Objective: We investigated the possible association between lower serum lactate to albumin ratio upon hospital arrival and out-of-hospital cardiac arrest (OHCA) outcome. Methods: Records from the Japanese Association for Acute Medicine–Out-of-Hospital Cardiac Arrest (JAAM-OHCA) Registry were used for this multicenter observational study. Enrolled patients were ≥18 years old with OHCA of medical etiology who were hospitalized after spontaneous circulation returned between June 1, 2014, and December 31, 2021. We excluded those with missing data or those who failed to meet predefined inclusion criteria. The primary outcome was a cerebral performance category scale of 1 or 2 which indicated 30-day survival with favorable neurological outcome. Patients were divided into quartiles based on serum lactate to albumin ratios. The multivariable logistic regression analysis included adjustment for multiple factors. Results: Data from 4,413 patients were analyzed. The primary outcome was achieved by 558 of 1,104 patients (50.5%) in the first quartile (lactate to albumin ratio, ≤2.23), 240 of 1,111 patients (21.6%) in the second quartile (lactate to albumin ratio >2.23–3.39), 96 of 1,096 patients (8.8%) in the third quartile (lactate to albumin ratio >3.39–4.70), and 24 of 1,102 patients (2.2%) in the fourth quartile (lactate to albumin ratio, >4.70). Adjusted odds ratios (95% confidence intervals) for the primary outcome in the second, third, and fourth quartile compared with the first quartile were 0.33 (0.26–0.42), 0.19 (0.14–0.26), and 0.07 (0.04–0.11), respectively. Conclusion A statistically significant association between categorization in the lower lactate to albumin ratio quartile group and favorable neurological outcome after OHCA was identified.

OBJECTIVESystemic and myelotoxic effects of 2,3,7,8-tetrabromodibenzo-p-dioxin (TBDD) were examined by the single administration of TBDD by gavage to rats.

METHODSFifteen Wistar rats of both sexes per group received 0, 10, 30, 100 or 300 μg TBDD/kg body weight. Rats surviving to the scheduled necropsy on Days 2, 7 and 36 after TBDD administration were examined for growth rate, organ weight, hematology, histopathology and adipose tissue levels of TBDD.

RESULTSThree 300 μg/kg-dosed females died on Days 21, 23 and 27, and exhibited a marked decrease in body weight, severe thymic atrophy, decreased bone marrow hematopoiesis and hemorrhage in the subarachnoid space of brain and spinal cord. TBDD-dosed surviving rats exhibited growth retardation, decreased bone marrow hematopoiesis, decreases in red blood cell counts, hemoglobin concentrations, and hematocrit values, an increase in reticulocytes and decreases in platelet counts, white blood cell counts and eosinophils. These signs suggested TBDD myelotoxicity. Splenic extramedullary hematopoiesis was increased in both sexes given TBDD, whereas atrophy of the splenic white pulp occurred only in TBDD-dosed females. Marked decreases in body weights and the size and weight of the thymus, severe thymic atrophy and death in TBDD-dosed females suggested a wasting syndrome. The adipose tissue level of TBDD culminated on Day 7 and decreased to 20-30% of the Day 7 level on Day 36.

CONCLUSIONSThe TBDD-induced effects were characterized by a wasting syndrome and myelotoxicity that appeared at the dose levels of 30 μg/kg and higher and caused death in 300 μg/kg-dosed females.