Positive end-expiratory pressure (PEEP) is used to improve oxygenation in patients with acute lung injury or the acute respiratory distress syndrome. In this pilot trial, the investigators show that adjusting PEEP with the use of measurements of esophageal pressure to estimate transpulmonary pressure leads to improved oxygenation as compared with the conventional approach to ventilator management.

This study examined the association of body-mass index (BMI), waist circumference, and waist-to-hip ratio with the risk of death among more than 350,000 European subjects who had no major chronic diseases. The data suggest that both general and abdominal adiposity are associated with the risk of death and support the use of waist circumference or waist-to-hip ratio in addition to BMI for assessment of the risk of death, particularly among persons with a lower BMI.

In this 10-month, crossover, double-blind study of 16 patients with severe, refractory obsessive–compulsive disorder (OCD), stimulation of the subthalamic nucleus reduced the symptoms of OCD. Eleven patients had serious adverse events, including one intracerebral hemorrhage and two infections requiring electrode removal.

A female high-school soccer athlete reacts to a defender, plants her leg, cuts to the left without contact, feels her leg give out, hears a pop, and has acute pain. She is unable to walk off the field or return to play. That evening her knee progressively swells. The next day she presents for evaluation. How should her case be managed?

This review deals with germ-line genes that increase susceptibility to five major types of cancer: breast, lung, pancreatic, prostate, and colorectal cancer. Often familial, often appearing at a young age, and often with atypical features, these cancers are caused by mutations in a germ-line gene and frequently with a second mutation in a gene in a somatic cell. The review ends with a discussion of clinical implications, especially for genetic counseling.

A 65-year-old right-handed man was transferred to this hospital because of the recent onset of confusion and memory loss. MRI scans of the brain showed symmetric abnormalities involving the temporal lobes, left basal forebrain, and insular regions. A CT scan of the chest disclosed an anterior mediastinal mass. A diagnostic procedure was performed.

U.S. primary care physicians must care for an increasing number of patients, with more chronic conditions, in less and less time, for which they are compensated far less than subspecialists. In a video roundtable discussion, several experts in primary care explore the crisis as well as possible solutions.