Acute lateral ankle sprain (ALAS) is one of the most common sport injuries, with high incidence, recurrence and disability rates. Currently, exercise rehabilitation-based non-surgical treatment is the primary management approach for ALAS. However, there remain improper practices such as excessive immobilization or uncontrolled activity, which contribute to recurrent sprains and chronic ankle instability, significantly impairing patients′ athletic function and quality of life. To standardize the non-surgical management of ALAS, improve the cure rates, and reduce the recurrence and disability rates, Chinese Sports Rehabilitation Medicine Training Project of Chinese Medical Association, Foot and Ankle Basics and Orthopedics Group, Orthopedic Branch of Chinese Medical Doctor Association, and Sports Medicine Branch of Jiangsu Medical Association organized relevant experts to formulate Expert consensus on non-surgical treatment for acute lateral ankle sprain ( version 2025), following the principles of scientific vigor, practicality, and innovation. Thirteen recommendations were proposed for standardized treatment protocols across different healing phases, aiming to provide references for standard management of ALAS and improve the therapeutic outcomes.

Acute lateral ankle sprain (ALAS) is one of the most common sport injuries, with high incidence, recurrence and disability rates. Currently, exercise rehabilitation-based non-surgical treatment is the primary management approach for ALAS. However, there remain improper practices such as excessive immobilization or uncontrolled activity, which contribute to recurrent sprains and chronic ankle instability, significantly impairing patients′ athletic function and quality of life. To standardize the non-surgical management of ALAS, improve the cure rates, and reduce the recurrence and disability rates, Chinese Sports Rehabilitation Medicine Training Project of Chinese Medical Association, Foot and Ankle Basics and Orthopedics Group, Orthopedic Branch of Chinese Medical Doctor Association, and Sports Medicine Branch of Jiangsu Medical Association organized relevant experts to formulate Expert consensus on non-surgical treatment for acute lateral ankle sprain ( version 2025), following the principles of scientific vigor, practicality, and innovation. Thirteen recommendations were proposed for standardized treatment protocols across different healing phases, aiming to provide references for standard management of ALAS and improve the therapeutic outcomes.

Objective:To explore the inhaled allergen sensitization status of children with allergic rhinitis in Beijing City, and to provide evidence for diagnosis and treatment, allergen avoidance and disease management.Methods:In this cross-sectional study, data from 8 741 children with allergic rhinitis treated in Children′s Hospital affiliated to Capital Institute of Pediatrics from January 2020 to December 2021 were retrospectively analyzed. The subjects were divided into toddlers (1 y-≤3 y), preschool children (3 y-≤6 y), school aged children (6 y-≤12 y) and adolescents (12 y-≤18 y) and according to season the subjects were divided 4 groups: spring, summer, autumn, winter. The ImmunoCAP system was used to detect serum allergens sIgE.Results:The positive rates of inhaled allergens among subjects in sequence from high to low were: mx2 [molds (penicillium speciosum/mycosporum multiflorum/aspergillus fumigatus/alternatia/demodex longum)], w6 (artemisiaargyi), wx5[weeds pollen combination (ragweed/artemisia argyi/marguerite/dandelion/goldenrod)], w1(ragweed), tx5[trees pollen combination (populus tomentosa/hazel/elm/willow)], d2(dermatophagoides farina), d1(dermatophagoides pteronyssinus), ex1[animal dander combination (catdander/dogdander/horsedander/cowdander)], i6(blattella germanica). Boys have higher positive rates of sIgE responses than girls (54.20% vs. 47.96%, χ 2= 8 923.000, P<0. 001). The primacy inhaled allergen in toddlers, preschool children and school aged children was mx2 (37.75%, 39.99% and 42.46%), and in adolescents w6 (45.45%), d2 (41.51%) and d1 (37.74%) were the largest categories. Except for mold, the positive detection rate of inhaled allergens increased gradually with age. In different seasons, the positive rates of ex1 (24.77% vs. 18.26% vs. 17.10% vs. 12.39%, χ 2= 31.469, P<0.001), wx5 (20.18% vs. 28.62% vs. 39.96% vs. 12.53%, χ 2= 155.788, P<0.001), mx2 (31.79% vs. 50.96% vs. 36.99 vs. 28.81, χ 2= 208.444, P<0.001), tx5 (28.14% vs. 27.01% vs. 26.77% vs. 9.64%, χ 2= 60.613, P<0.001) and w6 (26.57% vs. 34.39% vs. 52.11% vs. 25.35%, χ 2= 17.710, P<0.001) were statistically different among groups. Mx2 in spring and summer was the highest categories (31.79%, 50.96%), and w6 in autumn was the highest (52.11%). Conclusions:In this study, mx2 was the most important allergen in children (≤12 y) and w6 was the highest in adolescents treated in Children′s Hospital affiliated to Capital Institute of Pediatrics from January 2020 to December 2021 in Beijing City. The types of allergens and positivity rates were different for different sexes, ages and seasons.

Objective:To explore the inhaled allergen sensitization status of children with allergic rhinitis in Beijing City, and to provide evidence for diagnosis and treatment, allergen avoidance and disease management.Methods:In this cross-sectional study, data from 8 741 children with allergic rhinitis treated in Children′s Hospital affiliated to Capital Institute of Pediatrics from January 2020 to December 2021 were retrospectively analyzed. The subjects were divided into toddlers (1 y-≤3 y), preschool children (3 y-≤6 y), school aged children (6 y-≤12 y) and adolescents (12 y-≤18 y) and according to season the subjects were divided 4 groups: spring, summer, autumn, winter. The ImmunoCAP system was used to detect serum allergens sIgE.Results:The positive rates of inhaled allergens among subjects in sequence from high to low were: mx2 [molds (penicillium speciosum/mycosporum multiflorum/aspergillus fumigatus/alternatia/demodex longum)], w6 (artemisiaargyi), wx5[weeds pollen combination (ragweed/artemisia argyi/marguerite/dandelion/goldenrod)], w1(ragweed), tx5[trees pollen combination (populus tomentosa/hazel/elm/willow)], d2(dermatophagoides farina), d1(dermatophagoides pteronyssinus), ex1[animal dander combination (catdander/dogdander/horsedander/cowdander)], i6(blattella germanica). Boys have higher positive rates of sIgE responses than girls (54.20% vs. 47.96%, χ 2= 8 923.000, P<0. 001). The primacy inhaled allergen in toddlers, preschool children and school aged children was mx2 (37.75%, 39.99% and 42.46%), and in adolescents w6 (45.45%), d2 (41.51%) and d1 (37.74%) were the largest categories. Except for mold, the positive detection rate of inhaled allergens increased gradually with age. In different seasons, the positive rates of ex1 (24.77% vs. 18.26% vs. 17.10% vs. 12.39%, χ 2= 31.469, P<0.001), wx5 (20.18% vs. 28.62% vs. 39.96% vs. 12.53%, χ 2= 155.788, P<0.001), mx2 (31.79% vs. 50.96% vs. 36.99 vs. 28.81, χ 2= 208.444, P<0.001), tx5 (28.14% vs. 27.01% vs. 26.77% vs. 9.64%, χ 2= 60.613, P<0.001) and w6 (26.57% vs. 34.39% vs. 52.11% vs. 25.35%, χ 2= 17.710, P<0.001) were statistically different among groups. Mx2 in spring and summer was the highest categories (31.79%, 50.96%), and w6 in autumn was the highest (52.11%). Conclusions:In this study, mx2 was the most important allergen in children (≤12 y) and w6 was the highest in adolescents treated in Children′s Hospital affiliated to Capital Institute of Pediatrics from January 2020 to December 2021 in Beijing City. The types of allergens and positivity rates were different for different sexes, ages and seasons.

Objective:To evaluate the differential expression of blood routine in different types of infection and the diagnostic value of C-reactive protein (CRP), procalcitonin (PT), ferritin (SF) and lactate dehydrogenase (LDH) in bacterial and mycoplasma pneumonia and their early warning value in severe cases.Method:A total of 627 patients, including 176 cases of bacterial pneumonia, 275 cases of mycoplasma pneumonia, 176 cases of viral infection and 180 cases of normal control were collected from May 2018 to December 2019 in children′s Hospital Affiliated to Capital Institute of Pediatrics. The mycoplasma pneumonia group was divided into mild group (151 cases) and severe group (124 cases) according to the results of lavage fluid RNA-examination. All patients received completed blood routine test at the first day of admission, patients in bacteria group and Mycoplasma group received the examination of four inflammatory indicators. The Kruskal-Wallis test was used to analyze the differences in blood routine results between different infection groups, and the differences of inflammatory indexes between bacterial group and Mycoplasma mild and severe group. The receiver operating characteristic (ROC)-curve method was used to analyze the predictive value of inflammatory indexes between different infection groups.Results:There were significant differences in leukocyte count, neutrophil, lymphocyte and monocyte percentage between bacterial pneumonia, mycoplasma pneumonia, viral infection and normal control group ( P<0.05). The differences of four inflammatory indexes in bacterial group, mild Mycoplasma group and severe group were statistically significant ( P<0.05). The rest of the index (CRP, PCT, LDH, SF and white blood cell count) were P<0.05 (CRP: area under curve [AUC] 0.799; PCT: AUC 0.579; LDH: AUC 0.651; SF: AUC 0.854), in mild and severe mycoplasma group, except WBC, by ROC-curves analysis. The AUC value of the area under the curve of CRP and SF is high, and the sensitivity and specificity at the diagnostic critical point are high, which has great diagnostic value (CRP: diagnostic critical point 12.55 mg/L, sensitivity 0.719, specificity 0.755; SF: diagnostic critical point 176.02 μg/L, sensitivity 0.765, specificity 0.960). ROC curve results also showed that of PCT, White blood cell and neutrophil percentage had the diagnostic value in bacterial infection and mycoplasma infection, P<0.05 (PCT: AUC 0.658; leukocyte: AUC 0.804; neutrophil: AUC 0.630). Leukocyte count is the best differential index (diagnostic critical point 9.585×10 9/L, sensitivity 0.778, specificity 0.698), PCT has higher sensitivity at the diagnostic critical point of 0.55 μg/L, but the specificity is slightly lower (diagnostic critical point of 0.55 μg/L, sensitivity 0.862, specificity 0.366). Conclusions:PCT and leukocyte count can be used as the preferred inflammatory indexes to distinguish bacterial and mycoplasma infection. CRP, LDH, PCT and SF can be used as early warning indexes to evaluate severe mycoplasma infection.

Objective: To understand the epidemiological and etiological characteristics of enterovirus (EV)-associated diseases among children in Beijing from 2010 to 2016. Methods: This was a repeated cross-sectional study. The throat swabs were collected from children with probable EV-associated diseases at the Children' s Hospital Affiliated to Capital Institute of Pediatrics from 2010 to 2016. The samples were sent for pan-EV, enterovirus 71 (EV-A71) and coxsackievirus A16 (CV-A16) detection by real-time fluorescence reverse transcription polymerase chain reaction (RT-PCR) . The viral types of non-EV-A71 and non-CV-A16 EV-positive samples were identified using modified RT-PCR and sequencing with CV-A6, EV-A/B group and 5 'UTR universal primers. The constituent ratios of the prevalence of different EV types in different age and gender groups were compared. Results: Of the 2 703 throat swabs, 1 992 (73.7%) samples were positive for EV, including EV-A71 (19.1%, 516/2 703), CV-A16 (24.3%, 658/2 703), CV-A6 (22.2%, 600/2 703), CV-A10 (4.5%, 122/2 703) and other types of EV (3.5%, 95/2 703). There was 1 case of EV-A71 and CV-A16 co-infection. The positive detection rate of EV-A group (excluding EV-A71, CV-A16, CV-A6 and CV-A10) increased from 11.3% (7/62) to 95.2% (59/62) after using the modified VP1-specific primers and PCR amplification conditions. During the period between 2010 and 2012, CV-A16 and EV-A71 predominated in EV-positive samples. However, CV-A6 accounted for 60.7% (68/112) in 2013, much higher than CV-A16 (23.2%, 26/112) and EV-A71 (12.5%, 14/112). In 2014, EVs were mainly of CV-A16 and EV-A71, but CV-A6 was the predominant type in 2015 (68.2%, 232/340) and in 2016 (38.6%, 151/391). The epidemic season of EVs was mostly from April to August, but CV-A6 showed a small epidemic peak from October to November. The male-to-female ratio of EV-positive patients was 1.50∶1, and EV-associated diseases mostly occurred in children under 5 years of age. Younger children were more susceptible to CV-A6 than to EV-A71 and CV-A16. Conclusions From 2010 to 2016, there was a significant change in the spectrum of EVs in children with EV-associated diseases in Beijing. Since 2013, non-EV-A71 and non-CV-A16 increased, and CV-A6 gradually became one of the major pathogens of EV-associated diseases. The modified PCR primers and amplification conditions can effectively improve the reliability of test results.

OBJECTIVETo analyze the genotype, epidemic pattern and the characteristics of the disease of enteroviruses during the epidemic season of hand, foot and mouth disease (HMFD) in children from 2013 to 2014 in Beijing to provide the scientific evidence for prevention and treatment of HFMD.

METHODDuring April to September in 2013 and March to October in 2014, a total of 977 throat swabs were collected from children who visited the Children's Hospital Affiliated to Capital Institute of Pediatrics, including 147 from patients with HFMD in 2013, 343 with HFMD, 201 with atypical HFMD, 83 with herpangina, 25 with fever with convulsions, 64 fever with rash and 114 with rash in 2014. Enteroviruses universal type (EV), Enteroviruses type 71 (EV71) and Coxsackievirus group A 16 (CA16) were detected by real-time RT-PCR respectively. The nucleic acid of specimens which were identified with non-EV71, non-CA16 was tested by nested PCR and analyzed by VP1 sequencing. The detection rate and epidemic pattern of different genotypes of enterovirus were analyzed among different age groups and between 2013 and 2014.

RESULTOf 977 throat swabs, 80. 1% samples were detected positive for enteroviruses. The positive rates of CA16, EV71, CA6, CA10, CA4 and other EVs were 25. 6% (250/977), 18. 9% (185/977), 20. 0% (195/977), 5. 0% (49/977), 1.5% (15/977) and 9.1% (89/977), respectively. Twenty six of the 89 other EVs included CA2, CA5, CA8, CA9, CA12, CA14, CB2, CB5, E6, E9 and E25, each genotype of which was no more than 3. The nucleotide homologies shared among CA6, CA10 and CA4 strains between 2013 and 2014 were 94. 3% - 100%, 93. 8% - 99. 1% and 92.7% - 99. 8%, respectively. The positive rates of ≤1 year group were 71. 1% (106/149), which was lower than that of other age groups (all P <0. 05), but similar to that of >5 year group (χ2 =1. 181,P = 0. 277). In 2013, the positive rate of EV was 85. 7% (126/147) and the predominant genotype was CA6 54. 8% (69/126), followed by CA16 20. 6% (26/126) and EV71 11. 9% (15/126). In 2014, the positive rate of EV was 85. 4% (293/343) in the 343 children with HFMD, the predominant genotypes were CA16 with the positive rate of 42. 7% (125/293), EV71 with 38. 2% (112/293) and CA6 with only 11. 3% (33/293). In 2014, the positive rates of EV in 201 atypical HFMD, 83 herpangina, 25 fever with convulsions, 64 fever with rash and 114 rash were 83. 6% (168/201), 80. 7% (67/83), 76. 0% (19/25), 64. 1% (41/64) and 60. 5% (69/114), respectively. All genotypes of enteroviruses peaked mainly during May to August every year, but there were no obvious epidemiological pattern about each genotype.

CONCLUSIONCA6 became the main causative agent of HFMD in 2013, however, CA16 and EV71 predominated again in 2014 in Beijing. The clinical manifestations caused by CA6, CA10, CA4 and other genotype of enteroviruses differed from EV71 and CA16. Besides EV71 and CA16, more attention should be paid to CA6, CA10, CA4 and other type of enteroviruses.

Beijing ; epidemiology ; Child, Preschool ; Enterovirus A, Human ; classification ; Enterovirus Infections ; epidemiology ; virology ; Exanthema ; Fever ; Genotype ; Hand, Foot and Mouth Disease ; epidemiology ; virology ; Humans ; Infant ; Real-Time Polymerase Chain Reaction

OBJECTIVEHuman parechovirus (HPeV) is a single-stranded, positive sense RNA virus in the Parechovirus genus within the large family of Picornaviridae. As a possible new pathogen of neonatal sepsis, meningoencephalitis and other infections in young children, HPeV gets more and more attention. This study aimed to better understand the association of HPeV with central nervous system (CNS) infectious diseases and sepsis among hospitalized children in Beijing.

METHODA total of 577 cerebrospinal fluid (CSF) samples were retrospectively collected from 557 children suspected of CNS infections in 2012. Three hundred and fifty-one of them were male and 206 were female. HPeV was screened by reverse transcription-nested PCR (RT-nPCR) with the universal primers which target the highly conserved 5'UTR. The positive samples were genotyped by amplifying and sequencing for the VP3/VP1 junction region. The sequences were compared with the HPeV sequences from GenBank and performed phylogenetic analysis.Some samples other than CSF from HPeV positive children, including serum, nasopharyngeal aspirate and stool, were collected and carried out screening for HPeV.

RESULTWith the RT-nPCR by universal primers, HPeVs were detected in 18 out of 577 CSF samples obtained from 18 children with a positive rate of 3.1%. The ratio of male and female was 2: 1. There were no statistically significant differences on infection rate between boys (12/351, 3.4%) and girls (6/206, 2.9%). All of 18 positive CSF samples were negative for enterovirus, Epstein-Barr virus (EBV), human cytomegalovirus (HCMV), and herpes simplex virus 1 and 2 (HSV).HPeVs from 10 positive CSF samples were genotyped successfully, consisting of 7 HPeV3 and 3 HPeV1. In addition, 2 of 8 serum samples were positive for HPeV3 and 1 of 2 stool samples were positive for HPeV 1. HPeVs were identified in CSF from children aged from 15 days to 14 years, in which 7 cases were infants younger than 3 months and 5 cases were infants from 3 months to one year. Three children older than the age of 9 years (9, 13 and 14 years) were positive for HPeV. Most of the children (6/8) infected with HPeV3 were younger than 3 months and were diagnosed as sepsis, while the rest of HPeV3 positive children were diagnosed as meningitis and bronchopneumonia. HPeV3 infection clustered in August, while HPeV1 in January.

CONCLUSIONHPeVs were associated with CNS infections and sepsis in hospitalized children in Beijing, especially in children younger than one year.HPeV3 was the predominant type identified in CSF.

Adolescent ; Age Distribution ; Central Nervous System Infections ; cerebrospinal fluid ; epidemiology ; virology ; Cerebrospinal Fluid ; virology ; Child ; Child, Hospitalized ; Child, Preschool ; Female ; Genotype ; Humans ; Infant ; Infant, Newborn ; Male ; Parechovirus ; classification ; genetics ; isolation & purification ; Picornaviridae Infections ; cerebrospinal fluid ; epidemiology ; virology ; RNA, Viral ; genetics ; Retrospective Studies ; Reverse Transcriptase Polymerase Chain Reaction ; Seasons ; Sepsis ; cerebrospinal fluid ; epidemiology ; virology ; Sequence Analysis, DNA

BACKGROUNDAcute respiratory infection (ARI) is one of the most common infectious diseases in infants and young children globally. This study aimed to determine the virus profile in children with ARI presenting with different severities.

METHODSClinical specimens collected from children with ARI in Beijing from September 2010 to March 2011 were investigated for 18 respiratory viruses using an xTAG Respiratory Viral Panel Fast (RVP Fast) assay. The Pearson chi-square analysis was used to identify statistical significance.

RESULTSOf 270 cases from three groups of ARI patients, including Out-patients, In-patients and patients in the intensive care unit (ICU), viruses were detected in 176 (65.2%) specimens with the RVP Fast assay. The viral detection rate from the Out-patients group (50.0%) was significantly lower than that from the In-patients (71.1%) and ICU-patients (74.4%) groups. The virus distribution was different between the Out-patients group and the other hospitalized groups, while the virus detection rate and distribution characteristics were similar between the In-patients and ICU-patients groups. The co-infection rates of the Out-patients group, the In-patients group, and the ICU-patients group were 15.6%, 50.0% and 35.8%, respectively. In addition to respiratory syncytial virus (RSV) and adenovirus (ADV), human rhinovirus (HRV) was frequently detected from children with serious illnesses, followed by human metapneumovirus (hMPV), human bocavirus (HBoV) and coronaviruses. Parainfluenza virus 3 (PIV3) was detected in children with lower respiratory illness, but rarely from those with serious illnesses in the ICU-patient group.

CONCLUSIONIn addition to so-called common respiratory viruses, virus detection in children with ARI should include those thought to be uncommon respiratory viruses, especially when there are severe ARI-related clinical illnesses.

Antigens, Viral ; analysis ; Beijing ; Child ; Child, Preschool ; China ; DNA, Viral ; genetics ; Female ; Humans ; Infant ; Infant, Newborn ; Influenza A virus ; genetics ; pathogenicity ; Male ; RNA, Viral ; genetics ; Respiratory Tract Infections ; diagnosis ; virology ; Rhinovirus ; genetics ; pathogenicity

Background Acute respiratory infection (ARI) is one of the most common infectious diseases in infants and young children globally.This study aimed to determine the virus profile in children with ARI presenting with different severities.Methods Clinical specimens collected from children with ARI in Beijing from September 2010 to March 2011 were investigated for 18 respiratory viruses using an xTAG Respiratory Viral Panel Fast (RVP Fast) assay.The Pearson chisquare analysis was used to identify statistical significance.Results Of 270 cases from three groups of ARI patients,including Out-patients,In-patients and patients in the intensive care unit (ICU),viruses were detected in 176 (65.2％) specimens with the RVP Fast assay.The viral detection rate from the Out-patients group (50.0％) was significantly lower than that from the In-patients (71.1％) and ICU-patients (74.4％) groups.The virus distribution was different between the Out-patients group and the other hospitalized groups,while the virus detection rate and distribution characteristics were similar between the In-patients and ICU-patients groups.The coinfection rates of the Out-patients group,the In-patients group,and the ICU-patients group were 15.6％,50.0％ and 35.8％,respectively.In addition to respiratory syncytial virus (RSV) and adenovirus (ADV),human rhinovirus (HRV) was frequently detected from children with serious illnesses,followed by human metapneumovirus (hMPV),human bocavirus (HBoV) and coronaviruses.Parainfluenza virus 3 (PIV3) was detected in children with lower respiratory illness,but rarely from those with serious illnesses in the ICU-patient group.Conclusion In addition to so-called common respiratory viruses,virus detection in children with ARI should include those thoucht to be uncommon respiratory viruses,especially when there are severe ARI-related clinical illnesses.