Science at risk? Considering the importance of academic freedom for STEM research production across 17 OECD countries.

Since 2011, a declining trend in academic freedom globally has paralleled a rising tide of neo-nationalism. We use fixed effects models to examine data from the Varieties of Democracy (V-DEM) academic freedom index and bibliometric data for 17 OECD countries across nearly three decades (1981-2007) that precede the recent decline in academic freedom. We find substantial, statistically significant, positive relationships between cross-nationally comparable and longitudinal measures of academic freedom and volume of STEM publications. Additionally, academic freedom positively influenced the quality of STEM publications as measured by journal rankings. Our findings were relatively consistent across various measures of academic freedom and model specifications. We discuss implications for safeguarding academic freedom, applying neo-institutional theory, and identifying directions for future research.

Autoreactive-Aß antibodies promote APP ß-secretase processing.

Several prior investigations of Alzheimer's disease (AD) patients have indicated naturally occurring autoantibodies against amyloid-ß (Aß) species are produced. Although many studies have focused on the relative concentrations or binding affinities of autoantibodies against Aß-related proteins in AD and aging, data regarding their functional properties are limited. It is generally believed that these antibodies act to aid in clearance of Aß. However, as antibodies which bind to Aß also typically bind to the parent amyloid precursor protein (APP), we reasoned that certain Aß-targeting autoantibodies may bind to APP thereby altering its conformation and processing. Here we show for the first time, that naturally occurring Aß-reactive autoantibodies isolated from AD patients, but not from healthy controls, promote ß-secretase activity in cultured cells. Furthermore, using monoclonal antibodies to various regions of Aß, we found that antibodies generated against the N-terminal region, especially Aß(1-17) , dose dependently promoted amyloidogenic processing of APP viaß-secretase activation. Thus, this property of certain autoantibodies in driving Aß generation could be of etiological importance in the development of sporadic forms of AD. Furthermore, future passive or active anti-Aß immunotherapies must consider potential off-target effects resulting from antibodies targeting the N-terminus of Aß, as co-binding to the corresponding region of APP may actually enhance Aß generation.

Mutant presenilin-1 deregulated peripheral immunity exacerbates Alzheimer-like pathology.

Mutations in the presenilin-1 (PS1) gene are independent causes of familial Alzheimer's disease (AD). AD patients have dysregulated immunity, and PS1 mutant mice exhibit abnormal systemic immune responses. To test whether immune function abnormality caused by a mutant human PS1 gene (mhPS1) could modify AD-like pathology, we reconstituted immune systems of AD model mice carrying a mutant human amyloid precursor protein gene (mhAPP; Tg2576 mice) or both mhAPP and mhPS1 genes (PSAPP mice) with allogeneic bone marrow cells. Here, we report a marked reduction in amyloid-ß (Aß) levels, ß-amyloid plaques and brain inflammatory responses in PSAPP mice following strain-matched wild-type PS1 bone marrow reconstitution. These effects occurred with immune switching from pro-inflammatory T helper (Th) 1 to anti-inflammatory Th2 immune responses in the periphery and in the brain, which likely instructed microglia to phagocytose and clear Aß in an ex vivo assay. Conversely, Tg2576 mice displayed accelerated AD-like pathology when reconstituted with mhPS1 bone marrow. These data show that haematopoietic cells bearing the mhPS1 transgene exacerbate AD-like pathology, suggesting a novel therapeutic strategy for AD based on targeting PS1 in peripheral immune cells.

A Symbiosis of Access: Proliferating STEM PhD Training in the U.S. from 1920-2010.

Over the course of the 20th century, unprecedented growth in scientific discovery was fueled by broad growth in the number of university-based scientists. During this period the American undergraduate enrollment rate and number of universities with STEM graduate programs each doubled three times and the annual volume of new PhDs doubled six times. This generated the research capacity that allowed the United States to surpass early European-dominated science production and lead for the rest of the century. Here, we focus on origins in the organizational environment and institutional dynamics instead of conventional economic factors. We argue that three trends of such dynamics in the development of American higher education not often considered together-mass undergraduate education, decentralized founding of universities, and flexible mission charters for PhD training-form a process characterized by a term coined here: access symbiosis. Then using a 90-year data series on STEM PhD production and institutional development, we demonstrate the historical progression of these mutually beneficial trends. This access symbiosis in the U.S., and perhaps versions of it in other nations, is likely one critical component of the integration of higher education development with the growing global capacity for scientific discovery. These results are discussed in terms of the contributions of American universities to the Century of Science, recent international trends, and its future viability.

Biological or mechanical prostheses for isolated aortic valve replacement in patients aged 50-65 years: the ANDALVALVE study.

OBJECTIVES: The decision about whether to use a biological or a mechanical prosthesis for aortic valve replacement remains controversial in patients between 50 and 65 years of age and has yet to be addressed in a Mediterranean population. This research aimed to analyse long-term survival and major morbidity rates (30-day mortality, stroke, any prosthetic reoperation and major bleeding) within this population. METHODS: Our multicentre observational retrospective study included all subjects aged 50-65 years who had a primary isolated aortic valve replacement due to severe aortic stenosis at 7 public hospitals from Andalusia (Spain) between 2000 and 2015. Concomitant surgery, reoperations and endocarditis were the exclusion criteria. A total of 1443 patients were enrolled in the study (272 with biological and 1171 with mechanical valves). Multivariate analyses including a 2:1 propensity score matching (506 mechanical and 257 biological prostheses) were conducted. RESULTS: Bioprostheses were implanted in 18.8% (n = 272): 35% were women; the mean EuroSCORE-I was 3%. The mean follow-up was 8.1 ± 4.9 years in a matched sample: 8.8 ± 4.9 years in those receiving a mechanical vs 7.1 ± 4.5 years in those receiving a biological prosthesis (P = 0.001). In the paired sample, the 15-year survival rate was 73% in those who had a biological vs 76% in those who had a mechanical valve [hazard ratio (HR) 0.80, 95% confidence interval (CI) 0.54-1.20; P = 0.159]. No significant differences were observed in patients ≥55 years old (74% of 15-year survival in both groups: HR 0.88, 95% CI 0.56-1.34; P = 0.527). A higher rate of major bleeding was found in patients with a mechanical prosthesis (P = 0.004), whereas reoperation was more frequent among those with a biological prosthesis (P = 0.01). CONCLUSIONS: Long-term survival was comparable in patients above 55 years of age. Mechanical prostheses were associated with more major bleeding and bioprostheses, with more reoperations. A bioprosthesis in patients above 55 years old is a reasonable choice. CLINICAL TRIAL REGISTRATION NUMBER: NCT03239509.

Modulation of neuronal differentiation by CD40 isoforms.

Neuron differentiation is a complex process involving various cell-cell interactions, and multiple signaling pathways. We showed previously that CD40 is expressed and functional on mouse and human neurons. In neurons, ligation of CD40 protects against serum withdrawal-induced injury and plays a role in survival and differentiation. CD40 deficient mice display neuron dysfunction, aberrant neuron morphologic changes, and associated gross brain abnormalities. Previous studies by Tone and colleagues suggested that five isoforms of CD40 exist with two predominant isoforms expressed in humans: signal-transducible CD40 type I and a C-terminal truncated, non-signal-transducible CD40 type II. We hypothesized that differential expression of CD40 isoform type I and type II in neurons may modulate neuron differentiation. Results show that adult wild-type, and CD40(-/-) deficient mice predominantly express CD40 type I and II isoforms. Whereas adult wild-type mice express mostly CD40 type I in cerebral tissues at relatively high levels, in age and gender-matched CD40(-/-) mice CD40 type I expression was almost completely absent; suggesting a predominance of the non-signal-transducible CD40 type II isoform. Younger, 1 day old wild-type mice displayed less CD40 type I, and more CD40 type II, as well as, greater expression of soluble CD40 (CD40L/CD40 signal inhibitor), compared with 1 month old mice. Neuron-like N2a cells express CD40 type I and type II isoforms while in an undifferentiated state, however once induced to differentiate, CD40 type I predominates. Further, differentiated N2a cells treated with CD40 ligand express high levels of neuron specific nuclear protein (NeuN); an effect reduced by anti-CD40 type I siRNA, but not by control (non-targeting) siRNA. Altogether these data suggest that CD40 isoforms may act in a temporal fashion to modulate neuron differentiation during brain development. Thus, modulation of neuronal CD40 isoforms and CD40 signaling may represent important therapeutic modalities for neurodegenerative and neurodevelopmental disorders, as well as, for enhancement of neurogenesis.

Green tea epigallocatechin-3-gallate (EGCG) reduces beta-amyloid mediated cognitive impairment and modulates tau pathology in Alzheimer transgenic mice.

We previously reported that intraperitoneal (i.p.) injection (20 mg/kg) of (-)-epigallocatechin-3-gallate (EGCG), the main polyphenolic constituent of green tea, decreased beta-amyloid (Abeta) levels and plaques via promotion of the non-amyloidogenic alpha-secretase proteolytic pathway in "Swedish" mutant amyloid precursor protein overexpressing (APPsw, Tg) mice. Here, we find that EGCG administered orally in drinking water (50 mg/kg) similarly reduces Abeta deposition in these mice. Following a six month treatment of an 8 month old cohort, immunohistochemical analysis of coronal sections reveals that plaque burdens were reduced in the cingulate cortex, hippocampus, and entorhinal cortex by 54%, 43%, and 51%, respectively. Congo red plaque burdens were decreased in the cingulate cortex, hippocampus, and entorhinal cortex by 53%, 53%, and 58%, respectively as well. ELISA of brain homogenates of the treatment Tg mice revealed consistent reductions in both Abeta1-40 and 1-42 soluble and insoluble forms. In the present study we also investigated the effect EGCG administration had on tau pathology and cognition in Tg mice. Both i.p. and orally-treated Tg animals were found to have modulated tau profiles, with markedly suppressed sarkosyl-soluble phosphorylated tau isoforms. Radial arm water maze (RAWM) testing for working memory indicated that EGCG provided cognitive benefit to Tg mice with both i.p. and oral administration, although i.p.-treated animals showed a more pronounced benefit because of the greater impairment of their Tg controls at the time of testing. Taken together, these data further the notion of EGCG dietary supplementation as a potentially safe and effective prophylaxis for Alzheimer's disease.

Efectividad del tratamiento homeopático de la hipertensión arterial / Effectiveness of Homeopathic Treatment against Arterial Hypertension

Introducción: La hipertensión arterial es una de las enfermedades más comunes y afecta en el mundo a 800 millones de personas (20 %) de la población adulta mundial. En Cuba existen aproximadamente 215 hipertensos por cada 1000 habitantes, mientras que en Holguín 199 por cada 1000 habitantes padecen esa enfermedad. Objetivo: Evaluar la efectividad de la homeopatía en el tratamiento de la hipertensión arterial teniendo en cuenta los antecedentes patológicos personales, la clasificación de los pacientes según el grado de hipertensión arterial al iniciar y al concluir el estudio, así como el diagnóstico miasmático de cada uno. Método: Se realizó una investigación con diseño cuasiexperimental en el Hospital Militar "Fermín Valdés Domínguez" de Holguín en el período comprendido desde febrero de 2014 hasta febrero de 2016. El universo de estudio estuvo constituido por 243 pacientes diagnosticados con hipertensión arterial que asistieron a la consulta de Medicina Tradicional y Natural del Hospital Militar de Holguín. La muestra del estudio fue intencionada y quedó constituida por 217 pacientes de ambos sexos, mayores de 20 años. Luego de la repertorización de cada paciente, se trató a cada uno con el medicamento homeopático resultante de este proceso. Resultados: Se redujeron las cifras tensionales a niveles donde se consideran hipertensos controlados y hasta menores de 120/80 mm Hg en el 89,4 % de los pacientes tratados. Conclusiones: La homeopatía se considera un tratamiento eficaz para la hipertensión arterial.

Introduction: Arterial hypertension is one of the most common diseases and affects 800 million people, 20% of the world's adult population. In Cuba, there are near 215 hypertensive patients per 1000 inhabitants; while, in Holguín, 199 per 1000 inhabitants suffer from this disease. Objective: To assess the effectiveness of homeopathy in treating arterial hypertension, by taking into account the patients' individual pathological history, their classification according to degree of arterial hypertension at the beginning and at the end of the study, as well as each patient's miasmatic diagnosis. Method: A research with a quasiexperimental design was carried out, in the period from February 2014 to February 2016, at Fermín Valdés Domínguez Military Hospital in Holguín. The study universe consisted of 243 patients diagnosed with arterial hypertension who attended the traditional and natural medicine consultation at the Military Hospital in Holguín. The study sample was intentional and consisted of 217 patients of both sexes, aged over 20 years. After repertorization of each patient, they were treated with the homeopathic medicament resulting from this process. Results: Blood pressure figures were reduced to levels for which they are considered to be controlled hypertensive patients and even less than 120/80 mmHg in 89.4% of the patients treated. Conclusions: Homeopathy is considered an effective treatment for arterial hypertension.

Octyl gallate markedly promotes anti-amyloidogenic processing of APP through estrogen receptor-mediated ADAM10 activation.

Our previous studies showed that the green tea-derived polyphenolic compound (-)-epigallocatechin-3 gallate (EGCG) reduces amyloid-ß (Aß) production in both neuronal and mouse Alzheimer's disease (AD) models in concert with activation of estrogen receptor-α/phosphatidylinositide 3-kinase/protein kinase B (ERα/PI3K/Akt) signaling and anti-amyloidogenic amyloid precursor protein (APP) α-secretase (a disintegrin and metallopeptidase domain-10, ADAM10) processing. Since the gallate moiety in EGCG may correspond to the 7α position of estrogen, thereby facilitating ER binding, we extensively screened the effect of other gallate containing phenolic compounds on APP anti-amyloidogenic processing. Octyl gallate (OG; 10 µM), drastically decreased Aß generation, in concert with increased APP α-proteolysis, in murine neuron-like cells transfected with human wild-type APP or "Swedish" mutant APP. OG markedly increased production of the neuroprotective amino-terminal APP cleavage product, soluble APP-α (sAPPα). In accord with our previous study, these cleavage events were associated with increased ADAM10 maturation and reduced by blockade of ERα/PI3k/Akt signaling. To validate these findings in vivo, we treated Aß-overproducing Tg2576 mice with OG daily for one week by intracerebroventricular injection and found decreased Aß levels associated with increased sAPPα. These data indicate that OG increases anti-amyloidogenic APP α-secretase processing by activation of ERα/PI3k/Akt signaling and ADAM10, suggesting that this compound may be an effective treatment for AD.

HIV-1 Tat-induced microglial activation and neuronal damage is inhibited via CD45 modulation: A potential new treatment target for HAND.

Microglia become activated in humans subsequent to infection with HIV, and uncontrolled brain inflammation plays a key role in neuronal injury and and cognitive dysfunction during HIV infection. Various studies have shown a deleterious role for the HIV regulatory protein Tat in the development and maintenance of HIV-associated neurocognitive disorders (HAND). One cell surface receptor implicated in inhibiting microglial activation is the protein-tyrosine phosphatase (PTP), CD45. It is especially effective at inhibiting microglial activation because its action takes place far upstream from proinflammatory intracellular signaling mediators. To investigate the possible role of CD45 in microglial responsiveness to HIV-1 Tat protein, we treated BV-2 microglia with a tyrosine phosphatase inhibitor [potassium bisperoxo (1, 10-phenanthroline) oxovanadate (phen), 5 µM] and HIV-1 Tat protein (700ng/ml). We found a synergistic pro-inflammatory microglial activation as supported by tumor necrosis factor-alpha (TNF-α) and interleukin 1-beta (IL-1ß) release, both of which were dependent on p44/42 mitogen-activated protein kinase (MAPK) activation. Stimulation of microglial CD45 by anti-CD45 antibody markedly inhibited these Tat or Tat/Phen effects via attenuation of p44/42 MAPK, suggesting CD45 negatively regulates microglial activation. As a validation of these findings in vivo, brains from transgenic mice deficient for CD45 through complete genetic ablation, or by CNS delivery of CD45shRNA, demonstrate markedly increased production of TNF-α 24 hours after intracerebroventricular injection of HIV-Tat protein (5µg/mouse) compared to control mice. This increased microglial activation was accompanied by astrogliosis and a significant loss of cortical neurons due to apoptosis in CD45 deficient animals. These results suggest therapeutic agents that activate CD45 PTP signaling may be effective in suppressing microglial activation associated with HAND.

Características de los accidentes de trabajo ocurridos en el Hospital Regional Lambayeque durante los años 2013 - 2014 / Characteristics of occupational accidents in the Lambayeque Regional Hospital 2013 ­ 2014

Objetivo: Describir las características de los accidentes de trabajo ocurridos en el Hospital Regional Lambayeque. Material y Métodos: Estudio descriptivo retrospectivo de los accidentes de trabajo notificados a la Unidad de Salud y Seguridad Ocupacional del Hospital Regional Lambayeque, ocurridos en el período 2013-2014. La fuente de datos utilizada fue las Fichas de notificación de accidentes de trabajo del Ministerio de Salud. Resultados: Se registraron 83 accidentes de trabajo, el mayor porcentaje fue para el sexo femenino (77%), centro quirúrgico es el área que reporta el mayor porcentaje (16,9%), seguido del área de emergencia (15,7%) y por el área de hospitalización de medicina (12%), el turno de trabajo diurno registró el mayor número de accidentes (49%), el personal de enfermería es el mayor grupo ocupacional que sufre de accidentes de trabajo (34%). Conclusiones: Los hallazgos indican que los accidentes de trabajo ocurridos en este hospital se caracterizan por ser predominantemente accidentes punzocortantes, en personal de enfermería y en las áreas de cirugía y emergencia.

Influencia de la sepsis vaginal endógena sobre la calidad del moco cervical en mujeres infértiles / Influence of endogenous vaginal sepsis on the quality of the cervical mucus in sterile women

Se realizó un estudio descriptivo y observacional de 150 mujeres infértiles atendidas en el Hospital Universitario Ginecoobstétrico Provincial Ana Betancourt de Mora de Camagüey, desde el 1 de junio de 2012 hasta el 31 de mayo de 2013, con vistas a determinar la influencia de la sepsis vaginal endógena sobre la calidad del moco cervical en estas pacientes, para lo cual se confeccionó un modelo de registro que recogía los aspectos siguientes: datos personales, antecedentes de infecciones vaginales, evaluación del moco cervical, hallazgos microbiológicos y técnicas de aseo genital; también se aplicó una encuesta para verificar los conocimientos que poseían al respecto. En la serie predominaron las féminas de piel blanca, las mayores de 35 años, los resultados microbiológicos positivos, así como la levadura y la vaginosis como diagnósticos más comunes; asimismo, el moco cervical resultó no adecuado en todos los casos y fue evidente el nivel de desconocimiento de las pacientes acerca del tema(AU)

A descriptive and observational study of 150 sterile women assisted in Ana Betancourt de Mora University Gynecoobstetrical Provincial Hospital in Camagüey was carried out from June 1, 2012 to May 31, 2013, with the objective of determining the influence of the endogenous vaginal sepsis on the quality of the cervical mucus in these patients, for which a registration model was made which included the following aspects: personal data, history of vaginal infections, evaluation of the cervical mucus, microbiological findings and techniques for genital washing; a survey was also applied to verify the knowledge they had in this respect. White skin females, those older than 35 years, positive microbiological results, as well as yeast and vaginosis as the most common diagnosis prevailed in the series; also, the cervical mucus was not adequate in all the cases, and the ignorance level of the patients about the topic was evident(AU)

Influencia de la sepsis vaginal endógena sobre la calidad del moco cervical en mujeres infértiles / Influence of endogenous vaginal sepsis on the quality of the cervical mucus in sterile women

Se realizó un estudio descriptivo y observacional de 150 mujeres infértiles atendidas en el Hospital Universitario Ginecoobstétrico Provincial "Ana Betancourt de Mora" de Camagüey, desde el 1 de junio de 2012 hasta el 31 de mayo de 2013, con vistas a determinar la influencia de la sepsis vaginal endógena sobre la calidad del moco cervical en estas pacientes, para lo cual se confeccionó un modelo de registro que recogía los aspectos siguientes: datos personales, antecedentes de infecciones vaginales, evaluación del moco cervical, hallazgos microbiológicos y técnicas de aseo genital; también se aplicó una encuesta para verificar los conocimientos que poseían al respecto. En la serie predominaron las féminas de piel blanca, las mayores de 35 años, los resultados microbiológicos positivos, así como la levadura y la vaginosis como diagnósticos más comunes; asimismo, el moco cervical resultó no adecuado en todos los casos y fue evidente el nivel de desconocimiento de las pacientes acerca del tema.

A descriptive and observational study of 150 sterile women assisted in "Ana Betancourt de Mora" University Gynecoobstetrical Provincial Hospital in Camagüey was carried out from June 1, 2012 to May 31, 2013, with the objective of determining the influence of the endogenous vaginal sepsis on the quality of the cervical mucus in these patients, for which a registration model was made which included the following aspects: personal data, history of vaginal infections, evaluation of the cervical mucus, microbiological findings and techniques for genital washing; a survey was also applied to verify the knowledge they had in this respect. White skin females, those older than 35 years, positive microbiological results, as well as yeast and vaginosis as the most common diagnosis prevailed in the series; also, the cervical mucus was not adequate in all the cases, and the ignorance level of the patients about the topic was evident.

Morbimortalidad materna en la preeclampsia complicada / Maternal morbidity and mortality related to complicated pre-eclampsia

Los trastornos hipertensivos incluyen diversas perturbaciones vasculares que aparecen antes o durante el embarazo, el parto y/o el puerperio. Junto a la hemorragia y la infección constituyen la tríada más letal de la medicina humana. Se realizó un estudio descriptivo transversal para caracterizar la morbimortalidad materna secundaria a preeclampsia complicada en el Hospital Provincial Ginecobstétrico Ana Betancourt de Mora desde enero 2006 _ septiembre 2007...(AU)

Hypertensive disorders include many vascular alterations appearing before or during pregnancy, delivery and/or puerperium. Together with hemorrhage and infection they are the more lethal triad of human medicine. We made a cross-sectional and descriptive study to characterize maternal morbidity and mortality secondary to a complicated pre-eclampsia in Ana Betancourt de Mora Gynecology and Obstetrics Provincial Hospital from January 2006 to September 2007...(AU)

Morbimortalidad materna en la preeclampsia complicada / Maternal morbidity and mortality related to complicated pre-eclampsia

Los trastornos hipertensivos incluyen diversas perturbaciones vasculares que aparecen antes o durante el embarazo, el parto y/o el puerperio. Junto a la hemorragia y la infección constituyen la tríada más letal de la medicina humana. Se realizó un estudio descriptivo transversal para caracterizar la morbimortalidad materna secundaria a preeclampsia complicada en el Hospital Provincial Ginecobstétrico "Ana Betancourt de Mora" desde enero 2006 _ septiembre 2007. El universo estuvo conformado por 312 gestantes que presentaron algún trastorno hipertensivo. Se seleccionó una muestra de 82 embarazadas con diagnóstico de preeclampsia complicada que cumplieron los criterios de inclusión y exclusión. Predominó la preeclampsia grave (89,02 por ciento), las menores de 20 años (31,71 por ciento) y las nulíparas con 51 señoras. El mayor número de gestantes (48) fueron evaluadas como normopeso, mientras que 27 evidenciaron un aumento exagerado de este. La curva plana de tensión arterial incidió con 57,32 por ciento. Al 96,34 por ciento de las gestantes se les practicó cesárea, de éstas, a un 70 por ciento de forma electiva. No se reportó muerte materna. La caracterización de la morbimortalidad materna de la preeclampsia complicada en nuestro medio nos permitió realizar propuestas encaminadas a correlacionar un grupo de factores que influyen en la calidad del cuidado y sus resultados en la atención a estas gestantes complicadas(AU)

Hypertensive disorders include many vascular alterations appearing before or during pregnancy, delivery and/or puerperium. Together with hemorrhage and infection they are the more lethal triad of human medicine. We made a cross-sectional and descriptive study to characterize maternal morbidity and mortality secondary to a complicated pre-eclampsia in "Ana Betancourt de Mora" Gynecology and Obstetrics Provincial Hospital from January 2006 to September 2007. Sample included 312 pregnants presenting with some hypertensive disorder. We selected a sample including 82 pregnants diagnosed with complicated pre-eclampsia fulfilling inclusion and exclusion criteria. There was a predominance of severe pre-eclampsia (89,02 percent),), aged under 20 (31,71 percent), and nullipara with 51 ladies. Most of pregnants (48) was assessed as of normal weight, whereas 27 showed an exaggerated weight gain. Plain wave of arterial tension incidence was of 57, 32 percent. In 96,34 percent of pregnants we performed a cesarean section, from these, in a 70 percent in a elective way. There was not maternal death. Characterization of maternal morbidity and mortality of a complicated pre-eclampsia in our practice allow us to make proposal aimed to collect a series of risk factors influencing in care quality and its results in care to these complicated pregnants(AU)