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The heated cigarette (HC) generates mainstream smoke by vaporizing the components of the tobacco rod using a carbon heat source at the cigarette tip. Mainstream smoke of HC contains markedly less chemical constituents compared to combusted cigarettes. Mainstream smoke from HC was generated under Health Canada Intense regimen and its biological effects were compared to those of Reference (3R4F) cigarettes, using nose-only 5-week and 13-week inhalation studies. In the 13-week study, SD rats were necropsied following exposure to mainstream smoke from each cigarette at 200, 600 or 1000 µg wet total particulate matter/L for 1 h/day, 7 days/week or following a 13-week recovery period. Histopathological changes in the respiratory tract were significantly lesser in HC groups; e.g. respiratory epithelial hyperplasia in the nasal cavity and accumulation of pigmented macrophages in alveoli. After a 13-week recovery, the lesions were completely or partially regressed, except for accumulation of pigmented macrophages in alveoli, in both HC and 3R4F groups. In the 5-week study, SD rats were necropsied following exposure to mainstream smoke of either cigarette at 600 or 1000 µg/L for 1 h, two times/day (with 30 min interval), 7 days/week or following a 4-week recovery period. Bronchoalveolar lavage fluid (BALF) analysis of neutrophil percentages and enzyme levels like γ-GT, ALP and LDH indicated that pulmonary inflammation was significantly less in HC groups compared to 3R4F groups. In conclusion, HC demonstrated significantly lower biological effects compared to 3R4F, based on the BALF parameters and histopathology.

Bilateral symmetric claustrum lesions shown on MR imaging are rarely reported, especially transient and reversible lesions associated with seizures, such as herpes simplex encephalitis, 1 unidentified encephalopathy, 2 and acute encephalitis with refractory repetitive partial seizures. 3 To our knowledge, there are no reports of symmetric bilateral claustrum lesions with mumps encephalitis. A 21-year-old man had been experiencing coldlike symptoms with headache and fever for a week when he vomited and had a tonicclonic seizure and was subsequently taken to a nearby emergency hospital (day 1). He had been noticing spasms on the left side of his face for 2 days. On his last visit to the hospital, he reported disorientation accompanied by fever; however, a brain MR imaging and CSF analysis showed no abnormalities. Because he was in status epilepticus on hospitalization, midazolam was administered by intravenous infusion at 3.0 mg/h. Around this time, the patient started to experience visual hallucinations and reported seeing cats and people who were not present, as well as auditory hallucinations: clicking sounds and strange voices. Brain MR imaging on day 6 indicated symmetric high-intensity lesions in the bilateral claustrum (Fig 1). CSF showed pleocytosis (59/L, lymphocytes 36/L, Polymorphonuclear leukocytes 23/L) with normal protein (27 mg/dL) and sugar levels (71 mg/ dL), suggesting viral encephalitis, thus the administration of acyclovir, 1500 mg/day, was started. On day 14, he was transferred to our hospital. On arrival, he was in a confused state with high fever and neck stiffness. There was no parotitis. Visual and auditory hallucinations were observed. There was no abnormality in the cerebral nerves except for a tongue tremor of 5ϳ6 Hz. No pyramidal, extrapyramidal, or cerebellar symptoms or signs were observed. A blood test showed no abnormalities, with negative indication of various autoantibodies, including glutamic acid decarboxylase, anti-nuclear antibody, anti-phospholipid antibody, Ro antibody, and La antibody. Screening for influenza A and B antigens from nasal mucosa, twice for several days, was negative for both. Laboratory studies were negative for herpes simplex virus, varicellazoster virus, cytomegalovirus, and human herpes virus 6 polymerase chain reaction (PCR) antibodies, but mumps virus PCR was positive, from which mumps encephalitis was diagnosed. Following the observation of a secondary generalization of seizures starting from the left leg, we maintained midazolam. However, an electroencephalogram revealed a slow basic rhythm with epileptic discharge. Visual and auditory hallucinations as well as tongue tremor persisted. When we administered risperidone (1 mg/day), the visual and auditory hallucinations and tongue tremor gradually improved and disappeared by day 21. A brain MR imaging on day 19 showed no lesions in the bilateral claustrum (Fig 1). By day 65, the seizures could be controlled by oral administration of an anticonvulsant (sodium valproate at 900 mg/day and phenytoin at 250 m...

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