BackgroundCancer cachexia is a syndrome of progressive weight loss. Non-small cell lung cancer patients experience a high incidence of cachexia of 61%. Research into methods to combat cancer cachexia in various tumour sites has recently progressed to the combination of agents.The combination of the anti-cachectic agent Eicosapentaenoic acid (EPA) and the cyclo-oxygenase-2 (COX-2) inhibitor celecoxib has been tested in a small study with some benefit. The use of progressive resistance training (PRT) followed by the oral ingestion of essential amino acids (EAA), have shown to be anabolic on skeletal muscle and acceptable in older adults and other cancer groups.The aim of this feasibility study is to evaluate whether a multi-targeted approach encompassing a resistance training and nutritional supplementation element is acceptable for lung cancer patients experiencing cancer cachexia.Methods/DesignAuckland's Cancer Cachexia evaluating Resistance Training (ACCeRT) is an open label, prospective, randomised controlled feasibility study with two parallel arms. All patients will be treated with EPA and the COX-2 inhibitor celecoxib on an outpatient basis at the study site. In the experimental group patients will participate in PRT twice a week, followed by the ingestion of essential amino acids high in leucine. A total of 21 patients are planned to be enrolled. Patients will be randomised using 1:2 ratio with 7 patients enrolled into the control arm, and 14 patients into the treatment arm. The primary endpoint is the acceptability of the above multi-targeted approach, determined by an acceptability questionnaire.DiscussionTo our knowledge ACCeRT offers for the first time the opportunity to investigate the effect of stimulating the anabolic skeletal muscle pathway with the use of PRT along with EAA alongside the combination of EPA and celecoxib in this population.Trial registrationNetherlands Trial Register (NTR): ACTRN12611000870954

We performed a retrospective (n ‫؍‬ 121) and prospective (n ‫؍‬ 305) verification of the Cepheid Xpert Flu assay to determine its performance characteristics. The overall sensitivity and specificity were 93% and 100%, respectively. Nasopharyngeal specimen sensitivities were 100% for seasonal influenza A/H1 virus and influenza A/H3 virus, 90% for influenza A/2009/H1N1 virus, and 95% for influenza B virus.

Penicillin-binding protein (PBP) 2a latex agglutination was compared with conventional susceptibility testing and mecA real-time PCR for the detection of oxacillin resistance in Staphylococcus aureus. Inoculum volume and induction with oxacillin were PBP 2a testing variables. For coagulase-negative Staphylococcus, an increased inoculum volume of 10 l greatly reduced the number of isolates requiring induction.Staphylococcus aureus and coagulase-negative Staphylococcus (CoNS) are common isolates from positive blood and sterile body fluids (1). At our institution, oxacillin resistance in these organisms is relatively high; 47% of S. aureus and 71% of CoNS isolates are resistant to oxacillin by conventional (phenotypebased) antimicrobial susceptibility testing (AST) (2004 antibiogram; University of North Carolina Hospitals, McLendon Clinical Laboratories). The mecA product, penicillin-binding protein (PBP) 2a, mediates oxacillin resistance. PBP 2a has a lower affinity for beta-lactam antibiotics than do endogenous PBPs of staphylococci, thus allowing peptidoglycan synthesis in the presence of lethal doses of beta-lactams. Due to high rates of oxacillin resistance, empirical vancomycin therapy is rampant. To reduce the unnecessary use of vancomycin, the clinical microbiology laboratory must be able to provide accurate oxacillin susceptibility results with rapid turnaround times. However, the heteroresistant nature of oxacillin resistance in staphylococcal isolates can make detection problematic (3). Disk diffusion and oxacillin screening plate results are occasionally discordant for S. aureus isolates, and resistance detection in CoNS at our institution relies solely on disk diffusion. To improve the performance of phenotype-based susceptibility tests, we sought to evaluate the use of PBP 2a detection in staphylococcal isolates by using mecA real-time PCR as the reference method (11). In addition, the data in the literature vary regarding the necessities of inducing CoNS with oxacillin and of increasing the inoculum volume for the detection of PBP 2a (6-10, 13, 20, 21, 23). This study aims to determine a standard protocol for PBP 2a detection in CoNS that minimizes the time to detection of oxacillin resistance.(A preliminary report of this work has been presented previously [M. B.

Background Cancer cachexia is a condition often seen at diagnosis, throughout anti‐cancer treatments and in end‐stage non‐small‐cell lung cancer patients. Methods and results Participants with late‐stage non‐small‐cell lung cancer and cachexia (defined as ≥5% weight loss within 12 months) were randomly assigned 1:2 to 2.09 g of eicosapentaenoic acid (EPA) and 300 mg of cyclo‐oxygenase‐2 inhibitor celecoxib orally once daily vs. same dosing of EPA, celecoxib, plus two sessions per week of progressive resistance training and 20 g of oral essential amino acids high in leucine in a split dose over 3 days, after each session. Primary endpoint was the acceptability of the earlier multi‐targeted approach. Main secondary endpoints included change in body weight and fat‐free mass, by bioelectric impedance analysis and total quadriceps muscle volume by magnetic resonance imaging over 20 weeks. Sixty‐nine patients were screened resulting in 20 patients being enrolled. Acceptability scored high, with 4.5/5 (Arm A) and 5/5 (Arm B) for EPA and 5/5 for celecoxib within both arms and 4.8/5 for progressive resistance training sessions and 4.5/5 for essential amino acids within Arm B, all at Week 20. Results showed a net gain in bioelectric impedance analysis fat‐free mass of +1.3 kg, n = 2 (Arm A), compared with +0.7 kg, n = 7 (Arm B) at Week 12, and —1.5 kg, n = 2 (Arm A), compared with —1.7 kg, n = 4 (Arm B) at Week 20. Trends in efficacy in terms of improvement and/or stability in cachexia markers were seen within magnetic resonance imaging muscle volume, albumin, and C‐reactive protein levels within both arms. There were no exercise‐related adverse events, with one possible related adverse event of asymptomatic atrial fibrillation in one participant within Arm A. Conclusions Non‐small‐cell lung cancer cachectic patients are willing to be enrolled onto a multi‐targeted treatment regimen and may benefit from cachexia symptom management even during the late/refractory stage.