Factors influencing balance improvement in multiple sclerosis rehabilitation: A pragmatic multicentric trial.

OBJECTIVES: Treatment for progressive multiple sclerosis (pMS) is a key area of research. To date, whether MS type and the rehabilitation setting are associated with worse or better response to rehabilitation is unclear. We aimed to understand the association between balance and MS type, in/outpatient treatment and specificity of the intervention. METHODS: We assessed 150 people with MS before and after in/outpatient rehabilitation. The Berg Balance Scale (BBS) was used to discriminate between responders (≥+3-point improvement in BBS score; a clinically meaningful improvement) and non-responders to specific or non-specific balance rehabilitation. Factors associated with balance were analyzed by univariate and multivariable logistic regression analyses, estimating odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Balance improved after rehabilitation: median (quartile 1 [Q1]-Q3) BBS score pre- and post-rehabilitation of 49 (45-53) and 52 (47-55) (P<0.001). Univariate logistic analysis revealed a clinically meaningful improvement in balance associated with pMS (OR 2.21 [95% CI 1.09-4.05]), inpatient therapy (0.41 [0.19-0.84]), using a walking aid (1.68 [1.06-2.69]), and low baseline BBS score (0.86 [0.81-0.92]). On multivariable analysis, probability of improvement was similar for participants with pMS and the relapsing-remitting form but was associated with low baseline BBS score and specific treatment (OR 0.81 [95% CI 0.74-0.89] and 5.66 [1.79-21.5]). CONCLUSION: A clinically meaningful improvement in balance was more likely when MS individuals with moderate to high disability had specific exercises targeting balance, but MS type did not influence the outcome.

Clustering and separation of hydrophobic nanoparticles in lipid bilayer explained by membrane mechanics.

Small hydrophobic gold nanoparticles with diameter lower than the membrane thickness can form clusters or uniformly distribute within the hydrophobic core of the bilayer. The coexistence of two stable phases (clustered and dispersed) indicates the energy barrier between nanoparticles. We calculated the distance dependence of the membrane-mediated interaction between two adjacent nanoparticles. In our model we consider two deformation modes: the monolayer bending and the hydroxycarbon chain stretching. Existence of an energy barrier between the clustered and the separated state of nanoparticles was predicted. Variation analysis of the membrane mechanical parameters revealed that the energy barrier between two membrane embedded nanoparticles is mainly the consequence of the bending deformation and not change of the thickness of the bilayer in the vicinity of nanoparticles. It is shown, that the forces between the nanoparticles embedded in the biological membrane could be either attractive or repulsive, depending on the mutual distance between them.