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Objective: We evaluated subtle endometrial morphologic changes in postmenopausal women assigned to placebo, raloxifene hydrochloride 200 or 600 mg/day, or conjugated estrogens (Premarin 0.625 mg/day) according to a new estrogenicity scoring system. Raloxifene, a new selective estrogen receptor modulator, was not expected to stimulate the endometrium.Study Design: Baseline and end point endometrial biopsies were performed during this double-blind, placebo-controlled 8-week study. A scoring system that was based on standard glandular and stromal morphologic criteria was used to quantitate estrogen-induced effects. Baseline, end point, and baseline-to-end point changes were analyzed for treatment differences.Results: Treatment groups were similar at baseline with most women showing no estrogenic effects. At end point, statistically significant moderate and marked estrogenic effects were noted in 77% of estrogen-treated women versus 15% of placebo-treated women versus 0% of raloxifene-treated women.Conclusions: As expected, estrogen treatment stimulated postmenopausal endometrium. In contrast, raloxifene did not induce histopathologic evidence of endometrial stimulation in healthy postmenopausal women. [ABSTRACT FROM AUTHOR]

The 2019 ASCCP Risk Based Management Consensus Guidelines for prevention of cervical cancer promote clinical management recommendations aligned with our increased understanding of HPV biology and cervical carcinogenesis. They employ HPV-based testing as the basis for risk estimation, allow for personalized risk-based management by incorporating knowledge of current results with prior results, and streamline incorporation of new test methods as they are validated. They continue to support the principles of "equal management for equal risk" and "balancing harms and benefits" adopted in the 2012 version of the guidelines. These updated guidelines will be able to adjust for decreasing CIN3+ risks as more patients who received HPV vaccination reach screening age. Pathology organizations were closely involved in the development of these guidelines. Herein the pathologists who served as representatives to the 2019 ASCCP guidelines steering committee and workgroups, summarize the changes that are relevant to laboratories, pathologists, and cytotechnologists. Prior relevant screening and reporting recommendations that have not been widely and/or inconsistently adopted by laboratories are also discussed and considerations for modification of laboratory practices offered., (Copyright © 2020 American Society of Cytopathology. Published by Elsevier Inc. All rights reserved.)

Silylenes have become an indispensable tool for molecular bond activation. Their use for the construction of silicon-boron bonds is uncommon in comparison to the numerous studies on silylene-derived silicon-element bond formations. Herein we investigate the reactivity of the pyramidal NHC-coordinated hydrosilylene tBu3SiSi(H)LMe4 (1; NHC = N-heterocyclic carbene, LMe4 = 1,3,4,5-tetramethylimidazolin-2-ylidene) with various boron-centered electrophiles. The reaction of 1 with THF·BH3 or H3N→BH3 afforded the silylene complex 1→BH3 or the product of insertion of the silicon(ii) atom into an N-H bond with concomitant dehydrogenation along the HN-BH moiety (2). The respective conversion of 1 with BPh3 yields 1→BPh3 which readily reacts with excess LMe4 to form the more stable complex LMe4→BPh3 with release of 1. Treatment of 1 with the haloboranes Et2O→BF3, BCl3, BBr3 and Me2S→BBr3 resulted in the formation of the Lewis acid base adducts 1→BX3 (X = F, Cl, Br) and an equilibrium with their auto-ionization products [12BX2]+[BX4]- slowly develops. The ratio of 1→BX3 significantly increases with rising atomic number of the halide, thus 1→BF3 majorly transforms within hours while 1→BBr3 is near-quantitatively retained over time. Accordingly, the complex 1→BPhBr2 was isolated after conversion of 1 with PhBBr2.

Objectives: Infections due to Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are among the most common bacterial sexually transmitted infections worldwide, most of which are asymptomatic. Detection of infection using a variety of specimen types in symptomatic and asymptomatic subjects is important to effectively combat CT/NG infections. The performance of the cobas CT/NG v2.0 test was assessed for urogenital swabs, urine and cervical cytology samples collected in PreservCyt Solution from 5266 symptomatic and asymptomatic women (including 202 who were pregnant), and urine from 738 men., Methods: Sensitivity and specificity were estimated compared with a patient infected status determined using two US Food and Drug Administration-cleared nucleic acid amplification tests., Results: Among 6004 participants, 487 CT (8.1%) and 159 NG (2.6%) infections were identified. Sensitivity estimates for CT for women ranged from 91.2% to 97.6% depending on specimen type, and the estimate for male urine specimens was 98.4%. Specificity for CT ranged from 99.2% to 99.7%. Sensitivity estimates for NG ranged from 95.6% to 100.0% for women, and the estimate for men was 100.0%. Specificity for NG ranged from 99.3% to 100.0%., Conclusions: The cobas CT/NG v2.0 test performs well using urogenital swabs, urine and cervical samples collected in PreservCyt solution., Competing Interests: Competing interests: BVDP discloses consulting honoraria or research funding received from Atlas Genetics, BD Diagnostics, Beckman Coulter, Cepheid, Rheonix and Roche Molecular Systems. EWH III has received research support from Roche Molecular Systems, BD Diagnostics, Hologic Gen-Probe Inc., Siemens and Cepheid. SNT discloses research support from Roche Molecular Systems, BD Diagnostics, Hologic Gen-Probe Inc. and Cepheid. BAB discloses being former employee and officer of Laboratory Corporation, Holdings (LabCorp) and advisory board service and contracts for laboratory work for Roche Diagnostics for which LabCorp was compensated and advisory board service for Roche Molecular Systems for which LabCorp was compensated. She has current consulting contracts with LabCorp, Qiagen, Inc. and Meridian Biosciences, Inc. JO, ML and OL are employees of Roche Molecular Diagnostics. No other authors disclose conflicts of interest., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

An in-depth study of the synthesis and structures of N-heterocyclic carbene (NHC)-stabilized silylene transition-metal complexes is reported. An iron hydrosilylene complex, [tBu 3 Si(NHC)(H)Si:→Fe(CO) 4 ] (2), was synthesized starting from the corresponding hydrosilylene [tBu 3 Si(NHC)(H)Si:] (1). Complex 2 was fully characterized, including X-ray diffraction analysis, which showed an unusual long Si-Fe bond length. A very long bond length was also observed in the novel hydrosilylene tungsten complex [tBu 3 Si(NHC)(H)Si:→W(CO) 5 ] (3). A series of NHC-stabilized silylene iron complexes ([R 2 (NHC)Si:→Fe(CO) 4 ], where R = Cl (4), H (5), and Me (6)) were synthesized and fully characterized to investigate the influence of different substituents. The dihydrosilylene iron complex [H 2 (NHC)Si:→Fe(CO) 4 ] (5) represents a new example of a donor-acceptor-stabilized parent silylene (H 2 Si:). Density functional theory calculations were utilized to understand the influence of the electronic and steric effects of the silylene unit and its substituents on the Si-Fe bond in these iron complexes, in particular to rationalize the long Si-Fe bond in 2.

A dihydrophosphinosilylene iron complex [LSi{Fe(CO)4}PH2] has been prepared and utilized in the synthesis of novel heterobimetallic complexes. The phosphine moiety in this phosphinosilylene complex allows coordination towards tungsten leading to the iron-tungsten heterobimetallic complex [LSi{Fe(CO)4}PH2{W(CO)5}]. In contrast, the reaction of [LSi{Fe(CO)4}PH2] with ethylenebis(triphenylphosphine)platinum(0) results in the formation of the iron-platinum heterobimetallic complex [LSi{Fe(CO)4}PH{PtH(PPh3)2}] via oxidative addition.

An in depth study of the reactivity of an N-heterocyclic carbene (NHC)-stabilized silylene monohydride with alkynes is reported. The reaction of silylene monohydride 1, tBu3 Si(H)Si←NHC, with diphenylacetylene afforded silole 2, tBu3 Si(H)Si(C4 Ph4 ). The density functional theory (DFT) calculations for the reaction mechanism of the [2+2+1] cycloaddition revealed that the NHC played a major part stabilizing zwitterionic transition states and intermediates to assist the cyclization pathway. A significantly different outcome was observed, when silylene monohydride 1 was treated with phenylacetylene, which gave rise to supersilyl substituted 1-alkenyl-1-alkynylsilane 3, tBu3 Si(H)Si(CHCHPh)(CCPh). Mechanistic investigations using an isotope labelling technique and DFT calculations suggest that this reaction occurs through a similar zwitterionic intermediate and subsequent hydrogen abstraction from a second molecule of phenylacetylene., (© 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Through the use of an N-heterocyclic carbene (NHC) and the super-silyl group (tBu3Si), the novel silylene hydride 2 could be synthesized and isolated in 41% yield. The reaction of 2 with bis(1,5-cyclooctadiene)nickel(0) afforded complex 3, which represents the first example of a dihydrodisilene transition metal complex. Compounds 2 and 3 were fully characterized, including single-crystal X-ray diffraction analysis. The reaction mechanism for the formation of 3 from 2 was investigated by density functional theory calculations, which showed that migration of the NHC from silicon to nickel takes place in this reaction.

The next-generation amplification test for Chlamydia trachomatis and Neisseria gonorrhoeae (Roche cobas 4800), a fully automated system, was compared head to head, using female samples, to Gen-Probe Aptima Combo 2 and BD ProbeTec using Viper. Endocervical swabs, female urine, and endocervical samples in liquid-based cytology medium were run on at least two of three platforms. A total of 4,316 samples were evaluated, and 281 chlamydial and 69 gonococcal infections were identified. Estimates of sensitivity and specificity were obtained relative to the patient infection standard (PIS) and using latent class analysis (LCA). Chlamydia sensitivity estimates ranged from 86.9 to 95.6% using PIS and 97.6 to 98% using LCA. Specificity was ≥ 99.6% for all sample types. Sensitivity ranged from 95.6 to 100% using PIS and 96.9 to 100% using LCA for the detection of gonococcal infections. Specificity for gonococcal infections was ≥ 99.8%. cobas 4800 performance was equivalent to the comparator assays (all P values, >0.05), and the fully automated system provides high laboratory efficiency.

Salivary duct carcinoma is a high grade malignancy which histologically strongly resembles ductal carcinoma of the breast. The findings from five cases of histologically proven salivary duct carcinoma sampled by preoperative fine-needle aspiration (FNA) cytology are presented. Characteristic cytomorphologic features include cohesive clusters and flat sheets of epithelial cells which display a cribriform pattern with eccentrically located, hyperchromatic nuclei, abundant finely granular cytoplasm, and necrosis in the smear background.

Diagnostic Cytology Laboratory, Inc., has an outpatient Fine Needle Biopsy Clinic, which evaluated 7,487 fine-needle biopsies (FNB) from January 1989 to February 1992. Two hundred eighty-eight (3.8%) of these specimens were collected from patients 19 years old or younger and this represents the largest study of this population in the scientific literature. The majority of these specimens were obtained from palpable masses in the head and neck region [lymph nodes (58.3%), thyroid (7.6%), and salivary gland (5.2%)] while a smaller number were collected from miscellaneous soft tissue (18.8%) and breast masses (10.1%). Thirteen (4.5%) (from 12 patients) were diagnosed as malignant by FNB and 275 (95.5%) (264 patients) were benign by FNB. This benign:malignant ratio (22:1) is significantly higher than has been reported from tertiary care institutions and is a reflection of the difference of this outpatient population. Two hundred nine of 276 patients (75.7%) had adequate follow-up, including 137 (49.6%) patients followed by observation, 48 (17.4%) patients followed by surgical biopsy, and 24 (8.7%) patients followed by some other modality: imaging studies, flow cytometry, or treatment. There was a single false positive diagnosis (a pilomatrixoma) and one (1) false negative interpretation (a cystic acinic cell carcinoma) resulting in a diagnostic sensitivity of 92.3% and a specificity of 99.6%. The positive predictive value was 92.3%, the negative predictive value was 99.6%, and the test efficiency was 99.3%. The utility, cost-effectiveness and uniqueness of the clinic population is discussed.

Arterial hypertension is a consistent and modifiable cause of cardiovascular disease. The risk is further increased by left ventricular hypertrophy as an independent contributor to these cardiovascular events. However, the incidence of coronary mortality and sudden death could not be reduced by antihypertensive drug therapy. It seems possible that there is a subgroup of patients with arterial hypertension with excess risk associated with increased left ventricular mass, ventricular arrhythmias, and silent myocardial ischemia. These patients could be detected by a more developed diagnostic approach using echocardiography, 24-h ECG, and noninvasive 24-h blood-pressure measurement.

Three male patients with the acquired immunodeficiency syndrome revealed perforations of the intestine (jejunum-ileum; colon ascendens; coecum). The cause was necrosis due to cytomegalovirus infection. The characteristic findings were cytomegalic inclusion bodies in endothelial cells of the capillaries. These lesions caused alterations of the microcirculation. Therefore it seems reasonable to conclude that in these cases necrosis and perforation were due to ischemia. Cytomegalovirus infection must be taken into consideration in any patient with the acquired immunodeficiency syndrome and gastrointestinal ulcerations.

A term newborn with Candida albicans infection of the lungs and blood is described. Although no maternal risk factors were identified, this patient's rapid clinical deterioration and postmortem findings suggest congenital infection. Related cases in the literature are reviewed. This case suggests that a diagnosis of fungal pneumonia should be considered in any infant presenting with severe respiratory distress.