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Plastic pollution is a global issue that endangers both human health and the ecosystem. Although interest in sustainable alternatives to single-use plastics has grown, their adoption has been insufficient, and menstrual products are no exception. Disposable menstrual products, such as sanitary napkins, continue to dominate over sustainable options like menstrual cups (MCs). Although studies on women's perceptions and attitudes toward menstrual hygiene management have abounded, there is a lack of research on the development of promotional strategies for sustainable menstrual products. This study aims to fill this research gap by investigating consumers' decision-making process in the face of a real-life option regarding menstruation products. In this comparative study, we conducted a labeled discrete choice experiment on consumers in Japan (n = 1,929), Indonesia (n = 2,031), and France (n = 2,067) to reveal their preferences for sanitary napkins, tampons, and MCs. The respondents from each country were divided into three groups (one control group and two treatment groups with information provided). The results showed that in all countries, the information regarding the costeffectiveness of MCs (i.e., per-use cost) was unequivocally significant, whereas information about their health and environmental benefits was not. Access to free MCs can contribute to their adoption and alleviation of period poverty in all countries, with a relatively moderate acceptance in Japan. The results also showed variations across countries in consumer characteristics (attitude toward menstruation, innovation-friendliness, and green consumption) and the use and perceptions of MCs. Hence, tailored promotional strategies should be considered for each market. [ABSTRACT FROM AUTHOR]

Background: From menarche until menopause, the average menstruator will use over 11 000 tampons or sanitary pads. Vaginal and vulvar tissue is highly permeable, and chemicals are absorbed without undergoing first‐pass metabolism. Objectives: To conduct a review of the literature to determine exposure to environmental chemicals in menstrual products. Search strategy: This review identified 15 papers over the past 10 years. Selection criteria: Papers that measured chemicals in menstrual products and that measured human biomarkers of chemical exposure were included. Papers had to also be available in English. Data collection and analysis: Reviewers assessed the articles and data provided. Multiple chemical groups were found. Main results: Phthalates, volatile organic compounds, parabens, environmental phenols, fragrance chemicals, dioxins and dioxin‐like compounds were detected in menstrual products. Research gaps were identified, including the lack of studies on newer products such as menstrual underwear and cups/discs. In addition to measuring chemicals in these products, future research should focus on clarifying the exposure per menstrual cycle to these chemicals to understand how menorrhagia and cycle length influence exposure from menstrual products. Conclusion: Menstrual products contained measurable levels of a range of endocrine disrupting chemicals including phthalates, phenols and parabens. This reflects a potentially important route of exposure to chemicals that can impact women's reproductive health. [ABSTRACT FROM AUTHOR]

Plastic pollution is a global issue that endangers both human health and the ecosystem. Although interest in sustainable alternatives to single-use plastics has grown, their adoption has been insufficient, and menstrual products are no exception. Disposable menstrual products, such as sanitary napkins, continue to dominate over sustainable options like menstrual cups (MCs). Although studies on women’s perceptions and attitudes toward menstrual hygiene management have abounded, there is a lack of research on the development of promotional strategies for sustainable menstrual products. This study aims to fill this research gap by investigating consumers’ decision-making process in the face of a real-life option regarding menstruation products. In this comparative study, we conducted a labeled discrete choice experiment on consumers in Japan (n = 1,929), Indonesia (n = 2,031), and France (n = 2,067) to reveal their preferences for sanitary napkins, tampons, and MCs. The respondents from each country were divided into three groups (one control group and two treatment groups with information provided). The results showed that in all countries, the information regarding the cost-effectiveness of MCs (i.e., per-use cost) was unequivocally significant, whereas information about their health and environmental benefits was not. Access to free MCs can contribute to their adoption and alleviation of period poverty in all countries, with a relatively moderate acceptance in Japan. The results also showed variations across countries in consumer characteristics (attitude toward menstruation, innovation-friendliness, and green consumption) and the use and perceptions of MCs. Hence, tailored promotional strategies should be considered for each market.

Feminine hygiene products, used by millions of women worldwide on a daily basis, come in various forms. Among them, tampons are a prominent type that aims to absorb menstrual blood directly in the vagina. However, the underlying mechanisms governing liquid absorption in tampons have received limited research attention and remain poorly understood. This study aims to investigate these mechanisms by examining the two main types of viscose fibres used in tampons and their effects when employed in tampon production. The sole distinction between the fibre types lies in their geometric shape—round or trilobal—while all other fibre parameters remain constant. To explore these mechanisms, tampon proxies made from these fibres were created and subjected to tests measuring liquid absorption. In addition, a novel method employing infrared thermography was utilized to infer the stored energy within the compressed tampon. Furthermore, individual fibres were characterised for chemical composition, surface properties, fine structure, liquid interaction, mechanical parameters, and friction behaviour. The results revealed that trilobal fibres exhibited higher tampon absorbency compared to their round counterparts, despite sharing similar chemical composition and comparable mechanical characteristics. This disparity can be attributed to the greater specific surface area of trilobal fibres, leading to enhanced liquid uptake through fibre swelling. However, single fibre swelling only accounted for a minor fraction of the total liquid absorbency of a tampon. The most influential fibre parameter was the geometric shape, as trilobal fibres facilitated the construction and maintenance of a bulkier network with increased available volume for liquid absorption. [ABSTRACT FROM AUTHOR]

Introduction: Epistaxis, commonly known as nosebleed, refers to bleeding from the nasal cavity or nasopharynx and is a prevalent issue among many individuals. While epistaxis typically resolves on its own, in certain instances, such as in elderly patients or individuals with underlying health conditions, it can pose a life-threatening situation. Methods: This descriptive-analytical study was conducted using available sampling method on 226 patients who referred to Kamkar and Arabnia Hospitals of Qom University of Medical Sciences with complaints of epistaxis. The data was gathered through a checklist containing demographic details and actions taken. Subsequently, it was inputted into SPSS for analysis, utilizing both descriptive and analytical statistics. Results: The majority of patients with the conclusive diagnosis exhibited local causes limited to the nose and without any underlying diseases, accounting for 51.8% (117 individuals). In this research, a significant relationship was observed between pack-cell injection and Surgicel placement (P<0.001), pack-cell injection and the type of tampon used (anterior, anterior-posterior, or other treatment) (P=0.005), age and Surgicel placement (P<0.001), age and type of tampon placement (P<0.002), as well as age and reason for referral (P<0.001). However, no significant association was found between gender and type of tampon placement (P=0.511). Conclusion: Given the significant correlation between the variables and the reduction in patient visits for those implanted with Sergicel, as well as the potential use of pack-cell in severe cases, it is advisable to take necessary and crucial actions to enhance patient outcomes. It is recommended to consider the implementation of Sergicel for improved patient care. [ABSTRACT FROM AUTHOR]

Many women report embarrassment as the cause for their avoidance of routine gynaecological screening appointments. Methods of self-collection of bio samples would perhaps encourage women to participate in routine screening programs. The vaginal microbiome plays a key role in women's health and reproductive function. Microbial disturbances can result in the loss of lactobacillus dominance, also known as dysbiosis, associated with an increased risk of contracting sexually transmitted infections (STIs), pregnancy complications and infertility. Our primary aim was to determine if vaginal microbiome screening results are comparable between two methods for self-collected sample acquisition: tampons and lower vaginal swabs (LVSs). Secondary aims included the assessment of the effect of pre-analytic storage on the data (to streamline processing), the prevalence of dysbiosis and the acceptability of the tampons to the participants. Statistical analysis revealed no significant difference in the microbiome data, from tampons versus LVSs or fresh versus frozen samples. The prevalence of dysbiosis in this population of healthy volunteers was 42.9%. The questionnaire data revealed that 52.4% of volunteers use tampons every period, and the majority of volunteers rated the tampons as 5 on a 1–5 Likert scale regarding their perceived comfort using tampons. All (100%) of volunteers were happy to provide a tampon as a sample for testing. The findings from this study show that tampons and LVSs were comparable when analysing the vaginal microbiome, with potential superiority of the tampon with regard to patient acceptability. Self-collection of vaginal secretions for gynaecological screening using tampons warrants further research as this could change the screening landscape, ensuring wider participation and increasing efficacy. [ABSTRACT FROM AUTHOR]

Copyright of Anales de Geografía de la Universidad Complutense is the property of Universidad Complutense de Madrid and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: We illustrate a comprehensive tampon safety assessment approach that assures products can be used safely. Material biocompatibility, vaginal mucosa assessment, vaginal microbiome evaluation, and in vitro assessment of potential risk of staphylococcal toxic shock syndrome expressed through growth of Staphylococcus aureus (S. aureus) and production of TSST-1 are the four essential portions of the approach. Post-marketing surveillance informs of possible health effects that warrant follow up. The approach meets or exceeds US and international regulatory guidance and is described through the example of four tampon products. Methods/Results: Each product is comprised mostly of large molecular weight components (cotton, rayon, polymers) that cannot pass the vaginal mucosa, are widely used across the industry, and replete with a vast body of safety data and a long history of safe use in the category. Quantitative risk assessment of all small molecular weight components assured a sufficient margin of safety supporting their use. Vaginal mucosa assessment confirmed that pressure points, rough edges and/or sharp contact points were absent. A randomized cross-over clinical trial (ClinicalTrials.gov Identifier: NCT03478371) revealed favorable comfort ratings, and few complaints of irritation, burning, stinging, or discomfort upon insertion, wear, and removal. Adverse events were few, mild in severity, self-limited and resolved without treatment. Vaginal microbiota assessment in vitro presented no adverse effect on microbial growth. Culture-independent microbiome analyses from vaginal swab samples obtained during the clinical trial showed no differences attributable to tampon usage, but instead due to statistically significant subject-to-subject variability. Growth of S. aureus and TSST-1 toxin production in the presence of any of the four products in vitro were statistically significantly reduced when compared to medium control alone. Discussion: The data fromthe four elements of the comprehensive safety assessment approach illustrated herein confirm that tampons evaluated using this system can be used safely for menstrual protection. A post-marketing surveillance system that monitors and responds to in-market experiences indicated in-use tolerability of the product among consumers, thus confirming the conclusions of the pre-marketing safety assessment. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

IntroductionWe illustrate a comprehensive tampon safety assessment approach that assures products can be used safely. Material biocompatibility, vaginal mucosa assessment, vaginal microbiome evaluation, and in vitro assessment of potential risk of staphylococcal toxic shock syndrome expressed through growth of Staphylococcus aureus (S. aureus) and production of TSST-1 are the four essential portions of the approach. Post-marketing surveillance informs of possible health effects that warrant follow up. The approach meets or exceeds US and international regulatory guidance and is described through the example of four tampon products.Methods/ResultsEach product is comprised mostly of large molecular weight components (cotton, rayon, polymers) that cannot pass the vaginal mucosa, are widely used across the industry, and replete with a vast body of safety data and a long history of safe use in the category. Quantitative risk assessment of all small molecular weight components assured a sufficient margin of safety supporting their use. Vaginal mucosa assessment confirmed that pressure points, rough edges and/or sharp contact points were absent. A randomized cross-over clinical trial (ClinicalTrials.gov Identifier: NCT03478371) revealed favorable comfort ratings, and few complaints of irritation, burning, stinging, or discomfort upon insertion, wear, and removal. Adverse events were few, mild in severity, self-limited and resolved without treatment. Vaginal microbiota assessment in vitro presented no adverse effect on microbial growth. Culture-independent microbiome analyses from vaginal swab samples obtained during the clinical trial showed no differences attributable to tampon usage, but instead due to statistically significant subject-to-subject variability. Growth of S. aureus and TSST-1 toxin production in the presence of any of the four products in vitro were statistically significantly reduced when compared to medium control alone.DiscussionThe data from the four elements of the comprehensive safety assessment approach illustrated herein confirm that tampons evaluated using this system can be used safely for menstrual protection. A post-marketing surveillance system that monitors and responds to in-market experiences indicated in-use tolerability of the product among consumers, thus confirming the conclusions of the pre-marketing safety assessment.

Many women report embarrassment as the cause for their avoidance of routine gynaecological screening appointments. Methods of self-collection of bio samples would perhaps encourage women to participate in routine screening programs. The vaginal microbiome plays a key role in women’s health and reproductive function. Microbial disturbances can result in the loss of lactobacillus dominance, also known as dysbiosis, associated with an increased risk of contracting sexually transmitted infections (STIs), pregnancy complications and infertility. Our primary aim was to determine if vaginal microbiome screening results are comparable between two methods for self-collected sample acquisition: tampons and lower vaginal swabs (LVSs). Secondary aims included the assessment of the effect of pre-analytic storage on the data (to streamline processing), the prevalence of dysbiosis and the acceptability of the tampons to the participants. Statistical analysis revealed no significant difference in the microbiome data, from tampons versus LVSs or fresh versus frozen samples. The prevalence of dysbiosis in this population of healthy volunteers was 42.9%. The questionnaire data revealed that 52.4% of volunteers use tampons every period, and the majority of volunteers rated the tampons as 5 on a 1–5 Likert scale regarding their perceived comfort using tampons. All (100%) of volunteers were happy to provide a tampon as a sample for testing. The findings from this study show that tampons and LVSs were comparable when analysing the vaginal microbiome, with potential superiority of the tampon with regard to patient acceptability. Self-collection of vaginal secretions for gynaecological screening using tampons warrants further research as this could change the screening landscape, ensuring wider participation and increasing efficacy.

Background Studies describing the clinical features and short-term prognosis of patients admitted to the intensive care unit (ICU) for menstrual toxic shock syndrome (m-TSS) are lacking. Methods This was a multicenter retrospective cohort study of patients with a clinical diagnosis of m-TSS admitted between 1 January 2005 and 31 December 2020 in 43 French pediatric (n = 7) or adult (n = 36) ICUs. The aim of the study was to describe the clinical features and short-term prognosis, as well as to assess the 2011 Centers for Disease and Control (CDC) diagnostic criteria, in critically ill patients with m-TSS. Results In total, 102 patients with m-TSS (median age, 18 years; interquartile range, 16–24 years) were admitted to 1 of the participating ICUs. All blood cultures (n = 102) were sterile. Methicillin-sensitive Staphylococcus aureus grew from 92 of 96 vaginal samples. Screening for superantigenic toxin gene sequences was performed for 76 of the 92 vaginal samples positive for S. aureus (83%), and toxic shock syndrome toxin 1 was isolated from 66 strains (87%). At ICU admission, no patient met the 2011 CDC criteria for confirmed m-TSS, and only 53 (52%) fulfilled the criteria for probable m-TSS. Eighty-one patients (79%) were treated with antitoxin antibiotic therapy, and 8 (8%) received intravenous immunoglobulins. Eighty-six (84%) patients required vasopressors, and 21 (21%) tracheal intubation. No patient required limb amputation or died in the ICU. Conclusions In this large multicenter series of patients included in ICUs for m-TSS, none died or required limb amputation. The CDC criteria should not be used for the clinical diagnosis of m-TSS at ICU admission. [ABSTRACT FROM AUTHOR]

Purpura fulminans (PF) is a syndrome characterized by the sudden onset of progressive skin hemorrhage, necrosis of the extremities, and thrombotic occlusion. Although the cause is believed to be protein C deficiency, many aspects of this syndrome have yet to be clarified. A 45‐year‐old Japanese woman, G2P2 (vaginal delivery), developed fever and lower abdominal pain. It was her 5th day of menstruation, and a tampon had been in the vagina for a few days. Septic shock and disseminated intravascular coagulation were diagnosed, and multidisciplinary treatment was started. Also, toxic shock syndrome due to tampon use was suspected. The purpura on the limbs turned into blisters and then blackish‐purple spots, leading to hemorrhagic necrosis within a few days. Moreover, imaging showed that the uterus and both adnexa had enlarged significantly, and raised suspicion of abscess formation. Total hysterectomy and bilateral adnexectomy were performed, and the histopathological diagnosis was hemorrhagic necrosis due to extensive thrombus formation. In men, PF affects the scrotum and penis, leading to autoamputation of the male genitalia, while there are no reports of PF involving the female genitalia. Regarding the PF, in this case, we considered the possibility of pathologic conditions progressing to the female genitalia. [ABSTRACT FROM AUTHOR]

Emerging technologies may enable detection of endometrial cancer with methods that are less invasive than standard biopsy methods. This study compares patient pain scores among 3 office gynecologic tract sampling methods and explores their potential determinants. A prospective study including 3 sampling methods (tampon, Tao brush (TB), endometrial biopsy (EB)) was conducted between December 2015 and August 2017 and included women ≥45 years of age presenting with abnormal uterine bleeding, postmenopausal bleeding, or thickened endometrial stripe. Patients rated pain after each sampling procedure using a 100-point visual analog scale (VAS). Of 428 enrolled, 190 (44.39%) patients underwent all 3 sampling methods and reported a VAS score for each. Nearly half were postmenopausal (n = 93, 48.9%); the majority were parous (172, 90.5%) of which 87.8% had at least one vaginal delivery. Among the 190 patients, the median (IQR) pain score was significantly lower for sampling via tampon (0 [0,2]) compared to TB (28 [12, 52]) or EB (32 [15, 60]) (both p < 0.001, Wilcoxon signed rank test). Among women who underwent tampon sampling, age and pain scores showed a weak positive correlation (Spearman rank correlation, r = 0.14; p = 0.006); EB sampling was associated with a weak inverse correlation between parity and pain scores (r = −0.14; p = 0.016). Gynecologic tract sampling using a tampon had significantly lower pain than both EB and TB. Pain with tampon sampling was positively correlated with age and pain with EB sampling was inversely correlated with parity. Pain scores for TB and EB were not significantly related to age, menopausal status, or BMI. • Gynecologic sampling using a tampon was less painful than endometrial biopsy or cytology. • Increasing age was associated with higher pain scores with tampon sampling. • Future studies of tampon-collected vaginal fluid and molecular markers of cancer are needed. [ABSTRACT FROM AUTHOR]

Background: Allergenic fragrances are present in a wide range of products but they are not regulated in all industries to the same extent. In Europe, absorbent hygiene products (AHPs) are only covered by the general product safety directive and therefore fragrances can be used freely, whereas in cosmetics and toys the use of these ingredients is regulated. Method: An analytical method was developed to evaluate the presence of 24 sensitizing fragrances in AHPs. This method allows simultaneous identification and quantification and was validated using the total error approach with an acceptance value of ±15%. Results: The validated method was applied to evaluate 10 scented AHPs consisting of four tampons, three panty liners, and three sanitary pads. Eight allergenic fragrances were identified in these products and five products contained at least one allergen above 10 μg/g. Conclusion: The presence of these allergens is not communicated to the consumer. This is, however, a strict requirement in other industries (eg, cosmetics, toys) to ensure adequate consumer protection. Knowing that the exposed area is more susceptible to allergens and irritants, the presence of these allergens should be disclosed. [ABSTRACT FROM AUTHOR]

We aimed to assess whether endometrial cancer (EC) can be detected in shed DNA collected with vaginal tampon by analyzing copy number, methylation markers, and mutations. Tampons were collected prior to hysterectomy from 38 EC patients and 28 women with benign indications. Extracted tampon DNA underwent the following: 1) low-coverage whole genome sequencing (LC-WGS) to assess copy number, 2) pyrosequencing to measure percent promotor methylation of HOXA9, RASSF1 , and CDH13 and 3) next generation sequencing (NGS) to identify mutations in 19 genes associated with EC identified through The Cancer Genome Atlas. Sensitivity and specificity for each test and test combinations were calculated. Methylation analysis yielded the highest specificities but lowest sensitivities (37–40% sensitivity; 100% specificity for HOXA9 , RASSF1 and HTR1B) while mutation analysis had improved sensitivity (50% sensitivity; 83% specificity). Only one "false positive" result for copy number variants was identified among women with benign surgical indications, which was based on detection of copy number changes, and associated with a leiomyosarcoma that was only recognized at hysterectomy. Considering any of the 3 biomarker classes as a positive, resulted in a sensitivity of 92% and specificity of 86%. Mutation analysis did not add sensitivity to the combination of analysis of copy number and methylation. This study demonstrates a proof-of-principle for non-invasive yet precise detection of endometrial cancer. We propose that with improved biomarker testing, it may be possible to develop a clinically useful test for detecting EC. • A combined CNV, methylation, and mutation panel in tampon samples is sensitive and specific for endometrial cancer. • This sensitivity and specificity is preserved with the combination of CNV and methylation alone. • One patient with a clinically unsuspected leiomyosarcoma diagnosed at hysterectomy yielded a false positive via CNV. [ABSTRACT FROM AUTHOR]

Name of cellulose is referred to a type of natural carbohydrate with many hydroxyl groups and high water absorption capacity. Cellulose is the most abundant natural polymer, found as the main constituent of plants (plant cellulose). Some bacteria such as Acetobacter xylinum are also able to synthesize bacterial cellulose. Cellulose‐based hydrogels are superabsorbent materials, which make 3D networks. Chemical bonds or other cohesive forces such as hydrogen bonding or ionic interactions connect the cellulose chains together. Hydrogels can swell and absorb water and other aqueous fluids in their 3D networks, but they are insoluble in them. Nowadays, an increasing demand emerges for biodegradable materials and products made from renewable resources such as cellulose. The excellent biocompatibility of cellulose has prompted the large use of cellulose‐based personal care products. Cellulose hydrogel is used for these products as the thickener and stabilizing agents or as moisturizing agent to improve the skin feel of the product. Hygienic cellulosic absorbent products such as diapers, panty liners, tampons, paper towels, and tissue papers are used as personal care products. These products are available in different absorbency ratings from junior to ultra‐absorbency. Using cellulose‐based hydrogel, superabsorbent products are made. In this review, applications of cellulose‐based hydrogels in personal care products were reviewed. [ABSTRACT FROM AUTHOR]

Fifteen currently marketed intravaginal protection products (11 types of tampon and 4 types of menstrual cup) were tested by the modified tampon sac method to determine their effect on Staphylococcus aureus growth and toxic shock syndrome toxin 1 (TSST-1) production. Most tampons reduced S. aureus growth and TSST-1 production, with differences based on brand and composition, and the level of S. aureus growth was higher in destructured than in unaltered tampons. We observed higher levels of S. aureus growth and toxin production in menstrual cups than in tampons, potentially due to the additional air introduced into the bag by cups, with differences based on cup composition and size. [ABSTRACT FROM AUTHOR]

A one-year-old male Golden Retriever presented with acute onset of vomiting and hemorrhagic diarrhea since 2 days. The dog was depressed, showing abdominal pain, 12% dehydration, tachycardia and a bounding pulse. Diagnostic imaging showed severe dilatation and fluid retention of the entire gastrointestinal tract with decreased motility. A foreign body was found in the gastroduodenal region, but there was no obstruction or plication. The dog was tentatively diagnosed with acute hemorrhagic diarrhea syndrome and rapidly recovered after supportive treatment. However, on the morning of day 4, anorexia and vomiting recurred and diagnostic imaging revealed intestinal plication with free peritoneal fluid, not found on the previous image. An emergency laparotomy revealed the foreign body to be two used feminine hygiene products. These contaminated products were suspected to induce acute hemorrhagic diarrhea syndrome and led to subsequent complication in this large dog. [ABSTRACT FROM AUTHOR]

Copyright of Asian Journal of Women's Studies is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Protection against leakage is one of the key consumer needs for tampon products. The absorbency of tampons depends on both the density of material inside the device, and the density gradient which pulls fluid into the core. Measuring tampon densities in a non-destructive manner was achieved using high-resolution three-dimensional computed tomography (CT) imaging. X-ray density was converted to mass density, using imaging of fiber pellets of known density. Two tampon types were scanned, and density and density gradients were calculated in both regions of interest and voxel-by-voxel. The CT scan density data were used to explain the results from a consumer use study that indicated a higher density prototype resulted in higher leakage versus a commercially available product that had a lower density profile at the periphery of the tampon and a higher density at its core. [ABSTRACT FROM AUTHOR]

Objective We demonstrate the feasibility of detecting EC by combining minimally-invasive specimen collection techniques with sensitive molecular testing. Methods Prior to hysterectomy for EC or benign indications, women collected vaginal pool samples with intravaginal tampons and underwent endometrial brushing. Specimens underwent pyrosequencing for DNA methylation of genes reported to be hypermethylated in gynecologic cancers and recently identified markers discovered by profiling over 200 ECs. Methylation was evaluated individually across CpGs and averaged across genes. Differences between EC and benign endometrium (BE) were assessed using two-sample t-tests and area under the curve (AUC). Results Thirty-eight ECs and 28 BEs were included. We evaluated 97 CpGs within 12 genes, including previously reported markers (RASSF1, HSP2A, HOXA9, CDH13, HAAO, and GTF2A1) and those identified in discovery work (ASCL2, HTR1B, NPY, HS3ST2, MME, ADCYAP1, and additional CDH13 CpG sites). Mean methylation was higher in tampon specimens from EC v. BE for 9 of 12 genes (ADCYAP1, ASCL2, CDH13, HS3ST2, HTR1B, MME, HAAO, HOXA9, and RASSF1) (all p < 0.05). Among these genes, relative hypermethylation was observed in EC v. BE across CpGs. Endometrial brush and tampon results were similar. Within tampon specimens, AUC was highest for HTR1B (0.82), RASSF1 (0.75), and HOXA9 (0.74). This is the first report of HOXA9 hypermethylation in EC. Conclusion DNA hypermethylation in EC tissues can also be identified in vaginal pool DNA collected via intravaginal tampon. Identification of additional EC biomarkers and refined collection methods are needed to develop an early detection tool for EC. [ABSTRACT FROM AUTHOR]