Objective To evaluate the levels of plasma coupling factor 6(CF6) and cytochrome C(Cyt-c) in neonatal sepsis,and to explore the clinical significance in neonatal sepsis.Methods A total of 88 neonates admitted to Hunan Children's Hospital from January 2015 to April 2015 were collected.Neonates were divided into non-sepsis group(n=42) and sepsis group(n=46).According to the severity of infection,the non-sepsis group was further divided into non-infection group(n=20) and common infection group(n=22);the sepsis group was further divided into general sepsis group (31 cases,no organ failure) and severe sepsis group (15 cases,combined with multiple organ failure).Femoral venous blood was collected in all patients before the use of antibiotics after admission.The levels of Cyt-c and CF6 in plasma were measured by ELISA,and the levels of C-reactive protein(CRP),procalcitonin (PCT) were measured.The changes of CF6 and Cyt-c between these groups were compared,and the sensitivity and specificity with the traditional sepsis index (CRP,PCT) were analyzed.The correlation between the levels of CF6,Cyt-c and neonatal critical illness score was analyzed.Results (1)In sepsis group,the levels of CF6 and Cyt-c[(109.7±8.9)pg/ml and (44.5±4.9)ng/ml] were significantly higher than those in the non-sepsis group[(46.3±6.0)pg/ml,(31.8±6.7)ng/ml,P<0.01,respectively].(2) In the non-infection group,common infection group,general sepsis group and severe sepsis group,the levels of CF6 were (32.1±8.9)pg/ml,(59.3±7.2)pg/ml,(79.3±5.9)pg/ml,and (172.6±6.1)pg/ml,respectively;the levels of Cyt-c were (29.3±8.6)ng/ml,(35.4±4.1) ng/ml,(43.1±5.9) ng/ml,and (44.5±5.9)ng/ml,respectively.The differences between these groups were significant(P<0.01).(3)The receiver operating characteristic curve showed that the sensitivity and specificity of CF6 were 0.761,0.732,and the Cyt-c were 0.739,0.714.(4)Cyt-C and CF6 were negatively correlated with the neonatal critical illness score(r=-0.599,P<0.001;r=-0.337,P<0.01).Conclusion The levels of CF6 and Cyt-c increase in neonatal sepsis.The damage of mitochondria may be one of the pathological mechanisms in neonatal sepsis.The levels of CF6 and Cyt-c were closely related to the severity of neonatal sepsis.

Tripterygium wilfordii is a traditional Chinese medicinal herb belonging to the genus Tripterygium in the Celastraceae family， which has the effects of clearing heat and detoxifying， dispelling wind and dampness， and invigorating blood circulation to relieve pain， and is used to treat diseases such as rheumatoid arthritis， glomerulonephritis， nephrotic syndrome， lupus erythematosus， scabies， and stubborn tinea. Its chemical composition is diverse. Among them， triptolide（TP） is one of the main active and toxic components of T. wilfordii. It has significant biological activities such as anti-inflammation， anti-tumor， and immunosuppression. However， it causes serious adverse reactions such as liver and kidney function damage and reproductive system disorders. At the same time， TP has poor water solubility and low bioavailability， and the enhancement of bioavailability by increasing the dosage undoubtedly improves the exposure of the drug in non-target organs， leading to the occurrence of adverse reactions， and these largely limit the clinical application of TP. Based on this， this article extracted relevant data from the Web of Science， PubMed， and China National Knowledge Infrastructure（CNKI） databases， summarized the research on the adverse reactions of TP in recent years， and reviewed the progress of toxicity reduction research from the perspectives of structural modification， novel drug delivery systems， and compatibility. Structural modification can precisely alter the chemical structure of TP， reduce the activity of its toxic groups， and retain its biological activity while fundamentally reducing the occurrence of adverse reactions. New drug delivery systems can achieve targeted delivery of TP， increase its concentration in target organs， and reduce its exposure in non-target organs， thereby enhancing therapeutic efficacy and reducing adverse effects. In addition， the combination of TP with Chinese medicine compound， single-flavored Chinese medicine or monomer can reduce the adverse effects of TP and enhance the efficacy to different degrees， which is of clinical value. This paper systematically explains attenuation research from the above three perspectives， aiming to provide a theoretical basis for the full utilization of biological activity and drug development of TP.

Objective: To explore the clinical features, the serotype distribution and drug resistance of the isolates in patient with invasive pneumococcal disease (IPD). Methods: By retrieving the laboratory information system in 18 children′s hospitals from 2012 to 2017, the children with IPD were enrolled. Streptococcus pneumoniae (Spn) must be isolated from the sterile sites (blood, cerebrospinal fluid, hydrothorax and joint effusion etc.). The clinical characteristics, serotype, drug resistance, treatment and prognosis were reviewed and analyzed. According to the telephone follow up results, the patients were divided into death group and recovered group. The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis. Results: There were 1 138 children with IPD, including 684 male and 454 female. The proportion of male to female was 1.5∶1. The age ranged from one day to 16 years. The median age was 1 year 3 month. The majority was under 5 years of age (89.3%, n= 1 016), especially under 2 years of age (61.9%, n=704). In all cases, 88.2% (n=1 004) were community acquired infection. The infections included meningitis (n=446, 39.2%), pneumonia with bacteremia (n=339, 29.8%), and bacteremia without focus (n=232, 20.4%). Underlying diseases were found in 242 cases (21.3%). Co-infections were determined in 62 cases (5.4%) with mycoplasma, 27 cases (2.4%) with adenovirus and 34 cases with influenza virus (3.0%). The penicillin insensitivity (PNSP) rates in meningitis and non-meningitis isolates were 69.5% (276/397) and 35.9% (221/615), respectively. There were 81 strains serotyped, in which 93.8% (76/81) were covered by 13-valent protein-polysaccharide conjugate vaccine (PCV13). In the 965 patients who were followed up by phone call, 156 cases (16.2%) were confirmed dead. The independent risk factors for the death were under 2 years of age (OR=2.143, 95%CI 1.284-3.577, P=0.004), meningitis (OR=3.066, 95%CI 1.852-5.074, P<0.01), underlying disease (OR=4.801, 95%CI 2.953-7.804, P<0.01), septic shock(OR=3.542, 95%CI 1.829-6.859, P<0.01), disseminated intravascular coagulation (DIC) (OR=4.150, 95%CI 1.468-11.733, P=0.007), multiple organ failure (OR=12.693, 95%CI 6.623-24.325, P<0.01) and complications of central nervous system (OR=1.975, 95%CI 1.144-3.410, P=0.015). Conclusions Most children with IPD were under 5 years of age, having underlying diseases and acquired the infection in community. The independent risk factors for death were under two years old, meningitis, underlying diseases and multiple organ failure. The problem of drug resistance was severe. The universal immunization of PCV13 would be effective to prevent IPD in Chinese children.