| AIM: Tuberculous hydrocephalus is the most common complication of tuberculous meningitis. These patients’ lives are suffered, due to the cerebral parenchymal atrophy and cranial nerve compression caused by persistent intracranial hypertension and disorder of the brain nutrition and metabolism. At present, it is still controversial about the treatment of tuberculous meningitis with hydrocephalus. The debate focuses on whether it is necessary to take ventriculoperitoneal shunt treatment and the optimal timing, for considering the shunt device may cause exacerbations or recurrence of tuberculosis. However, the clinical practice showed that the tuberculous hydrocephalus patients with early ventriculo peritoneal shunt is feasible, rather its mechanism is still not clear. Therefore, this topic was in order to judge the feasibility about early ventriculoperitonealshunt with tuberculous hydrocephalus patients, by stud ying the adhesion of Mycobacterium tuberculosis with silicone rubber surface, and reviewing the clinical data. Further, through violet and hydrophilic outer surface grafting technique of medical silicone rubber, we tried to change the dear/hydrophobic of the silicon rubber surface, and reduce bacterial adhesion, for providing theoretical and applied foundation about early ventriculo-peritoneal shunt applying in tuberculous hydrocephalus treatment.METHODS: 1. Study of Mycobacterium tuberculosis forming biofilms ability with silicone rubber. In vitro, the ventricular catheter 9003-E and water soluble ventricular catheter 93522 fro m Medtronic Inc are respectively arranged in the tubercle bacillus and Staphylococcus aureus suspension culture. We arrange 5 observation time points: 10, 20, 30, 40, 50 generation of bacteria. At each time point, non adhesion bacteria wash out by PBS, and we draw the growth curve by counting the adhesion bacteria. At the same time, we analysis the adhesion differences of tuberculosis bacillus and Staphylococcus aureus by scanning electron microscopy. 2. Study of the early treatment of tuberculous hydrocephalus. Retrospective analysis of 30 tuberculous meningitis hydrocephalus patients with ventriculo-peritoneal shunt in the 309 th Hospital of PLA from 2006 January to 2010 December.The patients were divided into early or late ventricle-peritoneal shunt group, according to whether intracranial tuberculosis was controled. We record the patients’ age, gender, history of BCG vaccination, tuberculosis activity outside skull, hyponatremia, Palur grade, GCS score, CT and MRI imaging results, whether the drug resistant strains of Mycobacterium tuberculosis, and postoperative shunt patency data. 3. Study of bacterial adhesion of modificated silicone rubber. We change the hydeophilicity of silicone rubber, by using UV curable hydrophilic graft method. And, there are acrylic acid, PEG, PEG+OP10 experimental groups, as well as the blank control group and the ultraviolet control group. We measure the silicone rubber surface angle and adhesive force with Staphylococc us aureus. Then, we observe and count the formation ofbacterial colonies by scanning electron microscope.RESULTS: 1. It is difficult to form biofilm surface by Mycobacterium tuberculosis in silicone rubber tube, comparing with Staphylococcus aureus. The colony of Mycobacterium tuberculosis in the ventricular catheter 9003-E and 93522 on the surface is significantly lower than that of Staphylococcus aureus. And, the colony Tubercle bacillus and Staphylococcus aureus on the surface of water-soluble catheter 93522 are consistently lower than common duct 9003-E. Electron microscopy results showed that lots of Staphylococcus aureus adhesion to ventricular catheter 9003-E and a 93522 surface. While, only a single sparse of Mycobacterium tuberculosis attached to the two surface, only a small amount of clay like substance surrounding Mycobacterium tuberculosis bacteria. 2. The effect of early ventriculoperitoneal shunt and factors associated with curative effect of the operation. The patients with early ventriculoperitoneal shunt always have more severe hydrocephalus symptoms, but no statistically significant difference has been seen in the general data and shunt effect comparing with the late group. In ventriculoperitoneal shunt patients, age, gender, history of BCG vaccination, tuberculosis extracerebral activities combined, hyponatremia, Palur grade, GCS score, basal cisterns enhancement, intracranial tuberculoma, and cerebral infarction have no statistically significant correlation with long-term efficacy. Only the drug resistant strains of Mycobacterium tuberculosis could affect the long-term efficacy. 3. Silicone rubber surface modification significantly increased hydrophilic and reduced bacterial adhesion. After modification, the silicone rubber surface contac t angle of acrylic acid, PEG, PEG+OP10 groups are significantly reduced than that of the control groups. Meanwhile, the silicon rubber surface contact angle in PEG+OP10 group decreased most significantly. Colonies were counted under the light microscope and electron microscope. And the results showed the bacterial concentration and colony count of acrylic acid, PEG, PEG+OP10 three groups were significantly lower than those in the control groups, especially PEG+OP10 group.CONCLUSION: 1. By comparison of the differences in biofilm formation of Mycobacterium tuberculosis and the Staphylococcus aureus on the ventricular catheter, we found that the adhesion of Mycobacterium tuberculosis on silicone rubber surface was significantly lower than that of Staphylococcus aureus. Further, it was found that the lower adhesion might be derived from the less adhesion material. At the same time, the results also show that the colony count of Mycobacterium tuberculosis and Staphylococcus aureus on water-soluble catheter surface were consistently lower than common duct, which suggesting that changes in hydrophobic material may further reduce the adhesion of bacteria on the ventricular catheter. 2. By retrospective analysis of clinical cases, we found that using early ventriculoperitoneal shunt in the treatment of tuberculous hydrocephalus patients, whe n tuberculosis has not been cured in brain, also has a high success rate. And, the effect of early ventriculoperitoneal shunt had no statistically significant differences with tho se undergoing ventriculo peritoneal shunt, when intracranial tuberculosis has been cured. These results suggest that regardless of intracranial tuberculosis, positive early ventriculoperitoneal shunt did not result in increased risk of intracranial infecti on and CSF protein blocking. At the same time, this study also showed that patients of drug-resistant TB would affect long-term prognosis after ventriculoperitoneal shunt. 3. By using UV grafting technology to modificate the hydrophily of silicone rubber surface, we found that the contact angle reduced with the acrylic acid, polyethylene glycol 1000 and surfactant OP-10 treatment, which suggesting that the hydrophilicity enhanced. At the same time, bacterial adhesion on the modified silicone rubber surface is reduced significantly. The study also found that enhanced hydrophilicity of silicone rubber surface treated with polyethylene glycol 1000 and surface active agent OP-10 is more obvious, adhesion of bacteria lower. In conclusion, the UV curing grafting technology can improve the hydrophilicity of silicone rubber surface, thereby reducing the adhesion of bacteria. The modification will have the potential to further reduce the adhesion of bacteria to the ventricular catheter, thereby increasing the early ventriculo peritoneal shunt feasibility oftuberculous hydrocephalus. |
PDF Full Text Request