Almost 3000 men who received a placebo in the Prostate Cancer Prevention Trial and who never had a prostate-specific antigen (PSA) level of more than 4.0 ng per milliliter during the seven years of the trial underwent a prostate biopsy at the end of the study. Biopsy revealed prostate cancer in 449 men (15 percent), 67 of whom had high-grade tumors.

The finding that a PSA level 4.0 ng per milliliter does not rule out the presence of prostate cancer, including high-grade tumors, adds fuel to the debate over the use of PSA screening for prostate cancer.

In critically ill patients, both albumin and saline are commonly used for fluid resuscitation, but it is unknown whether one intravenous fluid is superior to the other. In this clinical trial in critically ill patients in the intensive care unit, the use of albumin and saline resulted in similar outcomes at 28 days.

Because the two treatments are equivalent with respect to clinical outcomes, the decision about which fluid to use should be determined by physician preference, safety, and cost.

Chronic thromboembolic pulmonary hypertension is believed to be rare after an episode of acute pulmonary embolism. This study showed that the incidence of this serious complication was nearly 4 percent — substantially higher than previously reported — and was associated with previous pulmonary embolism, large perfusion defects, and an idiopathic presentation. Possible approaches to prevention are discussed.

Black patients with chronic hepatitis C have a higher prevalence of genotype 1 infection and a lower rate of response to treatment. In this prospective study of 100 black and 100 non-Hispanic white patients with chronic hepatitis C (98 percent genotype 1), black patients had a lower rate of response to treatment with peginterferon alfa-2b and ribavirin (19 percent vs. 52 percent, P<0.001).

The lower rate of response in black patients with chronic hepatitis C is not explained by differences in viral genotypes.

This review explains our current understanding of the syndromes of defective glucose counterregulation and hypoglycemia unawareness in persons with diabetes. The physiologic defenses against hypoglycemia — the glucagon and epinephrine responses — are compromised in most people with type 1 diabetes and in many with advanced type 2 diabetes. In addition to hypoglycemia, exercise and sleep are causes of autonomic failure that must be recognized and require changes in the management of diabetes.

A woman who had recently fractured her ankle said she had chest pain and then collapsed at home. She had no palpable pulse but was resuscitated and taken to the hospital; additional episodes of pulseless electrical activity occurred. An electrocardiogram showed a rate of 56, atrioventricular dissociation, and a right bundle-branch block. A bedside echocardiogram showed no pericardial tamponade. Despite aggressive resuscitation, her blood pressure and oxygen saturation remained low. A therapeutic procedure was performed.

The author discusses the legal and ethical issues raised by the 2003 Supreme Court decision in the case of former dentist Charles Sell. The case focused on the legality of the forcible administration of psychiatric medication for the purpose of making a defendant competent to stand trial. The Court ruled that when certain criteria were met, a judge could order involuntary medication to restore competence. The Court, however, did not permit the forcible treatment of Sell, because these criteria had not been met.

Targeting the collagen gene in bone mesenchymal stem cells can prevent the synthesis of mutant collagen and therefore represents a potential strategy for the treatment of diseases such as osteogenesis imperfecta.