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Genetic generalized epilepsies (GGE), previously called idiopathic generalized epilepsies, constitute about 20% of all epilepsies, and include childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy, and epilepsy with generalized tonic-clonic seizures alone (CAE, JAE, JME, and GGE-GTCS, respectively). GGE are characterized by high heritability, likely underlain by polygenetic mechanisms, which may relate to atypical neurodevelopmental trajectories. Age of onset ranges from pre-school years, for CAE, to early adulthood for GGE-GTCS. Traditionally, GGE have been considered benign, a belief contrary to evidence from neuropsychology studies conducted over the last two decades. In JME, deficits in executive and social functioning are common findings and relate to impaired frontal lobe function. Studies using neuropsychological measures and cognitive imaging paradigms provide evidence for hyperconnectivity between prefrontal and motor cortices, aberrant fronto-thalamo-cortical connectivity, and reduced fronto-cortical and subcortical gray matter volumes, which are associated with altered cognitive performance. Recent research has also identified associations between abnormal hippocampal morphometry and fronto-temporal activation during episodic memory. Longitudinal studies on individuals with newly diagnosed JME have observed cortical dysmaturation, which is paralleled by delayed cognitive development compared to the patients' peers. Comorbidities and cognitive deficits observed in other GGE subtypes, such as visuo-spatial and language deficits in both CAE and JAE, have also been correlated with atypical neurodevelopment. Although it remains unclear whether cognitive impairment profiles differ amongst GGE subtypes, effects may become more pronounced with disease duration, particularly in absence epilepsies. Finally, there is substantial evidence that patients with JME and their unaffected siblings share patterns of cognitive deficits, which is indicative of an underlying genetic etiology (endophenotype), independent of seizures and anti-epileptic medication.

Efficient, wide-scale testing for SARS-CoV-2 is crucial for monitoring the incidence of the infection in the community. The gold standard for COVID-19 diagnosis is the molecular analysis of epithelial secretions from the upper respiratory system captured by nasopharyngeal (NP) or oropharyngeal swabs. Given the ease of collection, saliva has been proposed as a possible substitute to support testing at the population level. Here, we used a novel saliva collection device designed to favour the safe and correct acquisition of the sample, as well as the processivity of the downstream molecular analysis. We tested 1003 nasopharyngeal swabs and paired saliva samples self-collected by individuals recruited at a public drive-through testing facility. An overall moderate concordance (68%) between the two tests was found, with evidence that neither system can diagnose the infection in 100% of the cases. While the two methods performed equally well in symptomatic individuals, their discordance was mainly restricted to samples from convalescent subjects. The saliva test was at least as effective as NP swabs in asymptomatic individuals recruited for contact tracing. Our study describes a testing strategy of self-collected saliva samples, which is reliable for wide-scale COVID-19 screening in the community and is particularly effective for contact tracing.

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The ability to stabilise colloidal suspensions in solution against salt-induced aggregation is critical to many industrial applications, but it remains challenging at high salt concentration. To overcome this problem, Lan et al. introduce a raspberry-like colloidal particle with controllable morphology.

Saint John’s Baptistery in Florence (Italy), dating back to the XI century, represents one of the most outstanding historical buildings in the city, and has been under the UNESCO patronage as Cultural Heritage since 1982. In recent years, in the frame of a conservation project, detailed studies and mapping of all the tiles covering the Baptistery have been developed. Based on a laser-scan survey, a detailed wireframe model of all the external sides, reporting all the tiles and decor, has been developed. This model was implemented into a 2D-GIS, georeferenced in real scale and spatial position. An in situ survey of all the tiles, ashlars, inlays and columns, made in contradiction by experts in historical ornamental stones, allowed the recognition of several types of marble in place. All these marbles have been analyzed and characterized as geometric, geological and historical data, and the information implemented into a GIS for obtaining a spatial geodatabase representing a “box” to store all information achieved. All these data are manageable by web through smartphone, tablet and PC for querying or updating, thus representing an effective management tool for further conservation of such important historical cultural buildings.

Proliferative membranes of fibrocontractive retinal disorders are extensively studied from the morphological and evolutive point of view. Despite this, little is known of their cellular composition. In this study, the authors investigated the morphological characteristics and cell composition of various types of surgically excised proliferative membranes and internal limiting membranes (ILMs), in order to provide new data supporting or challenging the pathogenic theories proposed until now. Sixty-nine specimens from 64 eyes of 64 consecutive patients were collected at surgery and subjected to a multilevel analysis by means of optical and electron microscopy. Membrane samples were semiquantitatively evaluated for the amount and distribution of cell nuclei and pigment. Immunohistochemical staining was performed with antibodies to alpha smooth muscle actin and CD68. Data were analyzed after grouping according to the following tissue types: ILM (20 specimens), epiretinal membrane (ERM) (22 specimens), ILM + ERM (20 specimens), and proliferative vitreoretinopathy (PVR) (7 specimens). The cell components found in the ERM specimens, like myofibroblasts, macrophages, and polymorphonuclear cells, were recognized as the expression of cell migration and differentiation that induced an inflammatory process and a fibroproliferative repair process. The detection of pigments in specific types of ERM, like those associated with lamellar macular hole (LMH) or secondary to retinal detachment (RD), diabetes, and PVR, suggested that retinal pigment epithelium (RPE) cells may have a role in the development of these vitreoretinal disorders. The reduction of the ERM cellularity with the patient’s age supports the hypothesis that ERM evolves in time up to a fibrous tissue formation.

The political scientist Claus Leggewie with his essay Der Mythos des Neuafangs (1996), dedicated to the stages of foundation and refoundation of the Bundesrepublik, motivates the author to further and meditated comparative reflection on the different effects of the student revolution of the Sixty-eight on the Italian political system and on the German one. Also from the point of view of an Italian political scientist, ‘68 represented a milestone in the process of democratization of Western German society and the consolidation of its political-party system, born fragile in 1949. The analysis shows, instead, how in Italy a series of circumstances prevented the party and political system from using to renew the resources that the movement had freed. The ensuing system crisis will lead to the collapse of the First Republic.

Bone is one of the major tissues that undergoes continuous remodeling throughout life, thus ensuring both organic body growth during development and protection of internal organs as well as repair of trauma during adulthood. Many endogenous substances contribute to bone homeostasis, including purines. Their role has increasingly emerged in recent decades as compounds which, by interacting with specific receptors, can help determine adequate responses of bone cells to physiological or pathological stimuli. Equally, it is recognized that the activity of purines is closely dependent on their interconversion or metabolic degradation ensured by a series of enzymes present at extracellular level as predominantly bound to the cell membrane or, also, as soluble isoforms. While the effects of purines mediated by their receptor interactions have sufficiently, even though not entirely, been characterized in many tissues including bone, those promoted by the extracellular enzymes providing for purine metabolism have not been. In this review, we will try to circumstantiate the presence and the role of these enzymes in bone to define their close relationship with purine activities in maintaining bone homeostasis in normal or pathological conditions.

Longitudinal EEG recorded by implanted devices is critical for understanding and managing epilepsy. Recent research reports patient-specific, multi-day cycles in device-detected epileptiform events that coincide with increased likelihood of clinical seizures. Understanding these cycles could elucidate mechanisms generating seizures and advance drug and neurostimulation therapies. We hypothesize that seizure-correlated cycles are present in background neural activity, independent of interictal epileptiform spikes, and that neurostimulation may temporarily interrupt these cycles. We analyzed regularly-recorded seizure-free data epochs from 20 patients implanted with a responsive neurostimulation (RNS) device for at least 1.5 years, to explore the relationship between cycles in device-detected interictal epileptiform activity (dIEA), clinician-validated interictal spikes, background EEG features, and neurostimulation. Background EEG features tracked the cycle phase of dIEA in all patients (AUC: 0.63 [0.56–0.67]) with a greater effect size compared to clinically annotated spike rate alone (AUC: 0.55 [0.53–0.61], p < 0.01). After accounting for circadian variation and spike rate, we observed significant population trends in elevated theta and beta band power and theta and alpha connectivity features at the cycle peaks (sign test, p < 0.05). In the period directly after stimulation we observe a decreased association between cycle phase and EEG features compared to background recordings (AUC: 0.58 [0.55–0.64]). Our findings suggest that seizure-correlated dIEA cycles are not solely due to epileptiform discharges but are associated with background measures of brain state; and that neurostimulation may temporarily interrupt these cycles. These results may help elucidate mechanisms underlying seizure generation, provide new biomarkers for seizure risk, and facilitate monitoring, treating, and managing epilepsy with implantable devices. • Background EEG features track multidien cycles in RNS dIEA. • dIEA linked EEG features are patient-specific and may differ with cortical structure. • Responsive neurostimulation suppresses EEG-dIEA coupling. [ABSTRACT FROM AUTHOR]

Glioblastoma (GBM) stem cells (GSCs), which contribute to GBM unfavorable prognosis, show high expression levels of ATP/P2X7 receptors (P2X7R). Here, we reported that cells exposure to 2’(3’)-O-(4-benzoylbenzoyl)-ATP (BzATP), a P2X7R agonist, up-regulated the expression of markers associated to epithelial-to-mesenchymal transition (EMT), a process likely contributing to GSC malignancy, and increased GSC migration/invasiveness like the known EMT inducer, Transforming Growth Factor β1 (TGFβ1). These effects were coupled to phosphorylation of SMAD2, a downstream effector in the TGFβ pathway, suggesting its involvement in P2X7R-mediated activity in GSCs. All BzATP effects, including a decrease in the caspase 3/7 activity in GSC medium, were mostly counteracted by the P2X7R antagonist A438079. Finally, BzATP increased the subunit expression of two main human P2X7R splice variants, the full-length P2X7A and the truncated P2X7B, lacking the carboxylic tail, which have different functional properties depending on their arrangement. Since up-regulation of A/B subunits might favor their assembly into a heterotrimeric P2X7R with great sensitivity towards agonists and cell energy support, this is in line with increased EMT markers expression, cell migration/invasion and GSC survival observed following P2X7R stimulation. As in GBM microenvironment extracellular ATP levels may activate P2X7R, our data suggest a P2X7R role in GBM recurrence/invasiveness.

Mounting evidence suggests that the guanine-based purines stand out as key player in cell metabolism and in several models of neurodegenerative disorders, such as Parkinson’s and Alzheimer’s diseases. Guanosine (GUO) and guanine (GUA) are extracellular signaling molecules derived from the breakdown of the correspondent nucleotide, GTP, and their intracellular and extracellular levels are regulated by the fine-tuned activity of two major enzymes, purine nucleoside phosphorylase (PNP) and guanine deaminase (GDA). Noteworthy, GUO and GUA, seem to play opposite roles in the modulation of cognitive functions, such as learning and memory. Indeed GUO, despite exerting neuroprotective, anti-apoptotic and neurotrophic effects, causes a decay of cognitive activities, whereas GUA administration in rats results in working memory improvement (prevented by L-NAME pre-treatment). This study was designed to investigate, in a model of SH-SY5Y neuroblastoma cell line, the signal transduction pathway activated by extracellular GUA. Altogether, our results showed that: (i) in addition to an enhanced phosphorylation of ASK1, p38 and JNK, likely linked to a non-massive and transient ROS production, the PKB/NO/sGC/cGMP/PKG/ERK cascade seems to be the main signaling pathway elicited by extracellular GUA; (ii) the activation of this pathway occurs in a pertussis-toxin sensitive manner, thus suggesting the involvement of a putative G protein coupled receptor; (iii) the GUA-induced NO production, strongly reduced by cell pre-treatment with L-NAME, is negatively modulated by the EPAC-cAMP-CaMKII pathway, which causes the over-expression of GDA that, in turn, reduces the levels of GUA. These molecular mechanisms activated by GUA may be useful to support our previous observation showing that GUA improves learning and memory functions through the stimulation of NO signaling pathway, and underscore the therapeutic potential of oral administration of guanine for treating memory-related disorders.

Aim: several strategies have been tested in recent years to prevent bacterial colonization of dental implants. Sericin, one of the two main silk proteins, possesses relevant biological activities and also literature reports about its potential antibacterial properties, but results are discordant and not yet definitive. The aim of this study was to evaluate the effectiveness of different experimental protocols in order to obtain a sericin-based coating on medical grade titanium (Ti) able to reduce microbial adhesion to the dental implant surface. Materials and Methods: different strategies for covalent bonding of sericin to Ti were pursued throughout a multi-step procedure on Ti-6Al-4V disks. The surface of grade 5 Ti was initially immersed in NaOH solution to obtain the exposure of functional -OH groups. Two different silanization strategies were then tested using aminopropyltriethoxysilane (APTES). Eventually, the bonding between silanized Ti-6Al-4V and sericin was obtained with two different crosslinking processes: glutaraldehyde (GLU) or carbodiimide/N-Hydroxy-succinimide (EDC/NHS). Micro-morphological and compositional analyses were performed on the samples at each intermediate step to assess the most effective coating strategy able to optimize the silanization and bioconjugation processes. Microbiological tests on the coated Ti-6Al-4V disks were conducted in vitro using a standard biofilm producer strain of Staphylococcus aureus (ATCC 6538) to quantify the inhibition of microbial biofilm formation (anti-biofilm efficacy) at 24 hours. Results: both silanization techniques resulted in a significant increase of silicon (Si) on the Ti-6Al-4V surfaces etched with NaOH. Differences were found between GLU and EDC/NHS bioconjugation strategies in terms of composition, surface micro-morphology and anti-biofilm efficacy. Ti-6Al-4V samples coated with GLU-bound sericin after silanization obtained via vapor phase deposition proved that this technique is the most convenient and effective coating strategy, resulting in a bacterial inhibition of about 53% in respect to the uncoated Ti-6Al-4V disks. Conclusions: The coating with glutaraldehyde-bound sericin after silanization in the vapor phase showed promising bacterial inhibition values with a significant reduction of S. aureus biofilm. Further studies including higher number of replicates and more peri-implant-relevant microorganisms are needed to evaluate the applicability of this experimental protocol to dental implants.

The question regarding the existence of abnormalities in the neuroimaging exams immediately after status epilecticus or epileptic seizures, but showing complete reversibility after a proper antiepileptic therapy, has long been debated. The first reports attempting to demonstrate their existence date back to the 1980s, and relied upon computed tomography as the imaging method of choice. After the introduction of MRI, a more appropriate characterization of these abnormalities was obtained along with the description of their most frequent features: (a) T2 signal hyperintensity in the white matter and, occasionally, (b) reduced apparent diffusion coefficient (ADC) and increased signal in DWI sequences. The MRI abnormalities induced by epileptic activity pose a broad differential diagnosis including infections, inflammatory autoimmune encephalopathies, neoplasms. It remains a diagnosis of exclusion and requires proper diagnostic iter in order to reduce the risk of misdiagnosis and unnecessary intervention. In this case report, a thorough presentation will be outlined about MRI alterations in the left mesial temporal lobe, which resulted completely reversible after a proper antiepileptic therapy.

Since the beginning of the ongoing Amatrice seismic sequence on August 24, 2016, initiated by a Mw 6.0 normal faulting earthquake, the EMERGEO Working Group (an INGV team devoted to earthquake aftermath geological survey) set off to investigate any coseismic effects on the natural environment. Up to now, we surveyed about 750 km2 and collected more than 3200 geological observations as differently oriented tectonic fractures together with intermediate- to small- sized landslides, that were mapped in the whole area. The most impressive coseismic evidence was found along the known active Mt. Vettore fault system, where surface ruptures with clear vertical/horizontal offset were observed for more than 5 km, while unclear and discontinuous coseismic features were recorded along the Laga Mts. Fault systems.

As a phenomenon of the XX Century, the few existed mass parties were capable to build territorial political sub-cultures. The cornerstone of the subcultures was the capacity to implant itself in specific regions. In Germany from the end of the XIX Century until the rise to power of the Nazis Red Regions were Thuringia, Saxe and Berlin under socialist hegemony, and then under communist influence too. The Red Region in Austria coincided with Vienna and was also destroyed from the fascist reaction. In France the Red Region was the banlieue of Paris, where the Communist Party was predominant from the ‘30 to the ‘70, when working class and communist subculture disappeared because the de-industrialization. The Red Regions in Italy have had a longer wife, because the different social classes of composition and different electoral support. Economic and social changes as the dissolution of the Soviet World have been causes of the end.

We evaluated, in a preliminary study, the efficacy of umbelliferone, arbutin, and N-acetylcysteine to inhibit biofilm formation on urinary catheter. We used 20 urinary catheters: 5 catheters were incubated with Enterococcus faecalis (control group); 5 catheters were incubated with E. faecalis in presence of umbelliferone (150 mg), arbutin (60 mg), and N-acetylcysteine (150 mg) (group 1); 5 catheters were incubated with E. faecalis in presence of umbelliferone (150 mg), arbutin (60 mg), and N-acetylcysteine (400 mg) (group 2); and 5 catheters were incubated with E. faecalis in presence of umbelliferone (300 mg), arbutin (60 mg), and N-acetylcysteine (150 mg) (group 3). After 72 hours, planktonic microbial growth and microorganisms on catheter surface were assessed. In the control group, we found a planktonic load of ≥105 CFU/mL in the inoculation medium and retrieved 3.69 × 106 CFU/cm from the sessile cells adherent to the catheter surface. A significantly lower amount in planktonic (p

The regions – as the substatal institutions in-between State and local governments – have developped a leading role in the process of the Europea integration. Empirical evidences of the activism of the regions are also the increase of the regional policies of the European Union, the develop of the regional paradiplomacy, the proliferation of the regional entities with a strong European identity. The phase of the main develop and the more optimistic predictions – the Ninenties – is that of the Europe of the Regions perspective or that of the Third Level for a possible federalist model. In particolar, the policy of the political, economical and social cohesion of the European institutions for the overcoming of the territorial inequalities could favourite the active role of the Regions. If in the past the scholars frequently used the intergovernative model to the definition of the European network, now the multi-level-governance model is preferred. It stresses the regions position in the relations between the EU power levels, institutional or not. The paper aims to explore the theory that the weakening of the states owes the globalization and it could provoke the strenghtening of the role of the regions as guarantees od the citizen participation in Europe.

Purpose: Prostate calcifications are a common finding during transrectal prostate ultrasound in both healthy subjects and patients, but their etiopathogenesis and clinical significance are not fully understood. We aimed to establish a new methodology for evaluating the role of microbial biofilms in the genesis of prostate calcifications. Materials and Methods: Ten consecutive patients who had undergone radical prostatectomy were enrolled in this study. All of the patients presented with prostate calcifications during transrectal ultrasound evaluation before surgery and underwent Meares-Stamey tests and clinical evaluation with the National Institutes of Health Chronic Prostatitis Symptom Index and the International Prostate Symptom Score. At the time of radical prostatectomy, the prostate specimen, after removal, was analyzed with ultrasonography under sterile conditions in the operating room. Core biopsy specimens were taken from the site of prostate calcification and subjected to ultrastructural and microbiological analysis. Results: The results of the Meares-Stamey test showed only 1 of 10 patients (10%) with positive cultures for Escherichia coli. Two of five patients (40%) had positive cultures from prostate biopsy specimens. Enterococcus faecalis, Enterococcus raffinosus, and Citrobacter freundii were isolated. Ultrastructural analysis of the prostate biopsy specimens showed prostate calcifications in 6 of 10 patients (60%), and a structured microbial biofilm in 1 patient who had positive cultures for E. faecalis and E. raffinosus. Conclusions: Although the findings are supported by a low number of patients, this study highlights the validity of the proposed methodology for investigating the role of bacterial biofilms in the genesis of prostate calcification.

Giovanni Capellini (1833-1922) was one of the leading representatives of the Italian and international scientific community from the mid-19th century until 1922, the year of his death. Professor of Geology at the University of Bologna from 1860, geologist, palaeontologist and archaeologist, in 1871 he organised, straight after the unification of Italy, the 5th International Congress in Archaeology and Prehistoric Anthropology, first in Italy, and in 1881 brought to Bologna, for the first time ever in Italy, the 2nd International Geological Congress. His studies and publications strongly influenced the geological thinking of his times. At the Archiginnasio Library in Bologna there are as many as 30,000 documents from his scientific letters (The Capellini Archive), the result of an intense correspondence he had with geologists, seismologists, astronomers and meteorologists, but also with people from the world of culture and politics. The letters relating to the earth sciences, from scientific but also political point of view, are the majority. The archive includes letters from more then 4,300 senders, of which at least 25% foreign ones incuding Charles Lyell (geologist), Emmanuel Friedlaender (volcanologist), Philip Eduard De Verneuil (naturalist), Henry James Johnston Lavis (volcanologist).

A truncated version of the C1 gene of tomato yellow leaf curl geminivirus (TYLCV), encoding the first 210 amino acids of the multifunctional Rep protein, was introduced by Agrobacterium transformation into Lycopersicon esculentum cv. Moneymaker plants under the transcriptional control of an enhanced cauliflower mosaic virus 35S promoter. One R0 plant (line 47) carrying the C1 gene in two loci (A and B) and accumulating the truncated Rep protein (T-Rep), was crossed with either a wild-type plant, or a C1 antisense plant (line 10). The wild type (wt) × 47 progeny were phenotypically homogeneous, contained either A or B locus, expressed high levels of T-Rep protein, had a “curled” phenotype, and were resistant to TYLCV when challenged either by agroinfection or by the vector Bemisia tabaci. In the 10 × 47 progeny, plants carrying only the sense gene behaved like the wt × 47 progeny, while those containing both sense and antisense transgenes did not accumulate the T-Rep protein, showed a normal phenotype, and were not resistant, showing that accumulation of T-Rep protein is required to confer TYLCV resistance. Plants accumulating T-Rep were susceptible to a distinct geminivirus, tomato leaf curl virus (ToLCV-Au).

Asymptomatic bacteriuria (ABU) is a common clinical condition that often leads to unnecessary antimicrobial use. The reduction of antibiotic overuse for ABU is consequently an important issue for antimicrobial stewardship and to reduce the emergence of multidrug resistant strains. There are two issues in everyday urological practice that require special attention: the role of ABU in pre-operative prophylaxis and in women affected by recurrent urinary tract infections (rUTIs). Nowadays, this is the time to think over our practice and change our way of thinking. Here, we aimed to summarize the current literature knowledge in terms of ABU management in patients undergoing urological surgery and in patients with rUTIs. In the last years, the approach to patient with ABU has changed totally. Prior to all surgical procedures that do not enter the urinary tract, ABU is generally not considered as a risk factor, and screening and treatment are not considered necessary. On the other hand, in the case of all procedures entering the urinary tract, ABU should be treated in line with the results of a urine culture obtained before the procedure. In patients affected by rUTIs, ABU can even have a protective role in preventing symptomatic recurrence, particularly when Enterococcus faecalis (E. faecalis) has been isolated.

Le subculture politiche territoriali in via di ridefinzione offrono lo spunto per la rivisitazione del concetto e un esame delle attribuzioni che le aree tradizionalmente associate alla presenza subculturale dimostrano nel processo di mutamento sociale, economico e politico. In particolare, si affronta l’ipotesi del venir meno di tratti subculturali nelle regioni rosse di Italia, a seguito del venir meno della forza identitaria e organizzativa del partito politico dominante. A differenza di analisi fondate sulla geografia elettorale e di altre letture che vedono trasferirsi alle istituzioni il potere direttivo precedentemente esercitato dai partiti della sinistra, si affronta ed esamina la prospettiva storica sociologica e politologica del decadere della subcultura politica rossa. In questo senso la persistenza elettorale di una particolare maggioranza viene ricondotta a un colore politico, ma non più a tratti culturali propri di un sistema sociale e politico con connotati propri.

The reuse of single use devices is of particular interest in interventional cardiology where the economic load of the devices represents a significant share of the whole procedure. The sterility of the reprocessed device must be tested and warranted, together with chemical-physical and functional performances. This study evaluates the efficiency and limitations of an experimental reprocessing protocol in order to assess the sterility of cardiac electrophysiology catheters and the maximum number of regeneration cycles sustainable by the device. A first lot of 54 devices, collected after clinical use in the Cardiology Department of S.Chiara Hospital in Trento, was reprocessed and tested for sterility. Devices underwent repeated cycles of simulating-use (bacteria spiked blood) and regeneration (decontamination, cleaning and hydrogen peroxide gas plasma sterilization): 36, 24, 28, 35, 22 devices were regenerated respectively 2, 3, 4, 5 and 6 times. Entire devices were cultured for 28 days in trypticase soy broth. On the whole,we tested 199 samples, six cycles of regeneration and four inoculation species. No positive sample to inoculated strain was found until the fourth cycle of reprocessing. The inoculated Bacillus subtilis strain was recovered in samples reprocessed five and six times. Reprocessing procedures following the adopted protocol turned out efficient to guarantee device’s sterility up to five reuses in experimental conditions representing the worst case scenario for bacterial load. However, complexity of reprocessing protocols, organizational issues, economic and legal requirements addressed to qualifying and certifying all steps of the reprocessing procedure discourage “in house” reprocessing.