Two of the most significant challenges in transplantation medicine are human leukocyte antigen sensitization, which limits access to kidney transplantation for patients with end-stage kidney disease owing to the lack of effective desensitization strategies, and chronic active antibody-mediated rejection (cAMR), a major cause of allograft dysfunction and graft loss following transplantation. Despite its substantial clinical significance, there remains a lack of high-quality evidence and well-established therapeutic algorithms for the management of cAMR, while many patients continue to be excluded from kidney transplantation because of immunological barriers. Interleukin-6 (IL-6) is a pleiotropic cytokine that plays a central role in both innate and adaptive immune responses. Beyond its immunological functions, IL-6 has been implicated in the pathogenesis of a wide range of conditions, including atherosclerotic cardiovascular disease, diabetes mellitus, and various neurological disorders. Consequently, targeting the IL-6/IL-6 receptor signaling pathway has emerged as a promising therapeutic strategy in transplantation medicine, particularly for desensitization protocols and the treatment of cAMR. However, the current evidence base is restricted to studies evaluating tocilizumab and clazakizumab, with clinical benefits remaining inconsistent across studies. Limited evidence is available regarding the desensitization effectiveness of tocilizumab monotherapy. In cAMR, the phase III IMAGINE trial found no improvement in kidney function with clazakizumab despite reduced C-reactive protein. Current evidence does not support a routine IL-6 pathway blockade in cAMR, while further studies are required to prove the potential benefits in desensitization. In this narrative review, we comprehensively examine the role of IL-6 in the pathophysiology of kidney transplantation and critically appraise the available clinical evidence regarding IL-6/IL-6R-targeted therapies for the management of human leukocyte antigen sensitization and cAMR.
Treatment-emergent eczematous reactions have been reported in patients with psoriasis receiving biologic therapies, but their pooled incidence and associated factors remain unclear. We aimed to estimate the incidence and associated factors for treatment-emergent eczematous reactions in biologic-treated psoriasis patients. We searched PubMed, EMBASE, and Web of Science (to Jan 2026) for studies reporting new-onset or exacerbated eczema in psoriasis patients treated with tumor necrosis factor (TNF), interleukin-17 (IL-17), interleukin-12/23 (IL-12/23), or IL-23 inhibitors. Two eligible studies of the oral tyrosine kinase 2 (TYK2) inhibitor deucravacitinib were analyzed separately as an exploratory subgroup. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, data were synthesized using a random-effects model with Freeman-Tukey double arcsine transformation. The primary outcome was the pooled incidence of treatment-emergent eczematous reactions. Secondary analyses examined differences according to biologic class, dosage, and demographic characteristics. Analysis of 26 publications (34,511 exposures) showed a 2.17
Credibility is the quality or power of inspiring belief. Credibility has an important role in science and medicine, including relations with the press; physician-industry relations; and, public trust, mistrust, and perception. Residency and fellowship program directors seek to best prepare trainees for postgraduate medical education careers, and nurturing credibility is one goal to strive for. Credibility is different from trust. Credibility is a subjective evaluation, in contrast to objective criteria evaluated in entrustable professional activities. The goal of this manuscript is to introduce consideration of credibility as a metric in Graduate Medical Education evaluations, and as a discussion topic during mentorship of trainees.
For generations, pathologists learned to see beside someone else. At the double-headed microscope, a trainee did more than share a field of view with a teacher. They watched attention move, uncertainty, linger, and judgment take shape before a diagnosis was spoken. As pathology moves from glass slides and microscopes to whole-slide imaging and screens that intimate form of apprenticeship is changing with it. Something will be lost: the physical closeness of two people looking through the same instrument and the quiet rituals through which generations of pathologists learned their craft. But the microscope was never what made that teaching possible. Digital pathology can place the same image before an entire room, bring distant colleagues to the same case, and allow a trainee to learn from a teacher across an ocean. The second head is not simply disappearing; in important ways, it is multiplying. The challenge for pathology education is therefore not to preserve the microscope, but to preserve what happened across it: attention, uncertainty, reasoning, and the transmission of judgment from one pathologist to another. The posture may change. The work of teaching someone how to see does not.
Television medical dramas have long perpetuated a cultural hierarchy among medical specialties, and pathology has been a consistent target. From overtly comedic portrayals of incompetent physicians reassigned to the morgue to subtler character constructions that equate interest in pathology with professional disengagement, these narratives encode and broadcast the assumption that pathology is a lesser specialty — a destination for those who lack the commitment or endurance demanded by “real” clinical medicine. This piece examines the most recent iteration of this trope in the television series The Pitt, in which a medical student's stated interest in pathology is narratively tethered to her willingness to leave the emergency department on time, and contextualizes it within a broader pattern spanning Scrubs, The Good Doctor, Grey's Anatomy, House, and the forensic pathology subgenre. Drawing on workforce data, recruitment literature, and the documented scope of pathology and laboratory medicine — which underpins an estimated 60–70% of all clinical decisions — this article argues that the pathology trope is not merely a harmless fictional convention but an active contributor to the specialty's recruitment crisis, public invisibility, and cultural devaluation. At a time when the United States faces a projected deficit of more than 5000 pathologists by 2030, the cultural signals embedded in prestige television carry measurable consequences for the diagnostic infrastructure of modern medicine.
