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Background@#This study evaluated the diagnostic yield and positive predictive factors of post-percutaneous core needle biopsy (PCNB) sputum cytology in diagnosing malignancy. @*Methods@#This retrospective study included patients who underwent PCNB at a single center from January 2014 to March 2022. Patient demographics, lung lesion characteristics on computed tomography, underlying lung disease, post-PCNB complications, histopathologic results of PCNB, post-PCNB sputum specimens, and final diagnoses were reviewed. The diagnostic yields and related factors were analyzed. @*Results@#Overall, 177 consecutive patients with sputum specimens obtained after PCNB for intrapulmonary lesions were enrolled. Among them, 152 patients had a final diagnosis of malignancy. Diagnostic sputum specimens with atypical or malignant cells were obtained in 12 patients. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of sputum cytology were 7.89%, 100%, 20.90%, 100%, and 15.15%, respectively. Lesion size, air-bronchogram, lesion multiplicity, and the cell type of squamous cell and adenocarcinoma differed significantly between the groups with diagnostic versus non-diagnostic sputum (p<0.05). The lesion size (odds ratio [OR], 1.035; 95% confidence interval [CI], 1.008–1.064; p=0.013), presence of air-bronchogram (OR, 23.485; 95% CI, 2.532–217.316; p=0.005), and squamous cell carcinoma (OR, 7.397; 95% CI, 1.773–30.865; p=0.006) were significantly associated with a diagnostic sputum specimen post-PCNB. @*Conclusions@#Although post-PCNB sputum cytology had low sensitivity in diagnosing lung cancer, it showed diagnostic results in some peripheral lung cancer patients who have squamous cell types, relatively large tumors, and air-bronchograms in the lesions.
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Background@#Dermatophyte infection is one of the most common skin diseases affecting the skin, hair, and nails. Despite widespread recognition of the disease, missing details and misperceptions are commonplace in the general population. @*Objective@#This study aimed to investigate the public perception and behavior regarding dermatophytosis of the hands and feet. @*Methods@#This results from an online survey conducted between July 2022 and August 2022. The survey included 1,000 Korean participants aged 20 to 69 years, of whom 60% experienced symptoms of tinea pedis or onychomycosis. The questionnaire focused on the awareness and personal experience of tinea pedis and perception of the treatment of dermatophytosis. @*Results@#Of the 1,000 participants, nearly 80% regarded tinea pedis as a common skin condition by which anyone can be affected. Furthermore, 88.4% had heard that the treatment of tinea pedis could be harmful, causing skin rash (60.4%) and worsening liver function (48.5%). Among 896 participants who noticed suspicious symptoms, 81.2% did not visit the clinic because it was not severe (50.1%) and seemed easily manageable (25.7%). Of the respondents, 84.4% preferred to meet dermatologists rather than non-dermatologist doctors regarding skin diseases, mainly because of trust in experts and belief in a faster cure. @*Conclusion@#Providing accurate and detailed information via online media, educational campaigns, and medical papers can rectify misconceptions and improve patient appliance, contributing to public skin health.
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Purpose@#Several predictive models have been developed to predict the pathological complete response (pCR) after neoadjuvant chemotherapy (NAC); however, few are broadly applicable owing to radiologic complexity and institution-specific clinical variables, and none have been externally validated. This study aimed to develop and externally validate a machine learning model that predicts pCR after NAC in patients with breast cancer using routinely collected clinical and demographic variables. @*Methods@#The electronic medical records of patients with advanced breast cancer who underwent NAC before surgical resection between January 2017 and December 2020 were reviewed. Patient data from Seoul National University Bundang Hospital were divided into training and internal validation cohorts. Five machine learning techniques, including gradient boosting machine (GBM), support vector machine, random forest, decision tree, and neural network, were used to build predictive models, and the area under the receiver operating characteristic curve (AUC) was compared to select the best model. Finally, the model was validated using an independent cohort from Seoul National University Hospital. @*Results@#A total of 1,003 patients were included in the study: 287, 71, and 645 in the training, internal validation, and external validation cohorts, respectively. Overall, 36.3% of the patients achieved pCR. Among the five machine learning models, the GBM showed the highest AUC for pCR prediction (AUC, 0.903; 95% confidence interval [CI], 0.833–0.972).External validation confirmed an AUC of 0.833 (95% CI, 0.800–0.865). @*Conclusion@#Commonly available clinical and demographic variables were used to develop a machine learning model for predicting pCR following NAC. External validation of the model demonstrated good discrimination power, indicating that routinely collected variables were sufficient to build a good prediction model.
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In this comprehensive review, we discuss recent updates on tinnitus evaluation and treatment. Tinnitus evaluation commences with comprehensive medical history taking and audiological evaluation, which can provide valuable insight into the nature and extent of auditory disturbances. Additionally, tinnitus evaluation includes investigation of psychosomatic comorbidities to determine the intricate interplay between psychological factors and tinnitus perception. Various therapeutic approaches are available to minimize the burden of tinnitus. Cognitive behavioral therapy reshapes negative thought patterns and behaviors that are closely associated with tinnitus-induced distress. Acceptance and commitment therapy fosters mindfulness and value-aligned actions to address emotional effects. Tinnitus retraining therapy combines counseling and sound therapy for habituation. Tailor-made notched music therapy offers customized auditory experiences for symptom relief. Hearing aids and cochlear implants compensate for hearing loss and associated stress. Both neuromodulation and neurofeedback may be potentially useful. The role of pharmacotherapy and dietary supplements remains uncertain. Physiotherapy and head-neck manipulation relieve tinnitus associated with orofacial factors. Virtual reality, smartphone applications, and photobiomodulation may serve as novel therapeutic avenues. Although promising interventions are available, further research is warranted to confirm their effectiveness and long-term effects.
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Background and Objectives@#The guidelines for cochlear implantation (CIs) are expanding, and the number of CI procedures performed on the elderly is increasing. The purpose of this study was to analyze the results and safety of cochlear implantation in the elderly, as well as to evaluate the predictive factors on CI outcomes. @*Subjects and Methods@#The study included 56 patients aged ≥40 years, who received CIs between 2009 and 2020. They were divided into two groups: 27 younger adults (40-64 years) and 29 elderly (>64 years). The study compared their pre- and postoperative speech perception and category of auditory performance (CAP) scores, surgical complications, and hospitalization periods. It also evaluated associated factors in the elderly group by examining categorical and continuous variables and postoperative CAP score. @*Results@#There was a significant improvement in speech recognition tests (both word and sentence) and CAP scores in both groups compared to the pre-implantation scores (p<0.001). Postoperative results were slightly lower in the elderly group than in younger adults for sentence recognition and CAP scores, except for word recognition. No significant associated factors were found on postoperative CAP scores, except for etiology. Postoperative CAP significantly improved in the sudden hearing loss group compared to the groups with other etiologies (p=0.045). The elderly group had more comorbidities than that in the younger adult group (p=0.026), but there were no significant differences in postoperative complications and hospitalization periods. @*Conclusions@#While speech recognition and CAP scores were relatively lower in the elderly group compared to the younger adults, the elderly group showed significant improvements in audiological results after CI. Moreover, CI was safe and well tolerated in elderly patients.
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Background@#Atopic dermatitis (AD) patients usually wonder if their condition will worsen after vaccination or if they should continue with the treatment they are receiving. Considering that many patients treated with dupilumab had previously experienced severe AD symptoms and flares, the concerns are more understandable. @*Objective@#This study aimed to investigate the safety of the coronavirus disease 2019 (COVID-19) vaccination in patients with AD treated with dupilumab. @*Methods@#We enrolled 133 patients (101 dupilumab-treated and 32 systemic oral agentstreated as control group) with AD from six hospitals. Patients were asked about worsening pruritus and AD (5-point Likert scale) after vaccination. AD variables (eczema area and severity index [EASI], investigator’s global assessment [IGA], itch numerical rating scale [NRS], sleep NRS, and patient-oriented eczema measure [POEM]) were compared pre- and postvaccination. Adverse reactions to the COVID-19 vaccination were observed. @*Results@#The incidence of adverse reactions to COVID-19 vaccines and worsening AD symptoms in dupilumab-treated patients were not significantly different compared with that in the control group. The itch NRS score increased significantly after vaccination (p<0.001).However, there were no statistically significant differences between the pre-and post-EASI, IGA, and POEM scores. Eight patients (7.9%) had worse EASI scores and required rescue therapy; however, most were easily managed with low-dose steroids or topical agents. None of the patients discontinued dupilumab treatment. @*Conclusion@#No serious adverse reactions were observed in patients with AD after COVID-19 vaccination. Exacerbation of pruritus and AD symptoms was observed but was mostly mild and transient.
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Aerosolized antibiotics are being increasingly used to treat respiratory infections, especially those caused by drug-resistant pathogens. Their use in the treatment of hospital-acquired pneumonia and ventilator-associated pneumonia in critically ill patients is especially significant. They are also used as an efficient alternative to overcome the issues caused by systemic administration of antibiotics, including the occurrence of drug-resistant strains, drug toxicity, and insufficient drug concentration at the target site. However, the rationale for the use of aerosolized antibiotics is limited owing to their insufficient efficacy and the potential for underestimated risks of developing side effects. Despite the lack of availability of high-quality evidence, the use of aerosolized antibiotics is considered as an attractive alternative treatment approach, especially in patients with multidrug-resistant pathogens. In this review, we have discussed the effectiveness and side effects of aerosolized antibiotics as well as the latest advancements in this field and usage in the Republic of Korea.
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We report a case of a pseudoaneurysm secondary to skull base osteomyelitis (SBO) in an 82-year-old female. The patient was hospitalized with an acute episode of bleeding from the right ear, which persisted despite packing placed in the ear. We suspected bleeding from the internal carotid artery (ICA) and performed angiography, which revealed a pseudoaneurysm that presumably developed secondary to invasion of the wall of the petrous segment of the right ICA, and the patient underwent emergency coil embolization. Bleeding from the ear recurred a week later, and we performed repeat angiography, followed by embolization and deployment of multiple stents at the site of the pseudoaneurysm, which controlled the bleeding. Clinicians should be mindful of a pseudoaneurysm as a rare complication of SBO, following the spread of infection to adjacent soft tissues or vessels. A pseudoaneurysm should be considered in the differential diagnosis in patients with recurrent epistaxis or bleeding from the ears in addition to cranial nerve symptoms, and this condition warrants urgent evaluation.
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Background@#In a previous study, we carried out whole-exome sequencing to identify genetic variants associated with early onset atopic dermatitis (AD) in Koreans and found that collagen VI α6 chain (COL6A6) gene polymorphisms are associated. COL6A6 is one of the chains that makes up the triple helix of collagen VI, and little is known about its role in AD. @*Objective@#To identify how COL6A6 changes in AD and clarify its role. @*Methods@#Immunohistochemical staining for COL6A6 was performed on tissues of AD, other skin diseases, and healthy controls. Human keratinocytes and fibroblasts were exposed to inflammatory cytokines and cultured to evaluate changes in COL6A6 expression. COL6A6 small interfering RNA (siRNA) was transfected into cells to identify the role of COL6A6. @*Results@#Total COL6A6 mRNA was higher in AD than in controls. In AD tissues, COL6A6 mRNA decreased significantly in the epidermis compared to controls, whereas COL6A6 protein was increased in the dermis. In the cultured cells, COL6A6 mRNA was suppressed in the epidermis by interleukin (IL)-4 and IL-13, whereas COL6A6 protein was induced in the dermis. In the COL6A6 siRNA-transfected keratinocyte, mRNA of FLG, LOR, and CASP14 decreased compared to controls; in contrast, mRNA of MMP1 increased. @*Conclusion@#The reduction of epidermal COL6A6 due to the genetic mutation can cause skin barrier damage and it can contributes to the early onset of AD. COL6A6 is induced by IL-4 and IL-13, and it may play a role in fibrotic remodeling and inflammatory processes, which are major features of AD.
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Ectopic thymic neoplasm, particularly ectopic thymic carcinoma, is a rare disease that presents as a neck mass. Here, we present a case of ectopic thymic squamous carcinoma in a 65-year-old man who presented with persistent hoarseness. After fine needle aspiration cytology, the patient underwent total thyroidectomy with lymph node dissection. The final histopathological examination revealed the ectopic thymic squamous carcinoma. The patient was discharged without any postoperative complications. The patient received adjuvant radiation therapy and did not progress during the 1-year follow-up period.
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Syphilis is a sexually transmitted disease caused by Treponema pallidum, which can invade various organs. Syphilis can also cause otologic symptoms such as hearing impairment, tinnitus or dizziness and these otologic symptoms can occur at any stage of syphilis and can be associated with neurosyphilis. We report here a case of rapid progressive neurosyphilis showing hearing impairment in a patient with ankylosing spondylitis. He was treated with anti-interleukin 17A monoclonal antibody. Since syphilis is one of the causes of reversible sensorineural hearing loss and syphilis infection with immunosuppression can cause progressive hearing loss if patients in immunomodulatory therapy have sensorineural hearing loss, the possibility of syphilis should be considered.
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Background@#Rapid social media development has led to excessive medical misinformation. In this regard, the field of dermatology is no exception. There is persistent prejudice against dermatological drugs, and many patients hesitate to take them. @*Objective@#We aimed to resolve the misconception that dermatological drugs are harmful, by analyzing the results of online surveys regarding the public behavior and perception of dermatological drugs. @*Methods@#We analyzed the results of an online survey conducted by a research institution. The survey, which had been conducted between September 2020 and October 2020, included 900 online participants aged 10 to 69 years who had taken dermatological drugs. The online questionnaire consisted of items regarding patients’ behavior in relation to skin diseases and taking dermatological drugs, and their perception of dermatological drugs. @*Results@#The main reasons for withdrawal of dermatological drugs were concerns regarding the burden of long-term use and side effects. Except for that provided by physicians, most information regarding dermatological drugs was obtained online. The most commonly reported adverse reaction was heartburn, followed by dryness, and thirst. The proportion of responders who considered dermatological drugs to be harmful was 56.1%. To address this misconception, most respondents suggested that detailed explanations of the prescribed drugs should be provided by a dermatologist, as well as vigorous communication via online media, medical papers, and educational campaigns. @*Conclusion@#Addressing misconceptions through detailed explanations and active communication can improve patient compliance, and ultimately, the general public’s skin health.
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Elastosis perforans serpiginosa (EPS) is a rare condition that belongs to the group of acquired perforating dermatosis. It usually appears as keratotic papules in serpiginous configuration with central atrophy on the head, nape, and extremities. It is characterized by the transepidermal elimination of elastic fibers with clumping and vertical orientation of elastic fibers. In many cases, it is associated with genetic or connective tissue diseases. A 26-year-old female patient with Down syndrome presented with brownish keratotic papules on both arms. The lesion had been present for 2 years, but there were no symptoms. The biopsy specimen showed transepidermal elimination of the degenerated elastic fibers. Verhoeff elastic staining revealed an increased number of thick elastic fibers. Based on these findings, the patient was diagnosed with EPS. Treatment with CO 2 laser was performed with a successful outcome.
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Background@#Although several characteristics of coronavirus disease 2019 (COVID-19), an ongoing pandemic disease, have been identified, data on the infectivity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are limited. @*Methods@#This prospective cohort study was conducted to analyze the infectivity of SARSCoV-2 based on data of all patients diagnosed with COVID-19 confirmed using real-time polymerase chain reaction test from January to April 2020 in Gyeonggi-do, the largest province in Korea. @*Results@#Of the 502 patients, 298 consisting of 106 clusters with 5,909 contacts were included. Of these, 277 (93.0%) were symptomatic, and the most common symptoms were cough, fever, sputum, sore throat, and headache. A total of 94 patients (31.5%) had pneumonia, while 8 (2.7%) died during the follow-up period. The secondary attack rate (SAR) in the study population was 3.5% (204/5,909). In exposure settings, the SAR was higher in religious gathering (13.5% [95% confidence interval, 10.7–16.8%]), workplaces (8.49% [95% CI, 6.08–11.74%]), and schools (6.38% [95% CI, 3.39–11.69%]) than in health care facilities (1.92% [95% CI, 1.45–2.55%]). Sore throat at any period, dyspnea at diagnosis or any period, lower cycle threshold value in the lower respiratory tract samples, leukocytosis, and higher bilirubin levels were associated with higher infectivity of COVID-19. The presence of symptoms was not related to the infectivity. @*Conclusion@#In establishing the infection control strategies for COVID-19, the variables associated with high infectivity may be considered.
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BACKGROUND@#Polarization sensitive-optical coherence tomography (PS-OCT) provides the unique advantage of being able to measure the optical characteristics of tissues by using polarized light. Although the well-organized fibers of healthy muscle can change the polarization states of passing light, damaged tissue has different behaviors. There are studies on optical imaging methods applied to the respiratory organs; however, they are restricted to structural imaging. In particular, the intercostal muscle situated under the pleura is very challenging to visualize due to the difficulty of access.METHOD: In this study, PS-OCT was used to identify subpleural cancer in male New Zealand white rabbits (3.2–3.4 kg) and to assess the phase retardation changes in normal and cancerous chest walls. VX2 cell suspension was injected between the intercostal muscle and parietal pleura and a tented area was observed by thoracic scope. A group of rabbits (n = 3) were sacrificed at day 7 after injection and another group (n = 3) at day 14. @*RESULTS@#In the PS-OCT images, pleura thickness changes and muscle damage were criteria to understand the stages of the disease. The results of image and phase retardation analysis matched well with the pathologic examinations. @*CONCLUSION@#We were able to visualize and analyze subpleural cancer by PS-OCT, which provided structural and functional information. The measured phase retardation could help to identify the margin of the tumor. For further studies, various approaches into other diseases using polarization light are expected to have positive results.
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BACKGROUND@#Polarization sensitive-optical coherence tomography (PS-OCT) provides the unique advantage of being able to measure the optical characteristics of tissues by using polarized light. Although the well-organized fibers of healthy muscle can change the polarization states of passing light, damaged tissue has different behaviors. There are studies on optical imaging methods applied to the respiratory organs; however, they are restricted to structural imaging. In particular, the intercostal muscle situated under the pleura is very challenging to visualize due to the difficulty of access.METHOD: In this study, PS-OCT was used to identify subpleural cancer in male New Zealand white rabbits (3.2–3.4 kg) and to assess the phase retardation changes in normal and cancerous chest walls. VX2 cell suspension was injected between the intercostal muscle and parietal pleura and a tented area was observed by thoracic scope. A group of rabbits (n = 3) were sacrificed at day 7 after injection and another group (n = 3) at day 14. @*RESULTS@#In the PS-OCT images, pleura thickness changes and muscle damage were criteria to understand the stages of the disease. The results of image and phase retardation analysis matched well with the pathologic examinations. @*CONCLUSION@#We were able to visualize and analyze subpleural cancer by PS-OCT, which provided structural and functional information. The measured phase retardation could help to identify the margin of the tumor. For further studies, various approaches into other diseases using polarization light are expected to have positive results.
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A 57-year-old man with left flank pain was referred to our institute. Computed tomography scans revealed two enhancing masses in the left kidney. The clinical diagnosis was renal cell carcinoma (RCC). He underwent a radical nephrectomy with an adrenalectomy. Two well-circumscribed solid masses in the hilum and the lower pole (4.5 × 3.5 cm and 7.0 × 4.1 cm) were present. Poorly cohesive uniform round to polygonal epithelioid cells making solid sheets accounted for most of the tumor area. The initial diagnosis was RCC, undifferentiated with rhabdoid features. As the tumor showed loss of INI1 expression and a mutation in the SMARCB1 gene on chromosome 22, the revised diagnosis was a malignant rhabdoid tumor (MRT) of the kidney. To date, only a few cases of renal MRT in adults have been reported. To the best of our knowledge, this is the first report of MRT in the native kidney of an adult demonstrating a SMARCB1 gene mutation, a hallmark of MRT.
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COVID-19 has caused extensive human casualties with significant economic impacts around the globe, and has imposed new challenges on health systems worldwide. Over the past decade, SARS, Ebola, and Zika also led to significant concerns among the scientific community. Interestingly, the SARS and Zika epidemics ended before vaccine development; however, the scholarly community and the pharmaceutical companies responded very quickly at that time. Similarly, when the genetic sequence of SARSCoV-2 was revealed, global vaccine companies and scientists have stepped forward to develop a vaccine, triggering a race toward vaccine development that the whole world is relying on. Similarly, an effective and safe vaccine could play a pivotal role in eradicating COVID-19. However, few important questions regarding SARS-CoV-2 vaccine development are explored in this review.
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BACKGROUND@#We aimed to validate a pilot study of photodiagnosis using near infrared (NIR) transillumination and assess the clinical efficacy of hypericin-mediated photodynamic therapy (HYP-PDT) in a rabbit laryngeal cancer model in order to develop a novel therapeutic modality with complete remission and preservation of the functional organ. @*METHODS@#(1) In vitro study: VX tumor cells were subcultured and subjected to HYP-PDT. (2) In vivo study: A laryngeal cancer model was developed in which 12 rabbits were inoculated with a VX tumor suspension in the submucosal area of the left vocal fold using a transoral approach. All rabbits underwent NIR transillumination using light with a wavelength of 780 nm. The survival periods of the three treatment groups (6 rabbits in Group A: HYP-PDT, 3 each in Groups B and C: laser irradiation or HYP administration only) were analyzed. @*RESULTS@#The higher the HYP concentration, the lower the VX cell viability in response to HYP-PDT using 590 nm LED. Following HYP-PDT, small tumors in Group A-1 rabbits healed completely and the animals demonstrated a long survival period, and larger tumors in Group A-2 healed partially with a survival period that extended over 3 weeks after inoculation. The survival of Groups B and C were not different over the first 3 weeks of the study, and were shorter than in Group A. @*CONCLUSION@#We found HYP-PDT could be a curative therapy for early-stage cancers that may also preserve organ function, and may inhibit tumor progression and metastasis during advanced stages of laryngeal cancer.
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Glioblastoma multiforme (GBM) is the most lethal type of brain tumor and its prognosis was extremely poor. Here, we studied the clinical and prognostic value of telomerase reverse transcriptase (TERT) and GA Binding Protein Transcription Factor Subunit Beta 1 longer (GABPB1L) mRNA expression in GBM by using open big data. In total 152 GBM patients, gene expressions were downloaded from the Cancer Genome Atlas (TCGA) data and its values were statistically analyzed. TCGA data showed that GABPB1L mRNA expression levels did not correlate with those of TERT mRNA (r = -0.027, p = 0.744). GABPB1L and TERT expressions in GBM were associated with subtype by gene expression. GABPB1L (562.7 ± 76.8 days vs. 479.1 ± 5.8 days, p = 0.401) and TERT (468.1 ± 43.6 days vs. 565.3 ± 75.8 days, p = 0.403) expression was not associated with GBM prognosis. However, disease-free survival was tended to be different in GBM patients according to TERT and GABPB1L expressions though it did not get statistical significance (2122.6 ± 160.2 days vs. 1381.1 ± 244.0 days, p = 0.072). These genes may contribute to the GBM pathogenesis and its further study should be performed in GBM patients and cell lines.