Accidental tetanus: prognosis evaluation in a historical series at a hospital in Salvador, Bahia, Brazil

A total of 868 (84.89%) patients diagnosed with tetanus were studied, out of the 1,024 tetanus patients hospitalized at Couto Maia Hospital (Salvador, Bahia, Brazil), during the period between 1986 and 1997. Of this group (n = 868), 63.5% (n = 551) were discharged, 35.4% (n = 307) died, and 1.1% (n = 10) were transferred. The average age of the deceased patients (38.73 ± 23.31 years) was significantly greater (p < 0.0001) than the age of those who survived (29.21 ± 20.05 years). Analyzing the variables of the logistic regression model with statistic significance (p £ 0.25) for univariate analysis, we observed a greater association of risk for worst prognosis (death) in patients aged ³ 51 years; time of illness < 48 hours; time of incubation < 168 hours; neck rigidity; spasms; opisthotonos; body temperature ³ 37.7 ºC; heart beat ³ 111 beats/minute; sympathetic hyperactivity and association with pneumonia. Among the group of those who survived, patients with 1 to 5 of those variables (n = 398; 76.8%) were more frequent, while among patients of the group of the deceased, 70.3% (n = 206) presented 6 to 10 of those variables, with a highly significant difference (p < 10-8). In conclusion, the indicators described provide early information that may guide the prognosis and medical and nurse care.

A reliability-based measure of robustness for concrete structures subjected to corrosion

This work is a contribution to the definition and assessment of structural robustness. Special emphasis is given to reliability of reinforced concrete structures under corrosion of longitudinal reinforcement. On this communication several authors’ proposals in order to define and measure structural robustness are analyzed and discussed. The probabilistic based robustness index is defined, considering the reliability index decreasing for all possible damage levels. Damage is considered as the corrosion level of the longitudinal reinforcement in terms of rebar weight loss. Damage produces changes in both cross sectional area of rebar and bond strength. The proposed methodology is illustrated by means of an application example. In order to consider the impact of reinforcement corrosion on failure probability growth, an advanced methodology based on the strong discontinuities approach and an isotropic continuum damage model for concrete is adopted. The methodology consist on a two-step analysis: on the first step an analysis of the cross section is performed in order to capture phenomena such as expansion of the reinforcement due to the corrosion products accumulation and damage and cracking in the reinforcement surrounding concrete; on the second step a 2D deteriorated structural model is built with the results obtained on the first step of the analysis. The referred methodology combined with a Monte Carlo simulation is then used to compute the failure probability and the reliability index of the structure for different corrosion levels. Finally, structural robustness is assessed using the proposed probabilistic index.

O Valor Prognóstico da Resposta Neutrofílica na Era da Reperfusão Mecânica do Enfarte Agudo do Miocárdico

BACKGROUND: In ST-segment elevation myocardial infarction (STEMI) patients treated with primary angioplasty, neutrophil response and its prognostic significance are not entirely understood. METHODS: We retrospectively studied 305 consecutive and non-selected STEMI patients. They were divided into three groups according to the maximum neutrophil percentage in the first 48 hours. We compared baseline demographic characteristics, coronary disease risk factors, cardiac history, clinical presentation, therapeutics administered and clinical evolution. We then assessed survival in the three groups and determined predictors of 30-day mortality. Group 1 (G1) had a mean age of 57 +/- 14 years and showed mean neutrophilia of 73.3%, Group 2 (G2) 61 +/- 13 years and 79.9%, and Group 3 (G3) 66 +/- 13 years and 84.2%. We compared outcomes and 30-day mortality between the groups. RESULTS: Mean age rose with increased neutrophil response. There were no statistically significant baseline differences between the groups except for more smokers in Groups 1 and 2, and more patients presenting with Killip class > or = 2 and fewer with uncomplicated evolution in Group 3. During 30-day follow-up there were 19 deaths (G1=1, G2=3 and G3=15). In univariate analysis mortality predictors were age > or = 75 years, anterior STEMI, maximum creatinine kinase > or = 2500 UI/L, culprit lesion in proximal anterior descending artery, incomplete revascularization, Killip > or = 2 at presentation, and being in G3. After multivariate regression analysis independent predictors were age > or = 75 years, incomplete revascularization and being in G3. CONCLUSION: In myocardial infarction patients undergoing mechanical revascularization, an intense neutrophil response (routinely, easily and inexpensively assessed) is related to worse short-term prognosis.

Impacto da Obesidade nos Resultados após Angioplastia Primária em Doentes com Enfarte Agudo do Miocárdio com Elevação do Segmento ST

INTRODUCTION: Obesity is an important risk factor for the development of diabetes, hypertension, coronary disease, left ventricular dysfunction, stroke and cardiac arrhythmias. Paradoxically, previous studies in patients undergoing elective coronary angioplasty showed a reduction in hospital and long-term mortality in obese patients. The relation with body mass index (BMI) has been less studied in the context of primary angioplasty. OBJECTIVES: To evaluate the impact of obesity on the results of ST-segment elevation acute myocardial infarction treated by primary angioplasty. METHODS: This was a study of 464 consecutive patients with ST-segment elevation acute myocardial infarction undergoing primary angioplasty, 78% male, mean age 61 +/- 13 years. We assessed in-hospital, 30-day and one-year mortality according to BMI. Patients were divided into three groups according to BMI: normal--18-24.9 kg/m2 (n = 171); overweight--25-29.9 kg/m2 (n = 204); and obese-- > 30 kg/m2 (n = 89). RESULTS: Obese patients were younger (ANOVA, p < 0.001) and more frequently male (p = 0.014), with more hypertension (p = 0.001) and dyslipidemia (p = 0.006). There were no differences in the prevalence of diabetes, previous cardiac history, heart failure on admission, anterior location, multivessel disease, peak total CK or medication prescribed, except that obese patients received more beta-blockers (p = 0.049). In-hospital mortality was 9.9% for patients with normal BMI, 3.4% for overweight patients and 6.7% for obese patients (p = 0.038). Mortality at 30 days was 11 4.4% and 7.8% (p = 0.032) and at one year 12.9%, 4.9% and 9% (p = 0.023), respectively. On univariate analysis, overweight was the only BMI category with a protective effect; however, after multivariate logistic regression analysis, adjusted for confounding variables, none of the BMI categories could independently predict outcome. CONCLUSIONS: Overweight patients had a better prognosis after primary angioplasty for ST-segment elevation acute myocardial infarction compared with other BMI categories, but this was dependent on other potentially confounding variables.

Variáveis Ecocardiográficas Predizentes de Terapêuticas Apropriadas de Taquidisritmias Ventriculares em Doentes Submetidos a Terapêutica de Ressincronização Cardíaca Combinada

INTRODUCTION: The significant risk of sudden arrhythmic death in patients with congestive heart failure and electromechanical ventricular dyssynchrony has led to increased use of combined cardiac resynchronization therapy defibrillator (CRT-D) devices. OBJECTIVES: To evaluate the echocardiographic variables in patients undergoing CRT-D that predict the occurrence of appropriate therapies (AT) for ventricular tachyarrhythmia. METHODS: We analyzed 38 consecutive patients (mean age 60 +/- 12 years, 63% male) with echocardiographic evaluation before and 6 months after CRT-D implantation. Patients with AT were identified in a mean follow-up of 471 +/- 323 days. A standard echocardiographic study was performed including tissue Doppler imaging (TDI). Responders were defined as patients with improvement in NYHA class of < or = 1 in the first six months, and reverse remodeling as a decrease in left ventricular end-systolic volume of < or = 15% and/or an increase in left ventricular ejection fraction of > 25%. RESULTS: The responder rate was 74%, and the reverse remodeling rate was 55%. AT occurred in 21% of patients, who presented with greater left ventricular end-diastolic internal diameter (LVEDD) before implantation (86 +/- 8 vs. 76 +/- 11 mm, p = 0.03) and at 6 months (81 +/- 8 vs. 72 +/- 14 mm, p = 0.08), and increased left ventricular end-systolic internal diameter (66 +/- 14 vs. 56 +/- 14 mm, p = 0.03) and lower ejection fraction (24 +/- 6 vs. 34 +/- 14%, p = 0.08) at 6 months. In the group with AT, the responder rate was lower (38 vs. 83%, p = 0.03), without significant differences in reverse remodeling (38% for the AT group vs. 60%, p = 0.426) or in the other variables. By univariate analysis, predictors of AT were LVEDD before implantation and E' after implantation. Age, gender, ischemic etiology, use of antiarrhythmic drugs, reverse remodeling and the other echocardiographic parameters did not predict AT. In multivariate logistic regression analysis, both LVEDD before implantation (OR 1.24, 95% CI 1.04-1.48, p = 0.019) and postimplantation E' (OR 0.27, 95% CI 0.09-0.76, p = 0.014) remained as independent predictors of AT. CONCLUSIONS: In patients undergoing CRT-D, episodes of ventricular tachyarrhythmia occur with high incidence, independently of echocardiographic response, with LVEDD before implantation and E' after implantation as the only independent predictors of AT in the medium-term. These results highlight the importance of combined devices with defibrillation capability.

Predictive Variables Affecting Transfusion Requirements in Orthotopic Liver Transplantation

INTRODUCTION AND AIMS: Adult orthotopic liver transplantation (OLT) is associated with considerable blood product requirements. The aim of this study was to assess the ability of preoperative information to predict intraoperative red blood cell (RBC) transfusion requirements among adult liver recipients. METHODS: Preoperative variables with previously demonstrated relationships to intraoperative RBC transfusion were identified from the literature: sex, age, pathology, prothrombin time (PT), factor V, hemoglobin (Hb), and platelet count (plt). These variables were then retrospectively collected from 758 consecutive adult patients undergoing OLT from 1997 to 2007. Relationships between these variables and intraoperative blood transfusion requirements were examined by both univariate analysis and multiple linear regression analysis. RESULTS: Univariate analysis confirmed significant associations between RBC transfusion and PT, factor V, Hb, Plt, pathology, and age (P values all < .001). However, stepwise backward multivariate analysis excluded variables Plt and factor V from the multiple regression linear model. The variables included in the final predictive model were PT, Hb, age, and pathology. Patients suffering from liver carcinoma required more blood products than those suffering from other pathologies. Yet, the overall predictive power of the final model was limited (R(2) = .308; adjusted R(2) = .30). CONCLUSION: Preoperative variables have limited predictive power for intraoperative RBC transfusion requirements even when significant statistical associations exist, identifying only a small portion of the observed total transfusion variability. Preoperative PT, Hb, age, and liver pathology seem to be the most significant predictive factors but other factors like severity of liver disease, surgical technique, medical experience in liver transplantation, and other noncontrollable human variables may play important roles to determine the final transfusion requirements.

Resultado do Obstétrico de Gravidezes Gemelares Resultantes de Fecundação in Vitro, Microinjeção e Estimulação da Ovulação em Comparação com Espontâneas

Introduction: Uncontrolled studies suggest that twins conceived by in vitro fertilization have increased rates of preterm birth and low birth weight and would warrant increased antenatal monitoring. The objective of this study was to compare the obstetric outcome of twin pregnancies conceived by in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) and ovulation induction with those conceived spontaneously. Methods: All twin deliveries achieved by IVF/ICSI (n=235) and ovulation induction (n=68) from September 1994 through December 2010 were evaluated. Both groups and an additional control group who conceived spontaneously (n=997) and was delivered during the same time period were compared with each other. Results: In univariate analysis, patients who conceived with the assistance of IVF/ICSI had a significantly higher risk of being older (p=0.01), nulliparous (p=0.01), having hypertensive disorders (p=0.012), gestational diabetes mellitus (p=0.031), cesarean section (p=0.008) and lower gestational age at birth, compared with the control group. Newborns had similar birthweights in all groups (2229±544g; 2102±619g; 2251±553g). Spontaneous pregnancies had a higher risk of being monochorionic 38.4% versus 16.2% and 10.2% (p=0.01). Multivariate analysis however showed that patients who conceived with the assistance of IVF/ICSI only had a higher risk of gestational diabetes (OR=1.91,95%CI 1.168-3.120; p=0.01). Conclusions: Our study shows that twin pregnancies conceived with the assistance of IVF/ICSI had a higher risk of gestacional diabetes and a lower gestacional age at birth. Birthweights were similar, as was the incidence of perinatal death, low birth weight infants, and congenital malformations.

Efeito do Vento como Ação Dinâmica em Edifícios Altos

Este trabalho aborda uma série de conceitos base no que concerne à ação do vento sobre edifícios altos, começando por ser estabelecidas algumas considerações fundamentais acerca da circulação do vento na camada limite atmosférica bem como acerca da sua interação com as estruturas. É feita uma análise da metodologia proposta pelo Eurocódigo 1 para quantificação de tal ação sobre os edifícios, bem como é elaborada uma comparação da metodologia proposta por este com a metodologia ainda vigente na regulamentação portuguesa. Foram modelados computacionalmente, com recurso a um programa de cálculo estrutural automático, três edifícios altos com diferente secção geométrica em planta que servirão de caso de estudo. Para estes mesmos edifícios são aplicados os dois regulamentos considerados com vista à determinação de esforços e deslocamentos. Sendo os edifícios altos um género de estruturas capazes de ser excitadas dinamicamente perante a ação do vento, adota-se uma metodologia para quantificação desta ação de forma dinâmica na direção do escoamento. Assim, é obtida a resposta dinâmica ao longo do tempo em termos de deslocamentos e acelerações para o caso de estudo considerado e é feita uma comparação da resposta do edifício quadrangular sob a ação dinâmica do vento com a resposta estática regulamentar.

Realidade aumentada aplicada a BIM para a monitorização do progresso e controle de produção na construção

Dissertação para obtenção do Grau Mestre em Engenharia Civil – Perfil de Construção

Prevalence of hepatitis A virus infection: the paradoxical example of isolated communities in the western Brazilian Amazon region

This study evaluated the prevalence of hepatitis A virus infection in the rural area of Lábrea, in the western Brazilian Amazon region. Communities and households were selected randomly. Serum samples were analyzed by means of the immunoenzymatic method for the presence of total antibodies against HAV. The study included 1,499 individuals. The prevalence of anti-HAV was 74.6% (95% CI 72.3-76.8). Univariate analysis showed associations with age (chi-square for linear trend = 496.003, p < 0.001), presence of outside toilet (p < 0.001), history of hepatitis (p < 0.001) and family history of hepatitis (p = 0.05). After adjusting for age, HAV infection also showed an association with the number of people in the family (p = 0.03). The overall prevalence rates were high, but not more than 60% of the children under the age of ten years had already been infected. Very high prevalence was detected only within older cohorts, thus paradoxically defining this as a region with intermediate endemicity, even under the conditions of poverty encountered.

Desigualdades socioeconómicas no tabagismo em jovens dos 15 aos 17 anos : estudo SILNE

RESUMO - As desigualdades em saúde estão relacionadas com as condições em que as pessoas se desenvolvem. Estas condições podem ser afetadas, principalmente, por diferenças de rendimento, background socioeconómico, educação e estilos de vida. A adolescência é um período de mudança em que os jovens podem experienciar comportamentos de risco que podem prevalecer na idade adulta. Uma posição socioeconómica inferior, do adolescente, pode estar associada a um aumento na prevalência de consumo de tabaco. Este trabalho tem como objetivo: verificar a associação entre estatuto socioeconómico e consumo de tabaco nos adolescentes em Portugal. Utilizaram-se dados colhidos por questionário, em Abril e Outubro de 2013 na cidade de Coimbra. O questionário insere-se no projeto europeu SILNE. Para avaliar o estatuto socioeconómico foram analisadas cinco variáveis: Family Affluence Scale, privação material, posição social subjetiva, semanada, educação e emprego dos pais. Para estratificar o comportamento do fumador foram desenvolvidas três variáveis: não fumador, experimenter e fumador regular. A análise foi separada por sexo. Constata-se que as raparigas fumam, em média, menos que os rapazes (F =17.1%; M =22.1%). Concluímos que o estatuto socioeconómico, avaliado pela Family Affluence Scale, posição social subjetiva, privação material, educação e emprego dos pais não têm impacto no consumo de tabaco no adolescente. As desigualdades socioeconómicas no consumo de tabaco nos adolescentes estão sim, relacionadas com o próprio estatuto socioeconómico do adolescente, traduzido pela semanada que este recebe. Foi encontrado no desempenho escolar um efeito mediador entre desigualdades socioeconómicas e consumo de tabaco na adolescência.

Desigualdades socioeconómicas na utilização de cuidados de saúde na população com 65 ou mais anos de idade em Portugal : dados do 4.º Inquérito Nacional de Saúde 2005-2006

RESUMO - INTRODUÇÃO: A equidade em cuidados de saúde constitui uma prioridade das políticas de saúde, tendo vários estudos descrito uma iniquidade que geralmente favorece os indivíduos com maior rendimento e nível educacional. Este estudo visa caracterizar as desigualdades socioeconómicas na utilização de cuidados de saúde na população com 65 ou mais anos de idade, dadas as suas características, maior vulnerabilidade e crescente peso demográfico na população. METODOLOGIA: Através de dados do INS, procedeu-se à análise univariada e multivariada por regressão linear múltipla para avaliação das desigualdades socioeconómicas na utilização de cuidados de saúde em 8698 indivíduos. RESULTADOS: Identifica-se um padrão de desigualdade na utilização de cuidados de saúde – indivíduos com maior rendimento e nível de escolaridade utilizam em média mais consultas de especialidade; ocorrendo o inverso nas consultas de CSP. Com ajustamento pela necessidade, através do estado de saúde auto-reportado, observa-se um padrão de iniquidade no sexo masculino relativamente às consultas em geral e consultas de CSP. DISCUSSÃO E CONCLUSÕES: A iniquidade na utilização de cuidados de saúde, apesar de não constituir a única causa, pode determinar maior iniquidade em saúde, pelo que é relevante o seu estudo. Os resultados alcançados podem ser justificados pelas características do SNS, assim como pelas isenções de taxas moderadoras, rede social, outros indicadores económicos, ou ainda pelo próprio contexto de vida do individuo. Torna-se fundamental prosseguir a investigação acerca da equidade, assim como promover uma ampla reflexão sobre os desafios futuros do sistema de saúde, que permitam preservar a sua sustentabilidade e princípios fundadores.

Antimicrobial use and incidence of multidrug-resistant Pseudomonas aeruginosa in a teaching hospital: an ecological approach

INTRODUCTION: Multidrug-resistant Pseudomonas aeruginosa is a major threat in healthcare settings. The use of antimicrobials can influence the incidence of resistant strains by direct and indirect mechanisms. The latter can be addressed by ecological studies. METHODS: Our group attempted to analyze the relation between the use of antipseudomonal drugs and the incidence of MDR-PA among 18 units from a 400-bed teaching hospital. The study had a retrospective, ecological design, comprising data from 2004 and 2005. Data on the use of four antimicrobials (amikacin, ciprofloxacin, ceftazidime and imipenem) were tested for correlation with the incidence of MDR-PA (defined as isolates resistant to the four antimicrobials of interest) in clinical cultures. Univariate and multivariate linear regression analyses were performed. RESULTS: Significant correlations were determined between use and resistance for all antimicrobials in the univariate analysis: amikacin (standardized correlation coefficient = 0.73, p = 0.001); ciprofloxacin (0.71, p = 0.001); ceftazidime (0.61, p = 0.007) and imipenem (0.87, p < 0.001). In multivariate analysis, only imipenem (0.67, p = 0.01) was independently related to the incidence of multidrug-resistant strains. CONCLUSIONS: These findings share similarities with those reported in individual-based observational studies, with possible implications for infection control.

Health-related quality of life in patients with Chagas disease

INTRODUCTION: Chagas disease (ChD) is a chronic illness related to significant morbidity and mortality that can affect the quality of life (QoL) of infected patients. However, there are few studies regarding QoL in ChD. The objectives of this study are to construct a health-related QoL (HRQoL) profile of ChD patients and compare this with a non-ChD (NChD) group to identify factors associated with the worst HRQoL scores in ChD patients. METHODS: HRQoL was investigated in 125 patients with ChD and 21 NChD individuals using the Medical Outcomes Study 36-item Short-Form (SF-36) and the Minnesota Living with Heart Failure Questionnaire (MLWHFQ). Patients were submitted to a standard protocol that included clinical examination, ECG, Holter monitoring, Doppler echocardiogram and autonomic function tests. RESULTS: HRQoL scores were significantly worse among the ChD group compared to the NChD group in the SF-36 domains of physical functioning and role-emotional and in the MLWHFQ scale. For the ChD group, univariate analysis showed that HRQoL score quartiles were associated with level of education, sex, marital status, use of medication, functional classification and cardiovascular and gastrointestinal symptoms. In the multivariate analysis, female sex, fewer years of education, single status, worst functional classification, presence of cardiovascular and gastrointestinal symptoms, associated illnesses, Doppler echocardiographic abnormalities and ventricular arrhythmia detected during Holter monitoring were predictors of lower HRQoL scores. CONCLUSIONS: ChD patients showed worse HRQoL scores compared to NChD. For the ChD group, sociodemographic and clinical variables were associated with worst scores.

The influence of menopausal status on bone turnover and disease control in breast cancer patients with metastatic bone disease treated with chemotherapy plus zoledronic acid : an exploratory retrospective cohort study

RESUMO: Introdução: Uma meta-análise recente demonstrou que uso adjuvante de ácido zoledrónico (AZ) em mulheres pós-menopáusicas com cancro da mama precoce (CM) conduz a redução do risco de morte por CM em 17%. Investigámos o efeito do estado hormonal (pré [PrM] vs pós-menopausa tardia [PoM]) na remodelação óssea e controlo de doença em mulheres com CM e metástases ósseas (MO) tratadas com AZ e quimioterapia (QT). Métodos: Neste estudo de coorte retrospetivo, colhemos variáveis clinico-patológicas e quantificámos o telopéptido N-terminal (NTX) urinário e marcadores tumorais (MT) séricos em mulheres com CM e MO tratadas com QT e AZ. As doentes foram divididas em PrM (<45 anos) e PoM (>60 anos). Endpoints do estudo: variação do NTX, CA15.3 e CEA nos meses 3, 6 e 9, tempo até falência de QT de primeira-linha e sobrevivência. Quando apropriado foram usados os testes de Wilcoxon rank-sum, modelo de efeitos lineares mistos, teste log-rank e modelo de Cox. Resultados: Quarenta doentes foram elegíveis para análise (8 PrM e 32 PoM). Depois da introdução de AZ e QT, os níveis de NTX e MT caíram no coorte global. O perfil de resposta não diferiu entre grupos no mês 3 ou em tempos posteriores (valor-p para interação tempo-estado hormonal no mês 3=0.957). Ademais, o perfil de resposta dos MT também não diferiu entre grupos. O tempo mediano até falência de primeira-linha de QT em PrM e PoM foi de 15.2 e 17.4 meses, respetivamente. Não foi identificada diferença significativa entre grupos, quer em análise univariada quer após controlo para envolvimento visceral (p=0.399 e 0.469, respetivamente). Igualmente, não houve diferenças em termos de sobrevivência. Conclusões: Neste coorte, não foram identificadas diferenças no controlo de NTX ou MT em função do estado menopausico. Igualmente, não foi identificada diferença no tempo até falência de primeira-linha de CT ou sobrevivência.----------- ABSTRACT: Background: A recent meta-analysis showed that the adjuvant use of zoledronic acid (ZA) in postmenopausal women with early breast cancer (BC) leads to a reduction in the risk of breast cancer death by 17%. We investigated the effect of the hormonal status (pre [PrM] vs late post menopause [PoM]) on bone turnover and disease control among women with BC and boné metastases (BM) treated with ZA and chemotherapy (CT). Methods: In this retrospective cohort study, we collected clinicopathologic variables, urinary Nterminal telopeptide (NTX) and serum tumor marker levels from women with BC and BM treated with CT and ZA. Patients were divided in PrM (<45 years) and PoM (>60 years). Study endpoints were NTX, CA15.3 and CEA variation at 3, 6 and 9 months, and time to first-line CT failure and survival. We performed multilevel mixed-effects linear regression models to assess the variation of repeated measures and cox regression models for time to event outcomes. Results: Forty patients were eligible for analysis (8 PrM and 32 PoM). After introduction of ZA and CT, NTX and tumor markers declined in the overall cohort. Response profile was similar between menopausal groups at month 3 and at later time points (p-value for time-hormonal status interaction at month 3=0.957). Furthermore, tumor markers response profile was also equal between groups. Median time to first-line CT failure in PrM and PoM women was 15.2 and 17.4 months, respectively. No significant difference between groups was found, either using a univariate analysis or after controlling for visceral disease involvement (p=0.399 and 0.469, respectively). Likewise, no differences in survival were found. Conclusions: In this cohort, no differences were found in terms of NTX or tumor markers control according to menopausal status. Similarly, no difference in time to first-line CT failure or survival was found.