Team:Worldshaper-Shanghai/Human Practices
Human Practice
Summary
As we all know, making medical-related testing equipment needs a lot of consideration and effort, we have gradually improved our project according to Human practices step by step. Our works include background investigation, public surveys, field trip, professional interviews as well as collaboration with other teams. All of them make our project direction more clearly and available.
Background Investigation
Since we decided to make a blood uric-acid monitoring tools for patients, we have made great efforts to collect thesis and background information. We found that it is very important to detect the level of uric acid in blood regularly for gout control[1]. Also, the current monitoring method (like ultrasound, Dual-energy CT scan, Magnetic Resonance Imaging, X-ray imaging, etc.) has some limitations: people have to send samples to laboratories and they can not get result on the spot while the cost of each test is high[2]. According to the above-mentioned information, we noticed that blood uric acid level is regularly monitored for gout patients but the experiences are a little troublesome. In June, we luckily found the uric-acid related Hypothetical uricase regulator (HucR) and pHucO promoter from Deinococcus radiodurans, association of HucR to uric acid leading HucR leave pHucO[3]. This finding inspired us to design our project and optimized our research protocols like EMSA, uric-acid treatment, and fluorescence measurement.
June-AugustPublic Survey
A total of 2073 samples have been completed through online surveys and street spot surveys. The results indicated that gout has a high incidence in China and the regular routines for gout patients in hospitals are troublesome. Among 2073 respondents, more than half of them demonstrated high expectations for portable blood-test devices for gout.
According to the results revealed by this survey, we have determined the most important goal and significance of our project, that is, constructing a portable, convenient, sensitive gout monitoring kit. Besides, we find that most of the public has little knowledge about the gout, the synthetic biology, and the iGEM, in this way, we collaborated with the other six iGEM teams to make a publicity.
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Investigation on Portability of Gout Detection Device
Introduction
Gout is a type of arthritis which has a high morbidity around the world. However, people do not know the precise inducing factors of gout and the only medical method we could utilize is combining medicine and dieting together to control the level of uric acid in the blood. Therefore, patients must test their blood frequently to know their conditions and whether the treatments are effective or not. Based on these facts, our goal is to develop a portable blood-test device, and to promote it to the public. This survey allows us to understand different opinions about our idea, which helps us to acquire advices and inspirations.
A total of 2073 samples have been completed through online surveys and street spot surveys. In this paper, we have chosen several questions to help us analyze the potential market of our gout detection device.
Sample description
We have collected a total of 2073 samples in major provinces of China. The largest number of respondents was from Shanghai. Sample age group, gender distribution is uniform, and education background is mostly high school or above.
Contact rate of portable testing equipment
Among 2073 samples, 54% of the respondents have been exposed to or suffered from gout, which points out that gout has a high incidence in China. This indicates that there is a high demand for gout related products.
Cognition of gout detection methods
The graphs show that public believes that blood and urine tests are still the major ways to detect gout, which supports our design since it exactly tests the level of uric acid through blood. Therefore, it will be easily accepted because the principles of our product is perfectly in line with people’s common knowledge.
Regular visits to the doctor to test attitudes
Nearly 79% of respondents believe it is at least troublesome, while 52% of them believe it is very troublesome. In the second graph, yes refers to people who are either gout patients or are in contact with gout patients, and no refers to people who do not have, or are not directly related to gout patients. This set of data was reached by combing the result of Question 7 (Are you a victim of/Do you know (as a friend or a family member) a victim of gout?) and Question 12 (Nowadays, in the process of treating gout, patients must go to hospitals for blood tests regularly. What is your opinion about this?). Respondents who express strong negative opinions about going to the hospitals for blood tests are usually gout patients or related to them, while people who have not been exposed to gout tend to have the opposite opinion. From the data, we could reach the conclusion that respondents who are directly related to gout patients often find going to the hospital troublesome. If portable testing devices for uric acid is available, there should be a high demand for such devices.
Portable expectation
Total value is 15569. The mean is: 7.51. Among 2073 respondents, more than half of them demonstrated high expectations for portable blood-test devices for gout. High expectations are in line with market demands. These statistics indicate that our design could have a huge potential market.
Public awareness
In the survey, we found that pain (90.45%) and edema (53.93%) are the main symptoms that the publics focused on. This lead us wondering that some knowleges involves gout should be given to publics to let them know more about gout. Also, there are about 80% of people who have no knowledge about synthetic biology while 88.52% people have no idea of iGEM competation, we decided to put effort in public engagement and education in order to arouse people’s interest in synthetic biology and genetic engineering .
Conclusion
Through this survey, we found that that gout has a high incidence in China and the regular routines for gout patients in hospitals are troublesome. Our design is based on the most traditional and reliable way: blood testing. This design can offer patients an opportunity to detect their level of uric acid anywhere, anytime, which makes the testing part much more convenient. Therefore, conclusion can be reached that the demand of our design, a portable uric acid detection machine, will be high and there is an enormous potential market, especially in countries with huge population bases like China.
Conversation with AstraZeneca
We luckily interview the BD director of AstraZeneca. From this interview, we got the following points and clarify the initial goals of our project and the focus of further research.
- Our project has great potential in biology field in the society.
- We should know how great our potential market is.
- We should find out the advantages of our project: the method of detection of uric acid level that is greater than the others.
- We had better to interview the professor and doctors specialized in clinic or diagnosis company.
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Astra Zeneca is one of the top pharmaceutical companies in the world. And our interviewee, Mr.Cao, has specialized research on gout before. Mr.Cao pointed out that the public has not deeply understood the hyperuricemia, which means that they may not pay much attention to the treatment. Therefore, the diagnosis and medicines of hyperuricemia are not comprehensive. He said that there are only three types of medicine on the market currently, meaning that this biology field still has great potential in society. This current situation further our thoughts to those markets that already exist, and analyzed the precautions we may have in the application and the things that we need to investigate in the future. For applications, we need to understand how great our market is, the potential market is consist of human and needs. The more the potential market is, the more important our project is to society. Finally, Mr. Cao suggested that we could improve the response time and sensitivity of our biologic sensor for uric acid, showing the advantages of our research project. At the same time, he also suggested that we could consult our project with someone who specializes in diagnosis to make more technical suggestions.
Conversation with Dr. Zhang
To know the actual market need, we had the honor to interview the doctors in the diagnostic department of the hospital, who answered our questions about the methods, detection time and accuracy of the uric acid test in the hospital. Through the conversation, we know the actual situation of blood detection in the hospital is that patients often need to wait for a long time to get the result which is the reason people feel troublesome (same results were also revealed on our public survey). Besides, compared to chemical or physical methods, we find the possible advantages of our biological method to detect the uric acid level, which can effectively avoid the interference from the finger tip blood.
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Dr. Zhang is the Former 463 hospital laboratory biochemistry group leader, who is familiar with the whole detection process in the hospital. She emphasized that nowadays, generally, patients who come to register at 8:00 in the morning are able to get the blood test results until 2:00 in the afternoon. The waiting is very long, after all, the number of people who come to the hospital for the blood test is extremely large, which means that there is a great need to have a more convenient way of detection at home. Thus, this reality proved that our research is necessary and important. Moreover, Dr. Zhang analyzed the current method of detecting the uric acid level. Currently, the method is using a chemical or physical way to detect the uric acid level, which means those ways will meet the problem with the interferences. As we all know, there are tissue fluid and fibrin when getting the blood from the patient; however, the chemical or physical will be easily affected by the interferences. Therefore, we find the advantages of our project towards the current methods and find the great value of our project.
Conversation with Abbott
We interviewed Ms. Huang from the marketing department of Abbott, who has eighteen-years of working experience in the field. According to her useful advice, we realized that the most important thing about product design is its practicality and whether to meet market needs. Our initial design idea of "test paper" was also affirmed by her for visually alert to the naked eyes. After ending this interview, we noticed that determine the actual market need is the next step.
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Abbott is a very authoritative company that produces the medical instrument. One of their best known and the most advanced technological product is the blood glucose test meter. Ms. Huang firstly emphasized that we have to describe the product itself directly when publicizing. Rather than introducing the theory behind it, we better focus on the basic function so that the public can easily understand. The second point is that we have to describe the unmet needs, which is the thing that necessary and attractive to the public. Finally, she informed even though our way of using blood will be less precise than using serum, it will still be accepted by the patients. To be specific, she used traffic light as an example; that is, red light means alert, green light means safe. Patients only need to attend hospitals once to get the specific uric acid level; they can insert the number into the device, so it can provide a difference between the inserted number and the tested level afterward.
Meet up in Hangzhou
On August 2-3, our team, Worldshaper-Shanghai, was invited to a meet up in Hangzhou hosted by ASTWS-China, Worldshaper-XSHS, and ZJU-China, and seven other teams participated. According to the useful advices we collected, we preliminarily designed two types of applied method--cellulose acetate membrane method (for test paper) and magnetic beads method, and shared our idea with other teams in meetup. In this offline meetup, we accidentally gained the suggestions from the iGEM team of Zhejiang University in Hangzhou. They were confused by the liquid condition of the small magnetic beads as they think it will be unstable since they considered that the mechanical force of the liquid shaking is greater than the bond between the protein and the DNA, so we began to carefully check out this idea by searching research articles and asking some professors.
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On August 2-3, our team, Worldshaper-Shanghai, was invited to a meet up in Hangzhou hosted by ASTWS-China, Worldshaper-XSHS, and ZJU-China, and seven other teams participated. According to the useful advices we collected, we preliminarily designed two types of applied method--cellulose acetate membrane method and magnetic beads method, and shared our idea with other teams in meetup. In this offline meetup, we accidentally gained the suggestions from the iGEM team of Zhejiang University in Hangzhou. They were confused by the liquid condition of the small magnetic beads as they think it will be unstable since they considered that the mechanical force of the liquid shaking is greater than the bond between the protein and the DNA, so we began to carefully check out this idea by searching research articles and asking some professors.
Conversation with Ming Hu
With the problems we met during the experiments, we interview the professor in the college of pharmacy, University of Houston, who gave us the suggestions of the method of controlling the speed of translation, and also mention the contamination that we should care about after each experiment.
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On the morning of Aug 3, 2019, we had an interview with Ming Hu, the professor in the college of pharmacy, University of Houston. We explained our project to him and asked some questions about our project, especially about experiments, because we failed recently in the experiments to test the relationship between uric acid, HucR and pHucO by using gene pathway, which was transformed into E. coli. Then we described our experiments and some details to him. He suggested that we should kill the E. coli because we could not control the growth of E. coli, which might affect the speed of translation. Additionally, he said we should consider doing some experiments considering contamination such as ethanol after finishing our main parts our experiments of the relationship between concentrations as supplement. His suggestions were really meaning and we would converse with my instructors to improve our experiments and make sure that the E. coli would not have determined influence on the results of our experiments.
Publicity in Hangzhou Low Carbon Science and Technology Museum
By our social investigations and the questionnaires, we find that most of the public has little knowledge about the gout, the synthetic biology, and the iGEM, in this way, we collaborated with the other six iGEM teams to make a publicity. More details are presented on our Public Engagement Page
August 4Online Collaboration with QHFZ-China
After judges’ suggestion from Hangzhou meet up that there is a high school team also doing gout this year, we got in touch with the team: QHFZ-China. We scheduled an online meeting on August 6th, discussing and guiding the projects together. Before that, we were confused about how to find the right low-cost, portable fluorescence tester.
They provided us with the idea of the LEGO detection kit to optimize the magnetic beads method. In addition, they also gave us an advice on our part test work, which is critial to us to further design our gene pathway. The reference materials they gave us helped a lot, and we successfully redesigned our gene pathway and it is updated on wiki page now.
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Our team first introduced our project just as we did during meet up in Hangzhou, and addressed the problem we are now facing. We have failed to build the concentration grade between mCherry and uric acid, which means that the value we get from the mCherry does not form a clear relation with the uric acid level. We guessed that it is caused by the promoter of HucR, which is so strong that inhibits the following gene pathway by transcribing numerous hucR. To solve the problem, their team provided us two methods: using the light filter and changing to synthetic reporter genes. Then a team member from QHFZ-China introduced their project, the complete solution of gout, to us, they meet the problems of the Human Practice part, which is the advantage of our team. We, therefore, exchanged ideas of how to perfect the Human Practice part, specifically on how to contact the specialists, and how to do the education part. After this one-hour meet up, we had a deeper understanding of each other’s group. We noticed that they tried to solve the problem our team meet now at the beginning of their project by adding a length of gene sequence to the promoter, which can weaken the promoter to let the gene path prosperously. QHFZ-China also gave us new ideas on showing fluorescent protein and the solution to our problems of gene path way, and we guided them on the Human Practice section and gave an idea of choosing RFP. We were both looking forward to having a further collaboration on the experiment, especially the way to solve the problem of experiments we have met now.
Online meeting with QHFZ-China
Some discussion using Wechat with QHFZ-China
The simple version of the microplate readers by the team leader of QHFZ-China
Conversation with Dr. Kong
To got more professional suggestions, we have a face to face talk with Dr. Kong, who provided us with the real situation the patients having gout face who is the vice chief physician of the department of rheumatology and immunology. Through this conversation, she provided us with the real situation the patients having gout face, such as the necessity and frequency a patient should have to detect his blood uric acid level. More importantly, Dr. Kong introduced the significance of uric acid level in clinical diagnostics to us. Let us notice that the uric acid level has a significant meaning towards the clinic of gout, and different ages will accompany with a different standard level of uric acid. Accordingly, we eliminate our initial design of color warning and optimize the product design to be modeling a true number of the uric acid level alternatively.
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Dr. Kong is the vice chief physician of the department of rheumatology and immunology, Changhai hospital. During the conversation, there are four main points she gave us with our project. The first one is the frequency a patient should have to detect his blood, especially the uric acid level. During the first half-year a patient having gout, he should have the detection every one or two months, and each time a patient detects his blood, he must wait 2-3 hours for each detection, which is troublesome. The long continuity of detecting the uric acid level is a must to the patient but also an inconvenient thing to them. The second one is the actual incidence of gout. Gout affects 100 million people in China, and 10 to 15 percent of people with hyperuricemia will turn to gout. Therefore, there is a large number of patients in the society and there is an impressing need for our project. The third one is the diagnostic significance of the uric acid index in the clinic. The uric acid level has a significant meaning towards the clinic of gout, and different ages will accompany with a different standard level of uric acid. This information let us eliminate our past design of the thought of grade. It seems that the real number of the uric acid level is needed for the doctor and patients instead of just a grade, so this also means that we should devote ourselves to the mathematic modeling among the uric acid level. The last one is the dangerous factors. Dr. Kong told us that when the prescription is given, the doctors will also look for other factors of the patients, such as whether the patient has hyperglycemia, hyperlipidemia, heart disease, kidney failure and so on. Those dangerous factors accompany the uric acid level can enable the doctor to give the final suggestions to the patients. After this interview with Dr. Kong, we clear-cut our design to be modeling a true number of the uric acid level instead of just a grade, and we know more about the current situation among the clinic part in the society and how the patients feel about the detection of the uric acid level in the hospital.
Solution for improving product design
For blood testing, we searched a lot of online sources about blood test kits and serum separating (in order to reduce the interference of blood impurities). The most exciting finding were Paperfuge[4], which is an amazing simple centrifuge with low cost. We planed to add it to our kit design and convinced that it will surprise more people. At the same time, in order to convert the images into the true number, we establish the model of our project by using the R program with help from our instructor Dr. Cheng. Although we got the relationship between images and concentration of uric acid, we still wanted to do better since we found that there are some disadvantages in the way of fluorescence analysis by images. As a result, we continued to finish the design of magnetic beads kit based on the feedback we got from others and some online sources[5-8]. Our final portable device was designed tinier, it can get the data directly by detecting the fluorescence value in the buffer solution, making our future monitoring kit more reliable. Details are presented in our Applied design page.
August -SeptemberReferences
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