Necessity and proper way of intermediate kissing balloon dilation for culotte stenting: further insights from bench testing

Objective: The aim of this study was to investigate whether intermediate kissing balloon dilation(IKBD) is necessary during mini-culotte stenting(MCS) and how it can be properly conducted. Methods: MCS was emulated in a bifurcation model with a branch diameter difference(BDD) in three-step sizes of 0.50, 0.75 and 1.00 mm, and with intermediate balloon dilation(IBD) in three treatments of routine intermediate solo balloon dilation(rISBD), concurrent IKBD(cIKBD) or sequential IKBD. Microcomputed tomography was performed to assess stent under-expansion(SUE) around the polygon of confluence(POC), residual ostial stenosis(ROS) at the ostial side-branch(SB) and main-branch(MB) and stent cell distortion(SCD) in the bifurcation segments. Results: There were both main and interactive effects of IBD and BDD on ROS at the ostial SB and SCD in the ostial SB, but there were only main effects of IBD or BDD on SUE around the POC, ROS at the ostial MB and SCD in the ostial MB. Analysis of the main effects showed that SUE around the POC or ROS at the ostial SB was significantly different between sI KBD and rISBD and between cI KBD and rISBD. There was also a significant difference in SCD in the ostial SB between sI KBD and rI SBD and between sI KBD and cIKBD. Analysis of the interactive effects showed that ROS at the ostial SB or SCD in the ostial SB was affected by all IBD treatments in all BDD step-sizes. Moreover, increasing the BDD step-sizes significantly increased ROS at the ostial SB as treated by rISBD and SCD in the ostial SB as treated by rISBD or cIKBD. Conclusions: SIKBD was shown to be essential and superior to rISBD or cIKBD, resulting in better bifurcated stent expansion and coverage when using MCS.

Senescence in chronic wounds and potential targeted therapies

Chronic wounds(e.g.diabetic wounds,pressure wounds,vascular ulcers,etc.)do not usually heal in a timely and orderly manner but rather last for years and may lead to irreversible adverse events,resulting in a substantial financial burden for patients and society.Recently,a large amount of evidence has proven that cellular senescence has a crucial influence on chronic nonhealing wounds.As a defensive mechanism,cell senescence is a manner of cell-cycle arrest with increased secretory phenotype to resist death,preventing cells from stress-induced damage in cancer and noncancer diseases.A growing amount of research has advanced the perception of cell senescence in various chronic wounds and focuses on pathological and physiological processes and therapies targeting senescent cells.However,previous reviews have failed to sum up novel understandings of senescence in chronic wounds and emerging strategies targeting senescence.Herein,we discuss the characteristics and mechanisms of cellular senescence and the link between senescence and chronic wounds as well as some novel antisenescence strategies targeting other diseases that may be applied for chronic wounds.