Elsevier

Surgery

Volume 147, Issue 1, January 2010, Pages 134-137
Surgery

Evidence-Based Surgical Hypothesis
Women rule

https://doi.org/10.1016/j.surg.2009.04.033Get rights and content

Female animals tolerate trauma and hemorrhage better than male animals

AND

Estrogen has rapid nongenomic effects that protect organs from damage and attenuate insult–induced inflammation

MOREOVER

The survival deficit from trauma and hemorrhage produced in ovariectomized female animals is repaired with administration of exogenous estrogen

AND

Women survive injury, sepsis, and trauma-hemorrhage–induced hypoxemia/reperfusion better than men

THEREFORE

Women rule … in survival after trauma, thus, men would benefit from being more like women.

Section snippets

Sex and outcome

Animal models of trauma, hemorrhage, and sepsis show sex-based differences in outcome. Sex hormones have been implicated in these differences. Females at all ages exhibit a greater survival and lesser propensity for infection after shock or trauma and greater survival from sepsis than males.2, 5 Testosterone is linked to worse outcome, whereas estrogen is protective.3, 6 Animal studies mirror what is seen clinically; after injury is risk-adjusted, women experience a lesser incidence of multiple

Estradiol and inflammation

So why is estrogen special? Estrogen binds to and transcriptionally regulates DNA and in conjunction with other transcription factors, influences RNA synthesis. Estrogen also promotes nongenomic mechanisms.4 Membrane surface estrogen receptors in both sexes have been confirmed in breast, uterine, ovarian, neuronal, bone, cardiac, pulmonary, hepatic, dendritic, hematologic, and endothelial tissue.5, 8 Widespread estradiol–induced signaling and its effects vary depending on physiologic state. At

Estrogen and inflammation

The immunomodulatory effects of estrogen protect women from sepsis and multiple organ failure. In vascular smooth muscle cells, estrogen is antiinflammatory by inhibiting interleukin (IL)-1 and IL-6. Estrogen also increases the activity of tumor growth factor-β, IL-4, and IL-10 in monocytes, glial cells, and T cells. Estradiol inhibits the lipopolysaccharide–induced release of pro-inflammatory cytokines from peripheral mononuclear cells. Administration of estradiol also decreases activation of

Therapeutic option?

There is a well-documented association between the presence of estrogen and increased survival in humans. Animal data link estrogen and estrogen receptor agonists to improved end-organ function after ischemia/reperfusion and inflammation. These findings identify exogenous estrogen as a potential therapeutic option after injury or hemorrhage. We propose that the administration of exogenous estrogen will improve outcome after injury and hemorrhage. The critics fear that increased risk for

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