Cadaveric surgical demonstration of middle to distal ureteral injury repairs in urologic and gynecologic surgeries.

INTRODUCTION AND HYPOTHESIS: Iatrogenic ureteral injuries can occur during any surgery but are more likely to occur during urologic and gynecologic procedures. The middle and distal ureter are especially at risk of injury during these surgeries. METHODS: The objective of this surgical educational video was to demonstrate how to repair middle to distal ureteral injuries with the following techniques: direct ureteroureterostomy, ureteroneocystotomy, vesico-psoas hitch, and Boari-Ockerblad bladder flap. RESULTS: A female cadaver was used to show how to surgically repair injuries to the middle and distal ureter. CONCLUSIONS: Middle to distal ureteral injuries occurring during urologic and gynecologic surgeries can be repaired by the techniques demonstrated in this video manuscript.

Bilateral inguinal lipoblastomas presenting as inguinal hernias.

Lipoblastomas are rare, encapsulated tumors arising from embryonic white fat. They primarily occur in infancy and early childhood and have a male predominance. Lipoblastomas are usually located on the trunk and extremities although may develop on the head and neck, mediastinum, abdomen, and retroperitoneum. They are seldom encountered in the inguinal region. A complete resection of the tumor followed by diligent postoperative imaging are essential to detect recurrent disease in its earliest stage. Herein, we report the first case in the literature of a 1-year-old boy with bilateral inguinal lipoblastomas which presented as inguinal hernias.

Retinal prosthesis that incorporates the organization of the nerve fibre layer.

Recent efforts to restore partial vision in blind patients have made significant progress. Currently, prosthetic design concentrates on stimulating as many foveal retinal ganglion cells as possible but is hampered by stimulation of the nerve fibre layer. This results in a nonvisuotopic arrangement of phosphenes (stimulation percepts). This article suggests that by extending the stimulation area well beyond the fovea and stimulating the nerve fibre layer, axons from any remaining ganglion cells in more peripheral regions of the retina (low acuity) can be used to generate a visuotopic map. Stimulation of the fibre layer will generate a large number of stimulation percepts; however, it is unlikely that these will have sufficient topographic order to be immediately useful to the patient. Thus, it will be necessary to recreate an ordered visuotopic map by using appropriate computer algorithms and interactions between the patient and the clinician.

Analysis of the lateral geniculate nucleus in dichromatic and trichromatic marmosets.

Marmosets are diurnal New World monkeys that show sex-linked cone photopigment polymorphism, whereby all males and some females are dichromats ("red-green colorblind"), but most females show trichromatic color vision. Here we asked whether trichromats express chromatic-specific circuitry in the lateral geniculate nucleus (LGN). The volume of parvocellular (P), magnocellular (M), and koniocellular (K) layers was calculated in Nissl-stained sections from the LGN of adult marmosets (Callithrix jacchus; 10 trichromatic females; 2 dichromatic females; and 13 dichromatic males). Retinal ganglion cell axon terminals within the P and K layers were reconstructed and measured following anterograde tracer (dextran) injections. We show that there is little difference in LGN layer volume with respect to age, weight, or sex of the animals, or between dichromatic and trichromatic phenotypes. The morphology of retinal ganglion cell terminals was largely indistinguishable on comparing dichromats and trichromats, and likewise on comparing terminals representing peripheral or foveal retina. We conclude that the LGN circuits we studied are largely independent of red-green color vision phenotype and visual field location.

Human intraretinal myelination: axon diameters and axon/myelin thickness ratios.

PURPOSE: Human intraretinal myelination of ganglion cell axons occurs in about 1% of the population. We examined myelin thickness and axon diameter in human retinal specimens containing myelinated retinal ganglion cell axons. MATERIALS AND METHODS: Two eyes containing myelinated patches were prepared for electron microscopy. Two areas were examined in one retina and five in the second retina. Measurements were compared to normal retinal and optic nerve samples and the rabbit retina, which normally contains myelinated axons. Measurements were made using a graphics tablet. RESULTS: Mean axon diameter of myelinated axons at all locations were significantly larger than unmyelinated axons (P ≤ 0.01). Myelinated axons within the patches were significantly larger than axons within the optic nerve (P < 0.01). The relationship between axon diameter/fiber diameter (the G-ratio) seen in the retinal sites differed from that in the nerve. G-ratios were higher and myelin thickness was positively correlated to axon diameter (P < 0.01) in the retina but negatively correlated to axon diameter in the nerve (P < 0.001). CONCLUSION: Intraretinally myelinated axons are larger than non-myelinated axons from the same population and suggests that glial cells can induce diameter changes in retinal axons that are not normally myelinated. This effect is more dramatic on intraretinal axons compared with the normal transition zone as axons enter the optic nerve and these changes are abnormal. Whether intraretinal myelin alters axonal conduction velocity or blocks axonal conduction remains to be clarified and these issues may have different clinical outcomes.

Localization and developmental expression patterns of CSPG-cs56 (aggrecan) in normal and dystrophic retinas in two rat strains.

Proteoglycans have a number of important functions in the central nervous system. Aggrecan (hyaluronan-binding proteoglycan, CSPG-cs56) is found in the extracellular matrix of cartilage as well as in the developing brain. We compared the postnatal distribution of CSPG-cs56 in Long Evans (LE) and Royal College of Surgeons (RCS) rat retinas to determine if this proteoglycan played a role in the development of dystrophic retinas. CSPG-cs56 expression was examined in rat retinas aged between birth (postnatal day 0, P0) and P150 using immunofluorescence and Western-blots. Immunofluorescence was quantified using ImageJ. GFAP staining was used to compare Müller cell labeling and the distribution of CSPG-cs56. Both rat strains showed a significant rise in total retinal CSPG-cs56 between P0 and P21; values peaked on P21 in LE rats and P14 in RCS rats. CSPG-cs56 then significantly decreased to lower levels (P35) in both strains before reaching significantly higher levels by P90-P150. CSPG-cs56 positive staining was present in the ganglion cell layer at birth and clear layering of the inner plexiform layer was seen between P7 and P21 due to dendritic staining of retinal ganglion cells. Staining was less intense and diffuse within the outer plexiform over a similar time-course. Light CSPG-cs56 labeling in the region of the outer segments was present at (P14) and became more intense as the retina approached maturity. CSPG-cs56 in the outer segments was the main contributor to the higher expression in older animals. Substantial differences in CSPG-cs56 labeling were not seen between LE and RCS rats. There was no evidence to suggest that Müller cells were the source of CSPG-cs56 in either rat strain, although their staining distributions had a degree of overlap. The lack of significant differences between LE and RCS rats indicates that CSPG-cs56 may not be involved in the degenerative process or the reorganization of the RCS rat retina. We suggest that the main role of CPSG-cs56 is to maintain retinal ganglion cell dendritic structure in the inner plexiform layer and is closely related to providing adequate support and flexibility for the photoreceptor outer segments, which is necessary to maintain their function.

Projections from cingulate cortex to the cat's thalamic reticular nucleus.

The cingulate cortex (CG) and the adjacent region designated as the splenial visual area (SVA) project to areas of the extrageniculate thalamic system that are concerned with processing visual information. En route to the thalamus, they pass through the thalamic reticular nucleus (TRN), an important source of thalamic inhibition. We wished to determine whether SVA axon collaterals projected to the previously defined visual sector of the TRN or a separate projection zone and did this differ from the projection zone of CG. We iontophoretically injected different neuroanatomical tracers into several locations within CG/SVA and traced the labeled axons through the TRN. The CG and SVA have a projection zone that only partially overlaps the dorsorostral regions of the visuocortical projection zone; there was no evidence to suggest separate SVA and CG zones or tiers of label within the TRN. The projection formed only a weak topographic map in the TRN, which is largely defined in the rostrocaudal axis and is similar to that of the area 7 projection; both projections have a high degree of overlap in the dorsal TRN. We postulate that CG/SVA may be involved in the initiation of orientation behaviors via stimulation of thalamic nuclei and attentional mechanisms of the TRN.

Noggin induces human bone marrow-derived mesenchymal stem cells to differentiate into neural and photoreceptor cells.

The present study was undertaken to explore the effect of noggin on neuronal differentiating potential of human bone marrow-derived mesenchymal stem cells (hBMMSCs) in vitro so as to provide a means of alleviate retinal degeneration. A green fluorescent protein-tagged noggin gene was transferred into adult hBMMSCs or induce hBMMSCs with classical inducer, epidermal growth factor(EGF). Neurons were observed as early as 48 h after transduction of hBMMSCs with a noggin adenoviral vector. Differentiation peaked by 10 days in culture, and these differentiated cells expressed multiple markers including rhodopsin (18.4 +/- 1.5% of cells), chx10 (4.8 +/- 0.6%), nestin (4.2 +/- 0.8%), and Nrl (3.7 +/- 0.4%), as verified by immunofluorescence staining. Noggin-transduced cells produced more photoreceptor cells than non-transduced cells, suggesting that noggin has the ability to induce hBMMSCs to trans-differentiate into photoreceptor cells. In contrast, induction with EGF for 10 days led to lower levels of rhodopsin and chx10, and undetectable levels of Nrl and Nestin. These findings suggested noggin-transduced hBMMSCs produced more photoreceptor cells than EGF-induced cells. It is suggested that the present protocol has application in cell replacement therapy for patients suffering from photoreceptor cell loss.

Influence of 'feedback' signals on spatial integration in receptive fields of cat area 17 neurons.

'Feedback' signals from mammalian extrastriate visual cortices are reported to exert primarily an excitatory influence on the classical receptive field (CRF) of neurons in the primary visual cortex (V1). However, given the much larger CRFs of neurons in extrastriate visual cortices it is not yet understood how feedback signals influence the spatial integration of visual signals by V1 neurons. To investigate this, we reversibly inactivated one of the 'form-processing' extrastriate visual cortices, the postero-temporal visual (PTV) cortex, and examined changes in responses of V1 neurons to drifting grating patches up to 28 degrees in diameter. We found that during inactivation of PTV cortex the magnitude of the responses to CRF-confined stimuli and that to large stimuli inducing maximum suppression (i.e. minimum responses) was significantly reduced, while the spatial extent of the CRF remained largely unaffected. As a result, the relative strength of the surround suppression increased marginally. This effect was apparent in both simple and complex cells. It was also strong and consistent in cells located in supragranular and infragranular layers. For those cells exhibiting some relief from surround suppression or 'counter-suppression' when large stimuli patches were applied, the effect on counter-suppression was heterogeneous. Overall, the relative integrated responses to the 28 degrees grating patches were also decreased when PTV cortex was inactivated. Thus, a substantial reduction in the CRF response and the largely unaffected spatial extent of the CRF as well as a weak surround effect observed in the present study are consistent with a multiplicative scaling effect.

Contrast dependence of center and surround integration in primary visual cortex of the cat.

The magnitudes of spike responses of area 17 (striate cortex, area V1) neurons to stimulation of their classical receptive fields were reduced (suppressed) when the stimuli extended into the silent surround regions. We found that when optimally oriented sine-wave drifting grating patches extended into the distant parts of silent surround regions, over 35% of V1 neurons showed a 'counter-suppression', that is, a reduction in the magnitude of suppression. The magnitudes of both the suppression and the counter-suppression effects were dependent on stimulus contrast, that is, with a decrease of contrast the magnitude of suppression decreased, while the magnitude of counter-suppression increased. Overall, the surround modulation tended to be clearly suppressive at high contrast and less suppressive or even facilitatory at low contrast. The contrast-dependent effects described here appear to represent one of the fundamental properties of neurons in the mammalian visual system. These properties allow improvement of recognition (high contrast) or detection (low contrast) of visual objects under varying conditions. Putative changes of center and surround mechanisms at low contrast are discussed.

First order connections of the visual sector of the thalamic reticular nucleus in marmoset monkeys (Callithrix jacchus).

The thalamic reticular nucleus (TRN) supplies an important inhibitory input to the dorsal thalamus. Previous studies in non-primate mammals have suggested that the visual sector of the TRN has a lateral division, which has connections with first-order (primary) sensory thalamic and cortical areas, and a medial division, which has connections with higher-order (association) thalamic and cortical areas. However, the question whether the primate TRN is segregated in the same manner is controversial. Here, we investigated the connections of the TRN in a New World primate, the marmoset (Callithrix jacchus). The topography of labeled cells and terminals was analyzed following iontophoretic injections of tracers into the primary visual cortex (V1) or the dorsal lateral geniculate nucleus (LGNd). The results show that rostroventral TRN, adjacent to the LGNd, is primarily connected with primary visual areas, while the most caudal parts of the TRN are associated with higher order visual thalamic areas. A small region of the TRN near the caudal pole of the LGNd (foveal representation) contains connections where first (lateral TRN) and higher order visual areas (medial TRN) overlap. Reciprocal connections between LGNd and TRN are topographically organized, so that a series of rostrocaudal injections within the LGNd labeled cells and terminals in the TRN in a pattern shaped like rostrocaudal overlapping "fish scales." We propose that the dorsal areas of the TRN, adjacent to the top of the LGNd, represent the lower visual field (connected with medial LGNd), and the more ventral parts of the TRN contain a map representing the upper visual field (connected with lateral LGNd).

Do first order and higher order regions of the thalamic reticular nucleus have different developmental timetables?

The thalamic reticular nucleus (TRN) can been subdivided into sectors based on thalamic and cortical input. Additionally, in carnivores the visual sector of the TRN can be subdivided into first order (perigeniculate nucleus: PGN) and higher order (TRN) regions. This report examines whether TRN development reflects the nature of its higher order visual connections. 170 cells from 12 kittens aged between postnatal day 0 (P0) and P125 were fully analysed after single cell injections in 400-500 microm fixed brain slices. TRN cells have a period of exuberant dendritic branching that peaks between P3 and P12, around the time of eye opening (P7), followed by branch pruning until P68. Similarly, most dendritic appendages are added between P12 and P22 followed by pruning, which is also largely complete by P68. Most branch points occur within the first 10-30% of the dendritic arbor, peaking between 10 and 20% (roughly equivalent to 100 mum from the soma), while appendages were concentrated between 20 and 30% of the arbour; appendages tend to be distributed over a larger proportion of the arbor up to P14 compared to later ages. TRN and PGN maturation were not significantly different. The present data suggest that clear distinctions cannot be made between the maturation of first and higher order pathways and indicate that GABAergic cells of the ventral thalamus may mature earlier than relay cells of the dorsal thalamus. Furthermore, dendritic development in the TRN may be less dependent on extrinsic factors than an intrinsic growth pattern or factors other than a functional hierarchy within the visual pathway.

Geniculocortical relay of blue-off signals in the primate visual system.

A fundamental dichotomy in the subcortical visual system exists between on- and off-type neurons, which respectively signal increases and decreases of light intensity in the visual environment. In primates, signals for red-green color vision are carried by both on- and off-type neurons in the parvocellular division of the subcortical pathway. It is thought that on-type signals for blue-yellow color vision are carried by cells in a distinct, diffusely projecting (koniocellular) pathway, but the pathway taken by blue-off signals is not known. Here, we measured blue-off responses in the subcortical visual pathway of marmoset monkeys. We found that the cells exhibiting blue-off responses are largely segregated to the koniocellular pathway. The blue-off cells show relatively large receptive fields, sluggish responses to maintained contrast, little sign of an inhibitory receptive-field surround mechanism, and negligible functional input from an intrinsic (melanopsin-based) phototransductive mechanism. These properties are consistent with input from koniocellular or "W-like" ganglion cells in the retina and suggest that blue-off cells, as previously shown for blue-on cells, could contribute to cortical mechanisms for visual perception via the koniocellular pathway.

'Simplification' of responses of complex cells in cat striate cortex: suppressive surrounds and 'feedback' inactivation.

In mammalian striate cortex (V1), two distinct functional classes of neurones, the so-called simple and complex cells, are routinely distinguished. They can be quantitatively differentiated from each other on the basis of the ratio between the phase-variant (F1) component and the mean firing rate (F0) of spike responses to luminance-modulated sinusoidal gratings (simple, F1/F0 > 1; complex, F1/F0 < 1). We investigated how recurrent cortico-cortical connections affect the spatial phase-variance of responses of V1 cells in the cat. F1/F0 ratios of the responses to optimally oriented drifting sine-wave gratings covering the classical receptive field (CRF) of single V1 cells were compared to those of: (1) responses to gratings covering the CRFs combined with gratings of different orientations presented to the 'silent' surrounds; and (2) responses to CRF stimulation during reversible inactivation of postero-temporal visual (PTV) cortex. For complex cells, the relative strength of the silent surround suppression on CRF-driven responses was positively correlated with the extent of increases in F1/F0 ratios. Inactivation of PTV cortex increased F1/F0 ratios of CRF-driven responses of complex cells only. Overall, activation of suppressive surrounds or inactivation of PTV 'converted' substantial proportions (50 and 30%, respectively) of complex cells into simple-like cells (F1/F0 > 1). Thus, the simple-complex distinction depends, at least partly, on information coming from the silent surrounds and/or feedback from 'higher-order' cortices. These results support the idea that simple and complex cells belong to the same basic cortical circuit and the spatial phase-variance of their responses depends on the relative strength of different synaptic inputs.