Zein is a type of prolamine protein that is derived from corn, and it has been recognized by the US FDA as one of the safest biological materials available. Zein possesses valuable characteristics that have made it a popular choice for the preparation of drug carriers, which can be administered through various routes to improve the therapeutic effect of antitumor drugs. Additionally, zein contains free hydroxyl and amino groups that offer numerous modification sites, enabling it to be hybridized with other materials to create functionalized drug delivery systems. However, despite its potential, the clinical translation of drug-loaded zein-based carriers remains challenging due to insufficient basic research and relatively strong hydrophobicity. In this paper, we aim to systematically introduce the main interactions between loaded drugs and zein, administration routes, and the functionalization of zein-based antitumor drug delivery systems, in order to demonstrate its development potential and promote their further application. We also provide perspectives and future directions for this promising area of research. Graphical Abstract:

Background: Peripheral artery disease (PAD) patients after endovascular treatment (EVT) have a relatively high restenosis rate. However, this risk can be mitigated through precise risk assessment and individualized self-management intervention plans. Moreover, the number of predictive models for restenosis risk in PAD patients after EVT is gradually increasing, yet these results of study exhibit certain discrepancies, raising uncertainties regarding the quality and applicability in clinical practice and future research. Objective: The objective of this study was to systematically evaluate risk-predictive models for restenosis in patients with PAD after EVT. Methods: A systematic review and meta-analysis of predictive model construction and validation using observational studies was undertaken. The China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, SinoMed, PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to January 1, 2024. Two researchers independently conducted literature screening and data extraction, encompassing study design, data sources, outcome definition, sample size, predictive factors, model development, and performance. The Prediction Model Risk of Bias Assessment Tool (PROBAST) was used for risk of bias and applicability assessment of the models. Results: A total of 4275 studies were retrieved, ultimately resulting in the inclusion of 7 articles comprising 7 predictive models for restenosis in PAD patients after EVT, with a restenosis incidence ranging from 21.8% to 39.7%. The total sample size of the included models ranged from 137 to 1578 cases, with logistic regression analysis being the most commonly used modeling method. All models were built using R software. Only 2 models underwent external validation, and the reported area under the curve ranged from 0.728 to 0.864. The summary area-under-the-curve statistic was 0.80 (95% confidence interval [CI], 0.74-0.86), with an approximate prediction interval of 0.80 (95% CI, 0.62-0.91) . The number of included predictive factors ranged from 3 to 10, with the most common factors being age, Trans-Atlantic Inter-Society Consensus Ⅱ classification, hypertension, diabetes, high-sensitivity C-reactive protein, and surgical approach. All studies exhibited high risk of bias, primarily attributed to inappropriate sources of data and poor reporting of the analysis domain. Conclusion: Predictive models for restenosis after EVT in PAD patients demonstrate overall good predictive performance but are still in the developmental stage with higher risk of bias. Future studies should follow the TRIPOD statement, focusing on the development of new models with larger samples, rigorous study designs, and multicenter external validation. Clinical Impact: This systematic review adheres to the PRISMA 2020 statement, offering the most recent systematic assessment of risk prediction models for restenosis following endovascular treatment in peripheral arterial disease.The newly developed PROBAST tool was employed to assess the risk of bias and the applicability of the existing evidence.This review emphasizes the practical utility, limitations of the current evidence, and recommendations for future research, with the goal of providing valuable information for clinicians and patients in their decision-making process, while also supporting the advancement of future research endeavors.

Background: Tunneled-cuffed catheter (TCC) reaching the mid-atrium has been demonstrated to be associated with improved catheter survival. However, whether similar conclusions can be made for femoral TCC reaching the inferior vena cava (IVC) remains unknown. Methods: Data from 47 patients with end-stage renal disease receiving right femoral TCC were retrospectively collected and analyzed. The primary patency, catheter dysfunction, and TCC-associated infection rate were compared between patients with TCC tip at the IVC and those with TCC tip at non-IVC. Results: TCC tips were located at the IVC in 26 patients and non-IVC in 21 patients. The technical success rates for both groups were 100%. The primary patency of the former group were significantly higher than those of the latter group at 3 months (92.3% vs 61.9%, p = 0.011), 6 months (80.8% vs 52.4%, p = 0.017), and 12 months (50.0% vs 28.5%, p = 0.024) follow-up, respectively. Kaplan-Meier curve analysis demonstrated significantly different catheter dysfunction-free survival between the two groups (log-rank p = 0.017). The overall TCC-associated infection rate was similar between the two groups (7.7% vs 9.5%, p = 0.82). Conclusion: Femoral TCC with tips at IVC was associated with higher primary patency, lower catheter dysfunction but similar TCC-associated infection rate as compared with those at non-IVC.

Background: Although the candy-plug technique has been reported to be useful for the treatment of post-dissection aortic aneurysm, the stent graft needs be to customized to accommodate the size of vascular occluders. Case presentation: We present a case of a persistent false lumen successfully treated with endovascular stent-graft and atrial septal defect occluder in a patient with Stanford Type B dissection. A covered stent graft was implanted into the false cavity through a distal rupture, and an atrial septal defect occluder was inserted into the covered stent to seal of the false cavity. Decreased aneurysmal diameter and false lumen thrombosis were noted by CT scan at 6-month follow-up. Conclusions: Our case showed that combined use of a stent graft and atrial septal defect occluder is safe, technically feasible and effective in sealing of the false lumen in post-dissection aortic aneurysm patients with previously failed false lumen thrombosis.

Objective: To identify the most valuable predictor associated with overall survival (OS) and amputation-free survival (AFS) and to develop and validate OS and AFS prediction models for patients with peripheral arterial disease (PAD) who underwent endovascular therapy (EVT). Methods: This study included patient with PAD who EVT between January 2018 to June 2023 across 3 hospitals in southwest China. Outcomes were OS and AFS at 1, 2, and 3 years. Results: A total of 2792 consecutive patients with PAD who underwent EVT were included, with an average follow-up period was 14.0 ± 8.7 months. During the follow-up period, 412 (14.8%) patients died, and 737 (26.4%) patients experienced either amputation or death. The OS rates in 1-, 2-, and 3-years were 89.3%, 81.2%, and 74.2% in the whole cohort, respectively. In terms of AFS, the rates at 1-, 2-, and 3-years were 81.7%, 68.3%, and 54.1%, respectively. Predictors in the OS prediction model included age, diabetes mellitus (DM), body mass index (BMI) classification, dialysis-dependent renal failure (DRF), Rutherford classification, antiplatelet therapy, and cilostazol therapy (p < 0.05). Predictors in the AFS prediction model included DM, chronic obstructive pulmonary disease, DRF Rutherford classification, antiplatelet therapy, and cilostazol therapy (p < 0.05). The area under the curve and calibration curves for training, internal, and external validation of both OS and AFS prediction models indicated good performance. Conclusions: This study demonstrates that both OS and AFS prediction models exhibit good discriminative ability to predict survival rate and AFS rate in patients with PAD. PAD patients with DM, DRF, Rutherford classification R5 and R6, absence of antiplatelet, and cilostazol therapy were associated with significantly lower OS and AFS rates. Controlling these risk predictors may be guide patient care in clinical settings. Clinical Impact: In this multicenter longitudinal study, 2792 patients were included in the overall survival (OS) and amputation-free survival (AFS) prediction models development and validation. Patients with modifiable risk factors could potentially benefit from strategies aimed at preventing disease process (Rutherford classification), controlling comorbidities (diabetes mellitus, chronic obstructive pulmonary disease, and dialysis-dependent renal failure), and enhancing adherence to medical therapy (antiplatelet and cilostazol therapy). Our models have ability to predict survival and AFS rates at multiple time points, thereby facilitating early identification of high-risk patients and enabling timely interventions to optimize patient outcomes.