#3. November 22, 2017 at 3:07 pm · · minecraftcarpentersblocksmod18 Crack · ~REPACK~.Pelvic organ prolapse (POP) is the most common surgical condition in women and is associated with a significant psychosocial impact. The nadir of the greatest risk of developing POP is in young adulthood, but preventive strategies are lacking. Estrogen may play a central role in POP development, since POP is associated with low circulating estrogen levels in the follicular phase of the menstrual cycle and early menopause. We hypothesize that estrogen stimulates prolapse risk factors while suppressing anti-prolapse factors in the pelvic floor. A better understanding of these putative mediators will identify individuals at high risk of POP development, and may identify novel preventive strategies. Finally, we will examine the safety of a combination of established agents (TAM hormone therapy, erythromycin estolate ointment, and pessaries) in a phase 2, non-randomized, placebo- controlled trial (POP-EARTH). To test these hypotheses, we propose the following specific aims: 1) to examine the relationships between POP stage, estrogen levels, and prolapse risk factors in a case-control study; 2) to determine the influence of estrogen on prolapse risk factors in an in vitro model of the pelvic floor; and 3) to evaluate the safety and tolerability of a combination of established agents (hormone therapy, erythromycin estolate ointment, pessaries) in a phase 2, randomized, placebo-controlled trial (POP-EARTH). To accomplish these aims, we will compare POP cases to age-matched controls in the POP-EARTH study. The cohort will be evaluated at baseline and 24 weeks, and prolapse stage will be assessed in a quantitative, in vivo POP assessment. Prolapse risk factors (theta angle, levator plate descent, levator plate position, levator angulation, bladder neck descent, and anterior compartment urethral support) will be assessed in an ex vivo model of the pelvic floor. The influence of estrogen on each prolapse risk factor, and levels of anti-prolapse factors in the pelvic floor (fibroblast growth factor 7, hepatocyte growth factor, and connective tissue growth factor) will be assessed. These studies will provide the foundation for future human studies to test a preventive regimen involving a combination of estrogen plus selective

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