Objective:To analyze the cause of varicocele (VC) recurrence and investigate the efficacy of sub-inguinal microsurgical varicocelectomy (MV) for recurrent VC.Methods:All of 16 inpatients diagnosed as recurrent VC, in the Department of Andrology of the Affiliated Hospital of Qingdao University from 2015 April to 2019 April, were performed sub-inguinal MV. The age of the inpatients was 18-36 years old, median 27 years old.5 cases were originally performed retroperitoneal high ligation of spermatic vein and other 11 cases were originally performed laparoscopic varicocelectomy. During the review one to three years after the previous operation, all of 16 patients were diagnosed as VC recurrence. The complains of these patients during the review included male subfertility (10 cases) and scrotal pain (12 cases), in which 6 cases’ complains were male subfertility with scrotal pain. After admission, 13 patients were classified as Grade Ⅲ (left in 8 cases, bilateral in 5 cases) and 3 patients as Grade Ⅱ (all left). The median of their visual analogue scale (VAS) was 2.5. Color doppler flow imaging (CDFI) grading showed: Grade Ⅲ in 12 cases (left in 7 cases, bilateral in 5 cases), Grade Ⅱ in 4 cases (all left). Particularly, 12 of them were Graded as Ⅲ simultaneously accompanying with Nut-cracker Phenomenon (NCP). Preoperative tests showed that the average serum testosterone was (16.2±4.9)nmol/ml, the average sperm concentration was (11.8±3.9)×10 6/ml and the progressive motility rate (PR) was (24.4±4.2)%. All of the patients were performed sub-inguinal MV using general anesthesia and supine position. The spermatic cords were clearly exposed and padded up by inserting gauze strips under them. During the operation, the field was magnified 4-6 times with the microscope. Then all of the dilated external and internal spermatic veins were ligated, at the same time the internal spermatic artery and lymph vessels were well preserved. During these operations, 11 patients underwent left-side MV, while other 5 did bilateral MVs. During these MVs, we found twisted and dilated external and internal spermatic veins in all cases and well preserved the internal spermatic arteries and lymph vessels. The number of ligated left and right external spermatic veins were(2.1±0.6) and (1.4±0.5)respectively and the number of ligated left and right internal spermatic veins were (10.1±1.1) and (6.6±0.5) respectively. We also found out(1.3±0.5) internal spermatic arteries and (3.0±1.0)lymph-vessels on left side. On right side, there were (1.4±0.5) internal spermatic arteries and (2.6±0.5) lymph-vessels respectively. At last, we summarily analyzed the pre-operative and post-operative VAS, serum testosterone, CDFI and semen analysis data. Results:All of the 16 sub-inguinal MVs were successfully performed. All patients were reviewed comprehensively 6 months after MV. The reviewed results showed that the post-operative VAS was significantly reduced ( Z=-2.994, P<0.05), palpable scrotal vessels disappeared and Valsalva tests were negative. No obvious reflux of internal spermatic veins were detected by CDFI. Interestingly, the sperm concentration and motility were both significantly improved 6 months after MV ( P<0.05), while there was not remarkable increase of the serum testosterone after MV ( P>0.05). During the follow up, no testicular atrophy, hydrocele and other complications were found. Up to submission, five of the ten patients who presented for male subfertility have impregnated their wives. Conclusions:The most possible cause of VC recurrence could be the omission of the external and internal spermatic veins, particularly in the grade Ⅲ VC patients or VC accompanied with NCP. The sub-inguinal MV, which can discover more twisted spermatic veins and at the same time preserve the spermatic artery and lymph-vessels, shows better clinical efficacy than other procedures.

Objective:To investigate the status of secondary victim effect of nurses in tertiary hospitals after adverse events and analyze its influencing factors.Methods:This study was a cross-sectional study. The convenient sampling method was used to select nurses from tertiary hospitals in Beijing, Shanxi and Shandong Province from October to December 2019 as the survey objects. The general information questionnaire and the Second Victim Experience and Support Tool (SVEST) were used to investigate them. Through single factor analysis of variance and multiple linear regression analysis, influencing factors of second victims of nurses were analyzed. A total of 2 163 online questionnaires were distributed and 2 040 were effectively recovered, with an effective recovery rate of 94.3%.Results:Among them, 813 nurses reported adverse event experiences, which were included in the study analysis. The total score of second victim effect of 813 nurses was (58.01±15.32) . Among the average scores of each dimension item, the score of "psychological distress" was the highest and the score of "management support" was the lowest, which were respectively (3.20±1.04) and (2.02±0.90) . The results of univariate analysis showed that there were statistically significant differences in the total scores of the second victim effect of nurses in different departments, marital status, professional title and employment nature ( P<0.05) . The results of multiple linear regression analysis showed that department, professional title and employment nature were the influencing factors of the second victim effect of nurses. The employment nature, marital status and departments had effects on the physiological distress of the second victim, and adverse event classification and departments had an effect on the psychological distress of second victims. Conclusions:The occurrence of adverse events has a moderate impact on the second victim of nurses in tertiary hospitals. Nurses are faced with more serious psychological distress, and the support they feel mainly depends on "management support", which is affected by many factors. Hospital administrators should take a positive view of the second victim effect, pay attention to the physical and mental health of nurses experiencing the role of second victim and provide effective support for different influencing factors.

Objective:To explores the relationship between self-efficacy and marital adjustment in infertile couples based on Actor-Partner Interdependence Model (APIM) .Methods:This study was a cross-sectional survey. A total of 310 infertile couples who underwent in vitro fertilization-embryo transfer cycle treatment in Reproductive Center of Peking University Third Hospital from January to April 2022 were selected as the research objects by the convenient sampling method. General Self-Efficacy Scale and Locke-Wallace Marital Adjustment Test were used to investigate. The relationship between self-efficacy and marital adjustment of infertile couples was analyzed by Pearson correlation analysis and APIM. A total of 310 groups of questionnaires were distributed (1 group was 1 couple) , and 293 groups of effective questionnaires were collected, with an effective recovery rate of 94.5%. Results:The self-efficacy scores of infertile couples were (25.08±5.54) for wives and (27.08±5.35) for husbands, and the self-efficacy scores of wives were lower than those of husbands ( P<0.01) . In the score of marital adjustment, the wives scored (109.39±23.13) and the husbands scored (111.99±20.87) . The APIM analysis results show that in terms of subjective effects, the self-efficacy of both infertile couples could affect their own marital adjustment (β=0.166, 0.408; P<0.01) . In terms of object effects, the husbands' self-efficacy could affect the wives' marital adjustment (β=0.117, P<0.05) . Conclusions:The self-efficacy of infertile couples undergoing in vitro fertilization-embryo transfer cycle treatment is at the middle level, and the marriage adjustment is generally good. The self-efficacy of couples is closely related to their own marital adjustment, and the self-efficacy of husbands can also positively affect the wifes' marital adjustment. In clinical work, infertile couples should be regarded as a whole, focusing on the binary interaction between both parties, and developing targeted measures to help infertile couples improve their self-efficacy, thereby improving marital adjustment, improving health outcomes, and stabilizing family relationships.

Objective:To construct the teaching quality evaluation index system for clinical teachers of undergraduate nursing students based on teaching managers' perspective so as to provide a basis for clinical teaching management of undergraduate nursing students.Methods:From May 2018 to September 2019, the expert enquiry questionnaire on the teaching quality evaluation index system for clinical teachers of undergraduate nursing students based on teaching managers' perspective was developed by the literature review and expert interview. Delphi technique was used to select 20 nursing teaching management experts, 16 of them from 4 ClassⅢ Grade A teaching hospitals in Beijing, 4 of them from a nursing undergraduate university to carry out two rounds of expert enquiry.Results:The initial construction of the teaching quality evaluation index system for clinical teachers of undergraduate nursing students based on teaching managers' perspective included 5 first-level indexes and 30 second-level indexes. The valid recovery rates, expert authoritative coefficients, Kendall coordination coefficients of two rounds of expert enquiry questionnaire were 100%, 0.83 and 0.86, 0.395 and 0.554 respectively ( P<0.01) with the satisfied consistency test results and credible enquiry results. Conclusions:The construction of the teaching quality evaluation index system for clinical teachers of undergraduate nursing students based on teaching managers' perspective is scientifically rigorous. The system has definite evaluation indexes, rational administrative levels, objective and reliable system which could provide a basis for clinical teaching management of undergraduate nursing students.

Neurofibromas are benign tumors of the peripheral nerve sheath originated from mesenchymal tissue and can occur throughout the body, but rarely in the testis. The preferred imaging method is ultrasound. The contrast-enhanced ultrasound can assist in showing the lesions. The characteristic pathological changes are positive of S100 and SOX10 with immunohistochemical staining. It is recommended to choose organ-sparing surgery because of the good prognosis.