Predicting the effectiveness of drugs used for treating cardiovascular conditions in newborn infants.

BACKGROUND: Cardiovascular support (CVS) treatment failure (TF) is associated with a poor prognosis in preterm infants. METHODS: Medical charts of infants with a birth weight <1500 g who received either dopamine (Dp) or dobutamine (Db), were reviewed. Treatment response (TR) occurred if blood pressure increased >3rd centile for gestational age or superior vena cava flow was maintained >55 ml/kg/min, with decreased lactate or less negative base excess, without additional CVS. A predictive model of Dp and Db on TR was designed and the impact of TR on survival was analyzed. RESULTS: Sixty-six infants (median gestational age 27.3 weeks, median birth weight 864 g) received Dp (n = 44) or Db (n = 22). TR occurred in 59% of the cases treated with Dp and 31% with Db, p = 0.04. Machine learning identified a model that correctly labeled Db response in 90% of the cases and Dp response in 61.4%. Sixteen infants died (9% of the TR group, 39% of the TF group; p = 0.004). Brain or gut morbidity-free survival was observed in 52% vs 30% in the TR and TF groups, respectively (p = 0.08). CONCLUSIONS: New predictive models can anticipate Db but not Dp effectiveness in preterm infants. These algorithms may help the clinicians in the decision-making process. IMPACT: Failure of cardiovascular support treatment increases the risk of mortality in very low birth weight infants. A predictive model built with machine learning techniques can help anticipate treatment response to dobutamine with high accuracy. Predictive models based on artificial intelligence may guide the clinicians in the decision-making process.

The gut microbiome analysis of Anastrepha obliqua reveals inter-kingdom diversity: bacteria, fungi, and archaea.

The fruit fly Anastrepha obliqua is an economically important pest. The sterile insect technique to control it involves mass production and release of sterile flies to reduce the reproduction of the wild population. As noted in different Tephritidae, the performance of sterile males may be affected by the assimilation of nutrients under mass-rearing conditions. In the wild, the fly's life cycle suggests the acquisition of different organisms that could modulate its fitness and physiology. For A. obliqua, there is no information regarding microorganisms other than bacteria. This study analyzed bacteria, fungal, and archaea communities in the A. obliqua gut through denaturing gradient gel electrophoresis (DGGE) profiles of 16S (using a different set of primers for bacteria and archaea) and 18S ribosomal DNA markers. We found that wild flies presented higher microbial diversity related to fructose assimilation than laboratory species, suggesting that microorganisms have led to a specialized metabolism to process nutrients associated with an artificial diet. We identified species that have not been previously described in this fruit fly, especially actinobacteria and archaea, by employing different primer sets aimed at the same molecular marker but targeting diverse hypervariable regions of 16S rDNA. The possibility that Archaea affect fly fitness should not be ignored. This report on the intestinal microbial (bacteria, archaea, and fungi) composition of A. obliqua contributes to our understanding of the role of microorganisms in the development and physiology of the flies.

Effect of larval nutrition on the hemolymph protein composition during metamorphosis of Anastrepha obliqua.

Few studies have focused on how nutrition affects the bioavailability and investment of protein during the metamorphosis of tephritids. Our study allowed us to observe how the type and particle size of the bulking agent affected the protein composition in the hemolymph of the larva and adult of Anastrepha obliqua. Results indicated that, true protein bioavailability and protein profile was greatly modified by the bulking agent and its particle size. The physical structure of the food matrix affected the content of crude fiber (F), crude protein (P), F/P ratio, non-protein nitrogen, ammoniacal nitrogen, and α-amylase and trypsin inhibitors. Results from SDS-PAGE revealed 45 fractions with well-defined bands ranging from ~28 to ~401 kDa in larvae and adults, we found the main differences between the samples from different food matrices within the 75-100 kDa range. Hemolymph of adults from the coarse coconut fiber food matrix treatment showed a single band with a molecular weight close to 250 kDa, probably associated with a storage protein such as lipophorins. The food matrix with a coarse bulking agent had a high concentration of ammoniacal nitrogen, suggesting high microbial activity. In conclusion, the particle size of the bulking agent of the food matrix changes the bioavailability of protein in hemolymph in the adult regardless of the total concentration of protein. Also, when the particle size of the bulking agent favored the F/P ratio, higher larval density resulted in higher individual larval weight, larval yield, and adult emergence.

Big particles, best nutrition? Absorption and excretion of protein by Anastrepha obliqua larvae (Diptera: Tephritidae).

For purposes of mass-rearing fruit flies, nutrient intake through artificial diets is a challenge, artificial food content and processing should promote sufficient absorption and availability to ensure fly fitness. Bulking agents play an essential role in creating a quality diet, but its physical characteristics, such as particle size, may establish a better microenvironment for feeding and development. Currently, there is a lack of information about protein metabolism in mass-reared fruit flies. Therefore, we evaluated whether the particle size of the bulking agent affects the absorption and excretion of the proteins, as well as their effect on the life-history traits of Anastrepha obliqua. We determined the protein content of hemolymph and feces, as well as the presence of nitrogen end-products as indicators of their level of absorption in a diet elaborated with coarse and fine corn cob particles as a bulking agent. The bromatological composition showed that coarse particles increased the bioavailability and content of crude, digestible, and soluble protein for the diet and hemolymph protein of larvae alike. We found an inverse relationship between the protein content of the hemolymph and feces of the larvae. Ammonium was determined to be a product of the catabolism of proteins. Also, A. obliqua improved its development (yield and pupal weight) and fitness (adult emergence and flight ability) when larvae were reared on a coarse particle diet. In conclusion, a diet elaborated with a coarse bulking agent features increased protein bioavailability and nutritional quality, which, in turn, increases the life-history traits of A. obliqua.

Comparative Analysis of the Gut Bacterial Community of Four Anastrepha Fruit Flies (Diptera: Tephritidae) Based on Pyrosequencing.

Fruit flies are the most economically important group of phytophagous flies worldwide. Whereas the ecological role of bacteria associated with tephritid fruit fly species of the genera Bactrocera and Ceratitis has been demonstrated, the diversity of the bacterial community in Anastrepha has been poorly characterized. This study represents the first comprehensive analysis of the bacterial community in the gut of larvae and adults of Anastrepha ludens, A. obliqua, A. serpentina, and A. striata using 454 pyrosequencing. A total of four phyla, seven classes, 11 families, and 27 bacterial genera were identified. Proteobacteria was the most represented phylum, followed by Firmicutes, Actinobacteria, and Deinococcus-Thermus. The genera Citrobacter, Enterobacter, Escherichia, Klebsiella, and Raoultella were dominant in all samples analyzed. In general, the bacterial community diversity in adult flies was higher in species with a broader diet breadth than species with a restricted number of hosts, whereas it was also higher in adults versus larvae. Differences in bacterial communities in adults might be determined by the number of fruit species infested. Lastly, the predictive functional profile analysis suggested that community members may participate in metabolic pathways related to membrane transport and metabolism of carbohydrates, amino acids, cofactors, and lipids. These results provide the basis for the study of unexplored functional roles of bacteria in this insect group.

Partial Discharge Spectral Characterization in HF, VHF and UHF Bands Using Particle Swarm Optimization.

The measurement of partial discharge (PD) signals in the radio frequency (RF) range has gained popularity among utilities and specialized monitoring companies in recent years. Unfortunately, in most of the occasions the data are hidden by noise and coupled interferences that hinder their interpretation and renders them useless especially in acquisition systems in the ultra high frequency (UHF) band where the signals of interest are weak. This paper is focused on a method that uses a selective spectral signal characterization to feature each signal, type of partial discharge or interferences/noise, with the power contained in the most representative frequency bands. The technique can be considered as a dimensionality reduction problem where all the energy information contained in the frequency components is condensed in a reduced number of UHF or high frequency (HF) and very high frequency (VHF) bands. In general, dimensionality reduction methods make the interpretation of results a difficult task because the inherent physical nature of the signal is lost in the process. The proposed selective spectral characterization is a preprocessing tool that facilitates further main processing. The starting point is a clustering of signals that could form the core of a PD monitoring system. Therefore, the dimensionality reduction technique should discover the best frequency bands to enhance the affinity between signals in the same cluster and the differences between signals in different clusters. This is done maximizing the minimum Mahalanobis distance between clusters using particle swarm optimization (PSO). The tool is tested with three sets of experimental signals to demonstrate its capabilities in separating noise and PDs with low signal-to-noise ratio and separating different types of partial discharges measured in the UHF and HF/VHF bands.

Detection of Partial Discharge Sources Using UHF Sensors and Blind Signal Separation.

The measurement of the emitted electromagnetic energy in the UHF region of the spectrum allows the detection of partial discharges and, thus, the on-line monitoring of the condition of the insulation of electrical equipment. Unfortunately, determining the affected asset is difficult when there are several simultaneous insulation defects. This paper proposes the use of an independent component analysis (ICA) algorithm to separate the signals coming from different partial discharge (PD) sources. The performance of the algorithm has been tested using UHF signals generated by test objects. The results are validated by two automatic classification techniques: support vector machines and similarity with class mean. Both methods corroborate the suitability of the algorithm to separate the signals emitted by each PD source even when they are generated by the same type of insulation defect.

Comparison of Anastrepha ludens (Diptera: Tephritidae) Bisexual and Genetic Sexing (Tapachula-7) Strains: Effect of Hypoxia, Fly Density, Chilling Period, and Food Type on Fly Quality.

The use of genetic sexing strain (GSS) insects in the sterile insect technique (SIT) makes necessary the revision of quality parameters of some stressful steps used during the packing process for aerial release because of possible differences in tolerance between fly strains. Here, we determined the effect of three periods of hypoxia (12, 24, and 36 h at pupal stage), three cage densities (1.0, 1.3, and 1.5 flies/cm2), two different foods (protein/sugar (1/24) and Mubarqui), and three chilling times (20 min [control], 90, and 180 min) on the quality parameters of flies of two Anastrepha ludens (Loew) strains (bisexual and GSS Tapachula-7). In general, the response to stressful conditions of both fly strains was qualitatively equivalent but quantitatively different, as flies of both strains responded equally to the stressful factors; however, flies of Tapachula-7 exhibited lower quality parameters than the control flies. Thus, hypoxia affected the flying ability but not the emergence or longevity of flies. The food type affected the adult weight; protein/sugar produced heavier flies that also survived longer and had a greater mating propensity. Flies under the lowest density were better fliers that those at the other two densities. Increasing chilling time reduced flight ability but not longevity or mating propensity. The implications of these findings for the use of A. ludens GSS in SIT programs are discussed herein.

Influence of Methoprene on Pheromone Emission and Sexual Maturation of Anastrepha obliqua (Diptera: Tephritidae) males.

It has been demonstrated that the application of juvenile hormone analog, methoprene, reduces the time required for sexual maturation and enhances mating success in several species of tephritid fruit flies. This study examined the effect of different concentrations of methoprene incorporated into the diet of adult flies and distinct sugar:protein (S:P) ratios on sexual maturity and pheromone emission of Anastrepha obliqua males. Diets with 0.2 and 0.5% of methoprene accelerated sexual maturation of males compared with untreated males. In subsequent assays, the enhancement of male pheromone emission and sexual maturation by the incorporation of 0.02% methoprene into a 24:1 (S: P) diet was confirmed. Among the volatiles released by males, (Z)-3-nonenol and (Z,Z)-3,6-nonadienol were emitted at higher quantities by flies treated with methoprene than untreated ones. The results show that methoprene accelerates sexual maturation of mass-reared A. obliqua males and increases their mating propensity. This would reduce the time required to attain sexual maturation by sterile males, thus decreasing fly handling costs and improving the efficacy of the sterile insect technique.

Bayesian learning of feature spaces for multitask regression.

This paper introduces a novel approach to learn multi-task regression models with constrained architecture complexity. The proposed model, named RFF-BLR, consists of a randomised feedforward neural network with two fundamental characteristics: a single hidden layer whose units implement the random Fourier features that approximate an RBF kernel, and a Bayesian formulation that optimises the weights connecting the hidden and output layers. The RFF-based hidden layer inherits the robustness of kernel methods. The Bayesian formulation enables promoting multioutput sparsity: all tasks interplay during the optimisation to select a compact subset of the hidden layer units that serve as common non-linear mapping for every tasks. The experimental results show that the RFF-BLR framework can lead to significant performance improvements compared to the state-of-the-art methods in multitask nonlinear regression, especially in small-sized training dataset scenarios.

Adaptive Sparse Gaussian Process.

Adaptive learning is necessary for nonstationary environments where the learning machine needs to forget past data distribution. Efficient algorithms require a compact model update to not grow in computational burden with the incoming data and with the lowest possible computational cost for online parameter updating. Existing solutions only partially cover these needs. Here, we propose the first adaptive sparse Gaussian process (GP) able to address all these issues. We first reformulate a variational sparse GP (VSGP) algorithm to make it adaptive through a forgetting factor. Next, to make the model inference as simple as possible, we propose updating a single inducing point of the SGP model together with the remaining model parameters every time a new sample arrives. As a result, the algorithm presents a fast convergence of the inference process, which allows an efficient model update (with a single inference iteration) even in highly nonstationary environments. Experimental results demonstrate the capabilities of the proposed algorithm and its good performance in modeling the predictive posterior in mean and confidence interval estimation compared to state-of-the-art approaches.

Evaluation of ALBA device for upper extremity motor function in adults with subacute and chronic acquired brain injury: a randomised controlled trial protocol in a tertiary clinic of the metropolitan region of Chile.

INTRODUCTION: Stroke is a significant worldwide cause of death and a prevalent contributor to long-term disability among adults. Survivors commonly encounter a wide array of motor, sensory and cognitive impairments. Rehabilitation interventions, mainly targeting the upper extremities, include a wide array of components, although the evidence indicates that the intensity of practice and task-specific training play crucial roles in facilitating effective results. Assisted therapy with electronic devices designed for the affected upper extremity could be employed to enable partial or total control of this limb, while simultaneously incorporating the aforementioned characteristics in the rehabilitation process. METHODS AND ANALYSIS: 32 adults who had a subacute or chronic stroke, aged over 18 years old, will be included for this randomised controlled trial aiming to determine the non-inferiority effect of the inclusion of a robotic device (ALBA) to regular treatment against only regular rehabilitation. Participants will be assessed before and after 4 weeks of intervention and at 3 months of follow-up. The primary outcome will be the Fugl-Meyer assessment for upper extremities; secondary outcomes will include the questionnaires Functional Independence Measure, Medical Outcomes Study 36-item Short-Form Health Survey as well as the System Usability Scale. ETHICS AND DISSEMINATION: Full ethical approval was obtained for this study from the scientific and ethical review board Servicio de Salud Metropolitano Oriente of Santiago (approval number: SSMOriente030522), and the recommendations of the Chilean law no 20120 of 7 September 2006, concerning scientific research in the human being, its genome and human cloning, will be followed. Ahead of inclusion, potential participants will read and sign a written informed consent form. Future findings will be presented and published in conferences and peer-reviewed journals. TRIAL REGISTRATION NUMBER: International ClinicalTrials.gov Registry (NCT05824416; https://clinicaltrials.gov/ct2/show/NCT05824416?term=uMOV&draw=2&rank=1).

Hot-water phytosanitary treatment against Ceratitis capitata (Diptera: Tephritidae) in 'Ataulfo' mangoes.

We determined the thermal death rate constants and mortality curves for the eggs and different instars of Ceratitis capitata (Mediterranean fruit fly) (Wiedemann) submerged in isolation in water at 44, 46, and 48 degrees C and submerged within fruits of Mangifera indica (mango) (L.) in water at 43.1, 44.1, 45.1, and 46.1 degrees C. The first instar was the most tolerant to this treatment, with estimated times for achieving 99.9968% mortality of 103.28, 92.73, and 92.49 min at temperatures of 43.1, 44.1, and 45.1 degrees C, respectively. The results of the study indicate that 'Ataulfo' mangoes weighing < 329 +/- 2.11 g and at risk immature Mediterranean fruit fly infestation should be immersed for 95 min at 46.1-47 degrees C to ensure that the fruit pulp remains at this temperature for 10 min. An efficacy test was conducted that involved treating 730 mangoes, with an average weight of 326 +/- 2.11 g (mean +/- SE) and infested with 84 +/- 1.15 first instars. In this test, none of the 61,720 larvae treated survived. The confirmatory test was performed using commercial equipment in which 1,112 infested mango fruit weighing an average of 329 +/- 2.11 g were treated. Each fruit was previously infested with an average of 59 +/- 0.61 first instars (= 65,825 total larvae) of which none survived. The data collected on mango quality indicate that hot water immersion for 95 min at 46.1-47 degrees C can produce a more uniform fruit-color and positively modify the pH (producing more palatable fruits), but can also produce a loss of firmness and weight (5%). Taking all factors into consideration, we conclude that this treatment is sufficient to meet quarantine restrictions against C. capitata while maintaining market quality at least for 15 d.

Effects of a Bulking Agent on the Protein:Carbohydrate Ratio, Bioconversion, and Cost-effectiveness of a Larval Diet for Anastrepha ludens (Diptera: Tephritidae).

Although the bulking agent is categorized as 'inert', it could modify protein bioavailability and nutritional quality. In this study, the main goal was to determine if the bulking agent modified the protein:carbohydrate (P:C) ratio and bioconversion from diet biomass to larval biomass of Anastrepha ludens. The diet was altered only by modifying the type of bulking agent (corncob powder, coconut fiber, carrot fiber, oatmeal) added without changing the composition and concentration of the other components in the formulation. This allowed reclassification of the food matrices according to P:C ratios of 1:30, 1:35, 1:64, and 1:93. A food matrix with a high P:C ratio promoted a high protein and carbohydrate content in the larval hemolymph and immediately influenced the life-history traits of the larva or delayed them in the adult. The present study indicated a positive relationship between the P:G+T (glucose+trehalose) ratio in the larval hemolymph and the P:C ratio in the larval diet. Our results highlight the importance of including the optimum and real P:C ratio in whole fresh larval diets, since considering only the theoretical concentration of the formulation is not enough to understand the variation in key life-history traits. In addition, the bioconversion index should be included as an indicator of the efficacy of larval diets for mass rearing insects. A diet with high cost-effectiveness should be evaluated by taking into account flying flies as the end product of the mass rearing process to enhance operational SIT programs.

[Techniques for neurovascular bundle preservation during retropubic radical prostatectomy]. / Técnicas para la preservación de los haces neurovasculares durante la prostatectomía radical retropúbica.

Although radical prostatectomy is a curative therapy that has proven effective in many of our patients with prostate cancer, it is still associated with significant morbidity, which includes postoperative erectile dysfunction among its leading exponents. Potency after the intervention may be influenced by many factors, among which, presence of adequate erectile function before surgery, patient's age, stage of disease at the time of treatment, surgeon's experience and, of course, interpersonal anatomical variations may be pointed out. In recent decades, the exact knowledge of the neuroanatomy of the male pelvis has become very important, for both the student of human anatomy and the pelvic surgeon. Therefore, the anatomical nerve sparing techniques have led to fewer complications related to the injury of these structures. This article presents a brief description of the neuroanatomical substrate of the neurovascular bundles along with a detailed compilation of the different surgical techniques for their preservation during radical retropubic prostatectomy.

Diffuse cavernous hemangioma of the rectum.

Diffuse cavernous hemangioma (DCH) is a rare benign vascular lesion. The rectosigmoid colon is the most common site of this disease. It affects mainly young adults. The most frequent symptom is chronic rectal bleeding which is painless, often begins in the infancy and sometimes is uncontrollable. Endoscopy is the diagnose method of choice and complete surgical excision with sphincter-saving procedure is the primary mode of treatment. A high index of suspicion and a correct diagnose is necessary. We present a 34-year-old male with a DCH of the rectum and anus who required an APR because of affection of dentate line.

El hemangioma cavernoso difuso (HCD) es un tumor vascular benigno raro. Su localización más habitual es el rectosigma. Se presenta en adultos jóvenes como rectorragia indolora y recurrente, que suele aparecer en la infancia y puede llegar a ser incontrolable. La endoscopia digestiva es el método diagnostico de elección. El único tratamiento eficaz consiste en la resección completa siendo deseable la realización de una técnica con conservación esfinteriana. Un alto índice de sospecha y un correcto diagnóstico son necesarios. Presentamos el caso de un varón de 34 años con un HCD del anorecto que requirió una resección abdominoperineal.

Mass Rearing, Quality Parameters, and Bioconversion in Drosophila suzukii (Diptera: Drosophilidae) for Sterile Insect Technique Purposes.

The spotted wing drosophila, Drosophila suzukii Matsumura, has emerged as a major invasive insect pest of small and stone fruits in both the Americas and Europe in the last decade. Females oviposit in ripening fruit, and significant economic losses can occur. Control measures are mainly associated with the use of pesticides, but the sterile insect technique (SIT), an ecologically friendly pest-specific method, could be used against this species. The objective of this study was to estimate the mass rearing, quality control parameters, and bioconversion using four artificial larval diets and their economic aspects oriented to the SIT application. Diets were based on the combination of coconut fiber, corncob powder, Brewer's and Torula yeast and were used as oviposition substrate and larval development. We found that a life cycle is completed in 10.19 ± 0.35 d and that adults live an average of 33.67 ± 0.76 d. The highest number of pupae per gram of diet and the maximum bioconversion (6%) were associated with flies developed in the coconut fiber + Brewer's yeast diet. Under our conditions, the establishment of D. suzukii required at least four generations. The use of 30 × 40 × 30 cm Plexiglas cages, each loaded with 5,000 adults and stocked with 500 g of coconut fiber and Brewer's yeast diet distributed in 15 × 5 × 10 cm plastic trays with a diet layer 3-cm thick, allows a minimum production of 84,000 pupae of D. suzukii per day.

Attractiveness and Sexual Competitiveness of Anastrepha obliqua Males (Diptera: Tephritidae) Fed on a Diet Enriched With Providencia rettgeri.

The West Indian fruit fly, Anastrepha obliqua (Macquart), is the second most important tephritid fruit fly in Mexico, infesting mango, hog plum and guava fruits. To control this pest, the Mexican government has implemented the use of the sterile insect technique (SIT), which involves the mass production, sterilization and release of flies. However, the A. obliqua laboratory males used in SIT are selected to a lesser extent by the wild females during competitiveness tests. The objective of this study was to compare the effects of males fed on fruit fly food enriched with Providencia rettgeri to those in males fed on food alone, assessing male mating competitiveness, capture of females using traps baited with males fed with the enriched diet and sex pheromone components. The results indicated that males fed with the diet enriched with P. rettgeri had increased mating competitiveness and captured more females in the field cage tests. However, no difference was observed in the proportion of volatile sex pheromone components identified during the calling of A. obliqua males. The results suggest the value of incorporating bacteria into the mass rearing technique of A. obliqua adults in order to improve the sexual competitiveness of males from the laboratory compared to wild males.

SOMprocessor: A high throughput FPGA-based architecture for implementing Self-Organizing Maps and its application to video processing.

The design of neuromorphic chips aims to develop electronic circuits dedicated to executing artificial neural networks, mainly by exploring parallel processing. Unsupervised learning models, such as Self-organizing Maps (SOM), may benefit from massively concurrent hardware-based implementations to meet the requirements of real-time and embedded applications. This work first presents a theoretical analysis of the algorithms implemented in hardware to compute SOM learning and recall phases. This is important because, albeit similar, the processing steps executed in hardware are not necessarily identical to those executed in software. Then, the proposed FPGA architecture entitled SOMprocessor is shown in detail. The circuit of the processor explores two different computational strategies for increasing the performance of current state-of-the-art works. These computational strategies aim to improve the data flow through the processor and its flexibility to implement different network topologies. Finally, this work presents the application of the SOMprocessor to a video categorization task. The results show that topographic and quantization errors are similar between hardware and software implementations, as well as the overall accuracy. Moreover, the proposed FPGA architecture achieves acceleration of 3 to 4 orders of magnitude as compared to CPU executions.

Surgical treatment for colorectal cancer: analysis of the influence of an enhanced recovery programme on long-term oncological outcomes-a study protocol for a prospective, multicentre, observational cohort study.

INTRODUCTION: The evidence currently available from enhanced recovery after surgery (ERAS) programmes concerns their benefits in the immediate postoperative period, but there is still very little evidence as to whether their correct implementation benefits patients in the long term. The working hypothesis here is that, due to the lower response to surgical aggression and lower rates of postoperative complications, ERAS protocols can reduce colorectal cancer-related mortality. The main objective of this study is to analyse the impact of an ERAS programme for colorectal cancer on 5-year survival. As secondary objectives, we propose to analyse the weight of each of the predefined items in the oncological results as well as the quality of life. METHODS AND ANALYSIS: A multicentre prospective cohort study was conducted in patients older than 18 years of age who are scheduled to undergo surgery for colorectal cancer. The study involved 12 hospitals with an implemented enhanced recovery protocol according to the guidelines published by the Spanish National Health Service. The intervention group includes patients with a minimum implementation level of 70%, and the control group includes those who fail to reach this level. Compliance will be studied using 18 key performance indicators, and the results will be analysed using cancer survival indicators, including overall survival, cancer-specific survival and relapse-free survival. The time to recurrence, perioperative morbidity and mortality, hospital stay and quality of life will also be studied, the latter using the validated EuroQol Five questionnaire. The propensity index method will be used to create comparable treatment and control groups, and a multivariate regression will be used to study each variable. The Kaplan-Meier estimator will be used to estimate survival and the log-rank test to make comparisons. A p value of less than 0.05 (two-tailed) will be considered to be significant. ETHICS AND DISSEMINATION: Ethical approval for this study was obtained from the Aragon Ethical Committee (C.P.-C.I. PI20/086) on 4 March 2020. The findings of this study will be submitted to peer-reviewed journals (BMJ Open, JAMA Surgery, Annals of Surgery, British Journal of Surgery). Abstracts will be submitted to relevant national and international meetings. TRIAL REGISTRATION NUMBER: NCT04305314.