We injected acetylcholine (ACh), the neurotransmitter of the parasympathetic nervous system, into the coronary arteries of 28 patients with variant angina. Injection of 10 to 80 gg ACh into the coronary artery responsible for the attack induced spasm together with chest pain and ST segment elevation or depression on the electrocardiogram in 30 of the 32 arteries of 25 of the 27 patients. The injection of 20 to 100 gg ACh into the coronary artery not responsible for the attack in 18 patients resulted in various degrees of constriction in most of them, but no spasm in any of them. After intravenous injection of 1.0 to 1.5 mg atropine sulfate, the injection of ACh into the coronary artery responsible for the attack did not induce spasm or attack in any of the nine coronary arteries injected in eight patients. We conclude that the intracoronary injection of ACh induces coronary spasm and attack in patients with variant angina and that the activity of the parasympathetic nervous system may play a role in the pathogenesis of coronary spasm. We also conclude that the intracoronary injection of ACh is a useful test for provocation of coronary spasm. Circulation 74, No. 5, 955-963, 1986. IT IS NOW widely accepted that spasm of an epicardial coronary artery (coronary spasm) plays an important role in the pathogenesis, not only of variant angina, but also of other forms of resting angina, some types of exertional angina, and types of acute myocardial infarction. quently Endo et al.'0 confirmed our results. On the basis of this fact and the fact that the activity of the parasympathetic nervous system is enhanced at rest and is suppressed by physical activity," we postulated that the activity of parasympathetic nervous system might be related to the pathogenesis of variant angina or coronary spasm.7 It has been shown that stimulation of the parasympathetic (vagus) nerve or intracoronary injection of ACh causes coronary vasodilatation, as demonstrated by an increase in coronary blood flow in dogs,'2-'5 and that ACh dilates isolated epicardial coronary arteries in dogs'6 and monkeys. 17 In humans subcutaneous injection of methacholine causes profound dilatation of systemic vasculature, resulting in a transient fall in blood pressure and compensatory tachycardia due to reflex sympathetic discharge.7 We therefore speculated that coronary spasm might be induced by sympathetic discharge by way of a-adrenergic stimulation.7 Recently, however, reports have appeared that show that ACh contracts strips of human coronary arteries obtained from hearts of transplant recipients'8 or cadav-955

A target circle surrounded by larger "inducer" circles looks smaller, and one surrounded by smaller circles looks larger than they really are. This is the Ebbinghaus-Titchener illusion, which remains one of the strongest and most robust of contrast illusions. Although there have been many studies on this illusion in humans, virtually none have addressed how nonhuman animals perceive the same figures. Here the authors show that the Ebbinghaus-Titchener figures also induce a strong illusion in pigeons but, surprisingly, in the other direction; that is, all five successfully trained pigeons judged the target circle surrounded by larger circles to be larger than it really is and vice versa. Further analyses proved that neither the gaps between target and inducer circles nor the cumulative weighted surface of these figural elements could account for the birds' responses. Pigeons are known to show similarities to humans on various cognitive and perceptual tasks including concept formation, short-term memory, and some visual illusions. Our results, taken together with pigeons' previously demonstrated failure at visual completion, provide strong evidence that pigeons may actually experience a visual world too different for us to imagine.

The authors compared perception of the standard and reversed Müller-Lyer figures between pigeons (Columbia livia) and humans (Homo sapiens). In Experiment 1, pigeons learned to classify 6 lengths of target lines into "long" and "short" categories by pecking 2 keys on the monitor, ignoring the 2 brackets so placed that they would not induce an illusion. In the test that followed, all 3 birds chose the "long" key more frequently for the standard Müller-Lyer figures with inward-pointing brackets (><) than for the figures with outward-pointing brackets (<>). The subjects' responses were accountable by neither overall lengths of the figures nor horizontal gaps between the 2 brackets. For the reversed figures, effects of the brackets were absent. These results suggested that the pigeons perceived the standard Müller-Lyer illusion but not the reversed one. Experiment 2 confirmed that humans perceived both types of the illusion. Pigeons and humans may perceive the same illusory figures in different ways.

Introduction: Shock index (SI), calculated by dividing heart rate by systolic blood pressure, is used to detect hemodynamic instability and hypovolemia. In obstetric practice, limited evidence is available regarding its usefulness in detecting postpartum hemorrhage (PPH). We aimed to evaluate the usefulness of SI in detecting PPH in vaginal deliveries using clinical data from 12 primary maternity care units in Japan. Material and methods: In this multicenter retrospective study, a total of 30,820 women who delivered vaginally at term at 12 primary maternity care units from January 2012 to December 2018 were included. Systolic and diastolic blood pressures and heart rate were measured at five different time points from admission to postpartum 2 h, and postpartum blood loss was measured. We evaluated the trend of average SI and the performance of each vital sign for detection of PPH. Results: The trend of average SI during labor and the immediate postpartum period was approximately 0.7 in women with blood loss of <500 mL. SI from the time of delivery of the placenta increased with an increase in blood loss. SI had the highest area under the receiver operating characteristic curve of 0.699 [95% confidence interval (CI), 0.682-0.716] and 0.758 (95% CI, 0.729-0.788) for PPH of !1,000 and !1,500 mL, respectively. However, both sensitivity of SI (1.0) for PPH (!1,000 mL; 29.9%, and !1,500 mL; 40.5%, respectively) and correlation between maximum SI and blood loss (coefficient of correlation, 0.263) were low. Conclusions: SI is a better parameter for PPH detection in vaginal deliveries than other vital signs. However, clinical judgment must incorporate other vital signs and symptoms associated with hypovolemic shock due to the low sensitivity of SI.

A disk surrounded by smaller disks looks larger, and one surrounded by larger disks looks smaller than reality. This visual illusion, called the Ebbinghaus-Titchener illusion, remains one of the strongest and most robust illusions induced by contrast with the surrounding stimuli in humans. In the present study, we asked whether bantams would perceive this illusion. We trained three bantams to classify six diameters of target disks surrounded by inducer disks of a constant diameter into "small" or "large". In the test that followed, the diameters of the inducer disks were systematically changed. The results showed that the Ebbinghaus-Titchener figures also induce a strong illusion in bantams, but in the other direction, that is, bantams perceive a target disk surrounded by smaller disks to be smaller than it really is and vice versa. Possible confounding factors, such as the gap between target disk and inducer disks and the weighted sum of surface of these figural elements, could not account for the subjects' biased responses. Taken together with the pigeon study by Nakamura et al. (J Exp Psychol Anim Behav Process 34:375-387 2008), these results show that bantams as well as pigeons perceive an illusion induced by assimilation effects, not by contrast ones, for the Ebbinghaus-Titchener types of illusory figures. Perhaps perceptual processes underlying such illusory perception (i.e., lack of contrast effects) shown in bantams and pigeons may be partly shared among other avian species.