Implications of carbon catabolite repression for Aspergillus-based cell factories: A review.

Carbon catabolite repression (CCR) is a global regulatory mechanism that allows organisms to preferentially utilize a preferred carbon source (usually glucose) by suppressing the expression of genes associated with the utilization of nonpreferred carbon sources. Aspergillus is a large genus of filamentous fungi, some species of which have been used as microbial cell factories for the production of organic acids, industrial enzymes, pharmaceuticals, and other fermented products due to their safety, substrate convenience, and well-established post-translational modifications. Many recent studies have verified that CCR-related genetic alterations can boost the yield of various carbohydrate-active enzymes (CAZymes), even under CCR conditions. Based on these findings, we emphasize that appropriate regulation of the CCR pathway, especially the expression of the key transcription factor CreA gene, has great potential for further expanding the application of Aspergillus cell factories to develop strains for industrial CAZymes production. Further, the genetically modified CCR strains (chassis hosts) can also be used for the production of other useful natural products and recombinant proteins, among others. We here review the regulatory mechanisms of CCR in Aspergillus and its direct application in enzyme production, as well as its potential application in organic acid and pharmaceutical production to illustrate the effects of CCR on Aspergillus cell factories.

Traumatic irreducible dislocation of the fifth metatarsophalangeal joint in pediatrics: case report and clinical experience.

Dislocation of the metatarsophalangeal joint (MTPJ) by trauma commonly occurs in adults. Most dislocations of the MTPJ could be reduced by closed reduction. However, isolated traumatic irreducible dislocation of the fifth MTPJ is an extremely rare injury, particularly in children. We report the case of a 10-year-old boy with irreducible dislocation of the fifth MTPJ who presented with a dorsiflexion injury of the right foot 1 year previously. Closed reduction was attempted but failed. Computed tomography showed the dorsolateral dislocation of the fifth MTPJ. We performed an open reduction and metatarsal bone osteotomy, with a short osteotomy at approximately 0.8 cm. The osteotomy was adjusted to a reduction of the MTPJ and fixation by a lock compression plate. The distal growth plate in the metatarsal bone was protected to avoid pre-closure of the growth plate. There were no instances of dislocation or signs of avascular necrosis of the head of the metatarsal bone. The results of this study demonstrated that open reduction and metatarsal bone osteotomy could be an optional treatment for irreducible dislocation of the fifth MTPJ in children. We should pay more attention to the distal growth plate in the metatarsal bone to avoid pre-closure of the growth plate.

A Review on the Cognitive Neural Mechanisms of Anaphor Processing During Language Comprehension.

Anaphora is an essential means of maintaining textual coherence, the phenomenon of replacing one word or phrase in the preceding part of a discourse with another. At least two crucial stages are involved in anaphor processing: bonding and resolution. The links between the anaphor and potential antecedents are established in the former stage, which would be evaluated and integrated into the latter stage. We reviewed relevant event-related potential (ERP) studies that examined the time course of anaphor processing and neural oscillation studies that explored energy changes in alpha, theta, and gamma frequency bands, which were associated with attention, working memory retrieval, and integration, respectively. The existing neuroimaging studies revealed the involvement of language processing networks and the Theory of Mind (ToM). Further research should explore the neural correlates and the effects of potential factors on anaphor processing, which could help gain a more comprehensive picture from multiple perspectives.

Cochlear implantation in a patient with congenital microtia, cochlear hypoplasia, venous anomalies of the temporal bone and laryngomalacia: Challenges and surgical considerations.

RATIONALE AND PATIENT CONCERNS: Congenital hearing loss is often caused by an inner ear malformation, in such cases, the presence of other anomalies, such as microtia, and venous anomalies of the temporal bone and laryngomalacia makes it challenging to perform cochlear implantation surgery. DIAGNOSES: This study reports the case of a 28-month-old girl with congenital profound hearing loss, laryngomalacia, and malformed inner ear, who received cochlear implantation surgery. The bony structure, vessels and nerves were first assessed through magnetic resonance imaging and computed tomography before exploring the genetic basis of the condition using trio-based whole exome sequencing. Perioperative evaluation and management of the airway was then performed by experienced anesthesiologist, with the surgical challenges as well as problems encountered fully evaluated. INTERVENTIONS: Cochlear implantation was eventually performed using a trans-mastoid approach under uneventful general anesthesia. OUTCOMES: Due to the small size of the cochlea, a short electrode FLEX24 was inserted through the cochleostomy. LESSONS: Considering the high risk of facial nerve injury and limited access to the cochlea when patients present significant bony and venous anomalies, cochlear implantation in such patients require careful preoperative evaluation and thoughtful planning. In these cases, airway assessment, magnetic resonance venography, magnetic resonance arteriography, and magnetic resonance imaging and computed tomography can be useful to minimize the risks. Intraoperative facial nerve monitoring is also recommended to assist in the safe location of facial nerve.

Neutralizing antibodies and T-cell responses to inactivated SARS-CoV-2 vaccine in COVID-19 convalescents one and a half years after infection.

Vaccines have been considered the most promising solution for ending the coronavirus disease 2019 (COVID-19) pandemic. Information regarding neutralizing antibodies (NAbs) and T-cell immune response in inactivated SARS-CoV-2 vaccine-immunized COVID-19 convalescent patients were either only available for a short time after illness recovered or not available at all (T-cell immunity). We evaluated SARS-CoV-2 NAbs and cellular immune responses to the SARS-CoV-2 inactivated vaccine in convalescent patients who recovered from infection for about one and a half years. We found that compared to before vaccination, SARS-CoV-2 NAbs and specific T-cell responses were significantly boosted by the inactivated vaccine in convalescent patients, which confirmed the pre-existing adaptive immunity in SARS-CoV-2 infected people. We observed that NAbs and IFN-γ-secreting T-cell response elicited by a single vaccine dose in subjects with prior COVID-19 infection were higher than after two doses of vaccine in SARS-CoV-2 naïve subjects. Both humoral and cellular immune responses elicited by one and two doses of inactivated vaccine were comparable in COVID-19-recovered persons. In conclusion, inactivated COVID-19 vaccine induced robust NAbs and T-cell responses to SARS-CoV-2 in COVID-19 convalescent patients and immune responses after one dose were equal to that after receiving two doses, which highlighted that robust humoral and cellular immune response can be reactivated by the inactivated vaccine in SARS-CoV-2 convalescent patients.

Cystic angiomatosis in children: clinical experience and review of literature.

BACKGROUND: Cystic angiomatosis is a rare benign disease manifesting as multiple lytic and sclerotic bone lesions, described as the proliferation of vascular and lymphatic channels lined by a single layer of endothelial cells. However, the potential pathogenetic mechanism of the disease still remains unknown. Here, we reported a case of cystic angiomatosis with multifocal bone lesion evaluated by whole exome sequencing. CASE DESCRIPTION: In this presentation, we reported a case of an 11-year-old boy with pain in his chest. Computed tomography (CT) revealed the multiple lytic of the bone in the ribs, clavicle, vertebra thoracalis, skull, mandibula, shoulder blade, etc. The blood test showed ALP to be 393U/L and VEGF to be 287.26 pg/ml. The patient was performed with an open biopsy in the ribs and was diagnosed with cystic angiomatosis. Besides, the whole exome sequencing reported the single-nucleotide substitutions in the coding region of BRIP1, CHEK2, GRM4, and MUC16. Then, the upregulated genes involved CASC15, CENPF, ABCA13, ALK, BLM, and FGFR3. CONCLUSIONS: In this article, we report a rare case of cystic angiomatosis in a child with abnormal VEGF and ALP reported by peripheral blood examination. The whole exome sequencing could provide the reference for the potential molecular mechanism in the diagnosis and treatment of cystic angiomatosis.

Influence of Confucianism and Taoism on self-construal and thinking style: an intervention study.

Using original texts of Confucian and Taoist primary classics as materials, we conducted an eight-week educational intervention experiment combining classroom teaching and post-class reflection as cultural manipulation. Ninety-four sixth-grade students from three parallel mainstream classes were randomly assigned to three intervention groups, comprising two experimental groups (Confucian and Taoist values interventions) and a control group (natural science intervention). The results suggest that the Confucian intervention had a positive effect on interdependent self and holistic thinking, the Taoist intervention had a positive effect on independent self and holistic thinking, and the natural science intervention promoted analytical thinking.

Unity of heaven and humanity: Mediating role of the relational-interdependent self in the relationship between Confucian values and holistic thinking.

As the primary value system in Chinese culture for almost 2,000 years, Confucianism has profoundly influenced the mindset of Chinese people. Cultural psychology studies have highlighted that individuals with different cultural backgrounds vary in their preferences for certain personality traits, such as self-construal, and their metacognitive characteristics, such as thinking modes. Compared with Western cultures, Chinese culture shows a preference for the interdependent self and holistic thinking. To investigate the relationship between the relational-interdependent self, holistic thinking, and traditional Chinese values (which are represented by Confucian values), we surveyed 327 Chinese adults using the Confucian Traditional Values Survey, Holistic Thinking Scale, and Relational-Interdependent Self-Construal Scale. The results show that Confucian values positively influence both holistic thinking and the relational-interdependent self, the latter of which partially mediates the positive relationship between Confucian values and holistic thinking. This study deepens the understanding of the psychological features of Chinese culture.

Neutralizing antibodies and cellular immune response after two doses of inactivated SARS-CoV-2 vaccine in China.

BACKGROUND: As of 2022, inactivated SARS-CoV-2 vaccines had been used in more than 91 countries. However, limited real world information was available on the immune responses of the inactivated SARS-CoV-2 vaccine. METHODS: We used SARS-CoV-2 pseudovirues to determine the neutralizing antibodies (NAbs) to wild type and several global variants and utilized enzyme-linked immunosorbent assay to investigate IFN-γ-secreting T-cell responses to SARS-CoV-2 among 240 vaccinated individuals after two doses of inactivated vaccine in China. RESULTS: A majority of the vaccinated (>90%) developed robust NAbs and T-cell responses to SARS-CoV-2 in the first two months after the second dose. After six months, only 37.0% and 44.0% of vaccinees had NAbs and T-cell immunity to SARS-CoV-2, respectively. Immune serum retained most of its neutralizing potency against the Alpha and Iota variants, but lost significant neutralizing potency against the Beta, Kappa, Delta, and Omicron variants. Only 40% of vaccine-sera retained low-level neutralization activities to Omicron, with a 14.7-fold decrease compared to the wild type. CONCLUSION: The inactivated SARS-CoV-2 vaccine stimulated robust NAbs and T-cell immune responses in the first two months after the second dose but the immune effect dropped rapidly, highlighing that a third dose or additional booster immunizations may be required to boost immunity against SARS-CoV-2.

CRISPR/Cas9-Based Genome Editing and Its Application in Aspergillus Species.

Aspergillus, a genus of filamentous fungi, is extensively distributed in nature and plays crucial roles in the decomposition of organic materials as an important environmental microorganism as well as in the traditional fermentation and food processing industries. Furthermore, due to their strong potential to secrete a large variety of hydrolytic enzymes and other natural products by manipulating gene expression and/or introducing new biosynthetic pathways, several Aspergillus species have been widely exploited as microbial cell factories. In recent years, with the development of next-generation genome sequencing technology and genetic engineering methods, the production and utilization of various homo-/heterologous-proteins and natural products in Aspergillus species have been well studied. As a newly developed genome editing technology, the clustered regularly interspaced short palindromic repeats/CRISPR-associated protein 9 (CRISPR/Cas9) system has been used to edit and modify genes in Aspergilli. So far, the CRISPR/Cas9-based approach has been widely employed to improve the efficiency of gene modification in the strain type Aspergillus nidulans and other industrially important and pathogenic Aspergillus species, including Aspergillus oryzae, Aspergillus niger, and Aspergillus fumigatus. This review highlights the current development of CRISPR/Cas9-based genome editing technology and its application in basic research and the production of recombination proteins and natural products in the Aspergillus species.

The comparison of the wisdom view in Chinese and Western cultures.

Wisdom views in different cultural contexts are closely connected with the corresponding culture's worldview. Some results are found by comparing the wisdom concepts in Chinese and Western cultures: Firstly, the early wisdom concepts, both in China and the West, contain the elements of intelligence and virtue. Whereas, from the Enlightenment to the Piagetian school, the western concept of wisdom has then shifted to the role of cognition and knowledge; By contrast, the traditional Chinese wisdom concept has been treating wisdom as a virtue. Modern Chinese and western wisdom psychologists are inclined to accept the wisdom meta-theory of "integration of intelligence and virtue". Secondly, both Chinese and the Western philosophy advocate using wisdom to solve real-life problems. Western thinkers focus on practical problems in the material world, i.e. reconciling conflicts between people and the world through understanding and changing the environment. However, Chinese philosophers focus on internal spiritual problems, i.e. improving the individual realm to solve the contradictions inside oneself. Thirdly, both China and the West highlight the comprehensive application of multiple thinking modes. While comparing with the west, which is excelled in using logical and analytical thinking modes and utilizing rational cognition, China is far better at using dialectical and holistic thinking modes and applying intuitive comprehension.

Krüppel-like factor 7 attenuates hippocampal neuronal injury after traumatic brain injury.

Our previous study has shown that the transcription factor Krüppel-like factor 7 (KLF7) promotes peripheral nerve regeneration and motor function recovery after spinal cord injury. KLF7 also participates in traumatic brain injury, but its regulatory mechanisms remain poorly understood. In the present study, an HT22 cell model of traumatic brain injury was established by stretch injury and oxygen-glucose deprivation. These cells were then transfected with an adeno-associated virus carrying KLF7 (AAV-KLF7). The results revealed that, after stretch injury and oxygen-glucose deprivation, KLF7 greatly reduced apoptosis, activated caspase-3 and lactate dehydrogenase, downregulated the expression of the apoptotic markers B-cell lymphoma 2 (Bcl-2)-associated X protein (Bax) and cleaved caspase-3, and increased the expression of ßIII-tubulin and the antiapoptotic marker Bcl-2. Furthermore, KLF7 overexpression upregulated Janus kinase 2 (JAK2) and signal transducer and activator of transcription 3 (STAT3) phosphorylation in HT22 cells treated by stretch injury and oxygen-glucose deprivation. Immunoprecipitation assays revealed that KLF7 directly participated in the phosphorylation of STAT3. In addition, treatment with AG490, a selective inhibitor of JAK2/STAT3, weakened the protective effects of KLF7. A mouse controlled cortical impact model of traumatic brain injury was then established. At 30 minutes before modeling, AAV-KLF7 was injected into the ipsilateral lateral ventricle. The protein and mRNA levels of KLF7 in the hippocampus were increased at 1 day after injury and recovered to normal levels at 3 days after injury. KLF7 reduced ipsilateral hippocampal atrophy, decreased the injured cortex volume, downregulated Bax and cleaved caspase-3 expression, and increased the number of 5-bromo-2'-deoxyuridine-positive neurons and Bcl-2 protein expression. Moreover, KLF7 transfection greatly enhanced the phosphorylation of JAK2 and STAT3 in the ipsilateral hippocampus. These results suggest that KLF7 may protect hippocampal neurons after traumatic brain injury through activation of the JAK2/STAT3 signaling pathway. The study was approved by the Institutional Review Board of Mudanjiang Medical University, China (approval No. mdjyxy-2018-0012) on March 6, 2018.

Efficacy and safety of induction chemotherapy with daunorubicin or idarubicin in the treatment of an adult with acute lymphoblastic leukemia.

BACKGROUND: Anthracyclines are dispensable components of chemotherapy of patients with acute lymphoblastic leukemia (ALL). OBJECTIVE: To analyze the efficacy and safety of induction with idarubicin (IDA) or liposoma daunorubicin (L-DNR) in treatment of adults with high-risk ALL (HR-ALL) (presence of mixed lineage leukemia gene [MLL] rearrangements, t[1;19], or prednisone poor response). METHODS: Among 58 enrolled patients, 29 cases were defined as the IDA group and the other 29 patients were put into the L-DNR group. Both overall survival (OS) and progression-free survival (PFS) were estimated and overall response rate (ORR) was compared between the groups. RESULTS: The L-DNR group's OS and PFS were insignificantly higher than in the IDA group (P=0.261 and P=0.247). Although not significantly different, the ORR of adults with HR-ALL receiving L-DNR regimens was also higher than in the IDA group (P=0.085). Comprehensive cytogenetic analysis revealed that patients harboring MLL rearrangement, E2A-PBX1, and P53 mutation had poorer prognosis than others. All 58 patients experienced hematologic response in this study; however, the length of hematologic response in the IDA group was significantly longer than in the L-DNR group (P=0.005). The incidence of bleeding and infection was without significant difference between the groups (both P>0.05). CONCLUSION: L-DNR proved to be an effective drug within a multiagent approach, which shows a favorable overall profile, as well as similar adverse events when compared with IDA in HR-ALL. Patients with E2A-PBX1 are much more sensitive to L-DNR than IDA. Despite some progress made, outcomes in MLL rearrangement or P53 mutation carriers remain unsatisfactory, and intensive treatment will be critical.

Application and progress of medical imaging in total mesopancreas excision for pancreatic head carcinoma.

Pancreatic head carcinoma (PHC) is one of the common gastrointestinal malignancies with a high morbidity and poor prognosis. At present, radical surgery is still the curative treatment for PHC. However, in clinical practice, the actual R0 resection rate, the local recurrence rate, and the prognosis of PHC are unsatisfactory. Therefore, the concept of total mesopancreas excision (TMpE) is proposed to achieve R0 resection. Although there have various controversies and discussions on the definition, the range of excision, and clinical prognosis of TMpE, the concept of TMpE can effectively increase the R0 resection rate, reduce the local recurrence rate, and improve the prognosis of PHC. Imaging is of importance in preoperative examination for PHC; however, traditional imaging assessment of PHC does not focus on mesopancreas. This review discusses the application of medical imaging in TMpE for PHC, to provide more accurate preoperative evaluation, range of excision, and more valuable postoperative follow-up evaluation for TMpE through imaging. It is believed that with further extensive research and exploratory application of TMpE for PHC, large-sample and multicenter studies will be realized, thus providing reliable evidence for imaging evaluation.

Neutralizing Antibodies and Cellular Immune Responses Against SARS-CoV-2 Sustained One and a Half Years After Natural Infection.

Background: COVID-19 has caused more than 2.6 billion infections and several million deaths since its outbreak 2 years ago. We know very little about the long-term cellular immune responses and the kinetics of neutralizing antibodies (NAbs) to SARS-CoV-2 because it has emerged only recently in the human population. Methods: We collected blood samples from individuals who were from the first wave of the COVID-19 epidemic in Wuhan between December 30, 2019, and February 24, 2020. We analyzed NAbs to SARS-CoV-2 using pseudoviruses and IgG antibodies to SARS-CoV-2 spike (S) and nucleocapsid (N) protein using enzyme-linked immunosorbent assay in patients' sera and determined SARS-CoV-2-specific T-cell responses of patients with ELISpot assays. Results: We found that 91.9% (57/62) and 88.9% (40/45) of COVID-19 patients had NAbs against SARS-CoV-2 in a year (10-11 months) and one and a half years (17-18 months), respectively, after the onset of illness, indicating that NAbs against SARS-CoV-2 waned slowly and possibly persisted over a long period time. Over 80% of patients had IgG antibodies to SARS-CoV-2 S and N protein one and a half years after illness onset. Most patients also had robust memory T-cell responses against SARS-CoV-2 one and a half years after the illness. Among the patients, 95.6% (43/45) had an IFN-γ-secreting T-cell response and 93.8% (15/16) had an IL-2-secreting T-cell response. The T-cell responses to SARS-CoV-2 were positively correlated with antibodies (including neutralizing antibodies and IgG antibodies to S and N protein) in COVID-19 patients. Eighty percent (4/5) of neutralizing antibody-negative patients also had SARS-CoV-2-specific T-cell response. After long-term infection, protective immunity was independent of disease severity, sex, and age. Conclusions: We concluded that SARS-CoV-2 infection elicited a robust and persistent neutralizing antibody and memory T-cell response in COVID-19 patients, indicating that these sustained immune responses, among most SARS-CoV-2-infected people, may play a crucial role in protection against reinfection.

The Taiji Model of Self II: Developing Self Models and Self-Cultivation Theories Based on the Chinese Cultural Traditions of Taoism and Buddhism.

Based on the construction of the "Taiji Model of Confucian Self" that aims to explain self-structure, the progression of self-cultivation and the dominion of person-making in the context of Chinese Confucian culture, according to the ideas of Taoism and Buddhism, the present study develops the "Taiji Model of Taoist Self" and the "Taiji Model of Buddhist Self" and identifies four realms of Taoist self-cultivation and five realms of Buddhist self-cultivation. In light of the Taiji Model of Taoist Self, self-structure can be divided into the soft self (the Yin part) and the hard self (the Yang part). The Taiji Model of Taoist Self splits the process of self-cultivation into four realms: suren (vulgarian), xianren (solon), shengren (saint), and zhenren (immortal). The Taiji Model of Buddhist Self splits self-structure into the dusty self (the Yin part) and the pure self (the Yang part) and divides the process of self-cultivation into five realms: Humans and Heaven, Arhat, Pratyekabuddha, Bodhisattva, and Buddha.

[Three-dimensional analysis of the mandible with impacted mandibular second molar].

OBJECTIVE: To study the developmental and morphological characteristics of the mandible in patients with impacted mandibular second molar and to predict the possible trend of mandibular development via three-dimensional (3D) measurement and analysis. METHODS: A total of 88 cases of impacted group and 88 cases of control group were screened out. 3D measurements were performed by using Mimics software. A total of 23 landmark points and 17 measurements were determined. The measurements were analyzed by t-test. RESULTS: The mandible length, the space between the first molars, the space between mandibular angles, and the width between the first molars in the impacted group were lower than those in the control group (P<0.05). Moreover, the value of the submandibular angle was higher than that in the control group (P<0.05). CONCLUSIONS: The impacted mandible of patients with mandibular second molar showed lack of sagittal and width development, and the impacted mandibular second molar was a manifestation of its degeneration.

Combinatory transplantation of mesenchymal stem cells with flavonoid small molecule in acellular nerve graft promotes sciatic nerve regeneration.

Previous animal studies have demonstrated that the flavonoid small-molecule TrkB agonist, 7, 8-dihydroxyflavone (DHF), promotes axon regeneration in transected peripheral nerves. In the present study, we investigated the combined effects of 7, 8-DHF treatment and bone marrow-derived stem/stromal cells (BMSCs) engraftment into acellular nerve allografts (ANAs) and explore relevant mechanisms that may be involved. Our results show that TrkB and downstream ERK1/2 phosphorylation are increased upon 7, 8-DHF treatment compared to the negative control group. Also, 7, 8-DHF promotes proliferation, survival, and Schwann-like cell differentiation of BMSCs in vitro. While selective ERK1/2 inhibitor U0126 suppressed the effect of upregulation of ERK1/2 phosphorylation and decreased cell proliferation, survival, and Schwann-like cell differentiation partially induced by 7, 8-DHF. In vivo, 7, 8-DHF promotes survival of transplanted BMSCs and upregulates axonal growth and myelination in regenerating ANAs. 7, 8-DHF+BMSCs also improved motor endplate density of target musculature. These benefits were associated with increased motor functional recovery. 7, 8-DHF+BMSCs significantly upregulated TrkB and ERK1/2 phosphorylation expression in regenerating ANA, and increased TrkB expression in the lumbar spinal cord. The mechanism of 7, 8-DHF action may be related to its ability to upregulate TrkB signaling, and downstream activation of survival signaling molecules ERK1/2 in the regenerating ANAs and spinal cord and improved survival of transplanted BMSCs. This study provides novel foundational data connecting the benefits of 7, 8-DHF treatment in neural injury and repair to BMSCs biology and function and demonstrates a potential combination approach for the treatment of injured peripheral nerve via nerve graft transplant.

The Taiji Model of Self.

An important theme in the development of self-psychology is the attempt by scholars to construct a self-model with universal cultural adaptability. Among them, representatives are the tripartite model of self-built by Triandis, the theory of the independent self and interdependent self-proposed by Markus and Kitayama, Yang Kuo-Shu's four-part theory of the Chinese self, Hwang Kwang-Kwo's Mandala model of self, and Shiah Yung-Jong's Non-self-Theory. However, these models have a difficult time explaining the structure and development of the Chinese self in Chinese cultural background. After pondering over Chinese traditional culture and the Chinese self, inspired by the archetype of Taiji diagram, in this paper, we construct the Taiji Model of Self. The Taiji Model of Self can not only properly represent the Chinese self-structure, but also explain the growth course of the Chinese self and four kinds of life realms of Chinese people with satisfactory cultural and ecological validity.

Robotic-assisted surgery for pediatric choledochal cyst: Case report and literature review.

Our paper describes the key surgical points of pediatric choledochocystectomy performed completely by Da Vinci robotic system. A choledochocystectomy was safely carried out for a girl at our hospital, and without any complication. Then systematic literature review was done to discuss the methods of intestine surgery and intestinal anastomosis, the use of 3rd robotic arm, the surgical safety and advantages comparing open and laparoscopic surgery. We systematically reviewed choledochocystectomy for children performed by robotic surgery. We included a total of eight domestic and foreign reports and included a total of 86 patients, whose average age was 6.3 (0.3-15.9) years; the male-to-female ratio was 1:3.5 (19:67). Seven patients experienced conversion to open surgery, and the surgery success rate was 91.9% (79/86). The average total operation time was 426 (180-520) min, the operation time on the machine was 302 (120-418) min, 11 cases used the number 3 arm, and the remaining mainly used the hitch-stitch technique to suspend the stomach wall and liver. Forty-seven patients underwent pull-through intestine and intestinal anastomosis, and 39 patients underwent complete robotic intestine surgery and intestinal anastomosis. The hospitalization time of robotic-assisted choledochocystectomy was 8.8 d. Eight patients had biliary fistula and were all cured by conservative treatment and continuous observation. One patient had anastomotic stenosis, and one patient had wound dehiscence, both cured by surgery. Choledochocystectomy for children performed by completely robotic surgery and Roux-en-Y hepaticojejunostomy is safe and feasible. The initial experience shows that this surgical approach has a clearer field than the traditional endoscopy, and its operation is more flexible, the surgery is more accurate, and the injury is smaller. With the advancement of technology and the accumulation of surgeons' experience, robotic surgery may become a new trend in this surgical procedure.