[Pay for performance in public directly managed healthcare centers. Part 1: General framework. SESPAS Report 2024]. / Evaluación del rendimiento y compensación en centros sanitarios de gestión directa. Parte 1: marco general. Informe SESPAS 2024.

Assessing and compensating performance in professional organizations is extremely difficult in direct public management settings of health services. Performance assessment is technically complex and, more so, with multiplicity of principals influencing goal setting. Incentives are a lever to generate directionality and motivation, both structural (for attracting and retaining workers) and specific ones (rewarding performance and directing behavior towards institutional goals). Incentives influence the behavior of workers in various ways, and their effectiveness seams weak and controversial in publicly run health services. To overcome the problems of deciding and evaluating performance, both good governance models and the revitalization of contractual management are required. To improve the effectiveness of incentive models, it is convenient to: 1) widen the conceptual framework of incentives, to incorporate the structural aspects of employment contract and payment; 2) improve the designs from a greater understanding of the determinants of motivation; and 3) broaden the lens to survey the extra-mural factors that alter the behavior of workers, trying to counter them.

[Pay for performance in public directly managed healthcare centers. Part 2: The Spanish National Health System. SESPAS Report 2024]. / Evaluación del rendimiento y compensación en centros sanitarios de gestión directa. Parte 2: el Sistema Nacional de Salud. Informe SESPAS 2024.

In Spain, the compensation model for statutory health personnel is complex, heterogeneous, and more oriented to rewarding complementary functions and activities, than to paying for the actual performance in the position of employee. The various attempts to incorporate incentives have been distorted by a civil service egalitarianist culture, and weak systemic governance. External attractors (private practice, etc.) for healthcare professionals are becoming more important and neutralize many intramural incentives. There are few prospects of relevant or general changes, since the main actors involved are reforms-averse; but some environmental factors can lead to incremental improvements in employment contracts, in the information available to improve benchmarking, and in the creation of islands of good clinical governance and management. The economic scenario, increasingly concerned about inflationary trends and sustainability risks, may have a revitalizing effect of some governance and management reforms.

Controlling the protein corona of polymeric nanocapsules: effect of polymer shell on protein adsorption.

Understanding the interactions between nanocarriers and plasma proteins is essential for controlling their biological fate. Based on the reported potential of polymeric nanocapsules (NCs) for the targeted delivery of oncological drugs, the main objective of this work has been to investigate how the surface chemical composition influences their protein corona fingerprint. Thus, we developed six NC prototypes with different polymer shells and physicochemical properties and quantified the amount of protein adsorbed upon incubation in human plasma. Using sequential window acquisition of all theoretical mass spectra (SWATH-MS) and following the Minimum Information about Nanomaterial Biocorona Experiments (MINBE) guidelines, we identified different protein corona patterns. As expected, the presence of polyethylene glycol (PEG) in the polymer shell reduced the protein corona, particularly the adsorption of immunoglobulins. However, by comparing the different prototypes, we concluded that the protein adsorption pattern was not exclusively driven by PEG. In fact, a highly PEGylated prototype exhibited intense apolipoprotein IV adsorption. On the other hand, we also observed that polymeric NCs containing 1,2-dioleoyl-3-trimethylammonium propane (DOTAP) exhibited high adsorption of vitronectin, a protein that is known for enhancing the uptake of nanosystems by lung epithelium and several cancer cells. Overall, the gathered information allowed us to identify promising polymeric NCs with an expected prolonged circulation time, enhanced tumor targeting, liver accumulation, and preferential uptake by the immune system. In this sense, the analyses of the protein corona performed along this work will hopefully contribute to advancing a new generation of rationally designed nanometric drug delivery systems.

Biofunctionalization of 3D printed collagen with bevacizumab-loaded microparticles targeting pathological angiogenesis.

Pathological angiogenesis is a crucial attribute of several chronic diseases such as cancer, age-related macular degeneration, and osteoarthritis (OA). In the case of OA, pathological angiogenesis mediated by the vascular endothelial growth factor (VEGF), among other factors, contributes to cartilage degeneration and to implants rejection. In line with this, the use of the anti-VEGF bevacizumab (BVZ) has been shown to prevent OA progression and support cartilage regeneration. The aim of this work was to functionalize a medical grade collagen with poly (lactic-co-glycolic acid) (PLGA) microparticles containing BVZ via three-dimensional (3D) printing to target pathological angiogenesis. First, the effect of several formulation parameters on the encapsulation and release of BVZ from PLGA microparticles was studied. Then, the anti-angiogenic activity of released BVZ was tested in a 3D cell model. The 3D printability of the microparticle-loaded collagen ink was tested by evaluating the shape fidelity of 3D printed structures. Results showed that the release and the encapsulation efficiency of BVZ could be tuned as a function of several formulation parameters. In addition, the released BVZ was observed to reduce vascularization by human umbilical vein endothelial cells. Finally, the collagen ink with embedded BVZ microparticles was successfully printed, leading to shape-stable meniscus-, nose- and auricle-like structures. Taken altogether, we defined the conditions for the successful combination of BVZ-loaded microparticles with the 3D printing of a medical grade collagen to target pathological angiogenesis.

Experiencia de la pandemia por SARS-CoV-2 en un centro hospitalario de alta complejidad en Chile

Background: The knowledge about the epidemiological profile of patients admitted to the hospital for severe COVID infection, allows an adequate health care planning and resource allocation. Aim: To describe the epidemiology of patients with COVID-19 admitted to a public hospital between March 2020 and July 2021. Material and Methods: Demographic variables, comorbidities, ventilatory support requirements, and hospital resources were recorded from clinical records and hospital databases of diagnosis related groups. The primary outcomes were overall mortality and need of ventilatory support. Results: In the study period, 4,474 patients (56% males) were hospitalized with a diagnosis of COVID-19. Overall mortality was 25.8% and in-hospital mortality was 18%. Invasive and non-invasive ventilatory support was required in 1349 (30.2%) and 2060 (46%) patients, respectively. The most common comorbidities in admitted patients were diabetes mellitus (29.2%), chronic kidney disease (11.1%), and chronic liver disease (10.4%). The readmission rate was 3.2%. Conclusions: Mortality associated with COVID-19 in this hospital was similar to the rates reported abroad. Local risk predictors for this infection should be identified.

Piperazine-derived small molecules as potential Flaviviridae NS3 protease inhibitors. In vitro antiviral activity evaluation against Zika and Dengue viruses.

Since 2011 Direct Acting antivirals (DAAs) drugs targeting different non-structural (NS) viral proteins (NS3, NS5A or NS5B inhibitors) have been approved for clinical use in HCV therapies. However, currently there are not licensed therapeutics to treat Flavivirus infections and the only licensed DENV vaccine, Dengvaxia, is restricted to patients with preexisting DENV immunity. Similarly to NS5 polymerase, the NS3 catalytic region is evolutionarily conserved among the Flaviviridae family sharing strong structural similarity with other proteases belonging to this family and therefore is an attractive target for the development of pan-flavivirus therapeutics. In this work we present a library of 34 piperazine-derived small molecules as potential Flaviviridae NS3 protease inhibitors. The library was developed through a privileged structures-based design and then biologically screened using a live virus phenotypic assay to determine the half-maximal inhibitor concentration (IC50) of each compound against ZIKV and DENV. Two lead compounds, 42 and 44, with promising broad-spectrum activity against ZIKV (IC50 6.6 µM and 1.9 µM respectively) and DENV (IC50 6.7 µM and 1.4 µM respectively) and a good security profile were identified. Besides, molecular docking calculations were performed to provide insights about key interactions with residues in NS3 proteases' active sites.

Mannose-modified hyaluronic acid nanocapsules for the targeting of tumor-associated macrophages.

Tumor-associated macrophages (TAMs), a class of immune cells that play a key role in tumor immunosuppression, are recognized as important targets to improve cancer prognosis and treatment. Consequently, the engineering of drug delivery nanocarriers that can reach TAMs has acquired special relevance. This work describes the development and biological evaluation of a panel of hyaluronic acid (HA) nanocapsules (NCs), with different compositions and prepared by different techniques, designed to target macrophages. The results showed that plain HA NCs did not significantly influence the polarization of M0 and M2-like macrophages towards an M1-like pro-inflammatory phenotype; however, the chemical functionalization of HA with mannose (HA-Man) led to a significant increase of NCs uptake by M2 macrophages in vitro and to an improved biodistribution in a MN/MNCA1 fibrosarcoma mouse model with high infiltration of TAMs. These functionalized HA-Man NCs showed a higher accumulation in the tumor compared to non-modified HA NCs. Finally, the pre-administration of the liposomal liver occupying agent Nanoprimer™ further increased the accumulation of the HA-Man NCs in the tumor. This work highlights the promise shown by the HA-Man NCs to target TAMs and thus provides new options for the development of nanomedicine and immunotherapy-based cancer treatments.

[Epidemiological profile of patients with COVID-19 admitted to a tertiary care public hospital]. / Experiencia de la pandemia por SARS-CoV-2 en un centro hospitalario de alta complejidad en Chile.

BACKGROUND: The knowledge about the epidemiological profile of patients admitted to the hospital for severe COVID infection, allows an adequate health care planning and resource allocation. AIM: To describe the epidemiology of patients with COVID-19 admitted to a public hospital between March 2020 and July 2021. MATERIAL AND METHODS: Demographic variables, comorbidities, ventilatory support requirements, and hospital resources were recorded from clinical records and hospital databases of diagnosis related groups. The primary outcomes were overall mortality and need of ventilatory support. RESULTS: In the study period, 4,474 patients (56% males) were hospitalized with a diagnosis of COVID-19. Overall mortality was 25.8% and in-hospital mortality was 18%. Invasive and non-invasive ventilatory support was required in 1349 (30.2%) and 2060 (46%) patients, respectively. The most common comorbidities in admitted patients were diabetes mellitus (29.2%), chronic kidney disease (11.1%), and chronic liver disease (10.4%). The readmission rate was 3.2%. CONCLUSIONS: Mortality associated with COVID-19 in this hospital was similar to the rates reported abroad. Local risk predictors for this infection should be identified.

Polymeric nanocapsules loaded with poly(I:C) and resiquimod to reprogram tumor-associated macrophages for the treatment of solid tumors.

Background: In the tumor microenvironment (TME), tumor-associated macrophages (TAMs) play a key immunosuppressive role that limits the ability of the immune system to fight cancer. Toll-like receptors (TLRs) ligands, such as poly(I:C) or resiquimod (R848) are able to reprogram TAMs towards M1-like antitumor effector cells. The objective of our work has been to develop and evaluate polymeric nanocapsules (NCs) loaded with poly(I:C)+R848, to improve drug stability and systemic toxicity, and evaluate their targeting and therapeutic activity towards TAMs in the TME of solid tumors. Methods: NCs were developed by the solvent displacement and layer-by-layer methodologies and characterized by dynamic light scattering and nanoparticle tracking analysis. Hyaluronic acid (HA) was chemically functionalized with mannose for the coating of the NCs to target TAMs. NCs loaded with TLR ligands were evaluated in vitro for toxicity and immunostimulatory activity by Alamar Blue, ELISA and flow cytometry, using primary human monocyte-derived macrophages. For in vivo experiments, the CMT167 lung cancer model and the MN/MCA1 fibrosarcoma model metastasizing to lungs were used; tumor-infiltrating leukocytes were evaluated by flow cytometry and multispectral immunophenotyping. Results: We have developed polymeric NCs loaded with poly(I:C)+R848. Among a series of 5 lead prototypes, protamine-NCs were selected based on their physicochemical properties (size, charge, stability) and in vitro characterization, showing good biocompatibility on primary macrophages and ability to stimulate their production of T-cell attracting chemokines (CXCL10, CCL5) and to induce M1-like macrophages cytotoxicity towards tumor cells. In mouse tumor models, the intratumoral injection of poly(I:C)+R848-protamine-NCs significantly prevented tumor growth and lung metastasis. In an orthotopic murine lung cancer model, the intravenous administration of poly(I:C)+R848-prot-NCs, coated with an additional layer of HA-mannose to improve TAM-targeting, resulted in good antitumoral efficacy with no apparent systemic toxicity. While no significant alterations were observed in T cell numbers (CD8, CD4 or Treg), TAM-reprogramming in treated mice was confirmed by the relative decrease of interstitial versus alveolar macrophages, having higher CD86 expression but lower CD206 and Arg1 expression in the same cells, in treated mice. Conclusion: Mannose-HA-protamine-NCs loaded with poly(I:C)+R848 successfully reprogram TAMs in vivo, and reduce tumor progression and metastasis spread in mouse tumors.

Crisis de los Colegios Mayores de la Universidad de Salamanca (siglos XVIII–XX). Su vinculación con la Diputación (siglo XIX) / Crisis of the Colleges of the University of Salamanca (XVIII-XX centuries). Its link with the Diputación (XIX century)

Este trabajo constituye un relato histórico de los Colegios Mayores salmantinos. Para ello, se han revisado algunos documentos existentes en el Archivo de la Universidad de Salamanca y copias notariales de documentos inéditos custodiados por la Diputación Provincial. A pesar de que la historia de estos Colegios Mayores suele formar parte de numerosos trabajos relativos a la historia de la Universidad salmantina, el examen de dichos documentos le ha permitido al autor realizar rigurosos comentarios, que aportan originalidad en el conocimiento de este tema. (AU)

This review constitutes a historical account of the Salamanca Major Colleges. To do this, some existing documents in the Archive of the University of Salamanca and notarized copies of unpublished documents kept by the Provincial Council have been reviewed. Despite the fact that the history of these Halls of Residence is usually part of the numerous works related to the history of the University of Salamanca, the examination of these documents has allowed the author to make rigurous comments that provide originality in the knowledge of this subject. (AU)

Vinculación del virólogo profesor Adolfo García Sastre con la Universidad de Salamanca y con la Real Academia Nacional de Farmacia / Relationship of the virologist professor Adolfo García Sastre with the University of Salamanca and the Royal National Academy of Pharmacy

Se detallan y comentan algunos datos biográficos relativos al virólogo Profesor Adolfo García Sastre correspondientes a su etapa como estudiante en la Facultad de Biología de la Universidad de Salamanca, durante los cursos finales de su Licenciatura (años 1981-1986), así como a los siguientes en que realizó su Tesis de Licenciatura (Tesina) en 1986, y Doctorado (1986-1990), en el Departamento de Bioquímica y Biología Molecular de dicha Facultad (Director: Prof. J.A. Cabezas); habiendo obtenido en ambas las máximas calificaciones y el Premio Extraordinario en la de Doctorado. También se resumen las líneas de investigación que cultivó en Salamanca hasta 1991 en colaboración con el director de ambas Tesis (el Profesor Titular Enrique Villar), el Profesor J.A. Cabezas y, a veces, otros. Los resultados obtenidos, así como los derivados de su breve etapa inmediata en el Instituto Pasteur de Paris, en coordinación con el Departamento salmantino, fueron publicados en revistas de Virología o de Bioquímica de gran prestigio y presentados en congresos nacionales e internacionales. Posteriormente, en su etapa americana en el Mount Sinai de Nueva York, entró en contacto con el Profesor Mariano Esteban, entonces trabajando en el Downstate Medical Center de New York, SUNY, y ambos, conjuntamente con el grupo del New York University (NYU) dirigido por Ruth Nussenweig y Fidel Zavala, llevaron a cabo experimentos seminales de inmunología que abrieron las bases a la combinación de vacunas en protocolos prime/boost y activación de linfocitos TCD8+ con resultado de alta eficacia frente a patógenos. Estos protocolos están siendo implementados en numerosos ensayos preclínicos y clínicos. La contribución del Prof. García Sastre a la ciencia está actualmente en fase exponencial, abriendo nuevos horizontes en el entendimiento de la biología molecular de virus emergentes, su patología, interacción virus-hospedador y desarrollando nuevos procedimientos de control viral. (AU)

We give some biographical details of the virologist Professor Adolfo Garcia Sastre, as a Graduate student (1981-1986) in the Biology School of University of Salamanca and during his PhD Thesis (1986-1990) in the Department of Biochemistry and Molecular Biology (Chairman Prof J.A. Cabezas), under the supervision of Prof. Enrique Villlar and obtaining the highest academic marks. The research lines that he established in collaboration with his Thesis director, with Prof. J.A Cabezas and others, as well as his results during his stay at the Pasteur Institute in Paris, are also highlighted. His findings in this period were published in prestigious Virology and Biochemistry journals and presented at national and international meetings. Thereafter, when he moved to Mount Sinai in New York, he met Prof Mariano Esteban, then working at Downstate Medical Center in New York, SUNY, and both, in collaboration with the group of Prof. Ruth Nussenzweig and Fidel Zavala at New York University, set up seminal immunological studies that are the basis for combined vaccination approaches, prime/boost and activation of CD8+ T cells, now widely used in preclinical and clinical studies. The scientific research contributions of Prof. García Sastre are growing at an exponential rate, opening new horizons in understanding the molecular biology of emerging viruses, their pathology, virus-host cell interactions and strategies of virus control. (AU)

Colaboración hispano-alemana en Bioquímica mantenida por miembros de la Real Academia Nacional de Farmacia y por otros bioquímicos españoles / Spanish-German collaboration in Biochemistry maintained by members of the Royal Academy National of Pharmacy and by other Spanish biochemists

Considerada la Bioquímica alemana como la pionera en el mundo, ya en la etapa inicial de la misma, hacia 1872, se estableció la primera vinculación entre el Profesor alemán fundador de esta disciplina, Felix von Hoppe-Seyler, y el Catedrático español de Química Orgánica Laureano Calderón Arana. Después, algunos de los Catedráticos de la recién establecida asignatura de Química Biológica, cuya enseñanza se impartía únicamente en la Facultad de Farmacia madrileña para los alumnos de Doctorado (común a Farmacia, Medicina y Ciencias), mantuvieron esta relación, aunque menos intensa, con sus colegas germanos. Pero, a partir de 1928, el que sería Premio Nobel, Dr. Severo Ochoa, trabajó durante largos periodos en prestigiosos Departamentos de Berlín y Heidelberg. Y ya en época reciente, bioquímicos pertenecientes a la Real Academia Nacional de Farmacia (RANF) han continuado esta vinculación colaborando en diversos Departamentos alemanes. Por otro lado, bioquímicos germanos han impartido conferencias en Universidades españolas, invitados por sus colegas hispanos, además de hacerlo en congresos o simposios en España. Asimismo, algunos de ellos han sido miembros de la RANF. (AU)

German can be considered as world pioneer in the development of Biochemistry. Its founder, Prof. Felix von Hoppe-Seyler, established contacts with the Spanish Professor of Organic Chemistry, Laureano Calderón Arana, since the onset of this subject around 1872. Later, some other Professors of the newly created Química Biológica, which was taught only at the Faculty of Pharmacy in Madrid as a subject common to doctoral students in Pharmacy, Medicine and Science, maintained a connection, albeit minor, with their German colleagues. From 1928, Dr. Severo Ochoa, who would subsequently win a Nobel Prize, worked for long periods in the prestigious Departments at Berlin and Heidelberg. More recently, other biochemists, members of the Royal Academy National of Pharmacy (RANF), have followed this connection with several German Departments. Furthermore, German biochemists have delivered lectures in Spanish Universities invited by their Spanish colleagues, in addition to their participation in Spanish symposia. Moreover, several German biochemists have been RANF members. (AU)

Glicoconjugados (estructura, funciones biológicas, actividad patológica, utilización terapéutica) / Glycoconjugates (structures, biological functions, pathological activity, therapeutic use)

Se conocen principalmente algunas peculiaridades funcionales, muy importantes, de los ácidos siálicos denominados N-acetilneuramínico (NeuAc) y N-glicolilneuramínico (NeuGc), por ser agentes que participan en actividades fisiológicas o en procesos patológicos cada vez más investigados en seres humanos. Dichos ácidos forman parte de los glicoconjugados. Los glicoconjugados son moléculas resultantes de la unión fuerte, covalente, entre glúcidos y proteínas o entre glúcidos y lípidos. La desregulación de la actividad de enzimas que catalizan procesos metabólicos vinculados a los glicoconjugados produce anomalías en la estructura química de estos compuestos que impiden el desarrollo normal de la correspondiente función biológica. Tales anomalías pueden afectar a las rutas biosintéticas (desórdenes congénitos de glicosilación) o a las rutas catabólicas (anomalías por almacenamiento causadas por enzimas lisosómicas). Por fortuna, actualmente se dispone de agentes que son glicoconjugados o están relacionados con ellos que facilitan la prevención o la curación de enfermedades como la gripe, el SIDA, el cáncer, etc. Últimamente se ha intensificado la investigación con finalidad terapéutica mediante nuevos enfoques inmunológicos o genéticos relativos a los glicoconjugados, según se indica en este artículo. (AU)

Mainly N-acetylneuraminic acid (NeuAc) and N-glycolylneuraminic acid (NeuGc) exhibit very important peculiarities in certain biological (both physiological and pathological) processes. These acids are components of the glycoconjugates. Glycoconjugates are molecules resulting of the covalent link between carbohydrates and proteins or between carbohydrates and lipids. The disregulation of enzymes which catalyse the metabolic processess related to glycoconjugates produces anomalies in the chemical structure of these compounds which preclude their normal biological function, by abnormalities in the biosynthetic route (Congenital Disorders of Glycosylation) or abnormalities in the catabolic way (Lysosomal Storage Disorders). Fortunately, several agents related to glycoconjugates are now available to prevent or heal illness such as influenza, AIDS, cancer, etc. In this wiew, the research on immunological and genetic features of glycoconjugates with a therapeutic finality has been recently increased, as shown in this paper. (AU)

Components of case management in caring for patients with dementia: a mixed-methods study.

BACKGROUND: Case management has shown improvements in some health outcomes for dementia patients and their families. However, despite its benefits the components of case management in order to provide effective patient and family care remain unknown at present. Thus, the aim of this study is to identify the specific components of case management in caring for patients with dementia and to determine the necessary intensity of its deployment to enhance outcomes for these patients and their caregivers. METHODS: Mixed-methods study with a qualitative phase to characterise forms of service provision, according to the case management components involved, followed by a quantitative phase to analyse the correlations between different patterns of service provision, adverse events in patients and caregiver overload. This study will be based on the variables described in the RANGE.COM register. DISCUSSION: This research is expected to achieve a reproducible, evaluable set of interventions that can be modelled to optimise case management effectiveness for patients with dementia. Interactions between patients with dementia, their family caregivers and case management healthcare services, the components of these interactions and their association with the conditions of the individuals concerned are issues of great interest in the field of case management, which is constantly evolving.

Development of a nanocapsule-loaded hydrogel for drug delivery for intraperitoneal administration.

Intraperitoneal (IP) drug delivery of chemotherapeutic agents, administered through hyperthermal intraperitoneal chemotherapy (HIPEC) and pressurized intraperitoneal aerosolized chemotherapy (PIPAC), is effective for the treatment of peritoneal malignancies. However, these therapeutic interventions are cumbersome in terms of surgical practice and are often associated with the formation of peritoneal adhesions, due to the catheters inserted into the peritoneal cavity during these procedures. Hence, there is a need for the development of drug delivery systems that can be administered into the peritoneal cavity. In this study, we have developed a nanocapsule (NCs)-loaded hydrogel for drug delivery in the peritoneal cavity. The hydrogel has been developed using poly(ethylene glycol) (PEG) and thiol-maleimide chemistry. NCs-loaded hydrogels were characterized by rheology and their resistance to dilution and drug release were determined in vitro. Using IVIS® to measure individual organ and recovered gel fluorescence intensity, an in vivo imaging study was performed and demonstrated that NCs incorporated in the PEG gel were retained in the IP cavity for 24 h after IP administration. NCs-loaded PEG gels could find potential applications as biodegradable, drug delivery systems that could be implanted in the IP cavity, for example at a the tumour resection site to prevent recurrence of microscopic tumours.

Prediction of platelet counts with ROTEM-sigma in cardiac surgery.

BACKGROUND: Excessive bleeding is common after cardiac surgery. According to transfusion algorithms based on ROTEM results (TEM International Inc., Munich, Germany), platelet transfusion is recommended when FIBTEM amplitude is normal and EXTEM amplitude is reduced. The aim of this study was to evaluate whether ROTEM (TEM International Inc.) parameters may predict accurately platelet counts in cardiac surgery patients, and to determine which of these parameters is the most useful for predicting platelet counts. METHODS: In this retrospective single center study data from 83 patients who underwent cardiac surgery were reviewed. We analyzed the results of patients for whom ROTEM (TEM International Inc.) and conventional laboratory tests were performed simultaneously. The derived ROTEM (TEM International Inc.) parameter PLTEM was used to estimate platelet count; PLTEM is calculated by subtracting FIBTEM from EXTEM. Correlation between ROTEM (TEM International Inc.) variables and platelet counts were determined. Logistic regression analyses were performed to predict platelet counts. RESULTS: ROTEM A5 values show a high linear correlation with MCF values. PLTEM has a strong linear correlation with platelet counts. According to our results for PLTEM A5<32 mm the probability of platelet count <150×109/L is 100%, for PLTEM A5<27 mm the probability of platelet count <100×109/L is nearly 80%, and for PLTEM A5<22 the probability of platelet count <75×109/L is 70%. CONCLUSIONS: This study demonstrates the reliability of considering early ROTEM (TEM International Inc.) results and the feasibility of using PLTEM A5 to predict platelet counts and so, improve our ability to decide the need of platelet transfusion in cardiac surgery patients.