This retrospective study involved 96 patients, divided into a control group (50) and a prehabilitation group (46), to assess the impact of early nutrition support on patients with nasopharyngeal carcinoma (NPC) undergoing concurrent chemoradiotherapy. The control group followed a traditional diet, while the prehabilitation group received nutritional guidance and oral nutritional supplements. Results showed that the prehabilitation group had significantly better nutritional and inflammatory indicators compared to the control group ( P < .05). However, high-density lipoprotein cholesterol levels were lower in the prehabilitation group. The study suggests that nutritional prehabilitation plays a crucial role in maintaining nutritional and inflammatory status in patients with NPC.

The aim of this study is to conduct a retrospective analysis on the correlation between lymph node staining and lymph node metastasis following laparoscopic radical resection of colorectal cancer using a carbon nanoparticles tracer. Additionally, the study seeks to investigate the potential clinical implications of carbon nanoparticles (CNs) in the context of colorectal cancer surgery. Clinical data was collected from patients who underwent laparoscopic radical resection of colorectal cancer at a ward of the Department of General Surgery, Nanjing Drum Tower Hospital between January 2022 and December 2023. Patients were pathologically confirmed to have primary colorectal cancer with lymph node metastasis. The patients were divided into two groups based on whether they received carbon nanoparticle suspension injection under colonoscopy prior to the operation: the carbon nanoparticles group (CNs group, n = 80) and the control group (non-CNs group, n = 39). The histological sections of all lymph nodes were reviewed, assessing lymph node staining and tumor metastasis. There were no statistically significant differences in sex, age, body mass index, operation time, blood loss, tumor location, and postoperative pathological stage between the CNs group and the control group. However, the average number of lymph nodes differed significantly between the two groups (P = 0.001). A total of 1626 lymph nodes were obtained from the CNs group. Among these, 207 were identified as metastatic lymph nodes, with 27 showing staining with carbon nanoparticles (1.66%) and 182 showing no staining (11.19%). Of the remaining 1417 normal lymph nodes, 787 were found to be stained with carbon nanoparticle (48.4%) while 630 were not. Out of the 80 patients in the CNs group, none exhibited staining solely in metastatic lymph nodes, 56 patients (70%) did not exhibit staining in either metastatic or normal lymph nodes, 19 patients (23.75%) exhibited staining in both metastatic and normal lymph nodes, and 5 patients (6.25%) did not exhibit staining in either type of lymph node. The utilization of carbon nanoparticle staining prior to laparoscopic colorectal cancer surgery has been shown to enhance the detection of lymph nodes, providing valuable assistance to surgeons and pathologists. However, the efficacy of carbon nanoparticle staining in identifying metastatic lymph nodes is limited, as non-metastatic lymph nodes may also be stained. Consequently, reliance solely on lymph node staining for precise dissection during surgery is not advisable. There is a critical need for the development of more accurate active targeting tracers.

IntroductionColorectal cancer (CRC) is a prevalent digestive malignancy with significant global mortality and morbidity rates. Improving diagnostic capabilities for CRC and investigating novel therapeutic approaches are pressing clinical imperatives. Additionally, carcinoembryonic antigen (CEA) has emerged as a highly promising candidate for both colorectal tumor imaging and treatment.MethodsA novel active CEA-targeting nanoparticle, CEA(Ab)-MSNs-ICG-Pt, was designed and synthesized, which served as a tumor-specific fluorescence agent to help in CRC near-infrared (NIR) fluorescence imaging. In cell studies, CEA(Ab)-MSNs-ICG-Pt exhibited specific targeting to RKO cells through specific antibody-antigen binding of CEA, resulting in distribution both within and around these cells. The tumor-targeting-specific imaging capabilities of the nanoparticle were determined through in vivo fluorescence imaging experiments. Furthermore, the efficacy of the nanoparticle in delivering chemotherapeutics and its killing effect were evaluated both in vitro and in vivo.ResultsThe CEA(Ab)-MSNs-ICG-Pt nanoparticle, designed as a novel targeting agent for carcinoembryonic antigen (CEA), exhibited dual functionality as a targeting fluorescent agent. This CEA-targeting nanoparticle showed exceptional efficacy in eradicating CRC cells in comparison to individual treatment modalities. Furthermore, it exhibits exceptional biosafety and biocompatibility properties. CEA(Ab)-MSNs-ICG-Pt exhibits significant promise due to its ability to selectively target tumors through NIR fluorescence imaging and effectively eradicate CRC cells with minimal adverse effects in both laboratory and in vivo environments.ConclusionThe favorable characteristics of CEA(Ab)-MSNs-ICG-Pt offer opportunities for its application in chemotherapeutic interventions, tumor-specific NIR fluorescence imaging, and fluorescence-guided surgical procedures.

Abstract Background Colorectal signet-ring cell carcinoma (SRCC) is a rare cancer with a bleak prognosis. The relationship between its clinicopathological features and survival remains incompletely elucidated. Tumor deposits (TD) have been utilized to guide the N staging in the 8th edition of American Joint Committee on Cancer (AJCC) staging manual, but their prognostic significance remains to be established in colorectal SRCC. Patients and methods The subjects of this study were patients with stage III/IV colorectal SRCC who underwent surgical treatment. The research comprised two cohorts: a training cohort and a validation cohort. The training cohort consisted of 631 qualified patients from the SEER database, while the validation cohort included 135 eligible patients from four independent hospitals in China. The study assessed the impact of TD on Cancer-Specific Survival (CSS) and Overall Survival (OS) using Kaplan-Meier survival curves and Cox regression models. Additionally, a prognostic nomogram model was constructed for further evaluation. Results In both cohorts, TD-positive patients were typically in the stage IV and exhibited the presence of perineural invasion (PNI) (P < 0.05). Compared to the TD-negative group, the TD-positive group showed significantly poorer CSS (the training cohort: HR, 1.87; 95% CI, 1.52–2.31; the validation cohort: HR, 2.43; 95% CI, 1.55–3.81; all P values < 0.001). This association was significant in stage III but not in stage IV. In the multivariate model, after adjusting for covariates, TD maintained an independent prognostic value (P < 0.05). A nomogram model including TD, N stage, T stage, TNM stage, CEA, and chemotherapy was constructed. Through internal and external validation, the model demonstrated good calibration and accuracy. Further survival curve analysis based on individual scores from the model showed good discrimination. Conclusion TD positivity is an independent factor of poor prognosis in colorectal SRCC patients, and it is more effective to predict the prognosis of colorectal SRCC by building a model with TD and other clinically related variables.

目的 探究营养助理模式对头颈部肿瘤患者根治性放化疗期间营养方案执行程度、营养状况和身心状态的影响.方法 收集 2018 年 6 月至 2021 年12 月南京鼓楼医院肿瘤中心收治的头颈部肿瘤患者,采用随机数字表法将观察对象随机分为两组,对照组(常规护理模式,n=72)和干预组(营养助理模式,n=66).所有患者均采用根治性同步放化疗方案.比较两组能量和蛋白质的实际摄入量、心理、生活质量和营养指标变化.结果 治疗过程中,两组能量摄入量减少幅度差异无统计学意义(P＞0.05),同时干预组蛋白质的摄入量高于对照组,差异有统计学意义(P＜0.05);心理及生活质量方面,医院焦虑抑郁评估量表(HADS)评分和生活质量量表Karnofsky功能状态(KPS)评分,干预组的评分均优于对照组,差异有统计学意义(P＜0.05);营养指标方面,干预组在体重和血清白蛋白指标上均优于对照组,差异有统计学意义(P＜0.05),而C反应蛋白指标两组无统计学差异(P＞0.05).结论 在头颈部肿瘤根治性放化疗中,营养助理模式可能有利于帮助患者维持能量摄入水平,从而使患者维持较好的营养状况和身心健康状态.

Clinical nutrition therapy is an important part of comprehensive diagnosis and treatment of modern medicine, so that students majoring in nutrition must master relevant theories and skills. However, compared with the rapid development of clinical medicine, the construction and development of clinical nutrition specialty in Chinese medical institutions are not ideal. which makes some effects on the construction and development of clinical nutrition discipline because the level of practice teaching lags behind. In order to improve the practical skills of nutrition students and promote the development of clinical nutrition science in China,we hope to explore a new innovative application of holistic thought in clinical nutrition practice teaching by analyzing the characteristics of teaching model in Clinical Nutrition.

The annual morbidity and mortality due to gastric cancer are still high across the world, posing a serious threat to public health. Improving the diagnosis rate of gastric cancer and exploring new treatments are urgent issues in the clinical field. In recent years, photosensitizer (PS)-based photodynamic therapy (PDT) has proven to be an effective cancer treatment strategy and can be used to treat a variety of cancers. Developing PSs with tumor-targeting ability and high singlet oxygen yield (Φ(1O2)) is the key to improving the PDT effect. Herein, we developed a novel diagnosis and treatment system (Cy1395-NPs). Our active thio-photosensitizer is based on the sulfur substitution strategy as it can reduce the S1-T1 energy gap, which can promote the process of intersystem crossing (ISC), thus resulting in high ROS generation efficiency. Cy1395-NPs exhibited stable spectral characteristics, satisfactory biocompatibility and high 1O2 yield under laser irradiation due to the introduction of the sulfur atom. In cellular studies, Cy1395-NPs could specifically target MKN45 cells via integrin αvβ3-mediated cRGD endocytosis and selectively aggregate in the mitochondria. Cy1395-NPs had no obvious cytotoxicity for MKN45 cells and exerted obvious phototoxicity due to the production of 1O2 under laser irradiation. The in vivo results showed that the fluorescence signal from the tumor site was obviously enhanced in 16-48 h, and Cy1395-NPs could selectively target solid tumors with a retention time of about 32 h. Under laser irradiation, Cy1395-NPs significantly inhibited tumor growth and led to significant tumor suppression and apoptosis. In summary, the developed Cy1395-NPs could actively target tumors and exert mitochondrial selectivity, showing an excellent fluorescence imaging effect. Under the irradiation of an 808 nm laser, Cy1395-NPs achieved good inhibition of gastric cancer cells both in vitro and in vivo, thus displaying the functions of tumor targeting, mitochondrial selectivity, fluorescence imaging and tumor inhibition. Our strategy provides a new diagnostic and treatment method for gastric cancers in clinical settings.

Objective:To explore the diagnosis and treatment experience of bipolar coagulation forceps combined with ultrasonic knife transcervical approach for resection of retrosternal goiter.Methods:The medical records of 34 patients with retrosternal goiter admitted from July 2013 to December 2020 were retrospectively reviewed.Results:According to preoperative classification，there were 9 cases of typeⅠ，17 cases of type Ⅱ and 8 cases of type Ⅲ. Among the 34 patients，23 cases had no obvious clinical symptoms，1 case showed fear of heat and hyperhidrosis，and 10 cases showed pressure symptoms such as dysphagia，dyspnea and hoarseness. Postoperative pathology showed that 31 cases were benign，1 case was papillary thyroid carcinoma，1 case was follicular thyroid carcinoma，and 1 case was thyroid schwannoma. The transcervical approach was preferred in all patients，and four of them combined with sternotomy. The incidence of postoperative complications was 8.8%（3/34）. All patients had temporary limb numbness after operation，and their symptoms disappeared after calcium supplementation.Conclusion:After adequate preoperative evaluation and preparation，bipolar electrocoagulation forceps combined with ultrasonic knife is safe and effective in the transcervical approach to remove retrosternal goiter，which can perform "fine anatomy" during the operation，and maximize the protection of parathyroid gland，recurrent laryngeal nerve and other perithyroid tissues and organs.

Histidine-rich calcium binding protein (HRC) is a new type of Ca2+ homeostasis regulator, which acts as a nonnegligible role in regulating intracellular calcium homeostasis. Here, we demonstrated that HRC expression was upregulated in human gastric cancer (GC) samples, and its expression level was closely correlated with the overall survival (OS) rate of GC patients and the malignant potential of GC cell lines. Knockdown of HRC inhibited migration, invasion, and proliferation of GC cell lines in vitro, while HRC overexpression promoted GC cell migration, invasion, and proliferation in vitro, as well as the growth of subcutaneous tumors and peritoneal tumors in vivo. In terms of the mechanism, knockdown of HRC reduced the intracellular calcium ion level and the CaM protein level. Through cell function experiments, we found that HRC regulated the Raf/MEK/ERK pathway through Ca2+/CaM signaling and ultimately affected the epithelial-mesenchyme transition (EMT) of GC. In summary, we revealed that HRC represents a potential target for GC treatment.

目的:探索导致老年肺部感染患者死亡相关危险因素,为早期准确识别和干预高危老年患者提供科学依据.方法:回顾性分析我院2011年7月～2017年1月因肺部感染住院老年患者病历,通过单因素及多因素回归分析同时期存活和死亡老年肺部感染患者的临床资料.结果:老年住院肺部感染患者共225例,死亡组低BMI、吸烟史、慢性阻塞性肺疾病、慢性肾脏病、体温>38.5℃、消化道出血、管饲率、下肢水肿、白细胞≥10×109/L及中性粒细胞≥70％、血红蛋白≤90 g/L、CRP≥100 mg/L、白蛋白≤30 g/L、肌酐≥104 mmol/L、血钾异常、低氧血症、二氧化碳潴留、鲍曼不动杆菌检出率、使用呼吸机的病例数均高于存活组(P<0.05).通过二分类Logistic回归分析提示低BMI、体温>38.5℃、消化道出血、低氧血症、二氧化碳潴留有统计学意义.结论:老年肺部感染患者临床病情复杂,临床结局受多种因素影响,低BMI、体温>38.5℃、消化道出血、低氧血症、二氧化碳潴留均提示预后不佳,是其独立危险因素.

目的 比较日间手术开展初期与住院手术在腹股沟疝无张力修补手术中的临床疗效与医疗费用差异,总结我院开展日间手术以来的部分经验.方法 回顾性收集南京大学医学院附属鼓楼医院从2017年1—10月收治的单侧腹股沟疝日间手术与住院手术患者各50例,比较其临床疗效与医疗费用差异.结果 两组患者手术时间、术中出血量及术后并发症(阴囊及会阴积液水肿、中度以上疼痛、补片异物感、切口脂肪液化或感染、术后复发)均无明显差异(P>0.05);日间手术患者的住院时间与住院费用低于住院手术患者(P<0.05).结论 对腹股沟疝患者行无张力修补手术时,采用日间手术与住院手术临床疗效相仿,但日间手术方式总费用明显低于住院手术方式总费用,减轻了患者经济负担,提高了床位周转率,但对于开展日间手术初期,仍存在许多问题,需在病人满意度、治疗方案选择等方面进行不断的改进.

Increasing attention is focused on the down-regulation of miRNAs in cancer process. Nuclear receptor subfamily 2 (NR2F2, also known as COUP-TFII) is involved in the development of many types of cancers, but its role in gastric cancer remains elusive. In this experiment, oncomine and Kaplan-meier database revealed that NR2F2 was up-regulated in gastric cancer and that the high NR2F2 expression contributed to poor survival. MicroRNA-27b was targeted and down-regulated by NR2F2 in human gastric cancer tissues and cells. The ectopic expression of miR-27b inhibited gastric cancer cell proliferation and tumor growth in vitroand in vivo. Assays suggested that the overexpression of miR-27b could promote MGC-803 cells’ migration and invasion and retard their metastasis to the liver. In addition, down-regulation of miR-27b enhanced GES-1 cells’ proliferation and metastasis in vitro. These findings reveal that miR-27b is a tumor suppressor in gastric cancer and a biomarker for improving patients’ survival.

Breast cancer is the most common type of malignancy among females. Previous studies examining breast cancer tissue have demonstrated the presence of stem cells, and have detected octamer‑binding protein 4 (Oct4) and Nanog transcription factor expression. In the present study, breast cancer stem cells (CSCs) were isolated and enriched from MDA‑MB‑231 breast cancer cell lines, and were defined as MDA‑MB‑231 stem cells using flow cytometry. The expression of Oct4 and Nanog in breast CSCs were detected by quantitative polymerase chain reaction and western blotting. RNA interference (RNAi) was used in order to downregulate the expression of Oct4 and Nanog. Drug resistance and tumor‑initiating capability following in vivo injection of MDA‑MB‑231 stem cells trans-duced with negative RNAi, Oct4 RNAi and Nanog RNAi were compared with that of MDA‑MB‑231 stem cells without siRNA transfection as a control group. In addition the capability of MDA‑MB‑231 breast cancer cells to initiate tumor formation in mice was compared with that of MDA‑MB‑231 stem cells. A paclitaxel inhibition test was also conducted in order to detect resistance of MDA‑MB‑231 breast cancer stem cells to this treatment. The MDA‑MB‑231 stem cells were revealed to exhibit elevated percentages of the cluster of differentiation (CD)44+CD24‑/low subset, high tumorigenicity and resistance to chemotherapy, all of which are characteristic stem cell properties. In addition, the MDA‑MB‑231 stem cells were more tumorigenic in vivo. Furthermore, the breast CSCs also expressed high levels of the Oct4 and Nanog transcription factors. Therefore, downregulation of Oct4 or Nanog expression may reduce chemotherapeutic drug resistance and tumorigenicity in breast CSCs. In conclusion, Oct4 and Nanog expression may be a key factor in the development of resistance to chemotherapy and tumor growth of breast CSCs. This finding indicates that Oct4 or Nanog‑targeted therapy may be a promising means of overcoming resistance to chemotherapy and inhibiting tumor growth in breast cancer treatment.

Ischemia/reperfusion (I/R) is associated with leukocyte accumulation and tissue injury. The aim of this research was to investigate the protective effect of simvastatin on hind limb I/R inflammation and tissue damage. Mice were subjected to hind limb ischemic insult for 2 h and were simultaneously administered an intraperitoneal injection of simvastatin (5 mg/kg); this was followed by 36 h of reperfusion. Myeloperoxidase (MPO) levels in the muscles of the hind limb were determined. CXC chemokines and pro-inflammatory cytokines, such as macrophage inflammatory protein (MIP)-2, cytokine-induced neutrophil chemoattractant (KC), interleukin (IL)-6, tumor necrosis factor (TNF)-α, and P-selectin, were assessed using enzyme-linked immunosorbent assay (ELISA). Leukocyte rolling and adhesion in vitro was assessed to indicate leukocyte recruitment at the site of inflammation. Quantitative measurement of skeletal muscle tissue injury was performed. The fluorescent dye level in tissue and serum was used to determine hind limb vascular leakage and tissue edema after I/R. Systemic and differentiated leukocytes were also counted. Simvastatin significantly reduced MIP-2, KC, TNF-α, MPO, IL-6, and P-selectin levels compared to the sham group and I/R plus pretreatment with phosphate-buffered saline (PBS) group (P<0.05). Compared to the sham group and I/R plus PBS group, the I/R plus simvastatin group had attenuated inflammation, vascular leakage, and muscular damage (P<0.05). Simvastatin also significantly inhibited leukocyte rolling and adhesion compared to PBS (P<0.05). Our results suggest that simvastatin may be an effective protectant against tissue injury associated with I/R.

OBJECTIVE:To study the impact of preoperative enteral immune nutrition on patients with malignant gastrointestinal tumors. METHODS:82 patients with malignant gastrointestinal tumors were divided equally into 2 groups:enteral nutrition group (EN) and normal diet group (Control). Enteral Nutritional Emulsion (TPF-T) served as nasogastically-fed liquid diet for the patients in EN group over a period of 7 days prior to surgery. Normal diet was given to the patients in control group under the same condition as those in EN group in terms of calories and nitrogen contents. Enzyme linked immunosorbent assay (ELISA) was performed to determine the quantity of serum albumin (ALB), transferrin protein (TRF), pre-albumin (PA) and retinol binding protein (RBP). Flow cytometry (FCM) was performed to determine T cell subsets. Postoperative complications, resumption of peristalsis, length of hospital stay, and nutritional costs were also recorded. RESULTS:TRF, PA and RBP increased significantly in the patients in EN group compared with those in control group (P < 0.05). The patients in EN group had significantly higher proportions of CD3+, CD4+/CD8+ higher than those of control (P < 0.05). No serious complications (eg. death or gastrointestinal fistula) were found in the patients. The total nutritional cost for the patients in EN group was similar to that of the controls (P > 0.05). The patients in EN group had less postoperative complications, quicker resumption of peristalsis, shorter hospital stay and lower level of postoperative nutrition cost compared with those of controls (P < 0.05). CONCLUSION:Enteral nutrition support can improve the nutritional status and immunity of patients with malignant gastrointestinal tumors, which has both pre-operative and post-operative benefits for the patients.

OBJECTIVE:To explore the therapeutic efficacy of double suicide gene system driven by carcinoembryonic antigen (CEA) promoter (Cp-CDglyTK) on colorectal carcinoma xenograft in nude mice. METHODS:The plasmid pcDNA3.1(-)Cp-CDglyTK was transfected into the CEA-positive SW480 and CEA-negative HeLa cells respectively. The expression of suicide gene was detected by RT-PCR. And the transfected cells were treated with 5-fluorocytosine (5-FC) and ganciclovir (GCV) at different concentrations and the cell-killing and bystander effects assayed by methyl thiazolyl tetrazolium (MTT). By a transplantation of cultivated cells, SW480 or HeLa cell lines were injected subcutaneously into right axillary of nude mice to establish 96 SW480 and 72 HeLa tumor animal models. Nude mice were completely randomized with statistical software according to tumor volume. For prodrug therapy, 48 SW480-bearing mice were divided equally into 4 groups of I-IV. At the same time, 48 HeLa-bearing mice were divided equally into 4 groups of V-VIII. Groups I & V received an intratumoral injection of PBS, groups II & VIGCV and 5-FC intratumorally, groups III & VII PBS intraperitoneally and groups IV & VIII GCV and 5-FC intraperitoneally. Forty-eight SW480-bearing mice were divided equally into 4 groups of IX∼XII and 24 Hela-bearing ones into groups of & in therapy experiment by suicide gene plus prodrug. Six groups received an intratumoral injection of liposome Lipofectamine and plasmid CP-CDglyTK and then an intraperitoneal injection of drug. The groups of IX and received an injection of PBS, group X GCV, group XI 5-FC and groups XII & GCV and 5-FC. The observation parameters included tumor bulk, tumor weight, survival time and treatment effect in each group. RESULTS:SW480 cells transfected by plasmid pcDNA3.1(-)Cp- CDglyTK expressed CDglyTK gene. The inhibition rates of GCV and 5-FC were significantly higher than those of HeLa cells (59.87% ± 0.21% vs 9.90% ± 0.09%, P < 0.01). And higher inhibition rates and stronger bystander effect existed in double versus single produg (all P < 0.05). Tumor size, final tumor weight and survival time of nude mice in groups ofII, IV, VI & VIII had no significant difference with groups ofI, III, V & VII (all P < 0.05). Final tumor size and weight of group XII was significantly smaller than those of groups of IX, X and XI ((150.0 ± 3.2) vs (522.5 ± 1.9) and (256.8 ± 10.4) and (260.7 ± 2.2) mm(3), (54.1 ± 10.4) vs (682.0 ± 12.0) and (251.8 ± 15.1) and (271.6 ± 17.7) mg, all P < 0.05). Meanwhile, the tumor inhibition rate and survival time of group XII(92.1% and (25.7 ± 0.8)d) were significant higher and longer than group X (63.1% and (21.8 ± 0.5) d) and group XI (60.2% and (18.0 ± 0.9) d) (all P < 0.05). However, no significant difference existed in tumor size, final tumor weight and survival time between groups and (all P > 0.05). The inhibition rate of group was merely 0.9%. CONCLUSION:CDglyTK double suicide gene system driven by CEA promoter may inhibit CEA positive colorectal cancer xenograft in prodrug-treated nude mice.

Twist2 is a highly conserved basic helix-loop-helix transcription factor that plays a critical role in embryogenesis. Recent evidence has revealed that aberrant Twist2 expression contributes to tumor progression; however, the role of Twist2 in human hepatocellular carcinoma (HCC) and its underlying mechanisms remain undefined. In this report, we demonstrate that Twist2 is overexpressed in human HCC tumors. We show that ectopic expression of Twist2 induces epithelial-mesenchymal transition phenotypes, augments cell migration and invasion and colony-forming abilities in human HCC cells in vitro, and promotes tumor growth in vivo. Moreover, we found a higher percentage of CD24(+) liver cancer stem-like cells in Twist2-transduced HCC cells. Twist2-expressing cells exhibited an increased expression of stem cell markers Bmi-1, Sox2, CD24 and Nanog and an increased capacity for self-renewal. Knockdown of CD24 in HepG2/Twist2 cells decreased the levels of Sox2, pSTAT3 and Nanog, and reversed the cancer stem-like cell phenotypes induced by ectopic expression of Twist2. Furthermore, Twist2 regulated the CD24 expression by directly binding to the E-box region in CD24 promoter. Therefore, our data demonstrated that Twist2 augments liver cancer stem-like cell self-renewal in a CD24-dependent manner. Twist2-CD24-STAT3-Nanog pathway may play a critical role in regulating liver cancer stem-like cell self-renewal. The identification of the Twist2-CD24 signaling pathway provides a potential therapeutic approach to target cancer stem cells in HCCs.