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Purpose Regional differences in the adoption of electronic medical records (EMR) are a major problem, yet little is known about these differences internationally. We analyzed regional differences in EMR adoption in Japan and evaluated factors associated with these differences. Methods This nationwide ecological study used secondary data from all secondary medical service areas (SMSAs) in fiscal years 2008 (n = 348) and 2014 (n = 344). For each SMSA we collected the following information from a Japanese national database: the number of medical facilities that had adopted EMR, the population density, the average per capita income, the number of working doctors per 1000 people, and the proportion of interns to all working doctors. To adjust for medical facility characteristics in each SMSA, such as number of beds, public versus private hospital, and hospital type (psychiatric or other), we estimated the standardized adoption ratio (SAR) for EMR adoption, modeled on the standardized mortality ratio. We calculated Moran’s I for the SAR and investigated whether the SAR had spatial autocorrelations. We evaluated the association between the SAR and regional factors with a conditional autoregressive model. We compared these results in 2008 and 2014, for both hospitals and clinics. Results While the EMR adoption rate in SMSAs increased, Moran’s I of the SAR in hospitals was close to 1 in both 2008 and 2014, and Moran’s I of the SAR in clinics increased from 2008 to 2014. For hospitals, there was a significant association between the proportion of interns to all working doctors and the SAR only in 2008. For clinics, average income in the SMSA was positively associated with the SAR, whereas the number of working doctors was negatively associated with the SAR in both 2008 and 2014. Population density was positively associated with the SAR only in 2014. Conclusion From 2008 to 2014, EMR adoption in Japan generally increased, but geographical differences did not improve. Regional factors associated with the SAR were different for hospitals than for clinics. Therefore, the government should take different approaches for clinics and hospitals to improve regional differences in EMR adoption, especially in providing financial and technical support.

Although the types of pathophysiological stimulation that initiate an overexpression of OPN have yet to be determined, we hypothesized that mechanical stress is one of the candidates which initiates OPN expression in vascular smooth muscle cells. Cell proliferation assay indicated that a pure atmospheric pressure of 160 mmHg activated cell proliferation by 11% in human aortic smooth muscle cells (HASMC) compared to nonpressurized controls. Immunoblot analysis probed with an anti-OPN antibody demonstrated a 50% increase in OPN. Dual-luciferase reporter assay demonstrated that OPN promoter, corresponding to the −771 through −1 region of OPN gene, was highly responsive to pure atmospheric pressure by ten times that of the control. From these observations, we concluded that pure atmospheric pressure directly promotes an expression of OPN in HASMC, with these results also suggesting that high blood pressure-mediated mechanical compression is involved in the process of atherosclerosis and remodeling via OPN expression in HASMC.

Mechanical forces related to pressure and flow are important for the etiology of atherosclerosis and hypertension. We hypothesized the presence of mechanosensors that were solely sensitive to pure atmospheric pressure in the absence of shear and tensile stresses. A pressure-loading apparatus was set up to examine the effects of atmospheric pressure on human aortic smooth muscle cells (HASMC). Pressure application of 140 to 180 mmHg produced DNA synthesis in a pressure-dependent manner. In contrast, pressure of 120 mmHg or less produced no significant change. Both extracellular signal-regulated kinase and c-Jun N-terminal kinase activities, but not p38 activity, were stimulated by pressures of more than 160 mmHg. Pertussis toxin (PTx) completely inhibited the pressure-induced increase of DNA synthesis under the high pressure of 200 mmHg. These data suggest that HASMC have a mechanosensing cellular switch for DNA synthesis which is sensitive to pure atmospheric pressure, and that the molecular switch is activated by pressure of more than 140 mmHg. The activation mechanism consists of PTx-sensitive and -insensitive pathways, and the former is activated by high pure pressure.

To examine the contribution of the renin-angiotensin system to hypertrophic cardiomyopathy (HCM), we studied 96 patients with HCM (mean age 50 years, 55% male), 105 of their unaffected siblings and offspring, and 160 healthy subjects without known hypertension and left ventricular hypertrophy (LVH) who were frequency matched to cases by age and sex. Patients were divided into familial or sporadic HCM (FHCM or SHCM) groups with or without affected members of their family. The region of interest in the angiotensinogen (AGT) gene, the missense mutation with methione-to-threonine amino acid substitution at codon 235 in angiotensinogen (M235T), was amplified by polymerase chain reaction with the use of allele-specific oligonucleotide primers flanking the polymorphic region of the AGT gene to amplify template deoxyribonucleic acid prepared from peripheral leukocytes. The T allele frequency was higher in the SHCM group than in unaffected siblings and offspring (88% vs 78%, X2 = 4.6, p < 0.05). The M allele frequency was higher in unaffected siblings and offspring than in patients with SHCM (23% vs 12%, X2 = 4.6, p < 0.05). The T allele frequency among unaffected siblings and offspring was similar to that observed in healthy subjects (78% vs 78%). We conclude that HCM, especially in sporadic cases, is partially determined by genetic disposition. The molecular variant of angiotensinogen T235 seems to be a predisposing factor for cardiac hypertrophy in HCM and carries an approximately twofold increased risk.

The expression of three different subtypes of GTP binding protein beta-subunits (beta 1, beta 2 and beta 3) was examined in rat hearts at both mRNA and protein levels. Among three subtypes, beta 3 mRNA was more abundant in ventricles while beta 1 and beta 2 mRNAs were expressed ubiquitously among ventricles, atria and aortas. The immunodetectable beta 1- and beta 3-proteins were predominantly found in the cytosolic fraction of rat ventricles. In this study, we demonstrate ventricle-specific expression of beta 3-subunit and localization of G protein beta 3-subunit in the cytosol of rat hearts. This unusual cytosolic localization of G protein beta 3-subunit might indicate subtype-specific function of G protein beta (gamma)-subunits in rat hearts.

The effects of transforming growth factor beta-1 on concentration of intracellular Ca2+ changes in the presence of isoproterenol were studied in cardiac fibroblasts. Transforming growth factor beta-1 effect on cyclic-AMP production and ligand assay of beta-adrenergic receptors were also examined. Production of cyclic-AMP in fibroblasts preincubated with transforming growth factor beta-1 decreased compared with non-transforming growth factor beta-1-treated fibroblasts in the presence of isoproterenol. An increase of intracellular Ca2+ concentration in the presence of isoproterenol was also inhibited in transforming growth factor beta-1-treated fibroblasts. Islet-activating protein did not restore these reactions of transforming growth factor beta-1. Concentration change of intracellular calcium under the treatment of transforming growth factor beta-1 was unaffected by forskolin addition. Binding of [3H]CGP-12177 was decreased to 47% of control preincubated for 24 h with transforming growth factor beta-1 in fibroblasts. Scatchard plots suggested a decrease in beta-adrenergic receptor number without specific change in receptor affinity. These results suggested that transforming growth factor beta-1 modulates the signal transduction through beta-adrenergic receptor and intracellular Ca2+ concentration by regulating the number of receptor in fibroblasts.

The accumulations of inositol-1,4,5-trisphosphate (IP3) and inositol-1,3,4,5-tetrakisphosphate (IP4) after hormonal stimulation may have a physiological role, possibly by alteration of Ca2+ levels in cardiac tissue. But the accumulation of inositol polyphosphate in a pathophysiological condition has not been studied. We investigated phosphatidylinositol-4,5-bisphosphate (PIP2) metabolism in hypertrophic cardiac myocytes, and clarified that the accumulations of IP3, IP4 and diacylglyceride after stimulation with norepinephrine were significantly enhanced in isolated myocytes from spontaneously hypertensive rat heart. Phospholipase C activity increased with age in SHRSP heart cells. These data suggest that PI turnover pathways, which can be mediated by both phosphatidylinositol-4,5-bisphosphate and diacylglyceride, may play an important role in development of hypertrophy in the hearts of rats with spontaneous hypertension.

Cell death during hypoxia rose to 80% after 6 h. Calpain activity increased to 4 units during hypoxia, much higher than the 0.7 units seen in aerobic condition at 6 h. This activity was markedly inhibited by calpain-specific inhibitor I ( n -acetyl-leucyle-leucyle-norleucinal). β-Adrenergic blocking agents and calcium antagonists suppressed the calpain activity and decreased cell death during hypoxia. On the other hand, α-adrenergic blocking agents did not affect calpain activity and cell death under hypoxic conditions. These results prove that β-adrenergic blocking agents and calcium antagonists prevent protein degradation during hypoxic cell injury.

We observed that in hypoxic myocardial cells prostacyclin and arachidonic acid release increased and that during hypoxia phospholipid degradation also occurred. In order to clarify the mechanism of phospholipid degradation, we determined the activity of phospholipases A 2 and C. We found that phosphatidylcholine (PC) and phosphatidylethanolamine (PE) were markedly decreased and that lysophosphatidylcholine and lysophosphatidylethanolamine were increased. In contrast, there was only slight phosphatidylinositol degradation and no lysophosphatidylinositol elevation was observed. These results show that phospholipase A 2 was activated in hypoxic myocytes and had substrate specificity towards PC and PE. To study phospholipase C activity, membrane phospholipids were labeled with [ 3 H]choline, [ 3 H]inositol or [ 3 H]ethanolamine. The release of inositol was observed, but neither choline nor ethanolamine was released. In hypoxia, myocardial-cell phospholipase C has high substrate specificity towards phosphatidylinositol. The activation of phospholipases is closely related to the intracellular Ca 2+ concentration; it is thought that inositol polyphosphatides may regulate intracellular Ca 2+ . We determined how Ca 2+ influx occurs in hypoxia. β-Adrenergic blockade and Ca 2+ antagonists markedly suppressed Ca 2+ influx, phospholipase A 2 activity, phospholipase C activity and cell death. However, the α 1 -adrenergic blockade was less effective in suppressing these phenomena. These results suggest that in hypoxic myocardial cells Ca 2+ influx mediated by β-adrenergic stimulation activates phospholipases A 2 and C, and that phospholipid degradation and prostacyclin release then occur.

In the present experiment, we demonstrated that IP3 kinase activity was increased in SHRSP heart compared to WKY heart. IP3 kinase activity in the heart was highest in the cytosolic fraction in both SHRSP and WKY. Its activity progressively increased with age in 5- to 20-week SHRSP. The activity reached about three times the level of 5-week-old SHRSP in 40-week-old SHRSP. On the other hand, in WKY it was 1.3-fold at 40 weeks compared with that at 5 weeks. We determined the effect of divalent cations on IP3 kinase activity. Ca2+ stimulated its activity in a dose-dependent manner at 10(-9) to 10(-6) M. In SHRSP it was enhanced about 2.1-fold at 10(-6) M of Ca2+, but in WKY it was 1.5-fold at 1.0(-6) M of Ca2+. Mn2+ also stimulated IP3 kinase activity in both groups of animals, while, Fe2+, Zn2+, and Cu2+ inhibited IP3 kinase activity. In our experiment IP3 kinase activity was increased in SHRSP and its activity was markedly affected by divalent cations. These data suggest that the accumulations of IP3 and IP4 after hormonal stimulation play a physiologic role, possibly by alteration of Ca2+ levels in cardiac tissue.

We studied the effects of endothelin on the conversion of angiotensin I to angiotensin II in pulmonary artery endothelial cells. Endothelin had a novel effect on angiotensin I conversion. When endothelin was added to pulmonary artery endothelial cells, the conversion of angiotensin I to angiotensin II was enhanced about two-fold. The maximum stimulation was achieved at 10(-8) M of endothelin. This stimulatory effect was suppressed by angiotensin converting enzyme inhibitors such an enalapril. When the calcium antagonist, nifedipine, was incubated with 10(-8) M of endothelin, the conversion of angiotensin I to angiotensin II stimulated with endothelin was slightly suppressed by nifedipine. Enalapril (10(-6) M) completely inhibited the conversion of angiotensin I to angiotensin II in the presence of endothelin. These results suggest that endothelin may play an important role in regulating vascular tone by modulating the conversion of angiotensin I to angiotensin II.

We studied the effects of platelet activating factor (PAF) on angiotensin-converting enzyme (ACE). PAF (1 · 10 −10 to 1 · 10 −6 M) had a novel effect on angiotensin I conversion. Pulmonary artery endothelial cells converted 1 nmol/dish of 125 I-angiotensin I to angiotensin II in the absence of PAF. ACE activity was increased to 2.5 nmol/dish by the addition of 1 · 10 −6 M of PAF. To clarify the mechanism of this stimulatory effect of PAF on ACE, Ca 2+ influx and inositol 1,4,5-trisphosphate (IP 3 ) release in pulmonary artery endothelial cells were determined. PAF stimulated Ca 2+ influx in a dose-dependent manner. PAF also stimulated phospholipase C (PLC) activity and released IP 3 . To study the relationship between PLC activity and ACE activity, neomycin was added. The Ca 2+ influx and IP 3 release stimulated by 10 −6 M of PAF were suppressed by about 60–70%. ACE activity was also inhibited up to 70% in the presence of PAF (10 −10 − 10 −6 M) by 50 M of neomycin. These results suggest that ACE was stimulated by PAF, and that its activityl in endothelial cells may be mediated by the PI-turnover pathway via changes in PLC activity and IP 3 -mediated Ca 2+ release from intracellular stores.

We have studied the effects of elastase on phospholipase activity in aortic smooth muscle cells and have found that when added to cells prelabeled with [3H]arachidonic acid, elastase induced rapid phospholipid hydrolysis, resulting in release of up to 18% of incorporated [3H]arachidonic acid into the medium. Maximum stimulation by elastase without any cellular damage was observed at a concentration of 50 units/ml. At higher concentrations (75–100 units/ml), release of arachidonic acid was still observed, but cells were damaged. After the addition of elastase, degradation of phosphatidylcholine, phosphatidylinostiol and phosphatidylethanolamine was observed and it was found that their loss was comparable to the amount of [3H]arachidonic acid released. In aortic smooth muscle cells biosynthetically labeled by the incorporation of [3H]choline, [3H]inositol and [3H]ethanolamine into cellular phosphatidylcholine, phosphatidylinositol and phosphatidylethanolamine, respectively, the amount of phosphatidylcholine and phosphatidylethanol-amine hydrolyzed following elastase-treatment was not equal to the amounts of lysophosphatidylcholine and lysophosphatidylethanolamine produced. We also observed a transient rise in diacylglycerol after the addition of elastase. To test for phospholipase C activity, the release of incorporated [3H]choline, [3H]inositol and [3H]ethanolamine into the culture medium was determined. The levels of radioactive choline and ethanolamine showed increases, but the change in inositol was comparatively small. An increase in inositol was detectable within 1 min after elastase addition, and peaked after 15 min, whereas increases in choline and ethanolamine continued for up to 60 min. These results indicate that elastase stimulated the activities of phospholipases A2 and C. Both were shown to be Ca2+-dependent, and it was found that, moreover, elastase enhanced Ca2+ influx. These results suggest increased cell-membrane permeability to Ca2+stimulated phospholipases A2 and C. Prostaglandin biosynthesis in these cells was also enhanced by elastase.

Renal prostaglandins are involved in the regulation of blood pressure by a variety of mechanisms: "7,~2'13'~5 (1) direct vasodilation; (2) autoregulation of renal blood flow; (3) regulation of the sodium and water balance; (4) opposition of vasoconstriction influences such as catecholamines and angiotensin II. Increased prostaglandin biosynthesis in spontaneously hypertensive rats (SHR) has been reported. 5,a-'° It is well known that arachidonic acid, the major substrate for prostaglandins, is released by phospholipases A2 and C from phospholipids in several tissues. We have demonstrated that phospholipase A2 activity is not enhanced in young SHR, but it increases with age? The purpose of this study is to clarify the relationship between the changes in renal microsomal phospholipids and the increased arachidonic acid cascade in SHR.

The effects of elastase on prostacyclin biosynthesis in cultured rat aortic smooth muscle cells were investigated. Prostacyclin is the major product formed from arachidonic acid by aortic smooth muscle cells. When intact cells were incubated with elastase, a significant stimulatory effect on prostacyclin biosynthetic activity in cells was evident. However, the addition of elastase directly to the cell-free homogenates did not show any effects on prostacyclin biosynthesis. The maximal effect of elastase on the stimulation of prostacyclin biosynthesis without any cellular damage was observed at a concentration of 50 unit/ml elastase. Elastase also caused a marked release of arachidonic acid. At higher concentrations of elastase (75-100 units/ml), the release of arachidonic acid and prostacyclin synthesis was observed, but, at these concentrations of elastase, cells were slightly damaged. On the other hand, the releases of prostacyclin and arachidonic acid were markedly enhanced, when cells were preincubated with elastase (1 unit/ml) for 3 days. These results indicate that elastase, even at low concentrations, causes the releases of arachidonic acid and prostacyclin, especially when aortic smooth muscle cells are pre-treated with elastase.

Reptile venoms exhibit a wide diversity of phospholipase A2 forms when examined by electrophoretic and chromatographic techniques which separate on the basis of net charge. In principle, diversity in charge among the enzyme forms could result from two types of structural modifications: (i) pretranslational modifications, such as differences in amino acid sequences; (ii) post-translational modifications, such as partial proteolysis or hydrolysis of amide functions of asparagine and glutamine residues. Some types of modifications alter both charge and molecular weight. A radiolabeling technique has been developed which allows detection of phospholipase A2 enzymes after electrophoretic separation on the basis of molecular weight in polyacrylamide gels containing sodium dodecylsulfate. Venom preparations were radiolabeled by incubation with p-dodecylphenacylbromide, which was prepared radiolabeled to high specific activity with tritium. The labeling agent was dispersed in phosphatidylcholine liposomes and incubated with venom preparations under conditions of optimal enzyme activity. The preparations were then extracted with ether and hexane to remove substrate and unbound label and subjected to polyacrylamide gel electrophoresis under standard conditions. Protein-bound radiolabel was detected by fluorography and autoradiography. Patterns of labeled species obtained by gel electrophoresis of selected venoms using separation on the basis of charge were similar to the patterns of phospholipase A2 variants obtained under the same electrophoretic conditions using enzymatic detection in phosphatidylcholine-containing gels. Examination of a variety of snake and lizard venoms using this technique revealed the presence of multiple molecular weight forms of labeled enzymes, but the extent of diversity was less than that observed with the same venoms using separation of phospholipase electrophoretic variants on the basis of charge. The results are consistent with diversity in reptile venom phospholipase A2 forms being derived from differences in both molecular weight and charge.