Background: Microorganisms provide various benefits to their human hosts, including assisting with digestion, synthesizing certain vitamins, developing the gastrointestinal and immune systems, regulating metabolism, and protecting against some pathogens. However, microbial imbalances can cause tissue damage and contribute to inflammatory disorders and cancers. Microbial dysbiosis refers to an imbalance or disruption in the normal composition and function of the microbial communities that inhabit various body parts, including the gut, oral cavity, skin, and reproductive tract. Emerging research suggests that microbial dysbiosis plays a significant role in cancer development and progression. This issue is particularly relevant in achalasia, in which food stasis, changes in endoluminal pH, and poor esophageal clearance might contribute to esophageal microbial dysbiosis. This study aimed to evaluate the association between dysbiosis and esophageal cancer development, focused on esophageal dysmotility disorders. Methods: This study is a critical review, gathering the current evidence for the association between dysbiosis and the development of esophageal cancer. Results: Studies have shown that microbiota play a role in cancer development, although the mechanisms for how they do so are not yet fully understood. One possible explanation is that microbiota alterations can lead to chronic inflammation, promoting cancer cell growth. Additionally, some bacteria produce toxins that can damage DNA and cause genomic instability, and certain bacterial products can promote tumor growth. Conclusion: Despite the close relationship between dysbiosis and cancer development in esophageal dysmotility disorders, further investigations are still needed to elucidate the precise mechanisms by which dysbiosis contributes to cancer development and to identify potential therapeutic interventions targeting the microbiota to prevent or treat cancer.

Highlights Alkaline phosphatase: sensitivity of 97.6% and specificity of 72.6% for choledocholitiasis. The average cost of cholangioresonance would have decreased by almost half for each patient in this study. ABSTRACT Objective To assess the predictive value of preoperative serum laboratory test results for identifying choledocholithiasis and reduce the use of cholangioresonance and its inherent costs. Methods Patients aged 21-69 years who underwent preoperative cholangioresonance examination at our institute were included. Patients with a history of fluctuating jaundice or biliary pancreatitis,

Objective This work aims to review the existing use of robotics in plastic surgery. Methods A meticulous selection process identified 22 articles relevant to this scoping review. Results The literature on the use of robotics in plastic surgery is sparse. Nonetheless, this review highlights emerging benefits in microsurgery, breast reconstruction, and transoral surgery. Conclusion This scoping review identifies critical articles reporting the emerging use of robotics in plastic surgery. While the scientific medical community has yet to extensively document

To evaluate the national distribution and cost-effectiveness of oncologic microsurgical reconstructions performed within the Brazilian Public Health System over a 14-year period. A retrospective analysis of DATASUS data was conducted using three procedure codes related to oncologic microsurgical reconstruction. Surgical volume was assessed by state and geographic region. Hospital reimbursement values were compared with those of less complex reconstructive procedures, and inter-state patient referral patterns were analyzed to identify trends in service centralization. Between 2009 and 2023, a total of 1,902 microsurgical reconstructions were performed nationwide. The Southeast and South regions accounted for the majority of cases, with São Paulo (n=563) and Rio Grande do Sul (n=474) representing the highest-volume states. In contrast, the North and Center-West regions exhibited substantially lower availability of microsurgical services. Reimbursement analyses demonstrated that microsurgical procedures were compensated at levels comparable to those of less complex reconstructions, despite their greater technical and infrastructural requirements. Referral flow analyses revealed a pronounced concentration of patients toward a limited number of high-volume centers. Microsurgical reconstruction within the Brazilian Public Health System is cost-effective; however, its availability remains unevenly distributed, restricting equitable access to complex oncologic reconstructive care. Public policies focused on workforce training, capacity-building, and regional decentralization are necessary to expand access and reduce reliance on a small number of specialized centers.