Microbiopsy engineered for minimally invasive and suture-free sub-millimetre skin sampling

We describe the development of a sub-millimetre skin punch biopsy device for minimally invasive and suture-free skin sampling for molecular diagnosis and research. Conventional skin punch biopsies range from 2-4 mm in diameter. Local anaesthesia is required and sutures are usually used to close the wound. Our microbiopsy is 0.50 mm wide and 0.20 mm thick. The microbiopsy device is fabricated from three stacked medical grade stainless steel plates tapered to a point and contains a chamber within the centre plate to collect the skin sample. We observed that the application of this device resulted in a 0.21 ± 0.04 mm wide puncture site in volunteer skin using reflectance confocal microscopy. Histological sections from microbiopsied skin revealed 0.22 ± 0.12 mm wide and 0.26 ± 0.09 mm deep puncture sites. Longitudinal observation in microbiopsied volunteers showed that the wound closed within 1 day and was not visible after 7 days. Reflectance confocal microscope images from these same sites showed the formation of a tiny crust that resolved by 3 weeks and was completely undetectable by the naked eye. The design parameters of the device were optimised for molecular analysis using sampled DNA mass as the primary end point in volunteer studies. Finally, total RNA was characterized. The optimised device extracted 5.9 ± 3.4 ng DNA and 9.0 ± 10.1 ng RNA. We foresee that minimally invasive molecular sampling will play an increasingly significant role in diagnostic dermatology and skin research.

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Microbiopsy engineered for minimally invasive and suture-free sub-millimetre skin sampling

F1000Research ◽

10.12688/f1000research.2-120.v1 ◽

2013 ◽

Vol 2 ◽

pp. 120 ◽

Cited By ~ 2

Author(s):

Lynlee L Lin ◽

Tarl W Prow ◽

Anthony P Raphael ◽

Robert L Harrold III ◽

Clare A Primiero ◽

...

Keyword(s):

Minimally Invasive ◽

Punch Biopsy ◽

Steel Plates ◽

Design Parameters ◽

Puncture Site ◽

Skin Sample ◽

Naked Eye ◽

Skin Punch Biopsy ◽

Microscope Images ◽

Biopsy Device

We describe the development of a sub-millimetre skin punch biopsy device for painless and suture-free skin sampling for molecular diagnosis and research. Conventional skin punch biopsies range from 2-4 mm in diameter. Local anaesthesia is required and sutures are usually used to close the wound. Our microbiopsy is 0.50 mm wide and 0.20 mm thick. The microbiopsy device is fabricated from three stacked medical grade stainless steel plates tapered to a point and contains a chamber within the centre plate to collect the skin sample. We observed that the application of this device resulted in a 0.21 ± 0.04 mm wide puncture site in volunteer skin using reflectance confocal microscopy. Histological sections from microbiopsied skin revealed 0.22 ± 0.12 mm wide and 0.26 ± 0.09 mm deep puncture sites. Longitudinal observation in microbiopsied volunteers showed that the wound closed within 1 day and was not visible after 7 days. Reflectance confocal microscope images from these same sites showed the formation of a tiny crust that resolved by 3 weeks and was completely undetectable by the naked eye. The design parameters of the device were optimised for molecular analysis using sampled DNA mass as the primary end point in volunteer studies. Finally, total RNA was characterized. The optimised device extracted 5.9 ± 3.4 ng DNA and 9.0 ± 10.1 ng RNA. We foresee that minimally invasive molecular sampling will play an increasingly significant role in diagnostic dermatology and skin research.

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Diagnosing small fiber neuropathy in clinical practice: a deep phenotyping study

Therapeutic Advances in Neurological Disorders ◽

10.1177/17562864211004318 ◽

2021 ◽

Vol 14 ◽

pp. 175628642110043

Author(s):

Nadine Egenolf ◽

Caren Meyer zu Altenschildesche ◽

Luisa Kreß ◽

Katja Eggermann ◽

Barbara Namer ◽

...

Keyword(s):

Neurological Examination ◽

Punch Biopsy ◽

Small Fiber Neuropathy ◽

Fiber Density ◽

Axon Reflex ◽

Small Fiber ◽

Corneal Confocal Microscopy ◽

Intraepidermal Nerve Fiber Density ◽

Number Of Patients ◽

Skin Punch Biopsy

Background and aims: Small fiber neuropathy (SFN) is increasingly suspected in patients with pain of uncertain origin, and making the diagnosis remains a challenge lacking a diagnostic gold standard. Methods: In this case–control study, we prospectively recruited 86 patients with a medical history and clinical phenotype suggestive of SFN. Patients underwent neurological examination, quantitative sensory testing (QST), and distal and proximal skin punch biopsy, and were tested for pain-associated gene loci. Fifty-five of these patients additionally underwent pain-related evoked potentials (PREP), corneal confocal microscopy (CCM), and a quantitative sudomotor axon reflex test (QSART). Results: Abnormal distal intraepidermal nerve fiber density (IENFD) (60/86, 70%) and neurological examination (53/86, 62%) most frequently reflected small fiber disease. Adding CCM and/or PREP further increased the number of patients with small fiber impairment to 47/55 (85%). Genetic testing revealed potentially pathogenic gene variants in 14/86 (16%) index patients. QST, QSART, and proximal IENFD were of lower impact. Conclusion: We propose to diagnose SFN primarily based on the results of neurological examination and distal IENFD, with more detailed phenotyping in specialized centers.

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Exploiting the instability of eccentric tube robots for distal force control in minimally invasive cardiac ablation

Proceedings of the Institution of Mechanical Engineers Part C Journal of Mechanical Engineering Science ◽

10.1177/09544062211007524 ◽

2021 ◽

pp. 095440622110075

Author(s):

Hessa Alfalahi ◽

Federico Renda ◽

Conor Messer ◽

Cesare Stefanini

Keyword(s):

Minimally Invasive ◽

Force Control ◽

Motion Tracking ◽

Heart Surgery ◽

Compliant Mechanism ◽

Heart Rhythm ◽

Disease Recurrence ◽

Optimal Level ◽

Design Parameters ◽

Cardiac Ablation

While the dilemma of motion tracking and force control in beating-heart surgery is previously addressed using active control architectures and rigid robotic actuators, this work leverages the highly controllable mechanical properties of concentric tube robots for intelligent, design-based force control in minimally invasive cardiac ablation. Briefly, cardiac ablation is the conventional procedure for treating arrhythmia patients, by which exposing the diseased cardiac tissue to Radio-Frequency (RF) energy restores the normal heart rhythm. Yet, the procedure suffers low success rate due to the inability of existing flexible catheters to maintain a consistent, optimal contact force between the tip electrode and the tissue, imposing the need for future repeat surgeries upon disease recurrence. The novelty of our work lies in the development of a statically-balanced compliant mechanism composed of (1) distal bi-stable concentric tubes and (2) a compliant, torsional spring mechanism that provides torque at tubes proximal extremity, resulting in an energy-free catheter with a zero-stiffness tip. This catheter is expected to maintain surgical efficacy and safety despite the chaotic displacement of the heart, by naturally keeping the tip force at an optimal level, not less and not more than the surgical requirement. The presented experimental results of the physical prototype, reflect the feasibility of the proposed design, as well as the robustness of the formulated catheter mathematical models which were uniquely deployed in the selection of the optimal design parameters.

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Vulvar Skin Punch Biopsy

Primary Care Procedures in Women's Health ◽

10.1007/978-3-030-28884-6_21 ◽

2019 ◽

pp. 257-265

Author(s):

Matthew L. Picone

Keyword(s):

Punch Biopsy ◽

Skin Punch Biopsy

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Lupus vulgaris mimicking cutaneous leishmaniasis: A case report

Our Dermatology Online ◽

10.7241/ourd.20221.12 ◽

2022 ◽

Vol 13 (1) ◽

pp. 53-56

Author(s):

Nouf Faihan Bin Rubaian ◽

Haya Fahad Alzamami ◽

Gadah Abdulatif Alhosawi ◽

Leena Abdulrahman Almuhaish

Keyword(s):

Delayed Diagnosis ◽

Punch Biopsy ◽

Lupus Vulgaris ◽

Cutaneous Tuberculosis ◽

Dorsal Aspect ◽

Skin Punch Biopsy ◽

Diagnostic Difficulties ◽

Anti Tubercular Therapy ◽

The Right ◽

Saudi Male

Lupus vulgaris (LV) is a progressive, chronic form of cutaneous tuberculosis (CTB). The head and neck regions are the most commonly affected sites, followed by the arms and legs. Occurring in unusual sites may pose diagnostic difficulties. Herein, we report a case of LV present on the dorsal aspect of the right hand in a twenty-year-old Saudi male. It was misdiagnosed as leishmaniasis as the patient lived in an area in which it was endemic, and was treated accordingly with no benefit. A skin punch biopsy was taken and the diagnosis of LV was confirmed. The lesion responded well to anti-tubercular therapy (ATT), yet healed with atrophic scarring. Although rare, clinicians must be aware of the importance of considering CTB as an important differential, as misdiagnosis or delayed diagnosis of this entity may eventually cause prolonged morbidity.

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Darier White disease

Nepal Journal of Dermatology Venereology & Leprology ◽

10.3126/njdvl.v9i1.5770 ◽

1970 ◽

Vol 9 (1) ◽

pp. 34-36

Author(s):

A Amatya ◽

D Karn ◽

E Aryal ◽

R Makaju ◽

A Shakya ◽

...

Keyword(s):

Punch Biopsy ◽

Darier’S Disease ◽

Darier's Disease ◽

Skin Punch Biopsy ◽

The World ◽

The Given

Darier’s disease was described inependently by Darier and White in 1989 AD. Reported prevalence varies from 1/100,000 in Denmark to 1 in 30- 35,000 in northern England and Scotland.1 Darier’s disease has been reported from other parts of the world, however,there has been no reported cases in Nepal. It is an inherited autosomal dominat disease characterized by dark crusty lesions over the seborrheic areas of the skin. We are reporting a case of Darier’s disease in a Nepalese patient who developed skin leison’s over his face and body at the age of 12 years. We took skin punch biopsy from the leisons, which showed findings suggestive of Darier’s disease. Our case was treated with isotrerenoin and topical keratolytics. He responded with the given treatment within two weeks of therapy. DOI: http://dx.doi.org/10.3126/njdvl.v9i1.5770 NJDVL 2010; 9(1): 34-36

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Case Report: Borrelia-DNA Revealed the Cause of Arthritis and Dermatitis During Treatment With Rituximab

Frontiers in Neurology ◽

10.3389/fneur.2021.645298 ◽

2021 ◽

Vol 12 ◽

Author(s):

Johanna Sjöwall ◽

Georgios Xirotagaros ◽

Chris D. Anderson ◽

Christopher Sjöwall ◽

Charlotte Dahle

Keyword(s):

Bacterial Genome ◽

Punch Biopsy ◽

Calcium Pyrophosphate ◽

Young Female ◽

Monosodium Urate ◽

Patient History ◽

Skin Punch Biopsy ◽

The Right ◽

Antibody Levels ◽

Urate Crystals

Borrelia-specific antibodies in serum did not contribute to the diagnosis of Borrelia arthritis or Borrelia-associated dermatitis in a young woman with ongoing treatment with rituximab due to multiple sclerosis. The diagnosis was confirmed by the detection of Borrelia-DNA in a skin punch biopsy. The patient history did not reveal any tick exposure. She had suffered for several months from fluctuating pain and swelling of the right knee as well as skin involvement with redness and oedema around the ankle of the same leg. Monoarthritis was confirmed by a rheumatologist. Knee puncture was performed but the synovial fluid was only sufficient for microscopic examination of crystals. Neither monosodium urate crystals nor calcium pyrophosphate crystals were found. Borrelia serology in blood revealed borderline levels of immunoglobulin (Ig)M and IgG, respectively. Treatment with doxycycline resulted in resolution of the joint and skin manifestations within a month. This case highlights that Borrelia-specific antibody levels cannot be reliably interpreted in patients who have received B-cell depleting therapy. Under these circumstances, detection of the bacterial genome in different body fluids, such as in the skin, can be a useful complement to the diagnosis of Lyme disease. In this young female, the diagnosis would certainly have been further delayed without the detection of Borrelia-DNA in the skin.

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Minimally invasive diagnosis of vulvar disease using punch biopsy

Akusherstvo i ginekologiia ◽

10.18565/aig.2020.8.141-148 ◽

2020 ◽

Vol 8_2020 ◽

pp. 141-148

Author(s):

Apolikhina I.A. Apolikhina ◽

Sokolova A.V. Sokolova ◽

Musaeva A.K. Musaeva ◽

Zaitsev N.V. Zaitsev ◽

◽

...

Keyword(s):

Minimally Invasive ◽

Punch Biopsy ◽

Vulvar Disease

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Culture-Confirmed Reinfection of a Person with Different Strains of Borrelia burgdorferi Sensu Stricto

Journal of Clinical Microbiology ◽

10.1128/jcm.36.4.1015-1019.1998 ◽

1998 ◽

Vol 36 (4) ◽

pp. 1015-1019 ◽

Cited By ~ 11

Author(s):

William T. Golde ◽

Barbara Robinson-Dunn ◽

Mary Grace Stobierski ◽

Daniel Dykhuizen ◽

Ing-Nang Wang ◽

...

Keyword(s):

Borrelia Burgdorferi ◽

Profile Analysis ◽

Protein Profile ◽

Erythema Migrans ◽

Diagnostic Testing ◽

Serum Antibody ◽

Surface Protein ◽

Punch Biopsy ◽

Skin Punch Biopsy ◽

Different Strains

In recent years, the utility of serum-based diagnostic testing for Lyme disease has improved substantially; however, recovery by culture of the bacterium from skin biopsies of suspected patients is still the only definitive laboratory test. Reinfection of patients has been assumed to occur but as yet has not been documented by serial isolates from the same person. We present a case of culture-confirmed reinfection of a patient in Menominee County, Michigan. Borrelia burgdorferi was isolated from the skin punch biopsy specimens during each episode of erythema migrans (EM) and was subjected to molecular strain typing, genetic analysis of two outer surface protein genes, protein profile analysis, and serum antibody response testing. Results show that these isolates are distinct strains of the bacterium and that the two episodes of EM were caused by independent infections. This report describes the documented, culture-confirmed reinfection of a human by two different strains of B. burgdorferi.

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