Assessment of the quality of recommendations from 161 clinical practice guidelines using the Appraisal of Guidelines for Research and Evaluation-Recommendations Excellence (AGREE-REX) instrument shows there is room for improvement.

OBJECTIVE: To assess the quality of recommendations from 161 clinical practice guidelines (CPGs) using AGREE-REX-D (Appraisal of Guidelines REsearch and Evaluation-Recommendations Excellence Draft). DESIGN: Cross-sectional study SETTING: International CPG community. PARTICIPANTS: Three hundred twenty-two international CPG developers, users, and researchers. INTERVENTION: Participants were assigned to appraise one of 161 CPGs selected for the study using the AGREE-REX-D tool MAIN OUTCOME MEASURES: AGREE-REX-D scores of 161 CPGs (7-point scale, maximum 7). RESULTS: Recommendations from 161 CPGs were appraised by 322 participants using the AGREE-REX-D. CPGs were developed by 67 different organizations. The total overall average score of the CPG recommendations was 4.23 (standard deviation (SD) = 1.14). AGREE-REX-D items that scored the highest were (mean; SD): evidence (5.51; 1.14), clinical relevance (5.95; SD 0.8), and patients/population relevance (4.87; SD 1.33), while the lowest scores were observed for the policy values (3.44; SD 1.53), local applicability (3,56; SD 1.47), and resources, tools, and capacity (3.49; SD 1.44) items. CPGs developed by government-supported organizations and developed in the UK and Canada had significantly higher recommendation quality scores with the AGREE-REX-D tool (p < 0.05) than their comparators. CONCLUSIONS: We found that there is significant room for improvement of some CPGs such as the considerations of patient/population values, policy values, local applicability and resources, tools, and capacity. These findings may be considered a baseline upon which to measure future improvements in the quality of CPGs.

Molecular mechanisms underlying the entrance in secondary dormancy of Arabidopsis seeds.

As seasons change, dormant seeds cycle through dormant states until the environmental conditions are favourable for seedling establishment. Dormancy cycle is widespread in the plant kingdom allowing the seeds to display primary and secondary dormancy. Several reports in the last decade have focused on understanding the molecular mechanisms of primary dormancy, but our knowledge regarding secondary dormancy is limited. Here, we studied secondary dormancy induced in Arabidopsis thaliana by incubating seeds at 25 °C in darkness for 4 d. By physiological, pharmacological, expression and genetics approaches, we demonstrate that (1) the entrance in secondary dormancy involves changes in the content and sensitivity to GA, but the content and sensitivity to ABA do not change, albeit ABA is required; (2) RGL2 promotes the entrance in secondary dormancy through ABI5 action; and (3) multivariate analysis with 18 geographical and environmental parameters of accession collection place suggests that temperature is an important variable influencing the induction of secondary dormancy in nature.

Comparison of 3 techniques of fat grafting and cell-supplemented lipotransfer in athymic rats: a pilot study.

BACKGROUND: Given the wide application of autologous fat grafting, a new emphasis on fat processing techniques has emerged in an effort to limit unpredictable degrees of resorption often seen with this procedure. With the growing interest in regenerative medicine, approaches to supplement fat grafts with adipose-derived stem cells are evolving in hopes of promoting vascularization and neoadipogenesis. OBJECTIVE: The authors evaluated the outcomes of the most common processing techniques for fat grafting--decantation, washing, high-speed centrifugation--and stromal vascular cell-supplemented lipotransfer to determine which method yields a higher percentage of retention and better quality graft. METHODS: A total of 32 subcutaneous injections of processed human lipoaspirate were carried out in 8 athymic rats. Each animal received all 4 processing conditions, with end points at 4, 8, and 12 weeks postinjection. Evaluation of graft survival included serial measurements of volume retention and histologic analysis. RESULTS: At 12 weeks postinjection, cell-supplemented and centrifuged grafts showed the most consistent volume maintenance. Based on histologic analysis, cell-supplemented and washed grafts had higher scores of viability and vascularity, with the former presenting the least cystic necrosis and calcification as well as minimal inflammation. CONCLUSIONS: Cell-supplemented lipotransfer had optimal outcomes for graft retention, viability, and vascularity, while washing resulted in high viability with a less intensive process. High-speed centrifugation resulted in consistent volume retention but lower viability. Each of these approaches is ideal under different circumstances and contributes to the versatility and reliability of fat grafting.

Analysis of seed phorbol-ester and curcin content together with genetic diversity in multiple provenances of Jatropha curcas L. from Madagascar and Mexico.

Jatropha curcas L. has been promoted as an oilseed crop for use to meet the increased world demand for vegetable oil production, and in particular, as a feedstock for biodiesel production. Seed meal is a protein-rich by-product of vegetable oil extraction, which can either be used as an organic fertilizer, or converted to animal feed. However, conversion of J. curcas seed meal into animal feed is complicated by the presence of toxins, though plants producing "edible" or "non-toxic" seeds occur in Mexico. Toxins present in the seeds of J. curcas include phorbol esters and a type-I ribosome inactivating protein (curcin). Although the edible seeds of J. curcas are known to lack phorbol esters, the curcin content of these seeds has not previously been studied. We analyzed the phorbol ester and curcin content of J. curcas seeds obtained from Mexico and Madagascar, and conclude that while phorbol esters are lacking in edible seeds, both types contain curcin. We also analyzed spatial distribution of these toxins in seeds. Phorbol-esters were most concentrated in the tegmen. Curcin was found in both the endosperm and tegmen. We conclude that seed toxicity in J. curcas is likely to be due to a monogenic trait, which may be under maternal control. We also conducted AFLP analysis and conclude that genetic diversity is very limited in the Madagascan collection compared to the Mexican collection.