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In infants and children requiring prolonged, multiple central venous (CV) catheterizations, the superior (SVC) and inferior vena cava may become thrombosed or stenotic, making CV access a difficult problem. Use of the iliac vein may be an acceptable alternative. We report a patient with thrombosis of the SVC in whom the external iliac vein was accessed through a retroperitoneal approach for placement of an implantable port. This technique is easy to perform, and there are no special materials or patient positioning required. [ABSTRACT FROM AUTHOR]

The use of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) appears to be a safe and feasible means of confirming or excluding malignancy in the adrenal glands. EUS-FNA with biopsy of suspicious masses in either adrenal gland allows for assessment of these lesions while keeping complications relatively rare. The main advantages of EUS-FNA are that it can be done as an outpatient procedure, with good results, minimal morbidity, and a short hospital stay. Nevertheless, EUS-FNA of adrenal masses should be indicated only in selected cases, in which there is potential to either decrease unnecessary treatment or guide therapy in cancer patients by aiding in either staging of malignancy or treatment of recurrence.v.

The use of high-speed puncture mechanics for prey capture has been documented across a wide range of organisms, including vertebrates, arthropods, molluscs and cnidarians. These examples span four phyla and seven orders of magnitude difference in size. The commonality of these puncture systems offers an opportunity to explore how organisms at different scales and with different materials, morphologies and kinematics perform the same basic function. However, there is currently no framework for combining kinematic performance with cutting mechanics in biological puncture systems. Our aim here is to establish this framework by examining the effects of size and velocity in a series of controlled ballistic puncture experiments. Arrows of identical shape but varying in mass and speed were shot into cubes of ballistic gelatine. Results from high-speed videography show that projectile velocity can alter how the target gel responds to cutting. Mixed models comparing kinematic variables and puncture patterns indicate that the kinetic energy of a projectile is a better predictor of penetration than either momentum or velocity. These results form a foundation for studying the effects of impact on biological puncture, opening the door for future work to explore the influence of morphology and material organization on high-speed cutting dynamics.

Many of the materials that are challenging for large animals to cut or puncture are also cut and punctured by much smaller organisms that are limited to much smaller forces. Small organisms can overcome their force limitations by using sharper tools, but one drawback may be an increased susceptibility to fracture. We use simple contact mechanics models to estimate how much smaller the diameter of the tips or edges of tools such as teeth, claws and cutting blades must be in smaller organisms in order for them to puncture or cut the same materials as larger organisms. In order to produce the same maximum stress when maximum force scales as the square of body length, the diameter of the tool region that is in contact with the target material must scale isometrically for punch-like tools (e.g. scorpion stings) on thick targets, and for crushing tools (e.g. molars). For punch-like tools on thin targets, and for cutting blades on thick targets, the tip or edge diameters must be even smaller than expected from isometry in smaller animals. The diameters of a small sample of unworn punch-like tools from a large range of animal sizes are consistent with the model, scaling isometrically or more steeply (positively allometric). In addition, we find that the force required to puncture a thin target using real biological tools scales linearly with tip diameter, as predicted by the model. We argue that, for smaller tools, the minimum energy to fracture the tool will be a greater fraction of the minimum energy required to puncture the target, making fracture more likely. Finally, energy stored in tool bending, relative to the energy to fracture the tool, increases rapidly with the aspect ratio (length/width), and we expect that smaller organisms often have to employ higher aspect ratio tools in order to puncture or cut to the required depth with available force. The extra stored energy in higher aspect ratio tools is likely to increase the probability of fracture. We discuss some of the implications of the suggested scaling rules and possible adaptations to compensate for fracture sensitivity in smaller organisms.

Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Unlabelled: The rapid emergence of micro-devices for biomedical applications over the past two decades has introduced new challenges for the materials used in the devices. Devices like microneedles and the Nanopatch, require sufficient strength to puncture skin often with sharp-slender micro-scale profiles, while maintaining mechanical integrity. For these technologies we sought to address two important questions: 1) On the scale at which the device operates, what forces are required to puncture the skin? And 2) What loads can the projections/microneedles withstand prior to failure. First, we used custom fabricated nanoindentation micro-probes to puncture skin at the micrometre scale, and show that puncture forces are ∼0.25-1.75mN for fresh mouse skin, in agreement with finite element simulations for our device. Then, we used two methods to perform strength tests of Nanopatch projections with varied aspect ratios. The first method used a nanoindenter to apply a force directly on the top or on the side of individual silicon projections (110μm in length, 10μm base radius), to measure the force of fracture. Our second method used an Instron to fracture full rows of projections and characterise a range of projection designs (with the method verified against previous nanoindentation experiments). Finally, we used Cryo-Scanning Electron Microscopy to visualise projections in situ in the skin to confirm the behaviour we quantified, qualitatively., Statement of Significance: Micro-device development has proliferated in the past decade, including devices that interact with tissues for biomedical outcomes. The field of microneedles for vaccine delivery to skin has opened new material challenges both in understanding tissue material properties and device material. In this work we characterise both the biomaterial properties of skin and the material properties of our microprojection vaccine delivery device. This study directly measures the micro-scale puncture properties of skin, whilst demonstrating clearly how these relate to device design. This will be of strong interest to those in the field of biomedical microdevices. This includes work in the field of wearable and semi-implantable devices, which will require clear understanding of tissue behaviour and material characterisation., (Copyright © 2016 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.)

Internal jugular central venous line placement is a standardized and common clinical procedure. However, even the most skillful physician may face complications. Careful patient evaluation and detailed vascular anatomical knowledge can minimize the risk of iatrogenic injuries. Following a strict protocol in case of unsuccessful attempts of venous puncture helps to improve patient outcome. In this case report, we present a patient who suffered an unusual injury. Further, we discuss current treatment options for pseudoaneurysms.

Pericardial effusion can lead to cardiac tamponade, which endangers an animal's life. Ultrasound-guided pericardiocentesis is used to remove abnormal liquid; however, it requires technical expertise. In veterinary medical education, the opportunity to teach this procedure to save lives during emergencies is rare; therefore, simulators are recommended for this practice. The present study aimed to create a model that can be made "at home" at low cost for ultrasound-guided pericardiocentesis training and to gather feedback about this model through questionnaires given to the participants. Eighteen professionals and thirty-six students were introduced to the simulator in pairs. After the simulation training session, participants filled out the questionnaire. Participants considered the model strong in the following areas: visualization of the pericardium, the heart, fluid in the pericardium, and fluid decrease during fictitious pericardiocentesis and its realism. They considered the model weak or moderate in the following areas: visualization of the surrounding tissues, difficulty of pericardial puncture, and visualization of the catheter. The professionals classified the realism of the experimental heart as moderate, whereas the undergraduate students classified it as strong. All participants believed that the experimental model could be useful in preparing for a future real situation. This model fulfills the need for a practical, realistic, and cost-effective model for ultrasound-guided pericardiocentesis training., (Copyright © 2016 The American Physiological Society.)

Purpose: To evaluate the feasibility of CT-guided bone biopsies using a novel robotic needle guide., Material and Methods: The robotic needle guide iSYS 1.3 (iSYS Medzintechnik, GmbH, Kitzbuehel, Austria) mounted on the standard table of a CT scanner was used for all studies. For preclinical testing, eight vertebral bodies of dead swine were biopsied, trying to place the needle in the center of the vertebral body via a transpedicular access. For clinical evaluation, bone biopsies were taken in three different patients with ambiguous bone lesions. All biopsies were performed under general anesthesia, using a 12G bone biopsy needle., Results: The animal studies demonstrated that the biopsy needle could be placed accurately in the center of the vertebral body in all cases. No readjustment was necessary, the CT scans demonstrated an intrapedicular trajectory avoiding the spinal canal or the neural foramina. Subsequently, following the animal studies, all biopsies could be performed successfully. Needle placement was accurate without any need for readjustment. No complications occurred during the procedure., Conclusion: Using the iSYS 1.3 allows for accurate and simple stereotactic biopsies of bone lesions, avoiding the need for needle readjustment. The systems may offer even less experienced teams to take biopsies in regions which are difficult to access.

Purpose: The task of ultrasound-guided vessel cannulation can be technically difficult. Needle guides have been designed to facilitate vessel puncture. We aimed to identify and compare the learning curves of participants performing vessel puncture with conventional freehand (FH) and needle guide-assisted (NG) techniques., Methods: Thirty-six participants were randomly allocated to either the FH or the NG group. They were asked to consecutively perform as many as 30 vessel punctures on a simulated phantom model. Quantitative metrics (time taken and number of skin and posterior-wall punctures) were recorded and compared between the two groups. The cumulative sum and moving F-test statistical methods were used to delineate the learning curves., Results: There was a significantly lower rate of posterior-wall punctures in the NG group than in the FH group (15% versus 26%; p < 0.0001). Participants in the NG group also performed significantly fewer skin punctures than did those in the FH group (mean, 405 versus 515; p < 0.0001). Cumulative sum statistical method analysis showed that participants in the NG group surmounted the learning curve earlier (13 attempts; interquartile range, 10.3-17.0) than did those in the FH group (19 attempts; interquartile range, 15.0-27.5). The number of attempts to surmount the learning curve was significantly less for the FH group (7.2 versus 16 attempts; p = 0.007) when using the moving F-test., Conclusions: The NG puncture allows a greater number of trainees to cross the learning threshold and offers the advantages of fewer posterior-wall punctures and skin punctures. The use of NG puncture may result in a shorter path to proficiency, allowing trainees to attempt needle puncture earlier and with a greater degree of safety., (© 2015 Wiley Periodicals, Inc.)

Introduction: Training residents to perform a PCNL puncture is hampered by the non-availability of a good inanimate model that can be used for demonstration and practice. The ethics of surgical training during actual surgeries is being questioned and the role of simulation is increasingly important. Virtual reality trainers, however, are prohibitively expensive and the use of animal models is fraught with regulatory and ethical concerns. We have devised a model that can be used to teach the concept of depth perception during a PCNL puncture., Methods: A bottle gourd was used to mimic the posterior abdominal wall. Cotton pledgets dipped in intravenous contrast were fitted into 4 mm holes made at staggered levels in the bottle gourd which was strapped onto the operating table with the cotton pledgets facing away from the surgeon. Surgeons with varying degrees of experience made fluoroscopy-guided punctures onto the cotton pledgets. We recorded the time taken for puncture in seconds and the distance of the needle exit site from the center of the cotton ball. Speed was measured by recording the fluoroscopy time in seconds on the C-arm. Accuracy was documented by using a Vernier caliper to measure the distance from the edge of the target to the actual puncture. One second of fluoroscopy time and 0.1 mm distance were each given one point. The total points accumulated over a set of 10 punctures was added to give a total score. Longer fluoroscopy times and inaccurate punctures resulted in higher scores., Results: A surgeon with more than 1000 PCNLs to his credit had a score of 99. The average score of five residents was 555., Conclusion: The bottle gourd model provides an ethically acceptable, inexpensive, easy to replicate model that can be used to train residents in the PCNL puncture.

Traditionally, treatment of renal lesions is indicated based only on imaging features. Although controversy exists about tissue sampling from small renal masses, renal biopsy is indicated in some cases. In this review, we discuss the rationale for endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and summarize the recent advances in this field, providing recommendations for the practicing clinician. The use of EUS-FNA appears to be a safe and feasible means of confirming or excluding malignancy. EUS allows assessment and biopsy of masses or lesions within both kidneys and related complications are rare. The main advantages of EUS-FNA are that it can be done as an outpatient procedure, with good results, minimal morbidity and a short hospital stay. Nevertheless, EUS-FNA of renal masses should be indicated only in selected cases, in which there is potential to decrease unnecessary treatment of small renal masses and to best select tumors for active surveillance and minimally invasive ablative therapies. Additionally, some renal lesions may be ineligible for EUS-guided biopsy because of anatomical limitations. EUS-FNA renal biopsy will probably be best applied to central anterior renal masses, while tumors on the posterior aspect of the kidney, percutaneous access will probably be superior.

Purpose: to evaluate the short and long term effectiveness of ultrasonography (US)-guided percutaneous needle lavage in calcific tendinopathy of the rotator cuff. To study the evolution of the size of calcifications and pain in the two years after treatment., Methods: a 2 year longitudinal prospective study is carried out after applying the UGPL technique on a number of patients diagnosed with calcific tendinitis of the rotator cuff. Clinical, ultrasound and radiology follow-up controls were performed, 3 months, 6 months, one year and two years after the treatment. The Visual Analog Scale (VAS) was used to assess the pain. The degree and point of pain is selected on a 10cm line, arranged horizontally or vertically. The "0" represents no pain and "10" represents worst pain. The population studied was made up of 121 patients that required our service as a result of suffering from a painful shoulder., Results: the pain (VAS) and the size of the calcification significantly decreased with the application of the technique (p< 0,001 in both cases) and regardless of the sex (p: 0.384 for pain and p: 0.578 for the size of the calcification). This occurred from the first check-up (3 months) and was maintained for two year., Conclusion: we consider this technique to be a valid alternative as a first-choice treatment of calcific tendinitis of the shoulder. The intervention is simple, cost-effective, does not require hospitalization, involves no complications, rehabilitation treatment is not required and it shows very few side effects without sequelae, significantly reducing the size of the calcification and pain in the majority of patients.

Pneumomediastinum is a condition in which air is present in the mediastinum. This condition can result from physical trauma or other situations that lead to air escaping from the lungs, airways or bowel into the chest cavity. Pneumomediastinum is a rare situation and occurs when air leaks into the mediastinum. The diagnosis can be confirmed via chest X-ray or CT scanning of the thorax. The main symptom is usually severe central chest pain. Other symptoms include laboured breathing, voice distortion (as with helium) and subcutaneous emphysema, specifically affecting the face, neck, and chest. Pneumomediastinum can also be characterized by the shortness of breath that is typical of a respiratory system problem. It is often recognized on auscultation by a "crunching" sound timed with the cardiac cycle (Hamman's crunch). Pnemomediastinum may also present with symptoms mimicking cardiac tamponade as a result of the increased intrapulmonary pressure on venous flow to the heart. The tissues in the mediastinum will slowly resorb the air in the cavity so most pneumomediastinums are treated conservatively.

Background: Arterial puncture can be a painful procedure for many patients. This study investigates whether precooling of a puncture site with ice can reduce the pain associated with arterial puncture., Methods: This was a stratified randomized controlled trial of a convenience sample of out-patients with a physician order for an arterial blood gas (ABG) test. The intervention group had a plastic bag of ice applied to their wrists for 3 min before drawing an ABG sample from the radial artery. The control group had an ABG sample drawn from the radial artery without the application of ice. Pain from the arterial puncture was measured with a 100-mm visual analog scale., Results: Subjects pretreated with ice reported less pain from arterial puncture compared with subjects in the control group (mean visual analog scale 13.8 ± 16.9 vs 25 ± 23 mm, P = .01; median visual analog scale 7 mm, interquartile range (IQR) 1.5-19 vs 20 mm, IQR 4.5-38.5 mm, P = .01). Stratified analysis showed that visual analog scale pain scores were lower in the naive group when ice was applied (naive ice vs naive control: mean visual analog scale 11 ± 14.3 vs 26.5 ± 25 mm, P = .02; median visual analog scale 5 mm, IQR 2-14.5 vs 20 mm, IQR 6.5-36 mm, P = .02). Visual analog scale pain scores trended lower in the experienced group when ice was applied (experienced ice vs experienced control: mean visual analog scale 15.9 ± 18.9 vs 25.1 ± 22 mm, P = .15; median visual analog scale 8 mm, IQR 0.5-26.5 vs 23 mm, IQR 3.5-40 mm, P = .08). There was no difference in first-attempt success between groups (ice group: 85%, control group: 82.5%, P > .99). Only 3 subjects could not tolerate 3-min ice application., Conclusions: Ice application before arterial puncture is well tolerated and reduces procedure-related pain. (ClinicalTrials.gov NCT02065115)., (Copyright © 2015 by Daedalus Enterprises.)

Background Context: Many diseases can cause acute neck pain in elderly individuals. We conducted the present prospective study based on the hypothesis that arthritis of the lateral atlantoaxial joint may be involved in acute neck pain in elderly patients with limited neck rotation., Purpose: To clarify whether the lateral atlantoaxial joint is involved in acute neck pain among elderly individuals by conducting lateral atlantoaxial joint puncture., Study Design: A prospective study., Patient Sample: Twenty-seven patients (13 men, 14 women) aged 50 years or more who provided consent for atlantoaxial joint puncture met the following four inclusion criteria: acute neck pain with limited cervical rotation of less than 20° as the chief complaint; visual analog scale pain score of 70 mm or more at initial visit; tenderness in the paraspinal muscle of upper cervical vertebrae; and serum C-reactive protein level of 0.5 mg/dl or more., Outcome Measures: Visual analog scale pain score and radiologic findings., Methods: Patients underwent puncture of the lateral atlantoaxial joint and were evaluated clinically and radiologically., Results: Computed tomography obtained before puncture showed calcification of the transverse ligament of the atlas in the posterior dens in 22 patients (81.5%), calcification in the longus colli in 2 patients (7.4%), and no calcification in 3 patients (11.1%). Of 27 patients who underwent lateral atlantoaxial joint puncture, joint fluid was collected from 16 patients (59.3%) and calcium pyrophosphate dihydrate crystals were identified in 10 patients (62.5%). For the entire patient population, mean VAS score before puncture was 81.9±16.3 mm, significantly improving to 35.6±24.4 mm by 30 minutes after puncture (p<.001)., Conclusions: The results of this study suggest that crystal-induced arthritis (pseudogout) of the lateral atlantoaxial joint may be closely involved with acute neck pain in the elderly., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: to evaluate the short and long term effectiveness of ultrasonography (US)-guided percutaneous needle lavage in calcific tendinopathy of the rotator cuff. To study the evolution of the size of calcifications and pain in the two years after treatment., Study Design: A 2 year longitudinal prospective study is carried out after applying the UGPL technique on a number of patients diagnosed with calcific tendinitis of the rotator cuff. Clinical, ultrasound and radiology follow-up controls were performed, 3 months, 6 months, one year and two years after the treatment. The Visual Analog Scale (VAS) was used to assess the pain. The degree and point of pain is selected on a 10 cm line, arranged horizontally or vertically. The "0" represents no pain and "10" represents worst pain. The population studied was made up of 121 patients that required our service as a result of suffering from a painful shoulder., Results: the pain (VAS) and the size of the calcification significantly decreased with the application of the technique (p< 0,001 in both cases) and regardless of the sex (p: 0.384 for pain and p: 0.578 for the size of the calcification). This occurred from the first check-up (3 months) and was maintained for two year., Conclusions: we consider this technique to be a valid alternative as a first-choice treatment of calcific tendinitis of the shoulder. The intervention is simple, cost-effective, does not require hospitalization, involves no complications, rehabilitation treatment is not required and it shows very few side effects without sequelae, significantly reducing the size of the calcification and pain in the majority of patients.

Background Context: Degenerative disc disease is a common pathologic disorder accompanied by both structural and biochemical changes. Changes in stress distribution across the disc can lead to annulus fibrosus (AF) damage that can affect the strength and integrity of the disc. Given that some present degeneration therapies incorporate biological regrowth of the nucleus pulposus (NP), it is crucial that the AF remains capable of containing this newly grown material., Purpose: To examine the resistance of AF to delamination using an adhesive peel test in experimentally degenerated rabbit discs., Study Design: Experimentally induced disc degeneration; excised AF tissue study., Methods: Disc degeneration was induced in eight New Zealand white rabbits by annular puncture; four additional rabbits served as controls. In experimental rabbits, an 18-gauge needle was inserted into the anterolateral AF region of levels L2-L3 and L4-L5, and disc height was monitored by X-ray. Animals were sacrificed at 4 and 12 weeks postsurgery and magnetic resonance images and X-rays were taken. Four discs were excised from the experimental animals; two punctured (L2-L3 and L4-L5) and two controls (L3-L4 and L6-L7). The same four discs were also excised from the age-matched control animals and served as nonpunctured control discs. To determine resistance to delamination, AF samples were dissected from each disc and subjected to a mechanical peel test at 0.5 mm/s., Results: Magnetic resonance imaging and X-ray images confirmed dehydration of the NP and reduced disc height, similar to that found in clinical degeneration. Resistance to delamination was significantly lower in punctured/degenerated discs compared with both the nonpunctured discs from the same animal (27% lower) and the nonpunctured control discs (30% lower) (p=.024)., Conclusions: The findings of this study suggest that degeneration increases the potential for delamination between AF layers. Given this substantial change to the integrity of the AF after degeneration, clinical treatments should not only target rehydration or regrowth of the NP, but should also target repair and strengthening of the AF to confine the NP., (Copyright © 2014 Elsevier Inc. All rights reserved.)

It is an ongoing interdisciplinary pursuit to identify the factors shaping the emergence and maintenance of tool technology. Field studies of several primate taxa have shown that tool using behaviors vary within and between populations. While similarity in tools over spatial and temporal scales may be the product of socially learned skills, it may also reflect adoption of convergent strategies that are tailored to specific prey features. Much has been claimed about regional variation in chimpanzee tool use, with little attention to the ecological circumstances that may have shaped such differences. This study examines chimpanzee tool use in termite gathering to evaluate the extent to which the behavior of insect prey may dictate chimpanzee technology. More specifically, we conducted a systematic comparison of chimpanzee tool use and termite prey between the Goualougo Triangle in the Republic of Congo and the La Belgique research site in southeast Cameroon. Apes at both of these sites are known to use tool sets to gather several species of termites. We collected insect specimens and measured the characteristics of their nests. Associated chimpanzee tool assemblages were documented at both sites and video recordings were conducted in the Goualougo Triangle. Although Macrotermitinae assemblages were identical, we found differences in the tools used to gather these termites. Based on measurements of the chimpanzee tools and termite nests at each site, we concluded that some characteristics of chimpanzee tools were directly related to termite nest structure. While there is a certain degree of uniformity within approaches to particular tool tasks across the species range, some aspects of regional variation in hominoid technology are likely adaptations to subtle environmental differences between populations or groups. Such microecological differences between sites do not negate the possibility of cultural transmission, as social learning may be required to transmit specific behaviors among individuals., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Ascites, in 20% of cases, is not linked to liver cirrhosis. The pathophysiology is most often different. The understanding of these pathophysiological mechanisms can lead to etiologic diagnosis. The diagnostic approach is mainly based on the biological study of ascites, especially protein concentration and albumin gradient between serum and ascites. In Western countries, tumors and heart diseases are the predominant causes, while developing countries are mainly concerned by infectious diseases, among which tuberculosis is the leading cause. Other uncommon causes must be recognized, as ascites may be the presenting feature of the disease. Their knowledge will facilitate the therapeutic approach., (Copyright © 2013 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Background and Objectives: Cystic pancreatic lesions are a growing diagnostic challenge. The aim of this study was to proof a new diagnostic concept based on contrast-enhanced endoscopic ultrasound (CE-EUS) for differential diagnosis., Patients and Methods: A total of 125 patients with unclear cystic pancreatic lesions were included. The initial diagnostic was made by CE-EUS dividing the lesions in a group without contrast enhancing effect in the cystic wall, septae or nodule indicating pseudocysts or dysontogenetic cysts and a group with contrast enhancing effect in the described structures indicating cystic neoplasias. The investigations were performed using a Pentax echoendoscope and Hitachi Preirus ultrasound machine. The contrast enhancer used was 4.8 mL SonoVue(®) (Bracco, Italy). The group with suspected cystic neoplasia was referred for endoscopic fine-needle puncture for further diagnostic or treatment decisions., Results: The dividing of the groups by contrast-enhanced ultrasound was feasible because all (n = 56) suspected cystic neoplasias showed a contrast enhancing effect, whereas in only 4 from 69 pseudocystic or dysontogenetic cystic lesions a contrast enhancing effect in the wall could be observed. Endoscopic fine-needle puncture could diagnose all malignant neoplasias and relevant premalignant conditions. The long-term follow-up did not show any development of malignant cystic lesions., Conclusion: Using CE-EUS and endoscopic fine-needle puncture as diagnostic criteria seemed to be a feasible method to deal with different cystic lesions in daily practice.

The purpose of this study was to evaluate a motorized microneedle device in delivery of DNA into skin for gene expression. A plasmid DNA encoding both luciferase (Luc) and enhanced green fluorescent protein (EGFP) was delivered into rat skin by puncturing the skin with the microneedle device. Puncturing rat skin with a pre-applied DNA solution on the skin showed much higher luciferase gene expression than that with the procedure of puncturing the skin first then applied the DNA solution. The microneedle puncturing method was more efficient than intradermal injection method in generating high gene expression in the skin. There was no significant difference in the skin gene expression when rat skin was punctured with the microneedle device of different microneedle lengths (0.25 mm, 0.5mm or 0.75 mm). On the other hand, there was a significant difference in the skin gene expression between the short (10s) and the long puncturing durations (30 or 60s), with longer puncturing duration showed higher gene expression. Puncturing the skin with longer needles (0.75 mm) caused some skin damage, while puncturing the skin with shorter microneedle length (0.25 mm) caused only minimal skin damage. The EGFP gene expression was observed predominately in the epidermis layer of the skin from the puncturing method in delivery of DNA into the skin. In summary, the motorized microneedle device could have great potential in skin gene delivery., (Copyright © 2013 Elsevier B.V. All rights reserved.)