The Modern Meaning of J.M.Keynes’s Thinking

application/pdfケインズは『雇用・利子および貨幣の一般理論』（以下,『一般理論』）序文において,その著書の対象者は一般大衆ではなくて自らの仲間であるエコノミストたちであると述べている。本論文は『一般理論』がなぜエコノミストへ向けたものであるのか。また,なぜ彼はエコノミストを説得しようとするのか,という疑問に対してケインズの思考方法を辿りながら検討を加えるものである。また彼は,「正統派経済学」がその前提に「一般性」と「明確性」を欠いていると指摘する。なぜ,彼は経済学に一般性と明確性を与えたいとのモチベーションを持ったのかについても,本論文では検討を行う。また,討論を歓迎,説得を重視,過去のアイデアからの離脱などの「ケインズ的思考」はどこからきたのか。まず,『一般理論』の編集者序文と著者序文を参照して彼のアイデアを確認しつつ,次に世論の形成と討論と説得という彼の方法を探り,『蓋然性論』から始まる「ケインズ的思考」の現代的妥当性を探りたい。 　本論文の仮説としては,エコノミストや政治哲学者のアイデアは政策担当者や世論に対して大きな影響力を持つとケインズが考えていたため討論により彼らを説得したいと彼が考えた事,また,ケインズはそれまでの理論と現実との乖離を認めたことにより,理論に対して一般性と明確性を与えたいと考えた事,討論や説得により条件に応じて結論を変化させる「蓋然性判断」を彼が生涯持ち続けたことを提起したい。departmental bulletin pape

Neutral endopeptidase inhibitor suppresses the early phase of atrial electrical remodeling in a canine rapid atrial pacing model

Introduction We examined the acute effects of neutral endopeptidase inhibitor on the hemodynamics and electrical properties of dogs subjected to rapid atrial pacing. Methods Ten beagle dogs were used and divided into two groups with and without candoxatril, a neutral endopeptidase inhibitor preadministration. Before and after the 6 hours rapid atrial pacing from the right atrial appendage, the hemodynamics, atrial effective refractory period, and monophasic action potential duration of the right atrial appendage were measured and blood samples were collected. Atrial tissue was also excised after the experiment. Results Candoxatril significantly increased plasma ANP levels (Control: 88.4 ± 50.25 vs. Candoxatril: 197.1 ± 32.09 pg/ml, p = 0.004) and prevented reductions in atrial effective refractory period and monophasic action potential duration. We further demonstrated that the treated animals exhibited significantly higher levels of atrial tissue cyclic GMP (Control: 28.1 ± 1.60 fmol/mg vs. Candoxatril: 44.5 ± 12.28 fmol/mg, p = 0.034) as well as that of plasma cyclic GMP (Control: 32 ± 5.5 vs. Candoxatril: 42 ± 7.1 pg/ml, p = 0.028). Conclusion Candoxatril suppressed the shortening of atrial effective refractory period and monophasic action potential duration in the rapid atrial pacing model. As plasma ANP and the atrial tissue levels of cyclic GMP were higher in the Candoxatril group than the control, this effect was considered to appear through the reduction of calcium overload caused by ANP and cyclic GMP

Long-term observation of fibrillation cycle length in patients under angiotensin II receptor blocker therapy for chronic atrial fibrillation

AbstractIntroductionThe long-term effect of angiotensin II receptor blockers (ARBs) on atrial fibrillation (AF) is unclear. In this study, we evaluated the change in the fibrillation cycle length (FCL) in patients under long-term ARB therapy for chronic AF.Methods and resultsThe study population consisted of 25 chronic AF patients who were prescribed the same medication for more than 6 years and in whom specific ECG recording for FCL evaluation could be performed before and after the 6-year observation period. The patients were divided into 2 groups: those with and without ARB (ARB group and non-ARB group and n=15 and 10, respectively). FCL was calculated by the spectral analysis of the fibrillation waves in the surface ECG. There was no significant difference in the clinical characteristics between the 2 groups. In the ARB group, the mean FCL was prolonged from 154±20ms to 187±37ms (p=0.005), whereas it remained unchanged in the non-ARB group (150±12ms vs. 149±10ms). In the comparison between patients with and those without FCL prolongation (>30ms; n=6 and 19, respectively), a significant difference was observed only in those prescribed ARBs.ConclusionIn cases of chronic AF, FCL might be prolonged under long-term ARB treatment

Evaluation of the impact of atrial fibrillation on rehospitalization events in heart failure patients in recent years

SummaryBackgroundAlthough we have previously reported that the presence of paroxysmal atrial fibrillation (AF) is an independent risk factor for rehospitalization in patients with congestive heart failure (CHF) in a population from 1996 to 2002, the impact of AF configuration as a risk factor in a more recent population remains to be clarified.Methods and results319 patients with CHF admitted to our institute in 2006–2007 were retrospectively evaluated. The patients were divided into 3 groups in accordance with their basic cardiac rhythm, i.e. sinus rhythm (n=210), chronic AF (n=68), and paroxysmal AF (n=41). During the follow-up period of 19±17months, there was no significant difference in mortality or rehospitalization events among the 3 groups (p=0.542). In the multivariate analysis, no administration of β-blockers was the only independent risk factor for rehospitalization due to CHF exacerbation.ConclusionsThe clinical impact of AF configuration as a risk factor of rehospitalization due to CHF exacerbation was considered to be decreased in recent years

A case of the gastric metastasis from invasive lobular carcinoma of the breast

A 45-year-old woman underwent total mastectomy with axillary lymph node dissection for right breast cancer in 2015. Histopathological examination of the resected specimen showed triple-negative invasive lobular carcinoma and advanced lymph node metastasis. The patient underwent postoperative adjuvant therapy consisting of a dose-dense epirubicin-cyclophosphamide regimen and weekly paclitaxel and radiotherapy. However, multiple bone metastases were detected, 18 months postoperatively. The patient developed upper abdominal discomfort, 21 months postoperatively, and gastroscopy revealed multiple, irregular depressed lesions in the stomach. Histopathological examination of stomach biopsy specimens revealed tumor cells that showed diffuse invasion of the lamina propria of mucous membrane. Immunohistochemical evaluation of biopsy specimens obtained from the stomach and the excised breast tissue showed cells that were immunopositive for CK7 and GCDFP-15 and immunonegative for CK20. The gastric lesion was therefore diagnosed as metastases from invasive lobular carcinoma of the breast. Although the patient received chemotherapy, she died of meningeal carcinomatosis from breast cancer, 7 month after the diagnosis of stomach metastasis. Immunohistochemical evaluation for CK20, which is expressed in gastric cancer and GCDFP-15, which originates from breast tissue, is useful to distinguish between breast cancer metastases and signet ring cell carcinoma of the stomach

Assessment of activities and the participation domain based on the ICF for the elderly requiring care

ICFの「活動と参加」の評価を通して,要介護高齢者における生活機能低下の全体像を把握することを目的に調査を実施した.要介護高齢者672名を対象に,ICFの「活動と参加」の第2レベル73項目について,「実行状況」と「能力」の両面から評価点を評価し,Item　Indexとしてそれぞれの困難度を求めた.「活動と参加」における領域ごとの比較では第5領域「セルフケア」のItem Indexが最も低くなり,「実行状況」で37.7,「能力」で34.4となった.逆に高くなったのは第6領域「家庭生活」であり,それぞれ89.6,77.7となった.本研究の結果は要介護高齢者の生活機能低下の現状と評価手段としてのICF活用の可能性を示すものである.The purpose of this study was to understand the degree of functioning and disability level in elderly requiring care through the evaluation of each domain of "activity and participation" in ICF. The study investigated 672 elderly requiring care. In the investigation, regarding the 2nd level of 73 "activity and participation" domains in the ICF, the elderly were evaluated from "performance" and "capacity", and then converted to the Item Index. Subsequently, each item was evaluated, and the degree of difficulty for both performance and capacity was determined. In the comparison of both performance and capacity, the Item Index of Chapter 5 "SELF-CARE" was the lowest, while "performance" was 37. 7, and "capacity" was 34. 4. Conversely, the Item Index of Chapter 6 "DOMESTIC LIFE" became higher: it was 89. 6 and 77. 7 respectively. The results indicate the degree of both dysfunction and disability of the elderly requiring care, and also demonstrate the possibility of the ICF as an assessment tool

大学生の午前と午後の授業中の眠気は夜間の睡眠状況と関連するか

研究論文Original Articles　本研究の目的は，大学生の授業中の眠気と夜間の睡眠状況の関連性を，午前と午後の授業時間帯別に明らかにすることであった．対象は，本学リハビリテーション学部に所属する学生137 名であった．方法は，自己記入によるアンケート調査であり，午前・午後の授業中の眠気の有無を目的変数，夜間の睡眠状況，性別，授業への興味や関心，服薬中の薬剤，うつ症状を説明変数としてロジスティック回帰分析を行った．結果，午前の授業中の眠気は，就床時間が遅く（p0.05）．授業中に眠気を感じる学生に対して，夜間の睡眠環境の整備を行うよう指導する場合があるが，午後の授業中の眠気の予防には，夜間の睡眠環境の整備のみでは効果が得られない可能性がある．　The purpose of this study was to identify the relationship between sleepiness during taking classes and the nighttime sleep in university students. This study focused on sleepiness in the morning class and the afternoon class. 137 students in Seirei Christopher University, School of Rehabilitation Sciences were participated in this study. The method of this study was a selfadministered questionnaire. The statistical analysis was used as a logistic regression analysis. The objective variables were analyzed sleepiness in the morning and afternoon classes. The explanatory variables were analyzed nighttime sleep situations, sex, interests in the class, medication, and depressive symptoms. The result showed that the students who felt sleepiness in the morning class went bed significantly later (p 0.05). The professors sometimes instruct to the students who feel sleepy in class for improvement their sleep in the night. However, it may not be solved it for their afternoon class

Decline in Left Ventricular Ejection Fraction during Follow-up in Patients with Severe Aortic Stenosis

Objectives: The aim of this study was to investigate the prognostic impact of the decline in left ventricular ejection fraction (LVEF) at 1-year follow-up in patients with severe aortic stenosis (AS) managed conservatively. Background: No previous study has explored the association between LVEF decline during follow-up and clinical outcomes in patients with severe AS. Methods: Among 3, 815 patients with severe AS enrolled in the multicenter CURRENT AS (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis) registry in Japan, 839 conservatively managed patients who underwent echocardiography at 1-year follow-up were analyzed. The primary outcome measure was a composite of AS-related deaths and hospitalization for heart failure. Results: There were 91 patients (10.8%) with >10% declines in LVEF and 748 patients (89.2%) without declines. Left ventricular dimensions and the prevalence of valve regurgitation and atrial fibrillation or flutter significantly increased in the group with declines in LVEF. The cumulative 3-year incidence of the primary outcome measure was significantly higher in the group with declines in LVEF than in the group with no decline (39.5% vs. 26.5%; p 10% declines in LVEF at 1 year after diagnosis had worse AS-related clinical outcomes than those without declines in LVEF under conservative management. (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis Registry; UMIN000012140