Oral Soft Tissue Metastasis from Breast Cancer as the Only Primary Source: Systematic Review.

Background Breast cancer is one of the most lethal neoplasms causing death. Oral cavity is the rare site of distant metastasis from breast cancer. Very little research has been conducted to date to analyze breast cancer as the sole primary source of metastasis to the oral soft tissues. The goal of this study was to examine the published cases of oral soft tissue metastasis from breast cancer as the only primary source to date. Methods An electronic search of the published literature was performed without publication year limitation in PubMed/Medline, Scopus, Google Scholar, Web of Science, Science Direct, Embase, and Research Gate databases, using mesh keywords like ("Breast cancer", OR "Breast carcinoma") AND ("Metastasis" OR "Metastases"), And ("Oral soft tissues" OR "Tongue" OR "Palate" OR "Tonsil" OR "Buccal mucosa" OR "Floor of mouth" OR "Vestibule" OR "Salivary glands"). We also searched all related journals manually. The reference list of all articles was also checked. Results Our research revealed 88 relevant papers (September 1967-September 2023) with 96 patients in total. The most predominant oral soft tissues involved were salivary glands followed by the gingiva, tonsils, tongue, and buccal mucosa. A total of 23% of patients died with an average survival time of 1 to 15 months. Conclusions Oral soft tissue metastasis from breast cancer is a rare event and has a bad prognosis. More cases need to be published to raise awareness of these lesions.

Renal cell carcinoma metastasizing to salivary glands: Systematic review.

Distant metastasis to salivary glands is a very rare event. Renal cell carcinoma (RCC) has been known for its high propensity of metastasis to unusual locations and salivary glands are one among those sites. Approximately 0.1% of all salivary gland metastatic neoplasms originate from renal malignancies Literature has reported several studies analysing the metastatic tumors to the oral region. However, very little research work has been published to date to analyse solely the RCC metastasizing to the salivary glands. Thus, this review was conducted to examine the published cases of RCC metastasizing to salivary glands in the literature to date and to learn about their characteristics. An electronic search of the published literature was performed without publication year limitation in PubMed/ Medline, Scopus, Google Scholar, Web of Science, Science Direct, Embase, and Research Gate databases, using mesh keywords like ('Renal cancer', OR 'Renal carcinoma' OR 'Renal cell cancer' OR 'Renal cell carcinoma'), AND ('Metastasis' OR 'Metastases'), And ('Salivary glands' OR 'Parotid gland' OR 'Submandibular gland' OR 'Sublingual gland'). We also searched all related journals manually. The reference list of all articles was also checked. Our research revealed a total of 83 relevant papers (1965-2022) with 100 patients. Parotid was the most predominant gland affected. 8% of patients died with a mean survival time of 1.3 yr. From this research, it can be concluded that RCC metastasizing to salivary glands is a rare occurrence. Careful evaluation of these cases is needed in order to raise awareness of these lesions and gain a better understanding of their characteristics for clinical as well as global implications.

"You Need to Keep It Going, Mind, Body, and Spirit": Older Adults' Perspectives on Aging in Place in Subsidized Housing.

In the U.S., more than one million older adults with low incomes live in apartment buildings subsidized by the Low-Income Housing Tax Credit. Although this population experiences disproportionate rates of nursing home admission, little is known about residents' perspectives on factors that influence their ability to live independently in these settings. Fifty-eight residents aged 62 and older and eight study partners participated in qualitative interviews about their perspectives on living independently in subsidized housing, including barriers and facilitators. We analyzed transcripts using a hybrid inductive and deductive approach to qualitative thematic analysis. Barriers and facilitators for living independently in subsidized housing related to the influence of the social and physical environment on individuals' experiences of living independently, including factors unique to subsidized housing. Findings suggest how interventions to optimize functional status and promote independence among older adults living in subsidized housing can build on existing strengths of the subsidized housing environment to improve outcomes.

The perceived value of a geriatrics-surgery co-management program: Perspectives from three surgical specialties.

BACKGROUND: Geriatrics-surgery co-management (GSCM) programs have improved patient outcomes, but little is known about how they change care and whether their value varies by surgical specialty. We aimed to assess GSCM's effects as perceived by Orthopedic Trauma, Trauma, and Neurosurgery clinicians. METHODS: We conducted a mixed-methods study utilizing electronic survey and virtual interviews at Penn Presbyterian Medical Center, an academic trauma center, in Philadelphia, PA. Participants included physicians, advanced practice providers, nurses, social workers, and case managers in the aforementioned specialties. Key measures were perspectives on value of GSCM, its facilitators, specialty most appropriate to manage specified medical issues, and factors affecting use. RESULTS: Of 71 eligible clinicians, 45 (63%) completed the survey and 12 (21%) of 56 purposefully sampled for specialty-role diversity were interviewed. Clinicians across specialties valued GSCM highly and similarly for impact on personal management of older adults (grand mean [standard error, SE] = 4.33 [0.24] out of 5; p = 0.80 for specialty means comparisons), patient care (mean [SE] = 4.47 [0.21]; p = 0.27), patient outcomes (mean [SE] = 4.26 [0.22]; p = 0.51), and specialty overall (mean [SE] = 4.55 [0.23]; p = 0.25) but less so for knowledge growth (mean [SE] = 3.47 [0.29]; p = 0.11). Interviewees across specialties reported that value derived from improved understanding of patient history, management of complex medical conditions, goals of care support, communication with families, and patient discharge facilitation. Interviewees also agreed on program facilitators: aligned stakeholders, shared data-driven goals, champion/administrative support, continuity and availability of geriatricians, and thorough communication. Specialties differed on three issues: (1) who should manage some medical concerns; (2) whether GSCM makes their job easier (significantly easier for Orthopedic Trauma: mean [SE] = 4.75 [0.29] vs. Trauma: mean [SE] = 4.01 [0.19]; p = 0.05); and (3) whether GSCM increases coordination difficulty (more for Neurosurgery: mean [SE] = 2.18 [0.0.58] vs. Orthopedic Trauma: mean [SE] = 0.51 [0.42]; p = 0.03 and Trauma: mean [SE] = 0.89 [0.28]; p = 0.07). Orthopedic Trauma had the most positive impression of GSCM overall. CONCLUSIONS: Clinicians across diverse surgical specialties valued GSCM. Hospitals considering implementation or expansion of GSCM should attend to identified facilitators and may need to tailor to specialty.

"I'll fill in the gaps": perspectives of HHAs on promoting aging in place for older adults with low incomes.

Older adults with low incomes experience disproportionate rates of cognitive and functional impairment and an elevated risk of nursing home admission. Home health aides (HHAs) may have insight into how to optimize aging in place for this population, yet little is known about HHAs' perspectives on this topic. We conducted 6 focus groups with 21 English-speaking and 10 Spanish-speaking HHAs in Pennsylvania and New Jersey. Transcripts were analyzed using qualitative thematic analysis, and three themes emerged. First, HHAs described the uniqueness of their role within multidisciplinary care teams. Second, HHAs shared concrete interventions they employ to help their clients improve their function at home. Third, HHAs discussed barriers they face when helping clients age in place. Our findings suggest that HHAs have important insights into improving aging in place for older adults with low incomes and that their perspectives should be incorporated into care planning and intervention delivery.

A protocol for the development of PhyCaRe: An extension of the CARE guideline for physiotherapy using the Delphi method.

Background: Case reports are one of the important forms of documentation and publication of clinical physiotherapy presenting the first line of evidence in scientific literature. In order to provide a systematic and precise structure for reporting and presenting cases, the CARE guidelines were established in 2013. However, these guidelines present limitations as while reporting require items of specific specialties following the checklist. Authors from different specialities have developed CARE extensions specifying the characteristic features of corresponding fields, however, an extension dealing with physiotherapy assessment and line of management in the CARE guidelines is proposed as PhyCaRe. Method: After consulting with the advisors, a draft will be prepared of the specific elements that should be included in the PhyCaRe using web Delphi methodology considering CARE statement as the source and SurveyMonkey will be used to undertake the web Delphi questionnaire. The web Delphi methodology will be assumed for three rounds and will be open to physiotherapists and others with substantial experience in reviewing case reports. Subsequently, an online consensus meeting, pilot testing, and submission of the CARE extension for physiotherapy will be conducted for publication. Dissemination: The 2010 "Guidance for Developers of Health Research Reporting" and instructions from the EQUATOR Network will be followed in the preparation of PhyCaRe guidelines. The guidelines will be propagated at different platforms and journals will be requested to adopt the guidelines. Registration: The reporting guideline under development is prospectively registered on the EQUATOR Network website on PhyCaRe - Reporting guideline for physiotherapy case reports.

Mitochondrial superoxide dismutase Sod2 suppresses nuclear genome instability during oxidative stress.

Oxidative stress can damage DNA and thereby contribute to genome instability. To avoid an imbalance or overaccumulation of reactive oxygen species (ROS), cells are equipped with antioxidant enzymes that scavenge excess ROS. Cells lacking the RecQ-family DNA helicase Sgs1, which contributes to homology-dependent DNA break repair and chromosome stability, are known to accumulate ROS, but the origin and consequences of this oxidative stress phenotype are not fully understood. Here, we show that the sgs1 mutant exhibits elevated mitochondrial superoxide, increased mitochondrial mass, and accumulation of recombinogenic DNA lesions that can be suppressed by antioxidants. Increased mitochondrial mass in the sgs1Δ mutant is accompanied by increased mitochondrial branching, which was also inducible in wildtype cells by replication stress. Superoxide dismutase Sod2 genetically interacts with Sgs1 in the suppression of nuclear chromosomal rearrangements under paraquat (PQ)-induced oxidative stress. PQ-induced chromosome rearrangements in the absence of Sod2 are promoted by Rad51 recombinase and the polymerase subunit Pol32. Finally, the dependence of chromosomal rearrangements on the Rev1/Pol ζ mutasome suggests that under oxidative stress successful DNA synthesis during DNA break repair depends on translesion DNA synthesis.

Effect of Biologics in Subgroups of Axial Spondyloarthritis Based on Magnetic Resonance Imaging and C-Reactive Protein: A Systematic Review and Meta-Analysis.

OBJECTIVE: To determine if the efficacy of biologics differ based on magnetic resonance imaging (MRI) and C-reactive protein (CRP) findings. METHODS: We compared four subgroups (MRI+/CRP+, MRI+/CRP-, MRI-/CRP+, MRI-/CRP-) from randomized controlled trials (RCTs). A comprehensive database search was performed to include axial spondylarthritis (axSpA; both radiographic axSpA [r-axSpA] and nonradiographic axSpA [nr-axSpA]) RCTs with treatment efficacy reported by different MRI and CRP subgroups. Study-specific disease activity scores (at 12-16 weeks) were pooled using a random-effects model and compared between the four subgroups. RESULTS: Five trials (all nr-axSpA) were included: three with tumor necrosis factor inhibitors (TNFi, N = 729) and two with interleukin-17 inhibitors (IL-17i, N = 794). TNFi and IL-17i showed efficacy based on the Assessment of Spondyloarthritis International Society 40 (ASAS40) and Bath Ankylosing Spondylitis Disease Activity Index 50 (BASDAI50) in all MRI and CRP subgroups, except the CRP-/MRI- subgroup, which had a single study with only 39 patients. There was no statistically significant difference between the four subgroups in terms of patients achieving ASAS40 (P = 0.60, I2 = 0%) or BASDAI50 (P = 0.27, I2 = 23.9%). The number needed to treat was three for the CRP+/MRI+ and CRP+/MRI- subgroups and six for the CRP-/MRI+ and CRP-/MRI- subgroups. All trials had a low risk of bias. Between-study heterogeneity was low to moderate. Sensitivity analyses comparing TNFi or IL-17i versus placebo similarly showed no difference between subgroups in terms of ASAS40 (TNFi, P = 0.57; IL-17i, P = 0.28) and BASDAI50 (TNFi, P = 0.37; IL-17i, P = 0.18). CONCLUSION: In this systematic review, there was no statistically significant difference between the four subgroups in terms of efficacy based on ASAS40 or BASDAI50.

Challenges in the Classification of Oral Submucous Fibrosis and Proposing a New Classification Based on Systematic Review of Literature.

Aims and Objectives: Oral submucous fibrosis is one of the common oral potentially malignant disorders that can result in severe morbidity. Due to its widespread involvement in the oral cavity and high risk of malignant transformation, the diagnosis and treatment of this disease at an early stage is essential to prevent further complications. This research was carried out to review various classification systems of oral submucous fibrosis documented in the literature to date, including their benefits and drawbacks, thus focusing on a need to discover some reliable classification systems. Materials and Methods: An electronic search of the published English literature was performed without publication year limitation in PubMed/Medline, Science Direct, Web of Science, Google Scholar, and Scopus databases using keywords like ('Oral submucous fibrosis' OR 'Oral submucous fibroses'), AND ('Classification' OR 'Grade' OR 'Stage'), AND ('Clinical', OR/ AND 'Histological', OR/AND 'Functional') following PRISMA guidelines. A manual search of all related Dental and Medical journals was also performed. We also checked the reference lists of the relevant articles for any other possible information on the subject. Results: The search strategy revealed 31 relevant articles and it could be appreciated that oral submucous fibrosis has been classified in seven different ways. Each system is enclosed with its own limitations and benefits. Conclusion: From this research, it can be concluded that despite the existence of several classification systems for oral submucous fibrosis, at present, no classification scheme is considered to be reliable that could help in the accurate assessment of the progression of the disease and classifying oral submucous fibrosis still remains a challenging task for clinicians, surgeons, and pathologists. We have postulated a proposed new classification system based on our literature research, but still robust research is needed in this aspect.

Plasma Fibrinogen Degradation Products as the Nonsurgical Diagnostic Tool for Oral Submucous Fibrosis: A Systematic Review.

Aims and Objectives: Oral submucous fibrosis (OSMF) is known to be one of the most common premalignant conditions of the oral cavity. Areca nut (AN) is considered to be the disease's primary cause, while there are other potential causes as well. However, routine clinical practice has revealed that not all people who chew AN exhibit clinical signs of OSMF, and few people are reported to have it even without chewing AN. So, there must be other factors contributing to OSMF. Plasma fibrinogen degradation products (FDPs) have recently been discovered to be an early sign of this disease, indicating a potential link between the two. This review aims to examine the studies which have been published in the literature that explain the role of plasma FDPs in contributing to OSMF. Materials and Methods: An electronic search of the published literature was performed without publication year limitation in PubMed/ Medline, Scopus, Google Scholar, Web of Science, Science Direct, Embase, and Research gate databases, using mesh keywords like ('Oral submucous fibrosis' OR 'Oral submucous fibrosis') AND ('Fibrinogen degradation products' OR 'Plasma fibrinogen degradation products') AND ('Clinical grades' OR 'Histological grades') AND ('Diagnosis'). A manual search of all related journals was also done. We also referred to the reference lists of papers. The risk of bias was evaluated with the GRADE criteria (from the Grading of Recommendations Assessment, Development, and Evaluation Working Group). Results: The search revealed a total of 12 relevant studies from 1979 to 2022. Nine out of 12 studies demonstrated the definite presence of plasma FDPs in such cases. Conclusions: Although the studies documented in the literature showing evidence of plasma FDPs in patients with OSMF are very few in number, their detection signifies an important clinical finding. More research is still required in this aspect to establish stronger evidence.

Exploring the impacts of physicochemical characteristics and heavy metals fractions on bacterial communities in four rivers.

Heavy metals contamination in sediment poses serious threats to bacterial communities that play critical roles in sediment biogeochemical processes. However, the physicochemical factors and the major heavy metals fractions that affect sediment bacterial communities are still unclear. Here, we performed heatmap and redundancy analyses to examine the effects of physico-chemical characteristics and heavy metals fractions on the sediment bacterial community from rivers in the UK (River Tyne and Ouseburn) and India (River Ganga and Yamuna). The results revealed that physicochemical characteristics and heavy metals fractions altered the diversity, richness, and structures of the bacterial community. Moreover, the fractions of Co, Zn, Pb, Cr, and Cu played significant roles in shaping the bacterial community structure, and physicochemical variables, particularly NH4+-N and NO2--N, also influenced the bacterial diversity and structure. Firmicutes showed strong associations with both physicochemical factors and heavy metals fractions. Chloroflexi and Actinobacteriota can be used as biomarkers for Zn contamination. Overall, our study identified the significance of sediment chemical characteristics and heavy metals fractions in determining the bacterial community structure as well as bioremediation and environmental management of metals contaminated sites.

Detection of myocardial dysfunction using global longitudinal strain with speckle-tracking echocardiography in patients with vs without rheumatoid arthritis: a systematic review and meta-analysis.

OBJECTIVES: Rheumatoid arthritis (RA) is a systemic autoimmune disorder primarily involving the peripheral joints. Systemic involvement can occur, including myocardial dysfunction. Speckle tracking echocardiography (STE) is a novel diagnostic study which is recently being used to detect subclinical cardiac dysfunction. Global longitudinal strain (GLS) by STE is more sensitive than standard echocardiographic parameters to detect occult cardiac dysfunction. METHODS: A systematic search of PUBMED, EMBASE, Cochrane, and Google Scholar databases was performed to identify studies comparing the STE parameters between RA and non-RA patients. RESULTS: Left ventricular (LV) GLS was significantly lower in patients with RA compared to non-RA patients with a standard mean difference (SMD) of -1.09 (-1.48--0.70, P < 0.001). LV Global Circumferential Strain (GCS) was reported in five studies, and it was found to be lower in RA patients with an SMD of -1.25 (-2.59--0.10; P < 0.0010). Meta regression analysis studies failed to show any significant impact of disease duration, activity, age, sex and BMI on LV GLS and RV GLS. CONCLUSIONS: RA patients have lower LV GLS and LV GCS compared to controls suggesting impaired myocardial dysfunction. Further studies need to be done to delineate the importance of lower GLS in asymptomatic rheumatoid patients to guide disease management and risk factor modification in this selected population.

Heavy metal and antibiotic resistance in four Indian and UK rivers with different levels and types of water pollution.

Heavy metal pollution can enhance the level of antibiotic resistance, posing concerns to ecosystem and public health. Here, we investigated heavy metal concentrations, heavy metal resistant bacteria and antibiotic resistant bacteria and their corresponding resistant genes, and integrons in four different river environments, i.e., low heavy metals and low wastewater, high heavy metals and low wastewater, low heavy metals and high wastewater, and high heavy metals and high wastewater levels. Heavy metals were found to show positive and significant correlations with heavy metal resistance and antibiotic resistance and integrons (r > 0.60, p < 0.05), indicating that heavy metal selective pressure can cause heavy metal and antibiotic resistance to be transmitted simultaneously via integrons, which can result in the development of multi-resistant bacteria in the heavy metal-polluted environments. Moreover, there were significant associations between heavy metal resistance and antibiotic resistance (r > 0.60, p < 0.05), demonstrating heavy metal and antibiotic resistance are connected via a same or related mechanism. Class 1 integrons were found to have strong correlations with heavy metals and heavy metal resistance and antibiotic resistance (r > 0.60, p < 0.05), indicating a higher occurrence of antibiotic resistance co-selection in the heavy metal-polluted environments.

Lung cancer metastasizing to salivary glands: Systematic review.

ABSTRACTS: Metastasis to salivary glands from the secondary source outside the head and neck region is extremely rare and Carcinoma Lung is one of the rarest sources of distant spread to salivary glands. Owing to missed diagnosis and misdiagnosis, accurate identification of clinical and pathological aspects of these metastatic lesions remains a challenging task. Many studies regarding metastasis to the oral cavity have been already documented in the literature, but very little research work has been done to analyse the cases of lung cancer metastasis as the sole primary source, particularly to salivary glands. Thus this review was conducted to analyse the published cases of lung cancer metastasizing to salivary glands as the only primary source till date. An electronic search of the published literature was performed without publication year limitation in PubMed/ Medline, Scopus, Google Scholar, Web of Science, Science direct, Embase, and Research gate databases, using Mesh keywords like (Lung cancer', OR 'Lung carcinoma), AND (Metastasis OR Metastases), And (Salivary glands OR Parotid gland OR Submandibular gland OR Sublingual gland). We also searched all related journals manually. The reference list of all articles was also checked. Our research revealed 34 relevant papers between 1965-2022 with a total of 44 patients. The most prevalent diagnosed metastatic Lung cancer was Small cell lung cancer. Parotid was the most common gland involved in metastasis. 48% of patients died of metastasis with a mean survival time of 2.2 years. Salivary gland metastasis from Lung cancer is very rare and has a poor prognosis. More cases need to be published in order to raise awareness of these lesions and gain a better understanding of their characteristics.

Lung cancer metastasis to oral soft tissues; Systematic review of 122 cases.

Background: Lung cancer metastasis to oral region is very rare. Studies have been published analysing the cases of metastatic tumours to the oral cavity by many researchers. But very few research work has been conducted till date to analyse only the oral soft tissue metastasis from Lung cancer as the primary source. The goal of this study was to examine published cases of oral soft tissue metastasis from lung cancer as the only primary source from 1st August 1977 to 31st December 2021. Material and Methods: An electronic search of the published English literature was performed in PubMed/ Medline, Scopus, Google Scholar, and Research gate databases, using keywords like 'Lung cancer', OR/ AND 'Lung carcinoma' OR/ AND 'Oral cavity', OR/AND 'Metastasis', OR/AND 'Primary', OR/AND 'Source', OR/AND 'Initial', OR/AND 'Tongue', OR/AND 'Palate', OR/ AND 'Tonsil', OR/AND 'Lip', OR/AND 'Buccal mucosa', OR/AND 'Floor of mouth', OR/AND 'Salivary glands', OR/ AND 'Parotid', OR/ AND 'Submandibular', OR/ AND 'Sublingual' OR/ AND 'Mandible', OR/AND 'Maxilla. We also searched all related journals manually. Reference list of all articles was also checked. Results: Our research revealed total 122 patients. The most prevalent diagnosed metastatic lung cancer was adenocarcinoma. Gingiva, tongue and tonsils were the most common site of metastasis. 54% patients died of metastasis with a survival time of 1 week to 2.5 years. Conclusions: Oral soft tissue metastasis from lung cancer has a bad prognosis. More cases need to be published in order to raise awareness of these lesions and gain a better understanding of their characteristics. Key words:Lung cancer, metastasis, oral, primary, soft tissues.

Bibliometric Analysis on Bibliometric Studies of Case Reports in the Medical Field.

The studies on bibliometric analyses of case reports usually give valuable information regarding various aspects of case reports but lack investigation analysing these publications. This is the first-ever study to examine the bibliometric articles on case reports; hence, it is hypothesized to provide a valuable contribution to this gap. PubMed and SCOPUS databases were searched, and a total of 119 articles were obtained, but only five were analyzed matching the inclusion criteria. The keywords involved in the search were "Bibliometrics", "analysis", "case reports", "case series", and "articles" whereas, the time range in which the case reports were searched for was between 2011-2021. Common parameters from these five articles were employed for bibliometric analysis, which included publication year, publication type, the number of case reports per article, theme or subject of the article, citation, and impact factor (IF). Out of the five articles identified, four were published in 2021. One out of five was a case report, and the rest were review-type of articles. The overall citation number of these articles was less than 10, and the IF of these articles was between 0-0.007. The number of citations of the articles was in a period of one to two years or less than one year. A comprehensive overview of the parametrises, as well as the recent trends that are being used to conduct bibliometric analysis on case reports was acquired.

Jaw bone metastasis from Lung cancer as sole primary source: A systematic review.

Background: Lung cancer is one of the leading causes of death worldwide. Lung cancer metastasis to oral region is very rare. Very few research work has been conducted till date to analyse the jaw bone metastasis from Lung cancer as the primary source. The goal of this research was to examine published cases of jaw bone metastasis from lung cancer as the sole primary source from 1st December 1961 to 31st December 2021 and to learn about their characteristics. Material and Methods: An electronic search of the published English literature was performed in PubMed/ Medline, Scopus, Google Scholar, and Research gate databases, using keywords like 'Lung cancer', OR/AND 'Lung carcinoma', OR/AND 'Metastasis', OR/AND 'Primary', OR/AND 'Source', OR/AND 'Oral cavity' OR/AND 'Jaw', OR/ AND 'Mandible', OR/AND 'Maxilla', OR/ AND 'Temporomandibular joint', OR/ AND 'Condyle', OR/ AND 'Ramus', OR/ AND 'Maxillary sinus', AND Initial', OR/ AND 'Treatment', OR/AND 'Prognosis', OR/ AND 'Follow-up', OR/AND 'Recurrence', OR/ AND 'Survival rate'. We also searched all related journals manually. Reference list of all articles was also checked. Data extracted were tabulated and summarized. Results: In total, we found 60 relevant publications with 66 patients in our research. The prognosis was poor, with a survival time of 1 week to 1.5 years. The most prevalent diagnosed metastatic lung cancer to jaw bones was adenocarcinoma and mandible was the predominant site. Conclusions: Jaw bone metastasis from lung cancer is rare and has a bad prognosis. Because of their resemblance to other jaw problems and late clinical signs, these lesions go unnoticed the majority of the time, making detection difficult. More cases need to be published in order to raise awareness of these lesions and gain a better understanding of their characteristics. Key words:Jaw bone, lung cancer, metastasis, primary, prognosis.

Effects of heavy metals on the development and proliferation of antibiotic resistance in urban sewage treatment plants.

Sewage treatment plants (STPs) are considered as "hotspots" for the emergence and proliferation of antibiotic resistance. However, the impact of heavy metals contamination on dispersal of antibiotic resistance in STPs is poorly understood. This study simultaneously investigated the effect of removal of metal and antibiotic resistance as well as mobile elements at different treatment units of STPs in Delhi, India. Results showed that treatment technologies used in STPs were inefficient for the complete removal of metal and antibiotic resistance, posing an ecological risk of co-selection of antibiotic resistance. The strong correlations were observed between heavy metals, metal and antibiotic resistance, and integrons, implying that antibiotic resistance may be exacerbated in the presence of heavy metals via integrons, and that metal and antibiotic resistance share a common or closely associated mechanism. We quantified an MRG rcnA, conferring resistance to Co and Ni, and identified that it was more abundant than all MRGs, ARGs, integrons, and 16S rRNA, suggesting rcnA could be important in antibiotic resistance dissemination in the environment. The associations between heavy metals, metal and antibiotic resistance, and integrons highlight the need for additional research to better understand the mechanism of co-selection as well as to improve the removal efficacy of current treatment systems.