Factors affecting work productivity and activity impairment among chronic obstructive pulmonary disease patients.

Chronic obstructive pulmonary disease (COPD) can negatively affect patients' employment and work-life activities with a significant indirect economic impact. The current study aimed to measure unemployment, work productivity, activity impairment, and their associated factors among COPD patients. A cross-sectional study was conducted in the Chest outpatient clinic, Mansoura University Hospital, Egypt. COPD patients completed an interviewer-administered questionnaire including sociodemographic, occupational data, clinical history, medical research council (mMRC) dyspnea scale, the COPD assessment test (CAT), and work productivity and activity impairment Questionnaire (WPAI-COPD). A total 140 patients were included in the study and 22.1% of them gave up their jobs because of their COPD. Due to COPD, the mean percentage of daily activity impairment was 39.8 among all patients. The mean percentages of absenteeism, presenteeism, and overall work impairment among the 84 working patients were 0.07, 24.4, and 24.5. The CAT score was the significant predictor of all components of WPAI. In conclusion, COPD causes early retirement, high work productivity loss, and impaired daily activities. Higher CAT scores and increased disease severity significantly increase absenteeism, presenteeism, overall work, and activity impairment. Thus, timely diagnosis of COPD with appropriate management can help improve outcomes and lower the disease burden and economic impact.

The Baveno Classification as a Predictor of CPAP Titration Pressure in Obstructive Sleep Apnea Syndrome.

INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is a clinical condition characterised by repeated periods of partial or full obstruction of airflow throughout sleep, with impairment of the quality of life and increased mortality with socioeconomic impacts. CPAP therapy is a simple and effective treatment option for OSAS patients. To overcome the clinical and prognostic limitations of AHI-as a sole index of OSAS-the Baveno classification was recently set out and introduced into clinical practice. This study aims to analyse the effect of the Baveno classification on the optimum CPAP titration pressure. METHODS: A retrospective analysis of the records of sleep studies in two centres between 2018 and 2021 was carried out. Patients diagnosed with OSAS and recruited for CPAP titration were included. Based on the Baveno classification, the patients were categorised into four groups (A, B, C, and D). RESULTS: Consequently, 700 patients were analysed and 427 patients were included. A significant positive correlation was detected between the CPAP optimum titration pressure and OSAS severity, neck circumference, the oxygen desaturation index (ODI), mean oxygen saturation, the AHI, the BMI, and cumulative sleep time when the SpO2 was <90% (T90) on the other side (p: <0.0001). A non-significant correlation was seen between the Epworth Sleepiness Scale (ESS), symptom severity, end organ impact, and Baveno classification of the CPAP optimum titration pressure (p: 0.8, 0.4, 0.5, and 0.7, respectively). CONCLUSIONS: The Baveno classification is not useful in the prediction of CPAP optimum titration pressure. However, the ODI and neck circumference were significant independent predictors of a higher CPAP titration pressure.

Immunological changes in a cohort of COVID-19 survivors: Mansoura University experience.

Background: COVID-19 is a global pandemic that has affected millions of people all over the world since 2019. Infection with COVID-19 initiates a humoral immune response that produces antibodies against specific viral antigens, which in turn is supposed to provide immunity against reinfection for a period of time. The aim of this research was to study the kinetics of IgM and IgG antibodies against SARS-CoV-2. Methods: One hundred and seventeen post-COVID-19 participants were enrolled in the study.  Qualitative assessment of IgM and IgG antibodies over six months (three visits) post recovery was conducted. Results: The current study revealed a significant reduction in IgM and IgG titers between the first and second visits (p <0.001). After six months, the antibody titer had declined by 78.8% from the first visit for IgM and by 49.2% for IgG antibodies. Regarding younger age and male sex, statistically significant persistence of IgM antibodies was noticed at the six months follow up. Also, statistically significant persistent IgG immunity was found in male patients and diabetics by the end of the six months follow up. Conclusions: We observed a significant waning of IgM and IgG titers over a period of six months follow up.. The persistence of positive IgM and IgG antibodies by the end of six months was variable due to differences in age, gender and presence of diabetes mellitus.

Association of IL-17F Gene Polymorphism and Its Serum Level with SARS-CoV-2 Infection.

OBJECTIVE: Although multiple studies have addressed the clinical outcomes of coronavirus disease, little data exist regarding the defi- nition of immune and inflammatory profiles associated with this infection. Its clinical manifestations often worsen in association with hypercytokinemia (elevated interleukin 8 and interleukin 17). We conducted this research to elucidate the effect of interleukin 17 levels and interleukin 17F gene polymorphism on the severity and outcomes of coronavirus disease. MATERIAL AND METHODS: Ninety patients with confirmed coronavirus disease and 30 healthy controls were enrolled. Coronavirus disease cases were classified into nonsevere, severe, and critical according to the World Health Organization definition. Approximately 10 mL peripheral blood sample was collected from all patients and controls by venipuncture in-plane and ethylenediaminetetraacetic acid tube. Enzyme-linked immunosorbent assay kits were used for calculating serum interleukin 17 levels, whereas real-time polymerase chain reaction was used for genotyping using the 5'-nuclease allelic discrimination assay for single nucleotide polymorphisms genotyping. RESULTS: As regards interleukin 17 levels, there was a significant elevation of interleukin 17 in coronavirus disease cases compared to control healthy persons (P < .001). Moreover, serum interleukin 17 levels tended to be significantly higher with increased disease sever- ity (P = .004). Patients with critical diseases expressed a significant rise of interleukin 17 compared to severe (P = .03) and nonsevere cases (P = .02). We noted no significant difference between the critical, severe, and nonsevere cases regarding different interleukin 17F genotypes. CONCLUSION: Coronavirus disease is associated with elevated levels of interleukin 17, which tended to be considerably higher with disease severity. However, different interleukin 17F genotypes do not affect either the predisposition or the severity of coronavirus disease.

Nondaily dosing schedule of allergen-specific sublingual immunotherapy: efficacy and safety.

Purpose: Sublingual immunotherapy is currently promoted by various companies, with administration schedules variable in the different products even though almost all are standardized immunologically. So, this study was planned to examine the efficacy of simple nondaily dosing of sublingual immunotherapy instead of the widely used daily schedule. Materials and Methods: Fifty-two patients with allergic rhinitis and bronchial asthma were enrolled. Sublingual immunotherapy (manufactured at the allergen immunotherapy preparation unit at Mansoura University) was given in suitable bottles with a dropper mechanism that permits comfortable dosing under the tongue. The physician recommended that the patient put the drops under his/her tongue and leave the drops beneath the tongue for 2 minutes before swallowing. This was repeated every 3 days, with the drop number and concentration gradually rising. Results: After 2 months of follow-up, 65.8% responded partially to the symptom score and 26.3% responded completely to the medication score. There was a significant decline in the symptom and medication scores from the baseline scores (p<0.0001). After 4 months of follow-up, 95.8% responded partially to symptom scores and no one has not responded; 54.2% responded completely to medication scores; and 81% of studied patients had no side effects. However, the most frequent side effect was a sore throat. Conclusion: Our nondaily schedule of sublingual immunotherapy is tolerable, safe, and effective in patients with allergic rhinitis and bronchial asthma.

Screening for Subclinical Interstitial Lung Disease in Rheumatoid Arthritis Patients: Functional and Radiological Methods.

OBJECTIVE: Interstitial lung disease is the most frequent lung symptom of rheumatoid arthritis and is a significant contributor to morbid- ity. As a result, the target of this research was to measure the frequency of radiological and functional abnormalities in rheumatoid arthritis patients who did not have any respiratory symptoms. MATERIAL AND METHODS: This study consists of 30 patients diagnosed with rheumatoid arthritis. All involved cases were exposed to entire history taking and clinical examination. All patients were examined by high-resolution computed tomography and pulmonary function tests. RESULTS: According to the computed tomography visual score, 73.3% showed interstitial lung disease. The most common abnormalities were reticular patterns (46.7%) followed by nodular patterns (40%) and septal lines (23.3%). However, 36% of the patients had a normal pulmonary function, while 32% had a small airway affection, 20% had restrictive lung disease, and 12% had obstructive lung disease. A significant association was found between supine expiratory volume and computed tomography visual score. Results showed no associa- tion between interstitial lung disease and all lung function test parameters. CONCLUSION: Subclinical interstitial lung disease is frequent among rheumatoid arthritis patents. A combination of pulmonary func- tion tests with computed tomography is essential to enhance the recognition of subclinical interstitial lung disease as normal pulmonary function alone cannot exclude its presence.

Preparation of chemically stable allergen-specific sublingual immunotherapy from Egyptian allergens.

BACKGROUND: The term "allergen extracts" refers to solutions of proteins or glycoproteins extracted from source raw materials. OBJECTIVES: This study was planned to prepare chemically stable sublingual immunotherapy from different allergens in Egypt. METHODS: Allergen extraction from raw materials. The concentrated aqueous extract of each allergen was mixed with an equal volume of glycerol. The protein content of the preparations was determined using the modified Lowry assay method. The prepared allergens were stored for 9 months at 2-4°C. Samples were analyzed periodically (0, 3, 6, and 9 months of intervals) adopting the Lowry Assay method. Levels of specific IgE to Chenopodium album antigens were measured in patients' sera by ELISA. RESULTS: The concentration of all prepared allergens, as indicated by the concentration of the protein content, was found to decrease exponentially with time, implying first-order kinetics of degradation. From the values of the slopes of the log plot for each allergen, the half-life time (t1/2 ) and (t1/4 ) values were calculated. The expiration date was considered as the time after which the allergen loses 25% of its potency. The obtained values of t1/4% vary according to the type of vaccine. The most stable one is that of Chenopodium album pollens (2.4 years) and the least stable is that of house dust Mites (9 months). The immunological characters of Chenopodium album extract were stable for at least 6 months. CONCLUSION: Differences exist among allergen extracts made by multiple manufacturers. So, developments in studies on allergen preparation and characterization in a different locality are necessary.

ΔSpO2/distance ratio from the six-minute walk test in evaluation of patients with chronic obstructive pulmonary disease.

INTRODUCTION: The six-minute walk test (6MWT) contains two independent components: walk distance (6MWD) and oxygen saturation (SpO2). 6MWD does not give detailed data on numerous COPD associated disorders. As oxygen desaturation plays a key role in exercise limita-tions, a few new parameters integrating oxygen desaturation during exercise along with walk distance are necessary. So, this study was conducted to assess the relationships between ΔSpO2/distance ratio and pulmonary function test in addition to extent of pulmonary emphysema in COPD patients. MATERIAL AND METHODS: 57 stable COPD patients who attended the outpatient clinic of chest medicine department. Mansoura university. were enrolled. Included patients were classified according to GOLD airflow limitation. Age, sex, and modified Medical Research Council dyspnea score (mMRC) were recorded. furthermore, every patient completed the 6MWT and underwent a pulmonary function test and a CT scan to evaluate the degree of pulmonary emphysema. RESULTS: ΔSpO2/distance ratio was moderately correlated with DLCO%, FVC % and GOLD classification. However, strong correlation was found with FEV1% and RV%. mMRC was weakly correlated with ΔSpO2/distance ratio. In addition, weak nonsignificant correlation was found between ΔSpO2/distance ratio and extent of pulmonary emphysema as measured by HRCT volumetry. A significant moderate cor-relation was noticed between the ΔSpO2/distance ratio and 6MWD (r = -0.5, P < 0.001). a significant strong cor-relation was observed between the ΔSpO2/distance ratio and ΔSpO2 (r = 0.87, P < 0.001). CONCLUSION: ΔSpO2/distance ratio could be a simple and valuable index for the evaluation of exercise capacity in COPD individuals and might be utilized to predict severity of airway obstruction, pulmonary diffusing capacity disorder and severe hyperinflation.

Effect of the Fraction of Inspired Oxygen on Intermittent Central Venous Oxygen Saturation Measurements.

Background: Central venous oxygen saturation (ScvO2) is an essential test readily performed both by medical and nursing personnel in a critical care setting. It gives information on the patient's oxygen supply, oxygen consumption, and cardiac output. It plays an important role in early goal-directed treatment. Objectives: This study was planned to assess the effect of different fractions of inspired oxygen (FiO2) levels on central venous oxygen saturation for consideration during the evaluation of central venous oxygen saturation. Methods: This interventional cross-over study enrolled 60 critically ill, nonmechanically ventilated patients. Blood samples were repeatedly drawn from the distal end of the central venous catheter for blood gas analysis after administration of 30%, 40%, and 50% FIO2 respectively. Results: The results showed that increasing FiO2 from 30% to 40% resulted in a mean increase in ScvO2 of 6.2%. While increasing FiO2 from 40% to 50% resulted in a mean increase in ScvO2 of 3.2%. A significant increase in ScvO2 with changes in FiO2 level was recorded among patients in shock or patients with pneumonia (from 30% to 50%, p=0.002 in shock patients and from 30% to 40%, p=0.02 in patients with pneumonia). Conclusion: Increasing FiO2 resulted in a substantial rise in ScvO2. ScvO2 changes in response to a therapeutic challenge should be interpreted at constant FiO2 level, especially in patients with pneumonia.

Acetylsalicylic Acid Compared with Enoxaparin for the Prevention of Thrombosis and Mechanical Ventilation in COVID-19 Patients: A Retrospective Cohort Study.

BACKGROUND AND OBJECTIVE: Low-dose acetylsalicylic acid (ASA, aspirin) is a well-known and frequently studied drug for primary and secondary prevention of disease due to its anti-inflammatory and coagulopathic effects. COVID-19 complications are attributed to the role of thrombo-inflammation. Studies regarding the use of low-dose ASA in COVID-19 are limited. For this reason, we propose that the use of low-dose ASA may have protective effects in COVID-19-related thromboembolism and lung injury. This study was conducted to assess the efficacy of low-dose ASA compared with enoxaparin, an anticoagulant, for the prevention of thrombosis and mechanical ventilation. METHODS: We conducted a retrospective cohort study on COVID-19-confirmed hospitalized patients at the Mansoura University Quarantine Hospital, outpatients, and home-isolated patients from September to December 2020 in Mansoura governorate, Egypt. Binary logistic regression analysis was used to assess the effect of ASA compared with enoxaparin on thromboembolism, and mechanical ventilation needs. RESULTS: This study included 225 COVID-19 patients. Use of ASA-only (81-162 mg orally daily) was significantly associated with reduced thromboembolism (OR 0.163, p = 0.020), but both low-dose ASA and enoxaparin, and enoxaparin-only (0.5 mg/kg subcutaneously (SC) daily as prophylactic dose or 1 mg/kg SC every 12 hours as therapeutic dose) were more protective (odds ratio [OR] 0.010, OR 0.071, respectively, p < 0.001). Neither ASA-only nor enoxaparin-only were associated with a reduction in mechanical ventilation needs. Concomitant use of low-dose ASA and enoxaparin was associated with reduced mechanical ventilation (OR 0.032, 95% CI 0.004-0.226, p = 0.001). CONCLUSIONS: Low-dose ASA-only use may reduce the incidence of COVID-19-associated thromboembolism, but the reduction may be less than that of enoxaparin-only, and both ASA and enoxaparin. Concomitant use of ASA and enoxaparin demonstrates promising results with regard to the reduction of thrombotic events, and mechanical ventilation needs.

Human Endogenous Retrovirus-H Long Terminal Repeat- Associating Protein 2 (HHLA2) is a Novel Immune Checkpoint Protein in Lung Cancer which Predicts Survival.

ackground: Lung cancer is one of the most frequently diagnosed malignancies. Human endogenous retrovirus-H long terminal repeat-associating protein 2 (HHLA2) is a recently discovered ligand of the B7 family. Blocking this immune checkpoint has become an important treatment option for lung cancer. METHODS: The study includes 62 biopsy specimens either bronchoscopic or CT-guided biopsies diagnosed as lung cancer in Hospitals of Faculty of Medicine, Mansoura University, Egypt during the period from 2016 to 2020. Immunohistochemical Staining for HHLA2 and EGFR was performed. HHLA2 expression was assessed in different pathological types of lung Cancer, and it was correlated with other clinicopathologic parameters and patient prognosis. RESULTS: We found a significant association between HHLA2 expression and metastasis. About 83% of patients presented with metastasis showed positive expression of HHLA2 compared to 44.4% in patients with no metastasis (p=0.02). Also, results show significant mild positive correlation between expression of HHLA2 and EGFR markers (p=0.045). The mean OS time in cases with positive HHLA2 expression was nearly half that of patients with negative expression of the markers. However, this difference was not statistically significant. But, PFS of patients was significantly lower among the group with positive expression of HHLA2 compared to the group with negative expression of HHLA2 (p= 0.01). CONCLUSIONS: This study reports that recently discovered, HHLA2 is over expressed in lung cancer associating with higher stage. It is also correlated with EGFR overexpression. HHLA2 could serve as a predictor of progression and distant metastasis. Also, it has potential to be effective immune target in lung cancer immunotherapy such as checkpoint blockade and antibody-drug conjugate treatment.
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Validity of ROX index in prediction of risk of intubation in patients with COVID-19 pneumonia.

INTRODUCTION: One important concern during the management of COVID-19 pneumonia patients with acute hypoxemic respiratory failure is early anticipation of the need for intubation. ROX is an index that can help in identification of patients with low and those with high risk of intubation. So, this study was planned to validate the diagnostic accuracy of the ROX index for prediction of COVID-19 pneumonia outcome (the need for intubation) and, in addition, to underline the significant association of the ROX index with clinical, radiological, demographic data. MATERIAL AND METHODS: Sixty-nine RT-PCR positive COVID-19 patients were enrolled. The following data were collected: medical history, clinical classification of COVID-19 infection, the ROX index measured daily and the outcome assessment. RESULTS: All patients with severe COVID-19 infection (100%) were intubated (50% of them on the 3rd day of admission), but only 38% of patients with moderate COVID-19 infection required intubation (all of them on the 3rd day of admission). The ROX index on the 1st day of admission was significantly associated with the presence of comorbidities, COVID-19 clinical classification, CT findings and intubation (p ≤ 0.001 for each of them). Regression analysis showed that sex and ROX.1 are the only significant independent predictors of intubation [AOR (95% CI): 16.9 (2.4- 117), 0.77 (0.69-0.86)], respectively. Cut-off point of the ROX index on the 1st day of admission was ≤ 25.26 (90.2% of sensitivity and 75% of specificity). CONCLUSIONS: ROX is a simple noninvasive promising tool for predicting discontinuation of high-flow oxygen therapy and could be used in the assessment of progress and the risk of intubation in COVID-19 patients with pneumonia.

Screening of latent TB infection in patients with recently diagnosed bronchogenic carcinoma.

BACKGROUND: Cancer and pulmonary tuberculosis are major global health concerns and are associated with substantial morbidity and mortality. The association between active tuberculosis and subsequent cancer development has been investigated for many years. This study was planned to determine the prevalence of latent tuberculosis infection in patients with recently diagnosed bronchogenic carcinoma. METHODS: Sixty-four newly diagnosed primary lung cancer patients were enrolled. Diagnosis of latent tuberculosis infection was performed with QuantiFERON-TB Gold In-Tube tests, with exclusion of active tuberculosis. RESULTS: Latent tuberculosis infection was detected in 16 (25%) patients, and 8 (12.5%) had indeterminate results of the QuantiFERON-TB Gold In-Tube test. Being a current smoker was associated with a higher prevalence of latent tuberculosis (p = 0.001). Comorbidities, tumor site, and histopathology were not associated with latent tuberculosis infection. CONCLUSIONS: There is a considerable risk of concurrent latent tuberculosis in newly diagnosed primary bronchogenic carcinoma. The need for treatment of latent tuberculosis in these patients and its influence on the outcome and prognosis are issues for further investigations.

Prevalence of inducible laryngeal obstruction among patients diagnosed as bronchial asthma.

INTRODUCTION: Inducible laryngeal obstruction (ILO) is an important cause of a variety of respiratory symptoms and can mimic bronchial asthma (BA). This study was planned to measure the prevalence of ILO among patients diagnosed with BA and to detect its effect on BA control and severity. MATERIAL AND METHODS: Patients aged 18 years or older who were previously diagnosed with BA were enrolled. Laryngeal obstruction was induced using the patient's specific trigger (e.g. exercise). Visualization of vocal folds was accomplished using a 70-degree rigid laryngoscope (Karl Storz). A visual grade score was utilized to determine the severity of laryngeal obstruction. RESULTS: Results showed that 38.3% (n = 46) of the patients had ILO with the majority being classified as grade 2 (80.4%) (n = 37). The most common subtype was glottic ILO (63%). Bronchial asthma duration, level of control, and severity were not associated with ILO (P values: 0.2, 0.3 and 0.8 respectively). CONCLUSION: Asthma and ILO commonly co-exist. An accurate classification of patients is very important and must be considered in order to determine whether the symptoms are directly related to ILO or whether they are caused by BA. Ceasing inappropriate treatment may be necessary. Objective diagnostic modalities of ILO are essential.

Relationship between clot burden in pulmonary computed tomography angiography and different parameters of right cardiac dysfunction in acute pulmonary embolism.

BACKGROUND: Pulmonary computed tomography angiography (CTA) contains a wealth of information regarding the diagnosis and impact of acute pulmonary embolism (PE). Echocardiography remains the recommended examination to detect signs of right ventricular (RV) dysfunction in patients with shock or hypotension following PE. OBJECTIVES: To detect the relationship between clot volume in pulmonary CTA and different parameters of RV dysfunction assessed by echocardiography and pulmonary CTA in patients with acute PE. METHODS: A cross-sectional study was performed on patients with acute PE from June 2017 to June 2018. Enrolled patients were assessed clinically, radiologically and for cardiac dysfunction. The relationship between clot volume and RV dysfunction was assessed using pulmonary CTA and echocardiography. Data were analysed with SPSS version 16. Correlations were studied using the Spearman and Kruskal-Wallis tests. RESULTS: There was a significant correlation found between clot volume and parameters of RV dysfunction, assessed by pulmonary CTA, including RV diameter (p < 0.001), RV to left ventricular (LV) diameter ratio (p = 0.01), pulmonary artery diameter (p = 0.01), ratio of main pulmonary artery to ascending aorta diameter (p = 0.04), and superior vena cava diameter (p = 0.01). On the other hand, there was no significant correlation between clot volume and parameters of RV dysfunction assessed by echocardiography. CONCLUSIONS: In patients with acute PE, the assessment of RV dysfunction using pulmonary CTA showed good correlation with clot burden, unlike the assessment done with echocardiography.

Observación de Ascaris lumbricoides a través de una aguja de biopsia pleural. Un caso raro de ascariasis intrapleural / Ascaris lumbricoides through pleural biopsy needle. A rare case of intrapleural ascariasis

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Stem Cells and Lung Regeneration.

BACKGROUND: Tissues such as the lung, liver, and pancreas that have a low steady-state cell turnover yet can respond robustly after injury to replace damaged cells. The airway epithelium is exposed to inhaled particles and pathogens that may lead to the development of a many infectious and inflammatory respiratory diseases. Lung transplantation is an accepted modality of treatment for end-stage lung diseases. Since the early 1990 s, more than 26,000 lung transplants have been performed at centers worldwide. However, the availability of donor tissues and organs is limited, which presents a serious limitation for widespread transplantation surgery. The appearance of bioengineered lung and tracheal tissue transplants is considered a promising alternative to the classical transplantation of donor organ/tissue. Stem cells therapy arises as a new therapeutic approach, with a wide application potential.

The Effect of Bone Marrow Mononuclear Cells on Lung Regeneration and Apoptosis in a Simple Model of Pulmonary Emphysema.

BACKGROUND: In severe chronic stages of emphysema the only treatment is lung transplantation. SO, an urgent need exists for the development of effective treatments. Stem cells therapy arises as a new therapeutic approach. AIM OF THE WORK: To investigate whether bone marrow mononuclar cells (BMMNCs) can promote lung regeneration and decrease apoptosis in lipopolysaccharide (LPS) induced pulmonary emphysema in C57Bl/6 mice. MATERIAL AND METHODS: 14 weeks old female mice (C57Bl/6), weighing around 25 g were used in this study. The mice were divided into 4 groups (10 in each group): group A: mice received no treatment, group B: mice received intranasal instillation of LPS with no further treatment, group C: mice received intranasal instillation of LPS then given a dose of BMMNCs and evaluated 21 days later and group D: the mice that received intranasal instillation of LPS then given a dose of Dulbecco's Modified Eagle's Medium (DMEM) and evaluated 21 days later. Imaging analysis was done using imagej program. To measure apoptotic index, Anti-caspase 3 polyclonal antibody staining was done. RESULTS: Analysis of the mean of airspace equivalent diameters (D0) and its statistical distribution (D1) for the different groups allowed to observe that group treated with BMMNCs (group C) showed the significant improvement in D0 and D1 than the group received LPS only (group B). Analysis of apoptotic index showed significant difference between BMMNCs treated group (group C) and that received LPS only (group B). CONCLUSIONS: BMMNCs effectively promote lung regeneration and reduction of apoptosis in pulmonary emphysema.