Length Of Closure Research Articles

Regenerative potential of mesoporous silica nanoparticles scaffold on dental pulp and root maturation in immature dog’s teeth: a histologic and radiographic study

ObjectiveTo evaluate histologically and radiographically the potential of dog’s immature roots with apical periodontitis to regenerate after regenerative endodontic treatment using mesoporous silica nanoparticles (MSNs) with/without bone morphogenic protein (BMP-2) as scaffolds.MethodsIn 4 mongrel dogs, 56 immature teeth with 96 roots were infected, resulting in necrotic pulps and periapical pathosis. According to the evaluation time (Group I = 30 days and Group II = 90 days), 90 roots were divided into two equal groups (45 roots each) and 6 roots used to replace any lost root during the procedure. The two main groups were further divided according to treatment protocol into 5 subgroups (9 roots each): blood clot (BC subgroup), mesoporous silica nanoparticles scaffold only (MSNs subgroup), mesoporous silica nanoparticles impregnated with BMP2 (MSNs + BMP2 subgroup), infected teeth without treatment (+ ve control subgroup) and normal untouched teeth (-ve control subgroup). All teeth surfaces were coated with Tincture iodine and calcium hydroxide was applied prior to treatment protocols. Then, teeth were restored with glass ionomer filling to seal the remaining part of the access cavity. Radiography evaluation of the increase in root length, root thickness and occurrence of apical closure were performed. Following the sacrifice of the two dogs at each time of evaluation, histopathological analysis was performed and included the inflammatory cells count, bone resorption, tissue ingrowth, deposition of hard tissue, and closure of the apical part. All data were statistically analyzed.ResultsCompared to BC subgroup, MSNs and MSNs + BMP-2 subgroups exhibited significant higher increase in root length and thickness as well as higher vital tissue in-growth and new hard tissue formation in group II (P < 0.05). MSNs + BMP-2 subgroup had significant higher increase in root length and thickness as well as significant lower inflammatory cell count than MSNs subgroup in both groups (P < 0.05). There were no significant differences between MSNs and MSNs + BMP-2 subgroups regarding new hard tissue formation in both groups and apical closure in group I (P > 0.05).ConclusionMSNs with/without BMP-2 scaffolds enabled the continuing growth of roots in immature teeth with necrotic pulps and periapical pathosis. Addition of BMP-2 to MSNs scaffold improved its outcome in regenerative endodontics.Clinical relevanceMSNs with/without BMP-2 scaffolds may alternate blood clot for regenerative endodontic treatment of immature teeth with necrotic pulps.

Drowsiness Sensing System of Driver Based on Behavioral Characteristics to Prevent Road Accidents Using RealTime Optimized Computer Vision

A computer vision-based system called the Drowsiness Sensing Device using OpenCV was designed to identify driver drowsiness. The technology uses video frames from a camera positioned inside a car to identify different sleepiness indicators, including the length of eye closure and head position. The Eye Aspect Ratio (EAR), which aids in trying to assess drowsiness, is determined using the OpenCV library, which is also used to extract feature points and detect eye blinks. The system also has an alarm mechanism that sounds when a certain level of drowsiness is attained, alerting the driver to take the appropriate action. The proposed approach can be possibly employed to reduce the number of accidents occurred due to driver drowsiness. The suggested system is a real-time drowsiness sensing system that makes use of OpenCV to gauge a person's level of drowsiness. The technology employs a camera to take pictures of the driver's face, assessing the features like the mouth and eyes to determine how sleepy they are. The system can identify drowsiness by noticing changes in the eyes, such as drooping eyelids, and mouth movements, such as yawning. When the amount of drowsiness surpasses a predetermined threshold, the system informs the driver by assessing the photos using machine learning techniques. By prompting the driver to take a break, the proposed technology may help prevent accidents brought on by drowsy driving.

Drowsy Driver Detection using Deep Learning

Abstract: The face is an essential body feature that reveals a lot of information. When a driver is fatigued, their facial expressions change from what they would be in a normal state, such as their eyes blinking more frequently than usual. In this study, we used CNN algorithm to recognize signs of driver drowsiness such as blinking and length of eye closure. CNN algorithm uses video pictures. Due to the drawbacks of existing techniques, we propose a unique face-tracking algorithm to enhance tracking accuracy. Based on human key characteristics, we applied a unique detection algorithm i.e. CNN. Then, using these parts of the face, the drivers' drowsiness is evaluated by watching their eye movements. We have calculated the system's accuracy, which is around 97%.

A laser absorption spectroscopy chamber system based on closed dynamic chamber method for multi-point synchronous monitoring ammonia emissions

This study reports on the field testing of a newly and originally designed laser absorption spectroscopy chamber (LASC) system based on closed dynamic chamber method, which is well suited for multi-point synchronous measurement of ammonia emissions in field multiple plot experiment. Main design feature of the LASC system is individual multi-reflection cells for each chamber, achieving the synchronous in-situ monitoring ammonia emissions of all the chambers. Two movable covers for automated opening and closing of the chamber, and the highly transparent chamber walls made of acrylic plate minimize the disturbance of the chamber deployment on the ammonia transport process in the chamber. Controlled field assessment experiment was conducted to evaluate the applicability and reliability of the LASC system. The results indicated that the optimum time length of chamber closure for monitoring ammonia emission is 3 min, and the appropriate time length of chamber ventilation is 17 to 37 min. The LASC system has higher accuracy for measuring ammonia emission rate and reliability for comparatively measuring ammonia emissions from different treatments than the traditional chamber methods.

Understanding the impacts of floods on learning quality, school facilities, and educational recovery in Indonesia.

This research is among the first pieces of work to use the comprehensive school safety (CSS) framework to assess the impacts of floods on quality learning and education infrastructure. The CSS framework is employed here to identify the level of disruption to education services following floods in Jakarta, Indonesia, in 2013. The paper poses three key questions, concerning: (i) disruption to children's access to quality education during the flood emergency in 2013 and the early recovery phase; (ii) the impact of the floods on a school's physical infrastructure; and (iii) the effectiveness and level of success of the 2013 flood responses by relevant stakeholders. Combining quantitative and qualitative strategies, the paper examines the experiences of 100 schools in Jakarta. The findings suggest that the CSS framework offers a more nuanced approach to assessing post-disaster education needs. Moreover, it is also relevant for examining the relationship between the COVID-19 pandemic and relative losses in the education sector.

8418 Fascial Closure Technique after Gynecologic Laparoscopic Surgery and Postoperative Pain: A Randomized Controlled Trial

<h3>Study Objective</h3> To compare postoperative pain between closing port site fascia > 10 mm via traditional direct method versus fascial closure device (FCD) in patients undergoing minimally invasive gynecologic surgery. <h3>Design</h3> Prospective, singled-blinded, randomized controlled trial. Primary outcome was pain on postoperative days (POD) 1, 2, 7, and 14. <h3>Setting</h3> Tertiary care academic affiliated hospital. <h3>Patients or Participants</h3> Patients 18 years undergoing laparoscopic or robotic gynecologic procedure with one port site > 10 mm for any indication (benign and malignant) were eligible. Patients were identified in preoperative holding and consented. 123 participants were enrolled from March 2021 to March 2022. <h3>Interventions</h3> Participants were randomized to fascial closure with FCD or traditional direct closure on the day of surgery. Postoperative pain scores were assessed using digital 100-point Visual Analog Scale. Fascial closure was timed, and narcotics utilized while admitted were converted into morphine equivalents per hour. <h3>Measurements and Main Results</h3> Descriptive statistics were run on all variables and group comparisons made using independent sample t-tests, chi-squares, or Mann Whitney U. 60 patients (48.8%) were randomized to FCD group and 63 patients (51.2%) to traditional direct closure. There was no statistical difference in pain scores between FCD (POD1: 60.27±22.90, POD2: 48.61±23.01, POD7: 33.60±24.12, POD14: 23.00±24.99) and traditional closure (POD1: 53.60±29.33, POD2: 26.94±28.59, POD7: 29.31±24.05, POD14: 18.57±24.62) groups or narcotic use in morphine equivalents per hour (1.54±1.11 vs 1.98±1.23, FCD and traditional closure, respectively). Length of fascial closure was statistically significantly lower using the FCD (<i>Mdn</i> = 77.0) compared to traditional closure (<i>Mdn</i> = 137.0), <i>p</i> = .001. <h3>Conclusion</h3> This study demonstrates no significant difference in postoperative pain scores at multiple time points or narcotic use between use of FCD versus traditional direct closure, but it does show a statistically significant lower fascial closure time using the FCD.

Prevalence of clinical-level emotional/behavioral problems in schoolchildren during the coronavirus disease 2019 pandemic in Japan: A prospective cohort study.

BackgroundSeveral empirical studies have investigated negative mental health outcomes related to the spread of infectious diseases, including coronavirus disease 2019 (COVID‐19). However, little is known about children's emotional/behavioral problems, especially externalizing problems, during such situations. This prospective cohort study aimed to investigate pandemic‐related emotional/behavioral problems and their risk factors among schoolchildren in Japan.MethodsA total of 4800 parents with children in grades 1−12 participated in a two‐wave longitudinal survey. Wave 1 and Wave 2 were conducted on March 4−8 and May 15−18, 2020, respectively. Survey items included demographic information, parental depression, children's diagnoses of neurodevelopmental disorders, the total length of school closure, and emotional/behavioral problems. Children's emotional/behavioral problems were assessed using the Strengths and Difficulties Questionnaire (SDQ), which has cutoff points to differentiate clinical‐level problems, which were the primary focus of this study.ResultsThe proportions of clinical‐level problems were higher at Wave 2 (emotional symptoms = 24.8%, conduct problems = 22.7%, hyperactivity/inattention = 36.8%, peer relationship problems = 36.2%, and lack of prosocial behavior = 23.5%) compared to Wave 1. Lower grade‐level and lower annual family income predicted the increased proportions of children's clinical‐level emotional symptoms, hyperactivity/inattention, and prosocial behavior at Wave 2. The total length of school closure was not a significant predictor of subsequent emotional/behavioral problems. The highest proportion of clinical‐level problems at Wave 2 for the four SDQ subscales was observed in children with neurodevelopmental disorders.ConclusionsThe number of schoolchildren with severe emotional/behavioral problems increased during the COVID‐19 pandemic. Appropriate prevention and early intervention programs should be provided, especially for children who are in lower grade levels, have low family incomes, or have neurodevelopmental disorders.

Effect of Carica papaya Extract toward Incised Wound Healing Process in Mice (Mus musculus) Clinically and Histologically.

Wound healing entails a sequence of complex biological processes, which is a protective function of the body that focuses on a quick recovery. Reducing wound healing time is crucial in a wound as it lowers the chance of infection and decreases complications and costs. Papaya extract was obtained by a maceration method. It contains papain enzyme, flavonoid, saponin, and alkaloid, which act as an anti-inflammatory, astringent substance, vasodilator, antioxidant, analgesic, with antifungal, and antibacterial properties, and increase the collagen synthesis. This study aimed to assess the effect of Carica papaya extract application toward incised wound healing process in mice (Mus musculus) clinically and histologically. This experimental laboratory study was performed using 24 mice weighing between 30 and 40 grams and 12 and 14 weeks of age as experimental animals. Each group was incised along 5 mm at the labial gingiva under both of mandible anterior teeth with a depth reaching alveolar bone. Papaya extract was applied topically in the morning and evening for 14 days. The clinical result was obtained by assessing the length of wound closure measured every day for 14 days. Based on the statistic test result, it showed that the papaya extract has a significant effect (p ≤ 0.05) toward the healing process of an incised oral wound in mice. Histologically at day 14, 75% concentration papaya extract showed perfect epithelial layer and fibrillation.

Параметри крон дерев експериментальних соснових культур, створених з різною густотою у Житомирському Поліссі

Дослідження проведено у Житомирському Поліссі на стаціонарному досліді № 1, закладеному у 1976 р. Проаналізовано деякі параметри крон дерев (площу проекції, діаметр і протяжність крон дерев), а також зімкнутість пологу насаджень сосни звичайної (Pinus sylvestris L.) різної густоти. Встановлено, що за густоти насадження 4000–1000 шт.·га-1 середній діаметр крони становить 2,4–4,0 м, різниця значень цього показника змінюється у межах 9–40 %. Підтверджено достовірну різницю між середніми діаметрами крон дерев однофакторним дисперсійним аналізом на 95% довірчому рівні, де Fф = 7,82…126,03 &gt; Fт(0,95) = 3,89. Виявлено, що за густоти насаджень 4000–2000 шт.·га-1 форма крони є овальною, тоді як за густоти насадження 1000 шт.·га-1 – майже округлою. Встановлено, що середня проекція площ крон дерев за густоти насадження 4000 і 1000 шт.·га-1 коливається у межах 5,5–6,1 і 10,6–13,1 м2, різниця між цими параметрами становить 42–58 %. Достовірну різницю між величинами проекції площ крон дерев підтверджено однофакторним дисперсійним аналізом, де Fф = 8,0…108,7 &gt; Fт(0,95) = 3,89. Простежено, що середня протяжність крони за густоти насадження 4000 і 1000 шт.·га-1 знаходиться у межах 4,1–5,1 і 5,1–8,1 м, різниця між цими величинами становить 2–43 %. Зроблено висновок про те, що густота впливає на середній діаметр, проекцію площ і протяжність крон дерев, тоді як впливу густоти на зімкнутість намету не виявлено.

Potensi Ekstrak Etanol Daun Pare (Momordica charantia L.) sebagai Alternatif Obat Penyembuh Luka pada Punggung Mencit Jantan (Mus musculus L.)

The leaves of bitter melon (Momordica charantia L.) contains flavonoid, tannin and saponin which plays a role in wound healing. The purpose of this study was to determine the effect of bitter melon leaves (M. charantia L.) ethanolic extract on wound healing the back injury on male mice. The parameters of this study were the length of wound closure and histopathological observations by looking at the level of epithelialization, the number of new blood vessels, and the number of inflammatory cells.This study was conducted in a complete randomized design. The mice were divided into five groups: [K (+)], [K (-)], [ P1], [P2], [P3], each group consist four mice. All of mice was wounded by cut on the back skin about 1,5 cm in length. The wound were treated every two times a day for 9 days, K(+) is given povidone iodine as a positive control, K(-) is given 95% ethanol as a negative control, P1 is given 50% ethanolic extract of bitter melon, P2 is given 75% ethanolic extract of bitter melon and P3 is given 100% ethanolic extract of bitter melon. On the 10th day, one of the mice from all of groups was taken to observe the histopathology of their skin. The results showed that the leaf extract of bitter melon has wound healing potential by accelerate the healing process of back skin’s wound in mice and has best histopathology picture compared to controls. Keywords : Bitter Melon (Momordica charantia L.), Male Mice (Mus musculus L.), povidone iodine

Use of a Barbed Knotless Suture for Laparoscopic Ablation of the Nephrosplenic Space in 8 Horses.

To evaluate use of a knotless suture for laparoscopic closure of the equine nephrosplenic space. Experimental in vivo study. Normal horses without previous history of abdominal surgery (n=8). The nephrosplenic space was closed under laparoscopic visualization using a unidirectional, barbed 0 metric absorbable suture (copolymer of glycolic acid and trimethylene carbonate). Intracorporeal suturing of the nephrosplenic space was performed in a cranial-to-caudal direction in a simple continuous fashion. Repeat evaluation was performed laparoscopically in 2 horses and by necropsy in 6 horses. The length of closure was measured and nature of the healed tissue was evaluate grossly. Total surgery time was 65-167 minutes (mean ± SD, 89.6 ± 22.6). Suturing time was 30-65 minutes (40.4 ± 16.3). Second laparoscopy in 2 horses was performed at days 198 and 227. Necropsy was performed at day 69-229 postoperatively (132.7 ± 63.0) in 6 horses. The closure measured 12-14 cm in length (13 ± 1) and consisted of mature fibrous tissue bridging the splenic capsule and the nephrosplenic ligament. No residual suture material was identified grossly in any horses. The procedure was easily performed; extracorporeal suture management to hold it taut was unnecessary since the barbs had excellent purchase in the apposed tissues, and intracorporeal knot tying was not required. The barbed knotless suture appears to be a valid alternative to facilitate laparoscopic closure of the nephrosplenic space in normal horses; however, further work is necessary to investigate its suitability in clinically affected horses.

Monitoring the 2007 Florida east coast Karenia brevis (Dinophyceae) red tide and neurotoxic shellfish poisoning (NSP) event

have been reported in this area. This extensive red tide influenced commercial and recreational shellfish harvesting activities along Florida’s east coast. Fourteen shellfish harvesting areas (SHAs) were monitored weekly during this event and 10 SHAs were closed for an average of 53 days due to this red tide. The length of SHA closure was dependent on the shellfish species present. Interagency cooperation in monitoring this

Cost-effective length and timing of school closure during an influenza pandemic depend on the severity

BackgroundThere has been a variation in published opinions toward the effectiveness of school closure which is implemented reactively when substantial influenza transmissions are seen at schools. Parameterizing an age-structured epidemic model using published estimates of the pandemic H1N1-2009 and accounting for the cost effectiveness, we examined if the timing and length of school closure could be optimized.MethodsAge-structured renewal equation was employed to describe the epidemic dynamics of an influenza pandemic. School closure was assumed to take place only once during the course of the pandemic, abruptly reducing child-to-child transmission for a fixed length of time and also influencing the transmission between children and adults. Public health effectiveness was measured by reduction in the cumulative incidence, and cost effectiveness was also examined by calculating the incremental cost effectiveness ratio and adopting a threshold of 1.0 × 107 Japanese Yen/life-year.ResultsSchool closure at the epidemic peak appeared to yield the largest reduction in the final size, while the time of epidemic peak was shown to depend on the transmissibility. As the length of school closure was extended, we observed larger reduction in the cumulative incidence. Nevertheless, the cost effectiveness analysis showed that the cost of our school closure scenario with the parameters derived from H1N1-2009 was not justifiable. If the risk of death is three times or greater than that of H1N1-2009, the school closure could be regarded as cost effective.ConclusionsThere is no fixed timing and duration of school closure that can be recommended as universal guideline for different types of influenza viruses. The effectiveness of school closure depends on the transmission dynamics of a particular influenza virus strain, especially the virulence (i.e. the infection fatality risk).

Deriving land surface phenology indicators from CO2 eddy covariance measurements

Recent progress of CO2 eddy covariance (EC) technique and accumulation of measurements offer an unprecedented perspective to study the land surface phenology (LSP) in a more objective way than previously possible by allowing the actual photosynthesis measurement – gross primary productivity (GPP). Because of the spatial, temporal, and ecological complexity of processes controlling GPP time series, the extraction of important LSP dates from GPP has been elusive. Here, we present objective measures of several LSP metrics from GPP time series data. A case study based on long term GPP measurements over a mature boreal deciduous forest is provided together with LSP estimates from remote sensing data. Results show that most LSP metrics are interrelated within each season (spring and autumn) both from GPP and remote sensing based estimates. We provide simple mathematical derivatives of GPP time series to objectively estimate key LSP metrics such as: the start, end and length of growing season; end of greenup; start of browndown; length of canopy closure; start, end and length of peak; and peak of season. These key LSP metrics indicate the collective ecological responses to environmental changes over space and time.

School closures and influenza: systematic review of epidemiological studies

ObjectiveTo review the effects of school closures on pandemic and seasonal influenza outbreaks.DesignSystematic review.Data sourcesMEDLINE and EMBASE, reference lists of identified articles, hand searches of key journals and additional papers...

SP3-49 The relationship of class closure length and the change of absentees at elementary schools in the 2009 A/H1N1 influenza expansion in Japan: the analysis in T city, Ibaraki prefecture

IntroductionThe 2009 A/H1N1 influenza spread also in Japan. Many students were absent in elementary schools, To prevent its expansion, many school decided class closure with their original length under rough...

Closure of circular arc cracks under general loading: effects on stress intensity factors

The two-dimensional circular arc crack solution of Muskhelishvili (Some basic problems of the mathematical theory of elasticity, P. Noordhoff Ltd, Groningen, Holland, 1953) has been used widely to study curved crack behavior in an infinite, homogeneous and isotropic elastic material. However, for certain orientations and magnitudes of the remotely applied loads, portions of the crack will close. Since the analytical solution is incorrect once the crack walls come into contact, the displacement discontinuity method is combined with a complementarity algorithm to solve this problem. This study uses stress intensity factors (SIFs) and displacement discontinuities along the crack to define when the analytical solution is not applicable and to better understand the mechanism that causes partial closure under various loading conditions, including uniaxial tension and pure shear. Closure is mainly due to material from the concave side of the crack moving toward the outer crack surface. Solutions that allow interpenetration of the crack tips yield non-zero mode I SIFs, while crack tip closure under proper contact boundary conditions produce mode I SIFs that are identically zero. Partial closure of a circular arc crack will alter both mode I and II SIFs at the crack tips, regardless of the positioning or length of the closed section along the crack. Friction on the crack surfaces in contact changes the total length and positioning of closure, as well as generally decreases the magnitude of opening along the portions of the crack that are not closed.

Transitions in insect respiratory patterns are controlled by changes in metabolic rate

We examined the respiratory patterns of Rhodnius prolixus and Gromphadorhina portentosa as metabolic rates varied with temperature to determine whether insects transition from discontinuous (DGC), cyclical and continuous respiration as a response to increasing aerobic demand. Using flow through respirometry we: (1) determined the effects of temperature on metabolic rate; (2) objectively defined periods of spiracular closure; (3) observed whether there was a correlation between metabolic rate and length of spiracular closure. At low temperatures both species exhibit lengthy periods of spiracular closure reflecting a discontinuous respiratory pattern. As metabolic rate increased, periods of spiracular closure decreased and insects displayed a more cyclical pattern of respiration. As metabolic rates increased even further under the highest experimental temperatures, periods of spiracular closure decreased even more and a continuous respiratory pattern was employed by both species. Our results suggest that the three described respiratory patterns in insects are not distinct but are instead a continuum of respiratory responses driven by the metabolic demand experienced by the insect.

Normal anatomy of the external urethral meatus in boys: implications for hypospadias repair

Both papers in this section relate to the always difficult subject of hypospadias repair. One of them describes the anatomy of the external urethral meatus, and the other a technique for repairing coronal or subcoronal hypospadias. To investigate the normal external urethral meatal anatomy in boys, and to examine the proportional relationship between meatal length and degree of ventral glans closure. In all, 92 boys with presumed normal penile anatomy were considered eligible for the study; 17 were not assessed because either the boy or parents declined to participate, leaving 75 boys (mean age 6.9 years, range 0.3-15) who completed the study. Photographic records of the meatal appearance were obtained and meatal height and ventral glans closure measured using ophthalmic callipers. All 75 boys in the study had a vertical slit-like meatus that commenced at the tip of the penis and ran ventrally. The mean (sd) vertical meatal length was 5.4 (1) mm and the mean length of ventral glans closure was 4.7 (1.2) mm. There was an age-dependent increase in meatal length and a similar association was identified for the length of ventral glans closure. There was also a statistically significant proportional relationship between meatal length and length of glans closure (r = 0.36, confidence interval 0.14-0.54, P < 0.002). The position and size of the external urethral meatus in normal boys is consistent, and ventral glans closure is equal to or slightly less than meatal length. These data might be of interest to hypospadiologists in their efforts to reconstruct normal glanular anatomy.

How should complex perianal Crohn's disease be treated in the Remicade era?

Perhaps one of the most difficult aspects of treat­ ing Crohn's disease (CD) is the management of complex perianal disease. Perianal fistulas occur in 17%-43% of patients with CD and are more com­ monly associated with colonic CD than small bowel CD. Almost 100% of patients with rectal CD have perianal fistulas at some point. Perianal fistulas in CD can be broken down into two categories: simple or low and complex or high fistulas. The treatment for the two categories is dif­ ferent, and this review will concentrate on complex or high fistulas. This group includes high trans­ sphincteric, suprasphincteric, and extrasphincteric fistulas; multiple fistulas; fistulas with multiple exter­ nal openings; rectovaginal fistulas; and any perianal fistula in the presence of active rectal disease. Remicade is a genetically constructed IgG1 mu­ rine-human chimeric molecule (75% human) that binds both soluble and bound TNFa. In 1999, Pres­ ent et al. I performed a randomized double-blinded placebo controlled trial of Remicade for fistulizing CD. Fifty-five percent of the fistulas (of which 90% were perianal) treated with 5 mg/kg Remicade at 0,2, and 6 weeks were reported as closed. Closure was defined as no drainage despite gentle compres­ sion. The median length of closure was 3 months. Sixty percent of patients reported adverse events, in­ cluding 11 % abscess formation. Based on this study and subsequent studies, the standard dosing regimen of Remicade for perianal fistulas is 5 mg/kg given at 0, 2, and 6 weeks. Maintenance therapy, when indi­ cated is 5 mg/kg every 8 weeks. Premedication with Tylenol, Benadryl, or corticosteroids is given as needed. Subsequent studies have shown a complete peria­ nal fistula closure rate between 25% and 67% and a rectovaginal fistula closure rate of 0%-13%. The Accent II trial randomized patients with fistulizing CD to initial therapy at 0, 2, and 6 weeks with either 5 mg/kg of Remicade or placebo. Sixty-nine percent of patients in the Remicade group responded. Those 69% were then randomized to maintenance therapy with either Remicade at 5 mg/kg or placebo every 8 weeks for 54 weeks. Of those patients on Remicade maintenance, 42% lost the effect of the medication by 54 weeks. Infusion reactions are seen in about 20%-30% of patients, and especially in those patients with subse­ quent doses. The majority of reactions are minor and include low-grade fever, rash, and tachycardia. Symptoms usually resolve with decreasing the infu­ sion rate or cessation of the infusion. Pretreatment with Tylenol and Benadryl, and sometimes cortico­ steroids, usually permits subsequent administration of Remicade. Approximately 2 % of patients have a severe infusion reaction consisting of anaphylaxis, dyspnea, and/or hypotension. In these patients, further treatment with Remicade is contraindicated. Infusion reactions are thought to occur due to the development of human antichimeric antibodies. Infectious complications are not uncommon with Remicade treatment. Abscesses develop in about 10%-35% of patients due to healing of the external opening prior to healing of the fistula tract. This can usually be prevented in perianal fistulas by the place­ ment of setons. Upper respiratory infections, includ­ ing bacterial pneumonia and Pneumocystis carinii, develop in up to 16% of patients. Tuberculosis has been reported in over 70 patients, as have other op­ portunistic infections. Also reported is the possible increased risk of lymphoma and development of lupuslike reactions. Resolution of clinical signs of the fistula such as drainage and closure of the external opening does not mean that the fistula tract has healed. Several studies using endoanal ultrasound and magnetic res­ onance imaging have shown that the fistula tract persists despite cessation of drainage and apparent