scholarly journals Efficacy of Different Preemptive Analgesia on Postoperative Analgesia, Oxidative Stress, and Inflammatory Response after Gynecological Laparoscopic Surgery

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Chengcheng Sun ◽  
Qinghua Yang ◽  
Chenyu Wang ◽  
Jianyi Zhao ◽  
Ming Dai
Keyword(s):  
Oxidative Stress ◽  
Laparoscopic Surgery ◽  
Adverse Reactions ◽  
Serum Cortisol ◽  
Catheter Removal ◽  
Ketorolac Tromethamine ◽  
Tnf Α ◽  
Group A ◽  
Group D ◽  
Better Than

Objective. To observe and compare the analgesic effects of oxycodone, pentazocine, and ketorolac tromethamine pre-emptive analgesia on gynecological laparoscopic patients after operation and the effects on oxidative stress and inflammatory reaction. Methods. A total of 64 patients who underwent elective gynecological laparoscopic surgery in Yiwu Central Hospital from June 2019 to December 2020 were randomly divided into four groups (n = 16). Before anesthesia induction, oxycodone (group A), pentazocine (group B), ketorolac tromethamine (group C), and normal saline (group D) were, respectively, administered. Patients’ mean arterial pressure (MAP) and heart rate (HR) changes, visual analogue scale (VAS), Bruggemann comfort scale (BCS), serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), blood glucose (CLU), serum cortisol level, postoperative adverse reactions, and additional analgesia were recorded at each time point. Results. The MAP levels of T2 (immediate intubation), T3 (immediate catheter removal), and T4 (5 min after catheter removal) in the four groups were higher than those of T1 (quiescent state), and the HR levels T2, T3, and T4 were lower than those of T1 P < 0.05 . The MAP and HR levels of T2, T3, and T4 in patients of groups A, B, and C were lower than those of group D in the same period P < 0.05 . The VAS and BCS scores of groups A, B, and C at 1, 6, 12, and 24 h after operation were better than those of group D at the same time, and the scores of group A at 1 h and 6 h after operation were better than those of groups B and C at the same time P < 0.05 . The levels of serum TNF-α, IL-6, and CRP in the four groups of patients at 6, 12, and 24 h after operation were higher than those before operation, but those in groups A, B, and C were lower than those in group D, and those in group A were higher than those in groups B and C at 12 h and 24 h after operation P < 0.05 . The CLU and serum cortisol levels in the four groups were significantly higher at 6, 12, and 24 h after operation, but those in groups A, B, and C were lower than those in group D, and those in group A were lower than those in groups B and C at 6 and 12 h after operation P < 0.05 . There was no significant difference in the incidence of adverse reactions within 24 h between the four groups P > 0.05 . The incidence of additional analgesia in groups A, B, and C was lower than that in group D P < 0.05 . Conclusion. Oxycodone, pentazocine, and ketorolac tromethamine are effective and safe in inhibiting postoperative pain and the generation of inflammatory factors and relieving inflammatory state in gynecological laparoscopic pre-emptive analgesia. Oxycodone has better postoperative analgesic effect because it can effectively alleviate stress reaction.

scholarly journals The Efficacy and Safety of Nabufen and Sufentanil in the Prevention of Visceral Pain After Gynecological Laparoscopic Surgery: A Randomised Controlled Trial

2020 ◽  
Author(s):  
Xiaoxia Gu ◽  
Jingjing Wang ◽  
Huihua Liao ◽  
Jian Mo ◽  
Weiming Huang ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Adverse Reactions ◽  
Visceral Pain ◽  
Sedation Score ◽  
Efficacy And Safety ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Group D ◽  
Ramsay Sedation Score

Abstract Background: To compare the efficacy and safety of different compatibility schemes in the prevention of visceral pain after gynecological laparoscopic surgery. Methods: from April 2019 to April 2020, patients undergoing elective gynecological laparoscopic surgery in our hospital were randomly divided into four groups: group A: sufentanil 3 μ g / kg; group B: low-dose nalbuphine group: 0.1 mg / kg of nabufen + 3 μ g / kg of sufentanil; group C: medium dose of nabufen group: 1 mg / kg of nabufen + 2 μ g / kg of sufentanil; group D: high-dose nabufen 2 There were 30 cases in each group. The degree of pain and the number of adverse reactions at 2, 4, 8, 12, 24 and 48 hours after operation were observed and recorded. The number and dosage of morphine used as a remedial analgesic were recorded. The pain degree was assessed by visual analogue scale (VAS). The total amount of analgesic pump used, the total number of times of pressing and the effective times of pressing were recorded. The adverse reactions included respiratory depression, nausea and vomiting, drowsiness, restlessness and skin The skin itches. Results: the analgesic effect of group B was similar to that of group A, and there was no significant difference in the number of invalid pressing, total pressing times and rescue analgesia rate (P > 0.05), while the invalid pressing times, total pressing times and remedial analgesia rate of group C and group D were significantly lower than those of group A (P < 0.05). There was no significant difference between group C and group D in the number of invalid compressions, the total number of compressions and the rate of remedial analgesia (P > 0.05), suggesting that increasing the dose of nalbuphine could not significantly increase the analgesic effect. The incidence of postoperative nausea and vomiting, skin pruritus, lethargy and Ramsay Sedation score in group B and group C were significantly lower than those in group A (P < 0.05). Ramsay Sedation score and incidence of drowsiness were lower than those in group D, which indicated that the incidence of adverse reactions was higher in group D than group B and group C.Conclusion: the combination of 1 mg / kg nabufen and 2 μ g / kg sufentanil is a safe and effective combination scheme for the prevention of visceral pain after gynecological laparoscopic surgery with small adverse reactions.Trial registration: http://www.chictr.org.cn/showproj.aspx?proj=40635Registration number：ChiCTR1900025076 . Prospectively registered on 10 August 2019.

scholarly journals Lipidomic Analysis to Assess Oxidative Stress in Acute Coronary Syndrome and Acute Stroke Patients

Metabolites ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 412
Author(s):  
Martin Malý ◽  
Martin Hajšl ◽  
Kamila Bechyňská ◽  
Ondřej Kučerka ◽  
Martin Šrámek ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Acute Coronary Syndrome ◽  
High Performance ◽  
Coronary Syndrome ◽  
Lipidomic Analysis ◽  
Comprehensive Information ◽  
Group A ◽  
Fatty Acyls ◽  
Group D ◽  
Standard Marker

Alterations in lipid metabolism mediated by oxidative stress play a key role in the process of atherosclerosis and superimposed thrombosis; these can lead to acute coronary syndrome (ACS) and acute ischemic stroke (AIS). Multiple studies have shown that the formation of atheromatous lesions is initiated by oxidation of low-density lipoproteins incorporated into the intima of the vessel wall. Here, we studied lipids in plasma samples from three cohorts: 61 patients with ACS (group A), 49 patients with AIS (group D), and 82 controls (group K). Untargeted lipidomics based on high-performance liquid chromatography coupled to mass spectrometry (UHPLC-HRMS) was employed to obtain comprehensive information on whether relationships exist between these patient categories based on lipid patterns. In addition, malondialdehyde (MDA) as a standard marker of oxidative stress was monitored. The most characteristic lipids in group K were fatty acyls of hydroxyfatty acids (FAHFAs). As expected, MDA concentrations were the lowest in group K. Our findings can better explain ongoing pathologies, both acute and chronic, with the potential for future diagnosis and treatment.

The Effects of Moxibustion on Serum Interleukins and T Cell Subset in H.polyri Infected Rats

2015 ◽  
Vol 3 (1) ◽  
pp. 38-45
Author(s):  
Jing Shen ◽  
Yan Peng ◽  
Dong-Mei Shi ◽  
Yin-Shuai Feng ◽  
Yan-Ling Hou ◽  
...  
Keyword(s):  
Gastric Mucosa ◽  
Control Group ◽  
Intragastric Administration ◽  
Therapeutic Effects ◽  
Model Group ◽  
Tnf Α ◽  
Group A ◽  
Histomorphological Changes ◽  
Group B ◽  
Group D

Abstract Objective: to observe the effects of moxibustion on histomorphological changes of gastric mucosa, as well as on serum IL-6、IL-8、TNF-α，Hp IgG、CD3+、CD4+、CD8+ in helicobacter pylori (Hp) infected rats, so that to better understand how the moxibustion repairs the Hp- induced gastric mucosal injury. Methods: 40 SD rats were randomly assigned to four groups: group A (blank control), group B (Hp infection model), group C (moxibustion plus model), group D (electro-acupuncture plus model), 10 for each group. The “NaHCO3 plus Indometacin and Hp intragastric administration” method was employed to make gastritis model. Acupoints selected for “repair” purpose were Zu San Li (ST36), Zhong Wan (CV12), Guan Yuan (RN4), Pi Shu (BL20), Wei Shu(BL21). The histomorphological changes of gastric mucosa in rats were observed under light microscope after HE stain; IL-6, IL-8, TNF-α, Hp IgG values were evaluated by ELISA method; values of CD3+、CD4+、CD8+、CD4+/CD8+ were measured by flow cytometry method. Results: compared with group A, the values of IL-6, IL-8, TNF-α, Hp IgG and CD8+ in group B were increased（P＜0.01）, whereas the values of CD3+、CD4+、CD4+/CD8+ were decreased（P＜0.01）. Compared with group B, the values of IL-8（P＜0.05）,TNF-α（P＜0.05）, IL-6（P＜0.01）, Hp IgG（P＜0.01） and CD8+ （P＜0.05） in group C were decreased, whereas the values of CD3+（P＜0.05）,CD4+（P＜0.05）,CD4+/CD8+ （P＜0.05） were increased, meanwhile such values in group D had no significant changes. Compared with group D, the values of IL-6（P＜0.05）,IL-8 （P＜0.05）and Hp IgG （P＜0.01）in group C were decreased, whereas CD4+/CD8+（P＜0.05）were increased, all those changes had statistical significance. Conclusion: the preventive and therapeutic effects of moxibustion on Hp related gastritis might be realized by two ways- to inhibit the secretion of proinflammatory cytokines such as IL-6, IL-8 and TNF-α, or to regulate the production of immune factors (such as up-regulation of CD3+, CD4+ and down-regulation of CD8+).

scholarly journals The Impact of Pain Control on Invasive Clinical Procedure on Children with Leukemia

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5827-5827
Author(s):  
Jiayi WANG ◽  
Yingyi He ◽  
Zhimin Liang ◽  
Tiezhen Ye ◽  
Hui Zhang
Keyword(s):  
Local Anesthesia ◽  
Pain Control ◽  
Adverse Reactions ◽  
Low Dose ◽  
Invasive Procedure ◽  
Anesthesia Group ◽  
Group A ◽  
Group B ◽  
The Impact ◽  
Group D

Abstract Background: Palliative care is becoming more and more important for systemic cancer treatment in developed countries, while this remains infamous topic in developing countries, such as in China. Contemporary treatment strategies have greatly contributed to the improved outcome in childhood cancer patients, survivorship comes at the cost of developing some treatment-related health condition, such as pain-related depression, chronic pain etc. Thus, developing a well-tolerated pain control methods is of great importance within the cancer treatment. Objective: To evaluate the impact and outcome of different pain control applications on invasive procedure in children with leukemia, and record the adverse reactions. Methods: The enrollment of childhood leukemia patients in our hospital from November 2011 to November 2016 were divided into four groups, that is successively midazolam + local anesthesia (group A), midazolam + ketamine +local anesthesia (group B), midazolam + fentanyl + local anesthesia (group C), and fentanyl + propofol + local anesthesia (group D). The efficacy and adverse reactions were systemically recorded. The inter-group diffferences were calculated using x2 test. Results: No significancewas observed in age, gender, and disease distribution in these four groups by ANOVA ONEWAY analysis. The sedation outcome is more pronunced in group D than others. Also, the quality of procedural pain control in group D was the best (P<0.01). In terms of the analgesic effect, group B and D were better than that group A and C. There was significant difference in Hallucination was more easily detected in group B and C. Systemic recovery was delayed in group B other than group A, C, and D. Basing on the survey, we did found that the family members were more willing to accept pain control treatment for their sick kids under the safety assurance. The compliance was significantly improved in group D. Conclusion: Upon adequate auxiliary breathing preparation and rigorous monitor, propofol combined with low-dose fentanyl was the best sedative/analgesic option for pain control within leukemia patients receiving invasive procedure.The outcome of propofol combined with low-dose fentanyl wasvery safe, satisfactory and compliable. Up to now, this study is the first pain control study for invasive procedure in China mainland, it deserves being paid attention. Disclosures No relevant conflicts of interest to declare.

scholarly journals The Influence of Different Dexmedetomidine Doses on Cognitive Function at Early Period of Patients Undergoing Laparoscopic Extensive Total Hysterectomy

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Huiqiong Huang ◽  
Xiuyi Xu ◽  
Yirong Xiao ◽  
Junxiang Jia
Keyword(s):  
Cognitive Function ◽  
Gynecological Cancer ◽  
Early Period ◽  
The Other ◽  
Total Hysterectomy ◽  
Anesthetic Drugs ◽  
Tnf Α ◽  
Group A ◽  
Group B ◽  
Group D

Background. This study aims to analyze the influence of different dexmedetomidine doses on cognitive function. It works on early periods of patients undergoing laparoscopic extensive total hysterectomy. Method. 119 patients with gynecological cancer underwent a laparoscopic extensive total hysterectomy. The operation was performed at the Affiliated Women’s and Children’s Hospital of Xiamen University from January 2019 to June 2020. The score of MoCA and the level of TNF-α, IL-6, S-100β protein, NSE, and GFAP of each group were compared 1 day before and after operation and 3 and 7 days after operation. Result. In four groups, remifentanil, sufentanil, and propofol were given in the following order: group A > group D > group C > group B. Group A > group D > group C in terms of time spent in the recovery room, extubation, and recovery from anesthesia. The difference between groups B and C was not significant ( P > 0.05 ). Compared with group A, group B scored higher in MoCA at 1 day (T1), 3 days (T2), and 7 days (T3) after operation ( P < 0.05 ). At the same scoring point, the score was group B > group C > group D > group A. The POCD of four groups all occurred at 3 days after surgery. Compared with the T0 point, the level of TNF-α and IL-6 of the four groups at T1 and T2 was significantly increased ( P < 0.05 ). At T3, the level of TNF-α and IL-6 gradually decreased. At various periods, the levels of S-100 protein, NSE, and GFAP in groups B, C, and D were lower than those in group A (P0.05). Group B had a substantially higher rate of bradycardia than the other three groups (P0.05). The incidence of chills, respiratory depression, and restlessness in group A differed significantly from the other three groups ( P < 0.05 ). Conclusion. Using 0.5 μg/kg dexmedetomidine during the perianaesthesia can effectively reduce anesthetic drugs in patients. They had a laparoscopic extensive complete hysterectomy, which helps to reduce the adverse responses and the occurrence of POCD while also protecting brain function.

Effects of Ganoderma Lucidum and Krestin on Subset T-cell in Spleen of γ-irradiated Mice

1995 ◽  
Vol 23 (03n04) ◽  
pp. 289-298 ◽  
Author(s):  
Wang-Chi Chen ◽  
Dou-Mong Hau ◽  
Chih-Chung Wang ◽  
I-Hsin Lin ◽  
Shiuh-Sheng Lee
Keyword(s):  
Body Weight ◽  
Ganoderma Lucidum ◽  
Radiation Treatment ◽  
Whole Body ◽  
Control Group ◽  
Γ Irradiation ◽  
Group A ◽  
Group B ◽  
Group D ◽  
Better Than

Effects of Ganoderma lucidum (Gl) and Krestin (PSK) extracts on spleen, thymus and splenocytes in γ-irradiated mice were investigated in this study. ICR strain male mice were divided into five groups. Group A was the normal control. Group B, the experimental control, was treated with Gl. Group C, the radiation treatment control, was treated with whole body exposure to 4 Gy γ-irradiation (RT). Group D was treated with RT and Gl. Group E was treated with RT and PSK. The dosage of Gl was 400 mg/day/kg body weight and PSK was 500 mg/day/kg body weight. Our results indicated that the relative thymus weight in groups D and E were higher than group C on day 28 after γ-irradiation. Group D was the highest in all the experimental groups. CD4 and CD8 splenocytes in group D were higher than group C on days 7 and 28. Gl was better than PSK in repairing the damage of subset T-cells in the spleen of γ-irradiated mice.

scholarly journals Effect of Dexmedetomidine Administation on Analgesic, Respiration and Inflammatory Responses in Patients Undergoing Percutaneous Endoscopic Lumbar Discectomy: A Prospective Observational Study

2021 ◽  
Author(s):  
Xiaoli Zhang ◽  
Wenping Zhao ◽  
Cong Sun ◽  
Zhihua Huang ◽  
Lifang Zhan ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Serum Levels ◽  
Lumbar Discectomy ◽  
Lower Serum ◽  
Inflammatory Reactions ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Tnf Α ◽  
Group A ◽  
Group B ◽  
Endoscopic Lumbar Discectomy

Abstract BackgroundLocal anesthesia has been recommended for percutaneous endoscopic lumbar discectomy (PELD) in recent years; however, the efficacy, including oxidative stress, inflammatory reactions and ventilation effects, when intravenous dexmedetomidine (DEX) is administered during PELD has not been thoroughly described.MethodsSixty patients undergoing PELD were randomly allocated to either an intravenous DEX sedation group (Group A) or a normal saline group (Group B). Respiratory data, including minute ventilation (MV), tidal volume (TV), and respiratory rate (RR), were recorded using a respiratory volume monitor (RVM), and pulse oxygen saturation (SpO2) was measured by pulse oximetry. The visual analog score (VAS) and the plasma levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), malondialdehyde (MDA) and glutathione peroxidase (GSH-PX) were also recorded to evaluate oxidative stress and inflammatory reactions.ResultsThere were no significant differences in RR, MV, TV and SpO2 between the two groups at any time point (p>0.05). Group B exhibited lower serum levels of GSH-PX (p<0.0001) and higher serum levels of MDA (p<0.0001) than Group A at the end of surgery. Twenty-four hours after surgery, Group B exhibited higher serum levels of IL-6 (p=0.0033), TNF-α(p=0.0002), and MDA (p<0.0001) and lower serum levels of GSH-PX (p<0.0001) than Group A. In addition, Group B exhibited lower VAS (p<0.0001) than Group A.ConclusionsDEX administration using an RVM not only provides convenient analgesia and ventilation but also alleviates oxidative stress and inflammatory reactions in patients undergoing PELD .Trial registration ChiCTR2100044715(http://www.chictr.org.cn/index.aspx)

scholarly journals Comparison of the Efficacy and Safety between Doxycycline and Moxifloxacin in the Treatment of Tsutsugamushi Disease

2021 ◽  
Vol 5 (5) ◽  
pp. 73-77
Author(s):  
Qiang Qiu
Keyword(s):  
Liver Function ◽  
Adverse Reactions ◽  
Clinical Symptoms ◽  
Effective Rate ◽  
Clinical Treatment ◽  
Efficacy And Safety ◽  
Tsutsugamushi Disease ◽  
Group A ◽  
Group B ◽  
Better Than

Objective: To explore the efficacy and safety of doxycycline and moxifloxacin in the treatment of tsutsugamushi disease. Methods: There was a total of 80 cases of tsutsugamushi disease that were treated in Jiangsu Sihong Fenjinting Hospital from January 2017 to August 2020. The patients were divided into group A and group B, with 40 cases in each group. The patients in group A were treated with moxifloxacin whereas those in group B were treated with doxycycline. The efficacy and safety of the clinical treatment between the two groups were compared. Results: The effective rate was 72.5% in group A and 95.0% in group B. Compared with group A, group B was better (p < 0.05). The time taken for the resolution of clinical symptoms, the detection indexes of liver function, and the incidence of adverse reactions were also compared between the two groups, in which group B was significantly better than group A (p < 0.05). Conclusion: In the clinical treatment of tsutsugamushi disease, doxycycline has better therapeutic effect and higher safety compared to moxifloxacin. It can significantly improve the patient’s liver function, reduce the probability of adverse reactions, and accelerate the patient’s physical recovery.

Ameliorative effects of Lactobacillus against Aflatoxin B1

2024 ◽  
Vol 84 ◽  
Author(s):  
R. Yasmeen ◽  
B. Zahid ◽  
S. Alyas ◽  
R. Akhtar ◽  
N. Zahra ◽  
...  
Keyword(s):  
Aflatoxin B1 ◽  
Aqueous Environment ◽  
Serum Total Protein ◽  
Ameliorative Effect ◽  
Group A ◽  
Cell Fractions ◽  
Group D ◽  
Better Than

Abstract Lactobacilli are probiotics with Aflatoxin (AF) detoxification ability, found in fermented products, GIT of animals and environment. Purpose of this study was to investigate the ability of broiler isolates of Lactobacillus against Aflatoxin B1 (AFB1). For this purpose, 5 isolates of Lactobacillus from broiler gut were incubated with 100 ppb AFB1 in aqueous environment and effect of different parameters (cell fractions, time, temperature, pH) on detoxification was determined by HPLC. The ameliorative effect of Lactobacillus salivarius (LS) against AFB1 was studied in broiler. The results revealed that LS (CR. 4) showed the best results (in vitro) as compared to other isolates (L. salivarius (CR. 3, CR, 4), L. agilis (CE. 2.1, CE. 3.1) and L. crispatus (CE. 28). Cell debris of CR. 4 showed significantly higher detoxification (P<0.05). Maximum amount of AFB1 was detoxified at 30°C (97%), pH 4.0 (99%) and 6 h (99.97%). In vivo study showed that AFB1 decreased weight gain (1,269 ± 0.04 gm/ bird), feed consumed (2,161 ± 0.08 gm/ bird), serum total protein (2.42 ± 0.34 gm/ dl), serum albumin (0.5 ± 0.2 2 gm/dl) and antibody titer (4.2 ± 0.83). Liver function enzymes were found (alanine transaminase (ALT): 32 ± 10.7 U/L) and aspartate transaminase (AST): 314.8 ± 27 U/L) elevated in AFB1 fed broilers. Treatment with 1% LS not only decreased the toxic effects of AFB1 (group D) but also improved the overall health of broilers due to its probiotic effects (p<0.05) as compared to control negative (group A). The detoxification ability of LS was better than commercial binder (CB) (0.2% Protmyc). It was concluded that detoxification of AFB1 by Lactobacillus was strain, temperature, pH and time dependent. LS has detoxification ability against AFB1 in vivo.

scholarly journals Mao-to Prolongs the Survival of and Reduces TNF-α Expression in Mice with Viral Myocarditis

2010 ◽  
Vol 7 (3) ◽  
pp. 341-349 ◽  
Author(s):  
Zhu Shijie ◽  
Junji Moriya ◽  
Jun’ichi Yamakawa ◽  
Rui Chen ◽  
Takashi Takahashi ◽  
...  
Keyword(s):  
Survival Rates ◽  
Viral Myocarditis ◽  
Cardiac Damage ◽  
Emc Virus ◽  
Tnf Α ◽  
Group A ◽  
Group B ◽  
Factor Α ◽  
Group D ◽  
Necrosis Factor

Goal of this study was to evaluate effects of Mao-to on development of myocarditis induced by encephalomyocarditis (EMC) virus in mice. Mice were randomly divided into five groups. Group N included uninfected controls (n= 18), while group A, B and C underwent intraperitoneal injection of EMC virus. Group A was administered oral saline from day 0 to day 4. Group B was administered oral Mao-to (500 mg−1kg−1day−1) from day 0 to day 4. Group C was administered Mao-to from day 2 to day 6. Group D was administered Mao-to from day 5 to day 10. Treated mice were followed for survival rates during 2 weeks after infection. Body weight (BW) and organ weights including heart (HW), lungs, thymus and spleen were examined on days 4, 6 and 14. Survival rate of group C (36.4%) was significantly improved compared with group A, B or D (0% of each,P< 0.05). HW and HW/BW ratio in group C was significantly (P< 0.05) lower than those in group A, B or D. Viral titers of hearts were significantly different among groups A, B and C. Cardiac expression in tumor necrosis factor-α (TNF-α) was significantly reduced in group C in comparison with group A, B or D on day 6 by immunohistochemical study. Administration of Mao-to starting on day 2 improves mortality resulting from viral myocarditis in mice with reduced expression of cardiac TNF-α. These findings suggest that timing of Mao-to is crucial for preventing cardiac damage in mice with viral myocarditis.

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