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Background: The term uterine smooth muscle tumor of uncertain malignant potential (STUMP) indicates a rare, equivocal entity between benign leiomyomas and leiomyosarcomas. In the present study, we evaluated a comprehensive range of clinical, surgical, and pathological features in a large multicenter series of patients with STUMP to identify risk factors for recurrence., Methods: This is a retrospective study performed by collecting consecutive cases diagnosed between January 2000 and December 2020 in five tertiary centers. Associations between STUMP recurrence and clinicopathological characteristics as well as surgical treatment modality were investigated., Results: Eighty-seven patients affected by STUMP were considered. Of them, 18 cases (20.7%) recurred: 11 as leiomyosarcoma (LMS) and 7 as STUMP. The mean time to recurrence was 79 months. We found that fragmentation/morcellation, epithelioid features, high mitotic count, Ki-67 value > 20%, progesterone receptor (PR) < 83%, and p16 diffuse expression were associated with higher risk of recurrence and shorter recurrence-free survival (RFS). Furthermore, morcellation/fragmentation and mitotic count remained independent risk factors for recurrence and shorter RFS after multivariate analysis, while the presence of epithelioid features was an independent risk factor for recurrence only., Conclusions: Our results suggest that morcellation is associated with risk of recurrence and shorter RFS, thus it should be avoided if a STUMP is suspected preoperatively. Epithelioid features, high proliferation activity, low PR expression, and diffuse p16 expression are also unfavorable prognostic factors, so patients presenting these features should be closely followed up., (© 2022. The Author(s).)

Purpose: Does controlled ovarian stimulation (COS) and progesterone (P) luteal supplementation modify the vaginal and endometrial microbiota of women undergoing in vitro fertilization?, Methods: Fifteen women underwent microbiota analysis at two time points: during a mock transfer performed in the luteal phase of the cycle preceding COS, and at the time of fresh embryo transfer (ET). A vaginal swab and the distal extremity of the ET catheter tip were analyzed using next-generation 16SrRNA gene sequencing. Heterogeneity of the bacterial microbiota was assessed according to both the Bray-Curtis similarity index and the Shannon diversity index., Results: Lactobacillus was the most prevalent genus in the vaginal samples, although its relative proportion was reduced by COS plus P supplementation (71.5 ± 40.6% vs. 61.1 ± 44.2%). In the vagina, an increase in pathogenic species was observed, involving Prevotella (3.5 ± 8.9% vs. 12.0 ± 19.4%), and Escherichia coli-Shigella spp. (1.4 ± 5.6% vs. 2.0 ± 7.8%). In the endometrium, the proportion of Lactobacilli slightly decreased (27.4 ± 34.5% vs. 25.0 ± 29.9%); differently, both Prevotella and Atopobium increased (3.4 ± 9.5% vs. 4.7 ± 7.4% and 0.7 ± 1.5% vs. 5.8 ± 12.0%). In both sites, biodiversity was greater after COS (p < 0.05), particularly in the endometrial microbiota, as confirmed by Bray-Curtis analysis of the phylogenetic distance among bacteria genera. Bray-Curtis analysis confirmed significant differences also for the paired endometrium-vagina samples at each time point., Conclusions: Our findings suggest that COS and P supplementation significantly change the composition of vaginal and endometrial microbiota. The greater instability could affect both endometrial receptivity and placentation. If our findings are confirmed, they may provide a further reason to encourage the freeze-all strategy.

Predators may modify their diets as a result of both anthropogenic and natural environmental changes. Stable isotope ratios of nitrogen and carbon in bone collagen have been used to reconstruct the foraging ecology of South American fur seals (Arctocephalus australis) in the southwestern South Atlantic Ocean since the Middle Holocene, a region inhabited by hunter-gatherers by millennia and modified by two centuries of whaling, sealing and fishing. Results suggest that the isotopic niche of fur seals from Patagonia has not changed over the last two millennia (average for the period: δ 13 C 2200-0BP  = -13.4 ± 0.5‰, δ 15 N 2200-0BP  = 20.6 ± 1.1‰). Conversely, Middle Holocene fur seals fed more pelagically than their modern conspecifics in the Río de la Plata region (δ 13 C 7000BP  = -15.9 ± 0.6‰ vs. δ 13 C PRESENT  = -13.5 ± 0.8‰) and Tierra del Fuego (δ 13 C 6400-4300BP  = -15.4 ± 0.5‰ vs. δ 13 C PRESENT  = -13.2 ± 0.7‰). In the latter region, Middle Holocene fur seals also fed at a higher trophic level than their modern counterparts (δ 15 N 6400-4300BP  = 20.5 ± 0.5‰ vs. δ 15 N PRESENT  = 19.0 ± 1.6‰). Nevertheless, a major dietary shift was observed in fur seals from Tierra del Fuego during the nineteenth century (δ 13 C 100BP  = -17.2 ± 0.3‰, δ 15 N 100BP  = 18.6 ± 0.7‰), when marine primary productivity plummeted and the fur seal population was decimated by sealing. Disentangling the relative roles of natural and anthropogenic factors in explaining this dietary shift is difficult, but certainly the trophic position of fur seals has changed through the Holocene in some South Atlantic regions.