1.Shenqi Dihuang Decoction Improves Renal Function in Mouse Model of Diabetic Kidney Disease by Inhibiting Arachidonic Acid-related Ferroptosis Via ACSL4/LPCAT3/ALOX15 Axis
Yuantao WU ; Zhibin WANG ; Xinying FU ; Xiaoling ZOU ; Wenxiao HU ; Yixian ZOU ; Jun FENG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(12):140-149
ObjectiveTo investigate the therapeutic effects and mechanism of Shenqi Dihuang decoction (SQDHD) on diabetic kidney disease (DKD), with a focus on its impact on arachidonic acid-related ferroptosis. MethodsSixty C57BL/6 mice were allocated into a normal group (n=10) and a modeling group (n=50), with 43 mice successfully modeled. The successfully modeled mice were further allocated into model, low-, medium-, and high-dose (4.68, 9.36, and 18.72 g·kg-1, respectively) SQDHD, and dapagliflozin (0.13 mg·kg-1) groups. The drug treatment groups were administrated with corresponding agents by gavage, and the normal and model groups were administrated with equal volumes of normal saline by gavage. An electronic balance and a glucometer were used to monitor the body weight and fasting blood glucose level from the tail tip, respectively. Serum creatinine (Scr) and blood urea nitrogen (BUN) levels were measured by enzyme-linked immunosorbent assay (ELISA). Histopathological changes in the renal tissue were assessed by hematoxylin-eosin staining, Masson staining, and periodic acid-Schiff (PAS) staining. The fluorescence intensity of reactive oxygen species (ROS) in frozen sections was observed by an inverted fluorescence microscope to evaluate the levels of ferrous ions (Fe2+) and lipid peroxidation in the renal tissue. Immunofluorescence staining of glutathione peroxidase 4 (GPX4) and acyl-CoA synthetase long-chain family member 4 (ACSL4) in the renal tissue was performed to detect their localization and expression. Western blot was employed to assess the expression levels of key ferroptosis proteins such as GPX4 and cystine/glutamate antiporter (xCT), as well as the arachidonic acid metabolic pathway-related proteins, including ACSL4, lysophosphatidylcholine acyltransferase 3 (LPCAT3), and arachidonate 15-lipoxygenase (ALOX15). Real-time PCR was employed to measure the mRNA levels of key ferroptosis proteins, including solute carrier family 7 member 11 (SLC7A11) and GPX4, as well as arachidonic acid metabolism-related factors (ACSL4, LPCAT3, and ALOX15) in the renal tissue. ResultsCompared with the normal group, DKD model mice exhibited a decrease in body weight (P<0.01), increases in levels of blood glucose (P<0.01), 24-hour urinary protein, Scr, and BUN (P<0.01), along with severe pathological changes, such as mesangial cell proliferation, basement membrane thickening, tubular atrophy, and interstitial inflammatory cell infiltration. In addition, the modeling elevated the levels of Fe2+, MDA, LPO, and ROS (P<0.01), lowered the GPX4 and xCT levels (P<0.01), raised the ACSL4, LPCAT3, and ALOX15 levels (P<0.01), down-regulated the mRNA levels of GPX4 and SLC7A11 (P<0.01), and up-regulated the mRNA levels of ACSL4, LPCAT3, and ALOX15 (P<0.01) in the renal tissue. Compared with the model group, low-, medium-, and high-dose SQDHD groups and the dapagliflozin group showed an increase in body weight (P<0.01), decreases in levels of blood glucose (P<0.01), 24-hour urinary protein, and Scr (P<0.01), alleviated pathological changes in glomeruli and tubules, and reduced degree of glomerular and tubular fibrosis. The high-dose SQDHD group and the dapagliflozin group showed reductions in Fe2+, MDA, LPO, and ROS levels (P<0.01). The medium- and high-dose SQDHD groups and the dapagliflozin group exhibited increased levels of GPX4 and xCT (P<0.01), decreased levels of ACSL4, LPCAT3, and ALOX15 (P<0.05, P<0.01), and down-regulated mRNA levels of ACSL4, LPCAT3, and ALOX15 (P<0.01). ConclusionSQDHD ameliorates DKD by inhibiting ferroptosis potentially by reducing iron ion levels, inhibiting lipid peroxidation, up-regulating GPX4 expression, and down-regulating ACSL4 expression. This study provides new insights and a theoretical basis for the treatment of DKD with traditional Chinese medicine and identifies potential targets for developing novel therapeutics for DKD.
2.Shenqi Dihuang Decoction Improves Renal Function in Mouse Model of Diabetic Kidney Disease by Inhibiting Arachidonic Acid-related Ferroptosis Via ACSL4/LPCAT3/ALOX15 Axis
Yuantao WU ; Zhibin WANG ; Xinying FU ; Xiaoling ZOU ; Wenxiao HU ; Yixian ZOU ; Jun FENG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(12):140-149
ObjectiveTo investigate the therapeutic effects and mechanism of Shenqi Dihuang decoction (SQDHD) on diabetic kidney disease (DKD), with a focus on its impact on arachidonic acid-related ferroptosis. MethodsSixty C57BL/6 mice were allocated into a normal group (n=10) and a modeling group (n=50), with 43 mice successfully modeled. The successfully modeled mice were further allocated into model, low-, medium-, and high-dose (4.68, 9.36, and 18.72 g·kg-1, respectively) SQDHD, and dapagliflozin (0.13 mg·kg-1) groups. The drug treatment groups were administrated with corresponding agents by gavage, and the normal and model groups were administrated with equal volumes of normal saline by gavage. An electronic balance and a glucometer were used to monitor the body weight and fasting blood glucose level from the tail tip, respectively. Serum creatinine (Scr) and blood urea nitrogen (BUN) levels were measured by enzyme-linked immunosorbent assay (ELISA). Histopathological changes in the renal tissue were assessed by hematoxylin-eosin staining, Masson staining, and periodic acid-Schiff (PAS) staining. The fluorescence intensity of reactive oxygen species (ROS) in frozen sections was observed by an inverted fluorescence microscope to evaluate the levels of ferrous ions (Fe2+) and lipid peroxidation in the renal tissue. Immunofluorescence staining of glutathione peroxidase 4 (GPX4) and acyl-CoA synthetase long-chain family member 4 (ACSL4) in the renal tissue was performed to detect their localization and expression. Western blot was employed to assess the expression levels of key ferroptosis proteins such as GPX4 and cystine/glutamate antiporter (xCT), as well as the arachidonic acid metabolic pathway-related proteins, including ACSL4, lysophosphatidylcholine acyltransferase 3 (LPCAT3), and arachidonate 15-lipoxygenase (ALOX15). Real-time PCR was employed to measure the mRNA levels of key ferroptosis proteins, including solute carrier family 7 member 11 (SLC7A11) and GPX4, as well as arachidonic acid metabolism-related factors (ACSL4, LPCAT3, and ALOX15) in the renal tissue. ResultsCompared with the normal group, DKD model mice exhibited a decrease in body weight (P<0.01), increases in levels of blood glucose (P<0.01), 24-hour urinary protein, Scr, and BUN (P<0.01), along with severe pathological changes, such as mesangial cell proliferation, basement membrane thickening, tubular atrophy, and interstitial inflammatory cell infiltration. In addition, the modeling elevated the levels of Fe2+, MDA, LPO, and ROS (P<0.01), lowered the GPX4 and xCT levels (P<0.01), raised the ACSL4, LPCAT3, and ALOX15 levels (P<0.01), down-regulated the mRNA levels of GPX4 and SLC7A11 (P<0.01), and up-regulated the mRNA levels of ACSL4, LPCAT3, and ALOX15 (P<0.01) in the renal tissue. Compared with the model group, low-, medium-, and high-dose SQDHD groups and the dapagliflozin group showed an increase in body weight (P<0.01), decreases in levels of blood glucose (P<0.01), 24-hour urinary protein, and Scr (P<0.01), alleviated pathological changes in glomeruli and tubules, and reduced degree of glomerular and tubular fibrosis. The high-dose SQDHD group and the dapagliflozin group showed reductions in Fe2+, MDA, LPO, and ROS levels (P<0.01). The medium- and high-dose SQDHD groups and the dapagliflozin group exhibited increased levels of GPX4 and xCT (P<0.01), decreased levels of ACSL4, LPCAT3, and ALOX15 (P<0.05, P<0.01), and down-regulated mRNA levels of ACSL4, LPCAT3, and ALOX15 (P<0.01). ConclusionSQDHD ameliorates DKD by inhibiting ferroptosis potentially by reducing iron ion levels, inhibiting lipid peroxidation, up-regulating GPX4 expression, and down-regulating ACSL4 expression. This study provides new insights and a theoretical basis for the treatment of DKD with traditional Chinese medicine and identifies potential targets for developing novel therapeutics for DKD.
3.Ras Guanine Nucleotide-Releasing Protein-4 Inhibits Erythropoietin Production in Diabetic Mice with Kidney Disease by Degrading HIF2A
Junmei WANG ; Shuai HUANG ; Li ZHANG ; Yixian HE ; Xian SHAO ; A-Shan-Jiang A-NI-WAN ; Yan KONG ; Xuying MENG ; Pei YU ; Saijun ZHOU
Diabetes & Metabolism Journal 2025;49(3):421-435
Background:
In acute and chronic renal inflammatory diseases, the activation of inflammatory cells is involved in the defect of erythropoietin (EPO) production. Ras guanine nucleotide-releasing protein-4 (RasGRP4) promotes renal inflammatory injury in type 2 diabetes mellitus (T2DM). Our study aimed to investigate the role and mechanism of RasGRP4 in the production of renal EPO in diabetes.
Methods:
The degree of tissue injury was observed by pathological staining. Inflammatory cell infiltration was analyzed by immunohistochemical staining. Serum EPO levels were detected by enzyme-linked immunosorbent assay, and EPO production and renal interstitial fibrosis were analyzed by immunofluorescence. Quantitative real-time polymerase chain reaction and Western blotting were used to detect the expression of key inflammatory factors and the activation of signaling pathways. In vitro, the interaction between peripheral blood mononuclear cells (PBMCs) and C3H10T1/2 cells was investigated via cell coculture experiments.
Results:
RasGRP4 decreased the expression of hypoxia-inducible factor 2-alpha (HIF2A) via the ubiquitination–proteasome degradation pathway and promoted myofibroblastic transformation by activating critical inflammatory pathways, consequently reducing the production of EPO in T2DM mice.
Conclusion
RasGRP4 participates in the production of renal EPO in diabetic mice by affecting the secretion of proinflammatory cytokines in PBMCs, degrading HIF2A, and promoting the myofibroblastic transformation of C3H10T1/2 cells.
4.Ras Guanine Nucleotide-Releasing Protein-4 Inhibits Erythropoietin Production in Diabetic Mice with Kidney Disease by Degrading HIF2A
Junmei WANG ; Shuai HUANG ; Li ZHANG ; Yixian HE ; Xian SHAO ; A-Shan-Jiang A-NI-WAN ; Yan KONG ; Xuying MENG ; Pei YU ; Saijun ZHOU
Diabetes & Metabolism Journal 2025;49(3):421-435
Background:
In acute and chronic renal inflammatory diseases, the activation of inflammatory cells is involved in the defect of erythropoietin (EPO) production. Ras guanine nucleotide-releasing protein-4 (RasGRP4) promotes renal inflammatory injury in type 2 diabetes mellitus (T2DM). Our study aimed to investigate the role and mechanism of RasGRP4 in the production of renal EPO in diabetes.
Methods:
The degree of tissue injury was observed by pathological staining. Inflammatory cell infiltration was analyzed by immunohistochemical staining. Serum EPO levels were detected by enzyme-linked immunosorbent assay, and EPO production and renal interstitial fibrosis were analyzed by immunofluorescence. Quantitative real-time polymerase chain reaction and Western blotting were used to detect the expression of key inflammatory factors and the activation of signaling pathways. In vitro, the interaction between peripheral blood mononuclear cells (PBMCs) and C3H10T1/2 cells was investigated via cell coculture experiments.
Results:
RasGRP4 decreased the expression of hypoxia-inducible factor 2-alpha (HIF2A) via the ubiquitination–proteasome degradation pathway and promoted myofibroblastic transformation by activating critical inflammatory pathways, consequently reducing the production of EPO in T2DM mice.
Conclusion
RasGRP4 participates in the production of renal EPO in diabetic mice by affecting the secretion of proinflammatory cytokines in PBMCs, degrading HIF2A, and promoting the myofibroblastic transformation of C3H10T1/2 cells.
5.Ras Guanine Nucleotide-Releasing Protein-4 Inhibits Erythropoietin Production in Diabetic Mice with Kidney Disease by Degrading HIF2A
Junmei WANG ; Shuai HUANG ; Li ZHANG ; Yixian HE ; Xian SHAO ; A-Shan-Jiang A-NI-WAN ; Yan KONG ; Xuying MENG ; Pei YU ; Saijun ZHOU
Diabetes & Metabolism Journal 2025;49(3):421-435
Background:
In acute and chronic renal inflammatory diseases, the activation of inflammatory cells is involved in the defect of erythropoietin (EPO) production. Ras guanine nucleotide-releasing protein-4 (RasGRP4) promotes renal inflammatory injury in type 2 diabetes mellitus (T2DM). Our study aimed to investigate the role and mechanism of RasGRP4 in the production of renal EPO in diabetes.
Methods:
The degree of tissue injury was observed by pathological staining. Inflammatory cell infiltration was analyzed by immunohistochemical staining. Serum EPO levels were detected by enzyme-linked immunosorbent assay, and EPO production and renal interstitial fibrosis were analyzed by immunofluorescence. Quantitative real-time polymerase chain reaction and Western blotting were used to detect the expression of key inflammatory factors and the activation of signaling pathways. In vitro, the interaction between peripheral blood mononuclear cells (PBMCs) and C3H10T1/2 cells was investigated via cell coculture experiments.
Results:
RasGRP4 decreased the expression of hypoxia-inducible factor 2-alpha (HIF2A) via the ubiquitination–proteasome degradation pathway and promoted myofibroblastic transformation by activating critical inflammatory pathways, consequently reducing the production of EPO in T2DM mice.
Conclusion
RasGRP4 participates in the production of renal EPO in diabetic mice by affecting the secretion of proinflammatory cytokines in PBMCs, degrading HIF2A, and promoting the myofibroblastic transformation of C3H10T1/2 cells.
6.Ras Guanine Nucleotide-Releasing Protein-4 Inhibits Erythropoietin Production in Diabetic Mice with Kidney Disease by Degrading HIF2A
Junmei WANG ; Shuai HUANG ; Li ZHANG ; Yixian HE ; Xian SHAO ; A-Shan-Jiang A-NI-WAN ; Yan KONG ; Xuying MENG ; Pei YU ; Saijun ZHOU
Diabetes & Metabolism Journal 2025;49(3):421-435
Background:
In acute and chronic renal inflammatory diseases, the activation of inflammatory cells is involved in the defect of erythropoietin (EPO) production. Ras guanine nucleotide-releasing protein-4 (RasGRP4) promotes renal inflammatory injury in type 2 diabetes mellitus (T2DM). Our study aimed to investigate the role and mechanism of RasGRP4 in the production of renal EPO in diabetes.
Methods:
The degree of tissue injury was observed by pathological staining. Inflammatory cell infiltration was analyzed by immunohistochemical staining. Serum EPO levels were detected by enzyme-linked immunosorbent assay, and EPO production and renal interstitial fibrosis were analyzed by immunofluorescence. Quantitative real-time polymerase chain reaction and Western blotting were used to detect the expression of key inflammatory factors and the activation of signaling pathways. In vitro, the interaction between peripheral blood mononuclear cells (PBMCs) and C3H10T1/2 cells was investigated via cell coculture experiments.
Results:
RasGRP4 decreased the expression of hypoxia-inducible factor 2-alpha (HIF2A) via the ubiquitination–proteasome degradation pathway and promoted myofibroblastic transformation by activating critical inflammatory pathways, consequently reducing the production of EPO in T2DM mice.
Conclusion
RasGRP4 participates in the production of renal EPO in diabetic mice by affecting the secretion of proinflammatory cytokines in PBMCs, degrading HIF2A, and promoting the myofibroblastic transformation of C3H10T1/2 cells.
7.PU.1 regulation of type 1 dendritic cell function via NF-κB pathway in inhibition of non-small cell lung cancer progression.
Tingting WANG ; Yishuo LI ; Qiongyu DUAN ; Chunlei WANG ; Yixian WANG ; Tianyu HU
Journal of Pharmaceutical Analysis 2025;15(7):101154-101154
This research investigates the regulatory role of the transcription factor PU.1 in type 1 conventional dendritic cells (cDC1) and its therapeutic potential of modulating the nuclear factor kappaB (NF-κB) cells signaling pathway in non-small cell lung cancer (NSCLC). Utilizing single-cell transcriptome sequencing and comprehensive bioinformatics tools, including the CIBERSORT algorithm, we analyzed the immune cell landscape within NSCLC tissues. Our analysis revealed distinct NSCLC subtypes and delineated the developmental trajectories and functional distinctions of cDC1 cells. Key differentially expressed genes (DEGs) and pivotal functional modules within these cells were identified, highlighting PU.1 as a critical mediator underexpressed in NSCLC samples. Functionally, PU.1 demonstrated the induction of the NF-κB pathway, which led to inhibited tumor proliferation and enhanced activation of cDC1, thereby suggesting its role in tumor immune surveillance. In vivo models confirmed the suppressive effect of PU.1 on NSCLC progression, mediated through its influence on cDC1 functionality via the NF-κB pathway. These findings propose PU.1 as a promising target for NSCLC therapeutic strategies, emphasizing the importance of transcriptional regulators in the tumor microenvironment.
8.The effect of the AIM2 inflammasome in noise-induced cognitive dysfunction in rats
Kangyong WU ; Yixian REN ; Yanmei RUAN ; Jialuo MA ; Caixia LI ; Zhi WANG
Chinese Journal of Industrial Hygiene and Occupational Diseases 2024;42(5):332-339
Objective:To explore the effect of the absent in melanoma 2 (AIM2) -mediated neuroinflammation in noise-induced cognitive dysfunction in rats.Methods:In April 2023, sixteen male Wistar rats were randomly divided into control group and noise group, with 8 rats in each group. The rats in the noise group were placed in 50 cm×50 cm×40 cm transparent boxes and exposed to 100 dB (A) white noise with a sound pressure level of 100 dB (A) (4 h/d for 30 d) . At the same time, rats in the control group were kept in similar boxes with environmental noise less than 60 dB (A) . After 30 days of noise exposure, the Morris water maze experiment was applied to test the learning and memory abilities of the rats; the pathological morphology of hippocampal tissues was observed by Hematoxylin-Eosin (HE) staining. Western blot was used to detect the protein expression levels of AIM2, cysteinyl aspartate specific proteinase-1 (caspase-1) , apoptosis-associated speck-like protein (ASC) , interleukin-1β (IL-1β) , IL-18, ionic calcium-binding articulation molecule-1 (Iba-1) , and glial fibrillary acidic protein (GFAP) . The expression of both Iba-1 and GFAP in hippocampal tissue was assessed by immunohistochemical staining. The co-localization of AIM2 with Iba-1 or GFAP was determined by immunofluorescence double staining.Results:Compared with the control group, the escape latency of rats in the noise group was increased by 16.29 s, 17.71 s, and 20.26 s on days 3, 4, and 5, respectively. On day 6, the noise-exposed rats spent shorter time in the target quadrant and had fewer times in crossing the platform[ (7.25±2.27) s and (1.13±0.64) times] than the control group[ (15.64±3.99) s and (4.25±2.12) times] ( P<0.05) . After noise exposure, hippocampal neurons of rats displayed marked nuclear hyperchromatic and pyknosis phenomenon. The noise-exposed rats had higher numbers of both microglia and astrocytes (27.00±2.65 and 43.33±5.51) in the DG area of the hippocampus relative to the control group (14.67±3.06 and 20.00±4.58) ( P<0.05) . Moreover, the glial cells in the noise group had larger cell cytosol with more and thicker branches. The protein expression levels of inflammatory cytokines Cleaved-IL-1β and Cleaved-IL-18 in the hippocampus of rats in the noise group (1.55±0.19 and 1.74±0.12) were significantly higher than the control group (1.00±0.11 and 1.00±0.13) ( P<0.05) . After noise exposure, the protein expression levels of AIM2, Cleaved-Caspase-1 and ASC (1.19±0.09, 1.34±0.07 and 1.14±0.01) were higher than the control group (1.00±0.07, 1.00±0.14 and 1.00±0.06) and differences between the two groups were statistically significant ( P<0.05) . A significant increase in the number of cells co-localizing AIM2 with Iba-1 or GFAP in the noise group (28.67±4.04 and 40.67±5.13) compared with the control group (15.67±4.04 and 17.67±3.79) , and statistically significant differences were observed between the two groups ( P<0.05) . Conclusion:Noise exposure may activate the AIM2 inflammasome in hippocampal glial cells of rats, releasing excessive inflammatory cytokines and causing neuroinflammation that damages neurons.
9.The 5-year relative survival rate among cancer patients in Henan province of China, 2015-2019
Qiong CHEN ; Mingxia ZHANG ; Lanwei GUO ; Liyang ZHENG ; Chunya LIU ; Yixian WANG ; Yin LIU ; Hong WANG ; Huifang XU ; Ruihua KANG ; Xiaoyang WANG ; Shuzheng LIU ; Shaokai ZHANG
Chinese Journal of Oncology 2024;46(10):954-960
Objective:To analyze the 5-year relative survival rate of cancer in Henan province based on cancer registration data.Methods:Cancer survival data were extracted from the cancer registration database of Henan province with the diagnosis date between January 1, 2010 and December 31, 2019 were included. The closing date of follow-up was set as December 31, 2019. The 5-year relative survival rate of cancer was calculated using the period survival analysis method and the Ederer II method in the R package "periodR", and the interest period was between 2015 and 2019.Results:During the period of 2015-2019, the overall 5-year relative survival rate of cancer patients in Henan province was 43.6%, and after age-standardization, it was 40.2%. The overall 5-year relative survival rate showed the characteristics of higher survival rate in females than males (45.9% vs 34.7%, Z=39.60, P<0.001) and higher survival rate in urban areas than rural areas (44.9% vs 39.1%, Z=12.97, P<0.001). The 5-year relative survival rate for cancer patients among children aged 0-14 was 60.2%, and for adults aged 15 and above, it was 43.5%, which was standardized to 40.2% after age adjustment. There are two types of cancers with a standardized 5-year relative survival rate exceeding 70% (thyroid cancer at 82.2% and breast cancer at 71.6%), and four cancers with a rate below 30% (pancreatic cancer at 18.2%, liver cancer at 19.6%, lung cancer at 24.0%, and gallbladder cancer at 26.6%). Conclusion:The cancer 5-year survival rate in Henan Province is lower than that of the national average, indicating the need for continued enhancement of cancer prevention and control measures.
10.The 5-year relative survival rate among cancer patients in Henan province of China, 2015-2019
Qiong CHEN ; Mingxia ZHANG ; Lanwei GUO ; Liyang ZHENG ; Chunya LIU ; Yixian WANG ; Yin LIU ; Hong WANG ; Huifang XU ; Ruihua KANG ; Xiaoyang WANG ; Shuzheng LIU ; Shaokai ZHANG
Chinese Journal of Oncology 2024;46(10):954-960
Objective:To analyze the 5-year relative survival rate of cancer in Henan province based on cancer registration data.Methods:Cancer survival data were extracted from the cancer registration database of Henan province with the diagnosis date between January 1, 2010 and December 31, 2019 were included. The closing date of follow-up was set as December 31, 2019. The 5-year relative survival rate of cancer was calculated using the period survival analysis method and the Ederer II method in the R package "periodR", and the interest period was between 2015 and 2019.Results:During the period of 2015-2019, the overall 5-year relative survival rate of cancer patients in Henan province was 43.6%, and after age-standardization, it was 40.2%. The overall 5-year relative survival rate showed the characteristics of higher survival rate in females than males (45.9% vs 34.7%, Z=39.60, P<0.001) and higher survival rate in urban areas than rural areas (44.9% vs 39.1%, Z=12.97, P<0.001). The 5-year relative survival rate for cancer patients among children aged 0-14 was 60.2%, and for adults aged 15 and above, it was 43.5%, which was standardized to 40.2% after age adjustment. There are two types of cancers with a standardized 5-year relative survival rate exceeding 70% (thyroid cancer at 82.2% and breast cancer at 71.6%), and four cancers with a rate below 30% (pancreatic cancer at 18.2%, liver cancer at 19.6%, lung cancer at 24.0%, and gallbladder cancer at 26.6%). Conclusion:The cancer 5-year survival rate in Henan Province is lower than that of the national average, indicating the need for continued enhancement of cancer prevention and control measures.

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