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Abstract Objective Premature Progesterone Rise (PPR) is characterized by elevated serum progesterone concentrations either towards the end of the follicular phase or on the trigger day, surpassing a pre-defined threshold value. Aim of the study is to evaluate the impact of PPR exceeding 1.5 ng/ml at the time of hCG-trigger on embryo morphokinetic parameters and to identify predictive biomarkers of in IntraCytoplasmic Sperm Injection (ICSI) cycles outcomes. Methods It is a retrospective study including patients underwent ICSI cycles in the period 2020–2023. 58 patients were recruited in the study group showing P levels in the trigger day greater than or equal to 1.5 ng/ml. A matching control group of 58 patients with P levels below 1.5 ng/ml was after selected. The general characteristics of these patients, including age, Body Mass Index (BMI), antral follicle count (AFC), anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) levels, the type of infertility and smoking/non-smoking patients, were recorded on the day of their initial visit. Subsequently, data were collected regarding the number of eggs retrieved, mature eggs, successfully fertilized eggs, and embryos reaching the blastocyst stage. Additionally, the timing of embryonic development and the quality of obtained blastocysts, as assessed by the degree of expansion and the characteristics of the inner cell mass (ICM) and trophectoderm (TE), were evaluated using Time-Lapse technology. Results Elevated P levels exceeding 1.5 ng/ml on the trigger day were directly associated with a significantly larger number of antral follicles, consequently leading to a higher count of retrieved eggs, mature eggs, successfully fertilized eggs and embryos reaching the blastocyst stage. Furthermore, the analysis of morphokinetic parameters indicated faster division times and a notably greater number of high-grade blastocysts in the study group compared to the control group. Conclusions P levels ≥ 1.5 ng/ml on the trigger day did not negatively impact embryonic morphokinetic parameters, instead resulting in faster embryo development in the initial stages.

Extramedullary plasmacytoma (EMP) belongs to the group of plasma cell neoplasms, which include following entities: multiple myeloma (MM), lymphoplasmacytic lymphoma, solitary plasmacytoma of the bone (SBP) and EMP. Localization in the maxillary sinus with simultaneous involvement of the buccal cavity is rare. Misdiagnosis may lead to inappropriate or delayed management. X-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) scan provide useful information for diagnosis. Many CT and MRI features are not specific and it is important to find specific imaging characteristics for making differential diagnosis. Our case has shown how, in the context of advanced MRI techniques, DWI is decisive in achieving the correct diagnosis of EMP The peculiarity of this case, in addition to showing the possibility, although rare, of a simultaneous involvement of EMP of the buccal cavity and of the ipsilateral maxillary sinus, presents the behavior of the EMP in various imaging methods, highlighting how diffusion-weighted imaging (DWI) played an important role to suggest the correct diagnosis and differentiating it from squamous cell carcinoma (SCC) and non-Hodgkin lymphoma (NHL).

The COVID-19 pandemic had adverse health outcomes on individuals and communities. In this cross-sectional study we evaluated the admission rates in a tertiary-level hospital during the first wave of the pandemic (March 22, 2020 to August 31, 2020).

Abstract Lipid nanoparticles (LNPs) play a crucial role in addressing genetic disorders, and cancer, and combating pandemics such as COVID-19 and its variants. Yet, the ability of LNPs to effectively encapsulate large-size DNA molecules remains elusive. This is a significant limitation, as the successful delivery of large-size DNA holds immense potential for gene therapy. To address this gap, the present study focuses on the design of PEGylated LNPs, incorporating large-sized DNA, departing from traditional RNA and ionizable lipids. The resultant LNPs demonstrate a unique particle morphology. These particles were further engineered with a DNA coating and plasma proteins. This multicomponent bionanoconstruct exhibits enhanced transfection efficiency and safety in controlled laboratory settings and improved immune system evasion in in vivo tests. These findings provide valuable insights for the design and development of bionanoarchitectures for large-size DNA delivery, opening new avenues for transformative gene therapies.

The increased proportion of women in the workplace and the labor force aging have been demanding investigations of the link between menopause and occupational health issues, especially in healthcare settings. Evidence on the association between menopause and occupational burnout in healthcare settings is still inconclusive. Therefore, we aimed to evaluate the association between menopause and burnout among clinical and non-clinical workers in different occupational health environments. A multi-center, cross-sectional study, applying the Oldenburg Burnout Inventory (OBI) was conducted from September 2021 to March 2023 in University Medical Center (UMC) hospitals in Astana, Kazakhstan. The study involved 125 physicians and nurses and 82 non-clinical administrative and service staff. We found that 63.9% of respondents had disengagement and 61.7% had exhaustion. The affiliated clinical setting was associated with disengagement (p = 0.034), with the highest prevalence among employees in surgical departments (76.9%), while a higher prevalence of exhaustion was found in individuals with different work experience (p = 0.023) and among those who were dissatisfied with their work environment (74.3%). While burnout was identified in almost two-thirds of respondents, the self-reported menopause status of participants was not significantly related to either disengagement (p = 0.34) or exhaustion (p = 0.73), even though a higher prevalence of both was revealed among the postmenopausal group. We propose that healthcare management should understand the importance of burnout among postmenopausal healthcare workers and facilitate open communication and a supportive work environment.

Abstract Introduction Clinical remission is the main target in the management of patients with rheumatoid arthritis (RA). However, several authors found synovitis in patients with RA in clinical remission at ultrasonography (US). Upadacitinib is a selective Janus kinase 1 inhibitor that achieved significantly higher remission rates than adalimumab and abatacept in patients with RA. Here we present the 24-week data of the UPAdacitinib Rheumatoid Arthritis REmission UltraSonography (UPARAREMUS) study. Methods This is a longitudinal multicenter observational study, enrolling bio-naïve and bio-inadequate responder patients affected by RA. The primary endpoint was the proportion of patients achieving both clinical and US remission at week 24. The proportion of patients achieving clinical remission with different composite indexes at week 12 and 24 was also evaluated. US of four target joints (wrists and second metacarpophalangeal bilaterally) was performed at baseline and weeks 12/24, and US remission was defined as the absence of power Doppler (PD) signal ≥ 2 in one target joint, or PD ≥ 1 in two target joints. Results After 12 weeks and 24 weeks, 40% and 63.6% of patients achieved US plus clinical remission. The following parameters were associated with US plus clinical remission: being bio-naïve and having a shorter disease duration, although at multivariate analysis significant odds ratio (OR) was found only for being bio-naïve. Conclusions UPARAREMUS is the first study evaluating the efficacy of upadacitinib in reaching both clinical and US remission in patients with RA. At 24 weeks, 63.6% of patients reached the primary endpoint, the only baseline associated parameter was being bio-naïve.

Despite evidence indicating a decrease in ovarian reserve among BRCA patients, this factor seems to not impact their spontaneous fertility negatively.

The development of robust circuit structures remains a pivotal milestone in electronic device research. This article proposes an integrated hardware–software system designed for the acquisition, processing, and analysis of surface electromyographic (sEMG) signals. The system analyzes sEMG signals to understand muscle function and neuromuscular control, employing convolutional neural networks (CNNs) for pattern recognition. The electrical signals analyzed on healthy and unhealthy subjects are acquired using a meticulously developed integrated circuit system featuring biopotential acquisition electrodes. The signals captured in the database are extracted, classified, and interpreted by the application of CNNs with the aim of identifying patterns indicative of neuromuscular problems. By leveraging advanced learning techniques, the proposed method addresses the non-stationary nature of sEMG recordings and mitigates cross-talk effects commonly observed in electrical interference patterns captured by surface sensors. The integration of an AI algorithm with the signal acquisition device enhances the qualitative outcomes by eliminating redundant information. CNNs reveals their effectiveness in accurately deciphering complex data patterns from sEMG signals, identifying subjects with neuromuscular problems with high precision. This paper contributes to the landscape of biomedical research, advocating for the integration of advanced computational techniques to unravel complex physiological phenomena and enhance the utility of sEMG signal analysis.

Computed tomography (CT), magnetic resonance imaging (MRI), and radiography expose patients to electromagnetic fields (EMFs) and ionizing radiation. As an alternative, Electrical Impedance Tomography (EIT) offers a less EMF-influenced method for imaging by measuring superficial skin currents to provide a map of the body’s conductivity. EIT allows for functional monitoring of anatomical regions using low electromagnetic fields and minimal exposure times. This paper investigates the application of EIT for the morphological and functional assessment of tissues. Using the Finite Element Method (FEM) (Comsol 5.2), both two-dimensional and three-dimensional models and simulations of physiological and pathological tissues were developed to replicate EIT operations. The primary objective is to detect carcinoma by analysing the electrical impedance response to externally applied excitations. An eight-electrode tomograph was utilised for this purpose, specifically targeting epithelial tissue. The study allowed the characterisation of tomographs of any size and, therefore, the possibility to verify both their geometric profile and the ideal value of the excitation current to be delivered per second of the type of tissue to be analysed. Simulations were conducted to observe electrical impedance variations within a homogeneously modelled tissue and a carcinoma characterized by regular geometry. The outcomes demonstrated the potential of EIT as a viable technique for carcinoma detection, emphasizing its utility in medical diagnostics with reduced EMF exposure.

Lower extremity lymphedema (LEL) is a common complication following surgical staging of endometrial cancer. LEL is a chronic condition associated with significant impact on patient morbidity and quality of life (QoL). This review aimed to report the current evidence in the literature on secondary LEL after surgical staging for endometrial cancer, focusing on the incidence based on different approaches to lymph node staging, diagnosis, risk factors, and the impact on QoL. Due to the absence of a standardized agreement regarding the methodology for evaluating LEL, the documented frequency of occurrence fluctuates across different studies, ranging from 0% to 50%. Systematic pelvic lymphadenectomy appears to be the primary determinant associated with the emergence of LEL, whereas the implementation of sentinel lymph node biopsy has notably diminished the occurrence of this lymphatic complication after endometrial cancer staging. LEL is strongly associated with decreased QoL, lower limb function, and negative body image, and has a detrimental impact on cancer-related distress reported by survivors. Standardization of lymphedema assessment is needed, along with cross-cultural adaptation of subjective outcome measures for self-reported LEL. The advent of sentinel lymph node mapping represents the ideal approach for accurate nodal assessment with less short- and long-term morbidity. Further research is needed to definitively assess the prevalence and risk factors of LEL and to identify strategies to improve limb function and QoL in cancer survivors with this chronic condition.

Scabies, an old parasitic disease with a worldwide presence, has witnessed a recent resurgence in many parts of the world even in the light of the COVID-19 pandemic. We conducted a study on this resurgence in the Italian province of Messina, Sicily, evaluating the general features of affected people to better understand the possible modes of transmission. Specifically, we considered all the scabies notifications made in the period 2003–2022. Then, we focused on those cases occurred in the three-years period 2020–2022 carrying out an active surveillance by calling patients and asking them questions about their recent habits and movements and their consequent chances of contracting the disease. In total, 935 cases of scabies were reported from 2003 to 2022, with a remarkable increase between 2020 and 2022, when 288 cases were reported. Of these patients, we were able to reach by phone 240 (83.3 %) and interview them. Students were the most affected group (24.1 %), followed by retirees (21.0 %) and healthcare workers (13.2 %). Unfortunately, concerning the possible mode of transmission, more than half (58.5 %) of patients were not able to understand the real source of their infection. When known, the most common ways of transmission were a familiar origin (10.7 %) followed by causes linked to health environments (nursing home stays and hospital admissions). Moreover, 66.9 % of all the reported cases were part of an outbreak. Larger outbreaks occurred in healthcare facilities for more than half of the cases (69.4 %), the majority of which (88.9 %) were in nursing homes. Our research confirms the resurgence of scabies in our territory similar to trends in other European countries. Some critical factors, including the COVID-19 pandemic, probably played a key role in influencing this epidemiological trend and showed the importance of always monitoring the epidemiology of all notifiable diseases to enable prompt action by competent authorities to limit their spread to the community.

Background: Cesarean scar pregnancy (CSP) has become more frequent as a direct consequence of the increased number of cesarean deliveries and the advances in imaging. Although some cases are characterized by spontaneous resolution, unrecognized or mishandled CSP has the potential to cause both fetal and maternal morbidity and mortality. However, due to its infrequency, there is no agreement on the best management. Objective: The purpose of this study was to evaluate the safety, the risks and effectiveness of medical therapy with methotrexate and mifepristone to better understand its role in CSP therapy. Design: This study is a systematic review. Data Sources and Methods: The electronic databases PubMed, Medline, and Scopus were comprehensively searched until December 2023. Medical Subject Headings terms (Cesarean scar pregnancy) AND (Methotrexate) AND (Mifepristone) AND (Medical Therapy) were used to identify the relevant records. Due to the rarity of this pathology, the studies included are all case reports or case series. The methodological quality of the included studies was assessed using the JBI Critical Appraisal Checklist for case reports. Results: We included in our review a total of seven cases reported in five manuscripts at the end of the screening process. Our review suggests that this type of combination treatment can be considered. The success rate is 71.4%. Treatment seems to be most effective when beta human chorionic gonadotropin (B-hCG) is below 5,000 mUi/ml and when the gestational sac is less than 20 mm. The absence of fetal heartbeat seems to be a positive prognostic factor for a positive outcome. Conclusion: Methotrexate and mifepristone administration can be considered as an alternative first-line effective treatment, especially in case of pregnancy with B-hCG

Background: Uterine sarcomas (US) are rare cancer of possible occurrence even in women of childbearing age. To date, total hysterectomy is the standard treatment in the early stages. The possibilities of carrying out fertility-sparing treatments (FST) to save the fertility of women with unfulfilled reproductive desires are described in the literature, but to date, they can only be considered experimental. Objective: The aim of this systematic review was to evaluate the oncological and reproductive outcomes of women with different histological types of US undergoing FST. Design: Systematic review. Data sources and methods: Electronic databases were searched for English-language studies describing FST for US until January 31, 2024. Results: Forty-five papers which met the abovementioned inclusion criteria, were included in the qualitative analysis. Quantitative analysis was not possible because of the heterogeneity of the data. A descriptive summary of the results according to the histotype of US was provided. Six hundred forty-one patients of childbearing age with US and undergoing FST. After treatment with FST, 89 (13.9%) disease recurrences and 107 (16.7%) pregnancies were recorded. Conclusion: In selected cases of early-stage US, FST may be proposed. However, the patient must be informed of the real possibility of recurrence and potentially difficult achievement of pregnancy. Additional well-designed prospective studies and clinical trials are needed to address the knowledge gaps and enhance clinical decision-making in this population. Trial registration: PROSPERO ID: CRD42024509356.

Objective: To understand the adhesion rate and the features of women adherent to breast cancer (BC) screening test, an essential secondary prevention tool in early diagnosis and mortality reduction. Participants and Methods: We evaluated the adhesion of a group of target women aged 50-69, living in the provincial territory of Messina, Italy, in the five-year period 2018-2022. Specifically, we calculated the adhesion and the positivity rate through the analyses of electronic registries of the local Provincial Health Agency. Then, we investigated some features of the adherent women in order to understand which factors could be involved in the attitude to be screened. In particular, the counselling forms filled during the screening were examined and data about some well-known risk factors such as age, familiarity, number of children and breastfeeding were evaluated. Results: The overall adhesion rate was very poor (24.5% of the invited women) with a mean positivity rate (i.e. confirmed BC) of 8%. Especially in the group of older women we detected the lower adhesion rate (18.6%). A high percentage (28%) of screened women declared a familiarity for BC. BC positivity was directly associated with age and familiarity, and inversely with number of children and breastfeeding. Conclusions: Our findings suggest that familiarity for BC is the major motivation to be screened, especially for women with a certain awareness to be at risk; indeed, they are more inclined to adhere to mammogram screening. A strengthening of women’s awareness about all the protective and risk factors for the BC development through mass media and the involvement of healthcare professionals could improve the situation, increasing the compliance to screening campaigns, especially among older women.

Objective: To evaluate transperineal laser ablation (TPLA) with Echolaser® (Echolaser® TPLA, Elesta S.p.A., Calenzano, Italy) as a treatment for benign prostatic hyperplasia (BPH) and prostate cancer (PCa) using the Delphi consensus method. Methods: Italian and international experts on BPH and PCa participated in a collaborative consensus project. During two rounds, they expressed their opinions on Echolaser® TPLA for the treatment of BPH and PCa answering online questionnaires on indications, methodology, and potential complications of this technology. Level of agreement or disagreement to reach consensus was set at 75%. If the consensus was not achieved, questions were modified after each round. A final round was performed during an online meeting, in which results were discussed and finalized. Results: Thirty-two out of forty invited experts participated and consensus was reached on all topics. Agreement was achieved on recommending Echolaser® TPLA as a treatment of BPH in patients with ample range of prostate volume, from 80 mL (80%), comorbidities (100%), antiplatelet or anticoagulant treatment (96%), indwelling catheter (77%), and strong will of preserving ejaculatory function (100%). Majority of respondents agreed that Echolaser® TPLA is a potential option for the treatment of localized PCa (78%) and recommended it for low-risk PCa (90%). During the final round, experts concluded that it can be used for intermediate-risk PCa and it should be proposed as an effective alternative to radical prostatectomy for patients with strong will of avoiding urinary incontinence and sexual dysfunction. Almost all participants agreed that the transperineal approach of this organ-sparing technique is safer than transrectal and transurethral approaches typical of other techniques (97% of agreement among experts). Pre-procedural assessment, technical aspects, post-procedural catheterization, pharmacological therapy, and expected outcomes were discussed, leading to statements and recommendations. Conclusion: Echolaser® TPLA is a safe and effective procedure that treats BPH and localized PCa with satisfactory functional and sexual outcomes.

Purpose: The impact of dietary counseling on body composition in early breast cancer patients (EBC) treated with aromatase inhibitors (AIs) is uncertain. The aim of this study was to assess the effects of a diet counseling program on weight, BMI, total and regional body composition in patients treated with AIs. Methods: This observational study involved 194 EBC patients, of which 97 attended a 6-month personalized counseling program, based on Mediterranean diet principles (cohort A) and 97 did not (cohort B). Dual-energy X-ray absorptiometry (DXA) scan was used to measure the total and regional fat and lean body mass, before (baseline) and after at least 18 months of AI-therapy. Results: Weight and BMI increased significantly, on the average, in cohort B, but not in cohort A. In the cohorts A and B, fat mass increased by 10 % and 7.7 % respectively, while lean mass decreased by 3.3 % and 2.6 % from before to after AI therapy, without statistically significant differences between them using the Mann-Whitney test. The changes in body composition were greater in premenopausal than in postmenopausal women at cancer diagnosis. The proportion of patients with sarcopenia, obesity and sarcopenic obesity increased from before to after AI therapy, similarly in both cohorts. Conclusions: Patients treated with AIs reported an increase in fat mass and a decrease in lean mass, and consequently an increase in sarcopenia and obesity, regardless of the participation in a dietary counseling program. A combined dietary counseling and physical exercise program may be necessary for preventing these unfavourable changes in these patients.

The efficacy of adjuvant denosumab in combination with hormonotherapy in breast cancer patients was investigated in two randomized trials, ABCSG-18 and D-Care, but the results were mixed with respect to the impact of this drug on disease-free survival. However, the ABCSG-18 study has achieved its primary goal: prevention of clinical fractures. Therefore, the protective role of Denosumab on bone fragility induced by estrogen deprivation, already demonstrated in post-menopausal women, has been validated in the breast cancer setting.

Background: B-lineage acute lymphoblastic leukemias (B-ALL) harboring the t(9;22)(q34;q11)/BCR::ABL1rearrangement, represent a category with previously dismal prognosis whose management and outcome dramatically changed thanks to the use of tyrosine kinase inhibitors (TKIs) usage and more recently full chemo-free approaches. The prompt identification of these cases represents an important clinical need. Objectives: We sought to identify an optimized cytofluorimetric diagnostic panel to predict the presence of Philadelphia chromosome (Ph) in B-ALLs cases by the introduction of CD146 in our multiparametric flow cytometry (MFC) panels. Methods: We prospectively evaluated a total of 245 cases of newly diagnosed B-ALLs with a CD146 positivity threshold >10% referred to the Division of Hematology of ‘Sapienza’ University of Rome. We compared results of CD146 expression percentage and its mean fluorescence intensity (MFI) between Ph+ ALLs, Ph-like ALLs and molecularly negative ALLs. Results: Seventy-nine of the 245 B-ALL cases (32%) did not present mutations at molecular testing, with 144/245 (59%) resulted Ph+ ALL and 19/245 (8%) Ph-like ALLs. Comparing the 3 groups we found that: Ph+ B-ALL were characterized by higher expression percentage of myeloid markers such as CD13, CD33 and CD66c and low expression of CD38; Ph+ B-ALL showed a higher CD146 expression percentage and MFI when compared with both molecular negative B-ALL and Ph-like ALLs; neither the mean percentage of CD146 expression neither CD146 MFI were statically different between molecular negative B-ALL and Ph-like ALLs. Conclusions: Our data demonstrate the association between CD146 expression and Ph+ B-ALLs. CD146 along with myeloid markers may help to identify a distinctive immunophenotypic pattern, useful for rapid identification in diagnostic routine of this subtype of B-ALLs that benefits from a specific therapeutic approach.

IntroductionRegorafenib is an oral multi-targeted tyrosine kinase inhibitor (TKI) indicated for the treatment of various tumor types, including metastatic gastrointestinal stromal tumors (GIST), as a third-line systemic therapy. Erythrocytosis, which is characterized by an increase in erythrocyte count, hemoglobin, and hematocrit levels, has been described as a side effect of some antiangiogenic TKIs but has never been associated with regorafenib administration.Case presentationAn extra-GIST was diagnosed in a 58-year-old woman after she underwent surgery to remove a pelvic mass. Three years later, systemic therapy with imatinib was started due to pelvic disease recurrence. However, after six months, due to disease progression, we prescribed sunitinib, which the patient received for four years. Regorafenib was initiated in June 2019, and after six months, we noted an increase in the erythrocytes’ count and hemoglobin (Hb) levels. Given that the patient had clinical benefit and hematocrit was within normal range, we only monitored the blood cell count and continued to give regorafenib at the same dose. The drug was then stopped for over six weeks due to hospitalization for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and Hb levels returned to normal. Therefore, we decided to restart regorafenib at a lower dose. However, Hb levels rose again in conjunction with increased hematocrit, resulting in the need for multiple phlebotomies. We attempted to restart regorafenib every other day, but it was unsuccessful, so we stopped it permanently in May 2023, and all values returned to normal.ConclusionRegorafenib may cause secondary erythrocytosis that could not be dose-related, as this case report suggests. Secondary erythrocytosis might be a marker of TKI efficacy, given the patient’s prolonged clinical benefit during regorafenib treatment (48 months). In patients receiving regorafenib, monitoring blood count as well as any symptoms associated with erythrocytosis may be suggested.

Immune thrombotic thrombocytopenic purpura (iTTP) is a life-threatening thrombotic microangiopathy characterized by microangiopathic hemolytic anemia, thrombocytopenia, and ischemic end organ injury due to microvascular platelet-rich thrombi. iTTP pathophysiology is based on a severe ADAMTS13 deficiency, the specific von Willebrand factor (vWF)-cleaving protease, due to anti-ADAMTS13 autoantibodies. Early diagnosis and treatment reduce the mortality. Front-line therapy includes daily plasma exchange (PEX) with fresh frozen plasma replacement and immunosuppression with corticosteroids. Caplacizumab is recently added to the front-line therapy. Caplacizumab is a nanobody that binds to the A1 domain of vWF, blocking the interaction of ultra-large vWF multimers with the platelet, and thereby preventing the formation of platelet-rich thrombi. Caplacizumab reduces mortality due to ischemic events, refractoriness and exacerbations after PEX discontinuation. Until now, the criteria for response to treatment mainly took into account the normalization of platelet count and discontinuation of PEX, now with the use of caplacizumab, leading to rapid normalization of platelet count, it has been necessary to redefine the response criteria, taking into account also the underlying autoimmune disease. Monitoring of ADAMTS13 activity is important to identify cases with low value of activity (

IntroductionPelvic organs prolapse remains a significant health concern affecting millions of women worldwide. The use of native tissues to suspend the apex has acquired relevance in urogynecologic surgery. One of the most commonly used procedures performed without mesh is the technique described by Shull, consisting of suturing the vaginal apex to the uterosacral ligaments. The objective of the study is to evaluate the learning curve of laparoscopic Shull's repair for the correction of pelvic floor defects, including the surgery time and surgical outcomes.Materials and methodsThis is a retrospective study conducted at the Policlinico G. Martino, University of Messina, Messina, Italy, and Policlinico Vanvitelli, Vanvitelli University, Naples, Italy. All patients affected by grade I-IV POP, consisting of apical prolapse with or without cystocele, and who underwent laparoscopic Shull's technique for prolapse correction were enrolled. The endpoints to estimate the learning curve for the procedure were the percentage of laparoscopic procedures completed, operative time, and the early complication rate.ResultsA total of 31 laparoscopic Shull repairs were collected for the study. To evaluate the learning curve of the technique, we divided the 31 cases into three different groups: Procedures 0–10; 11–20; 21–31. The parameter for evaluating technique learning was the operative time. Group 21–31 demonstrated an operative time of 97 min (SD 20), compared with 121 min (SD 23) in group 0–10 and 120 min (SD 13) in group 11–20. A comparison of these means through ANOVA showed a p-value of 0.01 for the entire system, and 0.95 for the comparison between 0 and 10 and 11–20, 0.04 for 0–10 vs. 21–31, and 0.02 between 11 and 20 and 21–31.ConclusionsThe rate of surgical improvement in terms of time became effective after an average of 20 procedures. However, the improvement seems to be effective case by case for surgeons skilled in basic endoscopy.