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In addition, fibers expressing IL-31RA respond to IL-31 secreted by T cells by promoting neurite outgrowth and branching, a structural remodeling process that enhances cutaneous sensitivity to mild stimuli and represents a key mechanism underlying chronic itch (90) (124)

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These factors may include population density, vegetation [101], human modification [116], deprivation [117], tourism [118], hydrodynamic processes [119], waste management efficiency, and cigarette consumption patterns [120]

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