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THE RHYTHM OF LIFE: CHRONOTHERAPY AND CANCER CARE

BY ANDREA MONGLER
chronotherapy

Wake, sleep, repeat. Day in, day out. It’s a pattern we’re so familiar with that most of us give it little, if any, thought. The sleep-wake cycle is simply one of life’s daily rhythms. In fact, it’s one of our circadian rhythms. Put simply, circadian rhythms are physical, mental and behavioral changes that our bodies experience over a 24-hour cycle. They affect our sleep, our body temperature, our appetite, our hormones and more. And it turns out these daily rhythms may play a key role in cancer treatment.

A coordinated concert of cells

Circadian rhythms are controlled by “clock genes” in our cells. While every cell has around 20,000 genes, just a handful of these are clock genes. Despite their small number, their impact is huge. Because of clock genes, for example, you may grow tired around the same time each night and wake up around the same time each day. This circadian rhythm is your body’s way of making sure you get the sleep you need. Of course, many of us wake by alarm clocks, which interrupt our circadian rhythms.

When clock genes are disrupted, they in turn disrupt daily rhythms like the sleep-wake cycle. Anyone who’s ever had jet lag has experienced this firsthand.

Clock genes get their name because they function as miniature clocks, each with the ability to keep time on its own. In addition, these mini-clocks are synchronized with each other thanks to a central clock, technically called the suprachiasmatic nucleus (SCN) but commonly referred to as the circadian clock.

WHEN WE’RE THINKING ABOUT THE BEST TIME TO TREAT PEOPLE, WE NEED TO THINK ABOUT WHEN THEY NORMALLY GO TO SLEEP. CONSIDERING THE FACT THAT PEOPLE ARE DIFFERENT FROM EACH OTHER IN THEIR DAILY TIMING, THIS ENDS UP BEING SORT OF THE ULTIMATE PERSONALIZED MEDICINE.

ERIK HERZOG, PHD, CHRONOBIOLOGIST

Erik Herzog, PhD, a chronobiologist at Washington University, compares the SCN to the Atomic Clock in Boulder, Colorado. The Atomic Clock keeps extremely accurate time, and clocks nationwide—on our computers and smartphones, for example—are synchronized to match it. Similarly, the SCN sends out signals in the body to coordinate all of the mini-clocks in our genes. “The SCN is this tiny little population of cells in the brain that’s like a conductor for the clock genes throughout the body,” Herzog says. “The result is a coordinated concert of cells that sings together on a daily basis.”

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Addressing the Donor Organ Shortage

Addressing the Donor Organ Shortage

BY CONNIE MITCHELL
ILLUSTRATION BY ABIGAIL GOH

They would fill St. Louis’ Busch Stadium more than twice, take every seat in 261 jumbo jets and fill each bed in Barnes-Jewish Hospital 85 times over. They are the more than 108,000 Americans waiting for an organ transplant. And for too many, a donor organ won’t arrive in time.

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MEETING THE CHALLENGES OF PANCREATIC CANCER

MEETING THE CHALLENGES OF PANCREATIC CANCER

BY STEPHANIE STEMMLER

Every few years, as he pursues breakthroughs for one of the world’s most notoriously difficult cancers to treat, William Hawkins, MD, says he feels like the first man who walked on the moon. “When you have an idea, and you test it in the laboratory, and you find a new insight that no one else has known previously, that’s cool,” he says. “It pushes the frontier of cancer research that much closer to effective treatments for my patients. It really is like boldly going where no one has gone before.”

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MENTAL HEALTH AND THE GENDER GAP

MENTAL HEALTH AND THE GENDER GAP

BY ANDREA MONGLER
ILLUSTRATION BY ABIGAIL GOH

Whether it’s monthly menstrual cycles, pregnancy, childbirth or menopause, women’s bodies change a lot over a lifetime. But often, these life changes aren’t just physical. They can affect women’s mental health, too, in ways large and small.

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ADDRESSING DISPARITIES IN CANCER PREVENTION AND CARE IN RURAL COMMUNITIES

ADDRESSING DISPARITIES IN CANCER PREVENTION AND CARE IN RURAL COMMUNITIES

BY KELLY OMAN
PHOTO BY GREGG GOLDMAN

Though people living in rural communities across the United States may be less likely to get cancer, they are more likely than people living in suburbs and cities to die from it. That’s what is known as a health disparity, a term that can sound rather abstract. The problem, however, is anything but.

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TREATING ADDICTION: PREGNANCY AND OPIOIDS

TREATING ADDICTION: PREGNANCY AND OPIOIDS

BY JEN MILLER
PHOTOS BY JAY FRAM

When Jeannie Kelly, MD, MS, a Washington University maternal-fetal medicine specialist at Barnes-Jewish Hospital, first arrived on the medical campus in St. Louis in 2016, she had already seen how opioid use can devastate a community. “I finished my training in Boston, where the opioid epidemic was exploding,” she says. While working there, Kelly saw addiction and overdoses. She was aware of the difficulties and dangers for pregnant women addicted to opioids, and the great risks to their babies. And she wanted to help.

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RACIAL DISPARITY AND INFANT MORTALITY: WHEN DOING EVERYTHING RIGHT ISN’T ENOUGH

RACIAL DISPARITY AND INFANT MORTALITY: WHEN DOING EVERYTHING RIGHT ISN’T ENOUGH

BY ANDREA MONGLER
ILLUSTRATION BY ABIGAIL GOH | PHOTOS BY JAY FRAM

Every year in St. Louis, the infants who die before their first birthday could have one day populated 12 kindergarten classrooms. That’s according to Flourish St. Louis, an infant mortality reduction initiative supported by the Missouri Foundation for Health.

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THE PRESENT AND FUTURE OF DEPRESSION CARE

THE PRESENT AND FUTURE OF DEPRESSION CARE

BY HOLLY EDMISTON
PHOTOS BY JAY FRAM

Most of us have confessed, at one time or another, to feeling depressed. But often what we really mean is: I’m sad. Or maybe, I’m tired. Or bored. Actual depression, also known as major depressive disorder, is more than sad feelings. People living with this disorder may experience, among other symptoms, changes in appetite, suicidal thoughts, difficulty sleeping or oversleeping and a feeling of hopelessness.

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FERTILITY PRESERVATION: WHY, HOW AND WHEN

FERTILITY PRESERVATION: WHY, HOW AND WHEN

BY ANDREA MONGLER
PHOTOS BY JAY FRAM

A little girl has just been diagnosed with cancer, and her parents are facing a new and terrifying reality. Whys and what-ifs dominate their thoughts, and a feeling of helplessness threatens to overwhelm them. They would suffer the disease for her if they could, but they can’t. They would do anything for this to be over, for her to be OK.

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COMPASSION REQUIRES RESILIENCE

COMPASSION REQUIRES RESILIENCE

BY PAM MCGRATH
ILLUSTRATION BY ABIGAIL GOH | PHOTOS BY JAY FRAM

Taking care of sick people is hard. Whether you’re staying home with a kid who has a fever, spending the weekend with a friend and her broken ankle or helping a parent age at home, the task, though done with love and concern, can take a toll.

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EASING THE FINAL JOURNEY

EASING THE FINAL JOURNEY

JO ANN SHROYER
ILLUSTRATION BY ABIGAIL GOH

He was young — still in his 40s — and facing a devastating diagnosis: congestive heart failure that would end his life too soon. Readily admitting that his own lifestyle decisions had brought him to this place, Mr. D (his name has been changed to protect his privacy) suffered from what could only be described as transcendental angst.

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CAR-T IMMUNOTHERAPY: NEW TREATMENT, NEW HOPE

CAR-T IMMUNOTHERAPY: NEW TREATMENT, NEW HOPE

BY JULIA EVANGELOU STRAIT
ILLUSTRATION BY GUNILLA ELAM/ SCIENCE PHOTO LIBRARY

For decades, the list of standard treatments for many blood cancers has remained short and largely unchanged. But now there is a new entry on the list. If chemotherapy and a bone marrow transplant fail to stop the cancer, doctors can harness a type of personalized immunotherapy that trains a person’s own immune system to attack cancer cells.

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STROKE: EVERY SECOND COUNTS

STROKE: EVERY SECOND COUNTS

BY SARI HARRAR

PHOTOS BY JAY FRAM

Stroke recovery depends on quick thinking and fast action for everyone involved, from bystander to surgeon. One team of specialists, working to shave minutes off treatment time, has risen to the challenge.

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