There is overwhelming evidence that mechanical signaling plays a crucial role in development of the ovary, follicle, and oocyte throughout gametogenesis. Emerging data suggest the complexities of mechanotransduction and the biomechanics of oocytes and follicles are integral to understanding of primary ovarian insufficiency, ovarian aging, polycystic ovary syndrome, and applications of fertility preservation.

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Citation: Prabhu MV, Juneja D, Gopal PB, et al. Ultrasound-guided femoral dialysis access placement: a singlecenter randomized trial. Clin J Am Soc Nephrol. 2010;5:235-239.Analysis: Dialysis catheter insertion remains an area of interest with respect to the optimal location of insertion, complications, duration, thrombosis rates, infection rates, and outcomes. Ultrasound-guided placement of catheters has becom common in clinical practice, with evidence from numerous studies, both retrospective and randomized, that its use improves success rates and reduces complications. 1,2 Most of these studies, however, have looked at access in the internal jugular or subclavian veins. With some recent support for the equivalency of femoral access to internal jugular access in non-obese patients, 3 and due to the lower risks of complications with femoral access, 4 the femoral route is often chosen as the primary site for temporary dialysis catheter insertion. This study by Prabhu and colleagues addresses the use of ultrasound-guided dialysis catheter insertion versus the traditional anatomical technique in femoral vein dialysis catheters.This single-center prospective, randomized study included 110 patients 18 years and older who had no prior catheter at the chosen femoral site of insertion. A total of 55 patients in each group underwent catheterization using the same sterile Seldinger technique and each group was similar with respect to age, gender, anatomical site, and the experience of the physicians performing the insertion. The study demonstrated improved success rates with decreased complication rates and reduced numbers of attempts required in the ultrasound-guided group, especially when the procedure was performed by the less experienced clinicians.Validity and threats to validity: The strengths of this study include

As a key mechanism in fibrinolysis and tissue remodeling, the plasminogen activator system has been suggested in the process of endometrial shedding and tissue remodeling. Previous studies have explored the role of estrogen, progesterone, and androgen receptors as well as elements of the renin-angiotensin-aldosterone system in shaping the morphology of the endometrium. This study investigates the distribution and concentrations of the mineralocorticoid receptor, glucocorticoid receptor, tissue plasminogen activator, urokinase plasminogen activator, and plasminogen activator inhibitor-1 within the endometrial stroma, glandular, and endothelial cells of the primate endometrium during artificial menstrual cycles. Our immunohistochemistry quantification shows mineralocorticoid and glucocorticoid receptors are ubiquitously distributed within the macaque endometrium with their patterns of expression following similar fluctuations to urokinase and tissue plasminogen activators particularly within the endometrial vasculature. These proteins are present in endometrial vasculature in high levels during the proliferative phase, decreasing levels during the secretory phase followed by rising levels in the menstrual phase. These similarities could suggest overlapping pathways and interactions between the plasminogen activator system and the steroid receptors within the endometrium. Given the anti-inflammatory properties of glucocorticoids and the role of plasminogen activators in endometrial breakdown, the glucocorticoid receptor may be contributing to stabilizing the endometrium by regulating plasminogen activators during the proliferative phase and menstruation. Furthermore, given the anti-mineralocorticoid properties of certain anti-androgenic progestins and their reduced unscheduled uterine bleeding patterns, the mineralocorticoid receptor may be involved in unscheduled endometrial bleeding.

INTRODUCTION: Throughout the menstrual cycle, the endometrium undergoes morphological and biochemical changes reflecting ovarian hormone secretion. These changes are associated with specific receptors located throughout the endometrial tissue. Alongside receptors for ovarian hormones, the human endometrium contains all of the elements of renin-angiotensin-aldosterone system (RAAS). Given certain progestins play a role in RAAS modulation through anti-mineralocorticoid properties, we believe that the mineralocorticoid receptor (MR) has a significant role in the menstrual cycle and potentially in abnormal uterine bleeding (AUB). METHODS: Full-thickness uterine samples were obtained from adult female rhesus macaques during an artificial menstrual cycle controlled with estrogen (E) and progestin (P) implants at 3 separate points: menstrual (E-3P), proliferative (14dE) and secretory (E+5P). Tissue sections were immunohistochemically stained and evaluated under bright microscopy. ImageJ analysis software was used to analyze vasculature for integrated density and area fraction. RESULTS: MR is present in the endometrial endothelial cells during all three phases of the menstrual cycle in rhesus macaques. The percent area was 25.54% in the proliferative phase, 18.86% in the menstrual phase, 17.34% in the secretory phase. CONCLUSION: MR has been identified for the first time to our knowledge within the endometrial endothelial cells. Given the anti-mineralocorticoid properties of certain progestins used for contraception and their association with amenorrhea or AUB, MR antagonism specifically may explain these changes. In select patient populations, such as obese females at increased risk for hypertension and elevated aldosterone activity, the increased incidence of amenorrhea on certain progestin-only contraceptives may be related to higher degree of anti-RAAS activity within the endometrium.

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