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On page 1 showing 1 ~ 20 papers out of 42,979 papers

Soluble biological markers in osteoarthritis.

  • Jean-Charles Rousseau‎ et al.
  • Therapeutic advances in musculoskeletal disease‎
  • 2021‎

In recent years, markers research has focused on the structural components of cartilage matrix. Specifically, a second generation of degradation markers has been developed against type II collagen neoepitopes generated by specific enzymes. A particular effort has been made to measure the degradation of minor collagens III and X of the cartilage matrix. However, because clinical data, including longitudinal controlled studies, are very scarce, it remains unclear whether they will be useful as an alternative to or in combination with current more established collagen biological markers to assess patients with osteoarthritis (OA). In addition, new approaches using high-throughput technologies allowed to detect new types of markers and improve the knowledge about the metabolic changes linked to OA. The relative advances coming from phenotype research are a first attempt to classify the heterogeneity of OA, and several markers could improve the phenotype characterization. These phenotypes could improve the selection of patients in clinical trials limiting the size of the studies by selecting patients with OA characteristics corresponding to the metabolic pathway targeted by the molecules evaluated. In addition, the inclusion of rapid progressors only in clinical trials would facilitate the demonstration of efficacy of the investigative drug to reduce joint degradation. The combination of selective biochemical markers appears as a promising and cost-effective approach to fulfill this unmet clinical need. Among the various potential roles of biomarkers in OA, their ability to monitor drug efficacy is probably one of the most important, in association with clinical and imaging parameters. Biochemical markers have the unique property to detect changes in joint tissue metabolism within a few weeks.


Biological Markers in Anxiety Disorders.

  • Kacper Łoś‎ et al.
  • Journal of clinical medicine‎
  • 2021‎

Anxiety disorders are one of the most commonly reported disorders in psychiatry, causing a high medical and socio-economic burden. Recently, there has been a soaring interest in the biological basis of anxiety disorders, which is reflected in an increasing number of articles related to the topic. Due to the ambiguity of the diagnosis and a large number of underdiagnosed patients, researchers are looking for laboratory tests that could facilitate the diagnosis of anxiety disorders in clinical practice and would allow for the earliest possible implementation of appropriate treatment. Such potential biomarkers may also be useable in monitoring the efficacy of pharmacological therapy for anxiety disorders. Therefore this article reviews the literature of potential biomarkers such as components of saliva, peripheral blood, cerebrospinal fluid (CSF), and neuroimaging studies. There are promising publications in the literature that can be useful. The most valuable and promising markers of saliva are cortisol, lysozyme, and α-amylase (sAA). In the blood, in turn, we can distinguish serotonin, brain-derived serum neurotrophic factor (BDNF), cortisol, and microRNA. Structural changes in the amygdala and hippocampus are promising neuroimaging markers, while in CSF, potential markers include oxytocin and 5-Hydroxyindoleacetic acid (5-HIAA). Unfortunately, research in the field of biomarkers is hampered by insufficient knowledge about the etiopathogenesis of anxiety disorders, the significant heterogeneity of anxiety disorders, frequent comorbidities, and low specificity of biomarkers. The development of appropriate biomarker panels and their assessment using new approaches may have the prospective to overcome the above-mentioned obstacles.


Biological Markers for Pulpal Inflammation: A Systematic Review.

  • Dan-Krister Rechenberg‎ et al.
  • PloS one‎
  • 2016‎

Pulpitis is mainly caused by an opportunistic infection of the pulp space with commensal oral microorganisms. Depending on the state of inflammation, different treatment regimes are currently advocated. Predictable vital pulp therapy depends on accurate determination of the pulpal status that will allow repair to occur. The role of several players of the host response in pulpitis is well documented: cytokines, proteases, inflammatory mediators, growth factors, antimicrobial peptides and others contribute to pulpal defense mechanisms; these factors may serve as biomarkers that indicate the status of the pulp. Therefore, the aim of this systematic review was to evaluate the presence of biomarkers in pulpitis.


Biological Markers Predictive of Invasive Recurrence in DCIS.

  • Sharon Nofech-Mozes‎ et al.
  • Clinical medicine. Oncology‎
  • 2008‎

DCIS is a heterogeneous group of non-invasive cancers of the breast characterized by various degrees of differentiation and unpredictable propensity for transformation into invasive carcinoma. We examined the expression and prognostic value of 9 biological markers with a potential role in tumor progression in 133 patients with pure DCIS treated with breast conserving surgery alone, between 1982-2000. Histology was reviewed and immunohistochemical staining was performed. Pearson correlation coefficient was used to determine the associations between markers and histopathological features. Univariate and multivariate analysis examined associations between time to recurrence and clinicopathologic features and biological markers.Median age at diagnosis was 55 years (25-85). With a median follow up of 8.91 years, 41/133 patients recurred (21 as invasive recurrence). In this cohort 13.5% had low, 43% intermediate and 42% high nuclear grade. Comedo necrosis was found in 65% of cases. Expression of ER (62.4%), PR (55.6%), HER2/neu (31.6%), MIB1 (39.8%), p53 (22.6%), p21 (39.8%), Cyclin D1 (95.5%) calgranulin (20.5%), psoriasin (12%), was found in DCIS. HER2/neu was overexpressed in 45% that recurred as DCIS and 42.9% that recurred as invasive cancer, and only in 26.1% in cases that never recurred. On univariate analysis, HER2/neu overexpression was the only marker associated with an increased risk for any recurrence (p = 0.044). The hazard ratio for recurrence for HER2/neu positive DCIS was 1.927 (confidence interval 1.016-3.653) compared to HER2 negative DCIS. On multivariate analysis, HER2/neu overexpression remained the only independent variable significantly associated with any recurrence (p = 0.014) and with invasive recurrence (p = 0.044).This data suggest that HER2/neu testing may become an important parameter in the management of DCIS and the treatment of cases with positive HER2/neu status could be modified accordingly, similar to the current approach for HER2/neu positive invasive disease.


Biological markers and Alzheimer disease: a canadian perspective.

  • Hyman M Schipper‎
  • International journal of Alzheimer's disease‎
  • 2010‎

Decreased beta-amyloid(1-42) and increased phospho-tau protein levels in the cerebrospinal fluid (CSF) are currently the most accurate chemical neurodiagnostics of sporadic Alzheimer disease (AD). A report (2007) of the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (2006) recommended that biological markers should not be currently requisitioned by primary care physicians in the routine investigation of subjects with memory complaints. Consideration for such testing should prompt patient referral to a specialist engaged in dementia evaluations or a Memory Clinic. The specialist should consider having CSF biomarkers (beta-amyloid(1-42) and phospho-tau) measured at a reputable facility in restricted cases presenting with atypical features and diagnostic confusion, but not as a routine procedure in all individuals with typical sporadic AD phenotypes. We submit that developments in the field of AD biomarker discovery since publication of the 3rd CCCDTD consensus data do not warrant revision of the 2007 recommendations.


Floral markers and biological activity of Saudi honey.

  • Ibrahim A Alotibi‎ et al.
  • Saudi journal of biological sciences‎
  • 2018‎

The objectives of this research were to identify certain chemical compounds that may be used as fingerprints of Saudi honey and to evaluate their antioxidant and antibacterial activities. Eleven Saudi 'monofloral' honey samples were analyzed and evaluated. Non-phenolic compounds, such as 2,3-dihydro-3,5-dihydroxy-6-methyl-4H-pyran-4-one, methyl 3-hydroxyhexanaote and 5-hydroxymethyl-2-furancarboxaldehyde were present in different types of tested honey samples. Glyceraldehyde was only detected in five of the honey samples tested. The most promising result was the detection of an alkaloid (by using GC-MS) in only two types of Saudi honey samples. This alkaloid may be of great importance and has the potential to be used as a fingerprint marker for the botanical sources of the various honey samples tested. This alkaloid was present in Toran and Saha. The detected compound is 2-amino-4-hydroxypteridine-6-carboxylic acid, which may originate from the degradation of folic acid as identified by previous studies. These findings can be used as a gateway to obtain a fingerprint for these two types of honey samples and can potentially be used to track any impurities in honey sold on the market. All of the tested honey samples showed antioxidant and antibacterial activities. The highly effective activity was in Toran honey against Staphylococcus aureus and Methicillin resistant Staphylococcus aureus (MRSA). Shafalah honey was effective against MRSA and Acinetobacter baumannii which showed bactericidal effects at concentrations 70-100%. This study also examined the antioxidant activity of honey samples using the DPPH assay. DPPH values of tested honey samples varied between 53.93 ± 0.21%, as the highest value and 5.89 ± 0.125%, as the lowest value. Significant correlations between the antibacterial and the antioxidant activities of the tested honey samples were noticed. The corresponding total phenolic contents (TPC) values supported the fact that phenolic compounds enhanced the antibacterial activity. The study revealed that some of the locally produced honey samples, specifically Zaitoon, Shaflah, Saha, Rabea Aja and Bareq contained the monosaccharides called glyceraldehydes which was the precursor to produce methylglyoxal (MGO) compound, which has antibacterial effects as documented in several previous studies. There was no clear relationship between these activities and the sum total of phenolic compounds present in Saudi honey.


Acculturation and biological stress markers: A systematic review.

  • Laura Scholaske‎ et al.
  • Psychoneuroendocrinology‎
  • 2021‎

The association of acculturation with health among immigrant populations is believed to be mediated, in part, by acculturation-related stress and stress biology.


Biological markers and cardiac remodelling following the myocardial infarction.

  • Olga Gruzdeva‎ et al.
  • Aging‎
  • 2019‎

To assess growth stimulating factor ST2 and N-terminal pro b-type natriuretic peptide (NT-proBNP) levels in the sera of myocardial infraction (MI) patients, and their correlation with the adaptive and maladaptive variants of cardiac remodelling.


Relationship between Inflammatory and Biological Markers and Lung Cancer.

  • Füsun Şahin‎ et al.
  • Journal of clinical medicine‎
  • 2018‎

We seek to define inflammatory markers, lipid and protein profiles that may aid in distinguishing lung cancer cases from those who are healthy and to determine the relationships between these levels and cancer stage and cell type. Lung cancer patients (n = 140, Group 1) and healthy cases (n = 50, Group 2) were enrolled. We retrieved platelet, platelet-associated markers (plateletcrit (PCT), mean platelet volume (MPV), platelet distribution width (PDW)), neutrophil/lymphocyte ratio-NLR, platelet/lymphocyte ratio-PLR, lipids (total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), triglycerides), proteins (total protein (TP) and albumin), and C-reactive protein (CRP) from electronic records and compared the data from lung cancer patients with those from healthy controls. Platelet, PCT, neutrophil, NLR, PLR, triglycerides, VLDL, and CRP levels were significantly higher in Group 1 compared with Group 2. MPV, lymphocyte, albumin, and HDL levels were significantly lower in Group 1 compared with Group 2. No significant relationship was evident between histopathological types and the level of any marker. Compared to those with early-stage cancer, changes in marker levels in those with advanced-stage cancer were statistically significant. CRP and NLR were significantly higher; albumin and HDL were lower in metastatic patients. We found that platelet, PCT, NLR and PLR, albumin, HDL, and CRP levels aided in lung cancer diagnosis and the detection of late-stage disease. Furthermore, these inflammatory and biological markers are thought to be particularly useful in following the severity of lung cancer.


Identifying biological markers for improved precision medicine in psychiatry.

  • Erin Burke Quinlan‎ et al.
  • Molecular psychiatry‎
  • 2020‎

Mental disorders represent an increasing personal and financial burden and yet treatment development has stagnated in recent decades. Current disease classifications do not reflect psychobiological mechanisms of psychopathology, nor the complex interplay of genetic and environmental factors, likely contributing to this stagnation. Ten years ago, the longitudinal IMAGEN study was designed to comprehensively incorporate neuroimaging, genetics, and environmental factors to investigate the neural basis of reinforcement-related behavior in normal adolescent development and psychopathology. In this article, we describe how insights into the psychobiological mechanisms of clinically relevant symptoms obtained by innovative integrative methodologies applied in IMAGEN have informed our current and future research aims. These aims include the identification of symptom groups that are based on shared psychobiological mechanisms and the development of markers that predict disease course and treatment response in clinical groups. These improvements in precision medicine will be achieved, in part, by employing novel methodological tools that refine the biological systems we target. We will also implement our approach in low- and medium-income countries to understand how distinct environmental, socioeconomic, and cultural conditions influence the development of psychopathology. Together, IMAGEN and related initiatives strive to reduce the burden of mental disorders by developing precision medicine approaches globally.


Chemical, biological, and DNA markers for tracing slaughterhouse effluent.

  • P J Harvey‎ et al.
  • Environmental research‎
  • 2017‎

Agricultural practices, if not managed correctly, can have a negative impact on receiving environments via waste disposal and discharge. In this study, a chicken slaughter facility on the rural outskirts of Sydney, Australia, has been identified as a possible source of persistent effluent discharge into a peri-urban catchment. Questions surrounding the facility's environmental management practices go back more than four decades. Despite there having never been a definitive determination of the facility's impact on local stream water quality, the New South Wales Environment Protection Authority (NSW EPA) has implemented numerous pollution reduction requirements to manage noise and water pollution at the slaughter facility. However, assessment of compliance remains complicated by potential additional sources of pollution in the catchment. To unravel this long-standing conundrum related to water pollution we apply a forensic, multiple lines of evidence approach to delineate the origin of the likely pollution source(s). Water samples collected between 2014 and 2016 from irrigation pipes and a watercourse exiting the slaughter facility had elevated concentrations of ammonia (max: 63,000µg/L), nitrogen (max: 67,000µg/L) and phosphorus (max: 39,000µg/L), which were significantly higher than samples from adjacent streams that did not receive direct runoff from the facility. Arsenic, sometimes utilised in growth promoting compounds, was detected in water discharging from the facility up to ~4 times (max 3.84µg/L) local background values (<0.5µg/L), with inorganic As(∑V+III) being the dominant species. The spatial association of elevated water pollution to the facility could not unequivocally distinguish a source and consequently DNA analysis of a suspected pollution discharge event was undertaken. Analysis of catchment runoff from several local streams showed that only water sampled at the downstream boundary of the facility tested positive for chicken DNA, with traces of duck DNA being absent, which was a potential confounder given that wild ducks are present in the area. Further, PCR analysis showed that only the discharge water emanating from the slaughter facility tested positive for a generalized marker of anthropogenic pollution, the clinical class 1 integron-integrase gene. The environmental data collected over a three-year period demonstrates that the slaughter facility is indisputably the primary source of water-borne pollution in the catchment. Moreover, application of DNA and PCR for confirming pollution sources demonstrates its potential for application by regulators in fingerprinting pollution sources.


Biological ageing and frailty markers in breast cancer patients.

  • Barbara Brouwers‎ et al.
  • Aging‎
  • 2015‎

Older cancer patients are a highly heterogeneous population in terms of global health and physiological reserves, and it is often difficult to determine the best treatment. Moreover, clinical tools currently used to assess global health require dedicated time and lack a standardized end score. Circulating markers of biological age and/or fitness could complement or partially substitute the existing screening tools. In this study we explored the relationship of potential ageing/frailty biomarkers with age and clinical frailty. On a population of 82 young and 162 older non-metastatic breast cancer patients, we measured mean leukocyte telomere length and plasma levels of interleukin-6 (IL-6), regulated upon activation, normal T cell expressed and secreted (RANTES), monocyte chemotactic protein 1 (MCP-1), insulin-like growth factor 1 (IGF-1). We also developed a new tool to summarize clinical frailty, designated Leuven Oncogeriatric Frailty Score (LOFS), by integrating GA results in a single, semi-continuous score. LOFS' median score was 8, on a scale from 0=frail to 10=fit. IL-6 levels were associated with chronological age in both groups and with clinical frailty in older breast cancer patients, whereas telomere length, IGF-1 and MCP-1 only correlated with age. Plasma IL-6 should be further explored as frailty biomarker in cancer patients.


Electrophysiological markers of biological motion and human form recognition.

  • Nicole C White‎ et al.
  • NeuroImage‎
  • 2014‎

Current models suggest that human form and motion information are initially processed through separate pathways, then integrated in action perception. Testing such a sequential model requires techniques with high temporal resolution. Prior work demonstrated sensitivity of a posterior temporal event-related potential (ERP) effect - the N2 - to biological motion, but did not test whether the N2 indexes biological motion perception specifically, or human form/action perception more generally. We recorded ERPs while participants viewed stimuli across 3 blocks: (1) static (non-moving) point-light displays of humans performing actions; (2) static stick figures with clear forms; and (3) point-light biological motion. A similar sequence of ERP components was elicited by human forms in all blocks (stationary and moving), and reliably discriminated between human and scrambled forms. The N2 showed similar scalp distribution and sensitivity to stimulus manipulations for both stick figures and biological motion, suggesting that it indexes integration of form and motion information, rather than biological motion perception exclusively - and that form and motion information are therefore integrated by approximately 200ms. We identified a component subsequent to the N2, which we label the medial parietal positivity/ventral-anterior negativity (MPP/VAN), that was also sensitive to both human form and motion information. We propose that the MPP/VAN reflects higher-order human action recognition that occurs subsequent to the integration of form and motion information reflected by the N2.


Clinical features and biological markers of lung cancer-associated stroke.

  • Xingrui Xie‎ et al.
  • The Journal of international medical research‎
  • 2016‎

Objective To identify the unique clinical features and biological markers of lung cancer-associated stroke. Methods We recruited 102 patients with lung cancer plus stroke, 102 with lung cancer, and 102 with stroke. Detailed information was analysed and compared among groups. Results The groups were age-matched. Patients with lung cancer plus stroke showed multiple lesions involving multiple cerebral artery territories on magnetic resonance imaging, compared with stroke-alone patients. These patients also had a poorer modified Rankin Scale score at 30 days, and high mortality (18.6%). Patients with lung cancer plus stroke had a higher incidence of metastasis, and higher blood levels of D-dimer, CA125 and CA199 compared with patients with lung cancer alone. Multivariate logistic regression analysis showed that levels of D-dimer, CA125 and CA199 were independently related to lung cancer-associated stroke. Conclusion Elevated plasma D-dimer, CA125 and CA199 may be independent risk factors for and biomarkers of lung cancer-associated stroke.


Effects of smoking cessation on biological monitoring markers in urine.

  • Yuya Kawasaki‎ et al.
  • Genes and environment : the official journal of the Japanese Environmental Mutagen Society‎
  • 2020‎

Urinary nicotine and cotinine levels are often measured as biomarkers for tobacco smoke exposure. However, these biomarkers are not appropriate to evaluate the effects of quitting smoking for several days, because of their short half-lives. In this study, we focused on the changes in the urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) levels of 55 patients in a smoking cessation program, because of the long half-life. At the same time, urinary 7-methylguanine (m7Gua) and 8-hydroxy-2'-deoxyguanosine (8-OHdG), as DNA damage markers of cigarette smoking, were also measured.


Can markers of biological age predict dependency in old age?

  • Juulia Jylhävä‎ et al.
  • Biogerontology‎
  • 2019‎

Recent research has shown that markers of biological age, such as leukocyte telomere length (LTL), epigenetic clocks and the frailty index (FI) are predictive of mortality and age-related diseases. However, whether these markers associate with the need for care in old age, thereby having utility in reflecting dependency, is unclear. This study was undertaken to analyze whether LTL, two epigenetic clocks-the DNA methylation age (DNAmAge) and DNAm PhenoAge-and the FI are associated with the need for regular care in up to 604 individuals (aged 48-94 years) participating in the Swedish Adoption/Twin Study of Aging. Need for regular care was defined as receiving formal or informal help in daily routines at least once per week. Logistic regression adjusted for age, sex and education was used in the analysis. The predictive accuracies, assessed as the area under the curve (AUC) for the significant biological age measures were further compared to the accuracies of the limitations in activities of daily living (ADL) and instrumental ADL (IADL). Neither LTL nor the epigenetic clocks were associated with the need for care, whereas the FI was; odds ratio for 10% increase in FI 3.54 (95% confidence interval 2.32-5.41). The FI also demonstrated higher predictive accuracy than the ADL score (FI AUC 0.80 vs. ADL score AUC 0.62; p < 0.001 for equality of the AUCs), whereas the difference between FI AUC (0.80) and IADL score AUC (0.75) was not significant (p = 0.238). The FI might thus be a useful marker for the need for care.


Circulating microRNAs serve as novel biological markers for intracranial aneurysms.

  • Pengxiang Li‎ et al.
  • Journal of the American Heart Association‎
  • 2014‎

Biological markers that can be used to predict the risk of intracranial aneurysms (IAs) are not available.


The suitability of micronuclei as markers of relative biological effect.

  • Charlotte J Heaven‎ et al.
  • Mutagenesis‎
  • 2022‎

Micronucleus (MN) formation is routinely used as a biodosimeter for radiation exposures and has historically been used as a measure of DNA damage in cells. Strongly correlating with dose, MN are also suggested to indicate radiation quality, differentiating between particle and photon irradiation. The "gold standard" for measuring MN formation is Fenech's cytokinesis-block micronucleus (CBMN) cytome assay, which uses the cytokinesis blocking agent cytochalasin-B. Here, we present a comprehensive analysis of the literature investigating MN induction trends in vitro, collating 193 publications, with 2476 data points. Data were collected from original studies that used the CBMN assay to quantify MN in response to ionizing radiation in vitro. Overall, the meta-analysis showed that individual studies mostly have a linear increase of MN with dose [85% of MN per cell (MNPC) datasets and 89% of percentage containing MN (PCMN) datasets had an R2 greater than 0.90]. However, there is high variation between studies, resulting in a low R2 when data are combined (0.47 for MNPC datasets and 0.60 for PCMN datasets). Particle type, species, cell type, and cytochalasin-B concentration were suggested to influence MN frequency. However, variation in the data meant that the effects could not be strongly correlated with the experimental parameters investigated. There is less variation between studies when comparing the PCMN rather than the number of MNPC. Deviation from CBMN protocol specified timings did not have a large effect on MN induction. However, further analysis showed less variation between studies following Fenech's protocol closely, which provided more reliable results. By limiting the cell type and species as well as only selecting studies following the Fenech protocol, R2 was increased to 0.64 for both measures. We therefore determine that due to variation between studies, MN are currently a poor predictor of radiation-induced DNA damage and make recommendations for futures studies assessing MN to improve consistency between datasets.


Total and phosphorylated tau protein as biological markers of Alzheimer's disease.

  • Harald Hampel‎ et al.
  • Experimental gerontology‎
  • 2010‎

Advances in our understanding of tau-mediated neurodegeneration in Alzheimer's disease (AD) are moving this disease pathway to center stage for the development of biomarkers and disease modifying drug discovery efforts. Immunoassays were developed detecting total (t-tau) and tau phosphorylated at specific epitopes (p-tauX) in cerebrospinal fluid (CSF), methods to analyse tau in blood are at the experimental beginning. Clinical research consistently demonstrated CSF t- and p-tau increased in AD compared to controls. Measuring these tau species proved informative for classifying AD from relevant differential diagnoses. Tau phosphorylated at threonine 231 (p-tau231) differentiated between AD and frontotemporal dementia, tau phosphorylated at serine 181 (p-tau181) enhanced classification between AD and dementia with Lewy bodies. T- and p-tau are considered "core" AD biomarkers that have been successfully validated by controlled large-scale multi-center studies. Tau biomarkers are implemented in clinical trials to reflect biological activity, mechanisms of action of compounds, support enrichment of target populations, provide endpoints for proof-of-concept and confirmatory trials on disease modification. World-wide quality control initiatives are underway to set required methodological and protocol standards. Discussions with regulatory authorities gain momentum defining the role of tau biomarkers for trial designs and how they may be further qualified for surrogate marker status.


Biological and behavioral markers of pain following nerve injury in humans.

  • S A Holmes‎ et al.
  • Neurobiology of pain (Cambridge, Mass.)‎
  • 2020‎

The evolution of peripheral and central changes following a peripheral nerve injury imply the onset of afferent signals that affect the brain. Changes to inflammatory processes may contribute to peripheral and central alterations such as altered psychological state and are not well characterized in humans. We focused on four elements that change peripheral and central nervous systems following ankle injury in 24 adolescent patients and 12 age-sex matched controls. Findings include (a) Changes in tibial, fibular, and sciatic nerve divisions consistent with neurodegeneration; (b) Changes within the primary motor and somatosensory areas as well as higher order brain regions implicated in pain processing; (c) Increased expression of fear of pain and pain reporting; and (d) Significant changes in cytokine profiles relating to neuroinflammatory signaling pathways. Findings address how changes resulting from peripheral nerve injury may develop into chronic neuropathic pain through changes in the peripheral and central nervous system.


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