Objective To develop a novel electric stapler, so as to improve the automation, convenience and precision of minimally invasive surgery. Methods The clamping, firing and turning mechanism of the new electric stapler was innovatively designed to realize the electric drive of minimally invasive surgical anastomosis on the basis of traditional mechanical stapler. The motion process of electric clamping, firing and double-screw turning mechanism was analyzed in detail, and the equations for motion function of three mechanisms were solved, providing a theoretical basis for the intelligent control algorithm of electric stapler. Results The electric clamping and firing process was simulated using ADAMS software to verify the equation of motion. The prototype of the new electric stapler was made, and the anastomosis experiment and blasting pressure experiment of the in vitro small intestine tissues were carried out. The range of anastomotic blasting pressure was between 3.7 kPa and 11.67 kPa, meeting the basic requirements in clinic. Conclusions The structure of the new electric stapler can meet the requirements of electric pressing and firing in minimally invasive surgery, contributing to achieve tissue anastomosis more conveniently, quickly and effectively.

Objective To develop a new type of electric stapler, so as to solve the problems of insufficient rotation angle, inconvenient operation and difficulty in controlling the pressing strength of existing products. Methods An electric stapler was designed and manufactured. The motion trajectory curve of the prototype was measured by using the three-coordinate imaging instrument to build functional test platform of the prototype, and the goodness of fit was used to evaluate consistency between the theoretical curve and the measured curve. The small intestine tissues of fresh pig were anastomosed at different bending angles of the front end, and the forming rate of the anastomotic stoma was measured. Results The goodness of fit between the test curve and the theoretical curve for both turning motion and shooting motion was ideal, while the goodness of fit between the test curve and the theoretical curve for pressing motion was not ideal when the turning joint was bent at 0°-30°, and was ideal when it was bent at 45°-60°. In performance test, the deformity rate of the nail was smaller than 1.14%, indicating that the bending angle had no significant impacts on the anastomotic effect. Conclusions The kinematics curves of shooting motion and turning motion are consistent with the theoretical curves. The pressing motion curves fluctuate at different bending angles, which will not affect the anastomotic effect, and the effect of the electric stapler meets the clinical requirements.

Objective To design a notched flexible articulation applied to electric stapler and study its turning performance. Methods The notched flexible articulation was designed and modeled. The kinematics and statics models of the articulation were established for simulation calculations. The stress, deflection angle, top displacement and driving force of the articulation with 3 different turning structures were studied under equal and variable stiffness of symmetrical notches by using finite element simulation. An experimental platform for performance test of the turning structure was built to verify the simulation results and the model. Results The theoretical model of the turning structure in bending process was basically consistent with the experimental results. With the optimization of symmetrical notch stiffness, the maximum stress of the articulation with variable stiffness was reduced by 20.64% and 39.20%, respectively. The articulation with variable stiffness required the smallest tensile force during bending, which was 33.41% lower than that of the articulation with equal stiffness, and the tip displacement (30.8 mm) along the bending plane was the smallest. The maximum deflection angle for the articulation with 3 different turning structures all could reach 90°. Conclusions The kinematics and statics models of the articulation can be used for the calculation of its tensile force and position changes. The turning performance of the articulation with variable stiffness using symmetrical notch is better than that with equal stiffness. The notched flexible articulation meets the design requirements and the turning needs of electric stapler.

Nowadays potential preclinical drugs for the treatment of nonalcoholic steatohepatitis (NASH) have failed to achieve expected therapeutic efficacy because the pathogenic mechanisms are underestimated. Inactive rhomboid protein 2 (IRHOM2), a promising target for treatment of inflammation-related diseases, contributes to deregulated hepatocyte metabolism-associated nonalcoholic steatohepatitis (NASH) progression. However, the molecular mechanism underlying Irhom2 regulation is still not completely understood. In this work, we identify the ubiquitin-specific protease 13 (USP13) as a critical and novel endogenous blocker of IRHOM2, and we also indicate that USP13 is an IRHOM2-interacting protein that catalyzes deubiquitination of Irhom2 in hepatocytes. Hepatocyte-specific loss of the Usp13 disrupts liver metabolic homeostasis, followed by glycometabolic disorder, lipid deposition, increased inflammation, and markedly promotes NASH development. Conversely, transgenic mice with Usp13 overexpression, lentivirus (LV)- or adeno-associated virus (AAV)-driven Usp13 gene therapeutics mitigates NASH in 3 models of rodent. Mechanistically, in response to metabolic stresses, USP13 directly interacts with IRHOM2 and removes its K63-linked ubiquitination induced by ubiquitin-conjugating enzyme E2N (UBC13), a ubiquitin E2 conjugating enzyme, and thus prevents its activation of downstream cascade pathway. USP13 is a potential treatment target for NASH therapy by targeting the Irhom2 signaling pathway.