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Die periphere arterielle Verschlusskrankheit (paVK) ist ein in den Industrienationen zunehmendes Erkrankungsbild, bei der die radiologisch-interventionelle Therapie, insbesondere die perkutane transluminale Angioplastie (PTA) mit fakultativer Stentimplantation, eine wichtige Rolle spielt. Die vorliegende Arbeit beschäftigt sich mit der Auswertung von 48 interventionellen Eingriffen mittels PTA und fakultativer Stentimplantation der unteren Extremität bei paVK-Patienten. Die in den Kontrolluntersuchungen nach 1, 3, 6 und 12 Monaten erhobenen Parameter wurden bezüglich der Offenheitsrate nach bis zu einem Jahr ausgewertet, wobei die Erhebung des Knöchel-Arm-Index, die Sonografie und das Krankheitsstadium eine wesentliche Rolle spielten. Des Weiteren wurde die subjektive Bewertung der Intervention durch die Patienten in Hinsicht auf die Zufriedenheit beurteilt. Die Studie zeigte einen primären Interventionserfolg von 89,5% der Fälle (PTA: 73,9%, PTA + Stent: 100%). Nach einem Jahr fand sich eine Offenheitsrate von 76,5%, wobei die alleinige PTA mit einer Offenheit von 84,6% überlag (PTA + Stent: 71,4%). Subjektiv lag eine Verbesserung des Allgemeinzustands in 77,2% aller Fälle nach einem Jahr vor. Ein Vergleich der Ergebnisse wird jedoch durch mangelnde allgemeine Studienstandards in der Literatur und den Einfluss unterschiedlicher Patientenklientel erschwert. Im Vergleich mit ähnlichen Studien zeigt sich ein im guten Mittelfeld liegendes Interventionsergebnis. Auch die positive Auswirkung auf die Lebensqualität ist in der Literatur vorbeschrieben. Eine weitere Standardisierung von Studienbedingungen erscheint jedoch zur besseren Vergleichbarkeit sinnvoll.
Abstract
Two decades after the discovery of adult‐born neurons in the brains of decapod crustaceans, the deutocerebral proliferative system (DPS) producing these neural lineages has become a model of adult neurogenesis in invertebrates. Studies on crayfish have provided substantial insights into the anatomy, cellular dynamics, and regulation of the DPS. Contrary to traditional thinking, recent evidence suggests that the neurogenic niche in the crayfish DPS lacks self‐renewing stem cells, its cell pool being instead sustained via integration of hemocytes generated by the innate immune system. Here, we investigated the origin, division and migration patterns of the adult‐born neural progenitor (NP) lineages in detail. We show that the niche cell pool is not only replenished by hemocyte integration but also by limited numbers of symmetric cell divisions with some characteristics reminiscent of interkinetic nuclear migration. Once specified in the niche, first generation NPs act as transit‐amplifying intermediate NPs that eventually exit and produce multicellular clones as they move along migratory streams toward target brain areas. Different clones may migrate simultaneously in the streams but occupy separate tracks and show spatio‐temporally flexible division patterns. Based on this, we propose an extended DPS model that emphasizes structural similarities to pseudostratified neuroepithelia in other arthropods and vertebrates. This model includes hemocyte integration and intrinsic cell proliferation to synergistically counteract niche cell pool depletion during the animal's lifespan. Further, we discuss parallels to recent findings on mammalian adult neurogenesis, as both systems seem to exhibit a similar decoupling of proliferative replenishment divisions and consuming neurogenic divisions.
Abstract
Nervous system development has been intensely studied in insects (especially Drosophila melanogaster), providing detailed insights into the genetic regulatory network governing the formation and maintenance of the neural stem cells (neuroblasts) and the differentiation of their progeny. Despite notable advances over the last two decades, neurogenesis in other arthropod groups remains by comparison less well understood, hampering finer resolution of evolutionary cell type transformations and changes in the genetic regulatory network in some branches of the arthropod tree of life. Although the neurogenic cellular machinery in malacostracan crustaceans is well described morphologically, its genetic molecular characterization is pending. To address this, we established an in situ hybridization protocol for the crayfish Procambarus virginalis and studied embryonic expression patterns of a suite of key genes, encompassing three SoxB group transcription factors, two achaete–scute homologs, a Snail family member, the differentiation determinants Prospero and Brain tumor, and the neuron marker Elav. We document cell type expression patterns with notable similarities to insects and branchiopod crustaceans, lending further support to the homology of hexapod–crustacean neuroblasts and their cell lineages. Remarkably, in the crayfish head region, cell emigration from the neuroectoderm coupled with gene expression data points to a neuroblast‐independent initial phase of brain neurogenesis. Further, SoxB group expression patterns suggest an involvement of Dichaete in segmentation, in concordance with insects. Our target gene set is a promising starting point for further embryonic studies, as well as for the molecular genetic characterization of subregions and cell types in the neurogenic systems in the adult crayfish brain.