David Grant Medical Center

Edwards Air Force Base, CA, United States

David Grant Medical Center

Edwards Air Force Base, CA, United States

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Olson C.A.,University of California at Davis | Thornton J.A.,David Grant Medical Center | Adam G.E.,U.S. Army | Lieberman H.R.,U.S. Army
Journal of Clinical Psychopharmacology | Year: 2010

Quercetin, a phenolic flavonoid found in small quantities in some fruits and vegetables, is an adenosine receptor antagonist in vitro marketed as a dietary supplement for purported caffeine-like effects. A double-blind, placebo-controlled, between-subjects study was conducted to compare the behavioral effects of quercetin to a central adenosine receptor antagonist, caffeine. Fifty-seven volunteers received either 2000 mg of quercetin dihydrate (a dose estimated based on in vitro receptor binding to be equivalent in potency to 200 mg of caffeine), placebo, or 200 mg of caffeine. One hour later, a 45-minute visual vigilance task was administered. The Profile of Mood States questionnaire was completed before treatment and immediately after vigilance testing. On the vigilance task, caffeine increased the number of stimuli detected (P < 0.02) and decreased the reaction time (P = 0.001). Caffeine increased self-reported vigor and reduced fatigue and total mood disturbance Profile of Mood States scores compared with placebo. Quercetin did not significantly alter any parameter, but values were typically intermediate between caffeine and placebo on those tests affected by caffeine. Quercetin is unlikely to have any effects when consumed by humans in quantities present in the diet or in dietary supplements. Caffeine (200 mg) administration resulted in the expected effects on vigilance and mood. © 2010 Lippincott Williams & Wilkins.


Jesinger R.A.,David Grant Medical Center | Jesinger R.A.,Uniformed Services University of the Health Sciences | Thoreson A.A.,David Grant Medical Center | Lamba R.,University of California at Davis
Radiographics | Year: 2013

Abnormally enlarged visceral arteries in the abdomen and pelvis must be recognized radiologically because early treatment can improve the quality of life and prevent life-threatening complications. These lesions, typically classified as aneurysms and pseudoaneurysms, are being detected more frequently with increased utilization of imaging and have various causes (eg, atherosclerosis, trauma, infection) and complications that may be identified radiologically. Ultrasonography, computed tomography, and magnetic resonance imaging often enable detection of visceral vascular lesions, but angiography is important for further diagnosis and treatment. Endovascular treatment is often the first-line therapy. Endovascular intervention or open surgical repair is necessary for all visceral pseudoaneurysms and is likely indicated for visceral aneurysms 2 cm or more in diameter. Endovascular exclusion of flow can be achieved with coils, stents, and injectable liquids. Techniques include embolization ("sandwich" or "sac-packing" technique), exclusion of flow with luminal stents, and stent-assisted coil embolization. Management often depends on the location and technical feasibility of endovascular repair. Embolization is usually preferred for aneurysms or pseudoaneurysms within solid organs, and the sandwich technique is often used when collateral flow is present. Covered stent placement may be preferred to preserve the parent artery when main visceral vessels are being treated. It is usually tailored to lesion location, and a cure can often be effected while preserving end-organ arterial flow. Posttreatment followup is usually based on treatment location, modality accuracy, and potential consequences of treatment failure. Follow-up imaging may help identify vessel recanalization, unintended thrombosis of an artery or end organ, or sequelae of nontarget embolization. Retreatment is usually warranted if the clinical risks for which embolization was performed are still present.


Kurpinski K.T.,University of California at San Francisco | Kurpinski K.T.,University of California at Berkeley | Stephenson J.T.,David Grant Medical Center | Stephenson J.T.,University of California at San Francisco | And 5 more authors.
Biomaterials | Year: 2010

Biodegradable nanofibers simulate the fibril structure of natural extracellular matrix, and provide a cell-friendly microenvironment for tissue regeneration. However, the effects of nanofiber organization and immobilized biochemical factors on cell infiltration into three-dimensional scaffolds are not well understood. For example, cell infiltration into an electrospun nanofibrous matrix is often limited due to relatively small pore size between the fibers. Here we showed that biophysical and biochemical modification of nanofibrous scaffolds facilitated endothelial cell infiltration in three-dimensional scaffolds in vitro and in vivo. Aligned nanofibers significantly enhanced cell infiltration into the nanofibrous matrices in vitro. In a full-thickness dermal wound model, the nanofiber scaffolds enhanced epidermal skin cell migration across the wound when compared to a control group without scaffold. Aligned nanofibers promoted the infiltration of endothelial cells into the scaffolds. Furthermore, heparin-coated nanofibers also increased cell infiltration significantly. These results shed light on the importance of biophysical and biochemical properties of nanofibers in the regulation of cell infiltration into three-dimensional scaffolds and tissue remodeling.


Walsh M.P.,George Mason University | Seto J.,George Mason University | Jones M.S.,David Grant Medical Center | Chodosh J.,Massachusetts Eye and Ear Infirmary | And 2 more authors.
Journal of Clinical Microbiology | Year: 2010

Novel human adenoviruses (HAdVs) arise from genome recombination. Analysis of HAdV type 55 from an outbreak in China shows a hexon recombination between HAdV-B11 and HAdV-B14, resulting in a genome that is 97.4% HAdV-B14. Sporadic appearances as a re-emergent pathogen and misidentification as "HAdV-B11a" are due to this partial hexon. Copyright © 2010, American Society for Microbiology. All Rights Reserved.


Dunn D.P.,David Grant Medical Center | Lee K.S.,Beth Israel Deaconess Medical Center | Smith M.P.,Beth Israel Deaconess Medical Center | Mortele K.J.,Beth Israel Deaconess Medical Center
American Journal of Roentgenology | Year: 2015

Objective. The purpose of this article is to review infectious, inflammatory, and autoimmune-mediated processes in the gastrointestinal system where diffusion-weighted imaging can be helpful as well as pitfalls associated with its use. Conclusion. Diffusion-weighted imaging has become an important and widely used tool in abdominal and pelvic MRI, but it has been used primarily for oncologic applications. As more body MRI protocols are routinely including diffusion-weighted imaging, this sequence can be useful in evaluating an increasing number of nononcologic processes. © American Roentgen Ray Society.


Jesinger R.A.,David Grant Medical Center | Jesinger R.A.,Uniformed Services University of the Health Sciences
Techniques in Vascular and Interventional Radiology | Year: 2014

Normal breast anatomy can be seen on a variety of imaging modalities. Knowledge of normal breast anatomy on imaging examinations is important for an interventionalist, primarily to avoid mistaking normal anatomy for a pathologic disorder, so as not to harm a patient with an unnecessary intervention. Knowledge of breast anatomy is also critical in planning safe breast interventions and unwanted procedural complications. The key anatomical structures in the breast include skin, fat, fascial layers, Cooper ligaments, fibroglandular tissue, lymphatics, and neurovascular structures, all positioned over the chest wall. In men, the breast parenchyma is usually only composed of fat, with absence of fibroglandular tissue. In women, fibroglandular tissue volumes vary with age, with many women having a predominance of fat within the breasts after menopause. Embryologically, the breast develops under genetic and hormonal influence from skin precursor cells during the fourth through twelfth weeks of gestation, and the resulting breast bud continues to lengthen and branch throughout the remainder of gestation, forming a complex network of radially arranged breast ducts that connect the nipple with the mammary lobules. The key arterial blood supply to the breast arises from the internal thoracic artery, but additional arterial blood supply is seen from intercostal and lateral thoracic arteries. The venous anatomy and lymphatic drainage of the breast generally parallels the arterial anatomy, with presence of variation in communicating channels between deep and superficial venous and lymphatic channels. Tools that assess breast vascular structures (eg, contrast-enhanced breast magnetic resonance imaging) and lymphatic structures (nuclear medicine lymphoscintigraphy) are routinely used to assess extent of breast disease and help guide breast interventions. © 2014.


Metzgar D.,Naval Health Research Center | Gibbins C.,David Grant Medical Center | Ryan Hudson N.,David Grant Medical Center | Jones M.S.,David Grant Medical Center
Journal of Clinical Microbiology | Year: 2010

Every year, thousands of bask military trainees in each service of the U.S. Armed Forces experience acute respiratory disease. The majority of this disease burden results from infection with human adenoviruses. We designed single- and multiplex assays that detect and discriminate adenovirus types B3, E4, B7, B11, B14, and B21. A total of 116 oropharyngeal swab specimens obtained from patients at the Naval Health Research Center were used to validate the new assays. Type-specific singleplex assays were designed and used independently to successfully identify 94 representative patient specimens. The lower limits of detection for our singleplex real-time PCR assays were calculated to be 50, 500, 500, 50, 50, and 50 genomic copies per reaction for human adenovirus type B3 (HAdV-B3), HAdV-E4, HAdV-B7, HAdV-B11, HAdV-B14, and HAdV-BH, respectively. These were then multiplexed to increase efficiency and tested against singleplex assays using titrated controls. The HAdV-B3/B11 and HAdV-E4/B7 multiplex assays were as sensitive and specific as they were individually. The HAdV-B14/B21 multiplex assay was not as efficient at detecting HAdV-B14 as the singleplex assay. Interestingly, a statistically significant difference was found between the viral loads of HAdV-B14 and those of HAdV-B3, -E4, -B7, and -B21 (P < 0.001). The assays did not cross-react with other adenoviruses, influenza virus, respiratory syncytial virus, or respiratory disease-causing bacteria. These assays have the potential to be useful as clinical diagnostic tools for the detection of HAdV infection in adult populations. Copyright © 2010, American Society for Microbiology. All Rights Reserved.


Alexander A.M.,David Grant Medical Center
Current Sports Medicine Reports | Year: 2013

Atrial fibrillation (AF) is the most common arrhythmia in athletes. Evidence supports that it occurs more frequently in endurance athletes than in nonathletes and that it can result in decreased performance or even ineligibility for athletes. Although there is no clear etiology of why the increase in athletes exists, three supported mechanisms include morphologic adaptation, autonomic alteration, and chronic systemic inflammation. Although treatment in athletes can be challenging, type 1C antiarrhythmics are accepted generally as a first-line therapy in addition to risk factorbased anticoagulation. Radiofrequency catheter ablation also has become a recommended treatment for symptomatic paroxysmal AF that is refractory to at least one class 1 or 3 antiarrhythmic medication and a reasonable treatment in symptomatic paroxysmal AF prior to initiation of antiarrhythmic therapy. Copyright © 2013 by the American College of Sports Medicine.


Background: The Kineflex lumbar artificial disc replacement device (SpinalMotion, Mountain View, California) is a semiconstrained, posterior center of rotation, metal-on-metal intervertebral disc prosthesis. We performed a prospective, randomized, non-inferiority trial comparing the Kineflex Disc with the Food and Drug Administration (FDA)-approved Charité device (DePuy Spine, Raynham, Massachusetts). Our objective was to evaluate the Kineflex Disc's safety and efficacy using validated outcomes measures-the visual analog scale (VAS) and the Oswestry Disability Index (ODI). Methods: Sixty-four patients were randomized to receive either the Kineflex Disc or Charité device and were then followed up for up to 3 years. Patients completed VAS and ODI questionnaires and were evaluated clinically and radiologically for complication or device failure. Results were analyzed in terms of change in mean VAS score and ODI from baseline, as well as with a comparison of clinical success as defined by FDA investigational device exemption criteria. Non-inferiority was defined as a difference of less than 18 points in the VAS score and difference of less than 10 units on the ODI scale, in keeping with a previously established minimum clinically important difference. Results: The mean improvement for the Kineflex Disc group at 24 months was 56.80 for the VAS score and 37.30 for the ODI. Similarly, the mean improvement in the Charité group was 54.43 for the VAS score and 38.40 for the ODI. At 2 years of follow-up, no difference was found in VAS scores between the two groups. The Kineflex Disc group was therefore found to be non-inferior (mean difference, 2.37; 95% confidence interval, -12.5 to 17.3; P = .004). In addition, at 24 months, 83% of patients in the Kineflex Disc group and 85% of patients in the Charité group met FDA-defined criteria for clinical success, with no difference between groups (P = .802). Conclusions: This level I evidence shows the Kineflex Disc to be non-inferior to the Charité device in terms of pain reduction (VAS score) and FDA-defined clinical success at 24 months' follow-up. Both devices showed a high degree of safety. © 2011 Elsevier Inc.


Clay J.G.,David Grant Medical Center | Grayson J.K.,David Grant Medical Center | Zierold D.,David Grant Medical Center
Military Medicine | Year: 2010

Objective: To compare advanced hemostatic dressings: HemCon (HC), QuikClot ACS+ (advanced clotting sponge, and two granular agents: Celox (CX) and WoundStat (WS), with a standard field dressing in a swine model of extremity hemorrhage. Methods: We randomized 30 animals to treatment with a standard dressing or a hemostatic agent applied to a 2 × 6-mm injury in the femoral artery and vein after 45 s of free bleeding. Animals received 500 mL Hextend 15 min after the bleeding commenced without further resuscitation. End point was survival to 120 min or nonsurvivable blood pressure. Results: Survival to 120 min among treatment groups was 100% (WS), 83% (CX), 67% (HC), and 50% (ACS+). No control animals survived. Postinjury blood loss (mL/kg) was 4.6 (WS), 12.9 (CX), 10.0 (HC), and 15.8 (ACS+) compared to 27.0 for controls. Conclusion: All hemostatic dressings result in significantly less blood loss and improved survival over standard gauze dressing.

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