Weekly Programming of Hamstring-Related Training Contents in European Professional Soccer.

Hamstring injuries in soccer continue to be a challenge for professionals who work with soccer players daily. Although its origin is multifactorial, the proper management of neuromuscular fatigue during the training microcycle is a very important factor to consider. There are no clear guidelines regarding the weekly distribution of certain exercises that demand the hamstrings. The main objective of this study was to describe the usual training practices of professional European soccer teams. An international observational survey design was applied to some of the strength and conditioning coaches of professional soccer teams. The survey included different neuromuscular demanding exercises for the hamstrings. For each exercise, the strength and conditioning coaches had to respond in relation to their frequency of use and timepoint depending on the day of the weekly microcycle. Although there is no strong consensus in this regard, there does seem to be a trend when applying certain exercises, especially on the days matchday-4 and matchday-3.

Tier-specific contextualised high-intensity running profiles in the English Premier League: more on-ball movement at the top.

The present study aimed to determine the physical-tactical profiles of elite football teams and individual players according to final league rankings. A total of 50 English Premier League matches (n = 100 match and 583 player observations) were analysed by coding the player's physical-tactical actions through synchronising tracking data and video. Final league rankings were categorised into Tiers: (A) 1st-5th ranking (n = 25), (B) 6th-10th ranking (n = 26), (C) 11th-15th ranking (n = 26), and (D) 16th-20th ranking (n = 23). One-way analyses of variance were used to compare match performances between different Tiers, and effect size (ES) was determined for the meaningfulness of the difference. Tier A teams covered 39-51% more high-intensity distance for 'Move to Receive/Exploit Space' (ES: 1.3-1.6, P < 0.01) and 'Run with Ball' (ES: 0.9-1.0, P < 0.05) than Tier C and D, and 23-94% more distance for 'Over/Underlap' (ES: 1.0, P < 0.01), 'Run in Behind/Penetrate' (ES: 0.7, P < 0.05), and 'Break into Box' (ES: 0.9, P < 0.05) compared to Tier C. Central and Wide Defensive Players in Tier A covered 65-551% more high-intensity 'Move to Receive/Exploit Space' distance compared to other Tiers (ES: 0.6-1.0, P < 0.01). Moreover, the additional options within the physical-tactical actions and zonal differences unveiled more meaningful insights into 'HOW' the top Tier teams physically and tactically perform. Thus, the amalgamated physical-tactical data help improve our understanding of a team's playing style relative to their competitive standard.

Contextualised peak periods of play in English Premier League matches.

The present study aimed to determine the physical-tactical trends of elite players/teams during peak 1-, 3- and 5-min periods of match-play. A total of 50 English Premier League matches (n = 583 player observations) were analysed by coding the players' physical-tactical activities through the synchronisation of tracking data and video. The contextualised data showed that during the peak periods (i.e., the most demanding passage of play), players/teams covered the largest distances for 'Recovery Run' (28-37%) out of possession and 'Support Play' (9-13%) in possession. In the following periods, players covered less high-intensity distance versus the average with a more pronounced decline in the next 1-min period than longer duration 3- and 5-min periods (48% vs ~25-30%, ES: 0.4-0.5, P < 0.01); team data showed similar trends with different relative patterns (31% vs 17-30%, ES: 0.5-0.8, P < 0.01). After peak periods, players/teams performed 20-53% less high-intensity distances for 'Covering' and 'Recovery Run' (ES: 0.2-0.7, P < 0.01) out of possession. However, players covered 28-91% less distance for 'Run with Ball' (ES: 0.1-0.5, P < 0.05) when in possession. Some physical-tactical actions exhibited inconsistency in different time durations of the next periods; however, these physical-tactical data were position-specific. This may signify that each position has certain physical-tactical actions to execute even after the peak periods, especially when they are tactically required to do so. As the data demonstrates unique physical-tactical trends of players/teams during the peak and next periods of play, this could help practitioners prescribe position- and player-specific drills, and better understand transient decrements in high-intensity running after intense passages of play.

Appreciating Factors Beyond the Physical in Talent Identification and Development: Insights From the FC Barcelona Sporting Model.

FC Barcelona is a multi-sport organization that adopts a talent identification approach that emphasizes the technical, psychological, and perceptual-cognitive attributes. It is unclear within this type of sporting selection model whether the relative age effect (RAE) exists. Consequently, the aim of the study was to evaluate the RAE across multiple sports and age groups at FC Barcelona. The birthdates of all players (n = 6,542) affiliated to each sport [male basketball (n = 1,013), male (n = 3,012) and female (n = 449) soccer, male futsal (n = 761), male handball (n = 999), and male indoor roller hockey (n = 308)] across all age groups from U10 to Senior were recorded. These were then categorized into quartiles from the start of the selection year (Q1 = Jan-Mar; Q2 = Apr-Jun; Q3 = Jul-Sep; Q4 = Oct-Dec) and analyzed for (a) each sport; (b) each age group, irrespective of the sport; and (c) each age group within each sport, using Chi-squared statistics and odds ratios (ORs) with 95% confidence intervals (CIs). Birthdates across the entire club revealed a RAE (Q1 = 46.1%, Q2 = 27.1%, Q3 = 17.1%, and Q4 = 9.7%, χ2 = 29.8, P < 0.01), with OR in Q1, Q2, and Q3 representing a 4.76 (95% CIs: 1.96-11.57), 2.80 (1.12-7.03), and 1.77 (0.67-4.63) increased likelihood for selection when compared to Q4, respectively. Despite FC Barcelona's approach to talent identification and development, the RAE was still present within youth age groups (<18 years old). The current findings provide support that the RAE is more prevalent within regionally popular sports and reduces with increasing age; however, given the talent identification processes within FC Barcelona's sporting model, additional factors beyond the physical attributes, such as enhanced psychological and perceptual-cognitive attributes, in those born earlier in the selection year might further influence the RAE. Consequently, current results provide indirect evidence to suggest that sociological and psychological determinants might be a greater influence on the presence of RAE in sporting environments that prefer to consider technical and perceptual-cognitive attributes in their talent development programs.

Physical Demands of Ball Possession Games in Relation to the Most Demanding Passages of a Competitive Match.

The main aim of this study was to determine the physical demands of different small-sided ball possession games (SSBPGs) according to player field position and compare these demands in relation to the most demanding passages of play (MDP) in competitive matches. Global positioning system data were obtained from 25 football players (20.4 ± 2.1 yrs, 1.78 ± 0.66 m, 69.7 ± 6.1 kg) belonging to the reserve squad of a Spanish La Liga Club. Players were categorized according to positional groups; full back (FB), central defender (CD), midfielder (MF), wide midfielder (WMF) and forwards (FW). The variables analyzed were relativized to metres per minute (m·min-1): total distance covered (TD), TD at high speed (HSR; >19.8 km·h-1), TD at sprint (SPR; >25.2 km·h-1), the number of accelerations (ACC) and decelerations (DEC) at high intensity (> +/-3 m·s-2), the average metabolic power (AMP; W·kg-1) and the high metabolic load distance (HMLD; >25.5 W·kg-1). The MDP were analyzed using a rolling average method, where maximal values were calculated for 3 and 5 minutes to compare with SSBPGs using AMP as a criterion variable. The results were obtained from the SSBPGs relative to the MDP (expressed in %) for each player position. FB showed the greatest magnitude of overload in ACC/DEC according to the MDP in the two smaller SSBPGs formats (201-217%), whereas MF showed lower values (105-140%). The load expressed in relation to the MDP can be different depending on the format of the SSBPGs and the characteristics of playing position. These factors should be considered by the coaches when planning training.

Changes in markers of body composition of professional male soccer players during pre-season.

To evaluate changes achieved in whole-body and regional (upper limbs, lower limbs, and trunk) estimates of body composition, twenty professional male soccer players (7 defenders, 7 midfielders, 6 forwards) underwent dual-energy x-ray absorptiometry (DXA) analysis at the beginning and end of pre-season. Measures included: mass, fat mass (FM), fat-free mass (FFM), and body fat per cent (BF%). Players' activity during on-field training sessions was monitored using Global Positioning System (GPS) units, with GPS data used to obtain estimations of energy expenditure (EE). Whole-body mass remained unchanged across the pre-season. Moderate significant increases and decreases were achieved in whole-body FFM (Pre: 59.58 ±â€¯5.27 kg; Post: 60.61 ±â€¯5.18 kg; p = 0.001; d = 0.87) and FM (Pre: 10.60 ±â€¯1.88 kg; Post: 9.56 ±â€¯1.81 kg; p = 0.001; d = 0.85), respectively. Moderate significant decreases were achieved in whole-body BF% (Pre: 14.4 ±â€¯2.3%; Post: 12.9 ±â€¯2.0%; p < 0.001; d = 0.94). No significant inter-positional differences were observed for the changes achieved in any global or regional estimate of body composition. Total EE was significantly correlated with ΔFM (r = 0.65, p = 0.002), ΔFFM (r = 0.46, p = 0.03), and ΔBF% (r = 0.67, p = 0.002). The total EE of pre-season training accounted for 42%, 21%, and 45% of the variance in ΔFM, ΔFFM, and ΔBF%, respectively. These findings suggest that the pre-season period is a suitable time for initiating favourable alterations in body composition following the off-season in elite soccer players.

Looking for Complementary Intensity Variables in Different Training Games in Football.

Casamichana, D, Castellano, J, Díaz, AG, and Martín-García, A. Looking for complementary intensity variables in different training games in football. J Strength Cond Res XX(X): 000-000, 2018-The main aim of this study was to identify which combination of external intensity training load (iTL) metrics capture similar or unique information for different training game (TG) formats and official matches (OMs) in football using principal component (PC) analysis. Ten metrics of iTL were collected from 24 professional male football players using global positioning technology. A total of 348, 383, 120, 127, 148, and 207 individual files for small-sided possession games, medium-sided possession games, small-sided games, medium-sided games, large-sided games, and OMs, respectively, were studied. Principal component analysis was conducted on each game format. Extraction criteria were set at an eigenvalue of greater than one. Varimax rotation mode was used to extract more than one PC. Intensity training load metrics with PC "loadings" above 0.7 were deemed to possess well-defined relationships with the extracted PC. In each TG and OM, 3 PCs were identified. For the first PC, eigenvalues for each game format ranged from 3.89 to 4.45, which explained 39-44% of the information (i.e., variance) provided by the 10 iTL metrics. For the second PC, eigenvalues ranged from 2.17 to 2.47, explaining 22-26% of iTL information. For the third PC, eigenvalues ranged from 1.41 to 1.98, explaining 14-20% of iTL information. This would suggest that TG and OM have multidimensional demands; so, the use of only a single iTL could potentially lead to an underestimation of the physical demands. Consequently, a combination of 3 iTL metrics is required during professional football game formats.

Quantification of a Professional Football Team's External Load Using a Microcycle Structure.

Martín-García, A, Gómez Díaz, A, Bradley, PS, Morera, F, and Casamichana, D. Quantification of a professional football team's external load using a microcycle structure. J Strength Cond Res 32(12): 3520-3527, 2018-The aims of this study were to (a) determine the external load of a football team across playing position and relative to competition for a structured microcycle and (b) examine the loading and variation the day after competition for players with or without game time. Training and match data were obtained from 24 professional football players who belonging to the reserve squad of a Spanish La Liga club during the 2015/16 season using global positioning technology (n = 37 matches and n = 42 training weeks). Training load data were analyzed with respect to the number of days before or after a match (match day [MD] minus or plus). Training load metrics declined as competition approached (MD-4 > MD-3 > MD-2 > MD-1; p < 0.05; effect sizes [ES]: 0.4-3.1). On the day after competition, players without game time demonstrated greater load in a compensatory session (MD + 1C) that replicated competition compared with a recovery session (MD + 1R) completed by players with game time (MD + 1C > MD + 1R; p < 0.05; ES: 1.4-1.6). Acceleration and deceleration metrics during training exceeded 50% of that performed in competition for MD + 1C (80-86%), MD-4 (71-72%), MD-3 (62-69%), and MD-2 (56-61%). Full backs performed more high-speed running and sprint distance than other positions at MD-3 and MD-4 (p < 0.05; ES: 0.8-1.7). The coefficient of variation for weekly training sessions ranged from ∼40% for MD-3 and MD-4 to ∼80% for MD + 1R. The data demonstrate that the external load of a structured microcycle varied substantially based on the players training day and position. This information could be useful for applied sports scientists when trying to systematically manage load, particularly compensatory conditioning for players without game time.

The Frequency and Type of K-RAS Mutations in Mexican Patients With Colorectal Cancer: A National Study.

BACKGROUND: Current metastatic colorectal cancer (mCRC) therapy uses monoclonal antibodies against the epidermal growth factor receptor. This treatment is only useful in the absence of K-RAS gene mutations; therefore the study of such mutations is part of a personalized treatment. The aim of this work is to determine the frequency and type of the most common K-RAS mutations in Mexican patients with metastatic disease by nucleotide sequencing. PATIENTS AND METHODS: We studied 888 patients with mCRC from different regions of Mexico. The presence of mutations in exon 2, codons 12 and 13, of the K-RAS gene was determined by nucleotide sequencing. RESULTS: Patients exhibited K-RAS gene mutations in 35% (310/888) of cases. Mutation frequency of codons 12 and 13 was 71% (221/310) and 29% (89/310), respectively. The most common mutation (45.7%) in codon 12 was c.35G>A (p.G12D), whereas the one in codon 13 was c.38G>A (p.G13D) (78.7%). DISCUSSION: Given the frequency of K-RAS mutations in Mexicans, making a genetic study before deciding to treat mCRC patients with monoclonal antibodies is indispensable.

Chronic progressive disseminated histoplasmosis in a Mexican cockfighter.

We present illustrative images from a Mexican 58-year-old man who had the occupation of cockfighting from childhood and presented with chronic progressive disseminated histoplasmosis with primarily cutaneous manifestations.

Percepción subjetiva del esfuerzo en fútbol profesional: relevancia de los indicadores físicos y psicológicos en el entrenamiento y la competición / Rate of perceived exertion in professional soccer: importance of the physical and psychological factors for training and competition

Este estudio se llevó a cabo para determinar la relación existente entre la carga física y psicológica de entrenamiento de las sesiones precompetitivas, estimada mediante el tiempo de entrenamiento, la frecuencia cardiaca (FC) y la percepción subjetiva del esfuerzo (PSE), con el propio rendimiento físico de los jugadores en partido oficial. Para ello, en 21 jugadores profesionales de la Football Association Championship Division inglesa, se monitorizó la FC, PSE, el tiempo de entrenamiento y el tiempo específico sobre la zona de alta intensidad en todas las sesiones de entrenamiento durante los 5 días previos al partido. Se registró igualmente la distancia total cubierta y la distancia cubierta en alta intensidad de cada jugador en 22 partidos oficiales mediante el sistema multicámara ProZone®. Los resultados indican que los valores reportados de PSE correlacionan con el volumen y la intensidad de entrenamiento desarrollados durante las sesiones preparatorias, y que por lo tanto es una herramienta válida para cuantificar la carga de entrenamiento. No obstante, dentro de las múltiples variables que intervienen en la competición, estos registros de PSE o el promedio de FC durante las sesiones de entrenamiento precompetitivas, no parecen ser variables que permitan predecir el rendimiento condicional de los jugadores en competición oficial (AU)

This study was undertaken to determine the relationship between the precompetitive physical and psychological training sessions load, estimated by the training time, heart rate (HR) and the rate of perceived exertion (RPE), with the physical performance of players in the competitive match. To do this, in 21 professional players from the English Football Association Championship Division, HR, RPE, the training time and the specific training time in the high intensity zone were monitored during all the training sessions through all the 5 previous days before the match. It was also recorded the total distance covered and the total distance covered in the high intensity zone for each player in 22 official matches using the multicamera computerised tracking system ProZone®. The results indicate that the RPE values correlate with the precompetitive training volume and intensity, and therefore it is a valid tool to quantify the training load. However, within multiple variables involved in the competition, the RPE or the average HR data recorded during the precompetitive training sessions do not seem to be variables that can predict the players´ conditional performance during the official matches (AU)

Cuantificación de la carga física y psicológica en fútbol profesional: diferencias según el nivel competitivo y efectos sobre el resultado en competición oficial / Quantification of physical and psychological loads: differences in competitive levels and the effects on match

Este estudio analiza la respuesta que tienen los futbolistas profesionales de diferentes niveles competitivos a los estímulos de entrenamiento y competición, así como su relación con en el rendimiento en partido. Un total de 20 jugadores de nivel Élite (Premier League-1º División Inglesa) y 22 jugadores de nivel Sub-élite (Championship Division -2º División Inglesa) tomaron parte en el estudio. Individualmente se monitorizó la carga de entrenamiento a través del % frecuencia cardiaca máxima (%FCmax), tiempo de entrenamiento según intensidades y la percepción subjetivo del esfuerzo (PSE), así como la carga de competición mediante el sistema multi-cámara ProZone® durante toda la segunda vuelta de la liga en ambos equipos. La PSE, %FCmax y la distancia recorrida en entrenamiento, así como la distancia cubierta en partido oficial fueron significativamente inferiores (p < .05) en los jugadores Élite. La PSE, un indicador valido para estimar la carga física y psicológica de los jugadores, correlacionó significativamente (p < .05) con el propio rendimiento condicional de entrenamiento y competición. La distancia cubierta en partido oficial fue significativamente superior (p < .05) cuando obtuvieron victorias en sus encuentros. Los resultados de este estudio sugieren que los futbolistas de clase mundial soportan una menor carga de entrenamiento y competición, apoyándose en mayor medida en sus habilidades técnico-tácticas (AU)

This study analyses the response of professional soccer players of different competitive levels to competition and training stimuli, together with the latter’s relationship with performance during matches. A total of 20 Elite players (Premier League) and 22 Sub-elite players (Championship Division) took part in the study. The training load for each player was monitored by measuring the % maximum heart rate (% HRmax), training time at different intensities, rate of perceived exertion (RPE) and competition load through the ProZone® multi-camera tracking system during the second round of the league for both teams. The RPE, % HRmax, training distance and distance covered during the official match were significantly lower (p < .05) in the case of the Elite players. The RPE - a valid method of estimating the players' physical and psychological load - was significantly correlated (p < .05) with the recorded physical performance during training and competition. The total distance covered during the competition was significantly higher (p < .05) for both teams when they won their matches. The results of this study suggest that world-class soccer players have a lower training and competition load, relying more on their technical and tactical skills (AU)

Match performance and physical capacity of players in the top three competitive standards of English professional soccer.

The aim of this study was to compare the match performance and physical capacity of players in the top three competitive standards of English soccer. Match performance data were collected from players in the FA Premier League (n=190), Championship (n=155) and League 1 (n=366) using a multiple-camera system. In addition, a selection of players from the Premier League (n=56), Championship (n=61) and League 1 (n=32) performed the Yo-Yo intermittent endurance test level 2 (Yo-Yo IE2) to determine physical capacity. Players in League 1 and the Championship performed more (p<.01) high-intensity running than those in the Premier League (Effect Size [ES]: 0.4-1.0). Technical indicators such as pass completion, frequency of forward and total passes, balls received and average touches per possession were 4-39% higher (p<.01) in the Premier League compared to lower standards (ES: 0.3-0.6). Players also covered more (p<.05) high-intensity running when moving down (n=20) from the Premier League to the Championship (ES: 0.4) but not when players moved up (n=18) standards (ES: 0.2). Similar Yo-Yo IE2 test performances were observed in Premier League, Championship and League 1 players (ES: 0.2-0.3). Large magnitude relationships (p<.05) were observed between Yo-Yo IE2 test performances and the total and high-intensity running distance covered in both Championship (r=.56 and .64) and Premier League matches (r=.61 and .54). The data demonstrate that high-intensity running distance was greater in players at lower compared to higher competitive standards despite a similar physical capacity in a subsample of players in each standard. These findings could be associated with technical characteristics inherent to lower standards that require players to tax their physical capacity to a greater extent but additional research is still required to confirm these findings.

The effect of high and low percentage ball possession on physical and technical profiles in English FA Premier League soccer matches.

The aim of this study was to examine the effects of high (HPBPT) and low percentage ball possession teams (LPBPT) on physical and technical profiles in elite soccer matches. Match performance data were collected from players in the English FA Premier League (n = 810) using a multiple-camera computerised tracking system. Physical indicators such as the total (10690 ± 996 vs 10778 ± 979 m; effect size [ES] = 0.11) and high-intensity running distance covered in matches (931 ± 299 vs 938 ± 311 m; ES = 0.13) did not differ between HPBPT and LPBPT. However, high-intensity running with ball possession in HPBPT was 31% higher (P < 0.01) than LPBPT (449 ± 266 vs 343 ± 236 m; ES = 0.42) but 22% lower without ball possession (423 ± 153 vs 539 ± 177 m; ES = 0.73). Players in HPBPT performed 44% more (P < 0.01) passes than those in LPBPT (35.3 ± 14.2 vs 24.6 ± 11.2; ES = 0.83). This trend was also evident (P < 0.05) for successful passes, received passes, touches per possession, shots, dribbles and final-third entries (ES range of 0.20-0.94). Central defenders of LPBPT covered 33% less (P < 0.01) high-intensity running with ball possession than central defenders of HPBPT. While fullbacks, attackers, central and wide midfielders of LPBPT covered more (P < 0.01) high-intensity running without and less with ball possession than their HPBPT counterparts (ES range of 0.91-1.23). Technical indicators such as total passes and passes received were higher (P < 0.01) across all positions in HPBPT than LPBPT (ES range of 0.82-1.52). The data demonstrate that percentage ball possession does not influence the overall activity profile of a team but impacts on the composition of high-intensity running efforts (with and without ball) and some technical elements of performance. Position-specific changes in physical and technical profiles were evident for teams employing different ball possession percentages and this information could aid training preparation.

[A cystic mesenteric lymphangioma presented at the colon sigmoid. Case report]. / Linfangioma quístico de mesenterio en colon sigmoides. Informe de un caso.

BACKGROUND: Cystic lymphangioma of the mesentery is an uncommon tumor; its incidence is 1:160,000. Our objective was to present the case of a patient with cystic lymphangioma of mesentery located at the colon. CLINICAL CASE: Female 25 years, attending consultation with a clinical picture suggestive of right ovarian cyst and increased abdominal perimeter. On physical examination abdominal painful tumor was identified, with deep palpation and mobilization. Abdominal ultrasound findings suggested giant right ovarian cyst. Laparotomy showed a cystic mass (18 x 11 cm size) depending mesenterium and involving sigmoid colon, surgical intervention was done after two days for bowel preparation. Resection of the cyst, and colon section involving sigmoid colon with termino-terminal anastomosis, was performed. The pathological report was: cystic lymphangioma of sigmoid mesentery. There was no recurrence at six month follow up. CONCLUSIONS: Cystic lymphangioma of the mesentery is a benign abdominal tumor, which occurs frequently in children but in adults is rare. We found 49 cases of mesenteric cysts reported in Mexico, of which 21 were lymphangiomas with a range of 1 to 73 years of age.

Spontaneous peritonitis attributed to actinomyces species.

Abdominal actinomycosis is a rare condition caused by actinomyces species found in the normal flora of the oral cavity, gastrointestinal and genital tract. All cases reported describe localized forms demonstrating masses, pseudotumors or abscess during surgery or radiology studies and there are no reports about spontaneous peritonitis caused by actinomycetes. We report a case in which this disease present as symptomatic ascitic fluid infection refractory to antimicrobial therapy for intra- abdominal sepsis and detected during unsuspected cytology test. The case was successfully treated with a penicillin regimen. As a spontaneous peritonitis variety, the microbiology diagnosis remains difficult as we don't think in this form of abdominal actinomycosis not described previously in the literature. The present illustrative case strength the usefulness of cytology test in patients with suspected ascitic fluid infection refractory to a medical therapy.

Patología quirúrgica del apéndice cecal: análisis de 8.950 casos / Surgical pathology of the cecal appendix: analysis of 8.950 cases

Se reclasificó la patologia quirúrgica del apéndice cecal. El diagnóstico clínico emitido con mayor frecuencia fue apendicitis aguda ( 80.5%). Los diagnósticos histopatológicos de revisión más frecuentes fueron apendicitis aguda (72%), apendicitis aguda con abscesos (36.2%), apéndice perforado (18.2%), apéndice cecal normal (11.2%), periapendicitis (4.1%), apendicitis crónica (2.5%), diverticulosis adquirida (1.7%), diverticulitis (1.2%), parasitosis (2.7%), apendicitis amibiana (1.1%) y neoplasias (1.2%). Se practicaron 558 apendicectomías profilácticas y en 158 casos (28.3%) se encontraron diferentes alteraciones patológicas. En 8.092 pacientes se emitión el diagnóstico clínico de apendicitis aguda o amibiana y en 2,067 (25.5%) no se apreciaron alteraciones que repercutieran clínicamente. De los 6,444 casos de apendicitis aguda, 5,559 (86.2%) el diagnóstico clínico coincidió con el histopatológico de revisión. En 12,788 diagnóstico histopatológicos se identificaron 4,877 discrepancias (38.1%) entre el diagnóstico intencionado de revisión y el de rutina