Publications by authors named "Joao Amaral"

137 Publications

Pediatric May-Thurner Syndrome-Systematic review and individual patient data meta-analysis.

J Thromb Haemost 2021 Mar 2. Epub 2021 Mar 2.

The Hospital for Sick Children, Toronto, Ontario, Canada.

Background: The outcomes of deep vein thrombosis (DVT) in children with May-Thurner Syndrome (MTS) remain unclear.

Objectives: This systematic review and patient-level meta-analysis aims to describe the outcomes of children with MTS presenting with DVT.

Methods: A systematic review of the published literature was performed. Data related to patients <18 years diagnosed with MTS and DVT was extracted. Risk of bias was assessed using the Murad criteria. Outcomes included vessel patency post-treatment, DVT recurrence, and post-thrombotic syndrome (PTS). Predictive and explanatory models were developed for these outcomes.

Results: In total, 109 cases were identified (age range 4-17 years; 77 females) in 28 studies; 75% of patients had ≥1 additional risk factor for DVT. PTS was seen in 61% of patients, DVT recurrence in 38%, and complete vessel patency post-treatment in 65%. The models developed to predict and explain PTS performed poorly overall. Recurrent thrombosis (adjusted for age and patency) predicted PTS (odds ratio [OR] 3.36, 95% confidence interval [CI] 1.28-8.82). DVT management strategies (adjusted for age and DVT characteristics) predicted vessel patency (OR 2.10, 95% CI 1.43-3.08). Lack of complete vessel patency (adjusted for age and thrombophilia) predicted recurrent DVT (OR 2.70, 95% CI 1.09-6.67). Sensitivity analyses showed the same direction of effects for all outcomes.

Conclusions: PTS and DVT recurrence occur frequently in pediatric MTS. PTS prediction is complex and it was not possible to identify early predictors to guide clinical practice. Use of imaging-guided therapy and thrombus burden predicted venous patency, and lack of patency predicted DVT recurrence.
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http://dx.doi.org/10.1111/jth.15284DOI Listing
March 2021

Image-guided chest tube drainage in the management of chylothorax post cardiac surgery in children: a single-center case series.

Pediatr Radiol 2021 Jan 30. Epub 2021 Jan 30.

Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.

Background: In children, chylothorax post cardiac surgery can be difficult to treat, may run a protracted course, and remains a source of morbidity and mortality.

Objective: To analyze the experience with percutaneous image-guided chest-tube drainage in the management of post-cardiac-surgery chylothoraces in children.

Materials And Methods: We conducted a single-center retrospective case series of 37 post-cardiac-surgery chylothoraces in 34 children (20 boys; 59%), requiring 48 drainage procedures with placement of 53 image-guided chest tubes over the time period 2004 to 2015. We analyzed clinical and procedural details, adverse events and outcomes. Median age was 0.6 years, median weight 7.2 kg.

Results: Attempted treatments of chylothoraces prior to image-guided chest tubes included dietary restrictions (32/37, 86%), octreotide (12/37, 32%), steroids (7/37, 19%) and thoracic duct ligation (5/37, 14%). Image-guided chest tubes (n=43/53, 81%) were single unilateral in 29 children, bilateral in 4 (n=8/53, 15%), and there were two ipsilateral tubes in one (2/53, 4%). Effusions were isolated, walled-off, in 33/53 (62%). In 20/48 procedures (42%) effusions were septated/complex. The mean drainage through image-guided chest tubes was 17.3 mL/kg in the first 24 h, and 13.4 mL/kg/day from diagnosis to chest tube removal; total mean drainage from all chest tubes was 19.6 mL/kg/day. Nine major and 27 minor maintenance procedures were required during 1,207 tube-days (rate: 30 maintenance/1,000 tube-days). Median tube dwell time was 21 days (range 4-57 days). There were eight mild adverse events, three moderate adverse events and no severe adverse events related to image-guided chest tubes. Radiologic resolution was achieved in 26/37 (70%). Twenty-three children (68%) survived to discharge; 11 children (32%) died from underlying cardiac disease.

Conclusion: Management of chylothorax post-cardiac-surgery in children is multidisciplinary, requiring concomitant multipronged approaches, often through a protracted course. Multiple image-guided chest tube drainages can help achieve resolution with few complications. Interventional radiology involvement in tube care and maintenance is required. Overall, mortality remains high.
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http://dx.doi.org/10.1007/s00247-020-04928-2DOI Listing
January 2021

Magnetic Resonance Liver Lymphangiography for Investigation and Transhepatic Lymphatic Embolization for the Treatment of Protein-Losing Enteropathy.

J Vasc Interv Radiol 2021 02 29;32(2):327-329.e2. Epub 2020 Nov 29.

Division of Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada; Medical Imaging Department, University of Toronto, ON, Canada.

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http://dx.doi.org/10.1016/j.jvir.2020.10.012DOI Listing
February 2021

Ciliary body length revisited by anterior segment optical coherence tomography: implications for safe access to the pars plana for intravitreal injections.

Graefes Arch Clin Exp Ophthalmol 2020 Oct 19. Epub 2020 Oct 19.

Department of Ophthalmology, Inselspital, University Hospital of Bern, Bern, Switzerland.

Purpose: To investigate the dependence of the ciliary body length (CBL) on the axial length (AL) and to draw conclusions on implications regarding safe pars plana access for intravitreal injections and vitreoretinal surgery.

Methods: A total of 200 individuals (mean age 42 years, SD ± 15.4) were enrolled in the study. Objective refraction and AL were obtained. Spherical equivalent (SE) was calculated. Anterior segment optical coherence tomography (ASOCT) was used to image and measure the CBL.

Results: The mean SE was - 1.64 diopters (SD ± 3.15, range - 14.5 to + 9 diopters) and the mean AL was 24.19 mm (SD ± 1.65, range 19.8-32.2 mm). There was a significant correlation between SE and AL (r = 0.62, p < 0.0001). Mean CBL correlated significantly with age (r = 0.11, p < 0.0001), AL (r = 0.23, p < 0.0001) and SE (r = 0.25, p < 0.0001). The mean CBL was 3351 μm (SD ± 459, range 2184-4451 μm). Three separate groups were defined by their AL with a normal AL group (AL 22.5 to 25 mm), a short AL group (AL < 22.5 mm) and a long AL group (AL > 25 mm). The mean CBL in the normal AL group was 3311 μm (SD ± 427), in the short AL group 2936 μm (SD ± 335) and in the long AL group 3715 μm (SD ± 365), and differed significantly (p < 0.0001) when compared.

Conclusion: For interventions requiring pars plana access (as an intravitreal injection or vitreoretinal surgery), an incision distance of 3.5-4.0 mm posterior to the limbus is recommended. In our research, however, a difference of 0.77 mm in mean CBL between the group with short AL and the group with long AL is demonstrated, implying that the mean CBL in very short and very long eyes differs significantly. These findings suggest that the AL should be taken into account for pars plana access and that it would be advisable to prefer the shorter or longer recommended distance (3.5 and 4.0 mm, respectively) from the limbus, which correlates with the AL. If AL is > 25 mm, a distance of 4.0 mm from the limbus should be chosen; and if AL is < 22.5 mm, a distance of 3.5 mm seems adequate.

Trial Registration Number And Date: NCT00564291, 27 Nov 2007.
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http://dx.doi.org/10.1007/s00417-020-04967-3DOI Listing
October 2020

In-hospital resource utilization, outcome analysis and radiation exposure in children undergoing appendicostomy vs cecostomy tube placement.

J Pediatr Urol 2020 10 25;16(5):648.e1-648.e8. Epub 2020 Jul 25.

The Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, Canada. Electronic address:

Introduction And Objectives: Continence enemas for the purpose of bowel management may be delivered via trans-anal retrograde irrigations, and via antegrade conduits including surgical appendicostomy or placement of cecostomy tube (CT). An appreciation of the relative advantages and disadvantages of each antegrade continence enema (ACE) procedure allows clinicians, parents and children to make an informed decision regarding which procedure is most appropriate in individual cases. The objective of this study was to evaluate the differences in in-hospital resource utilization, surgical outcomes and radiation exposure between children undergoing appendicostomy creation and CT placement at our institution.

Methods: We conducted a retrospective chart review of children undergoing these procedures at our institution over a 10-year period. All patients 0-18 years of age undergoing either procedure for any indication were included. Data on demographics, length of stay (LOS), radiation exposure events (REE), and surgical outcomes were collected.

Results: One hundred fifteen (63 appendicostomy/52 CT) patients were included. Those undergoing CT placement had significantly increased post-procedural LOS, catheter exchanges and REE compared to those undergoing appendicostomy (see Table). Reported rates of bowel control were similar between the two groups, and there was no significant difference in rates of surgical complications, although each group had unique, procedure-specific complications.

Discussion And Conclusion: In our study, appendicostomy holds a clear advantage over CT in terms of post-procedural LOS, as well as REE. In general, children with CTs require more planned and unplanned device maintenance procedures than those with appendicostomy. These findings aside, the rates of success for bowel control between the two groups are similar, and the incidence of complications does not differ significantly between the two groups. CT remains a safe and effective conduit for delivery of ACEs, and is a particularly good option in patients whose appendix has been lost or used for another conduit. However, patients wishing to avoid repeated procedures and radiation exposure may find the option of appendicostomy more attractive.
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http://dx.doi.org/10.1016/j.jpurol.2020.07.022DOI Listing
October 2020

The utility of post-biopsy ultrasonography in detecting complications after percutaneous liver biopsy in children.

Pediatr Radiol 2020 11 13;50(12):1717-1723. Epub 2020 Aug 13.

Department of Medical Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.

Background: Surveillance post image-guided percutaneous liver biopsy in children is variable.

Objective: The aim of this study was to assess the value of 4-6-h post-procedure ultrasonography (US) in detecting post-liver-biopsy hemorrhage.

Materials And Methods: This prospective study included pediatric patients who underwent US-guided percutaneous liver biopsies. All children had a US study obtained pre-procedure and one obtained 4-6 h post-procedure; US examinations were deemed positive if abnormalities were present. We also reviewed any subsequent imaging that was performed within 7 days (late imaging) at the discretion of the referring team. Changes in US findings (ΔUS) were graded by two radiologists using a descriptive non-validated scale (none, minimal, marked). Hemoglobin (Hb) levels were assessed pre-procedure and 4 h post-procedure. The diagnostic accuracy of US changes for detecting post-procedural hemorrhage was calculated based on a drop in Hb >1.5 g/dL or Hb >15% from baseline (ΔHb). We used a Kruskal-Wallis test to correlate the ΔHb with ΔUS. Association between late-imaging and post-procedure US findings was tested using a chi-square test. We included 224 biopsies.

Results: The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of post-procedure US in detecting post-procedure hemorrhage ranged 26.3-42.1%, 72.4-93.3%, 0.22-0.42, and 0.87-0.88, respectively. No significant association was seen between the ΔHb and sonographic findings (P=0.068). No significant difference was seen in the need for late imaging between children who did and those who did not have positive US findings (P=0.814).

Conclusion: The sensitivity and PPV of post-procedure US in detecting post-procedural hemorrhage are low. Our findings do not support routine post-procedure surveillance US.
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http://dx.doi.org/10.1007/s00247-020-04783-1DOI Listing
November 2020

Changing the magnetic states of an Fe/BaTiO interface through crystal field effects controlled by strain.

Phys Chem Chem Phys 2020 Aug 6;22(32):18050-18059. Epub 2020 Aug 6.

Physics Department and CICECO, University of Aveiro, 3810-193 Aveiro, Portugal.

The search for better and inexpensive magnetoelectric materials is now commonplace in solid state physics. Intense coupling between technologically viable electric and magnetic properties, embedded in a single material, is still an attribute greatly pursued by the scientific community. Following this line of thought, using DFT, the study of a specific interface between the TiO layer of BaTiO and a monolayer of Fe atoms is presented, probing different uni-axial strain effects of the considered supercell. Depending on the strain, several different metastable magnetic states are predicted: a perfectly balanced antiferromagnetic state, an unbalanced ferrimagnetic state, a ferromagnetic state, and a non-magnetic state where each atom has its total magnetic moment quenched. Since these multiple magnetic states can be reversibly controlled by strain, under optimized conditions, this interface can switch from the ferromagnetic state (μ≈ 2.2 μ per Fe) to the non-magnetic state (μ = 0 μ per Fe), enabling enticing prospects for technological applications.
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http://dx.doi.org/10.1039/d0cp01087aDOI Listing
August 2020

Image guided sacroiliac joint corticosteroid injections in children: an 18-year single-center retrospective study.

Pediatr Rheumatol Online J 2020 Jun 17;18(1):52. Epub 2020 Jun 17.

Division of Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.

Background: Sacroiliitis is commonly seen in enthesitis-related arthritis (ERA), a subtype of juvenile idiopathic arthritis (JIA). Sacroiliitis is characterized by the inflammation of the sacroiliac (SI) joints (+/- adjacent tissues). The treatment options include systemic therapy with or without corticosteroid SI joint injections. Image guided SI joint injections are frequently requested in pediatric patients with sacroiliitis. The purpose of this study was to evaluate the feasibility and efficacy of SI joint injections in children with sacroiliitis.

Methods: A retrospective study of patients referred to Interventional Radiology (IR) for SI joint corticosteroid injections (2000-2018). Clinical information was collected from Electronic Patient Charts and procedural details from PACS. Efficacy was determined clinically, by MRI, or both when available.

Results: 50 patients (13.8 years; M:F = 35:15) underwent image-guided SI joint corticosteroid injections. Most common indications were JIA (84%) and inflammatory bowel disease (14%). 80% had bilateral injections. 80% were performed under general anesthesia and 20% under sedation. The corticosteroid of choice was triamcinolone hexacetonide in 98% of patients. Needle guidance and confirmation was performed using CT and fluoroscopy (54%), Cone Beam CT (CBCT, 46%), with initial ultrasound assistance in 34%. All procedures were technically successful without any complications. 32/50 patients had long-term follow-up (2 years); 21/32 (66%) had clinical improvement within 3-months. Of 15 patients who had both pre- and post-procedure MRIs, 93% showed short-term improvement. At 2 years, 6% of patients were in remission, 44% continued the same treatment and 47% escalated treatment.

Conclusion: Image-guided SI joint injections are safe and technically feasible in children. Imaging modalities for guidance have evolved, with CBCT being the current first choice. Most patients showed short-term clinical and imaging improvement, requiring long-term maintenance or escalation of medical treatment.
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http://dx.doi.org/10.1186/s12969-020-00435-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301971PMC
June 2020

Magnetic Resonance Lymphangiography.

Radiol Clin North Am 2020 Jul 6;58(4):693-706. Epub 2020 May 6.

Department of Diagnostic Imaging, The Hospital for Sick Children and Medical Imaging, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.

Dynamic contrast-enhanced magnetic resonance lymphangiography is a novel technique to image central conducting lymphatics. It is performed by injecting contrast into groin lymph nodes and following passage of contrast through lymphatic system using T1-weighted MR images. Currently, it has been successfully applied to image and plan treatment of thoracic duct pathologies, lymphatic leaks, and other lymphatic abnormalities such as plastic bronchitis. It is useful in the assessment of chylothorax and chyloperitoneum. Its role in other areas such as intestinal lymphangiectasia and a variety of lymphatic anomalies is likely to increase.
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http://dx.doi.org/10.1016/j.rcl.2020.02.002DOI Listing
July 2020

Embolization of congenital portosystemic shunt presenting after pediatric liver transplantation: Case report and literature review.

Pediatr Transplant 2020 08 14;24(5):e13713. Epub 2020 May 14.

Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

This case report describes a 13-year 10-month-old girl who underwent a deceased-donor split LT for primary diagnosis of biliary atresia at the age of 12 months, who presented with a lower GI bleed. Ultrasound and CT revealed a venous vascular anomaly involving the cecum and ascending colon, with communication of the SMV and pelvic veins consistent with a CEPS. Associated varices were noted in the pelvis along the uterus and urinary bladder. These findings were confirmed by trans-hepatic porto-venography, which was diagnostic and therapeutic as a successful embolization of the CEPS was performed using micro-coils. There were no complications following the procedure and no further GI bleeding occurred, illustrating the efficacy of this treatment option for CEPS. We discuss the literature regarding the presenting complaint of GI bleeding post-LT, CEPS as a rare cause of GI bleeding and its association with PV, and the classification and treatment of CEPS.
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http://dx.doi.org/10.1111/petr.13713DOI Listing
August 2020

Intraperitoneal hemorrhage in neonate with multifocal hepatic hemangiomas.

Radiol Case Rep 2020 Jul 1;15(7):895-899. Epub 2020 May 1.

Department of Medical Imaging, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.

We describe a case of a 5-day-old male who presented with severe hemoperitoneum due to rupture of one of multiple hepatic hemangiomas, necessitating urgent embolization. Hepatic hemangiomas are common in the pediatric age group. The multifocal type typically presents shortly after birth, and have not been reported to bleed. The focal type is typically congenital with intratumoral bleeding described as a potential complication. We report a previously undescribed presentation of multifocal hepatic hemangiomas.
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http://dx.doi.org/10.1016/j.radcr.2020.04.040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7200612PMC
July 2020

Hemodialysis Catheters in Infants: A Retrospective Single-Center Cohort Study.

J Vasc Interv Radiol 2020 05 15;31(5):778-786. Epub 2020 Apr 15.

Image Guided Therapy, Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON M5G 1X8, Canada.

Purpose: Evaluate technical aspects and outcomes of insertion/maintenance of hemodialysis (HD) central venous catheter (CVC) during infancy.

Materials And Methods: Single-center retrospective study of 29 infants who underwent 49 HD-CVC insertions between 2002 and 2016. Demographics, procedural, and post-procedural details, interventional radiology (IR) maintenance procedures, technical modifications, complications, and outcomes were evaluated. Technical adjustments during HD-CVC placement to adapt catheter length to patient size were labeled "modifications." CVCs requiring return visit to IR were called IR-maintenance procedures. Mean age and weight at HD-CVC insertion were 117 days and 4.9 kg.

Results: Of the 29 patients, 13 (45%) required renal-replacement-therapy (RRT) as neonates, 10 (34%) commenced RRT with peritoneal dialysis (PD), and 19 (66%) with HD. Fifteen nontunneled and 34 tunneled HD-CVCs were inserted while patients were ≤1 year. Technical modifications were required placing 25/49 (51%) HD-CVCs: 5/15 (33%) nontunneled and 20/34 (59%) tunneled catheters (P = .08). Patients underwent ≤6 dialysis-cycles/patient during infancy (mean 2.3), and a mean of 4.1 and 49 HD-sessions/catheter for nontunneled and tunneled HD-CVCs, respectively. Mean primary and secondary device service, and total access site intervals for tunneled HD-CVCs were 75, 115, and 201 days, respectively. A total of 26 of 49 (53%) patients required IR-maintenance procedures. Nontunneled lines had greater catheter-related bloodstream infections per 1,000 catheter-days than tunneled HD-CVCs (9.25 vs. 0.85/1,000 catheter days; P = .02). Nineteen patients (65%) survived over 1 year. At final evaluation (December 2017): 8/19 survived transplantation, 5/19 remained on RRT, 2/19 completely recovered, 1/19 lost to follow-up, and 3 died at 1.3, 2, and 10 years.

Conclusions: Placement/maintenance of HD-CVCs in infants pose specific challenges, requiring insertion modifications, and IR-maintenance procedures to maintain function.
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http://dx.doi.org/10.1016/j.jvir.2020.01.020DOI Listing
May 2020

Use of Tissue Plasminogen Activator in Abdominal Abscesses in Children-A Single-Center Randomized Control Trial.

Can Assoc Radiol J 2020 Apr 13:846537120914263. Epub 2020 Apr 13.

Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada.

Purpose: To establish the efficacy of once-per-day intracavitary tissue plasminogen activator (tPA) in the treatment of pediatric intra-abdominal abscesses.

Methods: A single-center prospective, double-blinded, randomized controlled trial of the use of intracavitary tPA in abdominal abscesses in children. Patients were randomized to either tPA-treatment or saline-treatment groups. Primary outcome was drainage catheter dwell (hours). Secondary outcomes were length of hospital stay, times to discharge, clinical and sonographic resolution, and adverse events (AEs).

Results: Twenty-eight children were randomized to either group (n = 14 each). Demographics between groups were not significantly different (age = .28; weight = .40; gender = .44). There were significantly more abscesses in the tPA-treated group ( = .03). Abscesses were secondary to perforated appendicitis (n = 25) or postappendectomy (n = 3). Thirty-four abscesses were drained, 4 aspirated, 3 neither drained/aspirated. There was no significant difference in number of drains ( = .14), drain size ( = .19), primary outcome ( = .077), or secondary outcomes found. No procedural or intervention drug-related AEs occurred. No patient in the saline-treated group required to be switched/treated with tPA.

Conclusion: No significant difference in the length of catheter dwell time, procedure time to discharge, or time to resolution was found. Intracavitary tPA was not associated with morbidity or mortality. The results neither support nor negate routine use of tPA in the drainage of intra-abdominal abscess in children. It is possible that a multicentre study with a larger number of patients may answer this question more definitively.
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http://dx.doi.org/10.1177/0846537120914263DOI Listing
April 2020

Measuring the topological charge of coherence vortices through the geometry of the far-field cross-correlation function.

Appl Opt 2020 Feb;59(6):1553-1557

Determination of orbital angular momentum of optical vortex beams has attracted the attention of many researchers over the last few years. For some applications, it is convenient to use a partially coherent vortex beam because of its robustness. In this work, we developed a method to measure the topological charge of a partially coherent vortex beam. Our method relies simply in the measurement of the minimum radius of a zero contour of the modulus of the cross-correlation function and in the measurement of the full width at half maximum of its central spot.
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http://dx.doi.org/10.1364/AO.381556DOI Listing
February 2020

Sorting of spatially incoherent optical vortex modes.

Sci Rep 2020 Feb 13;10(1):2533. Epub 2020 Feb 13.

Instituto de Física, Universidade Federal de Alagoas, P.O. Box 2051, Maceió, AL, 57061-970, Brazil.

Coherent optical vortices have promising applications in quantum and classical optical communication. They add new degrees of freedom to code information. In this context, to implement a tool enabling sorting of spatially multiplexed vortex states is fundamental. By other hand, spatially incoherent vortices can be more robust in propagation through noise media, such as turbulent atmosphere or obstacles that block part of the light. Therefore, in this work we propose directly applying a high-resolution sorting scheme to spatially incoherent vortex states.
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http://dx.doi.org/10.1038/s41598-020-59428-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018742PMC
February 2020

Magnetic Driven Nanocarriers for pH-Responsive Doxorubicin Release in Cancer Therapy.

Molecules 2020 Jan 14;25(2). Epub 2020 Jan 14.

CICECO-Aveiro Institute of Materials, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal.

Doxorubicin is one of the most widely used anti-cancer drugs, but side effects and selectivity problems create a demand for alternative drug delivery systems. Herein we describe a hybrid magnetic nanomaterial as a pH-dependent doxorubicin release carrier. This nanocarrier comprises magnetic iron oxide cores with a diameter of 10 nm, enveloped in a hybrid material made of siliceous shells and ĸ-carrageenan. The hybrid shells possess high drug loading capacity and a favorable drug release profile, while the iron oxide cores allows easy manipulation via an external magnetic field. The pH responsiveness was assessed in phosphate buffers at pH levels equivalent to those of blood (pH 7.4) and tumor microenvironment (pH 4.2 and 5). The nanoparticles have a loading capacity of up to 12.3 wt.% and a release profile of 80% in 5 h at acidic pH versus 25% at blood pH. In vitro drug delivery tests on human breast cancer and non-cancer cellular cultures have shown that, compared to the free drug, the loaded nanocarriers have comparable antiproliferative effect but a less intense cytotoxic effect, especially in the non-cancer cell line. The results show a clear potential for these new hybrid nanomaterials as alternative drug carriers for doxorubicin.
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http://dx.doi.org/10.3390/molecules25020333DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7024164PMC
January 2020

Is Routine Preprocedural Bloodwork Needed for Elective Central Venous Access Device Removals in Children without Bleeding Dyscrasias?

J Vasc Interv Radiol 2020 Feb 26;31(2):276-281.e1. Epub 2019 Dec 26.

Division of Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada.

Purpose: To assess the utility of routine preprocedural bloodwork during elective removal of central venous access devices (CVADs) with respect to bleeding complications.

Materials And Methods: Patients who underwent removal of a CVAD (tunneled central venous catheter [CVC] or port) by the interventional radiology service between January 2009 and December 2013 were retrospectively reviewed. Removals for infection or malfunction, without preprocedural bloodwork, with another concurrent procedure at the time of CVAD removal, or in patients with a bleeding dyscrasia were excluded. Peripherally inserted central catheter removals and temporary CVAD removals were also excluded. Routine preprocedural bloodwork included hemoglobin, platelet count, partial thromboplastin time, and International Normalized Ratio. Postprocedural complications were classified according to the Society of Interventional Radiology clinical practice guidelines.

Results: There were 802 CVAD removals in 777 patients (351 female, 426 male). Average patient age was 8.6 years (range, 5 wk to 19 y). In total, 246 permanent CVCs and 556 ports were removed. A total of 802 cases had preprocedural bloodwork. Of the 49 patients who had a bleeding complication after the procedure (6.1%; 49 of 802), 44 had normal findings on preprocedural bloodwork and 5 had abnormal findings. There was no statistically significant difference in bleeding complications between those with normal and abnormal bloodwork results (P = .7740).

Conclusions: Routine bloodwork is not necessary before elective CVAD removal in children without a bleeding dyscrasia. Most children have normal findings on preprocedural bloodwork, and the incidence of postprocedural bleeding is low and not determined by bloodwork results.
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http://dx.doi.org/10.1016/j.jvir.2019.10.012DOI Listing
February 2020

Patient-related outcomes in Sjögren syndrome treated with stimulants of salivary secretion: Randomized clinical trial.

Oral Dis 2020 Mar 26;26(2):313-324. Epub 2019 Dec 26.

Oral Biology & Biochemistry Research Group, LIBPhys-FCT UID/FIS/04559/2013, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal.

Objectives: To investigate the impact of gustatory stimulants of salivary secretion (GSSS) on Sjögren's syndrome patients' self-perception of xerostomia, oral health-related quality of life (OHRQoL) and salivary secretion.

Methods: A total of 110 Sjögren's syndrome patients were randomly allocated to be treated with either a malic acid lozenge or a citric acid mouthwash and then crossed over. Before and after the interventions, the Xerostomia Inventory 5 (SXI-5-PL) and the Oral Health Impact Profile (OHIP-14-PT) questionnaires (both in the Portuguese language) were administered to patients. Unstimulated, mechanical and gustatory-stimulated salivary flows were determined. Repeated measures and between-subject analyses were performed. Statistical significance was set at 5%.

Results: After the intervention and within each group, both GSSS elicited a reduction in the SXI-5-PL and OHIP-14-PT scores and an increase in salivary output, significant in the malic acid lozenge group. The malic acid treatment resulted in a greater effect size and percentage improvement than citric acid mouthwash. The malic acid lozenge also produced a significant greater salivary output than the citric acid rising solution.

Conclusions: In Sjögren's syndrome patients, lozenges containing malic acid increased saliva production and xerostomia relief, resulting in improved quality of life.
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http://dx.doi.org/10.1111/odi.13251DOI Listing
March 2020

Magnetic nanosorbents with siliceous hybrid shells of alginic acid and carrageenan for removal of ciprofloxacin.

Int J Biol Macromol 2019 Oct 5;139:827-841. Epub 2019 Aug 5.

CICECO-Aveiro Institute of Materials, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal. Electronic address:

Water contamination with antibiotics is a serious environmental threat. Ciprofloxacin (CIP) is one of the most frequently detected antibiotics in water. Herein, silica-based magnetic nanosorbents prepared using three seaweed polysaccharides, alginic acid, κ- and λ-carrageenan, were developed and evaluated in the uptake of ciprofloxacin. The sorbents were firstly characterized in detail to assess their morphology and composition. A systematic investigation was conducted to study the adsorption performance towards CIP, by varying the initial pH, contact time and initial CIP concentration. The maximum adsorption capacity was 464, 423 and 1350 mg/g for particles prepared from alginic acid, κ- and λ-carrageenan respectively. These high values indicate that these materials are among the most effective sorbents reported so far for the removal of CIP from water. The kinetic data were consistent with the pseudo-second-order model. The CIP adsorption on λ-carrageenan particles followed a cooperative process with sigmoidal isotherm that was described by the Dubinin-Radushkevich model. The high charge density of λ-carrageenan and the propensity of CIP molecules to self-aggregate may explain the cooperative nature of CIP adsorption. The sorbents were easily regenerated in mild conditions and could be reused in CIP removal up to 4 times without a significant loss of adsorptive properties.
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http://dx.doi.org/10.1016/j.ijbiomac.2019.08.030DOI Listing
October 2019

Evaluation of implanted venous port-a-caths in children with medical complexity and neurologic impairment.

Pediatr Radiol 2019 09 13;49(10):1354-1361. Epub 2019 Jul 13.

Image Guided Therapy Centre, Diagnostic Imaging Department, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.

Background: Children with medical complexity and associated neurologic impairment frequently face difficulties with venous access. Intermittently they require urgent intravenous administration of fluids and medication.

Objective: To analyze the use of implanted port-a-caths in children with medical complexity who have neurologic impairment and difficult venous access.

Materials And Methods: We performed a single-center observational study of port-a-caths placed by interventional radiologists in children with medical complexity with neurologic impairment. We analyzed peripheral intravenous access attempts, peripheral intravenous starts, peripheral intravenous complications, alternative temporary central venous access devices, port-a-cath insertions, catheter days, access days, port-a-cath-related complications, hospital admissions and emergency department visits. We compared the year pre port-a-cath to the year post port-a-cath.

Results: Twenty-one children with medical complexity with neurologic impairment (10 boys, 11 girls; median age 4.1 years; median weight 13.7 kg) underwent 26 port-a-cath insertions (median catheter days 787). In the year post port-a-cath compared to pre port-a-cath there was a highly significant reduction (P<0.001) in numbers of peripheral intravenous attempts, peripheral intravenous starts and skin punctures; and a significant reduction (P<0.05) in need for other devices, number of emergency department visits, emergency department visits resulting in hospital admissions, and total admissions. Adverse events were graded as mild (n=18), moderate (n=6) and severe (n=0).

Conclusion: Port-a-cath placement in children with medical complexity with neurologic impairment significantly reduced all peripheral intravenous attempts, peripheral intravenous starts, skin punctures, total number of emergency department visits, visits culminating in admission, and total number of inpatient admissions. Advantages must be considered against potential port-a-cath-related adverse events.
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http://dx.doi.org/10.1007/s00247-019-04470-wDOI Listing
September 2019

Experience with Compressed Gelfoam Plugs in Children during Liver Biopsies and Other IR Procedures: A Retrospective Single-Center Case Series.

J Vasc Interv Radiol 2019 Nov 13;30(11):1855-1862. Epub 2019 Jun 13.

Department of Diagnostic Imaging, Division of Image Guided Therapy, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.

Purpose: To analyze the experience using compressed gelfoam plugs (CGPs) in children during liver biopsies and other interventional procedures.

Materials And Methods: This was a single-center, retrospective, consecutive case series of 477 various pediatric interventional radiology procedures using CGPs (January 2012 to December 2016) performed on 397 children (209 males, 188 females; median age, 7 years [range, 9 days-17.8 years]; median weight, 18 kg [range, 2.7-141 kg]). Of 477 procedures, most (n = 371) were liver biopsies, 98 were biopsies of other organs, and 8 were non-biopsy procedures. Analysis focused on liver biopsies.

Results: Of liver biopsies, a median of 2 CGPs were used per procedure, and the mean drop in hemoglobin was -0.36 g/dl (-3.0% change). Thirty-seven mild, 8 moderate, 2 severe, and 1 life-threatening (an anaphylaxis to CGP) adverse events (AEs) occurred. Analysis of liver biopsies with AEs showed significant association between number of passes, cores, and focal-type lesions (unadjusted logistic regression: P = .007, P = .022, P = .028, respectively) and age, weight, and number of passes (adjusted multiple logistic regression: P = .006, P = .032, P = .046, respectively). Technical problems relating to CGP deployment were noted in 5 (1%), without any AEs.

Conclusions: CGPs were used in a wide variety of procedures and organs in children. There was 1 life-threatening AE resulting from the rare risk of anaphylaxis caused by the gelfoam-containing plug. After liver biopsies, transfusion was required in 2/371 (0.5%) procedures, 1 related to pre-biopsy anemia (0.25%).
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http://dx.doi.org/10.1016/j.jvir.2019.04.004DOI Listing
November 2019

Understanding oral health care team performance in primary care: A mixed-method study.

PLoS One 2019 30;14(5):e0217738. Epub 2019 May 30.

Department of Community and Preventive Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

Objective: This study aims to describe the primary care services carried out by Oral Health Teams (OHTs) in Brazil, and to understand the nuances that lead to different levels of OHT performance.

Material & Methods: A mixed-methods study with a sequential explanatory design was developed. In the quantitative phase, secondary data from a national survey (PMAQ-AB) was used to describe the work of 12,403 OHTs. Item response theory (IRT) was applied, to evaluate the psychometric qualities of 20 oral health questions from PMAQ-AB and to identify the performance of OHT. The quantitative results guided the selection of the qualitative sample. An extreme case sampling strategy was used (opposite results). OHTs were selected from Belo Horizonte metropolitan region in Brazil using scores measured by IRT. Data were collected through semi-structured interviews. Data analysis was conducted using deductive and inductive thematic analysis.

Results: Quantitative results showed that there are OHT with high and low performance in Brazil. The IRT analysis showed that items related to prostheses and oral cancer tend to discriminate high-performance OHTs from other OHTs. Qualitative results deepened the understanding of accessing oral health services and found several access barriers, such as the insufficient number of OHTs for the population, and a very long waiting time for dental consultations other than urgency. The qualitative results confirmed that high-performance OHTs tend to emphasize oral cancer surveillance and deliver prostheses in PHC services.

Conclusion: Despite the expansion of oral health in PHC in Brazil in recent years, OHTs still face many challenges such as: access barriers; failures in prevention, early diagnosis and follow-up of oral cancer cases; and insufficient rehabilitation with prostheses.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0217738PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6542530PMC
February 2020

Method to define non-diffracting optical beams mimicking the shape of simple plane curves.

Appl Opt 2019 May;58(13):3659-3663

We theoretically and experimentally demonstrate a method to define non-diffracting beams with different geometries. Our findings constitute an alternative to current methods for finding non-diffracting beams, which rely on the solution of the wave equation in a given coordinate system that has a limited number of possibilities or uses a complicated and time-consuming optimization algorithm. Therefore, the method is easier to follow, because it does not require optimization and allows one to obtain non-diffracting beams mimicking the geometry of simple plane curves. The method could find applications in manipulation of matter with optical waves, such as colloidal and living particles, and in quantum, nonlinear, and atom optics.
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http://dx.doi.org/10.1364/AO.58.003659DOI Listing
May 2019

Use of the Transrectal Ultrasound Probe in Aspiration and Drainage in Pediatric Patients: A Retrospective Observational Study.

J Vasc Interv Radiol 2019 Jun 5;30(6):908-914. Epub 2019 Apr 5.

Division of Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Avenue, 2810B, Toronto, Canada M5G 1X8.

Purpose: To retrospectively evaluate the safety and efficacy of transrectal ultrasound (TRUS) probe use for aspiration and drainage of pelvic abscesses in children.

Materials And Methods: Patient demographics, procedural details, technical success, safety, and clinical course of TRUS procedures were retrospectively analyzed. Between 2007 and 2016, 118 TRUS-guided procedures were performed in 115 children (60 males, 55 females); median age was 12.4 years (range, 2.4-17.9 years) and median weight was 45 kg (range, 12.6-112 kg). Ten children were 5 years of age or younger.

Results: In total, 113/118 procedures were performed under general anesthesia. The rectum accommodated the probe and needle guide without resistance in all children (technical feasibility, 100%). Abscesses were anterior to the rectum in 116/118 and posterior in 2/118. One hundred twelve collections were drained, 4 were aspirated, and 2 procedures were aborted, both subsequently successfully drained (2 and 3 days later). One patient underwent repeat drainage after 28 months. No major complications were reported. Median times to temperature normalization was 0 days (mean, 1.2; range, 0-13 days), catheter dwell time 5 days (mean, 6; range, 2-21 days), drain removal to discharge 1 day (mean, 2; range, 0-41 days), and follow-up 117 days (mean, 195; range, 5-2,690 days).

Conclusions: TRUS-guided drainage using the TRUS probe and needle guide is a safe and effective method for aspiration and drainage of pelvic abscesses in children as young as 2 years.
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http://dx.doi.org/10.1016/j.jvir.2018.09.023DOI Listing
June 2019

Effect of dietary supplementation of palm kernel cake on ovarian and hepatic function in buffalo (Bubalus bubalis).

Anim Reprod Sci 2019 May 14;204:76-85. Epub 2019 Mar 14.

São Paulo State University (UNESP), School of Agrarian and Veterinary Sciences, Department of Preventive Veterinary Medicine and Animal Reproduction, Campus Jaboticabal, São Paulo, Brazil; São Paulo State University (UNESP), School of Veterinary Medicine, Laboratory of Reproductive Physiology, Campus Araçatuba, São Paulo, Brazil.

To determine the optimal inclusion amount of palm kernel cake (PKC) in a buffalo diet, in the present study there was evaluation of the ovarian activity, metabolism and hepatic function of females that were treated to synchronize the time of ovulation. Twenty-four estrous-cyclic and non-lactating Murrah buffalo with a mean age of 5.7 years were supplemented with 0%, 0.25%, 0.5% and 1% of their body weight (BW) with PKC. Animals were subjected to the Ovsynch protocol (beginning of protocol = D0). The ovaries were examined and the blood was collected on D10 (follicular phase) and D17 (luteal phase). Follicular and luteal development and serum progesterone concentrations were not affected by diet (P > 0.05). Serum concentrations of cholesterol were greater in animals supplemented with PKC in amounts at 0.5% of BW or less with PKC, regardless of the phase of the estrous cycles when evaluations occurred (P < 0.05). Concentrations of HDL-cholesterol were similar (P > 0.05) during the follicular and luteal phases. Triglyceride concentrations increased linearly (P = 0.03) as percentage of PKC inclusion diets increased during the follicular phase, but were similar in the luteal phase (60.0 mg/dL; P = 0.51). Amount of PKC supplementation did not affect the concentrations of alanine aminotransferase, but there was a greater amount of aspartate aminotransferase (AST) and gamma glutamyl transferase (GGT) during both phases of the estrous cycle (P < 0.05). Animals supplemented at 1.0% of BW with PKC had greater AST and GGT concentrations than what is recommended for buffalo. The results of the present study indicate PKC supplementation of buffalo diets does not affect the development of the ovarian follicle and corpus luteum nor the peripheral concentration of progesterone, even though there are greater serum concentrations of total cholesterol and triglycerides. Because the amount of PKC supplementation in the present study does not result in hepatic dysfunction when fed at the 0.5% of BW amount, it is suggested that this agro-industrial byproduct of high nutritional value may be a new alternative for dietary supplementation of grazing buffalo.
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http://dx.doi.org/10.1016/j.anireprosci.2019.03.007DOI Listing
May 2019

Clinical Impact of Chronic Venous Changes Induced by Central Lines in Children: A Cohort with Abnormal Venograms.

J Vasc Interv Radiol 2019 May 27;30(5):715-723. Epub 2019 Mar 27.

Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, M5G 1X8, Canada.

Purpose: To explore the hypothesis that central venous stenosis/obstructions (CVS/O) in children are influenced by prior central venous access devices (CVADs) and are associated with future risk for thromboses.

Material And Methods: A convenience sample of 100 patients with abnormal venography (stenosis, collaterals, occlusions) documented during peripherally inserted central catheter (PICC) placements were identified from consecutive PICC placements (January 2008 to November 2012). The patients (41 males, 59 females, median age 2.7 years, median weight 11 kg) were categorized based on venographic presence (Group A, n = 53) or absence (Group B, n = 47) of visible connection to the superior vena cava. Each patient's CVAD history, before and after venography, was analyzed (until October 2016).

Results: Before venogram, Group B patients were associated with a higher number of previous CVADs, larger diameter devices, greater incidence of malposition, and more use of polyurethane catheters than Group A patients (P < .001). An ipsilateral PICC was successfully placed in 98% of Group A, compared to 32% of Group B (P < .001). After venogram, significantly more Doppler ultrasounds (DUS) were performed and thromboses diagnosed in Group B (57% and 36%) compared to Group A (21% and 8%) (P < .003; P = .001), respectively.

Conclusions: Previous catheter characteristics influenced the severity of venographic changes of CVS/O (Group B). Group B was associated with more subsequent symptomatic thromboses. This information may assist parents and referring physicians to anticipate potential adverse sequelae from CVS/O on the child's venous health.
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http://dx.doi.org/10.1016/j.jvir.2018.08.034DOI Listing
May 2019

Mothers' perception about health education in brazilian primary health care: A qualitative study.

Int J Paediatr Dent 2019 Sep 27;29(5):669-676. Epub 2019 Mar 27.

Dentistry School, Federal University of Minas Gerais - Social and Preventive Department, Belo Horizonte, Minas Gerais, Brazil.

Background: Health education actions are strategic actions aimed at health promotion. Moreover, better health education practices have been linked to comprehensive care developed by primary health services.

Aim: To understand the perception of mothers about the health education developed by the Primary Health Care (PHC) services.

Design: We adopted a qualitative research approach, conducted using semi-structured interviews, and assuming, as the theoretical reference, the attributes derived from PHC. Pregnant women and mothers of children under 1 year old attended by Brazilian Family Health teams were included.

Results: Eight pregnant women and twelve mothers of children under 1 year of age participated in the study. These mothers perceive educational actions as necessary only for primiparous mothers. They value the guidance of informal networks and maternity hospitals to the detriment of primary services, and they do not adhere to care that conflicts with their previous knowledge. The evidence shows that the educational actions of the primary health services do not adequately respond to the attributes of community orientation, family focus, and cultural competence.

Conclusion: It is necessary to modify the educational practices in order to incorporate and value the existing knowledge in the territory, thereby adapting the care guidelines to the local context.
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http://dx.doi.org/10.1111/ipd.12489DOI Listing
September 2019

In Situ Gonadal Vein Valvulotomy and Side-to-side Gonado-iliac Bypass for the Management of Nutcracker Syndrome in an Adolescent With a Solitary Kidney and Absence of Pelvic Congestion.

Urology 2019 Apr 4;126:200-203. Epub 2019 Jan 4.

Division of Urology, Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada. Electronic address:

Herein we present the first case report of laparoscopic exploration, endovascular valvulotomy, and open side-to-side bypass of a gonadal vein into the ipsilateral external iliac vein for Nutcracker syndrome in an adolescent patient with solitary kidney without pelvic congestion. Though prior management has included various large open surgeries or endovascular or extravascular approaches with the use of stents and shields, this case offers an expanded novel approach to weigh the unique challenges of the patient's age and solitary renal status. If reproducible, this technique may gain value in the management of patients with this rare, incapacitating condition.
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http://dx.doi.org/10.1016/j.urology.2018.12.033DOI Listing
April 2019

Features, Behavioral Change Techniques, and Quality of the Most Popular Mobile Apps to Measure Physical Activity: Systematic Search in App Stores.

JMIR Mhealth Uhealth 2018 Oct 26;6(10):e11281. Epub 2018 Oct 26.

School of Technology and Management at Águeda, University of Aveiro, Aveiro, Portugal.

Background: It is estimated that 23% of adults and 55% of older adults do not meet the recommended levels of physical activity. Thus, improving the levels of physical activity is of paramount importance, but it requires the use of low-cost resources that facilitate universal access without depleting the health system. The high number of apps available constitutes an opportunity, but it also makes it quite difficult for the layperson to select the most appropriate app. Furthermore, the information available in the app stores is often insufficient, lacks quality, and is not evidence based, and the systematic reviews fail to assess app quality using standardized and validated instruments.

Objective: The objective of this study was to systematically assess the features, content, and quality of the most popular apps that can be used to measure and, potentially, promote physical activity.

Methods: Systematic searches were conducted on Apple App Store, Google Play, and Windows Phone Store between December 2017 and January 2018. Apps were included if their primary objective was to assess the aspects of physical activity, if they had a user rating of at least 4, if their number of ratings was ≥100, and if they were free. Apps meeting these criteria were independently assessed by two reviewers regarding their general and technical information, aspects of physical activity, presence of behavioral change techniques, and quality. Data were analyzed using means and SDs or frequencies and percentages.

Results: Of 51 apps included, none specified the age of the target group and only one mentioned the involvement of health professionals. Most apps offered the possibility to work in background (n=50) and allowed data sharing (n=40). Regarding physical activity, most apps measured steps and distance (n=11) or steps, distance, and time (n=17). Only 18 apps, all of which measured number of steps, followed the guidelines on recommendations for physical activity. On average, 5.5 (SD 1.8) behavioral change techniques were identified per app; the most frequently used techniques were "provide feedback on performance" (n=50) and "prompt self-monitoring of behavior" (n=50). The overall quality score was 3.88 (SD 0.34).

Conclusions: Although the overall quality of the apps was moderate, the quality of their content, particularly the use of international guidelines on physical activity, should be improved. Additionally, a more in-depth assessment of apps should be performed before releasing them for public use, particularly regarding their reliability and validity.
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http://dx.doi.org/10.2196/11281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6229520PMC
October 2018