Skin is the outmost barrier that separates the human body from the external environment. In psoriasis, immune cells are resident and / or infiltrated into the epidermis in order to form the epidermal immunological microenvironment (EIME) and constitute a complex interaction with keratinocytes, together with nerve and microbiota influence. Our results have shown that psoriasis is mainly mediated by specific inflammatory environment composed by keratinocyte-neuro-immune cell units (KNICUs), which is the interaction of activated epidermal immune cells, keratinocytes and peripheral nerves fibers, which are increased in psoriatic lesions and are closely innervated around immune cells and keratinocytes. Multiple units gathering to complete circulatory and amplified loop, both an epidermal feed-forward inflammatory loop constituted with epidermal dendritic cells pDC, cDC, Langerhans cells and CD8+T cells, and a dermal loop with dermal pDC, cDC, macrophages and CD4+T cells. The epidermal loop plays a dominant role in the initiation and maintenance of psoriasis.

Psoriasis is a polygenic hereditary chronic inflammatory systemic disease mediated by T cells and dendritic cells. At present, the research on psoriasis mostly focuses on the immunological mechanism, and few studies focus on the role of neural mediators in the development of psoriasis disease. Studies have confirmed the existence of molecular "dialogue" between nerve fibers and keratinocytes. Our previous study also found that the protrusions of nerve cells extend to keratinocytes and form "synapse-like" structures on the surface of keratinocytes. In psoriatic lesions, our results illustrated that skin nerve fibers increased and were distributed closely around keratinocytes and several immune cells. Also, genes related to sensory nerve were disrupted in psoriasis and improved after biologics treatment. In order to explore the role of nerve in the development in psoriasis, we conducted imiquimod induced psoriasis-like dermatitis on spinal cord hemi-section model. We found that psoriasis-like dermatitis alleviated after sensory nerve impairment, with inhibition of abnormal keratinocyte proliferation. Botulinum toxin A pretreatment also improved psoriasis-like dermatitis by inhibiting the secretion of neuropeptide. In summary, nerve fibers connected with keratinocytes via synapse-like structure and participated in the progression of psoriasis. Impairment of nerve could improve psoriasis-like dermatitis on mouse model.

Purpose: Cyberattacks on health care systems have been on the rise over the past 5 years. Formulation and implementation of a robust postattack business continuity plan and/or contingency plan (CP) is essential for minimal disruption to patient care. The level of awareness and planning within the radiation oncology community for cyberattacks is not clear. This study was undertaken to survey and assess cyberattack CP awareness and preparedness. Methods and Materials: A survey instrument comprising 5 questions on awareness and preparedness of cyberattack CPs was e-mailed to 150 radiation oncology departments. Recipients included 105 institutions with residency programs in therapeutic medical physics, as listed by the Commission on Accreditation of Medical Physics Education Program (usually either school-based or large institutional settings), and 45 additional smaller settings within the United States, representing community practices. Results: Forty-three responses were deemed evaluable for analysis. Forty-two percent (18 respondents) of respondents responded that they are well-aware of the concept of a cyberattack CP. A large discrepancy in awareness exists between larger hospitals (LH) that have 5 or more treatment machines and smaller hospitals (SH) that have 4 or fewer, 54% versus 24 % (P < .05). Fifty-eight percent of respondents considered it "essential " to have such a plan in place, and 28% considered it "desirable " to do so but not practical. Nine percent regarded a cyberattack CP as unnecessary. No significant differences in responses were noted among different types or sizes of institutions on this issue. Sixty-two percent of LH responded that they were either preparing or evaluating a CP, compared with only 29% of SH (P = .03). However, no respondents explicitly replied that they already had a CP in place in their practices. Conclusions: The importance of cyberattack preparedness and implementation does not seem to be well-recognized in radiation oncology. Both the awareness and the preparedness of SH are substantially less than those of LH. Specific and ongoing education efforts in parallel with development of appropriate programs are needed to counter the increasingly pervasive and complex threat of cyberattacks. (C) 2022 The Author(s). Published by Elsevier Inc. on behalf of American Society for Radiation Oncology.

G.S. Alexander: None. B.Savla: None. L.J. Berg: None. K. Sun: None. J.S.Remick: None. E.S. Kowalski: None. S. Chen: None. N.Lamichhane: None. W.F. Regine: None. M.V. Mishra: Employee; Orthofix. Research Grant; ASTRO, Keep Punching. Advisory Board; Patient Centers Outcomes Research Institute (PCORI. Travel Expenses; Patient Centers Outcomes Research Institute (PCORI.