Anaerobic and aerobic cleavage of the steroid core ring structure by Steroidobacter denitrificans.

The aerobic degradation of steroids by bacteria has been studied in some detail. In contrast, only little is known about the anaerobic steroid catabolism. Steroidobacter denitrificans can utilize testosterone under both oxic and anoxic conditions. By conducting metabolomic investigations, we demonstrated that S. denitrificans adopts the 9,10-seco-pathway to degrade testosterone under oxic conditions. This pathway depends on the use of oxygenases for oxygenolytic ring fission. Conversely, the detected degradation intermediates under anoxic conditions suggest a novel, oxygenase-independent testosterone catabolic pathway, the 2,3-seco-pathway, which differs significantly from the aerobic route. In this anaerobic pathway, testosterone is first transformed to 1-dehydrotestosterone, which is then reduced to produce 1-testosterone followed by water addition to the C-1/C-2 double bond of 1-testosterone. Subsequently, the C-1 hydroxyl group is oxidized to produce 17-hydroxy-androstan-1,3-dione. The A-ring of this compound is cleaved by hydrolysis as evidenced by H2(18)O-incorporation experiments. Regardless of the growth conditions, testosterone is initially transformed to 1-dehydrotestosterone. This intermediate is a divergence point at which the downstream degradation pathway is governed by oxygen availability. Our results shed light into the previously unknown cleavage of the sterane ring structure without oxygen. We show that, under anoxic conditions, the microbial cleavage of steroidal core ring system begins at the A-ring.

Brief Report: Meeting the Needs of Medically Hospitalized Adults with Autism: A Provider and Patient Toolkit.

In an effort to meet the needs of adults with autism spectrum disorder (ASD) while hospitalized, a team of experts and providers from Massachusetts General Hospital (MGH), MGH for Children as well as parents of individuals with ASD was sparked in 2013. This became a multidisciplinary collaborative, the MGH Autism Care Collaborative, to improve adult care for inpatients with ASD. The collaborative was created with three goals in mind: (1) to educate internal medicine adult inpatient providers and staff on the unique needs of adults with ASD when hospitalized; (2) to create ASD specific resources for internal medicine adult inpatient providers; (3) to optimize patient care from admission to discharge among adults with ASD admitted to internal medicine services.

High incidence of focal left ventricular wall motion abnormalities and normal coronary arteries in patients with myocardial infarctions presenting to a community hospital.

BACKGROUND: Myocardial infarction with normal coronary arteries (MINCA) is a well-documented syndrome often associated with global left ventricular wall motion abnormalities (LVWMAs). Recent literature has emphasized the occurrence of Takotsubo cardiomyopathy associated with MINCA. What has not been reported is the incidence of MINCA in the general population and the relative frequency of other types of associated LVWMAs. METHODS AND RESULTS: Data were retrospectively collected on 165 consecutive patients with ST-elevation myocardial infarction (STEMI) and 244 patients with non-ST-elevation myocardial infarction (NSTEMI) who underwent cardiac catheterization at a single institution in Marin County, California. Thirty-two of the 409 (7.8%) patients had MINCA. Of the patients presenting with STEMI, 10.3% had MINCA, and 6.1% of the patients presenting with NSTEMI had MINCA. Females were more likely to present with MINCA than males, both for STEMI (21.6% vs. 5.3%; p < 0.001) and NSTEMI (12.1% vs. 2.6%; p < 0.001). Of the 32 patients who presented with MINCA, 7 (21.9%) females had Takotsubo cardiomyopathy, while 10 (31.3%) patients (9 females, 1 male) had other previously undescribed focal anterior and inferior LVWMAs. A recent stressful event was noted in 50% (47.8% of females, 55.6% of males) of the patients with MINCA. CONCLUSIONS: An unexpectedly high incidence of MINCA with newly-described focal anterior and inferior LVWMAs as well as Takotsubo cardiomyopathy was observed in our community hospital. This syndrome occurred predominantly in females and was often associated with a recent stressful event. As these results were from a community, rather than a referral hospital, this finding challenges the current thought about the incidence of this syndrome in the general population.