Objective:To summarize the pregnancy outcome of monochorionic triamniotic (MCTA) triplet pregnancy and its relationship with multifetal pregnancy reduction.Methods:This study retrospectively recruited 23 women with MCTA pregnancy who delivered at Peking University Third Hospital from January 1, 2012, to January 1, 2020. All 23 cases received regular prenatal examination at our hospital from the first trimester, who were divided into two groups: selective fetal reduction group (randomly reduced one fetus, n=8) and expectant group ( n=15). Pregnancy outcome was described in all participants, differences in maternal age, gestational weeks and outcomes were compared between the two groups. The selective fetal reduction group was further divided into two subgroups: first-trimester vacuum aspiration group ( n=3) and second-trimester radiofrequency ablation group ( n=5), to evaluate the differences in pregnancy outcomes. Two independent samples- t test and Fisher's exact test were used as statistical methods. Results:(1) There was no significant difference in the gestational weeks at the end of the pregnancy [(31.7±4.1) vs (28.8±8.8) weeks], preterm delivery after 32 weeks (9/15 vs 4/8), at least two surviving children (12/15 vs 4/8) and at least one surviving child (13/15 vs 5/8) between the expectant group and the selective fetal reduction group (all P>0.05). One case with twin-twin transfusion syndrome in the expectant group underwent fetoscopic surgery at 19 weeks of gestation and delivered three live infants through cesarean section at 33 +2 weeks due to premature rupture of membranes. One case with twin reversed arterial perfusion sequence at 17 weeks of gestation refused fetal reduction and gave birth to a child at 33 weeks when one fetus's heart stopped beating and one was acardia. (2) The first-trimester vacuum aspiration group and the second-trimester radiofrequency ablation group showed no significant differences in the average gestational weeks at the end of the pregnancy [(28.5±7.6) vs (28.9±10.4) weeks, t=1.145, P>0.05], or the rate of at least one (2/3 vs 3/5, Fisher's exact test, P>0.05) or two surviving children (2/3 vs 2/5, Fisher's exact test, P>0.05). No postoperative infection or amniotic fluid leakage was reported in the subgroups. Conclusions:The pregnancy outcome of MCTA triplet with fetal reduction is not different with expectant group.

Objective: To investigate knowledge, attitudes, and practice on exercise and dietary behaviors among the primary and middle school pupils in Shandong province, and to provide a theoretical basis for a targeted education on diet and physical health among the primary and middle school students. Methods: A questionnaire survey was conducted among 6 161 students from 3 cities in Shandong province by random cluster sampling. Results: Self-reported rate of having breakfast every day for primary and middle school students were 85.0% and 75.3% ,respectively(χ2=84.0，P<0.01). 41.2% of primary school students were reported to do physical exercises more than 60 minutes every day and the rate was only 29.6% for middle school students(χ2=270.0，P<0.01). 39.2% of boys were reported to do physical exercises more than 60 minutes every day and the rate was 28.7% for the girls(χ2=90.4，P<0.01). The awareness rates of knowledge about dietary and physical exercise among primary and middle school students were 44.4% and 55.8%, respectively(χ2=702.0，P<0.01). The awareness rates among boys and girls were 50.4% and 51.9% respectively (χ2=12.4，P<0.01). Parents’ occupation, knowledge score and education level of mother were influencing factors of breakfast behavior everyday. The physical exercise was influenced by gender, parents' occupation, knowledge score and education level of mother. Conclusion It is necessary to educate students to take healthy diet and have more physia1 activities. Families, schools and government departments need to take feasible measures to ensure the time and intensity of pupils’ physical exercise through many ways.

Objective: To investigate the associations between smoking and literacy on health among 4-6 grade primary school students. Methods: A questionnaire survey was conducted to research on health literacy and smoking among 4-6 grade pupils in Shandong province, through a multi-stage stratified cluster random sampling method. Sociodemographic characteristics, health literacy level and smoking rate were collected from respondents. Binary logistic regression analysis was used to evaluate the association of smoking and health literacy. Results: A total of 9 240 questionnaires were distributed, with the rate of valid response as 99.7%. The current smoking rate of the students was 2.6%, on higher in boys (3.1%) than in girls (2.0%). 60.8% of 4-6 grade students were found to have adequate health literacy level. Levels of literacy health in both boy and girl school students appeared 56.7% and 64.9%, respectively. Results indicated that health literacy in smokers (14.4%) was lower than that in non-smokers (62.0%). Results from the binary logistic regression analysis showed that the independent influencing factors would include grade, father’s education level, economic situation of the family, self-assessment on the school record and literacy on health (P<0.01). After controlling the other independent variables, the smoking rate was 8.62 (1/0.116) times in students with low literacy level on health, than those with high literacy level. Conclusions Literacy on health was significantly associated with smoking in the 4-6 grade pupils of Shandong province.

Objective To study the smoking status and influence of the families on pupils regarding smoking-related knowledge,attitudes and behavior,in Shandong province.Methods A multi-stage stratified-cluster random sampling method was used to investigate 6 050 students and their families in 3 different cities.A self-administered anonymous questionnaire survey was conducted by trained investigators.Results The overall passive smoking rate at households of the pupils was 49.7％ in Shandong province and appeared the highest in separate families,followed by in re-organized families and multiple-generation families under the same roofs.Major smokers in the families were fathers and grandfathers,with 43.4％ of the fathers and 74.0％ of the grandfathers had smoking histories for more than 10 years.The main smoking places at home were "elsewhere" or in the "living room".Attempting and current smoking rates of the families were 7.7％ and 1.7％ respectively,significantly higher than those families with no smokers.There was significant difference in smoking associated behavior and attitude between pupils whose family members with smoking habits or without.Conclusion The status of smoking in the families of the pupil' s family was not optimistic in Shandong province,especially in the families of the male students.Since smoking status of the families played an important role on their children,it is necessary to explore suitable health education model to improve the smoking associated behaviors in the families.

Objective To evaluate the serum levels of adiponectin(APN),B-type natri-uretic peptide(BNP),high sensitivity C-reactive protein (hs-CRP)and their clinical significance in patients with degenerative heart vascular disease (DHVD )according to different cardiac function classification.Methods According to New York Heart Association(NYHA),132 patients with DHVD were divided into NYHA class Ⅰ group(A group),NYHA class Ⅱ group (B group),NY-HA class Ⅲ group (C group),NYHA class Ⅳ group (D group).The serum levels of APN , BNP,hs-CRP were measured,left ventricular ejection fraction (LVEF)were determined by Doppler spectrum analysis.Results The serum levels of APN,BNP and hs-CRP levels signifi-cantly increased in patients with a higher class of NYHA (P <0.01).The serum APN,BNP and hs-CRPlevelswerenegativelycorrelatedwithLVEFinallpatients (r = -0 .3 6 ,P <0 .0 1 ;r =-0.42,P <0.01;r =-0.39,P <0.01).Conclusion The serum APN,BNP and hs-CRP levels are helpful in evaluating the changes in cardiac function of DHVD.

Objective To evaluate the serum levels of adiponectin(APN),B-type natri-uretic peptide(BNP),high sensitivity C-reactive protein (hs-CRP)and their clinical significance in patients with degenerative heart vascular disease (DHVD )according to different cardiac function classification.Methods According to New York Heart Association(NYHA),132 patients with DHVD were divided into NYHA class Ⅰ group(A group),NYHA class Ⅱ group (B group),NY-HA class Ⅲ group (C group),NYHA class Ⅳ group (D group).The serum levels of APN , BNP,hs-CRP were measured,left ventricular ejection fraction (LVEF)were determined by Doppler spectrum analysis.Results The serum levels of APN,BNP and hs-CRP levels signifi-cantly increased in patients with a higher class of NYHA (P <0.01).The serum APN,BNP and hs-CRPlevelswerenegativelycorrelatedwithLVEFinallpatients (r = -0 .3 6 ,P <0 .0 1 ;r =-0.42,P <0.01;r =-0.39,P <0.01).Conclusion The serum APN,BNP and hs-CRP levels are helpful in evaluating the changes in cardiac function of DHVD.

Objective:To understand the awareness, current or past behavior on electronic cigarette smoking (ECS) and associated factors, among adults aged ≥15 years old in Shandong province. Relationship between ECS and cessation of smoking was also studied.Methods:Using the global standard questionnaire, a cross-sectional survey was conducted among 6 401 adults selected by stratified multi-stage cluster sample method. Electronic data was collected by handheld computer. Data were weighted and analyzed by SPSS 19.0 complex program.Results:The prevalence rates of awareness, ever or current smoking of e-cigarettes appeared as 37.6 %, 3.8 % and 0.6 % respectively. Data from logistic regression analysis showed that risk factors for ECS were living in urban area, at younger age, being current or former cigarettes smoker and with knowledge on the risks of smoking or being encouraged to stop smoking. Among the electronic cigarettes smokers, those who tried to quit smoking (30.1 %) had a significantly higher rate than that of the non-smokers (19.5 %) ( P<0.05), however, the successful quitting rate was much lower than that in the non-ECS users ( P<0.05). Conclusions:Rates on the awareness and uptake of electronic cigarettes are on the rise. It is necessary to strengthen and standardize the monitoring programs to provide evidence for setting up targeting intervention strategies.

Objective:To understand the current status and its associated factors of dual use of e-cigarettes and cigarettes among adolescents in Shandong Province and explore the reasons for dual use behavior.Methods:A self-administered survey was conducted among 7 999 middle school students who were selected by stratified multi-stage cluster sample method. Data were weighted and analyzed by the SPSS 25.0 complex program.Results:In Shandong Province, the prevalence rates of attempting and current dual use of e-cigarettes and cigarettes among adolescents appeared as 7.7% and 1.3%, respectively. Male, friends smoking, and secondhand smoke exposure in the past 7 days were risk factors for dual use. Compared with cigarette smokers, dual users have no differences in cognition and behavior in quitting smoking ( P>0.05). The main reason for dual users to smoke e-cigarettes was curiosity. Conclusions:Dual use of e-cigarettes and cigarettes is common among adolescents in Shandong Province, and its influencing factors are similar to traditional cigarettes. Dual use is not a transitional stage for smoking cessation. Dual users are more likely to continue smoking in the future, which should be paid attention and concern.

Objective:To understand the status of tobacco use and related influencing factors in population in Shandong province.Methods:Stratified multi-stage cluster sampling was used to select respondents from 216 villages (communities) of 36 districts (counties) in Shandong province. Influencing factors on smoking were analyzed by logistic regression model.Results:The adequate sample size was 6 271 participants. After complex weighted, the current smoking prevalence was 23.93%,45.58% in males and 1.18% in females. The Public's smoking rates varied widely among different groups in the population. 45-64 age group had the highest smoking rate (25.07%). Smoking rates were substantially different in education levels, with the highest in junior high school (28.94%). The rate was higher in the rural area (24.98%) than that in the urban areas (23.08%). The average daily smoking rate was 20.23%. The average age of initiating smoking was 21.21 years. The average daily cigarette intake was 16.31 cigarettes. Among all the former and current smokers, the quitting rate was 20.79%. Multiple logistic regression model analysis showed that gender, age, occupation, region, and health knowledge score were correlated with smoking behavior. The current smoking rate of men was much higher than that of women ( OR=49.625, 95% CI: 37.832-65.093). The current smoking rate in 45-64 age group was higher than that in the 15-24 age group ( OR=1.830, 95% CI: 1.048-3.194). The current smoking rate of medical ( OR=0.403, 95% CI: 0.187-0.866) and retired personnel ( OR=0.648, 95% CI: 0.481-0.873) were lower than those engaging in agriculture, forestry, animal husbandry and the fishery ,respectively. The prevalence of residents living in the central part showed lower rate on current smoking than that in the eastern region ( OR=0.724, 95% CI: 0.606-0.865). The current smoking prevalence of smoke hazard in 1-3 score group was higher than that in the group with 4-6 score ( OR=1.432, 95% CI: 1.240-1.654). Conclusions:Smoking rate in adults in Shandong remained stable and at a high level. Comprehensive intervention measures such as tobacco control and health education should be carried out to reduce the smoking rate.