Effect of simvastatin on physiological and biological outcomes in patients undergoing esophagectomy: a randomised placebo controlled trial

OBJECTIVE: To test whether simvastatin improves physiological and biological outcomes in patients undergoing esophagectomy.

BACKGROUND: One-lung ventilation during esophagectomy is associated with inflammation, alveolar epithelial and systemic endothelial injury, and the development of acute lung injury (ALI). Statins that modify many of the underlying processes are a potential therapy to prevent ALI.

METHODS: We conducted a randomized double-blind placebo-controlled trial in patients undergoing esophagectomy. Patients received simvastatin 80 mg or placebo enterally for 4 days preoperatively and 7 days postoperatively. The primary end point was pulmonary dead space (Vd/Vt) at 6 hours after esophagectomy or before extubation. Inflammation was assessed by plasma cytokines and intraoperative exhaled breath condensate pH; alveolar type 1 epithelial injury was assessed by plasma receptor for advanced glycation end products and systemic endothelial injury by the urine albumin-creatinine ratio.

RESULTS: Thirty-nine patients were randomized; 8 patients did not undergo surgery and were excluded. Fifteen patients received simvastatin and 16 received placebo. There was no difference in Vd/Vt or other physiological outcomes. Simvastatin resulted in a significant decrease in plasma MCP-1 on day 3 and reduced exhaled breath condensate acidification. Plasma receptor for advanced glycation end products was significantly lower in the simvastatin-treated group, as was the urine albumin-creatinine ratio on day 7 postsurgery. ALI developed in 4 patients in the placebo group and no patients in the simvastatin group although this difference was not statistically significant (P = 0.1).

CONCLUSIONS: In this proof of concept study, pretreatment with simvastatin in esophagectomy decreased biomarkers of inflammation as well as pulmonary epithelial and systemic endothelial injury.

Red and dead:The progenitor of SN 2012aw in M95

Core-collapse supernovae (SNe) are the spectacular finale to massive stellar evolution. In this Letter, we identify a progenitor for the nearby core-collapse SN 2012aw in both ground based near-infrared, and space based optical pre-explosion imaging. The SN itself appears to be a normal Type II Plateau event, reaching a bolometric luminosity of 10$^{42}$ erg s$^{-1}$ and photospheric velocities of $\sim$11,000 \kms\ from the position of the H$\beta$ P-Cygni minimum in the early SN spectra. We use an adaptive optics image to show that the SN is coincident to within 27 mas with a faint, red source in pre-explosion HST+WFPC2, VLT+ISAAC and NTT+SOFI images. The source has magnitudes $F555W$=26.70$\pm$0.06, $F814W$=23.39$\pm$0.02, $J$=21.1$\pm$0.2, $K$=19.1$\pm$0.4, which when compared to a grid of stellar models best matches a red supergiant. Interestingly, the spectral energy distribution of the progenitor also implies an extinction of $A_V>$1.2 mag, whereas the SN itself does not appear to be significantly extinguished. We interpret this as evidence for the destruction of dust in the SN explosion. The progenitor candidate has a luminosity between 5.0 and 5.6 log L/\lsun, corresponding to a ZAMS mass between 14 and 26 \msun\ (depending on $A_V$), which would make this one of the most massive progenitors found for a core-collapse SN to date.

A 'ruin of all space, shattered glass and toppling masonry': Joyce's Orientalism in the Context of 11 September 2001 and 1922

Chapters 3 and 15 of Joyce's Ulysses exhibit glimpses of three dreams, fantasies and eventual nightmares linked to the figure of 'Haroun al Raschid.' Historically speaking, the latter was a powerful Caliph of Baghdad, a medieval potentate about whom many of the most memorable of The Thousand and One Nights or The Arabian Nights' Entertainments were once and then again spun as tales of pleasure. Joyce seizes upon the figure of 'Haroun al Raschid' as a fictive measure to articulate the 'orientalist' fantasies of Stephen Dedalus and Leopold Bloom. However, this evocative figure of Near Eastern history, of fabulous narrative and the progressively converging fantasies of two modern European literary characters is riddled with paradox. Such material provides Joyce a perceptive and proleptic sense of the paradoxes and brutal historical contradictions through which Western and Eastern dreams of theocratic nationalism, ethnic zealotry, colonial rebellion and Zionism are to be played out. W. B. Yeats' poem 'The Gift of Harun al-Raschid', written in 1923, the year after the book publication of Ulysses, provides both a fitting foil and a significant socio-historical point of reference for Joyce's own figurative use of the Caliph of Baghdad.

Performing Space

This article discusses how the notion of performance provides impetus for the design of interactive digital environments. These environments can ultimately be regarded as user-spaces; a condition which replaces the "fixed" art-object with a configuration of interactions. Our understanding of space, as suggested by Lefevbre (2001), defines the "inhabitant" as a full participant, a user, a performer of space. What is at play when the installation artist designs environments that invite performative exploration? The issue of improvised performance in the inhabiting of installation spaces is exposed. Two interactive installations by the author and works by others in the field provide a context for discussion for discussion and analysis.