Identification and risk stratification of coronary disease by artificial intelligence-enabled ECG.

Background: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death worldwide, driven primarily by coronary artery disease (CAD). ASCVD risk estimators such as the pooled cohort equations (PCE) facilitate risk stratification and primary prevention of ASCVD but their accuracy is still suboptimal. Methods: Using deep electronic health record data from 7,116,209 patients seen at 70+ hospitals and clinics across 5 states in the USA, we developed an artificial intelligence-based electrocardiogram analysis tool (ECG-AI) to detect CAD and assessed the additive value of ECG-AI-based ASCVD risk stratification to the PCE. We created independent ECG-AI models using separate neural networks including subjects without known history of ASCVD, to identify coronary artery calcium (CAC) score ≥300 Agatston units by computed tomography, obstructive CAD by angiography or procedural intervention, and regional left ventricular akinesis in ≥1 segment by echocardiogram, as a reflection of possible prior myocardial infarction (MI). These were used to assess the utility of ECG-AI-based ASCVD risk stratification in a retrospective observational study consisting of patients with PCE scores and no prior ASCVD. The study period covered all available digitized EHR data, with the first available ECG in 1987 and the last in February 2023. Findings: ECG-AI for identifying CAC ≥300, obstructive CAD, and regional akinesis achieved area under the receiver operating characteristic (AUROC) values of 0.88, 0.85, and 0.94, respectively. An ensembled ECG-AI identified 3, 5, and 10-year risk for acute coronary events and mortality independently and additively to PCE. Hazard ratios for acute coronary events over 3-years in patients without ASCVD that tested positive on 1, 2, or 3 versus 0 disease-specific ECG-AI models at cohort entry were 2.41 (2.14-2.71), 4.23 (3.74-4.78), and 11.75 (10.2-13.52), respectively. Similar stratification was observed in cohorts stratified by PCE or age. Interpretation: ECG-AI has potential to address unmet need for accessible risk stratification in patients in whom PCE under, over, or insufficiently estimates ASCVD risk, and in whom risk assessment over time periods shorter than 10 years is desired. Funding: Anumana.

Low-grade fibromyxoid sarcoma around the knee involving the proximal end of the tibia and patella: A rare case report.

Low-grade fibromyxoid sarcoma (LGFMS) is a distinctive variant of fibrosarcoma. LGFMS is a rare soft tissue tumor that tends to develop in the deep soft tissue of young adults and has the potential for local recurrence or distant metastasis. The current case report presents a 22-year-old male complaining of a slow growing painless mass in the right knee over a period of 10 years. Following complete evaluation by radiological and histopathological examination, a diagnosis of LGFMS was confirmed and a wide excision was performed. Currently, the patient has been under follow-up for the last five years without any evidence of metastasis. The present case report provides further information concerning the diagnosis, imaging and management of LGFMS.

Klippel Feil Syndrome: A Rare Case Report.

INTRODUCTION: In Klippel Feil syndrome, classically there is a triad of short neck, a low posterior hairline and a limited range of neck movements especially of lateral bending. In fewer than 50% of cases have all the three elements. CASE REPORT: In the present case we have found congenital Scoliosis, Sprengel deformity and there were no evidence of renal disease, congenital heart disease and neurological impairment. The present case has classical triad low posterior hairline, short neck and limited cervical range of motion. CONCLUSION: A rare case of Klippel Feil Syndrome is being presented with the aim that such cases should be identified and treated at an early stage to minimize cosmetic & social stigma to her and to her parents.

Regioselective synthesis of pyrimido[1,2-a][1,3,5]triazin-6-ones via reaction of 1-(6-oxo-1,6-dihydropyrimidin-2-yl)guanidines with triethylorthoacetate: observation of an unexpected rearrangement.

A novel thermal rearrangement, involving pyrimidine ring opening and subsequent ring closure leading to recyclization of the system, was identified in the reaction of (6-oxo-1,6-dihydropyrimidin-2-yl)guanidines 3 (where NR(1)R(2) = NH(2), NH alkyl, NH aralkyl, NHCH(2)Ph(R)) with triethyl orthoacetate, affording 4-substituted-2-methyl-6H-pyrimido[1,2-a][1,3,5]triazin-6-ones 6 and their ring opened products. However, no such rearrangement was observed with (6-oxo-1,6-dihydropyrimidin-2-yl)guanidines 3 bearing a tertiary amino or anilino substituent (i.e. where NR(1)R(2) = N(CH(3))(2), indoline, morpholino, NHAr). As expected, 2-substituted-4-methyl-6H-pyrimido[1,2-a][1,3,5]triazin-6-ones 4 were obtained as the final products. Experimental structural determination and theoretical studies were carried out to get an understanding of the observed thermal rearrangement. In addition, an attempt to obtain similar pyrimido[1,2-a][1,3,5]triazin-6-ones using N,N-dimethylacetamide dimethyl acetal (DMA-DMA) as one carbon inserting synthon had furnished triazine ring annulated product 14 bearing N,N-dimethyl enamino substituent at position 4 as a result of further reaction with a second molecule of DMA-DMA.

4-Amino-2,8-dimethyl-6H-pyrimido[1,2-a][1,3,5]triazin-6-one.

In the title compound, C(8)H(9)N(5)O, the mean planes through the pyrimidine and triazine rings form a dihedral angle of 2.83 (16)°. The amino group adopts a trigonal-planar configuration and forms an intra-molecular resonance-assisted N-H⋯O=C hydrogen bond with the carbonyl group. In the crystal, mol-ecules are linked via inter-molecular N-H⋯N hydrogen bonds into chains of C(2) (2)(6)[R(2) (2)(6)] motif. The molecules form two types of sheet parallel to (201) and (01), respectively.

2-Amino-4-(4-bromo-phen-yl)-8-trifluoro-methyl-3,4-dihydropyrimido[1,2-a][1,3,5]triazin-6(5H)-one.

The title compound, C(13)H(9)BrF(3)N(5)O, crystallizes with two independent mol-ecules in the asymmetric unit. The pyrimidine rings of the mol-ecules are planar [maximum deviations 0.053 (3) and 0.012 (3) Å], while the triazine rings adopt flattened half-boat conformations with the p-bromo-phenyl rings in the flagpole positions. The crystal packing is stabilized by a three-dimensional network of inter-molecular N-H⋯N, N-H⋯O and N-H⋯F hydrogen bonds.