Single Case Research Articles

Boucher-Neuhauser Syndrome: Chorioretinal Changes in a Single Case Over Time.

To describe chorioretinal changes in a single case of Boucher-Neuhauser Syndrome (BNHS) over 45 years of follow-up. Methods: Retrospective chart review was performed. Color fundus photography from 1977 to 2003 was obtained and digitized. Current fundus photography was obtained with widefield imaging. High-resolution spectral-domain optical coherence tomography (OCT) was performed. Genetic analysis was performed using an inherited retinal disorders panel. Results: Fundus examination demonstrated central chorioretinal atrophy with sclerotic choroidal vessels. Short posterior ciliary arteries became more prominent and tortuous over time. Mid-peripheral atrophy extends to the equator and demonstrates a scalloped pattern with islands of atrophy intervening with areas of normal retina. The far periphery remained minimally affected. High-resolution OCT demonstrated outer retinal atrophy and choriocapillaris loss. Genetic testing showed a homozygous variant for PNPLA6 and a heterozygous variant for TYRP1. Conclusion: Chorioretinal changes in BNHS vary in onset and severity. It is important to diagnose this condition in order to begin timely management of visual and systemic sequelae.

Achieving Environmental sustainability through the adoption of industry 4.0: an exploratory case study within the information technology industry

Abstract In the present-day competitive business landscape, integrating Industry 4.0 has transitioned from a choice to a necessity for companies striving to maintain their edge. Given the automation functions of IoT, the data management and transformation capabilities of AI, and the traceability benefits provided by Blockchain, this imperative is now more evident than ever. While widespread interest in Industry 4.0 is prevalent, the uncertainties surrounding the implementation process pose notable challenges. For this reason, in this paper, we present a single case study of a firm that operates in the information technology market to showcase the implementation process and how they overcome the challenges of digital transformation. Furthermore, the effect of this implementation on environmental sustainability experienced by the company and three of its customers was discussed.

Automatic 3D Augmented-Reality Robot-Assisted Partial Nephrectomy Using Machine Learning: Our Pioneer Experience.

The aim of "Precision Surgery" is to reduce the impact of surgeries on patients' global health. In this context, over the last years, the use of three-dimensional virtual models (3DVMs) of organs has allowed for intraoperative guidance, showing hidden anatomical targets, thus limiting healthy-tissue dissections and subsequent damage during an operation. In order to provide an automatic 3DVM overlapping in the surgical field, we developed and tested a new software, called "ikidney", based on convolutional neural networks (CNNs). From January 2022 to April 2023, patients affected by organ-confined renal masses amenable to RAPN were enrolled. A bioengineer, a software developer, and a surgeon collaborated to create hyper-accurate 3D models for automatic 3D AR-guided RAPN, using CNNs. For each patient, demographic and clinical data were collected. A total of 13 patients were included in the present study. The average anchoring time was 11 (6-13) s. Unintended 3D-model automatic co-registration temporary failures happened in a static setting in one patient, while this happened in one patient in a dynamic setting. There was one failure; in this single case, an ultrasound drop-in probe was used to detect the neoplasm, and the surgery was performed under ultrasound guidance instead of AR guidance. No major intraoperative nor postoperative complications (i.e., Clavien Dindo > 2) were recorded. The employment of AI has unveiled several new scenarios in clinical practice, thanks to its ability to perform specific tasks autonomously. We employed CNNs for an automatic 3DVM overlapping during RAPN, thus improving the accuracy of the superimposition process.

Advancements in the Detection and Treatment of Rare ALK Fusion Mutations in Hepatocellular Carcinoma: A Case Report and Literature Review

This case report and comprehensive literature review highlights the significance of advanced molecular diagnostic techniques, particularly next-generation sequencing (NGS), in the identification and treatment of rare ALK fusion mutations in hepatocellular carcinoma (HCC). Through a detailed analysis of a single patient case, accompanied by a review of existing literature, we underscore the diagnostic challenges and therapeutic potential associated with rare ALK fusions in HCC. Our findings demonstrate the superior capability of NGS, both DNA-based and RNA-based, in detecting these mutations, leading to targeted treatment approaches with ALK inhibitors. The case report illustrates the practical application of precision oncology in HCC, showcasing significant clinical benefit and improved treatment outcomes with the use of ALK inhibitors for rare fusion types. This study not only contributes to the existing body of knowledge by documenting a rare instance of ALK fusion in HCC but also advocates for the integration of comprehensive molecular profiling into standard clinical practice to enhance personalized treatment strategies and patient care.

(219) Lengthening Phalloplasty: Combined Technique of a Urologist and a Plastic Surgeon

Abstract Introduction Lengthening phalloplasty is an operation that aims at increasing the length of the penile shaft. This procedure has been gaining popularity with different surgical techniques being described and possible suboptimal patient satisfaction rate that can be optimized. The most popular surgical method used for penile lengthening is release of the suspensory ligament. Our technique differs as it involves a combination of urological and plastic surgical steps to achieve the maximum length with the safest optimum outcome. Objective We are advocating the above unique modified surgical technique aiming to achieve the desired results with higher satisfaction rate. Methods A retrospective study including consecutive male patients presenting for penile lengthening over the last 6years. Patients underwent pre-operative andrology and psychological evaluation. All procedures were performed by the same urologist and plastic surgeon simultaneously. A successful surgical outcome is defined as: achieving a lengthening equal to or more than 2cm. Results A total of 82 married male patients were included. The age ranged from 26 to 40 years with a median of 33years. They had normal sexual activity with no psychiatric nor behavioural disturbance. The average pre-operative penile length was: 9.75 cm. the average additional penile lengthening achieved post-operatively was: 3.7 cm. with a range of 2.8 to 4.7 cm. There was no major complications or failure of the procedure observed. One patient suffered from partial wound dehiscence following return to sexual activity two week after surgery. Patients satisfaction with the outcome 6 months following surgery reached 31/32 with a single case of dissatisfaction owing to the residual scar (success rate of 97%). Conclusions We have concluded that using our multimodality technique that this type of phalloplasty is a safe procedure with 100% anatomical surgical success rate in achieving the desired length gain and overall patient satisfaction rate of 97% which has not been reported using the standard procedure. Disclosure No.

Chitraka Rasayana in the management of rigidity dominant Parkinson’s disease –A single case report

Chitraka Rasayana in the management of rigidity dominant Parkinson’s disease –A single case report

(244) Optimization of Sperm Retrieval in Non-Obstructive Azoospermic Patients using Conventional TESE

Abstract Introduction Sperm retrieval in NOA patients remain to be the only hope for these patients for fatherhood using assisted reproductive techniques. Micro-TESE is the gold standard with the best retrieval rate. Microsurgical facilities are not available at every center and conventional TESE techniques are not standardized between different centers. Objective Our aim is To improve the spermatogenic function of NOA patients to enable the appearance of sperm in their ejaculate or to improve the chances of a successful retrieval from the testis for ICSI and To optimize and standardize our conventional TESE technique Methods Over last 7 years 94 cases of NOA patients were subjected to conventional TESE. We Exclude the cases of Obstructive Azoospermia, Cases with abnormal chromosomal analysis were referred for higher center for genetic counselling and diagnosis. Laboratory workup including at least two semen samples, hormonal valuation (FSH, LH, Prolactin, Testosterone) and chromosomal analysis (Karyotyping and Testing for Y chromosome micro-deletions. Pre-TESE medical Treatment: included Clomiphene citrate: 50 mg OD for 3–6 months, Anti-oxidant therapy (Vitamin E 200mg BID and Vitamin C, 1 gm, OD). 6 biopsies from each testis: upper pole 2(medial &Lateral), mid zone 2 (medial & Lateral), lower pole 2(medial &Lateral). Separate biopsy from each testis was sent for definitive histopathological correlation. Experienced embryologist attends each procedure examining each biopsy until sperms are retrieved. Samples taken were centrifuged and re-examined at lab for any missed sperm Results sperm retrieval was successful in 38patients (40.4%). All cases were done as day case No single case of wound infection or intra-testicular hematoma.Post-operative pain was tolerable and managed by paracetamol ±NSAID Negative cases for sperms were continued on higher dose of CC and referred for microTESE Conclusions Though of low-evidence, empiric Pre-TESE enhancement of spermatogenesis should be attempted whenever possible and after proper patients counselling. This systematic anatomical approach for biopsies yielded high SRR compared to other conventional TESE. Exact localization of + ve testicular site and side If patient needed Re-do TESE for more sperms in the future. Although micro TESE remains to be the best modality for SR in NOA, in our hands and in canters without Micro-TESE facilities, applying this standardized technique with pre-operative hormonal manipulation yields accepted rate of sperm retrieval Disclosure No.

Shwachman-Diamond syndrome associated with rod-cone dystrophy.

To report a patient with Shwachman-Diamond syndrome and concomitant rod-cone dystrophy who underwent bone marrow transplantation. Retrospective single case report. A female patient with Shwachman-Diamond syndrome was referred to a tertiary hospital to investigate possible pigmentary retinopathy at the age of 16. She described poor night vision and was found to have reduced visual acuity (6/20 right, 6/38 left). Over the ten-year follow-up period, her visual acuity remained relatively stable with no new visual symptoms. Optical coherence tomography revealed progressive, diffuse outer retinal thinning with disruption of the ellipsoid zone, which initially was relatively preserved subfoveally. Fundus autofluorescence images revealed generalised areas of hypoautofluorescence beyond the vascular arcades and a perimacular ring of increased autofluorescence. The flash electroretinogram was in keeping with a severe rod-cone dystrophy. The pattern visual evoked potential was abnormal but detectable indicating macular pathway dysfunction, suggesting encroachment into central macular regions but with some functional preservation. We report a patient with Shwachman-Diamond syndrome with severe early-onset rod-cone dystrophy noted at the age of 16. Slow anatomical progression has been observed over the subsequent ten years, with relative functional macular preservation to support a visual acuity of 6/36 in both eyes.

Differentiated approach to external acne therapy

Acne is a serious medical and social problem due to the widespread prevalence of the disease. Localized mainly on the face, acne leads to the development of disorders in the psycho-emotional sphere, significantly reducing the quality of life.
 The aim of the study was to study the effectiveness and safety of Epiduo/Effezel gel (adapalene 0.1% and benzoyl peroxide 2.5%) in patients with papulopustular acne.
 The Clinic of Skin and Sexually Transmitted Diseases of the Clinical Hospital No. 2 of Sechenov University has accumulated extensive experience in the treatment of acne. In the diagnostic and treatment department, patients with mild to moderate acne receive consultations and treatment almost every day. A dermatological examination is carried out visually with a simple count of eruptive elements: papules, pustules and nodes, on the basis of which the degree of severity is determined. Patients with severe forms of acne receive systemic retinoids with corrective therapy until a certain cumulative dose is reached, and then patients receive topical maintenance therapy intermittently for 12 months.
 Despite the development of effective methods for treating this dermatosis, patient adherence to treatment remains low. This is due, first of all, to the duration of therapy, not always the rapid achievement of the expected result, and to the development of psycho-emotional disorders in patients. In the latest edition of the Russian Society of Dermatovenerologists and Cosmetologists clinical guidelines for the treatment of mild to moderate acne with a high level of evidence A1, it is recommended to use benzoyl peroxide and a fixed combination of adapalene and benzene peroxide. When prescribing benzene peroxide (Baziron AS), we observed the best results in clearing the skin of rashes in the presence of a few papulopustular elements in the clinical picture due to the triple action of benzoyl peroxide ― antimicrobial, keratolytic and sebostatic. In our experience, it usually took 4 to 6 weeks to achieve clinical remission, and we did not note a single case of the development of bacterial resistance during treatment. For moderately widespread papulopustular acne rashes of moderate severity, as well as in cases of severe forms of the disease, when it is impossible to prescribe systemic isotretinoin or there is a tendency to scarring of the primary elements, we used a fixed combination of adapalene 0.1% and benzoyl peroxide 2.5% (Effezel) with anti-inflammatory, antimicrobial, keratolytic, sebostatic, comedolytic and anticomedogenic effects.
 In the arsenal of dermatologists and cosmetologists there are drugs for the external treatment of mild to moderate papulopustular acne with a high level of evidence. Thus, for papulopustular acne with a few inflammatory (papules and pustules) rashes, benzoyl peroxide gel may be recommended. For moderately widespread papulopustular acne with the presence of comedones (moderate severity), a fixed combination of adapalene and benzoyl peroxide can be recommended as the first line of therapy.

(076) Hyaluronic Acid Injection of Penis for Management of Premature Ejaculation: A Systematic Review with Single-Arm Meta-Analysis

Abstract Introduction Premature ejaculation (PE) is the most prevalent male sexual dysfunction globally. Pharmacological treatments as the primary mainstay for PE therapy have drawbacks in systemic effect and possible recurrence after drug cessation. In the last few years, there has been a progressive use of hyaluronic acid (HA) injection in Andrology, including its use to prolong ejaculation latency time by increasing penile glans sensitivity. However, no meta-analysis on its efficacy and safety exists. Objective The study aimed to conduct a comprehensive systematic review and single-arm meta-analysis to identify the efficacy and safety of HA injection in the penis for treating PE. Methods A systematic search on PubMed, Scopus, and Embase databases were searched from inception to May 31, 2023, according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Risk of bias of included study were carried out based on Cochrane ROB2 and ROBINS-I tools. Intravaginal ejaculatory latency time (IELT) was considered the primary outcome, whereas satisfaction and complication rate were the secondary outcomes. Pooled rate and mean difference with matching 95% confidence level intervals (CIs) in the random effect model were applied in analysis using STATA 18.0 and RevMan 5.4. To ensure the impact of each study, a leave-one-out sensitivity analysis was performed. Results Of the 60 studies identified, three clinical trials and six observational studies with low and moderate risk of bias met the inclusion criteria. A total of 616 participants were eligible for meta-analysis. The results found that HA injection, with different techniques, can significantly increase IELT by 239.78 (95% CI 147.14 – 332.43), 202.76 (95% CI 121.86 – 283.66), 164.62 (95% CI 112.19 – 217.06), and 189.01 (95% CI 71.74 – 306.28) seconds at 1, 3, 6, and ≥12 months follow-up. Despite significant heterogeneity among the studies, the sensitivity analysis results were unaffected by the removal of any of the articles. As for safety, the most commonly reported complications were pain, ecchymosis, and papule formation with pooled incidence of 19% (95% CI: 15% – 24%), 8% (95% CI: 5% – 13%), and 5% (95% CI: 3% – 8%), respectively. The majority of adverse events were mild, temporary, and self-limited, although a single case of skin necrosis and vascular emboli had been reported. In addition, patients and their partners also reported increased satisfaction after HA injection. Conclusions HA injection in the penile can effectively prolong the ejaculation time by at least a year with tolerable adverse events. Nevertheless, the optimal injection technique, ideal patient candidate, and long-term outcome still need to be determined through additional well-designed trials. Disclosure No.

Digital transformation in e-commerce logistics

Highlights: This article addresses the diagnosis of digital maturity in e-commerce logistics, specifically the final delivery stage, known as the last-mile. The last-mile has greater digitization demand than traditional logistics due to the extreme speed of the virtual world during shopping, where customers transfer these same expectations to delivery services. Goal: The main objective of this work is to evaluate the digital maturity of the last-mile area of operation of an e-commerce logistics company. Methodology: This study evaluates the maturity model in a case study with the company E-commerceCo. Interviews were conducted with key employees for data gathering. Results: The proposed method allows defining and analyzing the digital maturity of the last-mile area of the company in question, understanding strengths, such as a culture open to innovation and digitally mature, and weaknesses, such as technical limitations imposed by the main system used and lack of cybersecurity barriers. Limitations of the investigation: Since it is a single case study, it does not allow a broad generalization to industries in other branches. Another limitation is that this study is focused on Brazilian logistics operations, which may differ from other countries. Practical implications: This research is relevant to serve as a reference for other companies in the e-commerce logistics sector to assess their digital maturity from the proposed model and compare common challenges and opportunities. In addition, it will help the studied company to create a successful digital transformation strategy. Originality / Value: We propose a new approach on how to evaluate the digital maturity of the last-mile area of operation of an e-commerce logistics company.

Limitations of constant optimization with disclosed intraocular lens power formulae.

To investigate the effect of formula constants on predicted refraction and limitations of constant optimization for classical and modern intraocular lens (IOL) power calculation formulae. Tertiary care center. Retrospective single-center consecutive case series. This analysis is based on a dataset of 888 eyes before and after cataract surgery with IOL implantation (Hoya Vivinex). Spherical equivalent refraction predSEQ was predicted using IOLMaster 700 data, IOL power, and formula constants from IOLCon ( https://iolcon.org ). The formula prediction error (PE) was derived as predSEQ minus achieved spherical equivalent refraction for the SRKT, Hoffer Q, Holladay, Haigis, and Castrop formulae. The gradient of predSEQ (gradSEQ) as a measure for the effect of the constants on refraction was calculated and used for constant optimization. Using initial formula constants, the mean PE was -0.1782 ± 0.4450, -0.1814 ± 0.4159, -0.1702 ± 0.4207, -0.1211 ± 0.3740, and -0.1912 ± 0.3449 diopters (D) for the SRKT, Hoffer Q, Holladay, Haigis, and Castrop formulas, respectively. gradSEQ for all formula constants (except gradSEQ for the Castrop R) decay with axial length because of interaction with the effective lens position (ELP). Constant optimization for a zero mean PE (SD: 0.4410, 0.4307, 0.4272, 0.3742, 0.3436 D) results in a change in the PE trend over axial length in all formulae where the constant acts directly on the ELP. With IOL power calculation formulae where the constant(s) act directly on the ELP, a change in constant(s) always changes the trend of the PE according to gradSEQ. Formulae where at least 1 constant does not act on the ELP have more flexibility to zero the mean or median PE without coupling with a PE trend error over axial length.

Dilemmas of Teachers Related to the Supervision in Schools: A Case Study

School supervision is generally defined as the process of determining the realization level of performance indicators in schools, and evaluating the quality of education. Supervisors are not directly involved in these activities, and are appointed by the Ministry to assess fulfilment level of these educational activities. In current study, teachers’ perspective related to the supervision in Türkiye was examined in a qualitative research design. A single case study model was adopted to explore the case in depth. The aim of this research was to explore views of 28 teachers on supervision. The study group was chosen through maximum variation sampling technique. Data were collected via semi-structured interviews, observations, and focus group interviews. Thematic content analysis technique was adopted to analysis of raw data. Four themes emerged based on the analysis. These themes were low stakes inspection, high stakes inspection, decentralization, and decreasing in quality. The results revealed that the participants were in a dilemma about the supervision in schools. Moreover, this dilemma was related to the audit of teacher performance by school principal and the supervision of school by ministry inspectors. In addition, through the focus group interviews, the suggestions of the participants with different perspectives on inspection were explored and thus more generalizable themes were produced.

Inclusive Teaching in Higher Education: Challenges of Diversity in Learning Situations from the Lecturer Perspective

This paper contributes to the dialogue around how to increase inclusion in higher education, taking the lecturer perspective as the point of departure. Theoretically, disability is understood as an interaction, which means that lecturers partake in the constitution of dis/ability in learning situations. Two qualitative interviews were conducted with an interdisciplinary lecturer employed in an institution of higher education in Norway. These data are used for this single case study to illustrate and reflect on the challenges of diversity in learning situations. Findings suggest that the lecturer struggles to encounter their increasingly diverse student population inclusively. Overall, her experiences unpack the outcome of a structural lack of prioritization to ensure accessibility for disabled students at an institutional level at the university where she is employed. This article emphasizes that the responsibility to ensure an inclusive teaching practice in higher education must be recognized and treated as an institutional obligation. To signal its priority, all institutions of higher education should make inclusive training obligatory for lecturers, as well as assigning hours to work on enhancing the development of inclusive skills in this group.

Support Services Provided by a Child and Youth Care Centre (CYCC) to Adolescent Witnesses of Domestic Violence

Objective: This article presents the results of a case study conducted at a Child and Youth Care Centre (CYCC) in Pretoria, South Africa, on social service practitioners’ (SSP) views of the support services provided by a CYCC to adolescent witnesses of domestic violence. These support services are explored in terms of four inter-dependent levels including the micro, meso, exo and macro levels of the Ecological Theory, as described by Bronfenbrenner (1979).Method: For this study, a qualitative holistic case study design was adopted. This single case study design was chosen as information was gathered from various sources in only one CYCC. Information was triangulated by using various sources of data, that is interviews with SSPs and the children, as well as the policies of the CYCC regarding services offered for children who have witnessed domestic violence.Results: This study revealed that there are no specialised services at the identified CYCC to support adolescent witnesses of domestic violence. The services that are available seem to be generic and aimed at addressing problem behaviours in children and adolescents, rather than providing proactive, therapeutic support to deal with trauma such as witnessing physical and verbal domestic violence in their home of origin.

Exploring Positive Youth Development Approach in Indian Context

Positive youth development (PYD), which arose as a counterbalance to the treatment models in youth work, stresses the role of family, community and other change agents, such as NGOs and educational institutions, in creating services, opportunities and support systems for young people to excel. The article tries to locate the context of PYD approach. Single case study method is employed to document the historical emergence of the Anubhav Shiksha Kendra (ASK) and its adoption of PYD approach. Though the study cannot be generalised, it provides a framework for future empirical studies on PYD in India.

Intraoperative ECoG in bottom-of-the-sulcus syndrome using a novel flexible strip electrode.

The recording of epileptiform discharges from bottom-of-sulcus focal cortical dysplasia (BOSD) is often difficult during intraoperative electrocorticography (ECoG) due to the deep localization. We describe the use in this scenario of a new-generation electrode strip with high flexibility, easily adapted to cortical gyri and sulci. A right-handed 20-year-old male with drug-resistant focal epilepsy due to BOSD of the inferior frontal gyrus and daily focal aware seizures was evaluated for epilepsy surgery. Based on electroclinical and neuroimaging results, a focal cortectomy guided by ECoG was proposed. ECoG recordings were performed with new-generation cortical strips (Wise Cortical Strip; WCS®) and standard cortical strips. ECoG, performed on the convexity of the frontal cortical surface, recorded only sporadic spikes with both types of strips. Then, after microsurgical trans-sulcal dissection, WCS was molded along the sulcal surface of the suspected BOSD based on 3D-imaging reconstruction, showing continuous/subcontinuous 3-4-Hz rhythmic spike activity from the deepest electrode. Registration after resection of the BOSD did not show any epileptiform activity. Pathology showed dysmorphic neurons and gliosis. No surgical complications occurred. The patient is seizure-free after 12 months. This single case experience shows that highly flexible electrode strips with adaptability to cortical gyrations can identify IEDs originating from deep location and could therefore be useful in cases of bottom of the sulcus dysplasia.

ASXL3-related disorder: Molecular phenotyping and comprehensive review providing insights into disease mechanism.

ASXL3-related disorder, sometimes referred to as Bainbridge-Ropers syndrome, was first identified as a distinct neurodevelopmental disorder by Bainbridge et al. in 2013. Since then, there have been a number of case series and single case reports published worldwide. A comprehensive review of the literature was carried out. Abstracts were screened, relevant literature was analysed, and descriptions of common phenotypic features were quantified. ASXL3 variants were collated and categorised. Common phenotypic features comprised global developmental delay or intellectual disability (97%), feeding problems (76%), hypotonia (88%) and characteristic facial features (93%). The majority of genetic variants were de novo truncating variants in exon 11 or 12 of the ASXL3 gene. Several gaps in our knowledge of this disorder were identified, namely, underlying pathophysiology and disease mechanism, disease contribution of missense variants, relevance of variant location, prevalence and penetrance data. Clinical information is currently limited by patient numbers and lack of longitudinal data, which this review aims to address.

An integration protocol for aligning intraoral scans to facial scans using the nasal geometry reference in a fully dentate patient.

Advanced digital technologies have rapidly been integrated into prosthodontics to improve the digital workflow for prosthetic rehabilitation. The integration of 3D datasets acquired from various imaging sources such as intraoral scanners and facial optical scanners allows the creation of virtual patients to perform presurgical simulation and prosthetic rehabilitation. The presented technique introduced a straightforward protocol for aligning intraoral scans (Trios 4, 3Shape) to optical face scans (Face Hunter, Zirkonzahn) using a global best-fit algorithm of 3D evaluation software (GOM Inspect). Nasal geometry data were used as the matching reference to produce virtual dental patients. This integration protocol ensured that the intraoral scanner (Trios 4, 3Shape) was used not only to scan dental arches but also used effectively to scan the nose. These scans along with professional facial scans can be successfully aligned to produce virtual dental patients. As only a single fully dentate patient case with an alignment deviation of 243.6 µm was used, further research to evaluate the accuracy of this protocol is needed.

Limits of open innovation during the organizational change: a case study of a Partner Campus

The literature on open innovation (OI) has mainly been focused on the ‘bright side’ of OI, thus neglecting the limits of OI implementation influencing innovation processes during organizational change. It requires to develop a better understanding about the limits of OI. Therefore, this study explores the limits of OI during organizational change and provides approaches that drive firms to offset these limits. The empirical analysis is based on an in‐depth single case study and data was collected through semi‐structured interviews with the representatives engaged with Partner Campus – an OI initiative developed by a multinational manufacturing company. We have found that during the change process of adapting collaborative and absorptive capabilities, and developing organizational readiness, several internal and external challenges limit the company's drive to open up. Internal challenges arise when organizations start the change process in unfreezing stage. The traditional organizational culture and structure challenge incumbent firms to break the existing silos and utilize knowledge and resources effectively for OI implementation, hindering intra‐organizational collaboration. While external challenges arise when organizations transform their endeavors across organizational boundaries and collaborate with external stakeholders. When firms lack knowledge integration and technological capabilities, OI creates collaborative complexity given the magnitude of involved diverse actors and activities at different levels, which challenges the organizations to maintain the longevity of OI practices, resulting in several risks that limit firms to open up. However, we have identified the capabilities and actions that firms can take to strengthen a collaborative environment by counterbalancing these challenges. We contribute to the literature on OI by identifying and assessing the limits of OI, embedded in the organizational change process, that hinder organizational drive for OI. We also contribute to organizational change literature by identifying specific changes related to organizational processes, structure, and culture, and outlining approaches that can support a smooth transition.