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1.  Complementary and Alternative Medicine use in women during pregnancy: do their healthcare providers know? 
The National Institutes of Health reported in 2007 that approximately 38% of United States adults have used at least one type of Complementary and Alternative Medicine (CAM). There are no studies available that assess general CAM use in US pregnant women.
The objectives of our study were to determine the prevalence and type of CAM use during pregnancy at one medical center; understand who is using CAM and why they are using it; and assess the state of patients’ CAM use disclosure to their obstetrical providers.
A cross-sectional survey study of post-partum women was done to assess self-reported CAM use during pregnancy. Results of this survey were compared to results from a previous survey performed by this research team in 2006. Data were analyzed using binary logistic regression.
In 2013, 153 women completed the survey, yielding a response rate of 74.3%. Seventy-two percent and 68.5% of participants reported CAM use during their pregnancies in 2006 and 2013 respectively. The percentage of participants who reported discussing CAM use with their obstetrical providers was less than 1% in 2006 and 50% in 2013. Increased use of different CAM therapies was associated with increased maternal age, primagravida, being US-born, and having a college education (p ≤ 0.05). However, these factors were poor predictors of CAM use.
Given the frequency of CAM use and the difficulty in predicting who is using it, obstetrical providers should consider being informed about CAM and incorporating discussions about its use into routine patient assessments.
PMCID: PMC3945795  PMID: 24592860
Complementary and Alternative Medicine; Pregnancy; Maternal-fetal health; Patient-physician communication; Self-care; Prevalence; Cross-sectional study
2.  Characterization of cancer associated mucin type O-glycans using the exchange sialylation properties of mammalian sialyltransferase ST3Gal-II 
Journal of Proteome Research  2012;11(4):2609-2618.
Our previous studies suggest that the α2,3sialylated T-antigen (NeuAcα2,3Galβ1,3GalNac-) and associated glycan structures are likely to be elevated during cancer. An easy and reliable strategy to label mucinous glycans that contain such carbohydrates can enable the identification of novel glycoproteins that are cancer associated. To this end, the present study demonstrates that the exchange sialylation property of mammalian ST3Gal-II can facilitate the labeling of mucin glycoproteins in cancer cells, tumor specimens and glycoproteins in cancer sera. Results show that: i) the radiolabeled mucin glycoproteins of each of the cancer cell lines studied (T47D, MCF7, LS180, LNCaP, SKOV3, HL60, DU4475 and HepG2) is distinct either in terms of the specific glycans presented or their relative distribution. While some cell lines like T47D had only one single sialylated O-glycan, other like LS180 and DU4475 contained a complex mixture of mucinous carbohydrates. ii) [14C]sialyl labeling of primary tumor cells identified a 25–35 kDa mucin glycoprotein unique to pancreatic tumor. Labeled glycoproteins for other cancers had higher molecular weight. iii) Studies of [14C] sialylated human sera showed larger mucin glycopeptides and 2fold larger mucin-type chains in human serum compared to [14C]sialyl labeled glycans of fetuin. Overall, the exchange sialylation property of ST3Gal-II provides an efficient avenue to identify mucinous proteins for applications in glycoproteomics and cancer research.
PMCID: PMC3321112  PMID: 22329400
Cancer-glycoproteins; 3′sialyl T-hapten; sialylation; radiosialyl tagging; lectin affinity binding; Tn epitope clustering
3.  Mammalian sialyltransferase ST3Gal-II: Its exchange sialylation catalytic properties allow labeling of sialyl residues in mucin type sialylated glycoproteins and specific gangliosides 
Biochemistry  2011;50(44):9475-9487.
While glycosyltransferases are known to display unidirectional enzymatic activity, recent studies suggest that some members can also catalyze readily reversible reactions. Recently we found that mammalian sialyltransferase ST3Gal-II can catalyze the formation of CMP-NeuAc from 5′-CMP in the presence of a donor containing the NeuAcα2,3Galβ1,3GalNAc- unit [Chandrasekaran, E V et al. (2008) Biochemistry 47, 320–330]. The present study shows by using [9-3H] or [14C] sialyl mucin core 2 compounds that ST3Gal-II exchanges sialyl residues between CMP-NeuAc and NeuAcα2,3Galβ1,3GalNAc- unit and also radiolabels sialyl residues in gangliosides GD1a and GT1b, but not GM1. Exchange sialylation proceeds with relative ease as evident from a) radiolabeleling of fetuin was ~2 fold that of asialo fetuin when CMP- [9-3H] NeuAc was generated in situ from 5′-CMP and [9-3H] NeuAcα2,3Galβ1,3GalNAcβ1,3Galα-O-Me by ST3Gal-II; b) ST3Gal-II exchanged radiolabels between [14C] sialyl fetuin and [9-3H] NeuAcα2,3Galβ1,3GalNAcβ1,3Galα-O-Me by generating CMP-[14C] and -[9-3H] NeuAc through 5′-CMP; only 20.3% [14C] and 28.0%[3H] remained with the parent compounds after the sialyl exchange. The [9-3H] sialyl tagged MN Glycophorin A, human chorionic gonadotropin β subunit, GlyCAM-1, CD43, fetuin, porcine Cowper's gland mucin, bovine casein macroglycopeptide, human placental glycoproteins and haptoglobin were analysed by using pronase digestion, mild alkaline borohydride treatment, Biogel P6, lectin-agarose and silica gel thin layer chromatography. Sulfated and sialylated O-glycans were found in GlyCAM-1 and human placental glycoproteins. The present technique has the potential to serve as an important tool as it provides a natural tag for the chemical and functional characterization of O-glycan bearing glycoproteins.
PMCID: PMC3206213  PMID: 21913655
4.  The differential effects of maternal age, race/ethnicity and insurance on neonatal intensive care unit admission rates 
Maternal race/ethnicity, age, and socioeconomic status (SES) are important factors determining birth outcome. Previous studies have demonstrated that, teenagers, and mothers with advanced maternal age (AMA), and Black/Non-Hispanic race/ethnicity can independently increase the risk for a poor pregnancy outcome. Similarly, public insurance has been associated with suboptimal health outcomes. The interaction and impact on the risk of a pregnancy resulting in a NICU admission has not been studied. Our aim was, to analyze the simultaneous interactions of teen/advanced maternal age (AMA), race/ethnicity and socioeconomic status on the odds of NICU admission.
The Consortium of Safe Labor Database (subset of n = 167,160 live births) was used to determine NICU admission and maternal factors: age, race/ethnicity, insurance, previous c-section, and gestational age.
AMA mothers were more likely than teenaged mothers to have a pregnancy result in a NICU admission. Black/Non-Hispanic mothers with private insurance had increased odds for NICU admission. This is in contrast to the lower odds of NICU admission seen with Hispanic and White/Non-Hispanic pregnancies with private insurance.
Private insurance is protective against a pregnancy resulting in a NICU admission for Hispanic and White/Non-Hispanic mothers, but not for Black/Non-Hispanic mothers. The health disparity seen between Black and White/Non-Hispanics for the risk of NICU admission is most evident among pregnancies covered by private insurance. These study findings demonstrate that adverse pregnancy outcomes are mitigated differently across race, maternal age, and insurance status.
PMCID: PMC3495040  PMID: 22985092
5.  The first chemical synthesis of novel MeO-3-GlcUA derivative of hyaluronan-based disaccharide to elucidate the catalytic mechanism of hyaluronic acid synthases (HASs) 
Tetrahedron letters  2009;50(47):6543-6545.
The first chemical synthesis of MeO-3-GlcUAβ(1→3)GlcNAc-UDP to elucidate the catalytic mechanism of hyaluronic acid synthases (HASs) is described. Construction of the desired β(1→3)-linked disaccharide 10 was achieved very efficiently by coupling MeO-3-GlcUA donor 3 with the suitable protected GlcNTroc acceptor 4 using BF3.Et2O as Lewis acid. Chemoselective removal of anomeric NAP, phosphorylation, hydrogenation, coupling with UMP-morpholidate and finally complete deprotection gave the target compound 1 in good yield.
PMCID: PMC2808046  PMID: 20161585
MeO-3-GlcUA; hyaluronic acid synthases (HASs); oligosaccharides; phosphorylation
6.  Heat shock protein 70 secretion by neonatal tracheal tissue during mechanical ventilation: association with indices of tissue function and modeling 
Pediatric research  2009;65(4):387-391.
Mechanical ventilation (MV) of the neonatal airway alters mechanical properties and activates tissue-modeling pathways. Heat shock protein (HSP70) is a marker of tissue injury and modulates inflammation, which may influence subsequent pulmonary tissue modeling by matrix metalloproteinases (MMPs). HSP70 secretion is up regulated in MV airway tissues and associated with changes in airway elasticity and secretion of MMPs. Proximal tracheal segments were isolated in 13 newborn lambs and were either MV for 4 hr or SHAM. At baseline and hourly, tracheal segments were flushed and tracheal elasticity was determined. Tracheal wash fluid was assayed for HSP70 by ELISA and for MMPs by substrate zymography. HSP70 secretion increased from baseline to a peak at 1 hr in both groups (p<0.01), greater in the MV group (p<0.05), and returned to baseline values by 2 hr. This response was in contrast to the progressive decrease in tracheal elasticity (p<0.05). The HSP70 elevation pattern was noted in MMP-2, but beyond 1 hr, MMP-2 returned to baseline values in MV group but remained elevated in SHAM (p<0.05). HSP70 secretion is associated with the degree of biophysical tracheal injury as well as the time course of MMP-2 secretion by tracheal tissues.
PMCID: PMC2676716  PMID: 19127221
Tracheal tissue; ventilator induced injury; trauma-related proteins; tissue remodeling proteins
7.  Reversible Sialylation: Synthesis of CMP-NeuAc from 5′-CMP using α2,3-sialyl O-glycan, glycolipid and macromolecule based donors allow for the synthesis of diverse sialylated products 
Biochemistry  2007;47(1):320-330.
Sialyltransferases transfer sialic acid from CMP-NeuAc to an acceptor molecule. Trans-sialidases of parasites transfer α2,3 linked sialic acid from one molecule to another without the involvement of CMP-NeuAc. Here, we report another type of sialylation termed reverse sialylation catalyzed by mammalian sialyltransferase ST3Gal-II. This enzyme synthesizes CMP-NeuAc by transferring NeuAc from the NeuAcα2,3Galβ1,3GalNAcα-unit of O-glycans, 3-sialyl globo unit of glycolipids and sialylated macromolecules to 5′-CMP. CMP-NeuAc produced in situ is utilized by the same enzyme to sialylate other O-glycans and by other sialyltransferases such as ST6Gal-I and ST6GalNAc-I forming α2,6 sialylated compounds. ST3Gal-II also catalyzed the conversion of 5′-UMP to UMP-NeuAc, which was found to be an inactive sialyl donor. Reverse sialylation proceeded without the need for free sialic acid, divalent metal ions or energy. The direct sialylation using CMP-NeuAc as well as the formation of CMP-NeuAc from 5′-CMP had a wide optimum range (pH 5.2–7.2 and 4.8–6.4 respectively) whereas the entire reaction comprising in situ production of CMP-NeuAc and sialylation of acceptor had a sharp optimum at pH 5.6 (the activity level 50% at pH 5.2 & 6.8 and 25% at pH 4.8 & 7.2). Several properties distinguish forward/conventional vs. reverse sialylation: i. Sodium citrate inhibited forward sialylation but not reverse sialylation. ii. 5′-CDP, a potent forward sialyltransferase inhibitor, did not inhibit the conversion of 5′-CMP to CMP-NeuAc. iii. The mucin core 2 compound 3-O-sulfoα2,3Galβ1,4GlcNAcβ1,6(Galβ1,3)GalNAcα-O-Bn, an efficient acceptor for ST3Gal-II, inhibited the conversion of 5′-CMP to CMP-NeuAc. A significant level of reverse sialylation activity is noted in human prostate cancer cell lines LNCaP and PC3. Overall, the study demonstrates that the sialyltransferase reaction is readily reversible in the case of ST3Gal-II and can be exploited for the enzymatic synthesis of diverse sialyl products.
PMCID: PMC2678907  PMID: 18067323
8.  Increasing illness severity in very low birth weight infants over a 9-year period 
BMC Pediatrics  2006;6:2.
Recent reports have documented a leveling-off of survival rates in preterm infants through the 1990's. The objective of this study was to determine temporal changes in illness severity in very low birth weight (VLBW) infants in relationship to the outcomes of death and/or severe IVH.
Cohort study of 1414 VLBW infants cared for in a single level III neonatal intensive care unit in Delaware from 1993–2002. Infants were divided into consecutive 3-year cohorts. Illness severity was measured by two objective methods: the Score for Neonatal Acute Physiology (SNAP), based on data from the 1st day of life, and total thyroxine (T4), measured on the 5th day of life. Death before hospital discharge and severe intraventricular hemorrhage (IVH) were investigated in the study sample in relation to illness severity. The fetal death rate was also investigated. Statistical analyses included both univariate and multivariate analysis.
Illness severity, as measured by SNAP and T4, increased steadily over the 9-year study period with an associated increase in severe IVH and the combined outcome of death and/or severe IVH. During the final 3 years of the study, the observed increase in illness severity accounted for 86% (95% CI 57–116%) of the variability in the increase in death and/or severe IVH. The fetal death rate dropped from 7.8/1000 (1993–1996) to 5.3/1000 (1999–2002, p = .01) over the course of the study.
These data demonstrate a progressive increase in illness in VLBW infants over time, associated with an increase in death and/or severe IVH. We speculate that the observed decrease in fetal death, and the increase in neonatal illness, mortality and/or severe IVH over time represent a shift of severely compromised patients that now survive the fetal time period and are presented for care in the neonatal unit.
PMCID: PMC1413532  PMID: 16460568

Results 1-8 (8)