Background and Objectives: Bethesda Category IV thyroid nodules present a diagnostic challenge due to their variable risk of malignancy and uncertain cytological features. Therefore, determining the risk of malignancy before surgery is important. This study aims to identify clinical, biochemical, and ultrasonographic factors associated with malignancy and to explore the performance of a multivariable analysis based on routinely available preoperative features in thyroid nodules. Methods: This retrospective, single-center study included 105 patients who underwent thyroidectomy for Bethesda Category IV cytology. The mean age was 50.13 ± 11.78 years. 87 patients (82.9%) were female, and 18 (17.1%) were male. Patients were classified into benign/borderline (n = 79) and malignant (n = 26) groups based on their postoperative histopathological findings. Demographic characteristics, serum thyroid function tests, thyroid autoantibody levels, and ultrasonographic findings were compared. Variables significantly associated with malignancy were included in a Firth bias-reduced penalized multivariable logistic regression analysis. The discriminative performance of the multivariable analysis was evaluated using ROC curve analysis, and internal validation was performed using bootstrap resampling. The AUC was compared with that of ACR TI-RADS using DeLong’s test. Results: The malignant group showed a significantly higher prevalence of male sex, irregular margins, a taller-than-wide shape, and microcalcification (all p < 0.05). In the multivariable logistic regression analysis, only irregular margins (OR = 9.46, 95% CI: 1.88–47.59; p = 0.006) were independently associated with malignancy. The model demonstrated acceptable discrimination in this study population (n = 105), with an AUC of 0.717. The AUC of the multivariable analysis was 0.717, compared with 0.704 for ACR TI-RADS, and the difference was not statistically significant (ΔAUC = 0.013; DeLong p = 0.803). Conclusions: In Bethesda Category IV thyroid nodules, irregular margins remained independently associated with malignancy. The multivariable analysis did not demonstrate significantly better discrimination than ACR TI-RADS. These findings should be considered exploratory and require external validation in larger cohorts.

Background: Nuclear atypia is associated with an increased risk of malignancy in Bethesda III thyroid nodules; however, reactive nuclear changes related to Hashimoto thyroiditis (HT) may complicate its interpretation. We investigated whether HT modifies the association between nuclear atypia and malignancy in Bethesda III nodules. Methods: This retrospective single-center study included 426 surgically selected patients with Bethesda III nodules who underwent thyroidectomy between January 2015 and August 2026. HT was defined by postoperative histopathology. The association between nuclear atypia and malignancy was evaluated according to HT status. Effect modification was assessed using an HT × nuclear atypia interaction term in unadjusted and multivariable logistic regression models. Results: HT was present in 199 (46.7%) patients. Malignancy was less frequent in patients with HT than in those without HT (26.1% vs. 38.8%, p = 0.006), whereas nuclear atypia was more frequent (91.0% vs. 45.8%, p < 0.001). In patients without HT, nuclear atypia was strongly associated with malignancy and remained an independent predictor after multivariable adjustment (adjusted OR 13.24, 95% CI 5.46–32.10; p < 0.001). In patients with HT, nuclear atypia was not associated with malignancy (OR 0.68, 95% CI 0.24–1.94; p = 0.466). The HT × nuclear atypia interaction was significant in both unadjusted (OR 0.040, p < 0.001) and adjusted models (OR 0.031, p < 0.001). Conclusions: HT significantly modified the association between nuclear atypia and malignancy in Bethesda III nodules. Nuclear atypia strongly predicted malignancy in the absence of HT but not in its presence. Given the postoperative definition of HT, prospective validation using preoperative HT indicators is required before clinical application.

Background and Objectives: Tunneled hemodialysis catheters (TDCs) are essential for vascular access in patients with end-stage renal disease (ESRD). This study retrospectively evaluated the clinical outcomes of permanent TDCs placed at a single center, comparing heparin-coated versus non-heparin-coated catheters. Materials and Methods: A total of 189 patients who underwent permanent TDC placement between January 2021 and January 2022 were included. Patients were categorized by catheter type (heparin-coated, n = 80; non-heparin-coated, n = 109). Catheter failure-free survival was analyzed using the Kaplan–Meier method, with arteriovenous fistula creation treated strictly as a censoring event. Multivariable Cox proportional hazards regression was used to identify independent predictors of catheter failure. Results: Complications were significantly more frequent in the non-heparin-coated group (p = 0.004). Catheter exchange was required exclusively in the non-heparin-coated group (p < 0.001). Kaplan–Meier analysis demonstrated significantly longer failure-free catheter survival in the heparin-coated group (restricted mean 49.0 vs. 41.7 months; Log-Rank p < 0.001). On multivariable Cox regression, the complete absence of events in the heparin-coated group yielded a strong protective point estimate (HR = 0.087, 95% CI: 0.004–1.710), rendering individual patient covariates such as INR and age non-significant. Conclusions: Heparin-coated TDCs were associated with significantly longer failure-free survival and lower complication rates compared with non-heparin-coated catheters. Due to the low overall event rate, individual patient-level covariates including INR did not reach statistical significance in the multivariable model.

Background: Percutaneous drainage is the cornerstone of source control for pelvic abscess, yet the microbiology and resistance burden of the drained fluid remain underexplored. Methods: We retrospectively analyzed data from 149 patients who underwent image-guided percutaneous drainage of a pelvic abscess at a single center. Third-generation cephalosporin resistance (3GCR) was evaluated as the primary outcome, with documented resistance across at least three antimicrobial categories (DR ≥ 3) as a secondary descriptor. Results: Cultures were positive in 74/101 sampled aspirates (73%), Gram-negative-predominant (73%), with Escherichia coli most frequent (50% of isolates). At least one Enterobacterales isolate was recovered from 50 patients, of whom 32 (64%) had documented resistance to ceftriaxone or ceftazidime; among patients with E. coli, 27/41 (66%) were 3GCR-positive. This proportion applies to the culture-positive subset with an available antibiogram. It cannot be extrapolated to all drained pelvic abscesses, since culture acquisition was selective and strongly associated with macroscopic purulence. Median abscess volume was higher in 3GCR-positive patients (213 vs. 88 cc), but the association did not reach statistical significance (OR 1.60 per 100 cc, 95% CI 0.94–2.71; p = 0.081; AUC 0.70) and attenuated further when restricted to adults (OR 1.49, 95% CI 0.91–2.45; p = 0.114). Postoperative etiology was not associated with 3GCR (14/22, 64%, vs. 9/16, 56%; OR, 1.36; 95% CI, 0.37–5.07; p = 0.74). Overall clinical success was 128/148 (86%), and 47/50 (94%) in the primary analysis set. Conclusions: In a selected subset of culture-positive pelvic abscesses, two-thirds of Enterobacterales were resistant to third-generation cephalosporins. Neither abscess volume nor postoperative origin predicted resistance.