Abstract:\nObjectives:To evaluate the maternal and foetal risks in women who underwent their fifth or higher Caesarean Section (CS) compared to those who had two, three or four CSs.\nMethods: We performed a retrospective study of 126 women who underwent their fifth or higher CS (study group) compared with 246 women who underwent their second, third or fourth CS(control group) during the period of January 2006 to December 2010.\nResults: During the study period, the overall Caesarean section rate was 36%. Of the study group, 89 (70.6%) had four previous caesarean sections, 33(26.2%) had five, 3(2.4%) had six and 1(0.8%) had eight. Delivery occurred one week earlier in the study group compared to the control group, and women were significantly older with higher parity.\nWomen operated on five or more times had a significantly higher incidence of placenta previa and uterine scar fenestration. As a result of severe adhesions, the duration of the operation was longer in the study group compared with the control group, which increased the need for drainage and blood transfusion.\nPlacental abruption, adherent placenta (accreta), myometrial herniation and uterine scar rupture were similar between the two groups. Post-operative pyrexia and wound infection were not increased in women undergoing five or more caesarean sections.\nPreterm birth rates, small for gestational age foetuses, low 1- and 5- minute Apgar scores and admissions to the neonatal intensive care unit were significantly higher in the study group. We found no differences in birth weight between the two groups.\nConclusions: Subjects with five or more caesarean sections had a higher risk of placenta previa, uterine fenestration, severe adhesions and longer operation time compared to those who had two, three or four CSs. Five or more caesarean sections were also associated with a high rate of neonatal morbidity.\n\nKey words: multiple caesarean sections, outcome of caesarean section, five or more caesarean sections

The compensatory hyperplasia of the liver is the fastest tissue regeneration known in mammals. Due to its regenerative capacity following a tissue damage or surgical resection, the liver is crucial for the sustenance of vital functions. In the case of a flaw in the regeneration, liver failure or fibrosis may develop. New and broadly accepted treatment strategies are needed for regeneration. \n\nCaffeic acid phenethyl ester is an active component of the substance propolis and has been shown to have strong anti-inflammatory, anti-microbial, immunomodulator, anti-mitogenic and anti-oxidant properties. Our objective in this work is to demonstrate its effect on liver tissue regeneration in the experimental partial hepatectomy model.

With the development of democratic trends, various countries\' police affairs gradually transform from traditional public security maintenance works into convenience-based service activity in recent years. Police work is a part of governmental public administration, its services are closely related to common people\'s life, the quality of service is tightly related to common people\'s properties, life safety, and living quality, and even influences the government\'s image and common people\'s trust in government. Therefore, one of the important research subjects of current police affairs is how police personnel perform their specialty, build convenient and efficient public service action and image, create secure and high quality living environments free of fears and complaints for common people, and enhance common people\'s overall satisfaction with the administration of police affairs. In terms of police services, if an enterprise has provided poor service quality, it improves the service activity to upgrade the quality of service for unsatisfied customers, and changes them into satisfied and loyal customers. Therefore, the topics of police service quality improvements draw the attention of various countries\' police departments and personnel in recent years. Police service quality is mostly provided by front-line personnel; therefore, this study discusses front-line police service satisfaction analysis and important improvement factors, in order to evaluate whether the efforts revealed by front-line personnel can enhance common people\'s satisfaction.

AIM: Ataturk University Faculty of Medicine, Department of Cardiovascular Surgery in this retrospective study aimed to review the efficacy of subxiphoid tube pericardiostomy, computerized tomography and/or echocardiography guided percutaneous catheter drainage methods in treatment of pericardial effusion.\nMETHOD: Treatment methods applied in patients with pericardial effusion: Group A - 480 patients, subxiphoid tube pericardiostomy, Group B - 28 patients, CT-guided percutaneous catheter drainage, Group C – 45 patients, Echo-guided percutaneous catheter drainage.\nRESULTS: In all three groups of patients the most important symptom and physical sign were dyspnea and tachycardia, respectively. The most common causes of pericardial effusion were the following: uremic pericarditis in patients applied tube pericardiostomy, postoperative pericardial effusion (PE) in patients applied CT-guided percutaneous catheter drainage and cancer-related pericardial effusion (PE) in patients applied Echo-guided percutaneous catheter drainage. In all three groups of patients relief of symptoms was achieved after surgical intervention. There was no treatment-related mortality (TRM) in any group of patients. In patients with tuberculous pericarditis the rates of recurrent pericardial effusion and/or constrictive pericarditis progress were 2,9% and 2,2% after tube pericardiostomy and Echo-guided percutaneous catheter drainage, respectively.\nCONCLUSION: Nowadays there are many methods to treat pericardial effusion. The correct treatment method for each patient should be selected according to very careful analysis of patient’s clinical condition as well as expectable benefit of surgical intervention.

CCD is an autosomal dominant disorder caused by haploinsufficiency of Runt related transcription factor (RUNX2) essential for osteoblast cell commitment and chondrocyte maturation. A mutation of the RUNX2 (Core Binding Factor-α1 gene located at chromosome 6p21) is usually caused CCD. In general, the estimated prevalence of CCD is under diagnosed because of the relative lack of medical complications in comparison to other skeletal dysplasias. No available data on the prevalence of CCD or its characterization in Saudi families. \n\nIn our study, a Saudi family consists of a father, a mother, three daughters and one son was analyzed for mutation detection in seven exons (2, 4, 5, 6, 7, 8 and 9) of RUNX2 gene with flanking intronic boundaries. Diagnosis of CCD is mostly made on the basis of clinical and radiographic features. The results of scans in the skull, jaw, chest, pelvis and hand and wrist radiographs were evaluated. The clinical findings obtained clarified that the mother is normal, but the father and the youngest daughter are affected with classical CCD, while the son and the two elder daughters have dental anomalies only. While, we could not establish any phenotype-genotype correlation, a heterozygous mutation was detected in Intron2; a (T) nucleotide is substituted with a (C) nucleotide in the position 5565 of RUNX2 gene in the father, the son and the three daughters. These findings suggest that it has a regulatory function related with teeth differentiation. CCD clinical features are present at birth, but they are often diagnosed at a much later time. Family history, pathognomonic clinical and radiographic findings play a central role in the diagnosis of CCD. While this is the case, there is a necessity to develop an early detection technique in order to enable early treatment of affected cases.

Background: Port-A-cath (PAC) use is a preferred method for oncology patients and the most common complications are infection and occlusion. In this study, we aimed to evaluate the relationship between flushing intervals of port-A-cath used in oncology patients and the obstruction rate.\nMethods: 100 patients with port-A-cath who were routinely admitting to Oncology Clinic of Yeditepe University Hospital for flushing of their port catheters after completion of chemotherapy treatment were included in this research retrospectively between October 2008 and February 2016. Patients’ demographic characteristics, port-A-cath insertion dates and port-A-cath flushing intervals are recorded. As the hospital’s policy, port-A-cath flushing process is carried out by adding 1000 units of heparin (100 U/ml) to 10 ml saline.\nResults: 100 patients admitted 475 times in total to the hospital for port-A-cath flushing. Patient’s admission interval for port-A-cath flushing has been identified as 20 to 768 days with overall median of 92 days (13 weeks or 3 months). Cost of each port-A-cath flushing process has been calculated as 109 Turkish Lira (TL). Complications such as occlusion, infection, heparin induced thrombocytopenia and bleeding have not been identified in patients participated in the study.\nConclusions: Extending port-A-cath flushing interval from 4 weeks to 3 months is not associated with increase in complication rate, but increases patient’s comfort. It also reduced the annual cost by 988 TL (300 EUR).

Backgroundː several studies had observed a relation between varicose veins and hypoxia, but these studies focus on hypoxia genetic factors. Our aim was to evaluate the effect of living in high altitudes (hypoxia) on the prevalence of varicose veins, as well as correlations with aging, gender, tobacco smoking, chronic diseases, and blood groups. \nMethodsː the study evaluated the prevalence of varicose veins among 150 non-surgeon physicians at multiple areas with different heights above sea level in Saudi Arabia. \nResultsː 12.7% of the subjects had varicose veins while 87.3% did not have varicose veins. The effect of high altitudes on the prevalence of varicose veins was statistically non significant (p = 0.6) in our study. The The incidence of varicose veins between the two genders was statistically significant (p=0.03). However, there was no relationship between the incidence of varicose vein and the other studied factors. \nConclusionsː in our study, there was no consistent relation between living in high altitudes and incidence of varicose veins. As our study was done only in physicians, a large population- based study is recommended for more evaluation of the risk factors and to clarify the geographical variations.

Phishing web-sites causes lost of thousands of dollars and leads to damage brand image of organizations. Thus, automatic filtering of phishing web-site becomes a necessity. This paper presents a phishing detection technique based on Fuzzy Inference Process. The proposed phishing detection has rules for converting the input features of the web-sites into an output that reveals the nature of the web-site. The detection is built by constructing new set of features from the input data by transferring the features into different form of continuous values using clustering, frequent pattern mining and value mapping process. The newly constructed features are then used with fuzzy system, that is learned by optimizing a set of rules and membership function to predict phishing web-sites. The experiment results show that the proposed work has over performed other rule-based classification techniques on the same data by 2%. Moreover, the results show that the clustering and frequent pattern mining has enhanced the outcome by 4%. It is commended using the preprocessing and fuzzy system before detection to enhance the accuracy of detection phishing websites.