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Models predicting an individual's 10-year risk of cirrhosis complications have not been developed for a community setting. Our objectives were to assess the performance of existing risk scores - both with and without genetic data - for predicting cirrhosis complications in the community.We used a 2-stage study design. In stage 1, a systematic review was conducted to identify risk scores derived from routine liver blood tests that have demonstrated prior ability to predict cirrhosis-related complication events. Risk scores identified from stage 1 were tested in a UK Biobank subgroup, comprising participants with a risk factor for chronic liver disease (stage 2). Cirrhosis complications were defined as hospitalisation for liver cirrhosis or presentation with hepatocellular carcinoma. Discrimination of risk scores with and without genetic data was assessed using the Wolbers C-index, Harrell's adequacy index, and cumulative incidence curves.Twenty risk scores were identified from the stage-1 systematic review. For stage-2, 197,509 UK biobank participants were selected. The cumulative incidence of cirrhosis complications at 10 years was 0.58%; 95% CI 0.54-0.61 (1,110 events). The top performing risk scores were aspartate aminotransferase-to-platelet ratio index (APRI: C-index 0.804; 95% CI 0.788-0.820) and fibrosis-4 index (FIB-4: C-index 0.780; 95% CI 0.764-0.795). The 10-year cumulative incidences of cirrhosis complications for participants with an APRI score exceeding the 90Accessible risk scores derived from routine blood tests (particularly APRI and FIB-4) can be repurposed to estimate 10-year risk of cirrhosis morbidity in the community. Genetic data improves performance only minimally.New approaches are needed in community settings to reduce the late diagnosis of chronic liver disease. Thus, in a community cohort, we assessed the ability of 20 routine risk scores to predict 10-year risk of cirrhosis-related complications. We show that 2 routine risk scores in particular - "APRI" and "FIB-4" - could be repurposed to estimate an individual's 10-year risk of cirrhosis-related morbidity. Adding genetic risk factor information to these scores only modestly improved performance.

Background & aimsNon-invasive tests (NITs) offer a practical solution for advanced fibrosis identification in non-alcoholic fatty liver disease (NAFLD). Despite increasing implementation, their use is not standardised, which can lead to inconsistent interpretation and risk stratification. We aimed to assess the types of NITs and the corresponding cut-offs used in a range of healthcare settings.MethodsA survey was distributed to a convenience sample of liver health experts who participated in a global NAFLD consensus statement. Respondents provided information on the NITs used in their clinic with the corresponding cut-offs and those used in established care pathways in their areas.ResultsThere were 35 respondents from 24 countries, 89% of whom practised in tertiary level settings. A total of 14 different NITs were used, and each respondent reported using at least one (median= 3). Of the respondents, 80% reported using FIB-4 and liver stiffness by vibration-controlled transient elastography (Fibroscan®), followed by the NAFLD fibrosis score (49%). For FIB-4, 71% of respondents used a low cut-off of 7.5 to >20kPa, respectively).ConclusionsThe cut-offs used for the same NITs for NAFLD risk stratification vary between clinicians. As cut-offs impact test performance, these findings underscore the heterogeneity in risk-assessment and support the importance of establishing consistent guidelines on the standardised use of NITs in NAFLD management.Lay summaryOwing to the high prevalence of non-alcoholic fatty liver disease (NAFLD) in the general population it is important to identify those who have more advanced stages of liver fibrosis, so that they can be properly treated. Non-invasive tests (NITs) provide a practical way to assess fibrosis risk in patients. However, we found that the cut-offs used for the same NITs vary between clinicians. As cut-offs impact test performance, these findings highlight the importance of establishing consistent guidelines on the standardised use of NITs to optimise clinical management of NAFLD.

Pulmonary resection by video-assisted thoracoscopic surgery with single-lung ventilation has become a standardized modality over the last decades. With the aim to reduce surgical stress during operation procedures, some have adopted a uniportal approach in pulmonary resection as an alternative to multiportal VATS. The ERAS program has been widely spread to achieve even better outcomes. In 2004, Pompeo reported the resection of pulmonary modules by conventional VATS under intravenous anesthesia without endotracheal intubation. Within less than a decade thereafter, complete VATS pulmonary resections under anesthesia without endotracheal intubation had been reported for a range of thoracoscopic procedures. Avoiding tracheal intubation under general anesthesia can reduce the incidence of complications such as intubation-related airway trauma, residual neuromuscular blockade, ventilation-induced lung injury, impaired cardiac performance, and postoperative nausea. Numerous studies can be found especially from Asian countries, focusing on comparison of intubated and non-intubated procedures showing that non-intubated VATS could reduce the rate of postoperative complications, shorten hospital stay and decrease the perioperative mortality rate, indicating that non-intubated VATS is a safe, effective and feasible technique for thoracic disease. However, if we look closely at all studies, it is obvious that there are no significant differences between intubated and non-intubated surgery in terms of the standard procedures and maneuvers. In non-intubated procedures it can be less comfortable for the surgeon to manipulate in the thoracic cavity, but the procedural steps remain the same. All the differences between the intubated and non-intubated operation procedure are found in perioperative management of the patient. The patient is still in deep anesthesia during the procedure and hypecapnia can occur. It is easier to manage this if the patient is intubated. In addition, if a complication occurs during the operation and intubation is required, this can cause an emergent situation, which means that not all patients are suitable for such a procedure, especially those with severe emphysema, obese patients and those with a problematic oropharyngeal configuration-Mallampati score. Moreover, studies on non-intubated thoracic surgery point to shortened hospitalization, faster recovery etc. But there are also studies on intubated uniportal VATS procedures in combination with ERAS protocol showing shortened hospitalization and better outcome for patients. Currently, especially with the use of optical intubation canylas, totally intravenous anesthesia (TIVA), BIS and relaxometer, anesthesia is safe for avoiding airway injury, hypercapnia, and there is minimal risk of residual curarization as well as one of the postoperative lung complications such as microaspiration and atelectasis. In addition, the patient recovers rapidly from anesthesia and can be verticalised and mobilized a couple of hours after the operation. It is desirable to take into consideration what type of patient and what lung disease is suitable for non-intubated technique and what is more convenient for intubation.

In this article, the primary objective is to understand the resource management and know how that has made technological foresight viable in the “Núcleos de Inovação Tecnológica (NITs) of the State of Rio de Janeiro. As such, an analysis regarding the creation of an innovative environment in Brazil was conducted and the creation of the NITs, which they have as one of their competences the conducting of technological foresights. To support the research, case studies were initiated from a qualitative analysis of a range of NITs of the state of Rio de Janeiro, which are within the 28.5% that reported to “FORMICT”, base year 2017, to perform technological foresights and are “REPICT” members. Afterwards, a comparison of the technological foresight enabling traits. The uplifting results have been acknowledged by the studied NITs when performing the technological foresights. O objetivo geral deste artigo é entender o gerenciamento de recursos e know how que têm tornado viáveis estudos de prospecção tecnológica nos NITs do Estado do Rio de Janeiro. Desse modo, foi realizada uma análise acerca da criação de um ambiente inovador no Brasil e sobre a criação dos NITs, os quais possuem como uma de suas competências a realização de estudos de prospecção tecnológica. Para embasar a pesquisa, foram realizados estudos de caso a partir de uma seleção de NITs do Estado do Rio de Janeiro, esses NITs alegaram realizar estudos de prospecção tecnológica para o FORMICT ano base 2017 e disseram ser integrantes da REPICT. Percebeu-se que são poucos os estudos de prospecção tecnológica mais elaborados, já que os NITs selecionados possuem poucos profissionais na equipe dedicados a esses estudos. Mesmo com poucos estudos, resultados benéficos têm sido percebidos pelos NITs estudados ao efetuarem os estudos de prospecção tecnológica.

Introduction: Phthiriasis palpebrarum is an uncommon eyelid infestation mainly caused by Phthirus pubis also known as crab lice. Case report: A 16 years male presented with redness, itching and watering of the right eye for one week. On slit-lamp biomicroscopic examination lice and nits anchored to the eyelashes along with seborrheic material accumulation was noted. Lice, partial nits along with matted eyelashes were removed and sent to laboratory for microscopic examination. On follow up visit remaining nits were expunged. Conclusion: Meticulous slit lamp biomicroscopic examination should be done in all patients presenting with itching of the eyelids in conjunction with clinical findings resembling seborrhea and evidence for Phthiriasis palpebrarum should be looked for.

Objective: To report the occurrence and management of an eyelashes infestation by Phthirus pubis. Methods: A 27-year-old female presented with itching in her right eye and head after she had been traveling in southern Italy five days earlier. Visual acuity (VA) was 20/20 in both eyes. Slit-lamp examination showed bilateral blepharitis. Moreover, mobile insects and eggs attached to the eyelashes were observed. A microbiological study was performed with a Phthirus pubis result. The patient was treated with mechanical dislodging. Results: The resolution of the infection was carried out removing every insect and egg. A vaseline application twice daily for 7 days was necessary to stifle any nits that could remain. Conclusions: The eyelashes pediculosis is frequently caused by Phthirus pubis. Only a minor percentage of the cases are due to Phthirus capitis, but the differential diagnosis is essential: there are Phthirus pubis pediculosis cases due to sexual abuse. A sexual history and screening for other sexually transmitted diseases is warranted., GMS Ophthalmology Cases; 10:Doc09

During 2016, a joint experimental campaign was carried out by QST and Consorzio RFX on the Negative Ion Test Stand (NITS) at the QST Naka Fusion Institute, Japan, with the purpose of validating some design solutions adopted in MITICA, which is the full-scale prototype of the ITER NBI, presently under construction at Consorzio RFX, Padova, Italy. The main purpose of the campaign was to test a novel technique, for suppressing the beamlet criss-cross magnetic deflection. This new technique, involving a set of permanent magnets embedded in the Extraction Grid, named Asymmetric Deflection Compensation Magnets (ADCM), is potentially more performing and robust than the traditional electrostatic compensation methods. The results of this first campaign confirmed the effectiveness of the new magnetic configuration in reducing the criss-cross magnetic deflection. Nonetheless, contrary to expectations, a complete deflection correction was not achieved. By analyzing in detail the results, we found indications that a physical process, taking place just upstream of the plasma grid, was giving an important contribution to the final deflection of the negative ion beam. This process appears to be related to the drift of negative ions inside the plasma source, in the presence of a magnetic field transverse to the extraction direction, and results in a non-uniform ion current density extracted at the meniscus. Therefore, the numerical models adopted in the design were improved by including this previously disregarded effect, so as to obtain a much better matching with the experimental results. Based on the results of the first campaign, new permanent magnets were designed and installed on the Extraction Grid of NITS. A second QST-Consorzio RFX joint experimental campaign was then carried out in 2017, demonstrating the complete correction of the criss-cross deflection and confirming the validity of the novel magnetic configuration and of the hypothesis behind the new models. This contribution presents the results of the second joint experimental campaign on NITS along with the overall data analysis of both campaigns, and the description of the improved models. A general picture is given of the relation among magnetic field, beam energy, meniscus non-uniformity and beamlet deflection, constituting a useful database for the design of future machines.

Phthiriasis palpebrarum is a rare cause of eyelid infestation caused by phthiriasis pubis (crab louse) that mainly infests the hair of pubis and inguinal regions, but rarely eyelashes and eyelid. It is an uncommon condition of pruritus still seen in developing countries with poor personal hygiene. These conditions may have unusual presentations which may be misdiagnosed as conjunctivitis, blepharoconjunctivitis, dermatitis, or blepharitis due to similarities in the signs and symptoms. We report a case of a young male with unilateral pruritus and irritation which showed numerous nits adherent to the eyelashes and multiple lice at the base of eyelashes at the upper lid on examination. The patient was successfully treated with mechanical removal of lice and nits, and pilocarpine 2% drop were applied locally. A typical case of unilateral phthiriasis palpebrarum infestation, which is an unusual case of pruritus, is highlighted. Meticulous examination with suspicion is essential for the prompt diagnosis and treatment.

The research activity done during the three years Joint Doctorate in Fusion Science and Engineering was focused on negative ion sources and dedicated to numerical investigations of beam optics, experimental measurements and development of improvements for experimental devices. In particular, I carried out investigations on plasma source behavior and beam extraction under different operational conditions, paying special attention to beam optics improvement and co-extracted electron suppression efficiency, as well as analysing and developing solutions by means of numerical codes such as SLACCAD and OPERA, supported by dedicated post-processing by MATLAB scripts. I investigated the beam properties for three negative ion beam sources: SPIDER and NIO1 at Consorzio RFX (Padova, Italy) and NITS at National Institute for Quantum and Radiological Science and Technology (QST, Naka, Japan). SPIDER is the full-scale prototype of the negative ion source for ITER negative ion beam injectors (NBIs) and is in the advanced construction and assembly phase, so no further design improvements could have been done. SPIDER is provided with several peculiar design solutions: I have numerically assessed the efficiency of such solutions related to beam optics with 40 beamlets (half SPIDER beamlet group). I participated in the joint experiments of Consorzio RFX and QST in the NITS facility. The aim of this collaboration was to prove experimentally, for the first time, the effectiveness of a specific magnetic field configuration adopted for ITER NBIs requiring the use of the so-called ADCM magnets to correct the residual magnetic deflection of the beamlets induced by the (CESM) magnets devoted to deflect the co-extracted electrons. In particular my contribution was to design the new extraction grid and the new magnets (both CESM and ADCM) to be installed on the source. I also cooperated to the data analysis. Lastly, for the NIO1 source, I participated in the experimental sessions since the beginning, and I gave my contribution to the spectroscopic characterization of the source and to beam optics characterization. These experimental observations suggested some upgrades needed for optics improvement. Hence, I moved in this direction designing a new extraction grid and new magnet configurations. Furthermore, the successful experimental evidences at NITS have made us confident to introduce ADCM also in NIO1. This design work was performed in strict collaboration with Laboratori Nazionali di Legnaro (LNL, Legnaro, Italy). Unfortunately, these upgrades will be not installed on the source before spring 2017 and thus no experimental evidences of beam optics improvements are available yet. Concerning the thesis manuscript, it is constituted by five chapters, followed by an additional summary. Here is a brief summary of the chapter contents. In the first chapter I give an introduction on Fusion and ITER, highlighting the need for the use of NBIs in future fusion devices and the general issues related to MITICA, which is the full size prototype of ITER NBI. In the second chapter there is a general description of the theoretical considerations related to the physics of plasma in the source, beam extraction and optics, and main components constituting the ion sources. The final part of the chapter is dedicated to the presentation of the numerical tools available at Consorzio RFX: SLACCAD, EAMCC, COMSOL and OPERA. Concerning the latter, since it is the most important numerical tool I used during my PhD, I dwell more on the possibilities it can offer and I provide also a sensitivity study in order to increase the calculation precision. While the first two chapters have essentially introductory purposes, the last three present the actual activities I performed on the three ion sources, SPIDER, NITS and NIO1, as briefly described so far. In particular each of the three chapters is focused on the activity done on just one machine. Lastly, two appendixes supplement this thesis concerning further activities, which are loosely related to the rest. These are the development of an Excel GUI, in Visual Basic language, to simplify the interaction with NIO1 database (Appendix A) and investigations on the energy recovery system efficiency that NIO1 will feature in the future, an activity carried out in collaboration with CNR institute of Bari (Appendix B).

factPresentation Bu olguda her iki göz kirpiklerinde pitriyazis palpebrarum olan hasta sunulmaktadır. Kırk dokuz yaşında kadın hasta 2 aydır göz kapaklarında kaşıntı nedeniyle kliniğimize başvurdu. Hastanın hikayesinden şikayetleri için son iki aydır çeşitli ilaçların kullanıldığı öğrenildi.Biyomikroskopik muayenede göz kapağı kenarında kızarıklık, kirpik diplerinde kırmızı-kahverengi bit yumurtaları ve canlı bitler izlendi. Çayçiçeği yağı ile kirpik kenarlarına 3 kez temizlik önerildi. Kontrol vizitinde tüm yumurta ve bitlerin yokolduğu görüldü. A case with phthiriasis palbebrarum in both eyelashes is presented. A 49-year-old female patient was admitted to our clinic with itching complaint of both eye lids for 2 months. It has been learned from the patient's anamnesis that various medications have been used for the complaints over the past two months. On the biomicroscopic examination, hyperemia of the lid margin, and several red-brown nits and live lices attached to the lashes were detected. Cleaning with Tea Tree Oil was recommended on the margin of eyelashes three times a day. The control visit revealed that all the lice and nits were completely removed.

Background: Hair casts or pseudonits are tubular accretions that are movable encircling the hair shafts of the scalp. It is commonly confused as head lice or pediculosis capitis, which is a common concern in pediatric age group. Hair casts are common in psoriasis, seborrheic dermatitis, and pityriasis amiantacea. This misdiagnosis is a reason of patient and physician anxiety. We attempted to evaluate significance of trichoscopy in differentiating nits and pseudonits and therefore a better treatment plan. Aims and Objective: To evaluate trichoscopic patterns in nits and pseudonits. Methodology: The study was conducted in a tertiary hospital. Ethical clearance and consent from patients were obtained. DermLite 3 with ×10 magnification was employed for trichoscopy. Tiny concretions on the hair shafts were examined with trichoscopy. Patterns were analyzed. Results: Totally, 25 patients were included in the study with 7 boys and 18 girls. The mean age was 9 years. Trichoscopy demonstrated cylindrical white sheaths (2–7 mm) encircling the hair shafts in 15 patients (60%). Forty percent of the patients showed pyriform-shaped translucent and yellowish structures (0.8 mm) attached to hair shafts. Based on the trichoscopy patterns, diagnosis of pseudonits and nits was made in former and latter groups, respectively. Conclusion: Trichoscopy plays an important role in differentiation of nits and pseudonits. Since nits are contagious, correct diagnosis is of utmost importance for better management. Thus, trichoscopy is a reliable diagnostic procedure in daily practice of dermatologists.

This is the first part of the report on the joint experimental campaign carried out in collaboration by Consorzio RFX, Padova (Italy) and JAEA, Naka (Japan) for the development and testing of new magnetic configurations for accelerators of negative ion based neutral beam injectors. Th is f irst part reports weeks 1 - 3 of the campaign, describing the experiment preparation and the experimental campaign without Cesium seeding. Th e se cond part covers the Cs operations in week 4 - 6 and it is presented in RFX - MITICA - TN - 352 . The third part concerning data interpretation and proposal of further studies is presented in RFX - MITICA - TN - 349.

This report summarizes the design of the optics configuration and Extraction Grid to be installed on the Negative Ion Test Stand (NITS) during the joint experiments, to be carried out during the first part of 2016 in collaborati on between Consorzio RFX, Padova (Italy) and QST (formerly JAEA), Naka (Japan) . The main purpose of the joint experiments on NITS is to test for the first time, under realistic similarity conditions, the optics design of the MITICA accelerator, including the new magnetic configurations for the compensation of the typical ion beamlet deflection caused by the electron - suppression magnetic field. The results will allow to optimize the optics design of the negative ion accelerator for MITICA and for the next generation of Neutral Beam Inje c tors for ITER , JT60 - SA [1] and DEMO [8] . The first part of the report describes the mechanical design of the new grid, while in the second part the design of the related permanent magnets is illustrated.

This is the second part of the report on the joint experimental campaign carried out in collaboration by Consorzio RFX, Padova (Italy) and QST (former ly JAEA ) , Naka (Japan) for the development and testing of new magnetic configurations for accelerators of negative ion based neutral beam injectors. Th e f irst part reports weeks 1 - 3 of the campaign, describing the experiment preparation and the experimental campaign without Caesium seeding, are reported in [1] . This second pa rt covers the Cs operations in week 4 - 6. The third part concerning data interpretation and proposal of further studies is presented in [2] .

This report summarizes the proposals for additional joint experiments in the framework of the collaboration between Consorzio RFX, Padova (Italy) and QST (formerly JAEA ) , Naka (Japan) reg arding the development and testing of new magnetic configurations for accelerators of negative ion based neutral beam injectors. First, the results of the first Joint Experimental campaign of Feb - Mar 2016 are summarized and the open issues are discussed. Then, a series of additional experiments for better investigation of the beamlet formation and transport are proposed. Three chapters are dedicated to simulations devoted to the investigation of the experimental results which are not completely explained yet, and finally an analysis of the proposed experiments for 2017 is carried out.

The report describes the benchmark between the two f.e.m. codes OPERA and COMSOL in modelling the negative ion source and accelerator NITS (Negative Ion Te st Stand) located in QST lab (formerly JAEA) at Naka (Japan) . The experiments have been carried out in the framework of the RFX - QST collaboration regarding the development and testing of new magnetic configurations for accelerators of negative ion based n eutral beam injectors.

Phthiriasis palpebrarum of the eyelashes is not an uncommon condition when hygienic condition are inadequate. The lice occupy, chiefly, the roots of the eyelashes, to which they cling tenaciously, while the shafts of the cilia are covered with their brown nits. The patients with the symptom of pruritus of the eyelids and with clinical findings resembling exfoliation on the surface of lid skin and seborrhea accumulation on eyelashes must carefully be examined by slit lamp in order to avoid misdiagnosis. In the cases diagnosed as having lid eczema and seborrheic blepharitis, lice and nits might easily be overlooked and treatment might remain ineffective. Various treatment options are available from medical; mechanical removal of nits and lice, cryotherapy. In this short review we are describing in details about the organism, clinical features, mode of transmission, treatment about Phthiriasis palpebrarum.

[EN] Little is currently known about the population structure of lichen photobionts. Accordingly, in this study we analyzed the nature and distribution of phycobionts in different Spanish populations of Ramalina farinacea. Two different Trebouxia algae were isolated and identified on the basis of anatomical and chloroplast LSU rDNA sequence studies. Interestingly, most of the thalli contained the same two algae. To search for possible genetic variability among these algae, the internal transcribed sequences (ITS) of nuclear rDNA were compared. Surprisingly, only one ITS sequence was found in each thallus, even in those exhibiting multiple morphologically differentiated algae observed in thallus TEM sections. Therefore, ITS sequence analyses are probably only indicative of the predominant photobiont while the other photobiont remains undetected. One photobiont seemed to predominate in the Canary Islands populations and the other in peninsular ones. Additionally, here we describe a new potential DNA marker, based on plastid LSU rDNA, which may allow rapid identification of coexisting algae within the same thallus., This project was funded by the Spanish Ministry of Education and Science [CGL2006-12917-C00, CGL2009-13429-C02-00], and Generalitat Valenciana [PROMETEO 174/2008 GVA]. Dr. A. BECK (Germany) and reviewers are thanked for helpful comments. Wendy Ran revised the manuscript in English.

To the Editor: Bartonella quintana is a body louse–borne human pathogen that can cause trench fever, bacillary angiomatosis, endocarditis, chronic bacteremia, and chronic lymphadenopathy (1). Recently, B. quintana DNA was detected in lice collected from the heads of poor and homeless persons from the United States, Nepal, Senegal, Ethiopia, and the Democratic Republic of the Congo and in nits in France (2,3). The head louse, Pediculus humanus capitis, and the body louse, Pediculus humanus humanus, are obligatory ectoparasites that feed exclusively on human blood (4). Outside of their habitats, the 2 ecotypes are morphologically indistinguishable (1). Sequence variation in the PHUM540560 gene discriminates between head and body lice by determining the genotype of the lice (5). While surveying for trench fever among homeless persons in shelters in Marseille, France during October 2012–March 2013, we investigated the presence of B. quintana DNA in nits, larvae, and adult lice collected from mono-infested and dually infested persons and determined the genotypes of the specimens. The persons included in this study received long-lasting insecticide-treated underwear; lice were collected by removing them from clothing, including underwear, pants, and shirts. Because body lice reside in the clothing of infested persons except when feeding, they are sometimes called clothing lice. A total of 989 specimens were tested, including 149 (83 from clothing and 66 from hair) first–instar larvae hatched in the laboratory from eggs collected from 7 dually infested persons, and 840 adult body lice collected from the clothing of 80 mono-infested patients. We included DNA isolated from 3 nits collected from the hair of a mono-infested person who had previously been confirmed as positive for B. quintana (6) (Table). Table Distribution of Bartonella quintana DNA in nits, larvae, and adult body lice collected from hair and clothing of homeless persons in shelters, Marseille, France, October 2012– March 2013* Total DNA was extracted by using an EZ1 automated extractor (QIAGEN, Courtaboeuf, France) and subjected twice to real-time PCR specific for B. quintana. The first PCR targeted the 16S-23S intergenic spacer region. Positive samples were confirmed by using a second real-time PCR targeting the yopP gene (6). Samples that tested positive for B. quintana DNA were analyzed by multiplex real-time PCR that targeted the PHUM540560 gene (5). We used head and body lice that had known genotypes positive controls. Negative controls were included in each assay. Of the hatched larvae, 5 (6%) of the 83 recovered from clothing and 7 (11%) of 66 from the hair (Table) of 4 of the 7 dually infested persons were positive for B. quintana DNA (Technical Appendix). Of the 840 adult body lice, 174 (21%) collected from 42 (53%) of 80 of the mono-infested persons contained B. quintana DNA (Table, Technical Appendix). The multiplex real-time PCR that targeted the PHUM540560 gene clearly identified all nits, larvae, and adult lice as belonging to the body lice lineage. Negative controls remained negative in all PCR-based experiments. For 2 decades, B. quintana DNA has been regularly detected in lice collected from the heads of persons living in poverty, but it had not been detected in head lice that infest schoolchildren (7,8). All of the lice collected during this study that tested positive for B. quintana from homeless persons were body lice, including some that were recovered from hair. This observation supports our assertion that body lice are not confined to the body. The 3 eggs that were removed from the hair of a mono-infested homeless person whose samples tested positive for B. quintana were also body lice. During the clinical examination, no adult head lice or adult body lice were found on that person, confirming that the patient had been heavily infested with body lice in the past, not head lice. The nits were most likely laid by body lice that migrated toward the patient’s head. When a member of this research team (DR) collected the eggs from the hair shaft, they were found ≈3–3.5 cm from the hair follicle. Because hair grows ≈1.25 cm per month, the louse infestation occurred ≈3 months before egg collection (6). Homeless persons that we have monitored for many years are often heavily infested by body lice but are also occasionally infested with head lice. Before genetic tools that differentiate the head and body louse lineages were available (5), it was speculated that body lice may have originated from head lice (9). From our study, it is clear that under conditions of massive infestation, body lice can migrate and colonize hair; the opposite may also be true. However, there is no evidence that body lice are capable of causing an outbreak of lice living on the head, as happens among schoolchildren that have been found to be infested only by head lice. This suggests that body lice cannot thrive in the environment of head lice, which infest millions of children worldwide (10), further suggesting that outbreaks of trench fever are most likely not linked to head lice in industrialized countries. In conclusion, by analyzing lice harvested from the heads and clothing of homeless persons, we have shown that the 2 ecotypes belong to the same body lice population. Technical Appendix: Detailed distribution of B. quintana DNA among lice from mono-infested and dually infested homeless persons, France Click here to view.(33K, pdf)

A louse survey based on samples of cut hair collected from floors of barbershops and beauty parlors was conducted in Belo Horizonte, Minas Gerais State, Brazil, from October 1984 to April 1985, as an alternative way to determine the prevalence of pediculosis capitis in the population. Of 475 samples examined for nits, nymphs, or adults of Pediculus capitis, 140 were infested (29.5%). A total of 58 lice and 3.553 nits were found in 33.632.9 g of hair collected, giving a ratio of 0.10 nit/g. Almost 29% of the nits were viable and capable of being transmitted after hatching. There was significant difference among the infestation rates by socioeconomic levels, and samples from barbershops with male customers were the most infested. based upon the number of haircuts in each sample, we estimated that 5 or 6% of the population might be infested by this species. Foi realizado um estudo de piolhos em amostras de cabelo recolhidas do chão de barbearias e salões de beleza de Belo Horizonte, Estado de Minas Gerais, Brasil, no período de outubro de 1984 a abril de 1985, como um meio alternativo para se determinar a prevalência da pediculose do couro cabeludo junto a população. Das 475 amostras examinadas em relação a presença de lêndeas, ninfas ou adultos de Pediculus capitis, 140 estavam infestadas (29,5%). Um total de 58 piolhos e 3.553 lêndeas foi encontrado em 33.632,9 g de cabelo coletado, correspondendo a uma relação de 0,10 lêndea/grama. Quase 29% das lêndeas eram viáveis e capazes de serem transmitidas após eclosão. Houve uma diferença significativa da infestação por níveis sócio-econômico, assim como as amostras procedentes de salões masculinos foram as que se apresentaram mais infestadas. Considerando o número de cortes de cabelo por amostra, estima-se que 5 ou 6% da população poderia estar infestada por esta espécie.

A louse survey based on samples of cut hair collected from floors of barbershops and beauty parlors was conducted in Belo Horizonte, Minas Gerais State, Brazil, from October 1984 to April 1985, as an alternative way to determine the prevalence of pediculosis capitis in the population. Of 475 samples examined for nits, nymphs, or adults of Pediculus capitis, 140 were infested (29.5%). A total of 58 lice and 3.553 nits were found in 33.632.9 g of hair collected, giving a ratio of 0.10 nit/g. Almost 29% of the nits were viable and capable of being transmitted after hatching. There was significant difference among the infestation rates by socioeconomic levels, and samples from barbershops with male customers were the most infested. based upon the number of haircuts in each sample, we estimated that 5 or 6% of the population might be infested by this species.Foi realizado um estudo de piolhos em amostras de cabelo recolhidas do chão de barbearias e salões de beleza de Belo Horizonte, Estado de Minas Gerais, Brasil, no período de outubro de 1984 a abril de 1985, como um meio alternativo para se determinar a prevalência da pediculose do couro cabeludo junto a população. Das 475 amostras examinadas em relação a presença de lêndeas, ninfas ou adultos de Pediculus capitis, 140 estavam infestadas (29,5%). Um total de 58 piolhos e 3.553 lêndeas foi encontrado em 33.632,9 g de cabelo coletado, correspondendo a uma relação de 0,10 lêndea/grama. Quase 29% das lêndeas eram viáveis e capazes de serem transmitidas após eclosão. Houve uma diferença significativa da infestação por níveis sócio-econômico, assim como as amostras procedentes de salões masculinos foram as que se apresentaram mais infestadas. Considerando o número de cortes de cabelo por amostra, estima-se que 5 ou 6% da população poderia estar infestada por esta espécie.

Foram realizadas observações sobre o sítio de aderência de 3178 lêndeas em cabelos cortados e colhidos de 475 barbearias de Belo Horizonte - se na base, meio ou extremidade - e sobre o estado de viabilidade das mesmas (lêndeas formadas ou desenvolvidas). A direção do opérculo foi tomada como referência para determinação desta posição. Em outros 66 fios de cabelo foram encontradas 140 lêndeas em infestações duplas ou múltiplas. Estes dados nos permitiram estimar, de modo grosseiro, o período da infestação ao tempo do corte de cabelo (7-10 dias, em média), o tempo decorrido entre reinfestações consecutivas (21-25 dias, no mínimo), bem como em que proporção os cortes foram efetuados ou como medida de controle para tentar conter a infestação (28,8%), ou após a infestação haver sido debelada (71,2%).In 3,178 nits of Pediculus capitis attached in different cut hair and collected from floors of bar-bershops samples in Belo Horizonte, Minas Gerais State, observations were made on the point of attaehement of these nits in relation to the cut hair segments - if in the base, middle or extremity - as well as on the state ofdevelopment of them (nits developed or empty). The direction of the operculum was assumed as a criteriumfor determining of this place. Another 66 cut hairs segments presented 140 nits in double or multiple infestations. These data can help us to estimate, roughly, the relative age of the infestation at the time of the haircut (7-10 days, in average), the time spent among consecutive reinfestations'(21-25 days, at least), as well as in that proportion the haircuts were made as a control measure for the breaking ofthe infestation (28.8%), or after the pediculosis has already been overcame (71.2%).