Osteopontin (OPN) is a secreted glycophosphoprotein that has a role in inflammation, immune response and calcification. We hypothesized that plasma OPN levels are associated with adverse cardiovascular outcomes in patients with stable coronary artery disease (CAD) and preserved ejection fraction (EF) enrolled in the PEACE trial. We measured plasma OPN levels at baseline in 3567 CAD patients (mean age 64.5 ± 8.1 years, 81% men) by a sandwich chemiluminescent assay (coefficient of variation = 4.1%). OPN levels were natural log (Ln) transformed prior to analyses. We assessed whether Ln OPN levels were associated with the composite primary endpoint of cardiovascular death, non-fatal myocardial infarction and hospitalization for heart failure using multiple event multivariable Cox proportional hazards regression. Adjustment was performed for: (a) age and sex; (b) additional potential confounders; and (c) a parsimonious set of statistically significant 10 variates. During a median follow-up of 4.8 years, 416 adverse cardiovascular outcomes occurred in 366 patients. Ln OPN was significantly associated with the primary endpoint; HR (95% CI) = 1.56 (1.27, 1.92); P <0.001, and remained significant after adjustment for age and sex [1.31 (1.06, 1.61); P = 0.01] and after adjustment for relevant covariates [1.24 (1.01, 1.52); P = 0.04]. In a secondary analysis of the individual event types, Ln OPN was significantly associated with incident hospitalization for heart failure: HR (95% CI) = 2.04 (1.44, 2.89); P <0.001, even after adjustment for age, sex and additional relevant covariates. In conclusion, in patients with stable CAD and preserved EF on optimal medical therapy, plasma OPN levels were independently associated with the composite incident endpoint of adverse cardiovascular outcomes as well as incident hospitalization for heart failure.
A lingual abscess is a rare , potentially lifethreatening disorder. It may present with nonspecific symptoms such as pain, odynophagia, dysphagia, or difficulty in breathing. 1 It may develop idiopathically or secondary to a local trauma, foreign bodies, and surgical trauma. 2 Physical examination usually shows swollen tongue and tenderness. The abscess might be located at the lateral border, anterior 1/3, or posterior 1/3 of the tongue. 3 Although plain radiograms usually do not give valuable information, both magnetic resonance imaging (MRI) and computed tomography (CT) might show abscess. Treatment mainly focuses on airway protection, appropriate antibiotic usage, and drainage. With appropriate treatment, mortality due to lingual abscess is seen in less than 3% of cases. 4 CASE REPORTA 30-year-old female admitted to our outpatient clinic with odynophagia, dysphagia, pain, and tenderness in her tongue. Her complaints were existing for 5 days and getting worse. She did not use any medication before applying to the hospital. She did not have any trauma, surgical, or dental procedure history. She did not have any history of illness, medication usage, smoking, and alcohol consumption. Physical examination revealed swollen tongue with hyperemia in tongue base, with the normal flexible laryngoscopy examination. Oral hygiene was good, and tonsils were at a normal size without any infection signs. She was afebrile (36.6C). After the patient had been hospitalized, laboratory and
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