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| {{ArtBy| | | {{ArtBy| | autore = Gianni Frisardi | autore2 = Riccardo Azzali | autore3 = Flavio Frisardi }} |
| | autore = Gianni Frisardi | |
| | autore2 = Riccardo Azzali | |
| | autore3 = Flavio Frisardi | |
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| == Medical language is an extended natural language== | | ==Introduction to the Logic of Medical Language== In the previous chapter on the "[[Logic of medical language|Logic of Medical Language]]", we shifted the focus from symptoms or clinical signs to an encrypted machine language. The arguments of Donald E. Stanley, Daniel G. Campos, and Pat Croskerry are relevant, especially when linked to time '''<math>t_n</math>''' as an information vector and to the idea of a message as machine language rather than verbal. <ref>{{Cite book | autore = Stanley DE | autore2 = Campos DG | titolo = The logic of medical diagnosis | url = https://pubmed.ncbi.nlm.nih.gov/23974509/ | volume = | opera = Perspect Biol Med | anno = 2013 | editore = }}</ref><ref>{{Cite book | autore = Croskerry P | titolo = Adaptive expertise in medical decision making | url = https://www.tandfonline.com/doi/abs/10.1080/0142159X.2018.1484898?journalCode=imte20 | volume = | opera = Med Teach | anno = 2018 }}</ref> |
| Language is essential in the medical field, but it can sometimes lead to misunderstandings due to its semantically limited nature and lack of coherence with established scientific paradigms. For instance, terms like "orofacial pain" may have significantly different meanings if interpreted through classical logic rather than formal logic.
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| The transition from classical to formal logic is not just an additional step, but it requires precise and accurate description. Despite advances in medical technology—such as electromyographs, cone beam computed tomography (CBCT), and digital oral scanning systems—there remains a need for refinement in medical language.
| | Nevertheless, clinical history based on pseudo-formal verbal language remains essential. The idea of a machine language and system logic offers an opportunity to validate Medical-Diagnostic Science. |
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| It's crucial to distinguish between natural languages (like English, German, Italian, etc.) and formal languages (like mathematics). Natural languages emerge spontaneously within communities, while formal languages are artificially created for specific applications in fields like logic, mathematics, and computer science. Formal languages have well-defined syntax and semantics, whereas natural languages, despite having grammar, often lack explicit semantics.
| | {{q2|Could classical language logic solve the dilemma of poor Mary Poppins?|A bit of patience, please}} |
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| To keep the analysis dynamic, an exemplary clinical case will be examined through different language logics:
| | We cannot limit ourselves to conventional answers. Science progresses through questions and reflections. This drives us to explore key topics, such as "'''Craniofacial Biology'''". |
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| *[[The logic of the classical language|Classical language]],
| | '''Craniofacial Biology''' |
| * [[The logic of the probabilistic language|Probabilistic language]],
| | An influential study by Townsend and Brook<ref name=":0">{{Cite book | autore = Townsend GC | autore2 = Brook AH | titolo = The face, the future, and dental practice | url = https://onlinelibrary.wiley.com/doi/epdf/10.1111/adj.12157 | volume = | opera = Aust Dent J | anno = 2014 }}</ref> challenges research paradigms in "Craniofacial Biology", especially with the interdisciplinary approach. Innovations such as gene sequencing, CT, MRI, laser scanning, and image analysis are transforming the field. <ref>{{Cite book | autore = Sperber GH | autore2 = Sperber SM | titolo = The genesis of craniofacial biology | url = https://onlinelibrary.wiley.com/doi/epdf/10.1111/adj.12131 | volume = | opera = Aust Dent J | anno = 2014 }}</ref> |
| *[[Fuzzy language logic|Fuzzy logic]] and
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| *[[System logic|Logic of System]].
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| ===Clinical case and medical language logic=== | | The complexity of biological systems is also recognized, influenced by diversity and epigenetics.<ref>{{Cite book | autore = Brook AH | autore2 = Brook O'Donnell M | titolo = General and craniofacial development | url = https://onlinelibrary.wiley.com/doi/epdf/10.1111/adj.12158 | opera = Aust Dent J | anno = 2014 }}</ref> The role of epigenetics in craniofacial biology has been critically explored, especially in dental and craniofacial disciplines.<ref>{{Cite book | autore = Williams SD | autore2 = Hughes TE | titolo = Epigenetics: a new frontier in dentistry | url = https://onlinelibrary.wiley.com/doi/epdf/10.1111/adj.12155 | opera = Aust Dent J | anno = 2014 }}</ref> |
| The patient, Mary Poppins (fictitious name), has been receiving multidisciplinary medical attention for over a decade, involving dentists, general practitioners, neurologists, and dermatologists. Her medical history is summarized as follows: | |
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| <blockquote>At 40, Mrs. Poppins noticed small spots of abnormal pigmentation on the right side of her face. Ten years later, after a skin biopsy during dermatology hospitalization, she was diagnosed with localized facial scleroderma (morphea) and prescribed corticosteroids. By age 44, she experienced involuntary contractions of the right masseter and temporal muscles, which increased in frequency and duration over time. At her first neurological evaluation, her face showed significant asymmetry and hypertrophy of the right masseter and temporal muscles. Various diagnoses were made, illustrating the limitations of medical language.</blockquote> | | Phenomics (the study of the interaction between genetics and environment) is fundamental to understanding dental development.<ref>{{Cite book | autore = Yong R | autore2 = Ranjitkar S | titolo = Dental phenomics: advancing genotype to phenotype correlations | url = https://onlinelibrary.wiley.com/doi/epdf/10.1111/adj.12156 | opera = Aust Dent J | anno = 2014 }}</ref> Moreover, Irma Thesleff’s work on transient signaling centers in dental epithelium underlines the complexity of tooth development.<ref>{{Cite book | autore = Thesleff I | titolo = Current understanding of tooth formation | url = https://onlinelibrary.wiley.com/doi/epdf/10.1111/adj.12102 | opera = Aust Dent J | anno = 2013 }}</ref> |
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| After several investigations—such as anamnesis, stratigraphy, and computed tomography (Figures 1, 2, and 3)—the dentist diagnosed "Temporomandibular Disorders" (TMD).<ref>{{Cita libro | autore = Tanaka E | autore2 = Detamore MS | autore3 = Mercuri LG | titolo = Degenerative disorders of the temporomandibular joint: etiology, diagnosis, and treatment | url = https://pubmed.ncbi.nlm.nih.gov/18362309 | opera = J Dent Res | anno = 2008 | DOI = 10.1177/154405910808700406 }}</ref><ref>{{Cita libro | autore = Roberts WE | autore2 = Stocum DL | titolo = Part II: Temporomandibular Joint (TMJ)-Regeneration, Degeneration, and Adaptation | url = https://pubmed.ncbi.nlm.nih.gov/29943316 | opera = Curr Osteoporos Rep | anno = 2018 | DOI = 10.1007/s11914-018-0462-8 }}</ref><ref>{{Cita libro | autore = Lingzhi L | autore2 = Huimin S | autore3 = Han X | autore4 = Lizhen W | titolo = MRI assessment and histopathologic evaluation of subchondral bone remodeling in temporomandibular joint osteoarthritis: a retrospective study | url = https://pubmed.ncbi.nlm.nih.gov/30122441 | opera = Oral Surg Oral Med Oral Pathol Oral Radiol | anno = 2018 | DOI = 10.1016/j.oooo.2018.05.047 }}</ref> Meanwhile, the neurologist diagnosed "Neuropathic Orofacial Pain" (nOP), minimizing TMD as the primary cause. For objectivity, we refer to her condition as "TMDs/nOP."
| | Other researchers have explored dental development processes and the contribution of stem cells and tissue engineering in periodontal regeneration.<ref>{{Cite book | autore = Peterkova R | autore2 = Hovorakova M | titolo = Three‐dimensional analysis of the early development of the dentition | url = https://onlinelibrary.wiley.com/doi/epdf/10.1111/adj.12130 | opera = Aust Dent J | anno = 2014 }}</ref><ref>{{Cite book | autore = Han J | titolo = Stem cells, tissue engineering and periodontal regeneration | url = https://onlinelibrary.wiley.com/doi/epdf/10.1111/adj.12100 | opera = Aust Dent J | anno = 2013 }}</ref> |
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| We are thus faced with several questions that deserve thorough discussion, as they pertain to clinical diagnostics.
| | Variations in tooth development, morphology, and the role of tongue pressure on craniofacial growth further highlight the significance of interdisciplinary approaches.<ref>{{Cite book | autore = Brook AH | titolo = The Dentition: The Outcomes of Morphogenesis | url = https://onlinelibrary.wiley.com/doi/epdf/10.1111/adj.12160 | opera = Aust Dent J | anno = 2014 }}</ref><ref>{{Cite book | autore = Kieser JA | titolo = The role of oral soft tissues in swallowing function | url = https://onlinelibrary.wiley.com/doi/epdf/10.1111/adj.12103 | opera = Aust Dent J | anno = 2013 }}</ref> |
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| Medical language falls into a hybrid category—it arises from the expansion of everyday language by incorporating technical terminologies such as "neuropathic pain," "Temporomandibular Disorders," or "demyelination." This evolution does not separate it from the inherent ambiguity of natural language, which often lacks precision in critical contexts. For example, the term "disease," crucial in nosology, research, and practice, remains vague in its definition, which can lead to diagnostic uncertainty.
| | Practical Case |
| | Returning to Mary Poppins, diagnosed with TMD, the dentist’s conclusions about her condition are based on classical language logic, but questions arise. Through the analysis of diagnostic data, such as stratigraphy, axiography, and electromyography, it becomes clear that these findings diverge from the conventional approach. Figures 1b, 1c, and 1d illustrate this discrepancy, showing symmetrical motor evoked potentials and mandibular responses that challenge the traditional malocclusion diagnosis. |
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| A core question arises: is disease related to the patient as an individual, or does it pertain to the system as a whole (i.e., the organism)? Can a patient who is deemed healthy at a given time <math>t_n</math> coexist with a system that was structurally compromised at an earlier point <math>t_{i,-1}</math>?
| | <gallery widths="350" heights="282" perrow="2" mode="slideshow"> File:Occlusal Centric view in open and cross bite patient.jpg|Figure 1a: Malocclusion case File:Bilateral Electric Transcranial Stimulation.jpg|Figure 1b: Motor evoked potential File:Jaw Jerk .jpg|Figure 1c: Mandibular evoked reflex File:Mechanic Silent Period.jpg|Figure 1d: Mechanically evoked silent period </gallery> |
| | Mathematical Formalism |
| | To understand the complexity of diagnosing Orofacial Pain, mathematical logic can clarify how classical language may fail. Using propositions, we construct formal arguments that either confirm or contradict the dentist's diagnosis. |
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| This perspective urges a reconsideration of disease as an evolutionary process rather than a static condition. The dynamic nature of health and disease demands a sophisticated, possibly quantitative, interpretation that factors in temporal variations across biological and pathological systems.
| | Propositions in Dental Context |
| | If Mary Poppins' TMJ stratigraphic exam shows signs of TMD, the dentist deduces that she suffers from Orofacial Pain caused by TMD. This can be represented mathematically as: |
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| <blockquote>The notion of "language without semantics," treated as irrelevant, highlights a significant issue. Language's inherent semantic interdependence is vital for effective communication.<ref>{{Cita libro | autore = Sadegh-Zadeh Kazem | titolo = Handbook of Analytic Philosophy of Medicine | url = https://link.springer.com/book/10.1007/978-94-007-2260-6 | anno = 2012 | editore = Springer }}</ref></blockquote> | | <math>A(\text{x}) \rightarrow B(\text{x})</math> implies that a positive TMJ exam leads to a diagnosis of TMD. However, proof by contradiction can challenge this. If it were possible that someone with a positive exam does not have TMD, the dentist’s argument would not hold. |
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| In short, the debate on whether the patient is ill, or if it is her masticatory system exhibiting pathology, requires a detailed analysis from a medical standpoint. Distinguishing between systemic pathology (masticatory system as a whole) and localized pathology (e.g., TMJ) is key.
| | Compatibility and Incompatibility of Statements |
| | The dentist’s conclusion is based on several statements: TMJ bone remodeling, sensitivity and specificity of axiographic measurements, and EMG interference patterns. Each statement supports the diagnosis of TMD. |
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| <center>
| | However, these assertions can be contested. For example, a neurologist might propose that Mary’s Orofacial Pain is neuromotor in origin, not related to TMD. Using logical tools, we analyze whether the two sets of statements—dental and neurological—are compatible. If they are incompatible, the dentist's diagnosis could be invalid. |
| ==Clinical approach ==
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| (hover over the images)
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| </center>
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| <center><gallery widths="350" heights="282" perrow="2" mode="slideshow">
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| File:Spasmo emimasticatorio.jpg|'''Figure 1:''' Representation of a patient complaining of "orofacial pain" on the right side of the face.
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| File:Spasmo emimasticatorio ATM.jpg|'''Figure 2:''' Stratigraphy of the patient's TMJ showing condylar flattening and the presence of osteophytes.
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| File:Atm1 sclerodermia.jpg|'''Figure 3:''' Computed tomography of the TMJ corroborating the stratigraphy findings shown in Figure 2.
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| </gallery></center>
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| ==Understanding of Medical Terminology==
| | Final Considerations |
| Understanding what "meaning" signifies is a complex topic. The Cambridge Dictionary defines it as "what something expresses or represents."<ref>[https://dictionary.cambridge.org/dictionary/english/meaning Cambridge Dictionary online]</ref> But this definition remains broad and leads to further questions, as different theories offer varied perspectives without a definitive answer.<ref>{{Cita libro | autore = Blouw P | autore2 = Eliasmith C | titolo = Using Neural Networks to Generate Inferential Roles for Natural Language | url = https://pubmed.ncbi.nlm.nih.gov/29387031 | opera = Front Psychol | anno = 2018 | DOI = 10.3389/fpsyg.2017.02335 }}</ref><ref>{{Cita libro | autore = Green K | titolo = Dummett: Philosophy of Language | anno = 2001 }}</ref>
| | The application of mathematical logic strengthens the dentist's deductive reasoning. Still, as research evolves, new theories could emerge that align with the neurologist’s position. For now, classical logic favors the dentist’s interpretation, but future findings might shift this understanding, leading to a re-evaluation of Orofacial Pain diagnostics. |
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| In linguistic theory, terms act as labels for objects, either concrete or abstract. For example, the word "apple" evokes a clear image of a fruit. But expressions like "orofacial pain" acquire different meanings depending on the context—for a dentist, a neurologist, or for the patient, Mary Poppins, herself.
| | {{q2|Should we adopt a probabilistic approach?|It’s possible.}} {{Bib}} {{apm}} <onlyinclude> </onlyinclude> |
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| In the case of Mary Poppins, the neurologist will frame "pain in the right half of the face" using terms like synapses and action potentials, while the dentist will focus on teeth and occlusion. This variation in meaning highlights the importance of context in diagnosis.
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| A deeper exploration of modern philosophy of meaning, such as Gottlob Frege's distinction between "extension" (all entities sharing a characteristic) and "intension" (attributes that define an idea), sheds light on how diagnostic errors may occur.<ref>[[:wikipedia:Gottlob_Frege|Wikipedia entry]]</ref>
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| For example, "pain" is a broad term with high extension but low intension. However, focusing on specific pain types (dental implants, pulpitis, neuropathic pain) increases intension and reduces extension.<ref>{{Cita libro | autore = Porporatti AL | autore2 = Bonjardim LR | titolo = Pain from Dental Implant Placement, Inflammatory Pulpitis Pain, and Neuropathic Pain Present Different Somatosensory Profiles | url = https://pubmed.ncbi.nlm.nih.gov/28118417 | opera = J Oral Facial Pain Headache | anno = 2017 | DOI = 10.11607/ofph.1680 }}</ref>
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| This shows how the vulnerability of medical language to semantic and contextual ambiguity can lead to significant diagnostic challenges.<ref>{{Cita libro | autore = Jääskeläinen SK | titolo = Differential Diagnosis of Chronic Neuropathic Orofacial Pain | url = https://pubmed.ncbi.nlm.nih.gov/31688325 | opera = J Clin Neurophysiol | anno = 2019 | DOI = 10.1097/WNP.0000000000000583 }}</ref>
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| == Ambiguity and Vagueness in Medical Language==
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| Ambiguity in medical language occurs when terms have multiple meanings, leading to errors and inconsistencies in diagnosis. Both ambiguity and vagueness are underexplored in clinical practice, despite their significant impact on clinical guidelines.<ref>{{Cita libro | autore = Schick F | titolo = Ambiguity and Logic | anno = 2003 | editore = Cambridge University Press }}</ref><ref>{{Cita libro | autore = Teigen KH | titolo = The language of uncertainty | anno = 1988 }}</ref>
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| Doctors' interpretations of vague medical terms often differ, reducing uniformity in clinical practices compared to guidelines.<ref>{{Cita libro | autore = Codish S | autore2 = Shiffman RN | titolo = A model of ambiguity and vagueness in clinical practice guideline recommendations | url = https://pubmed.ncbi.nlm.nih.gov/16779019/ | anno = 2005 }}</ref>
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| This leads to inefficiencies in decoding the "machine message" transmitted by the system, as in the case of Mary Poppins' orofacial pain. Next, we delve into the concept of "encrypted machine language" in the subsequent chapters.
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| ===Encryption===
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| Imagine a brain sending a message in machine language (wave trains, ion field packets), and that this carries a message like "Ephaptic," which must be decrypted to translate into verbal language. Both the patient, with epistemic vagueness, and the doctor, constrained by their field of expertise, contribute to the distortion of the machine's original message.
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| Often, the system's message remains encrypted until symptoms become severe enough for a diagnosis to be made.
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| {{q2|Why is the patient's key the REAL one?|Answer: Consider the Gate Control phenomenon.}}
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| However, this concept brings our attention to an extraordinarily explanatory phenomenon called Gate Control. When a child is hit on the leg while playing soccer, in addition to crying, the first action they take is to rub the painful area extensively, to alleviate the pain. The child acts unconsciously, stimulating tactile receptors and closing the "gate" to the nociceptive entry of C fibers, thus reducing the pain; this phenomenon was discovered only in 1965 by Ronald Melzack and Patrick Wall.<ref>{{cita libro
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| | autore = Melzack R
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| | titolo = The McGill Pain Questionnaire: major properties and scoring methods
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| | url = https://pubmed.ncbi.nlm.nih.gov/1235985/
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| | volume =
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| | opera = Pain
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| | anno = 1975
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| | ISBN =
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| | DOI = 10.1016/0304-3959(75)90044-5
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| | oaf = <!-- qualsiasi valore -->
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| | PMID = 1235985
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| }}</ref><ref>{{cita libro
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| | autore = Melzack R
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| | titolo = Phantom limbs and the concept of a neuromatrix
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| | url = https://pubmed.ncbi.nlm.nih.gov/1691874/
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| | volume =
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| | opera = Trends Neurosci
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| | DOI = 10.1016/0166-2236(90)90179-e
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| | oaf = <!-- qualsiasi valore -->
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| | PMID = 1691874
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| | LCCN =
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| }}</ref><ref>{{cita libro
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| | autore = Melzack R
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| | titolo = From the gate to the neuromatrix
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| | url = https://pubmed.ncbi.nlm.nih.gov/10491980/
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| | volume =
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| | opera = Pain
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| | anno = 1999
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| | editore =
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| | città =
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| | ISBN =
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| | DOI = 10.1016/s0304-3959(99)00145-1
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| | oaf = <!-- qualsiasi valore -->
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| | PMID =
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| }}</ref><ref>{{cita libro
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| | autore = Melzack R
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| | autore2 = Wall PD
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| | titolo = On the nature of cutaneous sensory mechanisms
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| | url = https://pubmed.ncbi.nlm.nih.gov/14472486/
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| | volume =
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| | opera = Brain
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| | anno = 1962
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| | editore =
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| | città =
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| | ISBN =
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| | DOI = 10.1093/brain/85.2.331
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| | oaf = <!-- qualsiasi valore -->
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| | PMID = 14472486
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| | LCCN =
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| }}</ref><ref>{{cita libro
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| | autore = Melzack R
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| | autore2 = Wall PD
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| | titolo = Pain mechanisms: a new theory
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| | url = https://pubmed.ncbi.nlm.nih.gov/5320816/
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| | volume =
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| | opera = Science
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| | anno = 1965
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| | editore =
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| | DOI = 10.1126/science.150.3699.971
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| | oaf = <!-- qualsiasi valore -->
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| | PMID = 5320816
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| }}</ref>.
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| In the case of encrypted language, much like in computers, the brain also encrypts and decrypts information. For example, researchers have explored how synaptic memory might be digitally stored in the brain.<ref>{{Cita libro | autore = Petersen C | autore2 = Malenka RC | titolo = All-or-none potentiation at CA3-CA1 synapses | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC22559/pdf/pq004732.pdf | anno = 1998 }}</ref>
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| ==Final Considerations==
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| Language's role in diagnosis is a critical issue in medicine. The ICD-9 lists 6,969 disease codes, which increased to 12,420 in ICD-10.<ref name=":0">{{Cita libro | autore = Stanley DE | autore2 = Campos DG | titolo = The Logic of Medical Diagnosis | url = https://pubmed.ncbi.nlm.nih.gov/23974509/ | opera = Perspect Biol Med | anno = 2013 }}</ref> Studies estimate that diagnostic errors contribute to 40,000 to 80,000 deaths annually.<ref>{{Cita libro | autore = Leape LL | titolo = What Practices Will Most Improve Safety? | anno = 2002 }}</ref>
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| Charles Sanders Peirce's triadic approach—abduction, deduction, and induction—emphasizes that diagnostic errors often result from misinterpretations of clinical signs.<ref>{{Cita libro | autore = Vanstone M | titolo = Experienced Physician Descriptions of Intuition in Clinical Reasoning: A Typology | url = https://www.degruyter.com/document/doi/10.1515/dx-2018-0069/pdf | anno = 2019 }}</ref>
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| In this chapter, we shifted from discussing clinical signs to machine language and non-verbal signals. The next chapters will delve deeper into logic, time, and assembler codes.
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