CI보험중 '중대한 암'(Critical cancer)의 정의에 관한 Medical Underwriting의 제한적요소에 관한 고찰

정헌종,Chung, Hun-Jong 한국생명보험의학회 2006 保險醫學會誌 Vol.25 No.-

The definition of 'critical cancer' in critical insurance(CI) is more insurance meanings than medical meanings. The difference between critical cancer of insurance and critical cancer of medical cancer is made difficult problem to the underwriting of insurer, contractor and medical doctor. The limited factors of underwriting in critical cancer of critical insurance as follows: (1) the limitation factors in the definition of 1st item critical cancer in CI 1) the definition differences of meanings in insurer, contractor, and medical doctor 2) the meanings of "the table of malignance" 3) the definition difference between 'critical cancer' and 'a large of medical expense cancer' (2) the limitation factors in the definition of second item critical cancer in CI 1) The limitation in the change of cancer character 2) The missing malignancy in pathological result due to localized cancer 3) The differences in the test result of hospital (3) the limitation factors in the definition of third item critical cancer in CI. 1) the lower items disobey the higher items 2) clinical malignancy of benign cancer pathologically 3) others: (1) low grade of malignant melanoma (2) early prostate cancer. (3) malignancy related HIV (4) all skin cancer excepted malignant melanoma (5) accepted clinically and a medical certificate by medical doctor as critical cancer of premalignant lesion, carcinoma-in-situ, and borderline cancer.

국내 직업성암의 언더라이팅

정헌종,Chung, Hun-Jong 한국생명보험의학회 2008 保險醫學會誌 Vol.27 No.2

Now, we have experienced that the loss ratio of cancer insurance with prevalence of cancer increased. The insurance companies interest how the loss ratio of cancer insurance decrease. To decrease the loss of ratio of cancer, underwriting is very important. The underwriting of cancer are very important factors which are family history, habitual behavior and past history. We have spend the most of time under the occupational situation. Occupation may be very important factor causing cancer. But we neglect the occupation history. This article show how the underwriting of the occupational cancers in the field of occupation are managed Generally, Occupational cancers show special characteristic features. We know the characteristics of occupational cancer under the variety of occupation. For the underwriting of occupational cancer in Korea, we also understand the epidemiology of Korean occupational cancer with the varieties of occupation This article shows the characteristics of occupational cancer and epidemiology of Korean occupational cancers.

말초신경재생을 위한 hNGF-$\beta$ recombinant Adenovirus의 제작 및 수종세포주에서 신경성장인자의 발현

고은봉,정헌종,안강민,김윤태,박희정,성미애,김남열,유상배,명훈,황순정,김명진,김성민,장정원,이종호,Gao, En-Feng,Chung, Hun-Jong,Ahn, Kang-Min,Kim, Yoon-Tae,Park, Hee-Jung,Sung, Mi-Ae,Kim, Nam-Yeol,Yoo, Sang-Bae,Myoung, Hoon,Hwang, Soon-Jung,Kim 대한악안면성형재건외과학회 2005 Maxillofacial Plastic Reconstructive Surgery Vol.27 No.5

Nerve growth factor(NGF) has a critical role in peripheral nerve regeneration. The aim of this study is to construct a well-functioning hNGF-$\beta$ recombinat adenovirus for the ultimate development of improved method to promote peripheral nerve regeneration with adenovirus mediated hNGF-$\beta$ gene transfection into Schwann cells. First PCR associated cloning of GFP-tagged hNGF-$\beta$ which was ligated into E1/E3 deleted adenoviral vector was performed and tranfected into E. coli to construct hNGF-$\beta$ recombinant adenovirus. After production of recombinat adenovirus in a large scale, its transfection efficiency, expression, and function were evaluated using cell lines or primarily cultured cells of HEK293 cells, Schwann cells, fibroblast(NIH3T3) and myocyte(CRH cells). GFP expression was observed in 90% of infected cells compared to uninfected cells. Total mRNA isolated from hNGF-$\beta$ recombinat adenoviru infected cells showed strong RT-PCR band, however, LacZ recombinant adenovirus infected or uninfected cells did not. NGF quantification by ELISA showed a maximal release of 18.865 +/- 0.31ng/mL at 4th day. PC-12 cells exposed to media with hNGF-$\beta$ recombinant adenovirus infected Schwann cell demonstrated higher levels of differentiation compared with controls. We generated hNGF-$\beta$ recombinant adenovirus and induced over expression of NGF successfully in nonneuronal and neuronal cells. Following these result, it is expected to develop an improved treatment strategy peripheral nerve regeneration using the hNGF-$\beta$ gene transfected cells.

가토모델에서 배양 구강상피를 이용한 근-점막 피판의 형성에 관한 연구

신영민,정헌종,안강민,박희정,성미애,김성민,황순정,김명진,장정원,김성포,양은경,송계영,이종호,Shin, Young-Min,Chung, Hun-Jong,Ahn, Kang-Min,Park, Hee-Jung,Sung, Mi-Ae,Kim, Soung-Min,Hwang, Soon-Jung,Kim, Myung-Jin,Jahng, Jeong-Won,Kim, Sung-P 대한악안면성형재건외과학회 2005 Maxillofacial Plastic Reconstructive Surgery Vol.27 No.3

Purpose : Extensive defect of oral and maxillofacial area is usually reconstructed with composite flap including skin paddle. However, if the defects are lined with only skin components, the mucosa's role in mastication and texture are not restored. Furthermore, stiffness and hair-growing prevent denture rehabilitation and good oral hygiene. This study was performed to overcome the disadvantages of composite soft tissue flaps including the skin and to make a model for myo-mucosal flaps. Materials and methods : Buccal mucosa sized $0.5\times1.0\;cm^2$ from New Zealand rabbit (around 1.5kg) was harvested and cultivated by the modification of Rheinwald and Green's keratinocyte culture method. Cultured mucosa was grafted on the fascia of latismus dorsi as form of mucosal sheet. After 7, 10, 14 days, the myomucosal flap was excised and evaluated under light microscope with H & E and immunohistochemical staining. As control group, harvested buccal mucosa from rabbit was transplanted to gracilis muscle(n=6). Results : From 7 days after prelamination, the basal layer of the grafted mucosa resembled that of normal mucosa. As control group, transplanted mucosa had original shape but there's slight inflammatory reaction. Prelaminated mucosa has 19.8$\pm$4.59 cell layers and some samples have more than 20 layers. The expression rate of PCNA was relatively strong (42.9%$\pm$14.1) at the basal layer of grafted mucosa and the laminin was found at the basal layer. On the contrary, prelaminated mucosa at 10 days showed moderate expression rate of PCNA(32.4%$\pm$4.62). We found the mucosal layer was somehow disappeared and there is strong inflammatory reaction. After 14 days prelamination, the grafted oral keratinocytes were almost disappeared and expression of PCNA was not observed. Conclusion : We can make 75 fold large mucosal($3850mm^2$) sheet from small samples of mucosa $(50mm^2)$. Epithelial sheet that grafted on the fascia of muscle underwent differentiation and proliferation. But after 10, 14 days, there was strong inflammatory reaction and the grafted mucosa was destroyed from surface layer. In rabbit model, transfer of fascio-mucosal flap should be done from 7 to 10 days after prelamination.

백서 설신경 압박손상모델에서 신경성장인자 유전자 주입이 신경재생에 미치는 영향

고은봉,정헌종,안강민,김성민,김윤희,장정원,이종호,Gao, En-Feng,Chung, Hun-Jong,Ahn, Kang-Min,Kim, Soung-Min,Kim, Yun-Hee,Jahng, Jeong-Won,Lee, Jong-Ho 대한악안면성형재건외과학회 2006 Maxillofacial Plastic Reconstructive Surgery Vol.28 No.5

Purpose: Lingual nerve (LN) damage may be caused by either tumor resection or injury such as wisdom tooth extraction, Although autologous nerve graft is sometimes used to repair the damaged nerve, it has the disadvantage of necessity of another operation for nerve harvesting. Moreover, the results of nerve grafting is not satisfactory. The nerve growth factor (NGF) is well-known to play a critical role in peripheral nerve regeneration and its local delivery to the injured nerve has been continuously tried to enhance nerve regeneration. However, its application has limitations like repeated administration due to short half life of 30 minutes and an in vivo delivery model must allow for direct and local delivery. The aim of this study was to construct a well-functioning $rhNGF-{\beta}$ adenovirus for the ultimate development of improved method to promote peripheral nerve regeneration with enhanced and extended secretion of hNGF from the injured nerve by injecting $rhNGF-{\beta}$ gene directly into crush-injured LN in rat model. Materials and Methods: $hNGF-{\beta}$ gene was prepared from fetal brain cDNA library and cloned into E1/E3 deleted adenoviral vector which contains green fluorescence protein (GFP) gene as a reporter. After large scale production and purification of $rhNGF-{\beta}$ adenovirus, transfection efficiency and its expression at various cells (primary cultured Schwann cells, HEK293 cells, Schwann cell lines, NIH3T3 and CRH cells) were evaluated by fluorescent microscopy, RT-PCR, ELISA, immunocytochemistry. Furthermore, the function of rhNGF-beta, which was secreted from various cells infected with $rhNGF-{\beta}$ adenovirus, was evaluated using neuritogenesis of PC-12 cells. For in vivo evaluation of efficacy of $rhNGF-{\beta}$ adenovirus, the LNs of 8-week old rats were exposed and crush-injured with a small hemostat for 10 seconds. After the injury, $rhNGF-{\beta}$ adenovirus($2{\mu}l,\;1.5{\times}10^{11}pfu$) or saline was administered into the crushed site in the experimental (n=24) and the control group (n=24), respectively. Sham operation of another group of rats (n=9) was performed without administration of either saline or adenovirus. The taste recovery and the change of fungiform papilla were studied at 1, 2, 3 and 4 weeks. Each of the 6 animals was tested with different solutions (0.1M NaCl, 0.1M sucrose, 0.01M QHCl, or 0.01M HCl) by two-bottle test paradigm and the number of papilla was counted using SEM picture of tongue dorsum. LN was explored at the same interval as taste study and evaluated electro-physiologically (peak voltage and nerve conduction velocity) and histomorphometrically (axon count, myelin thickness). Results: The recombinant adenovirus vector carrying $rhNGF-{\beta}$ was constructed and confirmed by restriction endonuclease analysis and DNA sequence analysis. GFP expression was observed in 90% of $rhNGF-{\beta}$ adenovirus infected cells compared with uninfected cells. Total mRNA isolated from $rhNGF-{\beta}$ adenovirus infected cells showed strong RT-PCR band, however uninfected or LacZ recombinant adenovirus infected cells did not. NGF quantification by ELISA showed a maximal release of $18865.4{\pm}310.9pg/ml$ NGF at the 4th day and stably continued till 14 days by $rhNGF-{\beta}$ adenovirus infected Schwann cells. PC-12 cells exposed to media with $rhNGF-{\beta}$ adenovirus infected Schwann cell revealed at the same level of neurite-extension as the commercial NGF did. $rhNGF-{\beta}$ adenovirus injected experimental groups in comparison to the control group exhibited different taste preference ratio. Salty, sweet and sour taste preference ratio were significantly different after 2 weeks from the beginning of the experiment, which were similar to the sham group, but not to the control group.

비골 피판을 이용한 하악 및 하악과두 재건의 장기간 임상적 평가

안강민(Kang-Min Ahn),정헌종(Hun-Jong Chung),염학렬(Hak-Ryol Ryom),김항진(Hang-Jin Kim),김윤태(Yoon-Tae Kim),황순정(Soon-Jung Hwang),명훈(Hoon-Myoung),김명진(Myung-Jin Kim),김성민(Soung-Min Kim),장정원(Jeongwon Jahng),이종호(Jong-Ho 대한구강악안면외과학회 2005 대한구강악안면외과학회지 Vol.31 No.5

Purpose of study: The temporomandibular joint (TMJ) occupies a key functional role in mastication and contributes to normal deglutition, speech as well as cosmesis. When a large amount of mandible including the condyle head is resected, it is very difficult to reconstruct it as a functional unit. In this retrospective study, we present the functional, radiographic and cosmetic results of reconstructed temporomandibular joint using free fibular flap. Patients and Methods: Total 12 patients (M:F = 6:6) who underwent condylar reconstruction with the fibular flap were interviewed and examined by radiographs and Bio-PAK. Mean follow up periods was 47.7±20.0 months and the average age was 38.7±15.3 years. Remodeling of condyle and function of TMJ were evaluated and facial contour was judged subjectively. Results: All flaps were viable and no immediate postoperative complication had happened. One patient showed decreased mouth opening, so interpositional gap arthroplasty was performed. The resorption rates of reconstructed fibular were minimal and the condyle heads were changed into domeshaped neocondyle after 2 years. All patients had normal diet and no speech difficulty was reported. Nine patients were satisfied with their facial contour but three patients complained about the depression of cheek. Conclusion: The reconstruction of TMJ with free fibular flap was reliable methods and very effective means of restoring mandibular function. The functional and morphologic results were excellent and showed little complications.

상이한 분류 기준에 따른 근로형태별 자가평가건강수준 : 한국노동패널조사 자료를 이용한 패널회귀분석

김근회(Keunwhoe Kim),정헌종(Hun-Jong Chung),장성훈(Sounghoon Chang),김형수(Hyeongsu Kim),노대희(Daehee Noh),정최경희(Kyunghee Jung-Choi) 대한직업환경의학회 2010 대한직업환경의학회지 Vol.22 No.3

인간 무세포성 진피기질 위에 배양한 가토 구강각화상피세포의 중충화와 기저막 형성에 관한 연구

김용덕,안강민,염학렬,정헌종,김성민,장정원,성미애,박희정,황순정,이종호,Kim, Yong-Deok,Ahn, Kang-Min,Yum, Hak-Yeol,Chung, Hun-Jong,Kim, Soung-Min,Jang, Jeong-Won,Sung, Mi-Ae,Park, Hee-Jung,Hwang, Soon-Jung,Lee, Jong-Ho 대한악안면성형재건외과학회 2005 Maxillofacial Plastic Reconstructive Surgery Vol.27 No.6

To assess the clinical applicability of bio-artificial mucosa which was made with autologous oral keratinocytes and human acellular dermal matrix, the formation of basement membrane and stratification of oral keratinocytes were evaluated. Six New Zealand white rabbits (around 2kg in weight) were anesthetized and its buccal mucosa was harvested (1.0 $\times$ 0.5cm size). Oral keratinicytes were extracted and cultured primarily with the feeder layer of pretreated NIH J2 3T3 fibroblast. These confluent cells were innoculated on the human acellular dermal matrix and cultured in multiple layer by air-rafting method. After 3, 5, 7, 10, 14 days of culture, each cultured bio-artificial mucosa was investigated the number of epthelial layer of by H&E stain and toluidine blue stain. The immuhohistochemical methods were used to evaluate the cell division capacity, the formation of basement membrane, and it's property of specific cells (PCNA, cytokeratin 14, laminin). Transmission electromicroscopy was used for the attachment between cells and matrix with the number of hemidesmosome. In result, the numbers of layer of stratified growth of oral keratinocyte cultured on the human acellular dermal matrix and the number of hemidesomal attachment between epithelial cells and human acellular dermal matrix were similar to the layers of normal oral mucosa after 10 days of culture. The cell division rate, basement membrane formation and proliferation rate increased as culture period increased. With these results, bio-artificial mucosa with autologous oral epithelial cells cultured on the acellular dermal matrix had clinically adaptable properties after 10 days' culture and this new bio-artificial mucosa model with relatively short culture time can be expected clinical applicability.

Repetitive Sequence-based Genomic Fingerprinting을 이용한 Vibrio 속 균의 분자분류 및 동정

김규원 ( Gyu Won Kim ),정헌종 ( Hun Jong Chung ),박철민 ( Chul Min Park ),김기정 ( Kijeong Kim ),김원용 ( Won Yong Kim ),정상인 ( Sang In Chung ) 대한내과학회 2006 대한내과학회지 Vol.71 No.2

목적: 여러 rep-PCR genomic fingerprinting 방법들을 실시하여 비브리오 균종간의 유전적 상관성을 조사하고 이를 이용한 V. vulnificus의 신속한 분자 동정법을 개발하고자 하였다. 방법: 이 연구에서 사용한 균주는 48주로서 REP-, ERIC-, BOX- 및 SERE-PCR을 13종의 비브리오를 대상으로 수행하였다. 결과: ERIC-PCR은 서로 구별이 가능하였으며 약 320bp 크기의 특이 절편이 V. vulnificus에서 발견되었다. 그러나 REP-, BOX- 및 SERE-PCR은 V. vulnificus 균주들을 다른 비브리오균종들로부터 분류하는데 효과적이지 못하였다. 결론: ERIC-PCR은 V. vulnificus를 다른 Vibrio 균종들로부터 신속하게 분류하고 동정하는데 유용하게 이용될 수 있을 것으로 생각된다. Background: The aims of this study were to compare the suitability of repetitive-PCR genomic fingerprinting procedures to investigate genetic relatedness of the genus Vibrio and its applicability for the molecular identification of Vibrio vulnificus. Methods: Forty-eight Vibrio strains were included for this study. REP-, ERIC-, BOX- and SERE-PCR were compared with 13 members of the genus Vibrio. Results: REP-, BOX- and SERE-PCR showed V. vulnificus strains could not be separated well from other Vibrio species. However, approximately 320 bp of highly discriminatory specific fragments was recovered from V. vulnificus strains by ERIC-PCR. Conclusions: ERIC-PCR could be used as rapid classification and identification methods of V. vulnificus from other members of the genus Vibrio.(Korean J Med 71:189-197, 2006)

구강내 점막과 유리피판에 사용되는 피부의 rete ridge에 관한 2차원 및 3차원적 구조 연구

안강민(Kang-Min Ahn),정헌종(Hun-Jong Chung),김윤태(Yoon-Tae Kim),팽준영(Jun-Young Paeng),신영민(Young-Min Shin),성미애(Mi-Ae Sung),박희정(Hee-Jung Park),명훈(Hoon Myoung),황순정(Soon-Jung Hwang),최진영(Jin-Young Choi),정필훈(Pill-Ho 대한구강악안면외과학회 2005 대한구강악안면외과학회지 Vol.31 No.2

Objects : With the advancement of tissue engineering techniques, the effort to develop bioartificial mucosa have been actively delivered. The problem we met with this technique is the lack of mechanical strength between kerationocyte layer and dermal layer, where in the normal skin and mucosa, they are tightly bound with rete ridge structure. The purpose of this study is to understand the 2D and 3D structure of rete ridge of mucosa and skin paddle for rendering more biomimetic structure to the artificial mucosa. Materials and Methods : Oral mucosa and skin from the patients who received the oral surgery and maxillofacial reconstruction were harvested. The epidermis was separated from the dermis after treating with dispase for 12-16 hours. H & E staining was performed for 2D(dimensional) structure study and confocal LASER and SEM study were performed for 3D structure. Mean height(Sc) and arithmetic mean deviation(Sa) of all surface height were calculated. Results : The average height of rete ridge of skin flap was between 67.14㎛ and 194.55㎛. That of oral mucosa was between 146.26㎛ and 167.51㎛. Pressure bearing area and attached gingiva of oral mucosa showed deeper rete ridges. Conclusion : To obtain the adequate strength of artificially cultured keratinocyte skin and mucosa flap, it is necessary to imitate the original skin and mucosa structure, especially rete ridge. Through this study, 2D and 3D rete ridge structure of normal mucosa and skin was obtained. These results can be used as basis for substrate morphology for keratinocytes culture.