Hepatic lipid overload triggers biliary epithelial cell activation via E2Fs

During severe or chronic hepatic injury, biliary epithelial cells (BECs) undergo rapid activation into proliferating progenitors, a crucial step required to establish a regenerative process known as ductular reaction (DR). While DR is a hallmark of chronic liver diseases, including advanced stages of non-alcoholic fatty liver disease (NAFLD), the early events underlying BEC activation are largely unknown. Here, we demonstrate that BECs readily accumulate lipids during high-fat diet feeding in mice and upon fatty acid treatment in BEC-derived organoids. Lipid overload induces metabolic rewiring to support the conversion of adult cholangiocytes into reactive BECs. Mechanistically, we found that lipid overload activates the E2F transcription factors in BECs, which drive cell cycle progression while promoting glycolytic metabolism. These findings demonstrate that fat overload is sufficient to reprogram BECs into progenitor cells in the early stages of NAFLD and provide new insights into the mechanistic basis of this process, revealing unexpected connections between lipid metabolism, stemness, and regeneration.

Asparagine protects pericentral hepatocytes during acute liver injury

The non-essential amino acid asparagine can only be synthesized de novo by the enzymatic activity of asparagine synthetase (ASNS). While ASNS and asparagine have been implicated in the response to numerous metabolic stressors in cultured cells, the in vivo relevance of this enzyme in stress-related pathways remains unexplored. Here, we found ASNS to be expressed in pericentral hepatocytes, a population of hepatic cells specialized in xenobiotic detoxification. ASNS expression was strongly enhanced in two models of acute liver injury: carbon tetrachloride (CCl4) and acetaminophen (APAP). We found that mice with hepatocyte-specific Asns deletion (Asnshep-/-) were more prone to pericentral liver damage than their control (Asnshep+/+) littermates after toxin exposure. This phenotype could be reverted by intravenous administration of asparagine. Unexpectedly, the stress-induced upregulation of ASNS involved an ATF4-independent, non-canonical pathway mediated by the nuclear receptor, liver receptor homolog 1 (LRH-1; NR5A2). Altogether, our data indicate that the induction of the asparagine-producing enzyme ASNS acts as an adaptive mechanism to constrain the necrotic wave that follows toxin administration and provide proof of concept that intravenous delivery of asparagine can dampen hepatotoxin-induced pericentral hepatocellular death.

Engineering Modular 3D Liver Culture Microenvironments In Vitro to Parse the Interplay between Biophysical and Biochemical Microenvironment Cues on Hepatic Phenotypes

In vitro models of human liver functions are used across a diverse range of applications in preclinical drug development and disease modeling, with particular increasing interest in models that capture facets of liver inflammatory status. This study investigates how the interplay between biophysical and biochemical microenvironment cues influence phenotypic responses, including inflammation signatures, of primary human hepatocytes (PHH) cultured in a commercially available perfused bioreactor. A 3D printing-based alginate microwell system was designed to form thousands of hepatic spheroids in a scalable manner as a comparator 3D culture modality to the bioreactor. Soft, synthetic extracellular matrix (ECM) hydrogel scaffolds with biophysical properties mimicking features of liver were engineered to replace polystyrene scaffolds, and the biochemical microenvironment was modulated with a defined set of growth factors and signaling modulators. The supplemented media significantly increased tissue density, albumin secretion, and CYP3A4 activity but also upregulated inflammatory markers. Basal inflammatory markers were lower for cells maintained in ECM hydrogel scaffolds or spheroid formats than polystyrene scaffolds, while hydrogel scaffolds exhibited the most sensitive response to inflammation as assessed by multiplexed cytokine and RNA-seq analyses. Together, these engineered 3D liver microenvironments provide insights for probing human liver functions and inflammatory response in vitro.

The opioid peptide biphalin modulates human corneal epithelial wound healing in vitro

PURPOSE

Analgesic drugs, including nonselective opioids and non-steroidal anti-inflammatory drugs, should be used with great precautions to relieve pain after trauma to the corneal epithelium because of their unfavorable effects on wound healing. Biphalin is a synthetic opioid peptide that has been demonstrated to possess a strong analgesic effect on rodents. The purpose of this study is to investigate the effects of biphalin on human corneal epithelial wound healing.

METHODS

An immortalized human corneal epithelial cell (HCEC) culture was used to analyze the effects of biphalin on wound healing. The toxicity of biphalin at various concentrations was measured by the MTT assay. The effects of 1μM and 10μM biphalin on wound closure, cell migration and proliferation were tested in an in vitro scratch assay of HCECs. Naloxone, a non-selective competitive opioid receptor antagonist, was also used to inhibit the effects of biphalin in all experiments.

RESULTS

Biphalin did not cause any toxic effect on HCECs at concentrations lower than 100μM at various incubation time points. Biphalin significantly increased wound healing at 1μM concentration in an in vitro scratch assay of HCECs (P<0.05). It also significantly increased migration of HCECs (P<0.01). There was no significant difference between the biphalin and control groups of HCECs in the Ki67 proliferation assay.

CONCLUSION

Biphalin, which is a synthetic opioid peptide, promotes corneal epithelial wound healing by increasing cell migration. This role should be evaluated in further in vivo and clinical studies.

Bile Acids Signal via TGR5 to Activate Intestinal Stem Cells and Epithelial Regeneration

BACKGROUND & AIMS

Renewal and patterning of the intestinal epithelium is coordinated by intestinal stem cells (ISCs); dietary and metabolic factors provide signals to the niche that control ISC activity. Bile acids (BAs), metabolites in the gut, signal nutrient availability by activating the G protein-coupled bile acid receptor 1 (GPBAR1, also called TGR5). TGR5 is expressed in the intestinal epithelium, but it is not clear how its activation affects ISCs and regeneration of the intestinal epithelium. We studied the role of BAs and TGR5 in intestinal renewal, and regulation of ISC function in mice and intestinal organoids.

METHODS

We derived intestinal organoids from wild-type mice and Tgr5^-/- mice, incubated them with BAs or the TGR5 agonist INT-777, and monitored ISC function by morphologic analyses and colony-forming assays. We disrupted Tgr5 specifically in Lgr5-positive ISCs in mice (Tgr5^ISC-/- mice) and analyzed ISC number, proliferation, and differentiation by flow cytometry, immunofluorescence, and organoid assays. Tgr5^ISC-/- mice were given cholecystokinin; we measured the effects of BA release into the intestinal lumen and on cell renewal. We induced colitis in Tgr5^ISC-/- mice by administration of dextran sulfate sodium; disease severity was determined based on body weight, colon length, and histopathology analysis of colon biopsies.

RESULTS

BAs and TGR5 agonists promoted growth of intestinal organoids. Administration of cholecystokinin to mice resulted in acute release of BAs into the intestinal lumen and increased proliferation of the intestinal epithelium. BAs and Tgr5 expression in ISCs were required for homeostatic intestinal epithelial renewal and fate specification, and for regeneration after colitis induction. Tgr5^ISC-/- mice developed more severe colitis than mice without Tgr5 disruption in ISCs. ISCs incubated with INT-777 increased activation of yes-associated protein 1 (YAP1) and of its upstream regulator SRC. Inhibitors of YAP1 and SRC prevented organoid growth induced by TGR5 activation.

CONCLUSIONS

BAs promote regeneration of the intestinal epithelium via activation of TGR5 in ISCs, resulting in activation of SRC and YAP and activation of their target genes. Release of endogenous BAs in the intestinal lumen is sufficient to promote ISC renewal and drives regeneration in response to injury.

Mechano-modulatory synthetic niches for liver organoid derivation

The recent demonstration that primary cells from the liver can be expanded in vitro as organoids holds enormous promise for regenerative medicine and disease modelling. The use of three-dimensional (3D) cultures based on ill-defined and potentially immunogenic matrices, however, hampers the translation of liver organoid technology into real-life applications. We here use chemically defined hydrogels for the efficient derivation of both mouse and human hepatic organoids. Organoid growth is found to be highly stiffness-sensitive, a mechanism independent of acto-myosin contractility and requiring instead activation of the Src family of kinases (SFKs) and yes-associated protein 1 (YAP). Aberrant matrix stiffness, on the other hand, results in compromised proliferative capacity. Finally, we demonstrate the establishment of biopsy-derived human liver organoids without the use of animal components at any step of the process. Our approach thus opens up exciting perspectives for the establishment of protocols for liver organoid-based regenerative medicine.

3D liver organoids hold great promise for regenerative medicine but the use of ill-defined matrices limits their potential. Here, the authors generate human and mouse liver organoids using a chemically defined matrix, and reveal a link between matrix stiffness and organoid growth that does not require acto-myosin contraction.

The oral adverse effects of isotretinoin treatment in acne vulgaris patients: A prospective, case-control study

BACKGROUND

Isotretinoin is the most effective therapy to treat severe acne vulgaris and its systemic adverse effects have been well documented, but little is known on dental side effects over the course of treatment.

OBJECTIVES

This prospective case-control study aimed to evaluate the oral adverse effects of isotretinoin in Turkish patients with acne vulgaris; compare oral conditions between patients and normal controls; and investigate the association between salivary parameters and International Caries Detection and Assessment System (ICDAS) scores.

MATERIALS AND METHODS

For 6 months, the patients (n = 45) received isotretinoin daily (0.5 mg/kg). The age-matched untreated controls (n = 45) were patients without acne. Both groups were examined before the study and at 6 months for salivary flow, buffer capacity, microbiologic tests, and caries status (based on the ICDAS). Salivary parameters and ICDAS scores were analyzed by Spearman's rank correlations. Data were statistically analyzed by the Mann-Whitney U test, Wilcoxon signed rank tests, and McNemar's Chi-square tests (P < 0.05).

RESULTS

Twenty-two isotretinoin-treated patients and 18 controls completed the study. At baseline, the groups were not significantly different in the evaluated parameters (P > 0.05). At 6 months in the isotretinoin-treated group, salivary flow and buffer capacity significantly decreased, and the ICDAS scores significantly increased (P < 0.05). The changes in these criteria from baseline were insignificant in the controls (P > 0.05). Intraoral pathogen counts were not significantly different between the groups, compared to baseline (P > 0.05). Stimulated salivary parameters in both groups were not correlated significantly with the ICDAS scores.

CONCLUSIONS

Isotretinoin significantly affected salivary flow, buffer capacity, caries lesion activity scores for 6 months. However, salivary parameters and caries lesion activity scores had no significant correlations.

Enhancement of two photon absorption properties and intersystem crossing by charge transfer in pentaaryl boron-dipyrromethene (BODIPY) derivatives

Indication of charge transfer and an intersystem crossing mechanism for the B4 compound by using ultrafast pump probe spectroscopy.

Effect of a re-wetting agent on bond strength of an adhesive to primary and permanent teeth dentin after different etching techniques

OBJECTIVE

This study investigated the effect of a re-wetting agent on the microtensile bond strengths (mTBS) of primary and permanent dentin after acid or laser etching.

MATERIALS AND METHODS

Twelve permanent and 12 primary molar teeth were ground to expose an occlusal dentin surface. Each group teeth were randomly divided into groups; I-II: 37% phosphoric acid etching with/without re-wetting agent, III-IV: Erbium: Yttrium aluminium garnet laser etching with/without re-wetting agent. An etch-and-rinse adhesive was used, and vertical sticks were obtained for the microtensile test.

RESULTS

mTBS of permanent teeth was higher than that of primary teeth (P < 0.05). Re-wetting agent groups were similar with control groups in both etching groups in the permanent teeth (P > 0.05). Re-wetting agent group was similar with the control group in acid etch group (P > 0.05) and lower than the control group in laser etch group in primary teeth (P < 0.05).

CONCLUSION

Acid etching in permanent teeth; laser etching in primary teeth was found more successful. The use of re-wetting agent did not provide an advance on bond strength of the adhesive in both primary and permanent teeth after acid-etch or laser-etch.

Effect of caries removal techniques on the bond strength of adhesives to caries-affected primary dentin in vitro

AIM

The aim of this in vitro study is to evaluate the effects of three different caries removal techniques on the microtensile bond strength of adhesive materials to caries-affected dentin.

MATERIALS AND METHODS

Thirty primary molar teeth were used. The teeth were randomly divided into three groups according to the caries removal technique employed: conventional steel bur (group 1); Er:YAG laser (group 2); chemomechanical method (group 3). Each group was divided into two subgroups according to bonding agents: one-step self-etch adhesive and etch-and-rinse adhesive. The teeth were restored with composite resin. Vertical sticks were obtained and subjected to tensile stress. Data were analyzed by two-way analysis of variance (ANOVA), Tukey's test and an independent samples t-test.

RESULTS

The values for the laser groups were significantly lower than those of the bur groups for both bonding agents (p<0.05). There were no significant differences between the bur and chemomechanical groups (p > 0.05).

CONCLUSION

Bur and chemomechanical techniques in primary teeth were found more successful. Similar results were found according to the adhesives used for each caries removal techniques.

Early autoimmune complications after thymomectomy in a patient with interstitial lung disease. Case report

Thymoma has been associated with a variety of autoimmune disorders. We report a case of myasthenia gravis and pancytopenia in a 53-year-old man with lymphoepithelial thymoma and interstitial lung disease. Preoperative examination revealed neither hematologic abnormality nor myasthenia gravis. The patient had enteritis prior to thymomectomy, sternal infection in the first month of operation, and urinary infection at the third month. About three months after thymomectomy, he required mechanical ventilation support due to myasthenia gravis-related respiratory failure. One month later, a rapidly progressing pancytopenia developed. The patient died within two weeks of overwhelming septicemia unresponsive to treatment with antibiotics and steroids. The possible onset of myasthenia gravis or pancytopenia after thymomectomy should be kept in mind during follow-up. Recurrent infections in the early stages of thymomectomy may suggest a lethal onset of pancytopenia.

Urinary nuclear matrix protein 22 for diagnosis of renal cell carcinoma

OBJECTIVE

To determine the incidence of positive urinary nuclear matrix protein 22 (NMP22) values, which are currently used to detect transitional cell carcinoma of the bladder, in renal cell carcinoma (RCC).

MATERIAL AND METHODS

Urinary NMP22 values were determined preoperatively in 41 patients in whom a solid renal mass had been detected using CT and who were scheduled for radical nephrectomy; 38 of these patients were diagnosed with RCC. Two patients had xanthogranulomatous pyelonephritis and one had metastasis of a small cell adenocarcinoma to the kidney; these patients were excluded from the study. A total of 30 patients with kidney stones and simple renal cysts were used as controls.

RESULTS

The urinary NMP22 values of the RCC patients were significantly higher than those of the controls. Of the 38 patients with RCC, 23 (60.5%) had positive urinary NMP22 values > or =10 U/ml. There were four measurements above this cut-off level in the control group. Urinary NMP22 values increased with an increase in pathologic tumor stage, but the correlation was not statistically significant. There was no correlation between grade and urinary NMP22 or between tumor burden and urinary NMP22.

CONCLUSIONS

The urinary NMP22 test may help to diagnose RCC and may also result in an increase in the incidental discovery of RCC. As elevated urinary NMP22 levels have also been found to occur in RCC, patients with suspected bladder cancer and positive urinary NMP22 levels should be more broadly evaluated. Specific NMP assays for renal tumor cells may increase the utility of the test for RCC.

A comparative study of two fissure sealants: a 2-year clinical follow-up

The aim of the study was to compare the fluoride-containing fissure sealants (Helioseal F) with the conventional (Concise Light Cure White Sealant) fissure sealants in their retention and caries-prevention capabilities in young population. Sealant materials were applied by three dentists on 122 fissures of first and second molars in 59 adults, 18-20 years of age. One hundred and twenty-two non-carious and unsealed molar teeth were selected as controls. The teeth were assessed using the following criteria: 1 - fully retained (FR), 2 - partially lost (PL), 3 - totally lost (TL) and 4 - decayed (D). All teeth were clinically assessed at 3, 6, 12 and 24 months by two examiners who were blinded to the sealant materials. Data were statistically analysed with chi-square tests. After 3 months 72.1% of sealants were fully retained, at 24 months this had dropped to 46.7%. The partial loss of sealants was at 3 months (15.6%), 6 months (26.2%), 12 months (27.9%) and 24 months (27%). The total loss of Helioseal F (16.4, 19.7, 18, 23% at 3rd, 6th, 12th and 24th months, respectively) was more than the total loss of Concise Light Cure White Sealant (8.2, 9.8, 11.5, 18%, respectively); meaning that the retention rate of Helioseal F was lower than for Concise Light Cure White Sealant. No caries was detected at 3rd and 6th months in all sealant-treated teeth. The incidence of caries in Helioseal F treated teeth at 12 and 24 months was 11.5% and 0% in Concise Light Cure White Sealant treated teeth. The incidence of caries in all fissure-sealant-treated-teeth after 24 months was 5.7 and 25.4% in control group. The results underline that the application of fissure sealants to young people in this sample is an effective method for the prevention of fissure caries.

Prognostic value of the expression of Ki-67, CD44 and vascular endothelial growth factor, and microvessel invasion, in renal cell carcinoma

OBJECTIVE

To determine if use of cell proliferation, cell adhesion, level of angiogenesis-related factors and presence of microscopic vascular invasion (MVI) could better predict the biological behaviour of renal cell carcinoma (RCC), which has a widely variable clinical outcome despite the use of conventional prognostic factors (staging and grading).

MATERIALS AND METHODS

The expression of Ki-67, CD44H and vascular endothelial growth factor (VEGF) were assessed immunohistochemically in formalin-fixed, paraffin-embedded tissues from 48 RCCs, using a Ki-67 labelling index (LI), CD44 LI and level of VEGF expression, respectively. In addition all the pathological slides were reviewed retrospectively for the presence and absence of MVI. The prognostic value of all the variables assessed was then evaluated, and correlated with the usual prognostic variables and cancer-specific survival.

RESULTS

Univariate analysis of cancer-specific survival showed that tumour stage (P < 0.001), tumour size (P = 0.005), metastasis, MVI, Ki-67 LI, CD44H LI and VEGF expression (all P < 0.001) were predictors of tumour-related death. There was a statistical correlation between CD44H LI and each of Ki-67 LI (r = 0.61), expression level of VEGF (r = 0.72) and presence of MVI (r = 0.71). Independent predictors of cancer-specific survival in a multivariate analysis were: in all patients with RCC, the MVI (P = 0.003) and VEGF expression (P = 0.01); in those with no metastases, MVI (P = 0.01); in patients with no MVI, VEGF (P = 0.04); and in patients with MVI, Ki-67 LI (P = 0.003). No independent predictor was identified in patient with metastases.

CONCLUSION

This study suggests that cell proliferation, cell adhesion, the level of VEGF expression and the presence of MVI represent a complex tumour-host interaction that may favour the progression of RCC. Cell proliferation, CD44H and VEGF expression appear to be powerful markers for identifying patients with an adverse prognosis.

Sialic Acid is a Marker of Lung Injury Following Lower Extremities Ischemia/Reperfusion

OBJECTIVE

This study tests whether sialic acid is a mediator of the lung injury following lower extremity ischemia/reperfusion (I/R). Design. Prospective randomised study.

MATERIALS AND METHODS

Thirty-one Sprague-Dawley rats were randomised into four groups: group 1, aorta was exposed but not clamped; group 2, aorta clamped for 3 h, followed by 1 h of reperfusion; group 3, 50 mg/kg pentoxifylline administrated before the aorta was clamped; and group 4, 1 mg/kg dexametasone administrated before the aorta was clamped. Serial arterial blood samples for blood gas, tumor necrosis factor-alpha (TNF-alpha), and total SA (TSA) assay were obtained. The lungs were removed and histologically examined for evidence of injury.

RESULTS

Groups 2, 3, and 4 had significantly higher peak serum TSA concentrations compared with groups 1 (group 1 vs. 2, p=0.001; group 1 vs. 3, p=0.002; group 1 vs. 4, p=0.001). Group 3 had lower peak serum TSA concentration. Groups 2 and 4 had significantly higher peak serum TNF-alpha concentrations (p=0.0001) compared with groups 1 and 3. Group 3 had lower peak serum TNF-alpha concentration. Lower TSA and TNF-alpha levels are associated with lesser degrees of lung injury.

CONCLUSIONS

TSA and TNF appear during events that lead to lung injury following lower extremity I/R.

A Behçet case with renal amyloidosis

Behçet's disease is a chronic systemic vasculitis with unknown etiology characterized by recurrent oral and genital ulcerations, ocular inflammation,having manifestations related to the skin and joints. Neurologic, pulmonary and gastrointestinal findings can also be observed during the course of the disease. In this report a case of Behçet's disease that had amyloidosis due to renal parenchymal involvement of the disease showing itself by nephrotic syndrome is presented.

K-RAS mutation in transitional cell carcinoma of urinary bladder

In the present study it was aimed to investigate the frequency of K-RAS mutation in the human bladder transitional cell carcinoma. For this purpose, tissue specimens obtained from the patients with bladder tumors. Genomic DNAs were isolated and then PCR-SSCP analysis of K-RAS gene were performed. A heterozygous deleted mutation was detected in K-RAS oncogene (exon 2) in agarose gel electrophoresis in one patient and point or substitution mutations are detected using single strand conformational polymorphism (SSCP) in other different patients with bladder cancer (4/14). In conclusion, the frequency of K-RAS mutation is not rare and the role of this mutation in oncogenesis and in infiltration of the urinary bladder wall needs to be confirmed in a larger study.

K-RAS mutation in transitional cell carcinoma of urinary bladder

In the present study it was aimed to investigate the frequency of K-RAS mutation in the human bladder transitional cell carcinoma. For this purpose, tissue specimens obtained from the patients with bladder tumors. Genomic DNAs were isolated and then PCR-SSCP analysis of K-RAS gene were performed. A heterozygous deleted mutation was detected in K-RAS oncogene (exon 2) in agarose gel electrophoresis in one patient and point or substitution mutations are detected using single strand conformational polymorphism (SSCP) in other different patients with bladder cancer (4/14). In conclusion, the frequency of K-RAS mutation is not rare and the role of this mutation in oncogenesis and in infiltration of the urinary bladder wall needs to be confirmed in a larger study.

Adenomatoid tumors of testis and epididymis: a report of two cases

Adenomatoid tumors are rare benign tumors of female and male genital tracts. In this paper, we reported an epididymal and a testicular adenomatoid tumor in two patients presented with enlarged intrascrotal mass.

Clinical wear performance of eight experimental dental composites over three years determined by two measuring methods

The effect of matrix selection, filler composition, filler silanization, operator variations, and test site (dental clinic) on the wear rate of eight composites were evaluated. The wear was measured on replicas using both a microscopic and a laser scanning measuring method. The average wear rate on contact-free surfaces was 9.2 +/- 4.2 microm/month with the microscopic measurement and 8.5 +/- 3.7 microm/ month with the laser scanner over the 36-month period. The urethane-based composites performed significantly better than those which were bisGMA-based. Restorations placed at one dental clinic showed significantly lower initial wear. There was also a significant difference between the operators that was most pronounced during the first 6 months. The other variable (filler composition and silane treatment) did not affect the wear rate significantly.

Mullerian adenosarcoma of the uterus associated with tamoxifen therapy

Mullerian adenosarcoma of the uterus is a biphasic tumor exhibiting benign epithelial and malignant stromal component. This tumor may occasionally be associated with tamoxifen therapy which is used as an adjuvant drug for breast carcinoma. Reviewing the literature, we found only 12 adenosarcoma cases associated with tamoxifen therapy Thus, the clinical and pathological findings in a 58 years old postmenopausal woman who developed uterine adenosarcoma, following low dose tamoxifen therapy after 8 years, was discussed in this report.

Pedunculated lipofibroma

Pedunculated lipofibroma is a relatively rare form of nevus lipomatosus superficialis. The lesions are large, slow growing, pedunculated tumors. Histologically, groups and strands of fat cells are found embedded among the collagen bundles of the dermis. We presented a woman diagnosed with a pedunculated lipofibroma clinically and histopathologically.

A highly sensitive and specific enzyme-linked immunosorbent assay of antibodies to hepatitis C virus

In this study, a 178 amino acids long portion of the hepatitis C virus (HCV) core gene was cloned, sequenced, expressed in Escherichia coli, and purified. The resulting antigen (C178) was tested with human sera enzyme-linked immunosorbent assay (ELISA) in order to assess its ability to diagnose HCV. It was shown by ELISA that 92% of the patients sera, diagnosed previously by a 3rd generation enzyme immunoassay (EIA) as HCV-positive, had antibodies against the C178 antigen. This antigen gave no false positive results when tested with anti-HCV-negative sera.

Estrogen dermatitis

The aim of the present study was to evaluate the estrogen dermatitis of women who have chronic skin disorders with exacerbations or premenstrual dermatitis in a cyclic pattern. Twenty-three women exhibiting skin disorders of pruritus, urticaria, eczema, papulovesicular eruption, hirsutism-acne with hyperpigmentation (hirsutism and/or its related disorders such as acne) and 18 healthy control subjects were included in the study. Sensitivity to estrogen was described in 14 of 23 women. Of the 14 estrogen sensitive women, nine had a premenstrual flare of their skin lesions and five had a chronic dermatitis with exacerbations. In the evaluation of endocrine profile, mean serum testosterone and LH levels of the patient group were significantly higher than controls (2.814 +/- 0.839 vs. 1.561 +/- 0.645 nm/l, P < 0.001; 10.843 +/- 2.538 vs. 4.539 +/- 1.215 IU/l, P < 0.0001). The LH/FSH ratio of the patient group was also significantly higher than controls (1.765 +/- 0.329 vs. 0.810 +/- 0.0116, P < 0.0001). Mean serum progesterone level of the patient group was significantly lower than the control group (0.499 +/- 0.201 vs. 0.977 +/- 0.396 ng/ml, P < 0.001). Hyperandrogenism and anovulation were the two more common outcomes in the patient group. Skin lesions of estrogen sensitive women were all cured with the administration of tamoxifen 20 mg daily for 7 days premenstrually.