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Behrens F, Tak PP, Østergaard M, Stoilov R, Wiland P, Huizinga TW, Berenfus VY, Vladeva S, Rech J, Rubbert-Roth A, Korkosz M, Rekalov D, Zupanets IA, Ejbjerg BJ, Geiseler J, Fresenius J, Korolkiewicz RP, Schottelius AJ, Burkhardt H. MOR103, a human monoclonal antibody to granulocyte-macrophage colony-stimulating factor, in the treatment of patients with moderate rheumatoid arthritis: results of a phase Ib/IIa randomised, double-blind, placebo-controlled, dose-escalation trial. Ann Rheum Dis 2015; 74:1058-64. [PMID: 24534756 PMCID: PMC4431325 DOI: 10.1136/annrheumdis-2013-204816] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/09/2014] [Accepted: 01/24/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To determine the safety, tolerability and signs of efficacy of MOR103, a human monoclonal antibody to granulocyte-macrophage colony-stimulating factor (GM-CSF), in patients with rheumatoid arthritis (RA). METHODS Patients with active, moderate RA were enrolled in a randomised, multicentre, double-blind, placebo-controlled, dose-escalation trial of intravenous MOR103 (0.3, 1.0 or 1.5 mg/kg) once a week for 4 weeks, with follow-up to 16 weeks. The primary outcome was safety. RESULTS Of the 96 randomised and treated subjects, 85 completed the trial (n=27, 24, 22 and 23 for pooled placebo and MOR103 0.3, 1.0 and 1.5 mg/kg, respectively). Treatment emergent adverse events (AEs) in the MOR103 groups were mild or moderate in intensity and generally reported at frequencies similar to those in the placebo group. The most common AE was nasopharyngitis. In two cases, AEs were classified as serious because of hospitalisation: paronychia in a placebo subject and pleurisy in a MOR103 0.3 mg/kg subject. Both patients recovered fully. In exploratory efficacy analyses, subjects in the MOR103 1.0 and 1.5 mg/kg groups showed significant improvements in Disease Activity Score-28 scores and joint counts and significantly higher European League Against Rheumatism response rates than subjects receiving placebo. MOR103 1.0 mg/kg was associated with the largest reductions in disease activity parameters. CONCLUSIONS MOR103 was well tolerated and showed preliminary evidence of efficacy in patients with active RA. The data support further investigation of this monoclonal antibody to GM-CSF in RA patients and potentially in those with other immune-mediated inflammatory diseases. TRIAL REGISTRATION NUMBER NCT01023256.
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Clinical Trial, Phase I |
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Uchikov A, Nonchev B, Danev V, Murdzhev K, Vladeva S, Terzieva D. [Results of the surgical treatment of thyrotoxicosis]. Khirurgiia (Mosk) 2006:9-11. [PMID: 18788110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the results of the surgical treatment of patients with thyrotoxicosis in three surgical clinics in Plovdiv. PATIENTS AND MEDHOTS: We studied 90 patients, who underwent surgical treatment for thyrotoxicosis between 2000-2004. Of those 19 men (21%) and 71 women (79%); men:women = 1:3.74; mean age 38 +/- 8.3 years. The nosological distribution was as follows: Graves' disease--72 subjects (80.00%), solitary toxic adenoma--4 subjects (4.40%), toxic nodular goiter--14 subjects (15.60%). 77 subtotal thyroidectomies (85%) and 9 total thyroidectomies were performed. Patients with solitary toxic adenoma underwent lobectomy. RESULTS Massive bleeding witch required revision and haemostasis was encountered in 1 patient. Transient laryngeal nerve injury occurred in 3 patients (3.33%), and temporary hypoparathyroidism in 6 subjects (6.67%), necessitating calcium supplementation. One year postoperatively, 49.35% (n = 38) of the patients who have undergone subtotal thyroidectomy were euthyroid, 45.45% (n = 35) developed hypothyroidism, and 5.2% (n = 4) relapsed. DISCUSSION Our results indicate that surgery is safe and effective for patients with thyrotoxicosis referred for radical treatment. Because of the high rate of postoperative thyroid disfunction, assessment of the non-operative factors, witch influence the functional results, is recommended.
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English Abstract |
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Vladeva S, Bischoff E, Kirilov N, Bischoff F, Batalov Z, Batalov A. An observational study of the radiofrequency echographic multi-spectrometry (REMS)-based fragility score of the lumbar spine and total fracture risk at 5 years in women. Rheumatol Int 2023; 43:2107-2114. [PMID: 37572173 DOI: 10.1007/s00296-023-05412-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 07/28/2023] [Indexed: 08/14/2023]
Abstract
A novel fragility score (FS) parameter, obtained during radiofrequency echographic multi-spectrometry (REMS), was developed to estimate the ultrasound-based skeletal fragility. The aim of our study is to assess the REMS-based FS of the lumbar spine (LS) among the Bulgarian women and to compare their characteristics acquired with REMS between fracture risk classes corresponding to a total fracture risk at 5 years for major osteoporotic fractures (MOF). A total of 100 Bulgarian women, who underwent a screening for osteoporotic fracture risk using the REMS technology, were included in a prospective observational study. The mean age was 60 years (years) ± 13.9 standard deviations. We assessed the FS of the LS and for each subject. The fracture risk class (R1-R7) was identified using a table combining measured REMS T score and FS values. The mean FS was 36.9 ± 17.4 SD (range: 18.5-84.3). Twelve subjects (12%) were classified into the R6 group, twenty-three (23%) into the R5, sixty-one (61%) into R4, and four (4%) into R3. Statistical analysis showed significant difference in age, height, BMD, T score, Z score, age of menopause, FRAX for MOF, and FRAX for hip fractures between the risk class groups. This is the first study which showed the REMS-based FS of the lumbar spine among the Bulgarian women. T score alone is not a good predictor of fractures. Our study showed that its use in combination with the fragility score obtained during REMS offers a robust assessment of the fracture risk at 5 years for MOF.
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Observational Study |
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Kirilov N, Vladeva S, Bischoff F, Batalov Z, Batalov A, Bischoff E. Effect of the body mass index, basal metabolic rate, and body fat on the radiofrequency echographic multi-spectrometry (REMS)-based bone mineral density and fracture risk: a cross-sectional study. Rheumatol Int 2023; 43:2271-2279. [PMID: 37728773 DOI: 10.1007/s00296-023-05460-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/03/2023] [Indexed: 09/21/2023]
Abstract
Radiofrequency echographic multi-spectrometry (REMS) is a method to assess bone mineral density (BMD) of the axial skeleton, fragility score (FS), body mass index (BMI), basal metabolic rate (BMR), and body fat (BF) in %. The aim of the study was to investigate the influence of the BMI, BMR, and BF on the BMD and fracture risk with REMS. We conducted a cross-sectional study among 313 women, aged 20-90 years who underwent a screening for osteoporosis with REMS. Kruskal-Wallis was used to analyze the differences in BMI, BMR, and BF between the groups according to the BMD: normal BMD, osteopenia and osteoporosis and differences in the FS, fracture risk assessment (FRAX) for major osteoporotic fractures and for hip fractures (HF) according to the BMI groups: underweight, normal weight, overweight, obese, and extreme obese. Linear regression was used to assess the correlations BMI-BMD, BMR-BMD, and BF-BMD. BMI, BMR, and BF differed significantly between the groups according to the BMD (p < 0.001, p = 0.028, and p < 0.001, respectively). BMR showed high positive correlation to BMD (R = 0.765) with 95% confidence interval (CI) [0.715, 0.807] and significance of p < 0.001. BMI correlated significantly to BMD (p < 0.001), the correlation was low positive (R = 0.362) with 95% CI [0.262, 0.455]. In the BMI groups, there was significant difference in FRAX for HF and FS with p value 0.014 and < 0.001, respectively. Subjects with low BMI, BMR, and BF are at high risk for osteoporosis. Underweight women show significantly high fracture risk, assessed with FRAX and FS.
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Gatseva P, Vladeva S, Pavlov K. Incidence of goiter among children in a village with nitrate contamination of drinking water. Folia Med (Plovdiv) 2000; 40:19-23. [PMID: 10658350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
An epidemiological survey was conducted on the incidence of goiter among children in the 6-14 years age group, permanently living in a village with an increased content of nitrate pollutants in drinking water. Their incidence of goiter was compared to that in a control group of children. The study comprised a total of 359 children--181 from the experimental village and 178 from the control village. A high percentage (40.9%) of goiter is observed among the children in the village with nitrate contamination of drinking water. A statistically significant difference in goiter incidence in children between the experimental and control village is present.
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Gatseva P, Vladeva S, Pavlov K. [The role of nitrates in the genesis of goiter morbidity]. PROBLEMI NA KHIGIENATA 1999; 22:92-8. [PMID: 10202774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Epidemiologic study was carried out concerning the level of goitrous morbidity in the growing up individuals aged from 3 to 14 years, permanently living in a settlement with increased nitrate content in the drinking water and natural Iodine deficiency. The data for the incidence of the goitrous morbidity were compared with those of a control group of children. The investigation included a total of 325 children. A high percentage of goitrous morbidity was recorded in the observed by us settlement with increased nitrate content in the drinking water, respectfully 35% versus 8.1% in the control settlement. Low degree of juvenile goiter predominated with slight prevalence of the female sex. A statistically reliable difference (p < 0.001) in the incidence of goitrous morbidity in the observed by us settlement and the control settlement.
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Kirilova E, Kirilov N, Vladeva S. AB0609 RADIOFREQUENCY ECHOGRAPHIC MULTI-SPECTROMETRY FOR THE ASSESSMENT OF BOTH FEMORA IN PREGNANT WOMEN. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Radiofrequency Echographic Multi-Spectrometry (REMS) is a non-ionizing innovative approach for the assessment of REMS-based bone mineral density (BMD) of the axial skeleton. The principle of the REMS technology is based on the analysis of native raw unfiltered ultrasound signals during an echographic scan of the lumbar spine or the femoral neck [1]. Several studies demonstrated the high concordance with dual energy X-ray absorptiometry (DXA) in terms of measured BMD with this novel technology [2,3]. In previous published literature it was envisaged to apply this technology for the examination of the axial bone density in pregnant women. Pregnancy-associated bone loss has been demonstrated as decreased bone mineral density (BMD) in previous studies [4].Objectives:The aim of the current study is to compare the BMD values of both femora between pregnant and non-pregnant women matched for age and BMI using the novel REMS technology.Methods:Of total fifty women twenty pregnant women (40%) and thirty non-pregnant women (60%) were included in the study. The mean age of the pregnant women was 32 years ± 5 standard deviations (SD), (range 25-41 years) and the mean age of the non-pregnant women was 30 years ± 6 standard deviations (SD), (range 24-39 years). REMS approach was used to assess REMS-based BMD and REMS-based Z-score values of the femoral neck. Furthermore, body mass index (BMI) and gestational age in weeks were evaluated.Results:The mean BMI of the pregnant women was 26 kg/m2 ± 7 kg/m2 (range 14 kg/m2-42 kg/m2) and those of the non-pregnant women was 25 kg/m2 ± 5 kg/m2 (range 16 kg/m2-35 kg/m2). The mean gestational age was 20 weeks’ gestation ± 5 weeks’ gestation (range 13-27 weeks’ gestation). REMS-based mean BMD of the left femoral neck of the pregnant women was 0.793 g/cm2 ± 0.167 g/cm2 (range 0.563 g/cm2-1.154 g/cm2). REMS-based mean BMD of the right femoral neck of the pregnant women was 0.828 g/cm2 ± 0.153 g/cm2 (range 0.570 g/cm2-1.161 g/cm2). After comparing left femoral neck BMD with the right femoral neck BMD of the pregnant women, we found a linear correlation (R=0.764). Left femoral neck BMD value (0.793 g/cm2) of the pregnant women was significantly lower than those of the non-pregnant women (0.854 g/cm2), p=0.002. The mean left femoral Z-score of the pregnant women (-0.1 SD with range -2.5 SD-2.9 SD) was also significantly lower compared to those of the non-pregnant women (1.2 SD with range -1.5 SD-3.1 SD), p=0.003.Conclusion:This is the first study which provides data about BMD and Z-score values of both femora in pregnant women assessed with the radiation-free REMS technology. Pregnant women demonstrated significantly lower femoral neck BMD values and Z-scores compared to those of the non-pregnant women. Innovative REMS method could be very helpful for making decision about the treatment of pregnant women who are at risk of lower BMD due to concomitant diseases and/or treatment associated with osteoporosis.References:[1]Casciaro S, Conversano F, Pisani P, Muratore M. New perspectives in echographic diagnosis of osteoporosis on hip and spine. Clin Cases Miner Bone Metab. 2015; 12(2):142-150.[2]Nikolov M, Nikolov N. AB0908 Assessment of the impact of the lean mass with body composition by dual-energy x-ray absorptiometry on the bone mineral density. Annals of the Rheumatic Diseases 2020; 79:1756.[3]Chakova M., Chernev D., Kashukeeva P., Krustev P., Abedinov F. Lumbar Sympathectomy - Literature Review. International Journal of Science and Research (IJSR) Volume 7 Issue 8, August 2018 ISSN (Online): 2319-7064.[4]Degennaro, V. A.; Cagninelli, G.; Lombardi, F. A. “VP34.12: First assessment of maternal status during pregnancy by means of radiofrequency echographic multi-spectrometry technology”. Ultrasound in Obstetrics & Gynecology. 2020, 56 (S1): 199.Disclosure of Interests:None declared.
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Terziyski K, Tzenova R, Milieva E, Vladeva S. Possible mechanism of action of vanadium ions as an antidiabetic agent. Folia Med (Plovdiv) 1999; 41:34-7. [PMID: 10462917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
Vanadium compounds, at much higher concentrations than they are typically ingested, are being considered for use in the treatment of diabetes mellitus. They exert an insulin-mimetic effect in an insulin-receptor-independent manner. In our study we obtained new data about the vanadium insulin-receptor-independent mechanism of action on cell membranes. When rat stomach smooth muscle samples are treated with NH4VO3 (10(-7) divided by 10(-5) this action is possibly exhibited with increased influx of Ca2+ through VDCa2+C.
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Kirilov N, Bischoff F, Vladeva S, Bischoff E. A Case Showing a New Diagnostic Aspect of the Application of Radiofrequency Echographic Multi-Spectrometry (REMS). Diagnostics (Basel) 2023; 13:3224. [PMID: 37892045 PMCID: PMC10606550 DOI: 10.3390/diagnostics13203224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Radiofrequency echographic multi-spectrometry (REMS) is an ultrasound technique that has been recently introduced in the medical field to detect osteoporosis and fracture risk at axial sites. The use of sonography to visualize the region of interest (ROI) of the hip neck provides the opportunity to identify occult fractures. A 91-year-old woman with persistent right leg pain was referred to rheumatologist due to a known history of arthritis and osteoporosis. She was able to walk using a crutch, although experiencing an antalgic gait. The patient had recently fallen on her right side from standing height. During the visualization of the ROI of the right femoral neck using REMS, an abrupt break of the femoral cortex suspected to be a fracture was seen; therefore, the measurement of the femoral neck was performed on the left side. The T-score had value of -2.9 SD and the fragility score was 86.7. Due to unclear signs of a fracture after an X-ray of the hip, a computed tomography (CT) exam of the hip was performed, which revealed a femoral neck fracture. Occult fractures of the femoral neck are challenging to diagnose and require numerous radiologic exams. The use of ultrasound as a method to measure bone density allows the simultaneous diagnosis of osteoporosis and detection of fractures.
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Kirilova E, Kirilov N, Bischoff F, Vladeva S, Nikolov N, Nikolov M, Batalov Z, Batalov A, Kinov P, Kovachev V, Kovachev M, Todorov S. Prevalence of low bone mineral density at axial sites and fracture risk in Bulgarian population. Orthop Rev (Pavia) 2022; 14:57622. [PMID: 36589513 PMCID: PMC9796993 DOI: 10.52965/001c.57622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Osteoporosis is a common chronic disease characterized by low bone mineral density (BMD) and microarchitectural deterioration of the bone, which are associated with increased risk of fragility fractures. Currently the most popular tool is the fracture risk assessment model FRAX to calculate the 10-year probability of major osteoporotic fractures (MOF) and hip fractures (HF). Objective To investigate the prevalence of low BMD at axial sites and fracture risk in Bulgarian population. Methods We retrospectively analyzed dual energy X-ray absorptiometry (DXA) scan results of 12 478 subjects. Scan results included BMD and T-score assessments of lumbar spine and femoral neck. FRAX major osteoprotic fracture (MOF) and FRAX hip fracture (HF) were assessed in subjects between 40 and 90 years using BMD values. Results Of total 12478 subjects, 12119 were women and 359 were men. The mean age of the subjects was 61 years (yrs.) ± 10 yrs. The overall prevalence of low BMD at the lumbar spine was 6084/9336 subjects (65.2%). 3502/9336 subjects (37.5%) were considered as osteopenic and 2582/9336 subjects (27.7%) were considered as osteoporotic. The overall prevalence of low BMD at the femoral neck was 2036/3140 (64.8%). 1641/3140 subjects (52.3%) were classified as osteopenic and 395/3 140 subjects (12.6%) were classified as osteoporotic. The mean values of FRAX MOF and FRAX HF increased significantly with increasing the age interval. Conclusion This study is the largest epidemiological research in Bulgaria up to date about the prevalence of low BMD at axial sites.
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Vladeva S, Gatseva P, Gopina G. Comparative analysis of results from studies of goitre in children from Bulgarian villages with nitrate pollution of drinking water in 1995 and 1998. Cent Eur J Public Health 2000; 8:179-81. [PMID: 10965445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The role of nitrates in goitre genesis has been discussed for a long time. In the present report a comparative analysis is made of results obtained in villages with nitrate pollution of the drinking water. In two pairs of villages children aged between 3 and 14 were included, whose thyroid status was investigated by a clinical examination. The study was carried out in 2 stages--in 1995 and 1998. In this period the goitre incidence was significantly reduced in both sexes. Both investigations showed a higher relative risk of goitre in children exposed to water pollution by nitrates. In the first, as well as in the second examination, goitre was diffuse. We concluded that nitrate pollution of drinking water undoubtedly participated in goitre genesis. We did not underestimate the strumigenic effect of nitrates in the diet as they were not the object of our investigation and which, according to WHO experts, have a less strumigenic effect. After the first investigation we recommended a higher antistrumin dose as prophylaxis. That is why we conclude that the considerable goitre reduction in the second investigation was the positive result of the doubled antistrumin prophylaxis during the period between the two investigations.
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Comparative Study |
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