Prominent problems of clinical teaching in Tibet University school of medicine were analyzed and countermeasures were proposed from aspects of management system construction, facul-ty construction, curriculum construction, base construction and quality evaluation system construction. The aim was to increase students' opportunity, enhance students' learning interest and improve stu-dents' ability of analysis and problem solving so as to improve the practical effects of clinical teaching. All countermeasures taken above laid the foundation for future clinical work and provided help for clinical medical personnel in Tibetan border areas.

One hundred and eighty three women with high risk of breast cancer identified in Baoding First Central Hospital from June 2007 to June 2014,were enrolled in the study.In these 183 cases,41 received preventive therapy (22.4％),142 did not.Factors associated with acceptance of chemoprevention included older age,menopause,comorbidities,lower level education,being married,higher BMI,having high level hyperplasia of ductal epthelia and counseling to breast specialists (P ＜ O.05);whilenot informed by doctors was the main reason for failed taking preventive agents(95.1％,135/142).Thirteen of 41 women receiving chemoprevention discontinued the therapy (31.7％);no-insurance,no side-effects and higher BMI were related to the discontinuing (P ＜ 0.05).The 1-,2-,3-,and 5-year adherence rates of chemoprevention was 86.1％ (31/36),65.4％ (17/26),59.1％ (13/22),8/13 and 5/10,respectively.The results show that chemoprevention rate is low among Chinese women at high risk of breast cancer,and the long-term adherence to preventive therapy is poor.Corresponding measures should be taken to strengthen the chemoprevention of breast cancer.

Objective:To investigate the change of fibroblast growth factor 19 (FGF19) in patients with metabolic syndrome (MS) and its diagnostic significance.Methods:According to the number of abnormal metabolic indexes, 175 outpatients and inpatients with MS were divided into Group Ⅲ, Group Ⅳ and Group Ⅴ, with 68 cases, 57 cases and 50 cases, respectively. 40 healthy people were served as normal control group (NC group). Serum FGF19 concentration was measured by enzyme-linked immunosorbent assay (ELISA). The height, weight, waist circumference, blood pressure, blood lipid, fasting and 2-hour postprandial blood glucose, fasting insulin and serum C-reactive protein were measured. Multiple stepwise regression was used to analyze the related influencing factors of FGF19, and the threshold value of FGF19 in the diagnosis of MS was determined by drawing receiver operating characteristic (ROC) curve.Results:The levels of serum FGF19 in NC, Ⅲ, Ⅳ and Ⅴ groups decreased gradually, and the differences were statistically significant ( P<0.05). Multiple stepwise regression analysis showed that BMI, serum total cholesterol, glycosylated hemoglobin and waist circumference were independent influencing factors of FGF19 ( P<0.05). ROC curve analysis showed that the ROC area of FGF19 was 0.849, the threshold was 115.4 pg/ml, with sensitivity 0.875 and specificity 0.667. Conclusions:With the increase of metabolic abnormalities in MS, the level of FGF19 decreased, which was related to obesity and glucose and lipid metabolism disorder. It may be an index to predict and diagnose MS.

Objective:To observe the effect of rhGLP-1 (7-36) on Akt/GSK3 signaling pathway in hepatocytes.Methods:Human HL7702 cell line was cultured to the logarithmic growth stage and divided into experimental group and blank control group. The cultures were incubated with 100nM medium containing rhglp-1 (7-36) and without rhglp-1 (7-36) for 90min. The levels of Akt, Glycogen synthase Kinase 3 (GSK3) and Glycogen synthase (GS) in the two groups were detected by Western Blot.Results:Compared with blank control group, the protein expression of p-Akt (Thr308) in experimental group (1.81±0.28) was significantly increased ( P=0.01), but the protein expression of Akt and p-Akt (Ser473) was not significantly changed. The protein expression levels of p-GSK3α (Ser21) (1.27±0.09) and p-GSK3β (Ser9) (1.24±0.09) in the experimental group were significantly increased ( P=0.003, 0.002), while the protein expression levels of GSK3α and GSK3β were not significantly changed. The protein expression level of p-GS (Ser641) (0.70±0.16) was decreased in the experimental group ( P=0.03), but the protein expression level of GS did not change significantly. Conclusion:Glp-1 can inhibit GSK3/GS signaling pathway, activate GS activity and promote glycogen synthesis.