Overview
Figure 1. Map of interviewers
In 2024, our Integrated Human Practices (IHP) initiated exploration in
the emerging field of Reverse Cardio-oncology through the "Heartecho"
project. IHP is integrated with the project throughout the entire
process, promoting and enhancing each other.
In the selection of the research domain , the proposition of
cardiovascular diseases and tumors by cardiologists led us into the
interdisciplinary realm. Literature review focused our attention on
Reverse Cardio-oncology. Oncologists provided both empirical medical
affirmation and evidence-based medical proof supported by the database.
In the initial design stage of the project , through exchanges
with clinical experts, we went through a transformation from coronary
heart disease to the pathological process of atherosclerosis and then
back to coronary heart disease. Through bioinformatics analysis,
myocardial infarction was determined as the choice.
During the project refinement phase, we discussed with professors
and designed a two-arm AND gate LIRA detection system.
In the implementation of the project , suggestions from
scientific research experts aided in optimizing the technical points of
experiments and models, facilitating the project's realization.
Significantly, ethics was considered throughout the entire
process. We consulted experts and lawyers to obtain approvals, enabling
close communication with patient groups. For the final
implementation of the project, we have embraced full-scale
commercialization. Through extensive and meaningful interaction
with all stakeholders, we have successfully achieved
the closed loops. This not only showcases our commitment to
the best IHP but also paves the way for a sustainable and
impactful future in the field of Reverse Cardio-oncology (Figure 1).
Inspiration
Tune in to the world:
The World Health Organization's (WHO) 2024 World Health Statistics
report highlights that Ischaemic heart disease remained the leading
cause of global mortality in 2000, 2019, 2020, and 2021, which prompted
us to focus on cardiovascular diseases (Figure 2). Through extensive
literature reading, we are shocked to find that approximately 17.9
million people die from cardiovascular diseases annually, as reported by
the WHO.
Figure 2. WHO 2024 World Health Statistics report
To better understand the real dilemma of cardiovascular disease
patients, we decided to interview front-line clinicians working
in this field. We consulted Prof. Huan Sun from the Department of
Cardiology at the China-Japan Union Hospital of Jilin University (Figure
3). Professor Sun highlighted several high-risk factors for
cardiovascular diseases, including smoking, diabetes, hyperlipidemia,
and family history. Since our team is from the cancer biology
laboratory, when we heard about smoking and family history, we
associated it with cancer. Thus, Professor Sun put forward that cancer
and its treatment can accelerate the progression of cardiovascular
diseases, a phenomenon that has evolved into a mature research field
known as Cardio-Oncology. Additionally, He mentioned that some
patients with a previous history of cardiovascular diseases were found
to have cancer during follow-up visits, and this situation deserves our
attention. Armed with this information, we began to explore the
potential link between cardiovascular diseases and the cancer.
Figure 3. Interview with Dr. Huan Sun
Through extensive literature review, we focused on the emerging field of
Reverse Cardio-oncology, which reveals that cardiovascular
diseases can indeed facilitate the onset and progression of cancer. By
tracing relevant literature, we drew out the development of this field
in a timeline manner (Figure 4). This discovery led us to turn our
attention to oncology departments for further investigation to assess
whether cancer patients have a history of cardiovascular diseases.
Figure 4. Development of Reverse Cardio-Oncology
We then interviewed Dr. Linlin Liu, Director of the Oncology
Department at the China-Japan Union Hospital of Jilin University, and
learned that many cancer patients have a history of cardiovascular
disease (Figure 5). The affirmation of this fact sparked our
interest in conducting further research in the intersection of these two
health issues. In our in-depth discussion with Dr. Liu, we gained
valuable insights, particularly regarding the investigation of the
prevalence of cardiovascular diseases among cancer patients.
Next, Dr. Liu introduced us to the hospital's specialized disease
databases, which contain detailed records of patients' treatment
histories and provide valuable data support for conducting
retrospective and prospective studies . These data resources not
only can helped us identify more effective treatment methods but were
also crucial in understanding the interaction between cancer and heart
health. By leveraging these rich data resources, our project can explore
the link between cancer and cardiovascular disease more deeply,
ultimately providing scientific evidence for developing more targeted
and effective interventions.
Figure 5. Interview with Dr. Linlin Liu
This interview not only deepened our understanding of the clinical
realities faced by patients with both cancer and cardiovascular disease
but also emphasized the key areas we should focus on as we advance the
project. Dr. Liu's insights and recommendations have inspired us to
further refine our project to better serve this vulnerable patient
population and to contribute to the development of Reverse
Cardio-oncology.
After selecting Reverse Cardio-oncology as our research focus, to spread
the concepts of cardiac health to a broader group, including both
students and faculty, our team participated in the Health Run
event organized by Jilin University (Figure 6). During the event, we
conducted interviews on campus to gain insights into the diverse forms
of physical exercise among students and to explore the strong connection
between physical activity and cardiac health. Through these interviews,
we found that most students believed physical exercise could enhance
various aspects of heart function. However, we also discovered that
their knowledge of emergency measures and the prognosis of
cardiovascular diseases was limited. This lack of awareness among
college students highlights the importance of incorporating
heart health education into our future outreach efforts, with the
aim of raising public awareness of cardiovascular health.
Figure 6. The Heart Health Run interview
Subsequently, in order to obtain a reliable public sample and analyze
public awareness of Reverse Cardio-oncology through specific survey
data, we conducted the "Listening to the Heart - Heart Disease Survey"
(Figure 7). Within one week, we collected 236 results. Among them,
participants aged 18-25 and 36-55 accounted for about 90% and they were
mainly students and office workers. Among all the participants, more
than 90% were unaware of the potential link between cardiovascular
diseases and cancer. This lack of awareness, combined with the fact that
34% of people think about the high costs of cancer screening and 37% of
people consider the painful procedures of cancer screening, often led to
cancer being detected only in its late stages. This survey result
indicates that it is very necessary to raise the awareness of patients
with cardiovascular diseases on early cancer screening. More
importantly, this detection system should be less invasive and reasonably priced.
Figure 7. Listening to the Heart - Heart Disease Survey
At the Elderly Care and Health Expo, we had the opportunity to
interview a lot of salesmen in pharmaceutical companies that specialized
in various health-related products and services. During these
interviews, we gained valuable insights into the current market trends
and demands. They affirmed that there existed a notable market gap for
cancer early screening kits of patients with cardiovascular diseases.
This discovery highlighted the potential for innovation and development
in this specific area of healthcare, presenting an opportunity for
companies to fill this gap and make a positive impact on cancer
prevention and early diagnosis (Figure 8).
Figure 8. The Elderly Care and Health Expo interview
After conducting detailed surveys and thorough considerations among
university students, the public, and companies, we were inspired to
create an early cancer screening kit to identify high-risk cancer
patients among those who used to have cardiovascular diseases.
SWOT analysis for stakeholders
Understanding and addressing the interests of stakeholders is crucial to
the success of our project. Stakeholders play a pivotal role in shaping
the project's direction, influencing outcomes, and determining its
overall impact. Their perspectives, needs, and concerns can
significantly affect the project's success, making it essential to
engage with them thoughtfully and strategically. By conducting a
thorough analysis of
the strengths, weaknesses, opportunities, and
threats
associated with each stakeholder group, the Heartecho project is
better equipped to anticipate and address potential challenges, thereby
optimizing the use of available resources to achieve its objectives.
This comprehensive approach not only enhances our understanding of the
project but also supports informed decision-making throughout its
various phases (Figure 9).
Figure 9. Stakeholders SWOT analysis
Our SWOT analysis of stakeholders, including the public, experts,
doctors, and corporations, revealed complementary relationships that
help balance the limitations of individual groups. Recognizing this
synergy, our next step is to engage with a broader range of stakeholders
through interviews to gather more detailed feedback and additional
insights. This approach will allow us to effectively meet the diverse
needs of all involved and further optimize our project.
Consideration of ethics
Since our project is deeply intertwined with clinical practice, it is
crucial that we prioritize ethical considerations. Understanding the
critical role that ethics play in ensuring the well-being and rights of
patients, we sought guidance from Prof. Yunsheng Dong, an expert in
ethics from the School of Philosophy and Social Sciences at Jilin
University (Figure 10). Prof. Dong stressed that ethical vigilance
should be maintained at every stage of the project, from initial
planning through to implementation and beyond. He reminded us that when
working with vulnerable populations, such as specific patient groups, it
is essential to prioritize ethical principles like respect for autonomy,
non-maleficence, beneficence, and justice. These principles are not just
theoretical but must be actively upheld in all interactions with
patients and in every aspect of our research design.
Figure 10. Interview with Dr. Yunsheng Dong
Taking these insights to heart, we meticulously incorporated these
ethical considerations into our project design. Our aim is to create a
framework that not only advances scientific knowledge but also protects
and respects the dignity and rights of every participant. By integrating
these ethical guidelines, we hope to set a standard for responsible
research that others can follow.
Expertise boosts project
Project Initial Design:
We aim to identify cardiovascular diseases and cancers that show a
relatively strong correlation as indicated by epidemiological research.
To deepen our understanding of the latest advancements in these fields,
we actively participated in
Cardio-Oncology Day and the 5th National
Tumor Cardiology Publicity Week
(Figure 11). During this academic
conference, we learned that coronary heart disease is one of the most
prevalent cardiovascular diseases. Coronary heart disease is caused by
structural or functional abnormalities of the coronary arteries, leading
to coronary artery stenosis or occlusion, with atherosclerosis being the
most common cause of coronary heart disease[1]. Atherosclerosis, being
an important fundamental pathological change in cardiovascular diseases,
prompts us to shift from the exploration of clinical diseases to a focus
on pathology. Atherosclerosis association with cancer still needs to be
confirmed through literature review.
Figure 11. Cardio-Oncology Day and the 5th National Tumor Cardiology
Publicity Week
Subsequently, we conducted an extensive literature review on the
epidemiological studies of the association between atherosclerosis and
cancer. An epidemiological study on cardiovascular diseases and cancer
risks published in August 2023, JACC (J Am Coll Cardiol CardioOnc)
showed that the cancer risk in patients with atherosclerotic
cardiovascular disease (aCVD) is significantly higher than in those
without cardiovascular disease (no CVD) and in those with
non-atherosclerotic cardiovascular disease (na CVD). This study further
analyzed the risk ratios of different cancer sub-types between aCVD and
na CVD, and the results showed that, when directly comparing aCVD with
na CVD, the risk of lung cancer, bladder cancer, colon cancer, and other
cancers in aCVD was significantly higher than that in naCVD, with
lung
cancer
risk being the highest[2]. Therefore, we began to focus on the
association between atherosclerosis and lung cancer.
Not only is there macroscopic epidemiological evidence, but there is
also collateral evidence in the literature on the common target of the
relationship between atherosclerosis and lung cancer on a microscopic
level. A study published in 2017 in The New England Journal of Medicine
indicated that canakinumab, an IL-1βinhibitor, significantly reduced the
recurrence of cardiovascular diseases, particularly those associated
with atherosclerosis, in patients with cardiovascular diseases. This
trial was known as the CANTOS trial[3]. However, researchers discovered
that the incidence of lung cancer also decreased during the CANTOS
trial. The researchers analyzed the effect of canakinumab on the
incidence of lung cancer in patients with atherosclerosis, and the
results showed that IL-1β inhibition significantly reduced the incidence
of lung cancer in patients with atherosclerosis[4]. These two studies
further demonstrate that atherosclerosis may promote the development and
progression of lung cancer through certain mechanisms, providing
deeper
confirmation
of the association between the two.
To gain a deeper understanding of the clinical front-line situation of
atherosclerosis and to determine the feasibility of our project
selection, we interviewed Dr. Beibei Du, the Associate Chief Physician
of Cardiology at the China-Japan Union Hospital of Jilin University. Dr.
Du is an expert member of the American College of Cardiology (FACC) and
the International Cardio-Oncology Society (IC-OS) (Figure 12). He has
made significant contributions to the field of Cardio-Oncology,
specializing in the interventional treatment of complex coronary artery
disease and the management of myocardial damage caused by targeted
anti-cancer drugs.
Figure 12. Interview with Dr. Du
We consulted Dr. Du in detail about the clinical situation of
atherosclerosis. Dr. Du pointed out that atherosclerosis is a stage in
the development of vascular lesions. The process begins with endothelial
dysfunction in the blood vessels, followed by the formation of
atherosclerotic plaques. As these plaques grow, they can cause vascular
blockages and narrowing, leading to various diseases. The most commonly
affected target organs by atherosclerosis are the heart, brain, kidneys,
and peripheral arteries, potentially leading to conditions such as
myocardial infarction, cerebral infarction, renal insufficiency, and
peripheral arterial occlusion or stenosis, which are categorized as
specific diseases. From a scientific research perspective, focusing on
pathological processes is conducive to the exploration of specific
mechanisms. However, it is not practical enough if one wants to develop
a screening kit that can be applied in clinical practice. Simply
referring to "atherosclerosis" is too broad, and it's challenging to
find patients categorized solely under this term.
Dr. Du also mentioned that cardiology departments focus more on coronary
atherosclerotic heart disease because the symptoms in such patients are
more pronounced, such as chest tightness, chest pain, shortness of
breath, and cognitive disturbances, which are the symptoms that drive
patients to seek medical attention . On the other hand, in cases of
lower limb artery involvement, the presence of collateral circulation
may mean that plaque formation does not affect mobility, so patients
generally do not seek medical care.
The interview with Dr. Du has led us to narrow our research focus from
the broad scope of atherosclerosis back to coronary atherosclerotic
heart disease, and we were now ready to begin the next steps in our
project design.
After deciding to use LIRA as a tool to detect miRNA as biomarker, we
interviewed Dr. Daoyuan Si, Associate Chief Physician of Cardiology at
the China-Japan Union Hospital of Jilin University, to seek his opinions
on our project. Dr. Si is a member of the Heart Rhythm Society, with his
primary research focus on post-myocardial infarction ventricular
remodeling, arrhythmia, and endothelial dysfunction. He has been invited
multiple times to deliver a lecture at the American Heart Association
(AHA), American College of Cardiology (ACC), and Heart Rhythm Society
(HRS) conferences.
We presented the preliminary design of our project to Dr. Si in detail.
He suggested that while epidemiological surveys are a useful starting
point, they are not sufficient for establishing the connection between
heart disease and cancer. We should also conduct bioinformatic analyses
to screen the biomarker miRNA we intend to detect, thereby better
establishing the link between cardiovascular diseases and cancer.
During our bioinformatic analysis, we focused on both cardiovascular
diseases (CVD) using GEO dataset and cancer using the TCGA dataset.
Initially, we identified 294 different microRNAs from the TCGA database
(Figure 13). Our goal was to determine the microRNAs were present in
both CVD and cancer datasets, aiming to find biomarkers that could
indicate cancer risk in patients already diagnosed with CVD.
Figure 13. Bioinformatic analysis
In the data analysis of coronary heart disease, there are relatively few
databases to choose from. Moreover, the screened hsa-miR-187/185-3p is
involved in fewer cancer types, while hsa-miR-16-2-3p is involved in
more cancer types, but its expression fold is not at the forefront. The
less-than-ideal data structure cannot sufficiently support us in
selecting miRNAs with strong specificity. Therefore, we have shifted our
thinking to other cardiovascular diseases in the field of Reverse
Cardio-oncology. During our comparisons, we discovered that in the
Myocardial Infarction (MI) dataset, miR-210-3p demonstrated better
performance. Specifically, miR-210-3p showed a fold change of 73 and
also found in datasets for 13 different types of cancer. Based on these
findings, we concluded that miR-210-3p is particularly promising
biomarkers. It not only effectively identifies patients with Myocardial
Infarction but also show strong correlations with various cancers.
We further validated these results by revisiting the raw data in GEO and
conducting additional analyses, including ROC curves and literature
review. This confirmed that the detection of miR-210-3 shows the best
diagnostic outcomes.
Our findings consistently showed that miR-210-3p performed better across
these aspects, reinforcing their potential as biomarkers for myocardial
infarction and cancers.
We then communicated to Dr. Si that our screening led us to choose
myocardial infarction over coronary atherosclerotic heart disease
(Figure 14). Dr. Si agreed with our screening method and mentioned that
he would pay special attention to the occurrence of cancer in the
follow-up of patients with myocardial infarction in future clinical
work, and relay this information to the oncology department.
Figure 14. Communication with Dr. Si
After extensively seeking expert advice and continuously refining our
project, we have completed the background research and preliminary
design, and are now moving into the detailed design phase.
Project Refinement:
After deciding to focus on myocardial infarction as the cardiovascular
disease for our project, we sought to deepen our understanding of the
condition to refine our project design. Coincidentally, the Department
of Cardiology at China-Japan Union Hospital of Jilin University, where
we are based, hosted the First Spring City Cardiology Conference (Figure
15). We volunteered at this academic event, assisting the attending
physicians with the registration process and providing guidance
throughout the venue. By contributing our efforts to the event, we aimed
not only to give back to the community but also to seize this valuable
opportunity to seek more in-depth expert opinions.
Figure 15. The First Spring City Cardiology Conference
Taking advantage of our participation in the conference, we attentively
attended Dr. Yunzeng Zou's presentation on "Myocardial Injury and
Protection" on the first day ( Figure 16). Following the presentation,
we interviewed Dr. Zou to seek his insights and suggestions for our
project. Dr. Zou is a leading figure in the field of cardiovascular
medicine in China, serving as the Director of the Shanghai Institute of
Cardiovascular Diseases. His primary research focuses on the
pathogenesis of hypertensive myocardial hypertrophy, heart failure, and
miRNA-mediated cardiac hypertrophy.
Figure 16. Interview with Dr. Zou
Dr. Zou directly pointed out potential issues with the sensitivity and
specificity of our proposed detection system. He noted that, compared to
the traditional tumor screening methods currently used in clinical
practice, relying on the detection of a single miRNA could lead to
instability in the system, potentially resulting in a high rate of false
positives. After thorough discussion and reconsideration of our design,
we ultimately decided to modify the structure of the single-arm LIRA
system and develop a dual-arm AND-gate LIRA detection system.
After revisiting the miRNA screening results, we discovered that
miR-142-3p, which ranked second both in fold change values in the
myocardial infarction dataset and in occurrence frequency in cancer,
also stands out as a promising biomarker. Numerous studies have
indicated that the up-regulation of miR-142-3p expression promotes the
progression of various cancers. Following the advice of our Principal
Investigator, Professor Xin Hu, we conducted functional validation
experiments for both miR-210-3p and miR-142-3p in cancer cell lines. The
results from Transwell, Wound Healing, and CCK-8 assays consistently
demonstrated that elevated expression of miR-210-3p and miR-142-3p
promotes the progression of renal cancer.
After carefully considering the valuable advice from several experts,
along with our bioinformatic analysis, literature review, and functional
validation, we have ultimately identified miR-210-3p and miR-142-3p as
the two biomarkers we aim to detect. Additionally, we have chosen renal
cancer as the specific type of cancer for our detection focus. We then
proceeded to redesign the LIRA system using a dual-arm AND-gate
structure. After extensive consideration and discussion, we decided to
construct the LIRA system with one short arm and one long arm, forming
an AND-gate. The long arm was deliberately designed to be
thermodynamically stable, such that it can only be opened when the short
arm is activated, weakening the stability of the long arm. We
incorporated the sequences of miR-210-3p and miR-142-3p into the
recognition domains of the LIRA dual-arm structure, enabling the
simultaneous detection of both miRNAs.
On the second day of the conference, we attended Dr. Jian Wu's
presentation on "Mechanisms of Myocardial Remodeling Due to Volume
Overload and Precision Treatment Approaches." This lecture expanded our
understanding of myocardial infarction from a macro level to a more
detailed consideration of the underlying micro-mechanisms of its
prognosis and recovery. Dr. Jian Wu, who is affiliated with the Shanghai
Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan
University , focuses his research on cardiac remodeling and heart
failure. After the presentation, we shared our project with Dr. Wu and
conducted an interview to gain insights into the prognosis of myocardial
infarction patients, aiming to ensure that our diagnostic kit aligns
closely with the core needs of these patients (Figure 17). Dr. Wu
highlighted that myocardial infarction is a leading cause of cardiac
remodeling and heart failure, with a poor prognosis, particularly among
patients who also have cancer. He encouraged us to develop our
diagnostic kit into a viable product but also cautioned that there could
be discrepancies between in vivo and in vitro experimental results.
Additionally, he advised us to carefully consider the cost of testing.
Figure 17. Interview with Dr. Wu
The interview with Dr. Wu deepened our understanding of the critical
challenges faced by myocardial infarction patients and strengthened our
resolve to improve our project to better support them. His encouragement
also inspired us to consider the commercial potential of our work, with
the goal of developing a low-cost early cancer screening kit.
After numerous revisions and refinements, our project design has taken
shape. To seek further opportunities for exchange and collaboration, we
traveled to Shanghai to participate in the
18th Oriental Cardio-Oncology
Conference
, where we submitted our project as an abstract. The
submission was under the theme of Cardio-Oncology, titled "A Dual-Arm
RNA AND-Gate Detection System Based on Reverse Cardio-oncology" (Figure
18). We hope that our project can contribute even a small spark to the
ongoing research in Reverse Cardio-oncology. At the conference, we
engaged in discussions with experts from both domestic and international
institutions, fully immersing ourselves in the rich academic atmosphere
and experiencing the unique blend of cardiology research with intangible
cultural heritage. In the conference, our project was affirmed, and the
abstract we submitted attracted an amount of attention.
Figure 18. The 18th Oriental Cardio-Oncology Conference
Project Implement:
With a comprehensive project design in place, we proceeded to the
implementation phase, initiating both wet and dry lab experiments.
During the design of the parts, we sought to ensure that there were no
design flaws by consulting a paper that utilized LIRA technology for RNA
detection. We reached out to the corresponding author, Dr. Alex Green,
and the first author, Dr. Duo Ma. Dr. Ma provided us with valuable
feedback on our design, particularly emphasizing the importance of
ensuring that the input RNA is in sufficient excess (Figure 19). He
recommended using the high-copy plasmid backbone pET-15b for the input
RNA, while the plasmid for LIRA transcription should utilize the
low-copy plasmid backbone pCOLA. Following his advice, we swapped the
backbones of these two plasmids to ensure that the input RNA was present
in excess within the reaction system. Dr. Ma also suggested that even
without including the Lac Operator in the plasmid, IPTG could still be
used to induce the transcription of both LIRA and the input RNA. This is
because IPTG induces the production of T7 RNA polymerase in bacteria,
which initiates transcription. To avoid unnecessary complexity and
waste, Dr. Ma advised us to remove the Lac Operator from the plasmid, a
suggestion we followed successfully in our experimental validation.
With a comprehensive project design in place, we proceeded to the
implementation phase, initiating both wet and dry lab experiments.
Figure 19. Emails with Dr. Ma
During the design of the parts, we sought to ensure that there were no
design flaws by consulting a paper that utilized LIRA technology for RNA
detection. We reached out to the corresponding author, Dr. Alex Green,
and the first author, Dr. Duo Ma. Dr. Ma provided us with valuable
feedback on our design, particularly emphasizing the importance of
ensuring that the input RNA is in sufficient excess (Figure 19). He
recommended using the high-copy plasmid backbone pET-15b for the input
RNA, while the plasmid for LIRA transcription should utilize the
low-copy plasmid backbone pCOLA. Following his advice, we swapped the
backbones of these two plasmids to ensure that the input RNA was present
in excess within the reaction system. Dr. Ma also suggested that even
without including the Lac Operator in the plasmid, IPTG could still be
used to induce the transcription of both LIRA and the input RNA. This is
because IPTG induces the production of T7 RNA polymerase in bacteria,
which initiates transcription. To avoid unnecessary complexity and
waste, Dr. Ma advised us to remove the Lac Operator from the plasmid, a
suggestion we followed successfully in our experimental validation.
During the wet lab experiments, we encountered some challenges. In the
proof-of-concept stage, we aimed to co-transform the plasmid capable of
transcribing LIRA and the plasmid transcribing the input RNA into the
same host to validate the functionality of the single-arm LIRA system.
Given our lack of experience with co-transformation of two plasmids, we
sought to avoid technical setbacks. Dr. Ma explained two
co-transformation strategies: the first involved simultaneously
introducing the plasmid for LIRA transcription and the plasmid for input
RNA transcription into the same host; the second involved preparing a
competent cell with the LIRA transcription plasmid, followed by
introducing the input RNA transcription plasmid. We experimented with
both co-transformation methods and achieved initial success with each.
During the development of our LIRA optimization model based on logistic
regression, we encountered performance bottlenecks, particularly due to
the inadequacies in data processing, which led to suboptimal model
performance. To address this issue, we consulted Professor Lina Jin, a
renowned expert from the School of Public Health at Jilin University.
Professor Jin suggested that we consider incorporating more advanced
machine learning models, such as Random Forest or Gradient Boosting
Trees, to capture the nonlinear relationships in the data (Figure 20).
She also emphasized the importance of expanding the sample size and
refining variable selection.
Figure 20. Interview with Dr. Jin
After adopting Professor Jin's recommendations, we took immediate action
by significantly expanding our dataset and optimizing our variable set
through feature engineering. These improvements notably enhanced the
model's predictive accuracy and generalization ability, leading to
significant progress in our LIRA optimization project.
Close to clinical practice:
To understand clinical doctors' opinions on our Heartecho project and
its practical application, we interviewed Dr. Weihua Zhang from the
First Hospital of Jilin University (Figure 21). Dr. Zhang pointed out
that currently, the world has limited medical resources. If all patients
were to seek treatment at first-tired hospitals, it would inevitably
lead to overcrowding. However, our project aims to simplify and optimize
the diagnosis and treatment processes for cancer, enabling these medical
services to be extended to community hospitals. This approach would make
medical services more convenient. Meanwhile, a more crucial duty of
community hospitals is to improve and monitor the disease prognosis of
the extensive community population. And our project fits this need
perfectly. Dr. Zhang's endorsement of our testing kit concept provided
us with great confidence and encouragement.
Figure 21. Interview with Dr. Zhang
Additionally, during our interview with Dr. Wenqi Zhang from the
China-Japan Union Hospital of Jilin University, he emphasized the
importance of considering both clinical doctors' opinions and patients'
perspectives. Taking his advice to heart, we began conducting interviews
with patients to gather their views and insights (Figure 22).
Figure 22. Interview with Dr. Zhang
References
[1] Shaw, Leslee J., et al. "Sex differences in mortality associated
with computed tomographic angiographic measurements of obstructive and
nonobstructive coronary artery disease: an exploratory analysis."
Circulation: Cardiovascular Imaging 3.4 (2010): 473-481.
[2] Bell CF, Lei X, Haas A, et al. Risk of Cancer After Diagnosis of
Cardiovascular Disease. JACC CardioOncol. 2023;5(4):431-440. Published
2023 Apr 11.
[3] Ridker PM, Everett BM, Thuren T, et al. Antiinflammatory Therapy
with Canakinumab for Atherosclerotic Disease. N Engl J Med.
2017;377(12):1119-1131.
[4] Ridker PM, MacFadyen JG, Thuren T, et al. Effect of interleukin-1β
inhibition with canakinumab on incident lung cancer in patients with
atherosclerosis: exploratory results from a randomised, double-blind,
placebo-controlled trial. Lancet. 2017;390(10105):1833-1842.
Patient-focused care
Preparation of ethics and legal advice
Patient interviews play a crucial role in our project, as they ensure
that our efforts remain patient-centered, ethically sound, and
practically viable. By engaging with patients, we gain valuable insights
into their experiences, needs, and perspectives, allowing us to tailor
our project to better serve their interests. These interviews help us
understand the real-world implications of our work, ensuring that our
project is not only theoretically robust but also grounded in the
practical realities of patient care.
To obtain ethical guidance for interviewing patients and to understand
the considerations during the patient interview process, we consulted
with Professor Songli Mei, a doctoral advisor in medical ethics at the
School of Public Health, Jilin University (Figure 23). Prof. Mei brought
to our attention the issue of "labeling," a concept that arises
frequently in both sociology and medicine. He explained that labeling
can have profound psychological and social impacts on patients,
potentially leading to stigma or unintended consequences. Therefore, we
must be particularly careful in how we classify and describe patients
within our project, ensuring that our language and methodologies do not
inadvertently cause harm or perpetuate biases.
Figure 23. Interview with Prof. Mei
As for the legal field, we consulted with lawyer Jiuhui Feng. Our
discussions covered patient informed consent, considerations for
vulnerable patients, privacy policies, data security, communication of
results, follow-up recommendations, product liability, and handling
disputes. Her guidance has been crucial in shaping our approach to
patient interactions and ensuring alignment with legal and ethical
standards (Figure 24).
Figure 24. Interview with lawyer Feng
Ethical material preparation
Our project is based at the China-Japan Union Hospital of Jilin
University, and we aim to interview the hospital's patients to
understand their views and willingness to use our early cancer screening
kit, particularly among those who have experienced myocardial
infarction. To clarify the hospital's ethics committee requirements for
patient interviews, understand the proper procedures for communicating
with patients, and ensure the protection of patient privacy and rights,
we interviewed Professor Jun Wei, the Director of the Ethics Committee
at the China-Japan Union Hospital of Jilin University (Figure 25).
Figure 25. Interview with Dr. Wei
Professor Wei first explained the process for conducting patient
interviews. He emphasized that interviews should take place in a
private, secure setting, such as a conference room or a doctor's office.
He also reminded us that, unlike standard interviews, psychological
interviews should use post-interview informed consent to avoid
influencing the results. However, since our interviews with patients do
not involve psychological analysis, we decided, after discussion with
Professor Wei, to proceed with pre-interview informed consent, with a
registered physician from the hospital serving as a witness. During the
consent process, the patient should sign the informed consent form
first, followed by the interviewer and the witness, to avoid causing any
unnecessary psychological pressure on the patient. The exact time of
signing should be recorded, down to the minute. At the beginning of the
interview, the interviewer should clearly and thoroughly explain the
project plan to the patient to ensure that their genuine thoughts and
opinions are obtained.
Subsequently, we prepared the informed consent form and submitted it to
Professor Wei for review, hoping to receive his feedback. He noted that
our consent form was too simplistic and suggested that it should at
least include details about the potential impact on patients,
compensation for those who agree to participate, and information on how
to withdraw consent. He offered to provide us with a framework outlining
the necessary content to help us make the required revisions (Figure
26).
Figure 26. The first edition of consent form
Following Professor Wei's advice and using the informed consent
framework that he provided, we revised the consent form and presented it
to him again for review. Professor Wei indicated that the content of the
consent form was now relatively complete. He reminded us to strictly
adhere to ethical guidelines during the interviews and to ensure the
protection of patient privacy. He also pointed out that patients might
be more focused on their personal cancer risk rather than the project
itself, so we should be prepared to respond to unexpected questions and
concerns (Figure 27).
Figure 27. The final edition of consent form
Patient interviews
After extensive preparation, we were finally able to move forward with
confidence into the patient interview phase, where we aimed to
understand their real-life situations and gather their views on our
early cancer screening kit. Through direct conversations with patients,
we gained deeper insights into the health challenges that they faced in
daily life, their concerns about cancer and cardiovascular diseases,
their experiences with current medical practices, and their hopes for
the future of healthcare. Unlike previous interviews, no photos or video
recordings were taken throughout this session to ensure the privacy and
safety of the patients. The interviews were conducted in a private and
quiet environment, and informed consent was signed by the patients,
their families, and the attending physicians on the day of the
interview, with the signing time recorded to the minute.
We first contacted Dr. Ming Yu from the Department of Cardiovascular
Medicine at the China-Japan Union Hospital of Jilin University (Figure
28). We gave her a brief overview of the project, explained our
intention to interview heart attack patients, and submitted the project'
s ethical approval and informed consent forms. After obtaining consent
from both the patients and their families, Dr. Yu provided us with an
overview of the patients' conditions and highlighted key details to
consider when communicating with them.
Figure 28. Interview with Dr. Yu
At the start of the interviews, we clearly and thoroughly explained the
background and objectives of the Heartecho project to each of the two
patients. We then conducted individual interviews, carefully listening
to their thoughts and feedback. This approach ensured transparency and
independence in communication while allowing us to gain a more
comprehensive understanding of each patient's unique perspective and
needs regarding the project.
The patient is a 68-year-old woman who was admitted to the hospital
after experiencing intermittent chest tightness for one month, which
worsened over the course of a day. A coronary CTA revealed triple-vessel
coronary artery disease, and she was diagnosed with acute myocardial
infarction. Dr. Yu advised that when communicating with the patient, it
is important to use simple and easy-to-understand language, approach the
conversation from the patient's perspective, and minimize psychological
stress for her.
We are attentive to the cognitive differences between genders and are
also interested in understanding the perspectives of male patients. To
gain more insight, we reached out to Dr. Zhongfan Zhang from the
Department of Cardiovascular Medicine at the China-Japan Union Hospital
of Jilin University to learn more about the patients' basic conditions
(Figure 29).
Figure 29. Interview with Dr. Zhang
The patient is a 58-year-old man who has experienced episodic chest
pain for three years and persistent chest pain for two hours. Based on
the findings from an electrocardiogram and other diagnostic tests, he
was diagnosed with acute ST-segment elevation myocardial infarction
(STEMI).
The feedback from patients has highlighted that many individuals with
cardiovascular disease are unaware of their potential cancer risk and
often neglect the importance of early screening. Through our
conversations with them, we have become even more convinced of the
urgency and importance of developing this screening tool. This project
is not just about scientific research, but more about directly improving
the quality of life and health of patients. By offering earlier
intervention, particularly for those who with a history of
cardiovascular disease, we could improve their survival rates and
overall quality of life.
Additionally, the participation of patients has provided us with a clear
understanding of the key features that our test kit must have—rapid
results, affordability, and ease of use. These characteristics are
essential for ensuring Heartecho is widely accepted and accessible to a
broader population. The contribution of patients goes beyond the
technical aspects of the project; they are a driving force in moving the
project toward practical application. Their feedback not only helps us
evaluate the convenience and effectiveness of the kit in real-world use,
but it also provides valuable suggestions for improvement. This ensures
the test kit will be not only effective in the lab but also a true asset
in clinical practice, delivering meaningful benefits to patients.
Entrepreneurship
Unmet needs
In the face of the significant health burden posed by myocardial
infarction globally, coupled with the even more severe prognosis when
patients subsequently develop cancer, there is a pressing need for
effective solutions. Recognizing this urgent market demand, Heartecho
presents a revolutionary breakthrough. Our innovative Loop-Initiated RNA
Activator (LIRA)-based AND logic gate system detects the biomarker
microRNA (miRNA) and integrates with a cell-free system to show results.
With Heartecho, we aim to achieve cancer screening for post-myocardial
infarction patients, providing unparalleled benefits for both patients
and healthcare providers .
This diagram outlines the core elements driving the business plan of
Heartecho. We began with a identification of unmet needs within the
diagnostics landscape. After that we proposed innovative solutions.
Finally, it culminates in the outlining of a sustainable business model
designed to ensure market success through strategic positioning and
partnerships, thereby bridging the gap from need identification to
commercial viability (Figure 30).
Figure 30. The core elements driving the business plan of Heartecho
The "China Cardiovascular Health and Disease Report 2023" highlighted
that the prevalence of cardiovascular disease (CVD) in China is
continuing to rise, with an estimated 330 million CVD patients.
According to data from the Global Burden of Disease Study (GBD), the
age-standardized incidence of CVD among people aged 1-79 years in China
was 646.2 per 100,000 between 1990 and 2019. In 2022, a total of 1.034
million inpatients with AMI were treated, with 47.4% were ST-segment
elevation myocardial infarction (STEMI), 41.1% were non-ST-segment
elevation myocardial infarction (NSTEMI), and 11.5% were unclassified
acute myocardial infarction. The above data indicates that the health
burden of cardiovascular diseases is enormous and the number of patients
with myocardial infarction is large.
We have also conducted relevant research on microRNAs (miRNAs) as
biomarkers. According to Data Bridge Market Research, the global miRNA
sequencing and detection market is valued at $381.39 million in 2023 and
could reach $916.55 million by 2031, with a projected compound annual
growth rate (CAGR) of 11.6% over the forecast period. Growing awareness
of proper medication use has positioned hospitals as the dominant
segment in the miRNA sequencing and testing market. Increasing
functional genomics research, rising incidence of chronic diseases, and
advancements in next-generation sequencing (NGS) technology are the
growth drivers for the miRNA detection market.
From this, it is clear that Heartecho is not only an innovative solution
targeting unmet needs but also demonstrates strong potential and
promising prospects in the market.
Heartecho will be priced at $22 per unit. This affordable price point
ensures accessibility to a wider range of patients. The kit's key
advantages lie in its cost-effectiveness, ease of use, and the precision
it offers in identifying miRNA cancer biomarkers within this specific
patient population.
Stakeholders & Potential Customers
As we embark on the journey of Heartecho's commercialization, crafting a
comprehensive Stakeholder Map becomes a pivotal step. It not only aids
in clearly identifying and understanding all stakeholders vital to the
project's success , but also guides us in effectively managing and
communicating with them. This ensures that Heartecho's commercialization
strategy advances smoothly towards a mutually beneficial outcome. The
following is an introduction to our carefully crafted Stakeholder Map,
which outlines the core value and vision of this blueprint (Figure 31).
Figure 31. Stakeholder map
Presented as a three-dimensional jigsaw puzzle, our Stakeholder Map
vividly illustrates the multifaceted interactions and connections among
stakeholders in the Heartecho commercialization journey. Each
stakeholder has their own distinct role and influence, contributing to
the overall success and sustainability of our commercialization
strategy. Just like piecing together a puzzle, successful
commercialization requires careful consideration, strategic alignment,
and seamless integration of all stakeholder perspectives. It signifies
our commitment to working together, leveraging the strengths and
insights of each stakeholder to create a cohesive and effective
commercialization plan.
At the heart of effective stakeholder management lies a deep
understanding of each stakeholder's power and interest. The
Power-Interest Matrix is a valuable tool for mapping out these dynamics,
enabling us to identify key stakeholders, assess their level of
influence, and gauge their vested interest in our success(Figure 32) .
Figure 32. Power-Interest Matrix
By analyzing this matrix, we can strategically prioritize our
stakeholder engagement efforts, ensuring that we foster collaborative
relationships, address concerns proactively, and harness the collective
power of our stakeholders to drive successful commercialization
outcomes.
For the different quadrants of stakeholders in the Power-Interest
Matrix, tailored strategies are essential to ensure effective engagement
and collaboration.
High Power, High Interest:
These stakeholders have significant influence and a vested interest in
the commercialization of Heartecho. To engage them effectively, we will
establish regular communication channels, actively seek their input in
decision-making processes, and work closely to align our strategies with
their interests. Given their high interest and power, they are ideal
candidates for becoming our customers, as they are likely to be actively
involved in the adoption and promotion of our solutions.
High Power, Low Interest:
While these stakeholders possess considerable influence, their direct
interest in our commercialization may be limited. To manage this group,
we will focus on providing clear and concise information about our
progress and goals, demonstrating the value of their support, and
exploring opportunities for mutual benefit. Although they may not
initially show strong interest, by highlighting the benefits and
aligning our offerings with their broader objectives, we can potentially
convert them into customers.
Low Power, High Interest:
These stakeholders may have limited influence but are highly invested in
our success. To harness their enthusiasm, we will actively listen to
their perspectives, keep them informed about project developments, and
seek ways to empower them through collaboration or representation. While
they may not possess significant power, their high interest indicates
potential as customers. By nurturing these relationships and addressing
their specific needs, we can encourage their involvement and support.
Low Power, Low Interest:
Although their influence and direct interest may be minimal, maintaining
positive relationships with these stakeholders is still important. We
will ensure transparent communication, address any concerns they may
have, and explore potential areas of synergy where their interests can
align with our commercialization objectives. Although they may not be
immediate customers, by fostering positive relationships and
demonstrating the value of our offerings, we can lay the groundwork for
future engagement and customer conversion.
Product Feasibility
To ensure the feasibility of our Heartecho, we embarked on a
comprehensive process involving interviews with experts from various
domains.
We started by receiving valuable academic insights from
Professor Ling
Ren
, a respected expert at the Business School of Jilin University.
Professor Ren's expertise in business strategy and innovation management
provided us with a unique perspective on navigating the complex
landscape of commercializing cutting-edge technology.
During our interview, Professor Ren emphasized the importance of
understanding market dynamics and aligning Heartecho with evolving
customer needs. She highlighted the significance of conducting thorough
market research to identify key segments, assess competitor positions,
and uncover untapped opportunities for growth.
Furthermore, Professor Ren stressed the role of strategic partnerships.
She suggested seeking collaborations with industry leaders, research
institutions, and government entities to leverage their resources,
expertise, and networks. By forging these alliances, Heartecho can
enhance its technological capabilities, expand its market reach, and
gain a competitive edge (Figure 33).
Figure 33. Interview with Prof. Ren
On the commercial side, we consulted a business expert who helped us
assess the market potential of our product. Kunyang Xue, the Vice
General Manager of Dongguan Binhaiwan Industry Investment Co., Ltd,
provided valuable insights about pricing strategies, target
demographics, and potential competitors, allowing us to refine our
marketing and sales approach.
With his extensive experience in the investment of innovative
technologies, Xue provided us with a unique perspective on navigating
the complexities of bringing Heartecho to market. He recommended
conducting thorough market research to assess market demand, analyze the
competitive landscape, and develop pricing strategies, enabling us to
position Heartecho effectively in the market.
Furthermore, Xue highlighted the importance of a robust business model
that aligns with market realities. He advised us to consider various
revenue streams, pricing models, and distribution channels to ensure
sustainable growth and profitability. Additionally, he emphasized the
need for a clear value proposition that differentiates Heartecho from
competitors and resonates with customers (Figure 34).
Figure 34. Interview with manager Xue
Next, we engaged a legal expert, Junling Bai to received legal and
intellectual property (IP) insights, ensuring our product complied with
all relevant laws and regulations governing medical devices.
With her expertise in technology law and IP management, Bai offered
essential guidance on navigating the legal landscape and protecting
Heartecho's intellectual assets. She suggested conducting a thorough IP
audit to identify and assess existing patents, trademarks, copyrights,
and other IP assets. This will enable us to safeguard Heartecho's unique
technologies and brand identity.
During our interview, Bai emphasized the need for comprehensive legal
framework to support Heartecho's commercialization efforts, including
contracts, agreements, and compliance policies. This will ensure that
all business activities are conducted in accordance with applicable laws
and regulations.
Bai also called our attention to considering potential legal risks and
challenges. She advised us to conduct a thorough legal due diligence to
identify any potential legal issues or liabilities that may arise from
Heartecho's technology, partnerships, or market entry strategies. By
addressing these risks proactively, we can mitigate potential legal
disputes and protect our business interests (Figure 35).
Figure 35. Interview with lawyer Bai
We also sought input from industry experts who offered insights into
manufacturing, distribution, and supply chain management.
Hongyu Li, the
Secretary of Board of Changchun High-Tech Industry (Group) Co.,Ltd
,
provided us with a comprehensive understanding of the key factors
driving Heartecho's success. They offered insightful suggestions for the
company's development (Figure 36).
Figure 36. Interview with Li
Collaborative partnerships were considered essential for Heartecho's
success. Establishing partnerships with healthcare providers, insurance
companies, and government agencies will facilitate widespread adoption
and create a strong network of support. Maintaining product integrity
and patient safety is paramount, and obtaining necessary certifications
and approvals will enhance Heartecho's market credibility.
Scalability and sustainability were seen as important considerations for
Heartecho's long-term success. Planning for scalability to accommodate
growing demand and implementing sustainable business models that support
long-term growth and profitability will ensure the company's stability
and continued growth.Utilizing digital marketing channels and engaging
in industry events can expand Heartecho's reach and visibility.
Lastly, the experts stressed the importance of ongoing customer support
and feedback. Establishing customer support systems to address
inquiries, concerns, and provide technical assistance is vital. Actively
seeking customer feedback for continuous improvement and product
enhancement will allow Heartecho to adapt to market needs and stay ahead
of the competition.
After interviewing several experts, we are confident in moving forward
with the development and commercialization of our Heartecho, assured
that it meets the needs of the target audience and shows strong
potential in the marketplace.
When we completed the initial draft of our business plan and established
the business model, we embarked on the process of seeking validation for
our product's feasibility from the pharmaceutical company,
Johnson &
Johnson Medical Devices Companies China
.
We approached representatives of this company with a comprehensive
presentation outlining our Heartecho, its unique features, and the
market potential it holds. The Senior Clinical Specialist Junming Yan
expressed recognition of the feasibility of our product. His positive
feedback was based on a thorough evaluation of our business plan, which
outlined the scientific foundation, technical specifications, and market
potential of our product. They appreciated the comprehensive approach we
had taken, considering not only the technical aspects but also the
regulatory, commercial, and operational challenges. This recognition
from industry experts underscores the strong potential of our Heartecho
and its alignment with the needs and expectations of the pharmaceutical
sector (Figure 37).
Figure 37. Interview with Johnson & Johnson Medical Devices
Companies China.
SWOT Analysis
To comprehensively understand the strengths, weaknesses, opportunities,
and threats associated with our Heartecho, we conducted a thorough SWOT
analysis. This strategic planning tool allowed us to assess our internal
capabilities and external environment, providing a clear road-map for
our entrepreneurial journey. By identifying and leveraging our
strengths, addressing our weaknesses, capitalizing on opportunities, and
mitigating potential threats, we are confident in the viability and
success of Heartecho in the market (Figure 38).
Figure 38. SWOT analysis of Heartecho in the market
Development Plans
As part of our development plans, we have crafted a comprehensive
Business Canvas for Heartecho. This canvas serves as a strategic
roadmap, outlining the key elements and intricacies of our Heartecho. It
encapsulates our unique value proposition, target market insights,
revenue streams, and strategic partnerships, providing a holistic view
of our business model. The Heartecho Business Canvas not only guides our
development efforts but also illustrates the potential and viability of
our solution in addressing unmet needs in the healthcare industry. With
this strategic blueprint in place, we are poised to bring Heartecho to
market (Figure 39).
Figure 39. Business Canvas for Heartecho
We have also developed a milestone-driven plan to guide the future
growth and development of Heartecho. This plan outlines key milestones
and targets that will steer our efforts towards establishing Heartecho.
Each milestone, from product development to market expansion, represents
a critical step forward in realizing our vision. This comprehensive
roadmap keeps us focused , adaptable, and aligned with our strategic
objectives, ultimately positioning Heartecho for long-term success and
impact in the healthcare industry (Figure 40).
Figure 40. Development Plan for Heartecho
Bussiness Plan
A business plan is a document that outlines our new venture goals,
operations, industry position, commercialization strategy, marketing
objectives, risk analysis, and financial projections . We have crafted a
business plan for Heartecho. It encompasses a thorough analysis of the
market, a clear definition of our unique value proposition, and a
strategic blueprint for executing our vision. The business plan also
details our marketing strategies, revenue projections, and key
performance indicators, ensuring that we have a solid foundation for
growth and scalability. The pdf of our business plan shows all
entrepreneurial efforts undertaken by CJUH-JLU-China.
Responsible for the world
This year, we are deeply grateful to the many doctors, professors, and
patients whose support and guidance have continuously improved our
Heartecho project. Their contributions have inspired us to promote our
project to the broader society, raising awareness about Reverse
Cardio-oncology. By focusing on publications, ethical responsibility and
public engagement, we ensure that our work positively impacts the world.
Grounded in ethical theories, public health principles, and social
cognitive frameworks, we are dedicated to making our project responsible
on both moral and social levels (Figure 41).
Figure 41 Responsible for the world
Public participation
Numerous scientific studies have supported the benefits of regular
exercise for the prevention and management of cardiovascular disease
(CVD)[1] and cancer[2]. Despite this evidence, physical inactivity
remains highly prevalent worldwide, largely due to a lack of awareness,
as these topics are not typically covered in educational curriculum or
workplace health programs. Inspired by the spirit of the Paris 2024
Olympic Games, we initiated a series of innovative sport activities
aimed at raising public awareness about cardiac health and cancer
prevention through practical engagement to address this issue.
Our activities are designed based on
the triple interaction theory
model
, proposed by psychologist Albert Bandura. This interactive
approach fosters a cognitive cycle where participants learn about heart
disease and cancer prevention in a dynamic and engaging environment.
Through these activities, we aim to enhance public awareness and promote
healthier lifestyles, ultimately contributing to the reduction of CVD
and cancer rates. Our team believes that by integrating educational
content with physical activity, we can create a more profound and
lasting impact on public health (Figure 42).
Figure 42. The triple interaction theory model
Frisbee activity
We had the pleasure of organizing a truly meaningful event at Jilin
University's South Campus, which we called "Synthetic Journey: 'Fly'
with You." This event creatively combined frisbee, synthetic biology,
cardiac health, and cancer prevention, aiming to leave a lasting
impression on participants and the wider community. We provided each
participant with a free frisbee and offered them our custom-designed
stickers to help them understand what Reverse Cardio-oncology is.
Through this engaging activity, we helped participants understand the
vital importance of cardiovascular health and shared practical tips for
incorporating heart-healthy habits into their daily lives. This
innovative approach ignited curiosity and made complex subjects
accessible and enjoyable in a way that traditional methods might not
have achieved.The impact of our event went beyond the participants
themselves. We demonstrated how an interdisciplinary approach can
effectively engage the broader public, using simple and enjoyable
activities to communicate complex scientific and health-related ideas
(Figure 43).
Figure 43. "Synthesis Journey: Let Your Frisbee Fly" activity
Ultimately, "Synthesis Journey: Let Your Frisbee Fly" became more than
just an educational event—it was a celebration of creativity, health,
and community. The enthusiastic feedback we received from participants
confirmed that innovative, interdisciplinary approaches like this can
effectively bridge the gap between science, health, and society.
Additionally, through analyzing participant feedback, we discovered that
many attendees expressed a desire for more authoritative theories or
guidance from experts in future activities. In response, we made
improvements in our subsequent events to incorporate expert-led
sessions. This event inspired many to explore and appreciate the
critical importance of scientific discovery and heart health, and we are
excited to continue this journey in future initiatives (Figure 44).
Figure 44. Feedback from participators
Campus tennis teaching activity
We had the pleasure of hosting a tennis event at Song Zhiping Gymnasium,
Jilin University, titled "One Net Forward, Endless Heart Joy". This event
was a collaborative effort between our team and the Jilin University
Tennis Club. Twenty-eight students from 12 different faculties,
including Law, Economics, and Physics, came together for an afternoon
that combined the excitement of tennis with a focus on heart health
awareness.The impact of this event on the public was both multifaceted
and significant. It successfully raised awareness about the importance
of cardiovascular health, particularly by highlighting the benefits of
regular physical activity. By combining tennis—a sport that is both
accessible and enjoyable for many—with heart health education, we were
able to engage a diverse group of students who might not otherwise have
been involved in such discussions (Figure 45).
Figure 45. "One Net Forward, Endless Heart Joy"activity
The event also demonstrated the effectiveness of community-driven
initiatives in promoting health and well-being. Participants not only
gained practical knowledge about heart health but also experienced the
immediate benefits of physical exercise. This hands-on approach
reinforced the importance of maintaining an active lifestyle for
long-term health. Moreover, the collaboration between our team and the
Tennis Club underscored the power of interdisciplinary efforts in
addressing public health challenges. By integrating scientific research
with sports, we showcased how different fields can come together to
create impactful and meaningful programs. After considering
feedback
from participants in the frisbee activity, we enlisted the expertise of
Professor Xiaogang Ma from the School of Physical Education at Jilin
University to provide professional guidance for our tennis event. His
guidance played a crucial role in enhancing the quality and enjoyment of
the event, further amplifying its positive impact.
After the event concluded, we received feedback from participants who
highly recognized and praised our efforts. They expressed that we
provided them with a valuable opportunity to learn about the sport of
tennis and gain knowledge about heart health. However, they also
suggested that if we could create videos of our activities for wider
promotion, the impact would be even greater. We took this feedback into
account and made improvements in our subsequent activities (Figure 46).
Figure 46. Feedback from participators
Cardiac Health Excercises
The cardiac health exercise is a simple yet effective way to stay
active, with its lively rhythm attracting participants of all ages. We
designed the movements by incorporating elements of Tai Chi, using
gentle actions such as tapping and stretching to promote overall blood
circulation and protect heart health. We believe that regular exercise
is vital for maintaining overall well-being, especially for the
heart.This exercise routine has been implemented across campus through
various sports activities, such as tennis and frisbee events, making it
an integral part of our health initiatives (Figure 47).
Figure 47. Students doing the Cardiac Health Excercises
We've also extended its reach beyond the university by promoting it in
elderly care homes, where it has been warmly received by the senior
community. For older adults, this gentle routine improves flexibility
and endurance, significantly enhancing their quality of life.
Recognizing its potential impact and in order to improve our activity,
we further called upon several iGEM teams across China to collaborate on
creating a cardiac health exercise video. This collective effort
involved nearly 200 participants and reached a wide audience,
demonstrating the routine's broad appeal and effectiveness. As a
practice that encourages widespread participation, the cardiac health
exercise not only aids in the recovery of cardiovascular patients but
also strengthens the body and plays a crucial role in preventing
cardiovascular diseases (Figure 48).
Figure 48. Doing the Cardiac Health Excercises with the old
By organizing a series of sports activities, we effectively showcased
the importance of exercise in preventing cardio vascular disease and
cancer, while also raising public awareness about Reverse
Cardio-oncology. These events not only boosted public awareness for
doing regular exercise but also effectively disseminated crucial
knowledge about cardiac health and cancer prevention. The activities saw
widespread participation on campus and were then shared on social
platforms like Bilibili, TikTok, and WeChat, further amplifying their
positive impact on public awareness.
7th Chinese Doctor's Day
August 19 is the Chinese Doctor's Day, a special occasion
dedicated to honoring and appreciating healthcare professionals. To
celebrate this important day, we prepared some thoughtfully designed
mementos—badges featuring our team logo and refrigerator magnets—as
gifts for the cardiologists working tirelessly on the front-lines of
clinical practice. These doctors dedicate themselves to providing
high-quality treatment and care to patients in their daily work, and
their professionalism and dedication have deeply moved us. Through these
gifts, we hope to express our deep gratitude and wish them a day filled
with care and blessings, making this Doctor's Day a joyful and memorable
one (Figure 49).
Figure 49. Giving gifts to doctors we have interviewed
In addition, we provided a brief update on our project's latest progress
to several doctors we previously interviewed, including Dr. Yuquan He,
Dr. Daoyuan Si, and Dr. Huan Sun. During this exchange, we specifically
mentioned the valuable advice they had given us before, detailing how
this advice played a crucial role in helping us overcome various
challenges during the project's advancement. We sincerely appreciate the
time they took from their busy schedules to offer us guidance and
support, and we hope to continue receiving their help and direction in
the future. On this special day, we once again extend our heartfelt
respect and gratitude to them and wish them success in their careers and
happiness in their lives.
We plan to continue these activities with a focus on analyzing their
long-term effects on participants' health and well-being. By gathering
and assessing data from these initiatives, we aim to better understand
how regular physical activity can impact the prevention of
cardiovascular disease and cancer. Additionally, we will actively seek
collaboration with experts in the fields of cardiology, oncology, and
public health, as well as with educational institutions, to broaden our
reach and influence. We are confident that with sustained effort,
continued research, and strong community involvement, the Heartecho
project will not only maintain its momentum but also achieve even
greater success in promoting health and raising awareness on a larger
scale.
Inking our duty
In order to offers new insights for the prognosis assessment of
cardiovascular disease (CVD) patients and the development of precise,
personalized treatment plans, and aiming to enhance overall societal
well-being. Our PI, Professor Xin Hu, Professor Yuquan He, and Yutong
Yao, have published a review article titled
"Research Progress in Reverse Cardio-oncology" in the Chinese
Journal of Heart Failure and Cardiomyopathy. This article is the first
of its kind to be included in the Chinese Medical Journal, focusing on
the field of Reverse Cardio-oncology. The article systematically
explains the research advancements in Reverse Cardio-oncology and points
out directions for future development (Figure 50).
Figure 50. What could cause tumor growth
To safeguard the rights and welfare of all the participants involved in
our project, ensuring that every step of our project meets the highest
ethical standards. We adhere to the three fundamental ethical principles
outlined in the Belmont Report:
Respect for Persons, Beneficence, and Justice
, which have been a source of inspiration from Prof. Yunsheng
Dong. Guided by these principles, we have made the "Ethics of Synthetic
Biology" handbook. Under the principle of Respect for Persons, we
emphasize the importance of safeguarding the autonomy and dignity of all
participants. Our project includes a detailed informed consent process,
ensuring that each participant fully understands the procedures, risks,
and potential benefits involved, and can make autonomous decisions
accordingly. Additionally, we pay special attention to providing extra
protections for groups with limited autonomy, such as minors, the
elderly, and individuals with cognitive impairments, to ensure their
rights are fully protected. Secondly, the principle of Beneficence, we
aim to maximize benefits while minimizing harm for participants. We
conduct thorough risk assessments and implement safety measures, with
continuous monitoring to ensure the project remains beneficial and safe.
And Finally, guided by the principle of Justice, we ensure that the
benefits and risks of the project are fairly distributed. Our
participant selection is inclusive and unbiased, with specific
strategies to protect vulnerable groups. We are also committed to the
equitable global distribution of the project's benefits, ensuring all
groups can share in its outcomes.
Further, the handbook serves as a valuable resource for the general
public, aiming to share knowledge about synthetic biology, raise
awareness of its ethical issues, and foster public acceptance and
support for this technology. Through this comprehensive and
multi-faceted ethical guidance, our handbook will be an essential tool
in advancing the field of synthetic biology responsibly, balancing
technological progress with social responsibility.
References
[1] Fiuza-Luces C, Santos-Lozano A, Joyner M, et al. Exercise benefits
in cardiovascular disease: beyond attenuation of traditional risk
factors. Nat Rev Cardiol. 2018;15(12):731-743.
[2] Fiuza-Luces C, Valenzuela PL, Gálvez BG, et al. The effect of
physical exercise on anticancer immunity [published correction appears
in Nat Rev Immunol. 2024 Mar;24(3):229.