More than 35 years have passed since it was discovered that the application of positive end-expiratory pressure (PEEP) improved arterial oxygenation in patients with certain forms of respiratory failure who were treated with mechanical ventilation. In this study, investigators from an NIH-sponsored consortium compared the effects of higher and lower levels of PEEP on survival after the institution of mechanical ventilation. The trial was terminated early after neither approach proved to have an advantage.

Although the use of PEEP is important in ventilatory care, within a broad range of values, the exact amount of PEEP used does not have a major influence on survival.

In this randomized trial, cetuximab, a monoclonal antibody against the epidermal growth factor receptor, was given alone or in combination with irinotecan to patients with advanced colorectal cancer that was refractory to irinotecan therapy. The efficacy of the combination of antibody plus drug was clinically significant and was superior to that of the antibody alone.

This finding is rigorous evidence of the efficacy of the antibody and a clinically meaningful result.

Age-related macular degeneration (AMD) is common, affecting approximately 7 million people in the United States. However, knowledge of its causes is scant. This study builds on studies indicating that fibulin variants may confer susceptibility to AMD. The authors screened five genes encoding members of the fibulin family, extracellular matrix proteins, and found an association between variations in fibulin 5 and AMD.

Herpes simplex virus has been implicated in the pathophysiology of vestibular neuritis. In this placebo-controlled trial, a course of methylprednisolone initiated within three days after the onset of vestibular neuritis resulted in improved vestibular function at one year, whereas valacyclovir had no effect.

A course of methylprednisolone is likely to have a long-term benefit in patients with acute vestibular neuritis.

A complex homeostatic system involving the interplay of bone, the kidneys, and the intestines maintains extracellular calcium levels within a relatively narrow range. This article describes a patient with autoimmune hyperparathyroidism and hypocalciuric hypercalcemia caused by IgG4 autoantibodies directed against the calcium-sensing receptor. The patient's hypercalcemia and elevated parathyroid hormone levels responded to the administration of glucocorticoids.

West Nile virus is one member of the genus flavivirus, which includes mosquito-borne viruses that cause similar disease patterns in much of the world. The other members of this serogroup include the St. Louis encephalitis virus, the Murray Valley virus, and the Japanese encephalitis virus (which causes thousands of deaths each year in Asia). This review summarizes what is currently known about flavivirus encephalitis, with emphasis on the pathogenesis of West Nile virus infections.

A 50-year-old woman was found to have low oxygen saturation by pulse oximetry on preadmission testing for a hysterectomy. She had had an episode of cyanosis after general anesthesia in the past. A physical examination, radiographic studies, pulmonary-function testing, and echocardiography revealed no abnormalities. A diagnostic procedure was performed.

A recent study has uncovered a mechanism through which the proteasome mediates apoptosis. This process may be central to a new treatment for multiple myeloma.