Ambulation after in-utero fetoscopic or open neural tube defect repair: predictors for ambulation at 30 months.

OBJECTIVES: To compare the ambulatory status of a cohort of children who had undergone prenatal repair of an open neural tube defect (ONTD) using one of two different methods (fetoscopic or open hysterotomy) with that of a cohort who had undergone postnatal repair, and to identify the best predictors of ambulation at 30 months of age. METHODS: This was a retrospective review of a cohort of children who underwent ONTD repair either prenatally (n = 110), by fetoscopic surgery (n = 73) or open hysterotomy surgery (n = 37), or postnatally (n = 51), in a single tertiary hospital between November 2011 and May 2023. The cohort comprised a consecutive sample of cases who had undergone ONTD repair in-utero following Management of Myelomeningocele Study (MOMS) trial criteria and cases who had undergone postnatal repair, meeting the same criteria, which were also followed up after birth at the same institution. Motor function assessment by ultrasound was recorded at referral, 6 weeks after prenatal repair, or after referral in postnatally repaired cases, and at the last ultrasound scan before delivery. Clinical examinations to assess motor function at birth and at 12 months were retrieved from records. Intact motor function was defined as first sacral myotome (S1) motor function. Ambulatory status data at each follow-up visit were collected. The proportion of children who were able to walk independently after 30 months of age was compared between those who had undergone fetoscopic vs open prenatal surgery and between prenatal (by either fetoscopic or open surgery) and postnatal ONTD repair. Logistic regression analyses were performed to identify predictors for independent ambulation. RESULTS: After 30 months, the proportion of infants who were able to walk independently was higher in prenatally vs postnatally repaired cases (51.8% vs 15.7%, P < 0.01), and there was no difference between those with fetoscopic (52.1%) vs open (51.4%) prenatal repair (P = 0.66). In the prenatally repaired group, having intact motor function at 12 months (adjusted odds ratio (aOR), 9.14 (95% CI, 2.64-31.63), P < 0.01) and at birth (aOR, 4.50 (95% CI, 1.21-16.80), P = 0.02) were significant predictors of independent walking at 30 months; an anatomical level of lesion below L2 at referral (aOR, 1.83 (95% CI, 1.30-2.58), P = 0.01) and female gender (aOR, 3.51 (95% CI, 1.43-8.61), P < 0.01) were also predictive for this outcome. CONCLUSIONS: Prenatally repaired cases of ONTD have a better chance of being able to walk independently at 30 months than do those who undergo postnatal repair. In patients with prenatally repaired ONTD, ambulatory status at 30 months can be predicted by observing a low lesion level at referral (below L2) and intact motor function postnatally. These results have implications for parental counseling and planning for supportive therapy in pregnancies affected by ONTD. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Perforation of cavum septi pellucidi in open spina bifida and need for hydrocephalus treatment by 1 year of age.

OBJECTIVE: In-utero repair of an open neural tube defect (ONTD) reduces the risk of developing severe hydrocephalus postnatally. Perforation of the cavum septi pellucidi (CSP) may reflect increased intraventricular pressure in the fetal brain. We sought to evaluate the association of perforated CSP visualized on fetal imaging before and/or after in-utero ONTD repair with the eventual need for hydrocephalus treatment by 1 year of age. METHODS: This was a retrospective cohort study of consecutive patients who underwent laparotomy-assisted fetoscopic ONTD repair between 2014 and 2021 at a single center. Eligibility criteria for surgery were based on those of the Management of Myelomeningocele Study (MOMS), although a maternal prepregnancy body mass index of up to 40 kg/m2 was allowed. Fetal brain imaging was performed with ultrasound and magnetic resonance imaging (MRI) at referral and 6 weeks postoperatively. Stored ultrasound and MRI scans were reviewed retrospectively to assess CSP integrity. Medical records were reviewed to determine whether hydrocephalus treatment was needed within 1 year of age. Parametric and non-parametric tests were used as appropriate to compare outcomes between cases with perforated CSP and those with intact CSP as determined on ultrasound at referral. Logistic regression analysis was performed to assess the predictive performance of various imaging markers for the need for hydrocephalus treatment. RESULTS: A total of 110 patients were included. Perforated CSP was identified in 20.6% and 22.6% of cases on preoperative ultrasound and MRI, respectively, and in 26.6% and 24.2% on postoperative ultrasound and MRI, respectively. Ventricular size increased between referral and after surgery (median, 11.00 (range, 5.89-21.45) mm vs 16.00 (range, 7.00-43.5) mm; P < 0.01), as did the proportion of cases with severe ventriculomegaly (ventricular width ≥ 15 mm) (12.7% vs 57.8%; P < 0.01). Complete CSP evaluation was achieved on preoperative ultrasound in 107 cases, of which 22 had a perforated CSP and 85 had an intact CSP. The perforated-CSP group presented with larger ventricles (mean, 14.32 ± 3.45 mm vs 10.37 ± 2.37 mm; P < 0.01) and a higher rate of severe ventriculomegaly (40.9% vs 5.9%; P < 0.01) compared to those with an intact CSP. The same trends were observed at 6 weeks postoperatively for mean ventricular size (median, 21.0 (range, 13.0-43.5) mm vs 14.3 (range, 7.0-29.0) mm; P < 0.01) and severe ventriculomegaly (95.0% vs 46.8%; P < 0.01). Cases with a perforated CSP at referral had a lower rate of hindbrain herniation (HBH) reversal postoperatively (65.0% vs 88.6%; P = 0.01) and were more likely to require treatment for hydrocephalus (89.5% vs 22.7%; P < 0.01). The strongest predictor of the need for hydrocephalus treatment within 1 year of age was lack of HBH reversal on MRI (odds ratio (OR), 36.20 (95% CI, 5.96-219.12); P < 0.01) followed by perforated CSP on ultrasound at referral (OR, 23.40 (95% CI, 5.42-100.98); P < 0.01) and by perforated CSP at 6-week postoperative ultrasound (OR, 19.48 (95% CI, 5.68-66.68); P < 0.01). CONCLUSIONS: The detection of a perforated CSP in fetuses with ONTD can reliably identify those cases at highest risk for needing hydrocephalus treatment by 1 year of age. Evaluation of this brain structure can improve counseling of families considering fetal surgery for ONTD, in order to set appropriate expectations about postnatal outcome. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Longitudinal evaluation of motor function in patients who underwent prenatal or postnatal neural tube defect repair.

OBJECTIVE: To compare the evolution of motor function from mid-gestation to 12 months of age between prenatally and postnatally repaired cases of open neural tube defect (ONTD). METHODS: This was a retrospective cohort study of all fetuses that underwent prenatal (fetoscopic or open hysterotomy) or postnatal ONTD repair at a single institution between November 2011 and December 2018. The anatomical level of the lesion was defined as the upper bony spinal defect at initial magnetic resonance imaging assessment. Prenatal motor function of the lower extremities was evaluated by ultrasound according to the metameric level of the neurological lesion, based on the methodology of Carreras et al. Fetal motor function was assessed at referral, at 6 weeks after surgery in prenatally repaired cases or 6 weeks after referral in postnatally repaired cases (6-week follow-up) and at the last scan before delivery. In addition, motor function was assessed by a detailed neurological examination at birth and 12 months of age. First sacral (S1) neurological level of the lesion was considered as intact motor function. For statistical comparisons, we attributed numerical scores to each neurological level and motor function was expressed as median (range) neurological level. Motor function (as numerical score) and the proportion of cases with intact motor function and with motor function two or more levels better than expected based on the anatomical level of the lesion were compared between the prenatal- and postnatal-repair groups. Fetal motor function was compared to the anatomical level of the lesion at referral and a better motor function was defined when it was two or more levels better than the anatomical level of the lesion. To assess the evolution of motor function, we compared motor function at referral with that at each follow-up assessment using paired t-tests. RESULTS: We included 127 patients with ONTD, of whom 93 underwent prenatal (51 fetoscopic and 42 open hysterotomy) and 34 postnatal repair. At the time of referral, cases in the prenatal- and postnatal-repair groups presented with a similar anatomical level of lesion (L3 (T9-S1) vs L3 (T7-S1); P = 0.52), similar motor function (S1 (L1-S1) vs S1 (L1-S1); P = 0.52) and a similar proportion of cases with intact motor function (81% vs 79%; P = 0.88) and with motor function two or more levels better than expected based on the anatomical level of the lesion (62% vs 74%; P = 0.24). When compared with prenatally repaired cases, postnatally repaired cases showed worse motor function at birth (S1 (L1-S1) vs L4 (L1-S1); P < 0.01) and at 12 months of age (S1 (L1-S1) vs L4 (L1-S1); P < 0.01). In the prenatal-repair group, motor function remained stable from the time of referral to 12 months of age (P = 0.26). Furthermore, the proportion of patients with intact motor function at referral (81% (75/93)) was similar to that at the 6-week follow-up (74% (64/87)), at the last scan before birth (74% (42/57)), at birth (68% (63/93)) and at 12 months of age (67% (39/58)) in the prenatal-repair group. In the postnatal-repair group, worse motor function, starting from the third trimester to 12 months of age, was observed. The proportion of patients with intact motor function at referral (79% (27/34)) was similar to that at 6-week follow-up (80% (12/15); P = 0.92), but was lower at the last assessment before birth (25% (2/8); P < 0.01), at birth (24% (8/34); P < 0.01) and at 12 months of age (28% (7/25); P < 0.01). Similar findings were noted when assessing the evolution of the proportion of cases with motor function two or more levels better than expected based on the anatomical level of the lesion in each group. CONCLUSIONS: Infants with ONTD that underwent postnatal repair had worse motor function at birth and at 12 months of age than at mid-gestation and when compared with infants that underwent prenatal ONTD repair. Prenatal motor function assessment by ultrasound is an adequate tool to identify those infants who should have a good clinical motor function after delivery. Information obtained by fetal motor function assessment can have an important role for patient counseling and case selection for surgery. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Prenatal predictors of motor function in children with open spina bifida: a retrospective cohort study.

OBJECTIVE: To identify predictors for intact motor function (MF) at birth and at 12 months of life in babies with prenatally versus postnatally repaired open spina bifida (OSB). DESIGN: Retrospective cohort study. SETTING: Texas Children's Hospital, 2011-2018. POPULATION: Patients who underwent either prenatal or postnatal OSB repair. METHODS: Prenatal MF of the lower extremities was evaluated by ultrasound following a metameric distribution at the time of diagnosis (US1), 6 weeks postoperatively (or 6 weeks after initial evaluation in postnatally repaired cases) (US2) and at the last ultrasound before delivery (US3). At birth and at 12 months, MF was assessed clinically. Intact MF (S1) was defined as the observation of plantar flexion of the ankle. Results from logistic regression analysis are expressed as odds ratios (95% confidence intervals, P values). RESULTS: A total of 127 patients were included: 93 with prenatal repair (51 fetoscopic; 42 open hysterotomy repair) and 34 with postnatal repair. In the prenatal repair group, predictors for intact MF at birth and at 12 months included: absence of clubfeet (OR 11.3, 95% CI 3.2-39.1, P < 0.01; OR 10.8 95% CI 2.4-47.6, P < 0.01); intact MF at US1 (OR 19.7, 95% CI 5.0-76.9, P < 0.01; OR 8.7, 95% CI 2.0-38.7, P < 0.01); intact MF at US2 (OR 22, 95% CI 6.5-74.2, P < 0.01; OR 13.5, 95% 3.0-61.4, P < 0.01); intact MF at US3 (OR 13.7, 95% CI 3.4-55.9, P < 0.01; OR 12.6, 95% CI 2.5-64.3, P < 0.01); and having a flat lesion (OR 11.2, 95% CI 2.4-51.1, P < 0.01; OR 4.1, 95% CI 1.1-16.5, P = 0.04). In the postnatal repair group, the only predictor of intact MF at 12 months was having intact MF at birth (OR 15.2, 95% CI 2.0-113.3, P = 0.03). CONCLUSIONS: The detection of intact MF in utero from mid-gestation to delivery predicts intact MF at birth and at 12 months in babies who undergo prenatal OSB repair. TWEETABLE ABSTRACT: Detection of intact motor function in utero predicts intact motor function at birth and at 1 year in fetuses who undergo prenatal OSB repair.

Impact of the size of the lesion in prenatal neural tube defect repair on imaging, neurosurgical and motor outcomes: a retrospective cohort study.

OBJECTIVES: (1) To compare brain findings between large and non-large neural tube defect (NTD); (2) to evaluate the impact of large lesion on the surgical parameters; (3) to study any associations between the size of the lesions and brain findings 6 weeks postoperatively and neurological short-term outcomes. DESIGN: Retrospective cohort study. SETTING: Texas Children's Hospital, between 2011 and 2018. POPULATION: Patients who underwent prenatal NTD repair. METHODS: Large lesion was defined when the lesion's surface was >75th centile of our cohorts' lesions. MAIN OUTCOME MEASURES: Time of referral: ventriculomegaly and anatomical level of the lesion; surgery: duration and need for relaxing incisions. 6 weeks postoperative: hindbrain herniation (HBH) and ventriculomegaly. After delivery: dehiscence, need for hydrocephalus treatment and motor function. RESULTS: A total of 99 patients were included, 25 of whom presented with large lesions. Type of lesion and ventriculomegaly were comparable between individuals with large and non-large lesions. Individuals with large lesions were associated with increased need for relaxing incisions by 5.4 times (95% CI 1.3-23.2, P = 0.02). Six weeks postoperatively, having a large lesion decreased by ten times the likelihood of having a postoperative reversal of HBH (odds ratio = 0.1, 95% CI 0.1-0.4, P < 0.01). At birth, larger lesions increased the risk for repair dehiscence by 6.1 times (95% CI 1.6-22.5, P < 0.01) and the risk of dehiscence or leakage of cerebrospinal fluid at birth by 5.5 times (95% CI 1.6-18.9, P < 0.01). CONCLUSION: Prenatal repair of patients with large NTD presents a lower proportion of HBH reversal 6 weeks after the surgery, a higher risk of dehiscence and a higher need for postnatal repair. TWEETABLE ABSTRACT: Evaluation of the size of fetal NTD can predict adverse neurological outcomes after prenatal NTD repair.

Congenital Aqueductal Stenosis: Findings at Fetal MRI That Accurately Predict a Postnatal Diagnosis.

BACKGROUND AND PURPOSE: Congenital aqueductal stenosis is a common cause of prenatal ventriculomegaly. An accurate diagnosis provides prognostic information and may guide obstetric management. The purpose of this study was to identify specific anatomic findings on prenatal MR imaging that can be used as predictors of congenital aqueductal stenosis. MATERIALS AND METHODS: Prenatal and postnatal MRIs of fetuses referred to our institution for ventriculomegaly between June 2008 and August 2015 were reviewed. Imaging findings in postnatally confirmed congenital aqueductal stenosis (disease group) were compared with those of ventriculomegaly cases from other causes (control group). Univariate analysis was performed using the Fisher exact test and the Wilcoxon rank test, and multivariate analysis, via the random forest method. RESULTS: Forty-three cases of ventriculomegaly had a confirmed postnatal diagnosis of congenital aqueductal stenosis. Thirty-two ventriculomegaly cases negative for congenital aqueductal stenosis were included in the control group. Dominant findings associated with an accurate prenatal diagnosis of congenital aqueductal stenosis on multivariate analysis included the following: enlarged inferior third ventricular recesses, enlargement of the lateral ventricles and third ventricle, and an abnormal corpus callosum. Findings that significantly increase the probability of congenital aqueductal stenosis (high positive predictive value) included the following: enlarged third ventricular recesses, aqueduct funneling, hemorrhage in the cerebral aqueduct, ventricular diverticulum, rhombencephalosynapsis, and dystroglycanopathy-related cerebellar dysplasia. CONCLUSIONS: Our study identified specific characteristics on fetal MR imaging that can be used as predictors of the diagnosis of congenital aqueductal stenosis. Most of these findings are secondary to the obstructive nature of the resulting hydrocephalus. Common associated malformations such as rhombencephalosynapsis and dystroglycanopathies should also increase the suspicion of congenital aqueductal stenosis when present with ventriculomegaly.

Characterization and evaluation of chitosan matrix for in vitro growth of MCF-7 breast cancer cell lines.

Biodegradable polymer scaffolds were prepared from chitosan with varying degree of deacetylation for in vitro culture of human breast cancer MCF-7 cell lines. These polymers were characterized in terms of functional groups by FTIR and swelling properties. Polymers having high degree of deacetylation showed better swelling properties irrespective of the molecular weight. These polymers were biocompatible and non-toxic towards human epithelial MCF-7 cell lines. Attachment kinetics of MCF-7 cell lines on to polymer scaffold was investigated and it was observed that polymer having high degree of deacetylation favored better cell attachment. In CPIII polymer scaffold having 80% degree of deacetylation, a maximum of 1 millions cells per mg pf polymer were adsorbed within 1h. It appears that high swelling and high degree of deacetylation of chitosan helped in better adsorption of cancer cell lines. The cellular morphology of the attached cells on chitosan matrix was similar to that observed with regular plastic culture with the difference that, cells grew as three-dimensional clumps on chitosan matrix. Polymer having high degree of deacetylation not only favored better adsorption but also showed improved cell growth kinetics. Maximum cell concentration of 6.5 x 10(5) cells/ml was achieved in 5 days culture on CPIII polymer scaffold. The glucose consumption and lactate production pattern of the MCF-7 cell lines on chitosan polymer matrix were similar to that observed on cell growth on tissue culture flask. These results indicate that chitosan scaffold having high degree of deacetylation can be used for three-dimensional growth of MCF-7 cancer cell lines. Such in vitro 3D culture of cancer cells can thus be used as a model for the cytotoxic evaluation of anticancer drugs.

Synthesis and metal ion uptake studies of chelating resins derived from formaldehyde-furfuraldehyde condensed phenolic Schiff bases of 4,4'-diaminodiphenylether and o-hydroxyacetophenone.

Two new chelating resins (o-HAP-DDE-HCHO and o-HAP-DDE-FFD), having multiple functional groups are synthesised by condensing the Schiff base of o-hydroxyacetophenone-4,4'-diaminodiphenylether (o-HAP-DDE) with formaldehyde and furfuraldehyde, respectively. The extent of loading of metal ions Cu(II) and Ni(II) was studied in both competitive and non-competitive conditions varying the time of contact, metal ion concentration and the pH of the reaction medium. Both the resins are able to preferentially remove Cu(II) from the mixture of Cu(II) and Ni(II) at a pH 5.89 in the batch operation, maximum % uptake being 76.8 and 84.1, respectively, for o-HAP-DDE-HCHO and o-HAP-DDE-FFD. The furfuraldehyde condensed resin was found to be more effective in removing Cu(II) ions than the formaldehyde condensed resins in batch technique. The resins exhibited little affinity for alkali and alkaline earth metal ions. Further, the furfuraldehyde condensed resin was utilised in column operation for removing Cu(II) ions. Elution study with HCl (>1.0 mol l(-1)) resulted in removal of nearly 40-50% of loaded Cu(II) from the resin column.

Sustained release of antimicrobial drugs from polyvinylalcohol and gum arabica blend matrix.

Synthetic polymers are widely used in biomedical applications. Polymer blends have recently paved their way in this field. An attempt to prepare blend of synthetic polymer polyvinylalcohol and natural macromolecule gum arabica is made in this paper. Characterization of these blends by NMR, DSC and viscoelastic studies reveal preparation of a blend composition with synergistic properties. The blend composition with synergistic properties was used to release various antimicrobial drugs. The duration and release of the drug depends on the amount of drug loaded in the matrix and solubility of the drug in the matrix and release medium. The advantage of this system is that the release kinetics of the drug from the system can be tailored by adjusting plasticizer, homopolymer and crosslinker composition depending on the drug to be released.

Sustained release of ferrous sulfate from polymer-coated gum arabica pellets.

Sustained release of ferrous sulfate (FeSO4) from gum arabica pellets has been achieved for 7 h. Release is further sustained for 12 to 600 h by coating the pellets with polyvinyl acetate and ethylene vinyl acetate, respectively. An increase in the amount of gum arabica in the pellets decreases the rate of release due to the gelling property of gum arabica. The gel layer acts as a barrier and retards the rate of diffusion of FeSO4 through the pellet. In coated pellets, an increase in thickness of membrane helps to sustain the release of FeSO4 for a longer duration. Thus, the release of FeSO4 can be sustained for the required duration by adjusting the amount of gum arabica in the pellet and the composition and thickness of polymeric coat. The mechanism of release accordingly varies from Fickian to zero-order and super case II transport.

Synthesis and characterization of aliphatic polyurethane fiber: a potential suture material.

Polyurethane fibers were synthesized and characterized by IR, 1H NMR, DSC, and GPC. Their properties as fiber were compared with commercially available sutures of polypropylene, polyamide, polyester, and silk.

Antibacterial multifilament nylon sutures.

Multifilament nylon fibers were made antibacterial by dopping with iodine. Nylon fibers were immersed in acetone solution of iodine for 48 hours at room temperature for dopping of iodine. It was observed that iodine uptake by the nylon fibers increased with the increase in concentration of iodine in the solution. Antibacterial activity of these iodine dopped samples was evaluated by measuring the zone of inhibition. The bacterial species used for this study were Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Klebsiella pneumoniae. Iodine dopped fibers exhibited good antibacterial activity against these bacterial species. Release of iodine in distilled water is sustained for about 30 days. Antibacterial activity of the fibers decreases with the release of iodine in water. Ultra-violet and visible spectroscopic studies showed that tri-iodide ions were released from the dopped samples in the aqueous medium. These I3- ions might be responsible for the observed antibacterial activity. Fiber shrinks on iodine dopping leading to increase in the denier of the fiber. However effect of iodine dopping on the breaking load of fibers is not significant.

Radiation-induced graft copolymerization of methacrylic acid on to poly(vinyl chloride) films and their thrombogenicity.

Methacrylic acid (MAA) was radiation grafted on to poly(vinyl chloride) (PVC) films to improve the blood compatibility of PVC. The thromobogenicity of MAA grafted PVC was evaluated by thrombus formation, platelet adhesion and haemolytic activity in vitro. The hydrophilicity of grafted PVC films was investigated by contact angle measurement. Methacrylic acid grafted PVC film showed lower thrombogenicity than that of PVC. It was found that the weight of thrombus formed on grafted PVC was less than that of PVC and glass and decreased with the increase in the graft level. The adhesion of platelets on grafted PVC was retarded after grafting with MAA hydrogels.

Effect of anionic polymeric hydrogels on spermatozoa motility.

The effects of a few synthetic polymers on the motility of human spermatozoa in vitro have been studied. An alternate copolymer of styrene and maleic anhydride, poly(S-MA), poly (styrene-maleic acid), poly(S-MC), poly(hydroxy-ethyl methacrylate-methacrylic acid) copolymer, poly(HEMA-MAC), poly(HEMA) homopolymer and poly(MAC) homopolymer were chosen for this purpose. It was found that all the carboxylic acid containing polymers are strong inhibitors of the motility of spermatozoa. Poly(HEMA) did not have any inhibitory effect on the motility of spermatozoa.

PIP: This paper describes the effects of selected synthetic polymers on the motility of human spermatozoa in vitro. The authors have developed a new mehtod of male fertility control that involves the use of an anionic hydrophilic polymer which when infected into the vas deferens, is precipitated and lowers the pH in the vicinity, thus killing the spermatozoa passing through the vas deferens. The results of this experiment indicate that carboxylic acid-containing polymers are strong inhibitors of sperm motility. Almost all sperm became immotile within 15 minutes after treatment with polymer (styrene-maleic acid) (S-MC) and polymer methacrylic acid (MAC). Polymer (HEMA-MAC), a copolymer containing roughly equal ratios of hydroxyethyl methacrylate and methacrylic acid, showed inhibitory action, but it took 30 minutes for 100% immotility to be achieved. The stronger inhibition of motility observed with poly (S-MC) compared with poly (HEMA-MAC) is attributed to the presence in the former of 2 carboxylic groups on adjacent carbon atoms. It is possible that low pH environment created by ionization of carboxyl groups fixed in the polymer matrix is responsible for killing the spermatozoa. Hydrogen ion concentration is considered to be a key factor in influencing the motility, viability, and metabolism of spermatozoa. Poly (HEMA), containing only hydroxyl groups, did not have any inhibitory effect.

Novel mode of contraception using polymeric hydrogels. I.

A new method of fertility control has been proposed and tested. The technique involves the use of the polymer, which when injected into the vas deferens lowers the pH sufficiently so as to kill the spermatozoa passing through. The polymer provides an acidic environment for a prolonged time and slowly erodes. The fertility may be restored after complete solubility of the polymer itself over a period of time or by flushing it with a suitable solvent. This method of male contraception is nonsurgical, nonocclusive, and reversible.

PIP: Some data on the synthesis and characterization of poly(HEMA-MAC) and its applications for fertility control are presented. This new technique involves the use of the polymer, which when injected into the vas deferens lowers the pH sufficiently so as to kill the spermatozoa passing through. The polymer provides an acidic environment for a prolonged time and slowly erodes. The fertility may be restored after complete solubility of the polymer itself over a period of time or by flushing it with a suitable solvent. It is a nonsurgical, nonocclusive, and reversible method of male contraception. In regard to the experimental procedure, copolymerization of HEMA with MAC (35% by weight) in methanol was carried out in a nitrogen atmosphere in glass ampules. Irradiation was performed in a cobalt-60 radiation chamber. All the samples were irradiated at a dose rate of 130 rad/s for a total dose of 0.936 Mrad at room temperature. For studying the spermicidal actions of the copolymer, epididymal fluid from the male rat was collected, diluted 1:10 with Ringer-fructose buffer and microscopically examined. Small swollen pieces of poly(HEMA-MAC) copolymer as well as poly(HEMA) homopolymer were then added to the epididymal fluid and the effect on the spermatozoa was noted. The spermicidal action "in vitro" was indicated by the loss of motility of the spermatozoa immediately on coming in contact with the poly(HEMA-MAC). The spermatozoa remained immotile even after the removal of the copolymer, indicating that they were dead. The polymer treated spermatozoa did not take up any supravital stain confirming that they were killed. This effect was absent only when poly(HEMA) was used. These results clearly show that the spermicidal activity is mainly due to the carboxylic groups of MAC. Possibly the low pH environment due to the ionization of carboxylic groups is responsible for killing the spermatozoa. For all the experiments the injection of the polymeric solution into the vas deferens was given only by exposing the vas deferens, but it is reported that in humans injection into the scrotal wall is possible. The new technique has all the characteristics which can lead to an ideal contraceptive method. Preliminary results of "in vitro" experiments on human spermatozoa with these hydrogels are encouraging.

Histology of the rat vas deferens after injection of a non-occlusive chemical contraceptive.

An alternate co-polymer of styrene and maleic anhydride was dissolved in dimethylsulphoxide and injected into the vas deferens of rats. The polymer was retained in the vas deferens and the morphological changes detected were confined to the mucosa. When the polymer was removed by flushing dimethylsulphoxide, the mucosal structure became normal within 2 weeks.

An insulin delivery system from oxidized cellulose.

Cellulose oxidized with periodate (OC) has been shown to be a biocompatible, biodegradable matrix suitable for immobilization and sustained release of drugs. In the present work, insulin was immobilized on the OC-matrix and the release profile in vivo and in vitro was examined. The hormone is bound to the matrix by Schiff's bond formation and is released by hydrolysis of this bond as well by degradation of the OC-matrix. The release can be sustained over longer periods by reducing the Schiff's base with NaBH4. The insulin depots could be conveniently injected as suspensions and are able to maintain glucose levels in diabetized rabbits at normal values over several days.