Bed bug
Bed bug |
|
Cimex lectularius |
Scientific classification |
Kingdom: |
Animalia |
Phylum: |
Arthropoda |
Class: |
Insecta |
Order: |
Hemiptera |
Suborder: |
Heteroptera |
Infraorder: |
Cimicomorpha |
Superfamily: |
Cimicoidea |
Family: |
Cimicidae
Latreille, 1802 |
Subfamilies, Genera & Species |
Subfamily Afrociminae
Subfamily Cimicinae
- Genus Bertilia
- Genus Cimex
- Cimex adjunctus
- Cimex antennatus
- Cimex brevis
- Cimex columbarius
- Cimex incrassatus
- Cimex latipennis
- Cimex lectularius
- Cimex hemipterus (C. rotundatus)
- Cimex pilosellus
- Cimex pipistrella
- Genus Oeciacus
- Oeciacus hirundinis[1]
- Oeciacus vicarius
- Genus Paracimex
- Genus Propicimex
Subfamily Cacodminae
- Genus Aphrania
- Genus Cacodomus
- Genus Crassicimex
- Genus Leptocimex
- Genus Loxaspis
- Genus Stricticimex
Subfamily Haematosiphoninae
- Genus Caminicimex
- Genus Cimexopsis
- Genus Haematosiphon
- Genus Hesperocimex
- Hesperocimex coloradensis
- Hesperocimex sonorensis
- Genus Ornithocoris
- Ornithocoris pallidus
- Ornithocoris toledoi
- Genus Psitticimex
- Genus Synxenoderus
Subfamily Latrocimicinae
Subfamily Primicimicinae
- Genus Bucimex
- Genus Primicimex
|
Bed bugs are parasitic insects that prefer to feed on human blood.[2] The term is used loosely to refer to any species of the genus Cimex, and even more loosely to refer to any member of the family Cimicidae (cimicids).[3] The common bedbug, Cimex lectularius, is the most famous species of the family.[3][4] The name of the "bed bug" is derived from the insect's preferred habitat of houses and especially beds or other areas where people sleep. Bed bugs are mainly active at night but are not exclusively nocturnal and are capable of feeding on their host without being noticed.
A number of adverse health effects may occur due to bed bug bites, including skin rashes, psychological effects, and allergic symptoms. Diagnosis involves both finding bed bugs and the occurrence of compatible symptoms.
Bed bugs have been known as human parasites for thousands of years.[5] At a point in the early 1940s they were mostly eradicated in the developed world but since 1995 have recently increased in prevalence.[6][7] Because infestation of human habitats has been on the increase, bed bug bites and related conditions have been on the rise as well.[5][8]
Description
Physical
Adult bed bugs are light brown to reddish-brown, flattened, oval shaped and have no hind wings but front wings are vestigial and reduced to pad-like structures. Bed bugs have segmented abdomens with microscopic hairs that give them a banded appearance. Adults grow to 4–5 mm in length and 1.5–3 mm wide. Newly hatched nymphs are translucent, lighter in colour and become browner as they moult and reach maturity. Bed bugs may be mistaken for other insects such as booklice and carpet beetles, or vice-versa.
Bed bugs use pheromones and kairomones to communicate regarding nesting locations, feeding and reproduction.
The life span of bed bugs varies by species and is also dependent on feeding.
Bed bugs can survive a wide range of temperatures and atmospheric compositions. Below 16.1 °C (61.0 °F), adults enter semi-hibernation and can survive longer.[9] Bed bugs can survive for at least five days at −10 °C (14 °F) but will die after 15 minutes of exposure to −32 °C (−26 °F).[10] They show high desiccation tolerance, surviving low humidity and a 35–40 °C range even with loss of one-third of body weight; earlier life stages are more susceptible to drying out than later ones.[11] The thermal death point for C. lectularius is high: 45 °C (113 °F), and all stages of life are killed by 7 minutes of exposure to 46 °C (115 °F).[10] Bed bugs apparently cannot survive high concentrations of carbon dioxide for very long; exposure to nearly pure nitrogen atmospheres, however, appears to have relatively little effect even after 72 hours.[12]
Feeding habits
Bed bugs are obligatory hematophagous (bloodsucking) insects. Most species feed on humans only when other prey are unavailable.[13][14][15] Bed bugs are attracted to their hosts primarily by carbon dioxide, secondarily by warmth, and also by certain chemicals.[16]
A bed bug pierces the skin of its host with what is called a stylet fascicle. This is a unit composed of the maxillae and mandibles which have been modified into elongate shapes from a basic, ancestral style. The right and left maxillary stylets are connected at their midline and a section at the centerline forms a large food canal and a smaller salivary canal. The entire maxillary and mandibular bundle penetrates the skin. The tips of the right and left maxillary stylets are not the same: the right is hook-like and curved, the left straight. The right and left mandibular stylets extend along the outer sides of their respective maxillary stylets and do not reach anywhere near the tip of the fused maxillary stylets. The stylets are retained in a groove in the labium and during feeding they are freed from the groove as the jointed labium is bent or folded out of the way: its tip never enters the wound. The mandibular stylet tips have small teeth and through alternately moving these stylets back and forth, the insect cuts a path through tissue for the maxillary bundle to reach an appropriate sized blood vessel. Feeding by sucking for about three to five minutes or more, the bug then withdraws the stylet bundle from the feeding position and retracts it back into the labial groove, folds the entire unit back under the head, and returns to its hiding place.[4] It takes between five to ten minutes for a bed bug to become completely engorged with blood.”[17]
Although bed bugs can live for a year without feeding,[18] they normally try to feed every five to ten days. In cold weather, bed bugs can live for about a year; at temperatures more conducive to activity and feeding, about 5 months.[19]
At the 57th Annual Meeting of the Entomological Society of America in 2009, newer generations of pesticide-resistant bed bugs in Virginia were reported to survive only two months without feeding.[20]
DNA from human blood meals from bed bugs can be recovered for up to 90 days, which may allow them to be used for forensic purposes for identifying on whom the bed bugs have been feeding.[21][22]
Reproduction
All bed bugs mate by traumatic insemination.[3][23] Female bed bugs possess a reproductive tract that functions during oviposition, but the male doesn't use this tract for sperm insemination.[3] Instead, the male pierces the female's abdomen with his hypodermic genitalia and ejaculates into the body cavity. In all bed bug species except Primicimex cavernis, sperm are injected into the mesospermalege,[3] a component of the spermalege,[3] a secondary genital structure that reduces the wounding and immunological costs of traumatic insemination.[24][25][26] Injected sperm travel via the haemolymph (blood) to sperm storage structures called seminal conceptacles, with fertilisation eventually taking place at the ovaries.[25]
Male bed bugs sometimes attempt to mate with other males and pierce the latter in the abdomen.[27] This behaviour occurs because sexual attraction in bed bugs is based primarily on size, and males will mount any freshly fed partner regardless of sex.[28] The "bed bug alarm pheromone" consists of (E)-2-octenal and (E)-2-hexenal. It is released when a bed bug is disturbed, as during an attack by a predator. A 2009 study demonstrated that the alarm pheromone is also released by male bed bugs to repel other males who attempt to mate with them.[26]
C. lectularius and C. hemipterus will mate with each other given the opportunity, but the eggs then produced are usually sterile. In a 1988 study, 1 egg out of 479 was fertile and resulted in a hybrid, C. hemipterus × lectularius.[29][30]
Life stages
Bed bugs have six life stages (five immature and an adult stage).[31] They will shed their skins through a molting process (ecdysis) throughout multiple stages of their lives. The discarded outer shells look like clear, empty exoskeletons of the bugs themselves. Bed bugs must molt six times before becoming fertile adults.
Infestation
Bed bugs can cause a number of health effects including skin rashes, psychological effects and allergic symptoms.[32] They are able to be infected by at least 28 human pathogens, but no study has clearly found that the insect is able to transmit the pathogen to a human being.[33] Bed bug bites or cimicosis may lead to a range of skin manifestations from no visible effects to prominent blisters.[34] Diagnosis involves both finding bed bugs and the occurrence of compatible symptoms.[32] Treatment involves the elimination of the insect but is otherwise symptomatic.[32] They have been found with methicillin-resistant Staphylococcus aureus MRSA[35] and with vancomycin-resistant Enterococcus faecium (VRE) but the significance of this is still unknown.[36]
Cause
Dwellings can become infested with bed bugs in a variety of ways, such as:
- Bugs and eggs inadvertently brought in from other infested dwellings by visiting pets,[37] or a visiting person's clothing or luggage.
- Infested items (such as furniture, clothing or backpacks) brought in.
- Nearby dwellings or infested items, if there are easy routes that the bugs may travel (through duct work or false ceilings).
- Wild animals (such as bats or birds)[38][39] that may also harbor bed bugs or related species such as the bat bug.
- People or pets visiting an infested areas (apartment, subway, movie theater, or hotel) and carrying the bugs to another area on their clothing, luggage, or body.
Detection
Bed bugs are elusive and usually nocturnal, which can make them hard to spot. They often lodge unnoticed in dark crevices, and eggs can be nestled in fabric seams. Aside from bite symptoms, signs include fecal spots, blood smears on sheets, and molts.
Bed bugs can be found singly, but often congregate once established. They usually remain close to hosts, commonly in or near beds or couches. Harborage areas can vary greatly, however, including luggage, vehicles, furniture and bedside clutter. Bed bugs may also nest near animals that have nested within a dwelling, such as bats, birds,[39] or rodents. The eggs of bed bugs are found in similar places where the bed bugs themselves are found, and are attached to surfaces by a sticky substance.
Attractant devices for detection use heat and/or carbon dioxide.[20]
Bed bugs can be detected by their characteristic smell of over-ripe raspberries.[40] Bed bug detection dogs are trained to pinpoint infestations, with a possible accuracy rate of 97.5%, based upon tests conducted under controlled conditions by researchers.[10][41] The success rates in these tests may not reflect real world success rates of a pest companies’ dogs, operating with many more variables in the field.[42] Dog detection can often occur in minutes where a pest control practitioner might need an hour. In the United States, about 100 dogs are used to find bed bugs as of mid-2009.[43] A few companies are experimenting with high speed gas chromatography to detect bed bugs and other insect vermin.
Management
Eradication of bed bugs frequently requires a combination of pesticide and non-pesticide approaches.[5][8] Pesticides that have historically been found to be effective include: pyrethroids, dichlorvos and malathion.[8] Resistance to pesticides has increased significantly over time and there are concerns of negative health effects from their use.[5] Mechanical approaches such as vacuuming up the insects and heat treating or wrapping mattresses have been recommended.[5]
The carbamate insecticide propoxur is highly toxic to bed bugs, but in the United States the Environmental Protection Agency (EPA) has been reluctant to approve such an indoor use because of its potential toxicity to children after chronic exposure.[44]
Predators
Natural enemies of bed bugs include the masked hunter (also known as "masked bed bug hunter"),[45] cockroaches,[46] ants, spiders (particularly Thanatus flavidus), mites and centipedes. The Pharaoh ant's (Monomorium pharaonis) venom is lethal to bed bugs. Biological pest control is not very practical for eliminating bed bugs from human dwellings.[10]
Epidemiology
Bed bugs occur around the world.[47] Rates of infestations in developed countries, while decreasing from the 1930s to the 1980s, have increased dramatically since the 1980s.[5][8][47] Previously, they were common in the developing world, but rare in the developed world.[8] The increase in the developed world may have been caused by increased international travel, resistance to insecticides, and the use of new pest-control methods that do not affect bed bugs.[48][49] The fall in bed bug populations after the 1930s in the developed world is believed to be partly due to the use of DDT to kill cockroaches.[50] The invention of the vacuum cleaner and simplification of furniture design may have also played a role.[50] Others believe it might simply be the cyclical nature of the organism.[51] The exact causes of this resurgence remain unclear; it is variously ascribed to greater foreign travel, more frequent exchange of second-hand furnishings among homes, a greater focus on control of other pests resulting in neglect of bed bug countermeasures, and increasing resistance to pesticides.[8][48]
The common bed bug (Cimex lectularius) is the species best adapted to human environments. It is found in temperate climates throughout the world. Other species include Cimex hemipterus, found in tropical regions, which also infests poultry and bats, and Leptocimex boueti, found in the tropics of West Africa and South America, which infests bats and humans. Cimex pilosellus and Cimex pipistrella primarily infest bats, while Haematosiphon inodora, a species of North America, primarily infests poultry.[52]
History
C. lectularius may have originated in the Middle East, in caves inhabited by bats and humans.[14]
Bed bugs were mentioned in ancient Greece as early as 400 BC, and were later mentioned by Aristotle. Pliny's Natural History, first published circa 77 AD in Rome, claimed bed bugs had medicinal value in treating ailments such as snake bites and ear infections. (Belief in the medicinal use of bed bugs persisted until at least the 18th century, when Guettard recommended their use in the treatment of hysteria.[53]) Bed bugs were first mentioned in Germany in the 11th century, in France in the 13th century and in England in 1583,[14] though they remained rare in England until 1670. Some in the 18th century believed bed bugs had been brought to London with supplies of wood to rebuild the city after the Great Fire of London (1666). Giovanni Antonio Scopoli noted their presence in Carniola (roughly equivalent to present-day Slovenia) in the 18th century.[54][55]
Traditional methods of repelling and/or killing bed bugs include the use of plants, fungi, and insects (or their extracts), such as black pepper,[56] black cohosh (Actaea racemosa), Pseudarthria hookeri, Laggera alata (Chinese yángmáo cǎo | 羊毛草),[10] Eucalyptus saligna oil,[57][58] henna (Lawsonia inermis or camphire),[59] "infused oil of Melolontha vulgaris" (presumably cockchafer), fly agaric (Amanita muscaria), Actaea spp. (e.g. black cohosh), tobacco, "heated oil of Terebinthina" (i.e. true turpentine), wild mint (Mentha arvensis), narrow-leaved pepperwort (Lepidium ruderale), Myrica spp. (e.g. bayberry), Robert geranium (Geranium robertianum), bugbane (Cimicifuga spp.), "herb and seeds of Cannabis", "opulus" berries (possibly maple or European cranberrybush), masked hunter bugs (Reduvius personatus), "and many others".[60]
In the mid-19th century, smoke from peat fires was recommended.[61]
Dusts have been used to ward off insects from grain storage for centuries, including "plant ash, lime, dolomite, certain types of soil, and diatomaceous earth (DE) or Kieselguhr".[62] Of these, diatomaceous earth in particular has seen a revival as a nontoxic (when in amorphous form) residual pesticide for bed bug abatement. Insects exposed to diatomaceous earth may take several days to die.[62]
Basket-work panels were put around beds and shaken out in the morning, in the UK and in France in the 19th century. Scattering leaves of plants with microscopic hooked hairs around a bed at night, then sweeping them up in the morning and burning them, was a technique reportedly used in southern Rhodesia and in the Balkans.[19]
Prior to the mid-twentieth century, bed bugs were very common. According to a report by the UK Ministry of Health, in 1933 there were many areas where all the houses had some degree of bed bug infestation.[63]
Bed bugs were a serious problem during World War II. General MacArthur commented that bed bugs are the "greatest nuisance insect problem ... at bases in the U.S"[64]
With the arrival of potent pesticides, famously DDT in the 1940s, bed bugs almost disappeared in Western countries.[65] However, bed bug infestations have resurged in recent years, for reasons which are not clear, but contributing factors may be complacency, increased resistance, bans on pesticides and increased international travel.[65] The current wave of bed bug infestations across America has spawned an industry for bed bug prevention, eradication and the reporting of infestations.
Society and culture
The saying "Good night, sleep tight, don't let the bed bugs bite." is common for parents to say to young children before they go to sleep.[66]
Naming
The term bedbug may also be spelled bed bug or bed-bug. They have been known by a variety of other names including wall louse, mahogany flat, crimson rambler, heavy dragoon, chinche bug, and redcoat.[67][68]
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- ^ Encyclopedia Americana, 1996 ed., v. 3, p. 413
- ^ a b Heukelbach, J; Hengge, UR (2009). "Bed bugs, leeches and hookworm larvae in the skin". Clinics in dermatology 27 (3): 285–90. doi:10.1016/j.clindermatol.2008.10.008. PMID 19362691 pmid 19362691
- ^ a b A Romero, MF Potter, DA Potter, KF Haynes (2007). "Insecticide Resistance in the Bed Bug: A Factor in the Pest’s Sudden Resurgence?". Journal of medical entomology 22 (2): 175–178. doi:10.1603/0022-2585(2007)44[175:IRITBB]2.0.CO;2. ISSN 0022-2585. http://www.thermal-remediation.com/users/thermal_remediation/files/Insecticide%20Resistance%20in%20the%20Bed%20Bug%20-%20A%20Factor%20in%20the%20Pests%20Sudden%20Resurgence.pdf. Retrieved 2010-09-17.
- ^ Owen, James (13 May 2004). "Bloodthirsty Bedbugs Stage Comeback in U.S., Europe". National Geographic News. National Geographic. http://news.nationalgeographic.com/news/2004/05/0513_040513_bedbugs.html. Retrieved 31 May 2010.
- ^ a b Krause-Parello CA, Sciscione P (April 2009). "Bedbugs: an equal opportunist and cosmopolitan creature". J Sch Nurs 25 (2): 126–32. doi:10.1177/1059840509331438. PMID 19233933.
- ^ [4] p. 131
- ^ Cranshaw, W.S.; Camper, M.; Peairs, F.B. (Feb 2009). "Bat Bugs and Bed Bugs". Colorado State University Extension. http://www.ext.colostate.edu/PUBS/INSECT/05574.html. Retrieved 27 May 2010.
- ^ William Smith and Charles Anthon, A dictionary of Greek and Roman antiquities, 1847, pp. 252–253 http://books.google.com/books?id=41oMAAAAYAAJ&dq=cimex&source=gbs_navlinks_s
- ^ "That soon after the Fire of London, in some of the new-built Houses they were observ'd to appear, and were never noted to have been seen in the old, tho' they were then so few, as to be little taken notice of; yet as they were only seen in Firr-Timber, 'twas conjectured they were then first brought to England in them; of which most of the new Houses were partly built, instead of the good Oak destroy'd in the old." John Southall, A Treatise of Buggs [sic], pp. 16–17. http://www.archive.org/details/atreatisebuggss00soutgoog
- ^ "According to Scopoli's 2nd work (loc. cit.), found in Carniola and adjoining regions. According to Linnaeus' 2nd work on exotic insects (loc. cit.), before the era of health, already in Europe, seldom observed in England before 1670." Johann Friedrich Wolff and Johann Philip Wolff, Icones Cimicum descriptionibus illustratae, fourth fascicle (1804), p. 127. http://www.archive.org/details/iconescimicumdes00wolf
- ^ George Orwell, Down and Out in Paris and London, 1933
- ^ Schaefer, C.W.; Pazzini, A.R. (28 July 2000). Heteroptera of Economic Importance. Boca Raton, FL: CRC Press. p. 525. ISBN 0849306957. http://books.google.com/?id=AVcBI0GL-fQC&lpg=PP1&dq=Heteroptera%20of%20Economic%20Importance&pg=PA525#v=onepage&q=eucalyptus.
- ^ Kambu, Kabangu; Di Phanzu, N.; Coune, Claude; Wauters, Jean-Noël; Angenot, Luc (1982). "Contribution à l'étude des propriétés insecticides et chimiques d'Eucalyptus saligna du Zaïre (Contribution to the study of insecticide and chemical properties of Eucalyptus saligna from Zaire ( Congo))". Plantes Médicinales et Phytothérapie (Paris: Jouve) 16 (1): 34–38. http://hdl.handle.net/2268/14438.
- ^ Rictor Norton, Early Eighteenth-Century Newspaper Reports: A Sourcebook, "Getting Rid of Bed-Bugs", 18 November 2001, updated 30 November 2001 <http://grubstreet.rictornorton.co.uk/bedbugs.htm>
- ^ Johann Friedrich Wolff and Johann Philip Wolff, Icones Cimicum descriptionibus illustratae, fourth fascicle (1804), p. 127. http://www.archive.org/stream/iconescimicumdes00wolf#page/n163/mode/2up
- ^ (no byline) (17 June 1848). "Peat and peat mosses". Scientific American 3 (39): 307. http://digital.library.cornell.edu/cgi/t/text/pageviewer-idx?c=scia&cc=scia&idno=scia0003-33&node=scia0003-33:1&frm=frameset&view=image&seq=309. Retrieved 26 May 2010.
- ^ a b Hill, Stuart B. (May 1986). "Diatomaceous Earth: A Non Toxic Pesticide". Macdonald J. (Ste-Anne de Bellevue, QC: Macdonald College) 47 (2): 14–42. http://eap.mcgill.ca/publications/eap4.htm. Retrieved 26 May 2010.
- ^ Boase, Clive J. (April 2004). "Bed-bugs – reclaiming our cities". Biologist 51: 1–4. http://scholar.google.com/scholar_alerts?view_op=create_alert_options. Retrieved 2010-06-07
- ^ http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA506261&Location=U2&doc=GetTRDoc.pdf#page=23
- ^ a b Newsweek (September 8, 2010). "The Politics of Bedbugs". http://www.newsweek.com/2010/09/08/conservatives-blame-environmentalists-for-bedbugs.html. Retrieved October 28, 2010.
- ^ Berg, Rebecca. "Bed Bugs: The Pesticide Dilemma." Journal of Environmental Health 72.10 (2010): 32–35. Academic Search Premier. . Web. 30 Nov. 2010.
- ^ Capinera, John L. (17 Sep 2008). Encyclopedia of Entomology, Volume 1 (2nd ed.). Springer. ISBN 1402062427.
- ^ Dini Miller. "Bed Bugs (Hemiptera: Cimicidae: Cimex spp.". Virginia Tech University, VA.
Further reading
- Stephen Doggett. A Code of Practice for the Control of Bed Bugs in Australia. 3rd edition, ICPMR & AEPMA, Sydney Australia, May 2010. ISBN 1-74080-122-9. This is free from www.bedbug.org.au.
- Stephen Doggett. A Bed Bug Management Policy for Accommodation Providers. Draft first ed, ICPMR, Sydney Australia, May 2010. This is free from www.bedbug.org.au.
- David Cain, Richard Strand. Bed Bug Beware: An easy to understand guide to bed bugs, their prevention and control. Loughborough, United Kingdom: Foxhill Publishing, March 2009. ISBN 978-0-9562617-0-0
- Larry Pinto, Richard Cooper, Sandy Kraft. Bed Bug Handbook: The Complete Guide to Bed Bugs and Their Control. Mechanicsville, Maryland: Pinto & Associates, December 2007. ISBN 978-0-9788878-1-0
- Forsyth, Adrian. A Natural History of Sex: The Ecology and Evolution of Mating Behavior. Richmond Hill, Ontario: Firefly Books, 2001. ISBN 1-55209-481-2.
- MacQuitty, Miranda, and Lawrence Mound. Megabugs: The Natural History Museum Book of Insects. New York: Random House Children's Books, 1995. ISBN 1-898304-37-8, ISBN 1-85868-045-X.
- Goddard, Jerome A. The Physician’s Guide to Arthropods of Medical Importance (second edition).
External links
- bed bug on the University of Florida/IFAS Featured Creatures Web site
- Pollack, Richard; Alpert, Gary (2005). "Bedbugs: Biology and Management". Harvard School of Public Health. http://www.hsph.harvard.edu/bedbugs/. Retrieved 2010-06-21.
- National Geographic segment on Bed bugs
- Bed bugs – University of Sydney and Westmead Hospital Department of Medical Entomology
- "Vector surveillance and control: Bed bug fact sheet" NYC Department of Health and Mental Hygiene 12 January 2008
- Understanding and Controlling Bed Bugs – National Pesticide Information Center
- Bed Bug Infestations in an Urban Environment, Stephen W. Hwang, Tomislav J. Svoboda, Iain J. De Jong, Karl J. Kabasele, and Evie Gogosis : Emerging Infectious Diseases, Vol. 11, No. 4, April 2005.
- Barb Ogg (2010). "Bed Bug Management". Insects, Spiders, Mice and More. University of Nebraska-Lincoln Extension in Lancaster County. http://lancaster.unl.edu/pest/resources/BedBug263.shtml. Retrieved 2010-06-21.
- Taisey, Allison A.; Neltner, Tom (Feb 2010). What's Working for Bed Bug Control in Multifamily Housing: Reconciling best practices with research and the realities of implementation. National Center for Healthy Housing. http://www.healthyhomestraining.org/ipm/NCHH_Bed_Bug_Control_2-12-10.pdf
- CISR: Center for Invasive Species Research More information on Bed Bugs, with lots of photos and video
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Brain waves |
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Benign
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dsrd (o, p, m, p, a, d, s), sysi/epon, spvo
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proc(eval/thrp), drug(N5A/5B/5C/6A/6B/6D)
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anat(n/s/m/p/4/e/b/d/c/a/f/l/g)/phys/devp
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noco(m/d/e/h/v/s)/cong/tumr, sysi/epon, injr
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proc, drug(N1A/2AB/C/3/4/7A/B/C/D)
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