Mozi Salon: Protecting the "oil road" of life with technological innovation

If each of us is a car running forward, then our heart is the diligent engine. For the heart, the engine, the cardiovascular system is its oil circuit, and the heart valve can be regarded as its valve. With the aging of the population, the problems of "oil circuit" and "valve" are becoming more and more important. How to diagnose and treat it, countless medical scientists and doctors have devoted their creativity to this field.

What touching stories are there in the development of the cardiovascular field? How do contemporary doctors and scientists achieve innovation and creation in this field? The Mozi Salon 2023 Opening Event and the 2023 Pudong New Area National Science Popularization Day event invited three experts and scholars from Zhongshan Hospital Affiliated to Fudan University - internationally renowned cardiovascular disease expert and academician of the Chinese Academy of Sciences Ge Junbo, as well as deputy chief physician Wang Zhen and deputy chief physician Li Qing, to discuss the diagnosis, treatment and prevention of cardiovascular diseases. Academician Pan Jianwei of the University of Science and Technology of China hosted the event.

Medical innovation is full of hardships and uncertainties

As an internationally renowned cardiovascular disease expert, Ge Junbo has made fruitful work in the innovation of cardiovascular disease diagnosis and treatment technology and the transformation of results. However, when talking about the exploration of cardiovascular by medical predecessors a hundred years ago, Ge Junbo still has a lot of feelings. Starting from 1929, when German doctor Werner Forssman tried to insert a catheter from the left axial vein to the right atrium, Ge Junbo reviewed the medical history from balloon dilatation to coronary artery stents and then to valve interventional treatment. In terms of interventional aortic valve replacement (TAVR), Ge Junbo, his team members and collaborators made the earliest exploration in China.

In 2010, Ge Junbo performed the first TAVR clinical surgery and continued to conduct research and exploration for many years, gradually determining the position of TAVR in the treatment of aortic valve stenosis.

Looking at the international and domestic situation, medical devices have shown a significant growth trend. Benefiting from the country's innovation-driven policies, the scale of my country's medical device industry has gradually expanded. However, the innovation capacity of high-end technologies is still low, R&D investment is insufficient, the mechanism is still not sound, and the domestic market share of high-end medical device products is still low. But the good news is that the growth rate of my country's medical market is higher than the global level, the medical device industry has huge room for development, the domestic substitution rate of medical devices has gradually increased, and three major medical device industry clusters have been formed. Ge Junbo pointed out that to encourage innovation, it is necessary to straighten out the mechanism and protect the innovation enthusiasm of innovators.

Based on the ideal of protecting innovation, the Chinese Cardiovascular Doctors Innovation Club (CCI) has become the "experimental field" and "incubator" where Ge Junbo has invested a lot of energy in recent years. CCI is committed to building an innovative research and development platform with doctors as the main body, integrating innovation training, design exchanges, research support, and industrial cooperation, and opening up the "concept-practice-results" innovation industry chain, aiming to stimulate the innovative potential of front-line clinicians to discover and solve clinical needs, guide them to actively participate in the research of medical technology and related equipment, and further provide them with preclinical and clinical research platforms, and ultimately realize the marketization of domestic medical technology and equipment products. Since its establishment in 2015, a series of early cardiovascular projects have been incubated and landed, from the earliest imitation to improvement and then to originality, and excellent projects of trainees continue to emerge:

Innovative cardiovascular devices developed under the leadership of the club, such as the CryoFocus cryoneural ablation catheter, the new ultra-small caliber blood flow reserve fraction measurement catheter, the new high-resolution intravascular ultrasound catheter, the original transcatheter mitral valve leaflet clamping device, and the transcatheter valve for pure aortic regurgitation and stenosis, have entered the clinical research stage and have even become commercial products that directly benefit patients.

The road to innovation is not always smooth. Being in the process, Ge Junbo has a deep understanding of the hardships and uncertainties of medical innovation. Taking the bioresorbable stent XINSORB as an example, Ge Junbo introduced the 15-year innovation and exploration process. With the approval of XINSORB by the National Medical Products Administration, the thrombosis and inflammatory reactions caused by traditional drug stents will be greatly reduced.

Ge Junbo said that the uncertainty in medicine makes the road to innovation full of hardships, but there is no absolute truth in medical textbooks. It is the uncertainty that motivates medical scientists to continue exploring.

Prevention and control of chronic cardiovascular and cerebrovascular diseases

Ge Junbo has been deeply involved in complex cardiovascular diagnosis and treatment technologies and critical care for many years, but for more ordinary people, how to prevent and control chronic cardiovascular and cerebrovascular diseases in daily life is more important. At the event, Li Qing and Wang Zhen, deputy chief physicians of the Department of Cardiology at Zhongshan Hospital Affiliated to Fudan University, respectively gave health lectures on the two most common chronic diseases - hypertension and dyslipidemia.

Hypertension is the "most familiar stranger" in our lives. It is extremely common, but the public often has many misunderstandings about it. Deputy Chief Physician Li Qing introduced the diagnosis and treatment standards for hypertension and the correct way to measure blood pressure. In response to common misunderstandings of hypertensive patients such as irregular blood pressure measurement, irregular blood pressure measurement at home, not taking medicine without symptoms, reducing or stopping medication on their own, and unhealthy lifestyles, Li Qing explained the hazards and precautions. She pointed out that hypertension is like an invisible killer. Damage to blood vessels is a chronic and long-term process. If it is not controlled, the longer the course of the disease, the more risk factors will be associated with it, the more serious the degree of target organ damage, and the greater the risk of cardiovascular disease. It must be taken seriously in the early stage and monitored and treated scientifically and in a standardized manner.

In addition to hypertension, dyslipidemia is also a common chronic disease in my country. According to the "China Cardiovascular Disease Report 2021", the overall prevalence is estimated to be 34.7%. Speaking of dyslipidemia, what confuses us most may be the complex blood lipid indicators on the physical examination report. Deputy Chief Physician Wang Zhen introduced the definition, types, functions, and absorption, transportation, and metabolism of blood lipids in an easy-to-understand manner. Common blood lipid indicators include total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), apolipoprotein AI (apoAI), apolipoprotein B (apoB), lipoprotein (a) [Lp(a)], etc. Wang Zhen introduced the significance, target values, and pathogenic mechanisms of these indicators in detail. She pointed out that the management of blood lipids cannot rely solely on the indicators on the test sheet, but also needs to comprehensively consider the patient's age, the presence or absence of coronary heart disease, hypertension and other cardiovascular risk factors, and conduct stratified management. At present, lipid-lowering drugs are constantly developing. In addition to common drugs such as statins, ezetimibe, and PCSK9 inhibitors, some small nucleic acid drugs such as Inclisiran and Pelacarsen have entered Phase III clinical trials. Small nucleic acid drugs can regulate the expression of target genes at the mRNA level and are expected to open up a new direction for cardiovascular treatment.

Blood vessels are the rivers of our life. Blood supplies oxygen and nutrients to every part of our body through blood vessels. In addition to cardiovascular diseases, chronic diseases such as hypertension and dyslipidemia may have a significant impact on the brain, kidneys and other organs. With the advancement of medical technology, more and more drugs and diagnostic and treatment methods can protect our vascular health. We should also be responsible for our own health through scientific and standardized prevention and treatment, and a healthy lifestyle.