University of Wisconsin Health

Craniofacial implants are prone to skin necrosis and exposure, likely due to implant-induced stress and ischemia. However, this relationship has not been quantitatively validated. Identifying an imaging biomarker of skin vascular health could confirm this mechanism and help predict skin failure to mitigate implant complications. Photoacoustic tomography (PAT) was used to monitor changes in the skin vasculature surrounding subcutaneous implants with the goal of obtaining a quantitative metric predictive of implant exposure. Three designs of 3D-printed porous polycaprolactone (PCL) constructs-unimodal block, bimodal block, and unimodal dome-were implanted in 16 hairless mice. PAT was performed biweekly for 16 weeks, and a skeletonization algorithm was applied to quantify vascular density in skin overlying the implants. Mice that developed implant exposure ( ) exhibited a progressive decline in vascular density beginning 6 weeks before visible exposure, whereas nonexposed mice ( ) remained stable. Group differences were significant 4 weeks ( ) and 2 weeks ( ) before exposure onset. These findings establish a quantitative temporal relationship between vascular ischemia and implant exposure. PAT-derived vascular density serves as a predictive biomarker of skin failure, which can be used to enable interventional treatment and improve implant designs.

Traumatic injuries represent a significant public health challenge, affecting millions worldwide annually and necessitating acute pain management that frequently involves the use of opioid analgesics to mitigate discomfort and facilitate recovery. Although opioids remain an integral part of post-traumatic injury pain management, their use exposes trauma survivors to the risk of developing persistent use, misuse, or opioid use disorder (OUD). Pre-injury health determinants, such as age, gender, psychiatric conditions, medical conditions, and substance use history, may interact with injury-related factors to acutely escalate the risk for misuse and addiction. Despite the growing recognition of these potential vulnerabilities, there remains a lack of evidence-based clinical decision support on modifiable and non-modifiable risk factors specific to post-traumatic injury opioid risk trajectories. This review summarizes the literature related to the multifactorial contributors to opioid misuse and addiction following traumatic injury such as patient-level (e.g., demographics, behavioral health), injury-related (e.g., severity, type), and system-level (e.g., prescribing patterns) characteristics. A comprehensive literature search, inclusive of the literature from 1995 to November 2025, was performed in PubMed/MEDLINE, Scopus, and Google Scholar using combinations of terms related to "opioids," "misuse," "addiction," "trauma," and "injury." Search keywords and operators were developed in collaboration with a university librarian. Reference lists of articles were searched and synthesized. Case reports, case series, editorials, mini-reviews, letters to editor without original data, and qualitative studies were excluded. The findings of the review are expected to provide insight into clinical-decision making as it relates to the management of pain, pain-related distress and functional impact, and co-occurring conditions that may impact injury-related outcomes and the potential likelihood of substance misuse and addiction.

The online version contains supplementary material available at 10.1007/s12144-025-08981-8.

The serotonergic psychedelic psilocybin induces neural plasticity and profoundly alters consciousness. The benzodiazepine midazolam blunts neural plasticity and induces conscious sedation and amnesia at low doses. In our recent open label pilot study, we administered oral psilocybin (25 mg) along with intravenous midazolam at doses allowing a full psychedelic experience while blunting memory for the experience. We previously reported preliminary results from high density scalp electroencephalography (EEG) recorded during the dosing session. Here, we examined changes in EEG band power, normalized Lempel Ziv complexity (LZCn), and spectral exponent. We used linear mixed effects models that incorporated time and the subjective effects of midazolam and psilocybin, measured with the Observer's Assessment of Arousal and Sedation (OAA/S) and selected items from the Altered States of Consciousness (ASC) questionnaire, respectively. At 15-30 min, when midazolam but not psilocybin was at its targeted effect site concentration, we observed increased beta power and decreased spectral exponent. As the subjective effects of psilocybin commenced and over the next six hours, we observed increased LZCn and spectral exponent and decreased broadband power, with the most prominent power reductions in the delta, theta, and alpha frequency bands. OAA/S improved model fits for alpha power while ASC improved model fits for LZCn and spectral exponent. While recognizing limitations inherent to the small sample size and variability in dosages of midazolam, these data are further evidence that the effects of psilocybin are maintained in the presence of midazolam, supporting its utility in mechanistic studies of psilocybin's therapeutic activity.

Radiation necrosis (RN) presents a significant challenge in the treatment of pediatric central nervous system tumors. This narrative review synthesizes current evidence on the use of bevacizumab (BEV) for managing pediatric RN, drawing from case reports, retrospective reviews, and prospective clinical trials. While high-quality prospective data remain limited, emerging evidence suggests that BEV may be effective in alleviating both clinical symptoms and radiographic manifestations of RN in pediatric patients. This review explores the pathophysiology of RN, BEV’s mechanism of action, and existing evidence on the use of BEV in pediatric RN. Emerging evidence suggests that bevacizumab may provide symptomatic relief and radiographic improvement in pediatric patients with RN. By addressing current knowledge gaps, the aim is to provide insight into the potential role of BEV in improving outcomes for pediatric patients with RN.

One-size-fits-all opioid treatment for chronic pain may undermine treatment effectiveness and cause adverse effects. We explore personalized nonpharmacological and noninvasive chronic pain treatment as a promising approach to minimize these risks and optimize outcomes for each patient. Our paper introduces the definition of personalized treatment, emphasizes the significance of intervention personalization, and outlines strategies for inter- and intra-patient personalization in chronic pain management. We also discuss empirical studies on personalized chronic pain treatment. Research has shown a variety of strategies for personalizing nonpharmacological and noninvasive chronic pain treatment. These strategies have demonstrated the potential to improve effectiveness. However, many critical scientific questions remain unanswered. To fully harness the potential of personalized nonpharmacological and noninvasive chronic pain treatment, future research should conduct robust clinical trials and meta-analyses comparing personalized and non-personalized chronic pain interventions, examine diverse personalization approaches, incorporate ecological momentary assessment into outcomes assessment, leverage digital technologies, engage patients in treatment design, and assess factors influencing the implementation of personalized chronic pain treatment.