Extracorporeal Membrane Oxygenation for Acute Lung Injury in Idiopathic Inflammatory Myopathies-A Potential Lifesaving Intervention.

OBJECTIVES: Idiopathic inflammatory myopathies (IIM) can present with acute IIM-related lung injury and respiratory failure, leading to a high mortality risk in intensive care units (ICU). Extracorporeal membrane oxygenation (ECMO) in acute respiratory distress syndrome can be lifesaving. We aimed to report a case series of IIM patients that received ECMO. METHODS: Patients with IIM from tertiary care centers in Belgium, Canada, Denmark, United States, and Sweden who underwent ECMO were reviewed to describe clinical characteristics, disease outcomes and hospitalization course. Clinical characteristics at admission and during ICU stay including ECMO complications and mortality causes were summarized. RESULTS: The study included 22 patients (50% female, mean±SD age at admission 47 ± 12 years) with anti-MDA5 positive dermatomyositis (68%), anti-synthetase syndrome (14%), polymyositis (9%), overlap myositis (5%) and non-MDA5 dermatomyositis (5%). Patients had low comorbidity scores and 46% had received immunosuppression before their ICU admission. Eight (36%) patients died in the ICU, six (27%) were bridged to recovery and eight (36%) were bridged to transplant. When comparing patients bridged to recovery and those who died in the ICU, those who died were older (p= 0.03) and had higher median Charlson comorbidity index scores (p= 0.05). Both groups had similar frequencies of ECMO-related complications (33% vs 50%, p= 0.94). CONCLUSION: In the patients exposed to ECMO in this case series, 14 were successfully bridged to recovery or transplant, while 8 died in the ICU. Large studies are needed to collect data on clinical outcomes in patients with IIM-ILD exposed to ECMO to identify the best candidates for the intervention.

Cortical semantization of autobiographical memory over subjective chronological time: An fMRI study.

The content and neural representation of autobiographical memories change over time; however, these changes are poorly understood. We hypothesize that the content of memories becomes semanticized, while the neural representation moves from mesial to cortical structures. We conducted an fMRI (functional magnetic resonance imaging) study on the effects of time on autobiographical memory retrieval. Twenty healthy participants were cued by a selection of photographs that represented distinct episodic memories from 1, 2, 6, and 14 years prior to scanning. Our behavioural data of self-report measures of memory qualia suggests a loss of episodic content over time. GLM (general linear model) results demonstrate that across all time points, visual association cortices and mesial temporal lobes were activated. However, we did not observe any GLM differences between memory time points. We used SVM (support vector machine) in order to predict memory time point based on neural activation patterns. We were able to accurately predict classification accuracy for the 1-year (66.7%), 2-year (66.7%), and 14-year (33.4%) memory time points, with an overall classification accuracy of 55.6%. We suggest that our findings can be interpreted in light of cortical semantization; as memories age, they become more semanticized and shift in representation towards cortical structures.