Morning Group Research Articles

Successful 24-hour discharge for total knee arthroplasty: importance of timing of surgery and physiotherapy in enhanced recovery after surgery protocol.

The current literature is mixed on which patient factors, if any, predict the rate of successful discharge within 24 h of enhanced recovery after surgery (ERAS) total knee arthroplasty (TKA). This study aimed to investigate the influence of timing of surgery and physiotherapy on the rate of successful 24-h discharge. All 342 patients who underwent ERAS day surgery TKA from August 2020 to July 2021 were followed up prospectively. Patient characteristics and postoperative outcomes, such as number of physiotherapy sessions required before clearance for home, time taken after surgery to ambulate >10 m and length of stay (LOS), were recorded. Patients were grouped based on surgical end time (morning/afternoon/ evening) and time of physiotherapy review (morning/afternoon/evening/morning after). Patients successfully passed ERAS day surgery protocol if they were discharged within 24 h. With regard to the timing of operation, the morning group had the shortest LOS (P = 0.001) and a higher ERAS day surgery pass rate than the afternoon group (P = 0.016). With regard to the timing of physiotherapy, the afternoon group took the shortest time to ambulate >10 m (P < 0.001), had the shortest LOS (P < 0.001) and had a higher ERAS day surgery pass rate as compared to the morning after the operation group (P = 0.005). Patients who ended their operations in the morning and received physiotherapy review in the same afternoon were the most likely to be discharged within 24 h due to early ambulation and adequate time for spinal anaesthesia to wear off.

The relationship between chronotype and treatment time of day on post-treatment depression symptom severity for depressed patients receiving cognitive behavioural therapy

BackgroundMajor depressive disorder (MDD) represents a serious public health problem that affects a quarter billion individuals worldwide. Consequently, there is a need to identify modifiable factors of services that support treatment success. The relationship between circadian preferences (i.e., chronotype), treatment time of day, and outcomes is an understudied research area. Executing optimal treatment timing based on these factors could lead to substantial returns on a modifiable variable. MethodThe present study evaluated the associations between chronotype and treatment time of day on post-treatment depression symptom severity. In a tertiary setting, outpatients with MDD (n = 227) received 14 sessions of cognitive behavioural therapy in a group format, at one of three time of days: morning, afternoon, or evening. Participants completed measures of depression and chronotype at baseline and post-treatment. ResultStatistically significant increases in morningness were found for the afternoon and evening groups, but not the morning group. There was no significant interaction effect between pre-treatment morningness-eveningness scores and treatment time of day on post-treatment depression scores nor treatment response. However, there was a significant interaction effect of change in morningness-eveningness scores and post-treatment depression severity in the afternoon group. LimitationsThe lack of a control group limits conclusions drawn. ConclusionThe results suggest that individual circadian phase may impact treatment outcomes in relation to time of day. Further intentionally designed research is warranted to improve understanding of predictors, moderators, and mediators of patient outcomes based on treatment time of day and circadian phase and amplitude.

Retro TIMing: A multicentric retrospective analysis of immunotherapy timing in metastatic melanoma.

9542 Background: Immune checkpoint inhibitors (ICI) targeting programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) are now the standard of care in the treatment of metastatic melanoma (mM). The interplay between cancer cells and tumor microenvironment cells (e.g. immune cells) impacts cancer cell survival, local invasion, and metastatic dissemination. Chrono-immunotherapy is an emerging field as circadian oscillations are observed in the immune landscape (e.g immune cell numbers) as well as in the expression of immunotherapy targets (e.g. PD-1). Recently, a growing body of evidence suggests the outcome can be influenced by the time of the day when immunotherapy is administered (morning versus in the afternoon). This work aims to evaluate the impact of immunotherapy with ICIs administration timing on the overall survival (OS) and progression-free survival (PFS) of patients with mM. Methods: Multicentric, retrospective cohort study of mM patients under immunotherapy (ipilimumab/nivolumab, nivolumab, or pembrolizumab) with PS 0-1, between July 2016 and June 2023. Clinical, demographic characteristics, and time of treatment administration were obtained from medical records. Patients were distributed in two groups: those who received less than 75% of infusions after 2pm (morning group), and those who received at least 75% of infusions after 2pm (afternoon group). OS and PFS were calculated with Kaplan-Meier method and tested using a Cox regression model, with a 95% confidence interval. Results: We identified 168 patients from the 7 Oncology Centers included. The majority were men (n=100, 59.5%), with a median age of 69 years old, and 22% of the patients (n=37) were included in the afternoon group. No significant demographic or tumor burden differences were found between the morning and afternoon groups. The median follow-up time was 29 months, the estimated median PFS was 11.8 months (CI 95%, 8.0 - 14.6) and median OS was 31.4 months (CI 95%, 20.6 - NR). Patients in the afternoon group presented with shorter OS compared with those in the morning group (14.4 vs 37.6 months; HR 1.94 [CI 95% 1.16 to 3.23]; p 0,014). No statistically significant differences were observed in PFS. Subgroup analysis showed an increased detriment of performing ICIs infusions in the afternoon in women (OS 8.7 (4.2, 21.2) versus 30.9 months (18.9, NR), p=0.002; afternoon versus morning) and those older than 65 years old (OS 14.2 months (4.7, 31.4) versus 24.2 months (18.3, NR), p=0.002); afternoon versus morning). Conclusions: This work provides valuable insights into the potential role of the circadian timing of immunotherapy treatments for mM, suggesting patients may benefit from having ICIs infusion in the morning. Prospective randomized studies with a translational approach are needed to validate and fully understand the underlying mechanisms at play in circadian timing efficacy.

Efficacy and safety of time-of-day infusion of pemetrexed plus platinum and paclitaxel plus platinum for patients with advanced non-small cell lung cancer: A retrospective study.

e20557 Background: Retrospective studies suggest that administering chemotherapy infusions in the morning can enhance treatment efficacy and mitigate side effects in non-small cell lung cancer (NSCLC) patients. However, the effectiveness of chronotherapy using pemetrexed plus platinum (AP) and paclitaxel plus platinum (TP) in advanced NSCLC chemotherapy remains unexplored. This study aims to evaluate the impact of AP and TP chrono-chemotherapy (CCT) on treatment response and adverse events in advanced NSCLC patients. Methods: We retrospectively analyzed 78 advanced NSCLC patients treated with AP (AP cohort) and 50 advanced NSCLC patients treated with TP (TP cohort) at Guangdong Second Provincial General Hospital from 2018 to 2021. Based on previous research, we classified patients who received chemotherapy infusions more than twice after 2:00 PM as the afternoon (PM) group, while the rest were categorized as the morning (AM) group. Treatment response was evaluated using the Response Evaluation Criteria in Solid Tumors Criteria V.1.1. The primary endpoint was progression-free survival (PFS). All adverse events were identified and graded according to the National Cancer Institute-Common Terminology Criteria for Adverse Events version 5.0. Results: In the AP cohort, the AM group exhibited a longer PFS compared to the PM group (AM vs. PM, n = 26 vs. n = 52, 43.0 vs. 13.0 months, p = 0.001). However, no significant difference was observed in PFS in the TP cohort (AM vs. PM, n = 23 vs. n = 27, 11.0 vs. 22.0 months, p = 0.501). Subsequent subgroup analysis in the AP cohort favored the AM group across all major subgroups for PFS treatment effect. In contrast, the TP cohort subgroups showed a PFS benefit only in the smoking patients of the PM group. Furthermore, the analysis of adverse reactions revealed similar incidences of any treatment emergent adverse events (TEAE) in both AP and TP cohorts (AM vs. PM, 92.3% vs. 86.5% in AP cohort and 95.7% vs. 100.0% in TP cohort), and grade 3 TEAEs (AM vs. PM, 34.6% vs. 21.2% in AP cohort and 39.1% vs. 29.63% in TP cohort). The most common adverse events were anemia (73.1%), leukopenia (57.7%), and elevated ALT (46.2%) in AP cohort and anemia (100%), leukopenia (65.2%), and hypoalbuminemia (47.8%) in TP cohort. Univariate and multivariate analyses indicated that afternoon infusion of AP chemotherapy (p = 0.009) was an independent prognostic factor for NSCLC. Conclusions: AP treatment administered in the morning may enhance PFS in advanced NSCLC, while TP remains unaffected. This suggests that CCT could potentially enhance the efficacy of individualized chemotherapy in advanced NSCLC.

Clinical analysis of the efficacy of radiation therapy for primary high-grade gliomas guided by biological rhythms

ObjectiveHigh-grade glioma (HGG) patients frequently encounter treatment resistance and relapse, despite numerous interventions seeking enhanced survival outcomes yielding limited success. Consequently, this study, rooted in our prior research, aimed to ascertain whether leveraging circadian rhythm phase attributes could optimize radiotherapy results. MethodsIn this retrospective analysis, we meticulously selected 121 HGG cases with synchronized rhythms through Cosinor analysis. Post-surgery, all subjects underwent standard radiotherapy alongside Temozolomide chemotherapy. Random allocation ensued, dividing patients into morning (N = 69) and afternoon (N = 52) radiotherapy cohorts, enabling a comparison of survival and toxicity disparities. ResultsThe afternoon radiotherapy group exhibited improved overall survival (OS) and progression-free survival (PFS) relative to the morning cohort. Notably, median OS extended to 25.6 months versus 18.5 months, with P = 0.014, with median PFS at 20.6 months versus 13.3 months, with P = 0.022, post-standardized radiotherapy. Additionally, lymphocyte expression levels in the afternoon radiation group 32.90(26.10, 39.10) significantly exceeded those in the morning group 31.30(26.50, 39.20), with P = 0.032. ConclusionsThis study underscores the markedly prolonged average survival within the afternoon radiotherapy group. Moreover, lymphocyte proportion demonstrated a notable elevation in the afternoon group. Timely and strategic adjustments of therapeutic interventions show the potential to improve therapeutic efficacy, while maintaining vigilant systemic immune surveillance. A comprehensive grasp of physiological rhythms governing both the human body and tumor microenvironment can refine treatment efficacy, concurrently curtailing immune-related damage—a crucial facet of precision medicine.

Abstract PO4-13-06: Effect of neoadjuvant dose-dense dose-intense chemotherapy timing infusion on complete histological response rate among patients with triple negative breast cancer (SIMCLOCK)

Abstract Background: Triple-negative breast cancers (TNBC) exhibit major responses to dose-dense, dose-intense (DD-DI) neoadjuvant chemotherapy (NAC) (1). Although chronomodulated chemotherapy has shown efficacy and reducing toxicity in other cancers, there are no data in breast cancers (2). We report here a series of patients with TNBC treated with DD-DI NAC and analyzed the association between chemotherapy time infusion and pathological complete response rate (pCR) and residual tumor burden (RCB). Patients and Methods: Patients with non-metastatic TNBC treated at breast cancer disease center, St Louis hospital (Paris, France), with neoadjuvant DD-DI cyclophosphamide (1200 mg/m2 d1) – epirubicin (75 mg/m2 d1) q2w (SIM regimen) followed by 12 injections of paclitaxel (80 mg/m2) qw were included. Starting time of each chemotherapy infusion were systematically recorded. Primary endpoint was pCR defined as no residual invasive tumor in breast and in lymph nodes. Patients were dichotomized into “morning” and “afternoon” infusion groups, independently for “SIM” and “paclitaxel” regimens. Two timing cut-offs were defined according to: 1) median time of all infusions 2) cut-off maximizing morning/afternoon differences of RCB. Statistical differences between the two patient groups were assessed for metabolic response at 2 courses at Pet scan (breast delta SUVmax), RCB class (0-1 vs 2-3), pCR, dose reduction rate and 24-months event-free survival (24-months EFS). Results: Between January 2018 and January 2022, 93 patients were included. Median age was 51 (28-74). Majority of SIM administrations occurred between 12:00 and 15:00 and Paclitaxel administrations between 11:20 and 14:30. Median follow-up was 32.4 months. Main characteristics between “morning group” or “afternoon” groups in the SIM or paclitaxel were similar. pCR was obtained in 48.9% of the whole population. Regardless of cut-offs defined, no difference in pCR rate was observed. Similarly, no differences were observed between morning and afternoon groups in terms of either metabolic response, dose reduction rate or 24-months EFS (table 1). Conclusion: Time of DD-DI NAC infusion is not associated with differences in pCR rate nor in RCB, toxicity and EFS in patients with early TNBC. As immunotherapy combined with NAC is a new standard in TNBC, the impact of immunotherapy infusion time combined with NAC is under evaluation.

How does circadian rhythm affect postoperative pain after pediatric acute appendicitis surgery?

This study aimed to evaluate the relationship between postoperative pain and circadian rhythm after pediatric acute appendicitis surgery. Two hundred patients, aged 6-18 years, undergoing acute appendicitis surgery were included in this prospective observational study. The patients were divided into four groups according to the time they underwent surgery: the night group, 01:01-07:00; morning group, 07:01-13:00; afternoon group, 13:01-19:00; and evening group, 19:01-01:00. Intraoperative and postoperative vital signs, postoperative 24-h Wong-Baker Faces Pain Rating Scale (FACEs) scores, and the amount of analgesic required were recorded. A total of 186 patients were analyzed in the study. There was no statistically significant difference in the demographic characteristics of the patient groups. Additionally, no differences were observed in intraoperative and postoperative vital signs among the four groups. However, patients in the night group had significantly higher FACEs values than those in the other groups at each time point (1st, 3rd, 6th, and 12th h) up to 12 h (P = 0.007, P = 0.023, P = 0.048, and P = 0.003, respectively). The amount of analgesic required in the night group was statistically higher than in the other groups until 12 h (P = 0.002, P < 0.001, P = 0.002, and P = 0.004, respectively). A relationship was found between acute appendicitis operations performed at night (01:01 to 07:00) under general anesthesia and circadian rhythm in children. We believe that considering circadian time in the relief of postoperative pain would be beneficial.

Dynamic levels of hormonal, oxidants, insomnia, and stress in badminton athletes who practice morning and evening

Circadian rhythms are internal mechanisms that regulate various aspects of the human body's physiology and behaviour that are influenced by activity, physicality, and change time in 24 hours. This study aims to compare oxidant levels and hormonal levels based on differences in training times, namely morning and evening, in badminton athletes. This research involved 44 badminton athletes using a purposive sampling technique who were divided into a morning group (n = 22) and an evening group (n = 22). Melatonin levels were measured using the Elabscience Kit (No. E-EL-H2016) and malondialdehyde (MDA) levels using spectrophotometry. All research procedures have received ethical approval from the Hasanuddin University Medical Faculty Ethics Commission (Number: 377/UN4.6.4.5.31/PP36/2023). The results of this study indicate that the athlete's melatonin value in the morning was 76.71 ± (29.05-247.45) higher than in the evening 80.43 ± (50.83-155.24) Meanwhile, the athlete's MDA value in the evening was 2.08 ± (0.74–4.57) higher compared to the MDA in the morning of 1.09 ± (0.33–3.71). Meanwhile, based on the insomnia value for evening training, a higher value was obtained compared to morning training, namely 9.50 ± (3-11). However, there was no significant difference in stress levels. The results of the study showed that badminton athletes who trained at night tended to experience sleep disturbances (insomnia) and increased oxidant levels, while hormonal levels, especially melatonin, were higher in athletes who trained in the morning.

Morning or Afternoon Scheduling for Elective Coronary Artery Bypass Surgery: Influence of Longer Fasting Periods from Metabolic and Hemodynamic Perspectives.

Prolonged preoperative fasting may worsen postoperative outcomes. Cardiac surgery has higher perioperative risk, and longer fasting periods may be not well-tolerated. We analysed the postoperative metabolic and hemodynamic variables in patients undergoing elective coronary artery bypass grafting (CABG) according to their morning or afternoon schedule. Single-centre retrospective study at University teaching hospital (1-year data collection from electronic medical records). Using a mixed-effects linear regression model adjusted for several covariates, we compared metabolic (lactatemia, pH, and base deficit [BD]) and haemodynamic values (patients on vasoactive support, and vasoactive inotropic score [VIS]) at 7 prespecified time-points (admission to intensive care, and 1st, 3rd, 6th, 12th, 18th, and 24th postoperative hours). 339 patients (n = 176 morning, n = 163 afternoon) were included. Arterial lactatemia and BD were similar (overall P = 0.11 and P = 0.84, respectively), while pH was significantly lower in the morning group (overall P < 0.05; mean difference -0.01). Postoperative urine output, fluid balance, mean arterial pressure, and central venous pressure were similar (P = 0.59, P = 0.96, P = 0.58 and P = 0.53, respectively). A subgroup analysis of patients with diabetes (n = 54 morning, n = 45 afternoon) confirmed the same findings. The VIS values and the proportion of patients on vasoactive support was higher in the morning cases at the 18th (P = 0.002 and p=0.04, respectively) and 24th postoperative hours (P = 0.003 and P = 0.04, respectively). Mean intensive care length of stay was 1.94 ± 1.36 days versus 2.48 ± 2.72 days for the afternoon and morning cases, respectively (P = 0.02). Patients undergoing elective CABG showed similar or better metabolic and hemodynamic profiles when scheduled for afternoon surgery.

Efficacy of Ushnodakapana in the Management of Vibhandha w.s r to Usha-Kaal (Sunrise) and Nisha-Kaal (Sunset)

Vibandha is the most common digestive complaint and cause for lot of lifestyle disorders. Almost 70%-80% people struggle with constipation and the market of laxative is growing healthy each year. So, it appears that vibandha is the issue that most of us must deal with, one time or other. This study was aimed to find an affordable and quick relief from Vibandha using Ushnodakapana as well as lifestyle modification. 32 patients who diagnosed as suffering from Vibhanda was divided into two groups as Group -A (study) and Group -B (control). Group A was administered 2 glasses of Ushnodaka given in morning time and Group B was administered 2 glasses of Ushnodaka given in night-time. There was marked and moderate improvement observed in morning group when compared to night group patients. Relief in main complaints like consistency of stools is 45.83% in morning group when compared to 45.83% in night group which is highly significant at (p&gt;0.001), straining is 60% in night group when compared to 58% in morning group which is highly significant at (p&gt;0.001), unsatisfied evacuation is 71.11% in morning group as compared to 61.22% in night group which is highly significant at (p&gt;0.001), daily evacuation is 83.33% in morning group as compared to 80% in night group which is highly significant at (p&gt;0.001). Ushnodaka due to the Vatanulomana, Deepana property relieves Vata and clears the Aama. Therefore, Ushnodakapana can be prescribed as a better solution for Vibhandha.

Holştayn İneklerde Kırmızı Işıkla Gece Aydınlatmasının Melatonin ve Süt Kalite Parametrelerine Etkileri

In this study, it was aimed to investigate the effects of red lighting on blood and milk melatonin levels, and milk quality. The experiment was carried out on 6 lactating Holstein Dairy cows, which were being reared at the Hümeyra Özgen Research and Application Farm, affiliated to Selcuk University Faculty of Veterinary Medicine. After a control period of 15 days in which night lighting was not applied (control group), night lighting was provided by LED bulbs emitting red light with a wavelength of 652 nm during the following 15-day trial period (experimental group). On days 5th, 10th and 15th days of the control and experimental groups, milk and blood samples were taken at the 06:00 am and at 06:00 pm.Serum and milk melatonin concentrations in the morning of the control, on days 5th, 10th and 15th; were 8.64±1.4, 7.02±0.97, 8.71±2.3, and 5.01±0.92, 5.23±0.35 , 3.93±0.81pg/ml, respectively while control evening group were respectively 8.59±1.8,7.53±2.14,8.35±0.94, 6.91±1.73, 6.8±1.27. It was obtained as 3.67±0.97 pg/ml. Serum and milk melatonin levels in the trial morning group were 10.93±2.06, respectively, on the same days; 15.37±2.6; 11.25±1.71 and 2.97±0.64; 5.7±1.06; While it was measured as 3.33±0.73 pg/ml, it was 14.83±3.11 in the trial evening group; 14.5±3.57; 12.95±4.09 and 4.42±0.61; 2.51±0.56; It was obtained as 2.48±0.79 pg/ml.It was observed that serum and milk melatonin levels and milk parameters were not adversely affected in the use of red LED lamps (652 nm) at night for 12h.

Do Different Times of The Day Affect Dart Throwing Performance?

Background: Dart sport has become a sport that has recently become widespread among sports branches and its popularity is increasing rapidly day by day. With this popularization, research on darts is increasing. It is stated that athletes can do the training they do at any time of the day with a much better performance at a different time, as in many changing conditions. In addition, at a different time of day, fatigue may be reached later or recovery may occur more quickly. For these reasons, knowing the effect of training at different times of the day is important for both the coach and the athlete. Objectives: The aim of this study was to investigate the effect of different times of the day on throwing performance in darts, an indoor skill in which focus, attention, concentration are at the forefront and environmental factors are less effective than outdoor skill. Methods: In this study, 16 dart athletes (8 boys, 8 girls) with a sport age of 2 - 3 years and an age of 12 - 14 years, who did not have any health problems in Mardin province, participated voluntarily: 2 m and 2.37 m from two different distances at 8.00 and 17.00, 1 day apart. Before the dart throws, the Daily Rhythm Determination Scale for Children was administered to the participants. The center of the dartboard was placed at eye level for each subject. After the throws, the Perceived Difficulty Scale was applied. In the analysis examining the relationship between perceived degree of difficulty, morningness-eveningness and throwing, the subjects’ evening throwing scores and evening perceived degree of difficulty scores were examined; a negative and significant relationship was observed in the eveningist group (r = -1, P = 0.01). No significant relationship was observed in the morning group. Results: In the study, a statistically significant difference was found between the subjects’ morning and evening throws at 2 m and 2.37 cm. In both morning and evening groups, it was determined that the throwing performance increased in the evening measurements. Conclusions: As a result, this study concluded that there is an effect of time of day in dart sport and that dart throws made in the evening give better results than dart throws made in the morning. Based on these results, it is recommended that a program should be made by the coaches considering the school programs and daily routines to reduce the effect of time of day. It is thought that this study will be important for chronobiological researches to reveal the factors affecting performance as well as the effect of time of day in darts sport.

Opioid infusions at different times of the day produce varying degrees of opioid-induced hyperalgesia

BackgroundOpioids are metabolised by enzymes the activities of which vary with the circadian rhythm. We examined whether opioid infusions administered at different times of the day produce varying degrees of opioid-induced hyperalgesia (OIH) in animal experiments and clinical studies. MethodsMale Sprague–Dawley rats received remifentanil infusions (1 μg kg−1·min−1 for 1 h) at Zeitgeber times (ZT) 0, 4, 8, 12, 16, or 20 h. Rhythmicity of mechanical hypersensitivity was assayed after the infusion. Mechanical hypersensitivity, drug concentration, and metabolic enzyme activity of Wistar rats that received sufentanil (10 μg kg−1; four consecutive i.p. injections at 15-min intervals) or remifentanil infusion at ZT0 or ZT8 were assayed. Sixty patients who underwent abdominal laparoscopic surgery under general anaesthesia received remifentanil infusion (0.15 μg kg−1 min−1) and sufentanil injection (0.2 μg kg−1) at induction and skin incision, respectively. Postoperative pressure pain sensitivity, pain Numeric Rating Scale (NRS), drug concentrations, and nonspecific esterase activity were assessed. ResultsSprague–Dawley rats that received remifentanil infusion exhibited a robust rhythmic paw withdrawal threshold (JTK_CYCLE: P=0.001, Q=0.001, Phase=26). Wistar rats infused with remifentanil or sufentanil at ZT8 exhibited greater OIH (P<0.001) than those infused at ZT0, with higher blood concentrations (P<0.001) and lower metabolic enzyme activities (P=0.026 and P=0.028, respectively). Patients in the afternoon group exhibited higher pressure pain sensitivity at forearm (P=0.002), higher NRS (P<0.05), higher drug concentrations (sufentanil: P=0.037, remifentanil: P=0.005), and lower nonspecific esterase activity (P=0.024) than the morning group. ConclusionsOpioid infusions administered at different times of day produced varying degrees of OIH, possibly related to circadian rhythms of metabolic enzyme activities. Clinical trial registrationNCT 05234697.

The prevalence of temporomandibular disorder and temporomandibular morphology among diverse chronotype profiles

ABSTRACT This study investigates the influence of chronotype on the prevalence of temporomandibular joint disorders (TMD) and the morphology of temporomandibular joint (TMJ). According to the Morningness–Eveningness Questionnaire-Self-Assessment, the participants were divided into morning group (n = 30), intermediate group (n = 83), and evening group (n = 30). Thirty participants were randomly selected from the intermediate group for subsequent examination and measurements. The morphology of TMJs was investigated using questionnaire and clinical examination form in Diagnostic Criteria for Temporomandibular Disorder. Meanwhile, the morphological results of TMJs were measured from cone-beam computed tomography images. The prevalence rate of TMD in the morning group (23%) was significantly lower than that in the intermediate group (56.7%), while there was no difference between the evening (53.4%) and intermediate groups. As to morphological measurements, there was no significant difference among three groups in mediolateral width of condylar process, anteroposterior width of condylar process, radius of condyle, medial joint space, lateral joint space, condylar stress angle, horizontal condylar inclination, width of glenoid fossa, depth of glenoid fossa, and posterior joint space, while there was a significant difference in horizontal condylar angle (p = 0.00490), articular eminence inclination (p < .0001), anterior joint space (p = 0.0163), and superior joint space (p = 0.0004). The morphology of TMJ in the morning group was better than that in the evening and intermediate groups. An association was found between TMD prevalence, temporomandibular morphology, and chronotype.

The diurnal pattern of moderate-to-vigorous physical activity and obesity: a cross-sectional analysis.

Moderate-to-vigorous physical activity (MVPA) is obesity-protective. However, the optimal time of the day to engage in MVPA for weight management is controversial. This study is designed to investigate the influence of the diurnal pattern of MVPA on the association between MVPA and obesity. A total of 5285 participants in the 2003 to 2006 National Health and Nutrition Examination Survey (NHANES) were cross-sectionally analyzed. The diurnal pattern of objectively measured MVPA was classified into three clusters by K-means clustering analysis: morning (n = 642); midday (n = 2456); and evening (n = 2187). The associations of MVPA level and the diurnal pattern with obesity were tested. A strong linear association between MVPA and obesity was found in the morning group, whereas a weaker curvilinear association between MVPA and obesity was observed in the midday and evening groups, respectively. Among those who met the physical activity guidelines, the adjusted means for BMI were 25.9 (95% CI: 25.2-26.6), 27.6 (95% CI: 27.1-28.1), and 27.2 (95% CI: 26.8-27.7) kg/m2 in the morning, midday, and evening groups, respectively, and for waist circumference were 91.5 (95% CI: 89.4-93.6), 95.8 (95% CI: 94.7-96.9), and 95.0 (95% CI: 93.9-96.1) cm, respectively. The diurnal pattern of MVPA influences the association between MVPA and obesity. The promising role of morning MVPA for weight management warrants further investigation.

Effects of Exercise Sequence and Circadian Rhythms on Molecular Mechanisms of Muscle Hypertrophy and Mitochondrial Biogenesis in Obese Rat

PURPOSE: This study aimed to investigate whether endurance and resistance training sequences and circadian rhythms affect muscle hypertrophy and mitochondrial biogenesis-related molecules in obese rats.METHODS: Rats were randomly divided into five groups: the obesity control group (OCG), aerobic-resistance exercise in the morning group (ARMG), resistance-aerobic exercise in the morning group (RAMG), aerobic resistance exercise in the evening group (AREG), and resistance-aerobic exercise in the evening group (RAEG). The exercise groups performed endurance and resistance exercises for 8 weeks according to their circadian rhythms and exercise sequences.RESULTS: We evaluated specific muscle hypertrophy and mitochondrial biogenesis markers in the flexor pollicis longus and soleus muscles using western blot and immunofluorescence techniques. The body weight was significantly decreased in the ARMG, RAMG, AREG, RAEG compared to the OCG after intervention. The soleus muscle fiber cross-sectional area and muscle hypertrophy markers p-Akt and p-mTOR were significantly increased in the AREG group compared with those in the OCG, ARMG, RAMG, and RAEG groups after exercise intervention. Most mitochondrial biogenesis-related markers were significantly increased in the RAMG group than in the other groups after exercise intervention.CONCLUSION: Our findings provide new evidence that muscle hypertrophy might be upregulated by resistance exercise after evening endurance exercise. In addition, morning resistance exercise followed by aerobic exercise, might promote mitochondrial biogenesis.

Association of Time-of-Day Physical Activity With Incident Cardiovascular Disease: The UK Biobank Study.

Early morning is characterized by an increased risk of cardiovascular events, a sudden rise in blood pressure, impaired endothelial function, and exacerbated hemodynamic changes during physical activity. The study aims to examine whether the time of day of physical activity is associated with incident cardiovascular disease (CVD). We prospectively analyzed 83,053 participants in the UK Biobank with objectively measured physical activity and initially free of CVD. Based on the diurnal patterns of physical activity, participants were categorized into 4 groups: early morning (n = 15,908), late morning (n = 22,371), midday (n = 24,764), and evening (n = 20,010). Incident CVD was defined as the first diagnosis of coronary heart disease or stroke. During 197.4million person-years of follow-up, we identified 3454 CVD cases. After adjusting for the overall acceleration average, the hazard ratios and 95% confidence intervals were 0.95 (0.86-1.07) for late morning, 1.15 (1.03-1.27) for midday, and 1.03 (0.92-1.15) for evening, as compared with the early morning group. In the joint analyses, higher levels of physical activity were associated with a lower risk of incident CVD in a similar manner across the early morning, late morning, and evening groups. However, the beneficial association was attenuated in the midday group. In conclusion, early morning, late morning, and evening are all favorable times of day to engage in physical activity for the primary prevention of CVD, while midday physical activity is associated with an increased risk of CVD compared with early morning physical activity after controlling for the levels of physical activity.

DIFFERENCES IN BLOOD SUGAR LEVELS BEFORE AND AFTER MORNING AND AFTERNOON WALK IN TYPE II DIABETES MELITUS PATIENTS AT BABAKANSARI PUSKESMAS

Diabetes Mellitus (DM) is a non-communicable disease which causes an increase in blood sugar levels and is at risk of causing disease complications. Walking is done to increase the sensitivity of insulin receptors. Blood vessels in the afternoon are more vasodilated than in the morning due to the effects of circadian rhythms which affect hormone action. This study aims to determine the difference in the average value of blood sugar levels before and after walking in the morning and afternoon in patients with type II DM. The research design used was a preexperiment with a pretest-posttest two group design approach. The sample of 20 respondents who are divided into 2 groups, namely the morning group of 10 people and the afternoon group of 10 people, with purposive sampling. The results of this study showed that the amount of decrease in blood sugar levels in the morning group was 31.6 mg/dL and the amount of decrease in blood sugar levels in the afternoon group was 43.5 mg/dL. The results of statistical tests in the morning group obtained a value of p = 0.007 (p &lt;0.05) and in the afternoon group obtained a value of p = 0.005 (p &lt;0.05). The results showed that the afternoon group was more effective in reducing average blood glucose levels as a result of vasodilatation of blood vessels which is influenced by circadian rhythms compared to the morning group, so it can be concluded that there are differences in blood sugar levels before and after walking in the morning and in the afternoon in patients with type II DM. Therefore it is advisable to walk, especially in the afternoon which can lower blood sugar levels more for type II DM sufferers in an effort to control blood sugar levels.

Associations of timing of physical activity with all-cause and cause-specific mortality in a prospective cohort study

There is a growing interest in the role of timing of daily behaviors in improving health. However, little is known about the optimal timing of physical activity to maximize health benefits. We perform a cohort study of 92,139 UK Biobank participants with valid accelerometer data and all-cause and cause-specific mortality outcomes, comprising over 7 years of median follow-up (638,825 person-years). Moderate-to-vigorous intensity physical activity (MVPA) at any time of day is associated with lower risks for all-cause, cardiovascular disease, and cancer mortality. In addition, compared with morning group (>50% of daily MVPA during 05:00-11:00), midday-afternoon (11:00-17:00) and mixed MVPA timing groups, but not evening group (17:00-24:00), have lower risks of all-cause and cardiovascular disease mortality. These protective associations are more pronounced among the elderly, males, less physically active participants, or those with preexisting cardiovascular diseases. Here, we show that MVPA timing may have the potential to improve public health.

How Teacher Verbal Prompting and Demonstrated Modeling Correlate to Preschooler's Physical Activity Levels.

Teacher-led strategies targeting verbal prompting and demonstrated modeling can increase preschoolers' physical activity levels; however, it is unknown which strategy promotes higher levels. The purpose of this study was to explore whether teacher verbal prompting or demonstrated modeling elicits higher levels of physical activity among preschoolers. Participants included 117 (56 females and 61 males; mean = 3.77y) preschoolers who were observed for 3days during regular preschool instructions. The System for Observing Student Movement in Academic Routines and Transitions observation system assessed verbal prompting and demonstrated modeling of the teachers, and preschoolers wore an ActiGraph accelerometer to measure physical activity. The multivariate analysis of variance results showed a significant difference for verbal prompting (P < .001), demonstrated modeling (P = .032), light physical activity (P < .001), and moderate to vigorous physical activity (MVPA; P < .001) between segments of the preschool day. A stepwise linear regression showed that preschooler's MVPA (P = .005) and light physical activity and MVPA (P = .036) were significantly related to demonstrated modeling, but not verbal prompting. During indoor time, light physical activity and MVPA were highest during large group, work time, and morning group, where teacher demonstrated modeling occurred the most. Teacher demonstrated modeling had a significant relationship to preschoolers' MVPA and light physical activity levels, while teacher verbal prompting did not.