The utricle provides the vestibular reflex pathways with the sensory codes of inertial acceleration of self-motion and head orientation with respect to gravity to control balance and equilibrium. Here we present an anatomical description of this structure in the adult oyster toadfish and establish a morphological basis for interpretation of subsequent functional studies. Light, scanning, and transmission electron microscopy techniques were applied to visualize the sensory epithelium at varying levels of detail, its neural innervation and its synaptic organization. Scanning electron microscopy was used to visualize otolith mass and morphological polarization patterns of hair cells. Afferent nerve fibers were visualized following labeling with biocytin, and light microscope images were used to make three-dimensional (3-D) reconstructions of individual labeled afferents to identify dendritic morphology with respect to epithelial location. Transmission electron micrographs were compiled to create a serial 3-D reconstruction of a labeled afferent over a segment of its dendritic field and to examine the cell-afferent synaptic contacts. Major observations are: a well-defined striola, medial and lateral extra-striolar regions with a zonal organization of hair bundles; prominent lacinia projecting laterally; dependence of hair cell density on macular location; narrow afferent dendritic fields that follow the hair bundle polarization; synaptic specializations issued by afferents are typically directed towards a limited number of 7-13 hair cells, but larger dendritic fields in the medial extra-striola can be associated with > 20 hair cells also; and hair cell synaptic bodies can be confined to only an individual afferent or can synapse upon several afferents.

We compliment Volkmann and colleagues for their excellent recent editorial 1. The authors addressed an important aspect of rheumatologic care, practice, and scholarship. We too have been interested in this topic 2,3. We carried out a systematic search 3,4 of the US National Library of Medicine, the Cochrane Central Registry of Controlled Trials, the Science Citation Index Expanded, and the Conference Proceedings Citation Index-Science from 1950 through August 2013; included in the search were randomized, controlled trials consisting of adult participants, with diagnoses of rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), polymyalgia rheumatica (PMR), or giant cell arteritis (GCA), who were being withdrawn from glucocorticoid therapy as part of the intervention. We also found insufficient randomized controlled trials of steroid-tapering regimens similarly relating outcome measures to perform statistical comparisons of data for safety and efficacy 5. We concur that randomized, controlled trials reporting outcome measures uniformly would be desirable to inform us better about how to taper steroids for patients with rheumatic diseases, although we consider it unlikely that such studies will be completed. Current practices for tapering steroids for patients with rheumatic diseases derive largely from recommendations that are experiential, authoritative, based on consensus or opinion, and/or intuitive. We are not aware of consistent, comparable, rigorous, controlled data to support any specific approach to tapering steroids for RA, SLE, PMR, or GCA other than doing so judiciously and gradually, as seems appropriate for the individual patient. Perhaps this represents an area of medicine that simply cannot be reduced to protocols or algorithms, reflecting the art of medicine 6 .