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Main results and the role of chance: This guideline aims to help clinicians to apply best care for women with endometriosis. Although studies mostly focus on women of reproductive age, the guideline also addresses endometriosis in adolescents and postmenopausal women. The guideline outlines the diagnostic process for endometriosis, which challenges laparoscopy and histology as gold standard diagnostic tests. The options for treatment of endometriosis-associated pain symptoms include analgesics, medical treatments and surgery. Non-pharmacological treatments are also discussed. For management of endometriosis-associated infertility, surgical treatment and/or medically assisted reproduction are feasible. While most of the more recent studies confirm previous ESHRE recommendations, there are five topics in which significant changes to recommendations were required and changes in clinical practice are to be expected. Limitations reasons for caution: The guideline describes different management options but, based on existing evidence, no firm recommendations could be formulated on the most appropriate treatments. Also, for specific clinical issues, such as asymptomatic endometriosis or extrapelvic endometriosis, the evidence is too scarce to make evidence-based recommendations. Wider implications of the findings: The guideline provides clinicians with clear advice on best practice in endometriosis care, based on the best evidence currently available. In addition, a list of research recommendations is provided to stimulate further studies in endometriosis. Study question: How should endometriosis be diagnosed and managed based on the best available evidence from published literature? Summary answer: The current guideline provides 109 recommendations on diagnosis, treatments for pain and infertility, management of disease recurrence, asymptomatic or extrapelvic disease, endometriosis in adolescents and postmenopausal women, prevention and the association with cancer. What is known already: Endometriosis is a chronic condition with a plethora of presentations in terms of not only the occurrence of lesions, but also the presence of signs and symptoms. The most important symptoms include pain and infertility. Study design size duration: The guideline was developed according to the structured methodology for development of ESHRE guidelines. After formulation of key questions by a group of experts, literature searches and assessments were performed. Papers published up to 1 December 2020 and written in English were included in the literature review. Participants/materials setting methods: Based on the collected evidence, recommendations were formulated and discussed within specialist subgroups and then presented to the core guideline development group (GDG) until consensus was reached. A stakeholder review was organized after finalization of the draft. The final version was approved by the GDG and the ESHRE Executive Committee. Summary answer: The current guideline provides 109 recommendations on diagnosis, treatments for pain and infertility, management of disease recurrence, asymptomatic or extrapelvic disease, endometriosis in adolescents and postmenopausal women, prevention and the association with cancer. What is known already: Endometriosis is a chronic condition with a plethora of presentations in terms of not only the occurrence of lesions, but also the presence of signs and symptoms. The most important symptoms include pain and infertility. Study design size duration: The guideline was developed according to the structured methodology for development of ESHRE guidelines. After formulation of key questions by a group of experts, literature searches and assessments were performed. Papers published up to 1 December 2020 and written in English were included in the literature review. Participants/materials setting methods: Based on the collected evidence, recommendations were formulated and discussed within specialist subgroups and then presented to the core guideline development group (GDG) until consensus was reached. A stakeholder review was organized after finalization of the draft. The final version was approved by the GDG and the ESHRE Executive Committee. Main results and the role of chance: This guideline aims to help clinicians to apply best care for women with endometriosis. Although studies mostly focus on women of reproductive age, the guideline also addresses endometriosis in adolescents and postmenopausal women. The guideline outlines the diagnostic process for endometriosis, which challenges laparoscopy and histology as gold standard diagnostic tests. The options for treatment of endometriosis-associated pain symptoms include analgesics, medical treatments and surgery. Non-pharmacological treatments are also discussed. For management of endometriosis-associated infertility, surgical treatment and/or medically assisted reproduction are feasible. While most of the more recent studies confirm previous ESHRE recommendations, there are five topics in which significant changes to recommendations were required and changes in clinical practice are to be expected. Limitations reasons for caution: The guideline describes different management options but, based on existing evidence, no firm recommendations could be formulated on the most appropriate treatments. Also, for specific clinical issues, such as asymptomatic endometriosis or extrapelvic endometriosis, the evidence is too scarce to make evidence-based recommendations. Wider implications of the findings: The guideline provides clinicians with clear advice on best practice in endometriosis care, based on the best evidence currently available. In addition, a list of research recommendations is provided to stimulate further studies in endometriosis. Study funding/competing interests: The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the dissemination of the guideline. The guideline group members did not receive payments. C.M.B. reports grants from Bayer Healthcare and the European Commission; Participation on a Data Safety Monitoring Board or Advisory Board with ObsEva (Data Safety Monitoring Group) and Myovant (Scientific Advisory Group). A.B. reports grants from FEMaLE executive board member and European Commission Horizon 2020 grant; consulting fees from Ethicon Endo Surgery, Medtronic; honoraria for lectures from Ethicon; and support for meeting attendance from Gedeon Richter; A.H. reports grants from MRC, NIHR, CSO, Roche Diagnostics, Astra Zeneca, Ferring; Consulting fees from Roche Diagnostics, Nordic Pharma, Chugai and Benevolent Al Bio Limited all paid to the institution; a pending patent on Serum endometriosis biomarker; he is also Chair of TSC for STOP-OHSS and CERM trials. O.H. reports consulting fees and speaker's fees from Gedeon Richter and Bayer AG; support for attending meetings from Gedeon-Richter, and leadership roles at the Finnish Society for Obstetrics and Gynecology and the Nordic federation of the societies of obstetrics and gynecology. L.K. reports consulting fees from Gedeon Richter, AstraZeneca, Novartis, Dr KADE/Besins, Palleos Healthcare, Roche, Mithra; honoraria for lectures from Gedeon Richter, AstraZeneca, Novartis, Dr KADE/Besins, Palleos Healthcare, Roche, Mithra; support for attending meetings from Gedeon Richter, AstraZeneca, Novartis, Dr KADE/Besins, Palleos Healthcare, Roche, Mithra; he also has a leadership role in the German Society of Gynecological Endocrinology (DGGEF). M.K. reports grants from French Foundation for Medical Research (FRM), Australian Ministry of Health, Medical Research Future Fund and French National Cancer Institute; support for meeting attendance from European Society for Gynaecological Endoscopy (ESGE), European Congress on Endometriosis (EEC) and ESHRE; She is an advisory Board Member, FEMaLe Project (Finding Endometriosis Using Machine Learning), Scientific Committee Chair for the French Foundation for Research on Endometriosis and Scientific Committee Chair for the ComPaRe-Endometriosis cohort. A.N. reports grants from Merck SA and Ferring; speaker fees from Merck SA and Ferring; support for meeting attendance from Merck SA; Participation on a Data Safety Monitoring Board or Advisory Board with Nordic Pharma and Merck SA; she also is a board member of medical advisory board, Endometriosis Society, the Netherlands (patients advocacy group) and an executive board member of the World Endometriosis Society. E.S. reports grants from National Institute for Health Research UK, Rosetrees Trust, Barts and the London Charity; Royalties from De Gruyter (book editor); consulting fees from Hologic; speakers fees from Hologic, Johnson & Johnson, Medtronic, Intuitive, Olympus and Karl Storz; Participation in the Medicines for Women's Health Expert Advisory Group with Medicines and Healthcare Products Regulatory Agency (MHRA); he is also Ambassador for the World Endometriosis Society. C.T. reports grants from Merck SA; Consulting fees from Gedeon Richter, Nordic Pharma and Merck SA; speaker fees from Merck SA, all paid to the institution; and support for meeting attendance from Ferring, Gedeon Richter and Merck SA. The other authors have no conflicts of interest to declare

Η παρούσα εργασία αναφέρεται στο άθλημα του μπάσκετ και στη μυϊκή ενδυνάμωση, βελτίωση της έκρηξης και της αλτικότητας παικτών ηλικίας 14-16. Αρχικά, γίνεται μια προσπάθεια κατανόησης των απαιτήσεων μιας προπόνησης αυτής της ηλικιακής ομάδας, η οποία παρουσιάζει διαφορετικές απαιτήσεις και ανάγκες από την προπόνηση άλλων ηλικιακών ομάδων. Η προπόνηση αυτών των αθλητών θα πρέπει αρχικά να επικεντρώνεται στη σωστή εκμάθηση των βασικών τεχνικών του μπάσκετ. Επιπλέον, θα πρέπει να εστιάζει στην εφαρμογή ασκήσεων που θα βελτιώνουν τη φυσική κατάσταση των παικτών, αλλά παράλληλα θα τους προστατεύουν από πιθανούς τραυματισμούς. No

Polyps of the lower reproductive tract are found in 7.8-50% of women. It has been hypothesized that cytogenetic modifications on chromosomes 6, 7 and 12 as well as epigenetic factors involving enzyme and metabolic activities may cause polyps to develop. Cervical polyps found in 2-5% of cases are of low clinical significance and can cause, although rarely, post coital bleedings. Cervical polyps grow during pregnancy and mucorrhoea. Trans vaginal ultrasound (TVU) provides an excellent diagnostic technique to diagnose the size and the anatomic location of endometrial polyps (EPs). In asymptomatic young woman with small EPs

Laparoscopic surgery has now replaced traditional open surgery as the preferred method of intervention for many procedures. Although there are advantages of laparoscopic surgery to the patient, the technology puts additional strain on the surgical team. There are three aspects to the theatre environment that need to be considered: staff safety, patient safety and cost efficiency. We have previously published on the effect of the laparoscopic theatre environment on staff safety. To our knowledge, there are no data on the effect of integrated theatres on surgical teamwork. We therefore wished to determine staff perception of the effect that the integrated theatre environment had on their working interactions and behaviour in the operating room. This was a cross-sectional questionnaire survey. Twenty-seven theatre staff (nurses, consultants and trainees) working in a laparoscopic theatre were asked to complete a questionnaire. This included general demographics and their perception regards the theatre environment and team interaction. Visual analogue scores were used to compare the integrated and non-integrated theatres. Non-parametric statistical analysis was used. Overall the theatre team members had a strong preference for working in an integrated theatre environment. They felt that it resulted in greater efficiency, better teamwork and reduced stress levels. Differences were highly significant (p

Key content Mini laparotomy (suprapubic, transumbilical, ancillary port-site) and posterior colpotomy are methods that have been used for the removal of specimens excised laparoscopically, with the use of morcellators and endoscopic bags growing in popularity in recent years. The size, cystic versus solid component and the risk of malignancy are essential factors influencing the route of specimen retrieval. The risk of spillage (especially in suspected early malignancy) has to be considered during excision and retrieval. Natural orifice transluminal endoscopy (NOTES) may be the operative and retrieval route of the future. Learning objectives To be aware of the different methods and routes of retrieving laparoscopically excised specimens. To be aware of the risks associated with each method and route. To review the factors that will influence the optimal choice of route and method. Ethical issues In the age of specialisation, a clinician who is not specially trained in operative laparoscopic surgery should not be practicing it. To minimise complications, the excision and retrieval of specimens via minimally invasive incisions should be limited to specially trained individuals.

An employer has a legal requirement to offer a safe working environment to its employees. The risks and hazards should be reduced as far as practicably possible, and the set-up should be as ergonomic as possible. Modern laparoscopic surgery carried out in an old-fashioned theatre without the advantages that an integrated operating room has to offer results in increased risk of injury to the staff. We have assessed the relative risks and determined reasons why modernisation is essential to the safety of the theatre team.

STUDY QUESTION Is temporary ovarian suspension following laparoscopic surgery for severe pelvic endometriosis an effective method for reducing the prevalence of postoperative ovarian adhesions? SUMMARY ANSWER Temporary ovarian suspension for 36-48 h following laparoscopic treatment of severe endometriosis does not result in a significant reduction of postoperative ovarian adhesions. WHAT IS KNOWN ALREADY Pelvic adhesions often develop following laparoscopic surgery for severe pelvic endometriosis. Adhesions can cause chronic pelvic pain and fertility problems compromising the success of treatment. Small observational studies suggested that temporary postoperative ovarian suspension to the abdominal wall may significantly reduce the prevalence of postoperative ovarian adhesions. STUDY DESIGN, SIZE, DURATION This was a prospective within group comparison double-blind RCT. We recruited premenopausal women with severe pelvic endometriosis who required extensive laparoscopic surgery with preservation of the uterus and ovaries. Severity of the disease and eligibility for inclusion were determined at surgery. A total of 55 women were randomized to unilateral ovarian suspension for 36-48 h, 52 of which were included in the final analysis. Both ovaries were routinely suspended to the anterior abdominal wall during surgery. At the end of the operation, each woman was randomized to having only one ovary suspended postoperatively. The suture suspending the contralateral ovary was cut and a new transabdominal suture was inserted to act as a placebo. Both sutures were removed 36-48 h after surgery prior to discharge. Three months after surgery, all women attended for a detailed transvaginal ultrasound scan to assess ovarian mobility. Both the women and the ultrasound operators were blinded as to the side of postoperative ovarian suspension. The primary outcome was the prevalence of ovarian adhesions as described on ultrasound examination. Secondary outcomes were the severity of adhesions and the presence and intensity of postoperative pain. PARTICIPANTS/MATERIALS, SETTING, METHODS All 55 participants had severe pelvic endometriosis confirmed at laparoscopy. As each participant had only one of their ovaries suspended at the end of surgery, they acted as their own control. MAIN RESULTS AND THE ROLE OF CHANCE The median interval between ovarian suspension and postoperative scan was 99 days (interquartile range 68-114). There was no significant difference (P = 0.23) in the prevalence of postoperative ovarian adhesions between the suspended (20/52) and unsuspended (27/52) side (38.5 versus 51.9%) [odds ratio 0.56 (95% confidence interval 0.22-1.35)]. LIMITATIONS, REASONS FOR CAUTION Ovaries were suspended postoperatively for 36-48 h. Longer suspension could result in lower prevalence of postoperative adhesions. WIDER IMPLICATIONS OF THE FINDINGS The value of temporary ovarian suspension in women having surgery for mild-to-moderate endometriosis should be investigated further. The potential benefits of other adhesion prevention strategies, such as surgical barrier agents, in women undergoing surgical treatment for severe pelvic endometriosis should also be explored. STUDY FUNDING/COMPETING INTERESTS E.S. received honoraria from Ethicon for provision of training to healthcare professionals and consultancy fees from Bayer. W.H. was supported by the research fund provided by the Gynaecology Ultrasound Centre, London UK. A.C. is on the advisory board for surgical innovations for which he receives an annual honorarium. A.C. also received support for courses and education from Storz and Johnson and Johnson and support for clinical nursing from Covidien and Lotus. The other authors declared no competing interests. TRIAL REGISTRATION NUMBER Current Controlled Trials ISRCTN24242218.

Bei piezoresistiven Silizium-Druckmesselementen ruft die Messgröße Druck eine Widerstandsänderung von dotierten Halbleiterwiderständen hervor. Die Funktion von piezoresistiven Silizium-Druckmesselementen kann durch die Reihenschaltung folgender Wandler beschrieben werden: a) Der mechanische Wandler, der der Umwandlung des zu messenden Druckes in mechanische Spannungen dient, b) der mechanoelektrische Wandler, der die Änderung des Betrags der dotierten Halbleiterwiderstände auf der Oberseite des Messelements aufgrund der mechanischen Spannungen in der Druckmessplatte umwandelt und c) der elektrische Wandler, der aus der Änderung der Widerstände eine elektrische Messgröße erzeugt. Die Aufgabe des Entwurfs von piezoresistiven Drucksensoren besteht im Wesentlichen in der Dimensionierung des Primärsensors und der Bestimmung des quasistatischen Übertragungsverhaltens der Sensoren. Im Vordergrund steht dabei die Sicherung eines möglichst großen Übertragungsfaktors bei minimalen systematischen Fehlern für einen vorgegebenen Nenndruckbereich. Hauptentwurfskenngrößen sind dabei der Übertragungsfaktor, der Linearitätsfehler, die systematischen Temperaturfehler, der Nenndruckbereich und der Überlastfaktor. Zur Durchführung des mechanischen Entwurfs von piezoresistiven Silizium-Druckmesselementen wird gegenwärtig ein zweistufiges Verfahren eingesetzt. Ein erster Grobentwurf wird mit Hilfe von analytischen Ansätzen aus der Plattentheorie anhand von vereinfachten Druckmesselementmodellen durchgeführt. Der anschließende Feinentwurf wird zunehmend durch Finite-Elemente-Simulationen (FEM) vollendet, die den Entwurf des gesamten Druckmesselements in einem durch den analytischen Grobentwurf vorausgewählten Parameter ohne Vereinfachungen erlauben. Das Hauptziel dieser Arbeit besteht darin, durch Nutzung der Vorteile der beiden Verfahren für den Entwurfsprozess des realen mechanischen Wandlers eine möglichst exakte Beschreibung des statischen Übertragungsverhaltens und der systematische Fehler von piezoresistiven Silizium-Druckmesselementen zu finden. Die Vorteile des analytischen Verfahrens liegen in der einfachen Beschreibung der Zusammenhänge mit Hilfe von geschlossen lösbaren Gleichungen und der schnellen Optimierung des Entwurfs durch Variation der Modellvariablen. Nachteilig bei den vorhandenen analytischen Ansätzen ist es, dass sie sich aufgrund von vielen Vereinfachungen zur exakten Beschreibung realer Modelle nicht eignen. Einige dieser Vereinfachungen sind z.B. das Vernachlässigen der realen Randeinspannung der Druckmessplatten, die Vernachlässigung der Passivierungsschichten und die Annahme von isotropen Materialeigenschaften für das Silizium. Die FEM-Simulationen bieten den Vorteil der einfachen und exakten Modellierung der vorhandenen Struktur, sowie die Möglichkeit der übersichtlichen Darstellung der Ergebnisse bei gleichzeitiger Variation mehrerer Einflussparameter. Die wesentlichen Nachteile dieses Verfahrens sind die Abhängigkeit der Ergebnisse von der Wahl der Simulationsparameter, wie Art und Anzahl der Finiten Elemente zur Modellierung der Struktur und der hohe Aufwand für die Optimierungsrechnung. Ein wesentlicher Teil dieser Arbeit besteht in der Erstellung von verbesserten analytischen Modellen zur genaueren Beschreibung des mechanischen Verhaltens realer piezoresistiver Drucksensorelemente. Die neuen Modelle sollen als Basis eines PC-gestützten Entwurfsprogramms dienen, das durch getestete Berechnungsvorschrifte und Richtlinien zur Auslegung von piezoresistiven Silizium Druckmesselementen eingesetzt werden kann. Im Rahmen dieser Arbeit wurde zunächst der gegenwärtig angewandte Entwurfsprozess von piezoresistiven Silizium-Druckmesselementen untersucht. Dabei wurde speziell der Entwurf des mechanischen Wandlers behandelt. In einem ersten Schritt wurden alle momentan auf Vereinfachungen basierende analytischen Ansätze zum Entwurf von technisch interessanten piezoresistiven Silizium-Druckmesselementen zusammengestellt und bewertet. Das Ziel war die Ermittlung der Grenzen ihrer Einsetzbarkeit im Entwurfsprozess. Dazu ist die Kenntnis der erreichbaren Genauigkeit bei der Verwendung der einzelnen analytischen Ansätze notwendig. Aus diesem Grund wurde eine Datenbank mit FEM-Simulationsergebnissen für alle technisch interessanten Modelle von realen piezoresistiven Silizium-Druckmesselementen aufgebaut. Bei den einzelnen Simulationsmodellen wurden alle reale Randbedingungen, wie z.B. die tatsächliche Randeinspannung der Druckmessplatte und die primäre Passivierungsschicht, berücksichtigt. Bei den Simulationen wurden außerdem die Entwurfsparameter systematisch variiert, so dass ein möglichst exakter Vergleich mit den analytischen Ansätzen ermöglicht wird. Weiterhin wurden Möglichkeiten zur Kombination der beiden Entwurfsverfahren untersucht. Das Ziel war die Verbesserung der analytischen Ansätze, um eine Reduktion der Entwurfsschritte zu erzielen. In diesem Zusammenhang wurden die Möglichkeiten eines neuartigen Verfahrens, basierend auf die Regressionsanalyse der FEM-Simulationsergebnisse, aufgezeigt. Alle Erkenntnisse der vorgestellten Untersuchungen sind in der Entwicklung eines Entwurfprogramms zur Unterstützung des Entwurfs von piezoresistiven Silizium-Druckmesselementen eingeflossen. Das neu entwickelte Programm bietet eine alternative zum gegenwärtig üblichen Entwurf nach der Versuch-Irrtum Methode (trial and error), indem die optimale Dimensionierung des Messelementes unter Berücksichtigung von Vorgaben bezüglich des gewünschten statischen Übertragungsverhaltens des Drucksensors durchgeführt wird. Die Erprobung des neuen Entwurfprogramms wurde an zwei konkreten Entwürfen, eines Druckmesselementes für den Nenndruck von 40 bar und eines neuartigen Hochdruckmesselementes für den Nenndruck von 1000 bar, durchgeführt.