge which I mentioned and we can see that entering the port hepatitis we have the common hepatic duct here next structure that is entering the port hepatitis is the hepatic artery and the third structure that is entering the port hepatitis is the portal wave all of which we'll divide into a right and left branch the port hepatitis itself is not covered by visceral peritoneum but the margins are attached by the hepatodontal ligament this port hepatitis is where the hepatodontal ligament is attached and the fissure for the ligament of venosa where my finger is gone in is where the hepatocastric ligament is attached so therefore the lesser momentum is attached to the liver in the form of an L shape so this is the attachment of the lesser momentum to the liver and the lesser momentum if you were to look at it in the stomach this is the portion which gives rise to the membranous part of the hepatogastric and this is the portion which gives rise to the hepatodontal part hepatodontal gets attached to the port hepatitis margins hepatogastric gets attached to the fissure for ligamentum venosa now let us take a look at this one special triangle which is used in gallbladder surgery this triangular space that we see here this is called the callot triangle or the colisus to hepatic triangle it is bounded by the common hepatic duct the cystic duct and the liver this is the callot triangle the most important content of the callot triangle is this artery here and that is the cystic artery which has to be ligated when we are doing a colisus to me or gallbladder surgery and it also contains a lymph node known as a cystic node so this is the importance of the callot triangle and finally when we are doing a gallbladder surgery or any surgery in this region suppose there is accidental bleeding from the hepatic artery what is the best way to stop it my one finger has gone into the epicoic for a minute my thumb is in front and i grip the structures of the portal drive between my two fingers and by so doing i'm compressing the hepatic artery when i do that it stops the bleeding and allows me to catch the bleeding point this procedure is a very important surgical maneuver and that is referred to as the Pringles maneuver this is a patient who has obviously got micro nodular cirrhosis he may have been an alcoholic this is also referred to as Lenic cirrhosis and the liver has got hobnane appearance so sometimes this is also referred to as a hobnane liver in such patients we can they can develop what is known as portal hypertension where the portal vein gets engorged that's called portal hypertension the blood pressure inside the portal vein increases then there are certain areas in the body where portal systemic communications become big one of that site is the lower end of the east of Vegas and we can see an engorged vein here this is a portal systemic anastomosis site another site is the para umbilical vein which runs in the free margin of the aciform ligament the third is the rectum and the fourth site is the retropatrial areas of the colon so these are the four sites of portal systemic anastomosis which become big in cases of cirrhosis with portal hypertension so this was a rather extensive coverage of the liver the patonal cavity the gallbladder surgery portal hypertension cirrhosis thank you very much for watching have a nice day Dr. Sanjay Sanyal