Relative Age Effects in Korean Football: Analysis of Age-Specific International Teams / 대한스포츠의학회지

PURPOSE: This study aimed to identify relative age effects of South Korea national male football teams that participated in 38 international competitions in age-specific categories from 2000 to 2018; U-16 (n=176), U-17 (n=82), U-19 (n=198), U-20 (n=147), and U-23 (n=166). METHODS: Available information on birth-dates, heights, and body weights of South Korean elite male football players was collected from the official websites. Chi-square test was conducted and odds ratios were calculated with 95% confidence interval in order to examine differences of quarter distribution between expected and observed subgroups. RESULTS: The birth distributions observed in each team were significantly different than those expected in general population of the same age (U-16: χ2=59.364, p<0.05; U-17: χ2=36.829, p<0.05; U-19: χ2=51.697, p<0.05; U-20: χ2=39.531, p<0.05) except U-23 (χ2=17.759, p=0.087). The magnitude of birth distribution was 3.2 times higher in the first quarter compared to that in the fourth quarter and was decreased in accordance with age. In accordance with age, the distribution of “competition age group” was significantly decreased in each team (U-16, 91%; U-17, 89%; U-19, 76%; U-20, 63%; U-23, 42%; p<0.05) but that of “under-competition age group” was increased (U-16, 9%; U-17, 1 1%; U-19, 2 4%; U-20, 37%; U-23, 5 8%; p <0.05). There is also significant difference in distribution between both “competition” and “under-competition age group” at the same tournament category (p<0.05). CONCLUSION: Conclusively, these findings indicate that Korean players who are in the early stage of development have higher “relative age effects” than those in the late stage of development. This may implicate that it is necessary to develop strategies for relatively late-mature players who have potentials in terms of skills and intelligence of football.

Effectiveness of Captopril for the Management of Autonomic Dysreflexia in Spinal Cord Injuries

OBJECTIVE: In this study, we evaluate the efficacy of captopril comparing with nifedipine for management of hypertensive urgencies in autonomic dysreflexia in patients with spinal cord injury (SCI). METHOD: Twenty-four patients with SCI above T6 were documented and treated with drug therapy in this study whose systolic blood pressure (SBP) was at or above 150 mmHg despite the use of nondrug management during an autonomic dysreflexia episode. They were divided into two groups; captopril group (n=12) and nifedipine group (n= 12). Captopril group was administered captopril 25 mg sublingually and nifedipine group was administered nifedipine 10 mg sublingually. Diastolic blood pressure(DBP), systolic blood pressure (SBP), heart rate and side effects were monitored after administration. RESULTS: Mean DBP and SBP at baseline and 15, 30, 60 minutes after captopril were significantly decreased (p<0.05). There were no significant side effects such as reactive hypotension. The administration of nifedipine also successfully reduced mean SBP and DBP after 15, 30, 60 minutes (p<0.05), but some side effects were reported such as reactive hypotension, tarchycardia and headache. CONCLUSION: For the management of hypertension in autonomic dysreflexia, captopril appears to be one of the safe and effective methods in patients with SCI.

The Significance of Posture on Assessment of Pulmonary Function after Pulmonary Rehabilitation in Tetraplegia

OBJECTIVE: In patients with cervical spinal cord injury (SCI), it is known that vital capacity of the supine position is larger than that of the sitting position, but after pulmonary rehabilitation treatment, the effect on assessment of vital capacity according to the posture is not yet clearly known. In this study, we evaluated the significance of posture on assessment of pulmonary function after pulmonary rehabilitation treatment in patients with cervical SCI. METHOD: Twenty-eight patients with cervical SCI were participated in this study. The pulmonary function was evaluated by measuring vital capacity (VC), tidal volume (TV), maximum insufflation capacity (MIC) and forced expiratory volume at the first second (FEV1) in both supine and sitting position, before and after the 4 weeks pulmonary rehabilitation treatment. The parameters of pulmonary function were analyzed and compared according to the posture. RESULTS: Before pulmonary rehabilitation treatment, VC, TV, MIC and FEV1 of the supine position were significantly larger than those of the sitting position (p0.05). CONCLUSION: For the proper assessment of the pulmonary function after pulmonary rehabilitation treatment in patients with cervical SCI, the significance of posture should be considered.

The Efficacy of Pulmonary Rehabilitation Using Mechanical In-Exsufflator in Cervical Cord Injured Patients

OBJECTIVE: It is known that Mechanical in-exsufflator (MI-E) can reduce pulmonary complications such as pneumonia, atelectasis in tetraplegia by increasing inspiratory and expiratory capacity. The aim of this study is to clarify the effectiveness of MI-E on pulmonary function and coughing capacity in tetraplegia. METHOD: Thirty tetraplegic patients who had neither history nor radiologic finding of pulmonary disease were divided into two groups; control (n=15) and experimental (n=15) groups. Control group received conventional pulmonary rehabilitation, while experimental group received additional MI-E therapy for one month. The pulmonary function was evaluated by measuring percentage of predicted value of vital capacity (% VC), maximal insufflation capacity (MIC), unassisted peak cough flow (UPCF), volume assisted peak cough flow (VPCF), manual assisted peak cough flow (MPCF), manual and volume assisted peak cough flow (MVPCF). These data of pulmonary function before and after treatment were compared between two groups. RESULTS: 1) There are significant improvement of pulmonary function in both groups (p<0.05) except UPCF in control group before and after treatment. 2) The experimental group showed more improvement in MIC, VPCF, MPCF and MVPCF than control group (p<0.05). Conclusion: MI-E therapy can be used as an effective therapeutic modality for the improvement of pulmonary function in combination with conventional pulmonary rehabilitation.

The Relationships of Coughing to the Respiratory Muscle Strength and Pulmonary Compliance in Tetraplegic Patients

OBJECTIVE: To analyze the factors influencing the capacity of cough, the relationships between maximal respiratory pressure, lung compliance, capacity of cough, and assisted cough techniques were evaluated in tetraplegics. METHOD: The vital capacity (VC) in seated and supine position, maximum insufflation capacity (MIC), maximum inspiratory (MIP) and expiratory (MEP) pressure in seated position were measured. Unassisted and assisted peak cough flow (PCF) at two different conditions (a volume assisted method by the mechanical insufflation [PCFmic] and the manual assistance by abdominal compression [MPCF]) were evaluated in 44 tetraplegic patients. RESULTS: The mean value of VC in supine was greater than that of seated position (p<0.01). The MICs of the subjects were significantly higher than VCs in a same position (<0.01). Both volume and manual assisted method showed significantly higher PCF than unassisted PCF (p<0.01). MIP (r=0.53) correlated with UPCF as well as MEP (r=0.68), although MEP was better correlated with UPCF. CONCLUSION: Generally the therapists apply manual pressure only to increase capacity of cough, which assist the expulsive phase. The results of this study showed that both inspiratory and expulsive phases should be assisted to enhance the effectiveness of cough.

Rehabilitation of the Bilateral Upper Extremity Amputees

Rehabilitation in patients with bilateral upper extremity amputation presents a considerable problem for prosthetic training. This is a report of a bilateral transhumeral amputee and a bilateral transradial amputee admitted for intensive prosthetic rehabilitation. They underwent bilateral upper extremity amputation due to electric burn. They were successfully fitted with conventional body-powered prostheses. The problems in rehabilitation of adult bilateral upper extremity amputees were discussed and the patients' compliance was assessed. In our two cases, good acceptance and functional benefit were noted. Thus, we suggest that multidisciplinary approach including prosthetists with full discussion should be a very important factor for specialized comprehensive prosthetic training of multiple complexed amputee.

The Clinical Usefulness of KCl Provocative Urodynamic Study in Spinal Cord Injured Patients with Neurogenic Bladder

OBJECTIVE: The purpose of this study was to determine the clinical usefulness of KCl provocative urodynamic study in spinal cord injured patients with neurogenic bladder. METHOD: Urodynamic studies using normal saline and 0.2 M KCl solution were performed on 46 spinal cord injured patients. The reflex volume was measured on urodynamic study using normal saline and 0.2 M KCl solution. If the reflex volume using KCl solution was smaller than 85% of reflex volume using normal saline, it was considered as positive response. Urine culture and urinalysis were also performed before urodynamic study. RESULTS: KCl provocative tests showed positive response in patients showing current infection on urine culture and urinalysis (p<0.05). Comparing with the positive response group and negative response group, mean maximal bladder capacity was smaller and mean bladder compliance was lower in the positive response group (p<0.05). No significant differences were found between positive and negative response groups according to age, duration since injury, completeness of injury, voiding methods, and anticholinergic medication. The mean reflex volume provoked by KCl solution was smaller and mean bladder compliance provoked by KCl solution was lower than those provoked by normal saline in the positive response group (p<0.01). CONCLUSION: The response of KCl provocative test suggested increased bladder-blood-urine barrier permeability by current urinary tract infection. We conclude that the KCl provocative urodynamic study is a useful method for detection of impaired bladder-blood-urine barrier in spinal cord injuries with neurogenic bladder.

Clinical Effectiveness of Intravesical Oxybutynin Instillation in Spinal Cord Injured Patients with Hyperreflexic or Hypertonic Neurogenic Bladder

OBJECTIVE: The purpose of this study was to evaluate the clinical effectiveness of intravesical oxybutynin chloride instillation in the management of neurogenic bladder dysfunction in spinal cord injured patients. METHOD: Fifty-two spinal cord injured patients with hyperreflexic or hypertonic neurogenic bladder were treated with intravesical oxybutynin instillation therapy. The purified oxybutynin chloride was dissolved in sterile water and mixed with normal saline. This oxybutynin solution was instilled twice a day for 7 days. The urodynamic studies were compared before and after the instillation. Total volume of daily incontinence was also monitored. RESULTS: After the intravesical oxybutynin instillations, mean maximal bladder capacity increased from 212.13 to 323.81 ml (p<0.01), mean bladder compliance increased from 11.73 to 18.56 ml/cmH2O (p<0.01), mean maximal detrusor pressure decreased from 67.19 to 50.90 cmH2O (p<0.01) and mean daily amount of incontinence decreased from 735.58 to 201.73 ml (p<0.01). No significant differences were found between the groups according to the level of injury, completeness of injury, duration since onset of injury and the presence of asymptomatic bacteriuria. CONCLUSION: This study proved that intravesical instillation of oxybutynin solution is an effective method in spinal cord injured patients with hyperreflexic or hypertonic neurogenic bladder dysfunction regardless the level and completeness of injury, as well as duration since the onset of injury or the presence of asymptomatic bacteriuria.

Ice Water Urodynamic Study in Neurogenic Bladder of Spinal Cord Injured Patients

OBJECTIVE: To determine the clinical utility of ice water test for the urodynamic study in neurogenic bladder of spinal cord injured patients. METHOD: Warm water (20~30oC) urodynamic studies were performed on 66 spinal cord injured patients. Subsequently, ice water (4~8oC) urodynamic studies were performed. We determined the ice water test to be positive if the reflex volume of ice water urodynamic study is lower than the volume of the warm water urodynamic study. RESULTS: Ice water test was positive in 24 (55.8%) and negative in 19 (44.2%) of the 43 patients showing hyperreflexic detrusor activity in warm water urodynamic study. Ice water test was negative in all 23 cases showing areflexic detrusor activity. No significant difference was found between positive and negative ice water test groups for the level of injury, sex, age, extent of injury and duration since injury. If water was cool enough, positivity of ice water test was not affected by infusion rate. There was no difference between the two urodynamic studies of maximal bladder pressure and compliance. CONCLUSION: This study suggests that ice water urodynamic study is a useful method for the evaluation of hyperreflexic neurogenic bladder activated by cold specific receptors via C afferent fibers in spinal cord injured patients.

The Clinical Effectiveness of Serial Radioisotope Renography in Evaluation of Renal Function Changes in Spinal Cord Injured Patients

OBJECTIVE: The purposes of our study were to determine the effect of serial radioisotope renography on the diagnostic evaluation and therapeutic intervention of spinal cord injured patients and to determine the characteristics of renographic findings in spinal cord injured patients. METHOD: Three hundred and two spinal cord injured patients were examined with radioisotope renography using Technetium-99m mercaptoacetyltriglycine. Forty-two of 302 patients were examined in serial studies. Intravenous pyelogram, urodynamic study, 24-hour creatinine clearance, and voiding cystourethrogram were also performed. Radioisotope renography was correlated with diagnostic procedures and therapeutic interventions. Therapeutic interventions included changes in medication and bladder management. RESULTS: The renal functions in the left kidney were better than the functions in the right kidney after spinal cord injury (p<0.01). If neurogenic bladders were managed properly, renal functions improved after the shock stage of injury (p<0.05). Patients with significant improvement in their renal function underwent changes in proper medication and methods of bladder management (p<0.05). Renal function changes were correlated with the type of neurogenic bladder and maximal detrusor pressure (p<0.05). No significant renal function changes were found between the groups according to the completeness of injury and gender. CONCLUSION: Radioisotope renography is a good initial indicator to show problems that required management changes. Serial radioisotope renographic findings give valuable informations about the urinary tract in spinal cord injured patients.