The pubertal activation of the hypothalamic-pituitary-gonadal axis and development is influenced by multiple factors，including genetics，neuroendocrine factors，gut microbiota，diet and other factors and their interactions.The mechanism involving the gut microbiota and pubertal sexual development is one of the current research hotspots.Studies have shown that the gut microbiota might interact with pubertal sexual development through the brain-gut axis，the sex hormone-gut microbiota axis，and other pathways，with the specific mechanisms involving overweight/obesity，leptin，insulin and its receptors，hyperandrogenism，genes related to precocious puberty，adiponectin，dietary fiber，and growth hormone-releasing peptides.This review provides an overview of the research progress related to pubertal sexual development and gut microbiota，providing a reference for further exploring its mechanisms and the prevention and treatment of related diseases.

Objective:To explore the impact of pain, functional disability, self-efficacy and social support on health-related quality of life (HRQOL) in gout patients.Methods:From November 2019 to January 2020, a total of 218 patients with gout were investigated using the general information questionnaire, Visual Analogue Scale, Health Assessment Questionnaire Disability Index, General Self-Efficacy Scale, Perceived Social Support Scale, and Gout Impact Scale. The structural equation model was established by AMOS 24.0 for parth analysis, and the mechanism of pain dysfuction, self-efficacy and social support affecting the quality of life in gout patients was tested.Results:The total score of Gout Impact Scale, pain, functional disability, self-efficacy and social support respectively was 59.94±18.39, 6.00±2.76, 0.25 0, 0.88, 23.39±6.40 and 62.92±8.24. Pain directly influenced HRQOL ( β=-0.293, P<0.01), and indirectly influenced HRQOL ( β=-0.039, P<0.05). Functional disability directly influenced HRQOL ( β=-0.244, P<0.01). Self-efficacy directly influenced HRQOL ( β=0.182, P<0.01), and indirectly influenced HRQOL ( β=0.202, P<0.01) through pain and functional disability. Social support indirectly influenced HRQOL ( β=0.278, P<0.01) through pain, functional disability and self-efficacy. Conclusions:HRQOL of patients among gout is affected by several factors, mainly affected by pain, functional disability and self-efficacy; and there are interactions among them. Targeted interventions should be strengthened to relieve pain, prevent or slow down the progress of physical disability, enhance self-efficacy and social support to improve HRQOL.

Objective:To observe the expression characteristics of small ubiquitin-like modified protein (SUMO) pathway members in osteosarcomaby using molecular biology methods, and provide theoretical basis for targeted therapy based on protein SUMO modification.Methods:Eighteen fresh osteosarcoma tissue samples surgically resected at Tianjin Cancer Hospital from January 2017 to June 2019 were collected. Western blot and immunohistochemical methods were used to detect the protein expressions of SUMO1, SAE1, Ubc9, and SENP1, which are core members of SUMO pathway, in the cancerous and adjacent tissue. Taking osteosarcoma cell line 143B as the research object, three targeted treatment regimens were designed and grouped as follows: control group, nonsense group, siR-SUMO1 group, siR-Ubc9 group, and SENP1 group. Western blot was used to verify the efficiency of gene transfection, the positive expression rate of EdU was detected by cell proliferation detection kit, the ability of cell migration and invasion was measured by scratch test and Transwell invasion test, and the apoptosis rate was detected by flow cytometry. Bone marrow mesenchymal stem cells (BMSCs) were used to evaluate the side effects of three treatment regimens.Results:Results from Western blot and immunohistochemistry showed that the protein expression levels of SUMO1, SAE1, andUbc9 in osteosarcoma tissues were significantly higher than those in adjacent tissues ( P<0.05), but SENP1 was significantly lower than in adjacent tissues. The experimental results based on 143B osteosarcoma cells showed that the siR-SUMO1 group, siR-Ubc9 group, and SENP1 group can significantly inhibit the activation of SUMO pathway in osteosarcoma cells, showing lower tumor cell proliferation ( P<0.05), slower cell migration and invasion capacity ( P<0.05), and higher apoptotic rate ( P<0.05), than the control group and nonsense group; however, experimental results based on BMSCs showed that the siR-SUMO1 group and siR-Ubc9 group can significantly inhibit the proliferation of BMSCs, induce apoptosis, and show great therapeutic side effects, but the SENP1 group has almost no effect on the proliferation and apoptosis of BMSCs ( P>0.05). Conclusion:The SUMO pathway is abnormally activated in osteosarcoma. Exogenous supplementation or endogenous activation of SENP1 is one of the alternatives for targeted osteosarcoma treatment.

Objective To investigate the current status of learning burnout on Basic Nursing Science practical course among five-year higher vocational nursing students and to analyze the reasons for burnout from nursing students' perspectives.Methods We selected 285 nursing students in a five-year higher vocational college by convenience sampling. The higher vocational nursing students practical training learning burnout questionnaire was used to investigate them. Among 285 nursing students, a total of 12 of them were selected to carry out focus group interview to explore the reasons for learning burnout of nursing students.Results A total of 285 questionnaires were sent out and 278 valid questionnaires were collected. Among 278 nursing students, the total score of higher vocational nursing students practical training learning burnout questionnaire was (2.78±0.52) with 93.9％ for the detection rate of learning burnout. There were statistical differences in the scores of the learning burnout questionnaire among nursing students with different sexes, places of birth, academic record and whether like nursing specialty (P<0.05).Conclusions The learning burnout of five-year higher vocational nursing students is common in nursing practical training. Many factors lead to practical training learning burnout of nursing students, such as individual, teachers, companions and vocational perspective.

Objective To investigate the effect of Goserelin in protection of the ovarian function of pre-menopausal breast cancer patients. Methods Eighty premenopausal patients with breast cancer randomly divided equally into study group and control group. The two groups were compared in terms of the menstrual status and the levels of E2,FSH,LH before and after chemotherapy. Results The menstrual recovery rates of the study group and the control group were 90% and 57.5%,respectively ,with statistically significant difference between them (P = 0.018). In the study group,the serum E2 decreased gradually to the postmenopausal level,and the serum levels of FSH and LH were also significantly decreased during the treatment. While in the control group ,the E2 levels gradually decreased ,but the levels of FSH and LH significantly increased during the chemotherapy. Conclusions Goserelin can effectively prevent the injury of ovarian function caused by chemotherapy.

Objective We observed influence of different handgrip exercise on the changes of blood flow velocity and blood vessel diameter of basilic vein before and after the PICC placement and discuss the best model for handgrip exercise.Methods 60 patients with PICC were chosen and divided into group A,B and C with 20 patients in each groups.Group A received routine guidance on unarmed handgrip exercise,group B used electronic handgrip,the frequency was 25 times/min,the time period was 2 min with 4 times a day,once every 4 hours,group C adopted the same model as that of group B and 6 times a day,once every 3 hours.The venous blood flow velocity and blood vessel diameter was measured by pulsed Doppler ultrasound one hour before the PICC placement and one hour,1 day,3 days,7 days,10 days,14 days,21 days after placement.Results The venous blood flow velocity before and after PICC placement had statistically significant differences at different time points (F=2.934,P ＜ 0.05).The effect of group B and C was better than that of the group A and group C showed the best effect.The blood vessel diameter before and after PICC placement had significant differences at different time points(F=3.940,P ＜ 0.05).There was significant differences in the blood vessel diameter 1h before and 1h after PICC placement.Conclusions Handgrip exercise can effectively promote the upper limb venous blood flow velocity in patients with PICC,but shows little effect on the blood vessel diameter.Using the electronic hand grip in weak tap position,25 times/min,2 min every time,and 6 times a day (once every 3 hours),can obviously promote the upper limb venous blood flow velocity.

Performance evaluation system of 13 research institutions funded by the South Korean government was introduced in terms of policy and management.The situation of Korea Institute of Oriental Medicine performance evaluation in 2012 was presented.A reference has been provided for further improving science and technology evaluation system of China.

Objective To investigate the distribution of the CTX-M- extended spectrum beta-lactamase (ESBLs) producing Esche- richia coli(ECO) and the molecular mechanism of dissemination. Methods To analyze the drug resistance of the 43 isolates, Kirby-Bauer susceptibility method was used. Multiple polymeraso chain reaction (PCR) was used to amplify the gene of ESBLs, AmpC, full length of blaCTX-M-like gene, insertion sequence (IS) ISEcp1B, IS903 , IS26 and integron I. NEST-PCR was used to detect if the beta-lactamase gene lo- cated in the integron I. The product of full length of bla-CTX-M like gone amplified by PCR was sequenced. Results Susceptibility test showed the resistance from high to low in turn was Ampicillin (97.68%), Coftriaxone (67.44 % ), piperacillin(65.12 % ), Cefotaxime (62.79 % ) ,Coftasidime(58.14% ), Cofasolin(55.81% ), Cofepime (53.49%), Cefexitin(51.16%), ciprofloxacin (44. 19% ), Aztreo- nam(41.86% ), Cefoperasone/Sulbactam ( 20.93% ), Amikacin (0% ), Imipenem (0% ), respectively. ECO was susceptive to Imipenem. CTX-M-G1 was found in 25 strains of ECO , TEM, SHV, CTX-M-G1, ISEcp1B, and integron I were found in the nine isolates. IS903 were found in ECO 3 and 5, and IS26 was found in ECO 3. In ECO 3 and 5, blaCTX-M-like was flanked upstream by ISEcp1B element that provided -35 and -10 promoter sequences and a right inverted repeat (IRR) recognized by transposase, downstream by IS903 provided an inverted re- peat, ISEcp1 B and IS903 composed the complex transpeson. Conclusion ISEcplB may drive the expression and dissemination of blaCTX-M-like gene at a high level.