Objective:To investigate the predictive value of a nomogram based on multimodal CT parameters for the outcome of endovascular therapy (EVT) in patients with acute vertebrobasilar artery occlusion (AVBAO).Methods:Patients with AVBAO underwent EVT at Xuzhou Central Hospital from January 2021 to March 2024 were included retrospectively. At 90 days after EVT, the modified Rankin Scale was used to evaluate clinical outcome. 0-3 points were defined as good outcome and 4-6 points were defined as poor outcome. Multivariate stepwise logistic regression model was used to screen for predictive variables. Then a nomogram was drawn and the prediction model was evaluated. Results:A total of 91 patients with AVBAO were included. There were 60 males (65.9%), aged 69.09±10.57 years. Thirty-eight patients (41.8%) had good outcome, 53 (58.2%) had poor outcome, and 35 (38.5%) died. Univariate analysis showed that there were significant differences in white blood cell count, neutrophil count, National Institutes of Health Stroke Scale (NIHSS) score, Glasgow Coma Scale (GCS) score, posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS), Basilar Artery on Computed Tomography Angiography (BATMAN) score, core infarct volume, mismatched volume ratio, onset to door time between the poor outcome group and the good outcome group (all P<0.05). The above indicators were included in a binary multivariate stepwise logistic regression model. The results showed that higher NIHSS scores (odds ratio [ OR] 1.154, 95% confidence interval [ CI] 1.070-1.244; P<0.001), lower BATMAN scores ( OR 0.626, 95% CI 0.416-0.943; P=0.025), and larger core infarct volumes ( OR 1.147, 95% CI 1.046-1.258; P=0.004) on admission were the independent risk factors for poor outcome. A nomogram was plotted using the above three independent risk factors as predictor variables. Its area under the receiver operating characteristic curve for predicting poor outcome was 0.942 (95% CI 0.894-0.990). The sensitivity and specificity were 81.1% and 97.4%, respectively. The calibration curve fluctuates within a small range around the ideal curve. A mean absolute error was 0.027 and a mean square error was 0.001. The clinical decision curve suggested that the model had good clinical applicability. The dynamic nomogram is shown in: https://yuepeng.shinyapps.io/VBAO_model/. Conclusion:The nomogram prediction model based on multimodal CT parameters has good predictive performance for poor outcome in patients with AVBAO after EVT.

Objective:To analyze the clinical characteristics and endoscopic surgical procedures of the second branchial cleft cyst type Ⅳ in children.Methods:A retrospective review was conducted on 15 pediatric cases with type Ⅳ second branchial cleft cysts treated at the Beijing Children′s Hospital affiliated with Capital Medical University and Henan Children′s Hospital from September 2019 to November 2023. All patients underwent excision via a two-person, three-hand endoscopic transoral approach. The cohort included 12 males and 3 females, with an age range of 10 months to 10 years and 5 months, and a median age of (59.20±32.05) months. The clinical data of initial symptoms, sides, imaging features, treatment methods, complications, length of hospital stay, prognosis and outcome were recorded and analyzed. SPSS 22.0 software was used for statistical analysis.Results:Of the 15 children, 13 cases presented with snoring as the primary symptom, 1 case with dysphagia, and 1 case was asymptomatic and was found unintentionally. The mean disease duration was (6.74±9.05) months (range, from 3 days-2 years). MRI revealed cystic lesions on the right side in 12 cases and on the left side in 3 cases, characterized by uniform long T2 signal, equal T1 or short T1 signal. The cysts appeared dumbbell-shaped in 10 cases with the pharyngeal constrictor muscle as the waist, the posterior outside of the mass was adjacent to the internal carotid artery. The remaining 5 cases showed an isolated cyst located inside the pharyngeal constrictor muscle. The intraoperative MRI findings were consistent. Partial cystectomy was performed in 10 cases near the internal carotid artery, leaving only the portion with a clear arterial pulse intact. Five cases with isolated cysts on the medial side of the pharyngeal constrictor muscle were totally removed. The average length of hospital stay was (4.53±0.52) days (4-5 days). All patients were followed up for 7-56 months [median (30±15.12) months] with no recurrence of symptoms observed.Conclusions:The second branchial cleft cyst type Ⅳ in children is characterized by prominent pharyngeal cystic mass, with snoring as a predominant initial symptom, MRI provides excellent diagnostic value. The two-person, third-hand endoscopic transoral approach for cyst excision is feasible, safe, and offers the benefits of minimal invasiveness and reduced hospitalization time.