The value of 18 F-Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in the detection of carcinoma of unknown primary (CUP) differs among the studies. This study aimed to evaluate the role of 18 F-FDG PET/CT in CUP.Fifty-one patients (19 women, 32 men) with metastasis confirmed by histopathology from an unknown primary tumor were included in this study. Patients received 370 MBq of 18 F-FDG intravenously, and PET/CT was performed at 60 minutes after injection.Primary tumor sites were detected in 5 of 51 patients (9.6%): in 2 patients with carcinoma of the lung, in 1 patient with carcinoma of the gallbladder, in 1 patient with carcinoma of the esophagus, and in 1 patient with carcinoma of the stomach. No primary tumor was discovered in the remaining 46 patients (90.4%) during the follow-up. The sensitivity, specificity, and accuracy of 18 F-FDG PET/CT were 100%, 80.4%, and 82.4%. The positive and negative predictive values were 35.7 and 100%, respectively.Based on the data presented, 18F-FDG PET/CT has a clinical implicative value in detecting the primary tumor of CUP. PET/CT can be useful to rule out the possibility of detecting the primary tumor during the follow-up.

Recently, resistance to diamide insecticides (IRAC group 28) has been reported in various lepidopteran pests, including Spodoptera exigua. In the present study, susceptibility of six field populations was evaluated to two diamide insecticides: chlorantraniliprole and flubendiamide. The bioassay test for resistance revealed a high level of diamide resistance and helped to select a diamide resistant (Di-R) strain, whose LC50 values against chlorantraniliprole and flubendiamide were 28,950-and 135,286-fold higher, respectively, than those of susceptible strains. In the ryanodine receptor, instead of the G4946E mutation, one of the well-known diamide resistance mechanisms, we found a I4790M mutation and identified the resistance allele-specific indel linked to it. Resistance allele diagnostic primers were designed using this distinct region and applied in loop-mediated isothermal amplification (LAMP) and general PCR. LAMP accurately detected the specific indel when conducted for 2 h at temperature range from 63 ℃ to 65 ℃ and using four LAMP primers; its efficiency was further amplified by an additional loop primer. A broad range of DNA concentrations was workable in the LAMP assay, with the minimum detectable DNA concentration of 100 pg. The new DNA releasing method used for the LAMP assay consisted of 5 min of incubation of a larva or adult tissue at 95℃. The entire diagnostic process, which included the DNA releasing technique and LAMP, lasted only 100 min. This simple and accurate LAMP assay can be applied to monitor diamide resistance and for integrated resistance management of S. exigua in the field.

The safety of simultaneous bilateral total knee arthroplasty (TKA) remains controversial. The objective of the current study was to investigate perioperative morbidity and mortality rates within 30 days of simultaneous bilateral TKA. A detailed analysis of medical, surgical and anaesthesia records of 183 consecutive patients who underwent total knee arthroplasty between 2002 and 2006 was performed. The mean age of the patients was 67.6 years old. More than 80% had one or more co-morbidities, but none of them had ASA score greater than class 2. The mean hospital stay was 10 days, and the mean surgical time 156 minutes. Less than half of the patients (42.6%) required blood transfusion. The rate of perimorbidity was 15.3 % and there was no mortality in this series. We believe that simultaneous bilateral total knee arthroplasty is a safe and cost effective option for our patients, provided that patients are selected and informed appropriately. Key Words:Bilateral total knee arthroplasty, Morbidity, Mortality INTRODUCTIONTotal knee arthroplasty (TKA) is a common orthopaedic procedure that is considered highly successful and safe, with very low rates of perioperative complications and death. However, there remains concern associated with simultaneous bilateral TKA. Several studies have reported increased risk of serious complications or even death when bilateral TKA are done simultaneously 1,2 , whereas other investigators have found that the rate of complications associated with simultaneous bilateral TKA is the same as or lower than that associated with unilateral TKA 3,4 .In Malaysia, due to the increased accessibility to affordable and success TKA, more and more patients are requesting this procedure. Many of these patients have bilateral knee arthritis requiring operative intervention on both knees. The surgeon and patient are then faced with the decision of whether to proceed with a staged bilateral TKA, performed as two unilateral TKA procedures on separate days, or a simultaneous bilateral TKA. It is therefore important to ascertain the risks and complications associated with simultaneous TKA in this country. In addition, the current published literature is based on the western population in well-established arthroplasty centres. At present, there is no published data on post-operative morbidity and mortality after simultaneous bilateral TKA in an Asian arthroplasty centre in general, and in Malaysia in particular.This study was therefore undertaken to assess the early complications and mortality occurring within 30 days of simultaneous bilateral TKA in our medical centre and to compare the outcome with that of other published reports, especially those from Western institutions. We also sought to identify any risk factors associated with increased morbidity and mortality of simultaneous bilateral TKA. MATERIALS AND METHODSThe operative database in University Malaya Medical Centre (UMMC) was searched to retrospectively identify all patients who had undergone simultaneous bilateral TKA between June 2002 ...