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PubMedDate not supplied

The Microsponge Delivery System (MDS): a topical delivery system with reduced irritancy incorporating multiple triggering mechanisms for the release of actives.

The Microsponge Delivery System (MDS) is a unique technology for the controlled release of topical agents and consists of macroporous beads, typically 10-25 microns in diameter, loaded with active agent. When applied to the skin, the MDS releases its active ingredient on a time mode and also in response to other stimuli (rubbing, temperature, pH, etc). MDS technology is being used currently in cosmetics, over-the-counter (OTC) skin care, sunscreens and prescription products. By delivering the active gradually to the skin, MDS-benzoyl peroxide formulations, for example, have excellent efficacy with minimal irritation. These are typical benefits from the use of the MDS.

Acne Vulgaris↗
PubMed1999

Opinions of MDs, RNs, allied health practitioners toward osteopathic medicine and alternative therapies: results from a Vermont survey.

The authors surveyed 191 allopathic physicians (MDs), registered nurses (RNs), and allied health professionals (AHPs) regarding their opinions toward osteopathic medicine and alternative therapies. A self-administered questionnaire was distributed to these healthcare professionals practicing in a rural region of west-central Vermont. Participants responded to six questions concerning osteopathic medicine and 18 types of alternative therapies. These questions addressed safety issues, efficacy, personal experience, patient referrals, interest in learning more about alternative medicine, and whether alternative medicine should be provided at the regional hospital. The number of positive responses was totaled as a positive opinion score (POS) for each respondent. Survey results indicated that MDs' general acceptance of osteopathic medicine was less than that of relaxation techniques, massage therapy, self-help groups, and acupuncture. Allopathic physicians' opinions toward osteopaths mirrored that shown toward chiropractors. Nevertheless, MDs responded more positively to osteopathy than did RNs and AHPs. Overall, RNs had a higher opinion of alternative therapies (mean POS 50.4) than did AHPs (mean POS 41.7) or MDs (mean POS 36.0; F = 4.98; P-value = 0.009). Among MDs, primary care providers averaged a POS of 41.1, while specialists had a mean POS of 24.0 (F = 6.85; P-value = 0.012). Overall, female respondents had a mean POS of 45.7 and men had a mean POS of 37.0 (F = 3.91; P-value = 0.051). The POS did not correlate with age (Pearson's r test; r = -0.105).

Adult↗
PubMed1999

MDS+ items not contained in the pressure ulcer RAP associated with pressure ulcer prevalence in newly institutionalized elderly.

All federally funded facilities are required to use the Minimum Data Set Plus (MDS+) for functional assessment of their residents. Within the MDS+ there are 18 specific conditions addressed through Resident Assessment Protocols (RAPs). The purpose of this study was to determine if MDS+ items not included in the pressure ulcer RAP correlated with pressure ulcer prevalence in newly institutionalized elderly. Additionally, this study examined whether the addition of nutritional status information to the correlated items increased association with pressure ulcer prevalence. Data were collected through a retrospective chart review of 990 residents over age 65 at eight nursing homes. Pressure ulcer prevalence was 33.2%. Nineteen of 59 non-RAP MDS+ items were correlated with pressure ulcer prevalence. Logistic regression determined that 10 MDS+ items predicted pressure ulcer prevalence in 28.88% of the subjects. Including serum albumin in the logistic model increased the predictability for pressure ulcer prevalence to 36.3%. Results of this study demonstrate the strong association between nutrition and pressure ulcer prevalence and the need to revise the pressure ulcer RAP.

Aged↗
PubMed2000

The role of apoptosis, proliferation, and the Bcl-2-related proteins in the myelodysplastic syndromes and acute myeloid leukemia secondary to MDS.

Bone marrow CD34(+) cell apoptosis (annexin V), proliferation (Ki-67), and Bcl-2-related protein expression was evaluated by flow cytometry in 102 patients with myelodysplastic syndrome (MDS) and acute myeloid leukemia secondary to MDS (MDS-AML) and in 30 normal donors (NBM). Apoptosis was significantly increased in refractory anemia (RA)/RA with ringed sideroblasts (RARS) (56.9% [20.4%-93.6%]) and refractory anemia with excess blasts (RAEB) (51.2% [25.2%-76. 6%]) compared with NBM (16.7% [3.4%-35.3%], P <.0001). In RA/RARS, apoptosis always exceeded proliferation (Ki-67-positivity, 26.1% [9.5%-47.8%]; apoptosis:proliferation ratio 2.08 [1.15-3.63]); whereas in RAEB, this ratio equalized (1.14 [0.93-2.08]) due to increased proliferation (40.4% [22%-69.5%]). Progression to RAEB in transformation (RAEB-t)/MDS-AML was associated with a significant reduction in apoptosis (22.3% [2.1%-53.2%]; P <.0001) and proliferation (16.8% [1.9%-75.8%); P =.04; ratio 1.69 [0.16-12.21]). Pro-apoptotic (Bax/Bad) versus anti-apoptotic (Bcl-2/Bcl-X) Bcl-2-related protein ratios were increased in RA/RARS compared with NBM (2.57 [1.93-9.42] versus 1.89 [0.65-4.1]; P =.06), whereas disease progression was associated with significantly reduced ratios (1.16 [0.06-3.32]; P <.0001) due primarily to increased Bcl-2 expression. Apoptosis and Bax/Bad:Bcl-2/Bcl-X ratio were inversely correlated with both International Prognostic Scoring System score and cytogenetic risk group; highest levels observed in patients with low score and/or good risk cytogenetics. There was a trend toward an association between Bcl-2-related protein expression and apoptosis (P =.07). This study indicates that MDS progression arises through multiple hits that alter levels of CD34(+) cell apoptosis and proliferation. Early disease is associated with excessive apoptosis and elevated ratio of apoptosis to proliferation. Increased proliferative rates are observed in RAEB, whereas leukemic transformation arises through inhibition of apoptosis rather than excessive cell growth. Although disease progression is accompanied by a fall in pro-apoptotic versus anti-apoptotic Bcl-2-related protein ratios, heterogeneity in patterns of protein expression indicates that factors additional to Bcl-2 family members play a role in the deregulated apoptosis in MDS. (Blood. 2000;96:3932-3938)

Acute Disease↗
PubMed2001

[Clinical significance of WHO classification and MDS 2000 classification in myelodysplastic syndromes].

Excluding chronic myelomonocytic leukemia, a total of 92 consecutive patients with myelodysplastic syndrome showing less than 20% blasts in the bone marrow were analyzed. We evaluated the clinical significance of the WHO and MDS 2000 classifications by reviewing each MDS patient according to the classification. The WHO criteria classified the MDS patients into 36 with RA, 22 with RCMD and 33 with RAEB, whereas according to the MDS 2000 criteria there were 19 RAEB-I patients and 15 RAEB-II patients. Based on the WHO classification, the RCMD patients had higher platelet counts and percentages of blasts among BM cells than the RA patients (P = 0.0018, P = 0.0001). Twenty percent of the RA patients, 44.8% of the RCMD patients, and 70.8% of the RAEB patients had cytogenetic abnormalities. Among them, the poor karyotype was present in 6.7% of the RA patients, 21.0% of the RCMD patients and 41.6% of the RAEB patients. The rate of acute leukemia death was 14.3% in the RA patients, 67.7% in the RAEB patients and 50.0% in the RCMD patients. Analysis of survival times revealed significant differences between RA and RCMD patients (P = 0.0482). The clinical features of RCMD patients were intermediate between those of RAEB and RA patients. There was no difference between the clinical features of the RAEB-I and RAEB-II patients in the MDS 2000 classification.

Aged↗
PubMed2005

[Effect of IL-15 on the proliferation and differentiation of CD34+ cells from MDS patients].

AIM: To explore the effect of IL-15 on proliferation and differentiation of CD34 (+) cells from MDS patients. METHODS: The CD34 (+) cells were separated by magnetic bead-activated cell sorter (MACS) system, and cultured in fluid or methylcellulose semisolid medium. MTT colorimetry was used to examine the inhibitory effect of IL-15 on the proliferation of MDS CD34(+) cells.The numbers of CD34(+)cells and colony formation of CFU-E, BFU-E, CFU-G, CFU-GEMM were counted. The expressions of CD33, CD13, CD71, CD19 and CD3 on cultured cells and the change of cell-cycle were analyzed by FCM. RESULTS: The recovery rate of CD34(+) cells was (75.4+/-5.2) %, the purity of CD34 (+) cells in positive fraction was (90.3+/-6.3) % and the enriched rate was (83.1+/-12.5) % in 11 MDS patients. MTT colorimetry detection showed that IL-15 could promote the proliferation of MDS CD34(+) cells. The optimal time of promotoing CD34(+) cell proliferation by IL-15 was 8 days and optimal dosage of IL-15 was 20 microg/L. After culture for 8 days with 0 microg/L IL-15 (control group) and 20 microg/L IL-15(experimental group), the number of CD34 (+) cells increased by 4.6-fold in control group and 6.3-fold in experimental group (P<0.05, n=5). The colony formation rates of experimental group were significantly higher than those of control group. The expression rates of the CD molecules (except for CD3) on CD34(+) in experimental group were notably higher than those in control group. As compared with control group, much more CD34(+) cells of experimental group were in G(2) and S phase of cell cycle(P<0.05, n=7). CONCLUSION: IL-15 can obviously promote the proliferation and differentiation of CD34(+) cells from MDS patients.

Adolescent↗
PubMed2005

[Inhibition effect of vitamin K2 on human MDS-JSN04 cell line and its possible mechanism].

To study the effects and possible mechanism of Vitamin K(2) (VK(2)) in the treatment of MDS-JSN04 cells, the changes of morphologic features of MDS-JSN04 cells were investigated by cytomorphology, the apoptosis of MDS-JSN04 cells was observed by transmission electron microscope; cellular proliferation was determined by the MTT assay; cell apoptosis, cell cycle shift and expression of myeloid-specific differentiation antigen (CD11b, CD13) were analyzed by flow cytometry (FCM). The expression of apoptosis-related genes bcl-2, survivin and bax were detected by retrotranscriptase polymerase chain reaction (RT-PCR); the activity of caspase-3 was determined by chemiluminescence assay. The results showed that the typical apoptotic morphological features appeared in cells treated with VK(2) for 72 hours; VK(2) induced apoptosis of MDS-JSN04 cells and in a dose-and-time-dependent manner, G(0)/G(1) cell arrest and significantly down-regulated the expression of bcl-2 and survivin, but had no effect on the expression of bax; the activity of caspase-3 significantly increased. It is concluded that VK(2) induces apoptosis of MDS-JSN04 cells through activating caspase-3 pathways and the apoptosis-related genes bcl-2, survivin may play an important role in this process.

Apoptosis↗
PubMed2006

Managing patients with low-risk MDS.

Supportive care with blood transfusion and administration of hematopoietic growth factors (eg, erythropoietin, colony-stimulating factors) has been the standard of care for patients with low-risk myelodysplastic syndromes (MDS), a group of disorders characterized by hyperproliferation of the bone marrow and ineffective hematopoiesis. However, the development of new drugs, including lenalidomide, azacitidine, and decitabine, has led to a new era of more effective treatment for MDS. Further, the use of classification and risk stratification has allowed for the identification of individuals who are expected to benefit from some therapies while simultaneously excluding over-treatment and unnecessary toxicity in those who are unlikely to benefit from specific drugs. In this Clinical Roundtable Monograph, the faculty discusses the epidemiology, classification, and risk stratification for MDS, medical and nursing issues associated with supportive care and the new therapies for low-risk MDS, and patient education and other strategies for the optimization of quality of life in patients with low-risk MDS.

Antimetabolites, Antineoplastic↗
PubMed1990

[Analysis of 259 patients with myelodysplastic syndromes. The Czechoslovak MDS Cooperative Group].

The authors analyze data of 259 patients assembled in seven haematological departments by the Czechoslovak cooperative MDS group and compare them with world-wide groups. The mean age of 60 years of our patients is by 5-10 years lower than of groups reported abroad. In our group and in the majority of groups abroad refractory anaemia predominates over "preleukaemic" types of MDS. CMML is obviously a heterogeneous group from the diagnostic aspect. With the exception of CMML there is marked agreement as regards survival of different types of MDS starting with the longest survival of RAS, via RA, RAEB and finally the lowest survival of patients with RAEB-T. The diagnostic classification is thus to a certain extent also the prognosis of the patient with MDS. Transformation into AL (in 22% in our group) belongs to groups with a lower incidence of AL. Nevertheless more than 50% of the patients do not die from AL but from the sequelae of cytopenia. The incidence of secondary MDS (in the authors' group 13% patients, most frequently after mutagens) is mentioned in groups reported abroad only in one quarter of the papers. The incidence of chromosomal aberrations in our group is one of the highest in the world and along with the low average age of our patients is an alarming finding.

Female↗
PubMedDate not supplied

Preleukemic myelodysplastic syndromes (MDS): pathogenetical considerations based on retrospective clinicomorphological sequential studies.

Analysis of myelodysplastic syndromes (MDS) in 77 patients terminating in "overt" leukemia revealed sequential changes of marrow morphology with respect to cellularity and involvement of lineages, indicating that different "forms" of MDS represent in reality different phases. Three main phases were observed, which occurred in the following non-reversible sequence: (a) hypocellular dysplasia (H), (b) hypercellular dysplasia with predominance of erythropoiesis (E), and (c) with predominance of myelo(mono)poiesis (MM). Published studies suggest that these phases represent different manifestation stages of the stem cell lesion leading to MDS. Manifestation may probably be promoted by factors causing marrow aplasia. Transition to "overt" leukemia in several cases occurred locally, not throughout the whole marrow. In some patients a mature myelo(mono)-cytic cell population showed the capacity for widespread tissue infiltration, characteristic of leukemic cells. This argues against the theory that "overt" leukemia is the result of continuous dedifferentiation in MDS, but favours the concept of multiple initiating "events" leading to evolution of a leukemic subclone within a myelodysplastic clone. A connection between leukemia differentiation and MDS phase, from which leukemia developed, was also observed indicating that the risk of different stem cell subpopulations to become the target of the leukemia initiating "event" varies during the course of myelodysplasia.

Adult↗
PubMed1989

[Study on pathophysiology of the myelodysplastic syndromes (MDS)--pattern of dysmegakaryopoiesis related to leukemic transformation].

A series of 116 patients with MDS consisted of 74 cases of RA, 10 cases of RARS, 14 cases of RAEB, 9 cases of RAEB-T and 9 cases of CMML, were studied on the quantity and morphological abnormalities of megakaryocytes in relation to over all survival and leukemic change. The amount of megakaryocytes was graded into four groups; marked hypoplasia (O), moderate hypoplasia (L), normoplasia (N) and hyperplasia (H), RA cases showed heterogeneous pattern; containing 14 cases (18.9%) of group (O), 18 cases (24.3%) of group (L), 31 cases (41.9%) of group (N) and 11 cases (14.9%) of group (H). RARS, RAEB, RAEB-T and CMML cases were classified into group (N) or group (H). The heterogeneous pattern of RA did not relate to leukemic change, but over all survival tended to be shorter in group (N) cases. A significant number of young female cases of RA were involved in group (O). Morphological abnormalities of MDS megakaryocytes were classified into five types; I, mononuclear micromegakaryocytes, II, binuclear micromegakaryocytes, III, mononuclear small megakaryocytes, IV, multiseparated-nuclear megakaryocytes and V, megakaryocytes with bizzare nuclei. RAEB and RAEB-T cases uniformly showed marked dysmegakaryopoiesis ranging from type I to V. whereas RA, RARS and CMML cases showed mild dysmegakaryopoiesis. Only five cases (6.4%) of RA cases had type I micromegakaryocytes. Eight RA cases with type I on diagnosis or obtaining it during the clinical course tended to develop acute myeloid leukemia (5 cases) or to transform to RAEB sooner or later. In two cases of RAEB in which hematological improvement was obtained with low dose cytosine arabinoside regimen, disappearance of type I micromegakaryocytes was noted. A female case with 5q-anomaly surviving more than 10 years showed marked megakaryocyte hyperplasia and almost exclusively type III and IV megakaryocytes. These findings indicated that pattern of dysmegakaryopoiesis, especially appearance of type I, was closely related to leukemic change in MDS. Thus quantitative and qualitative evaluations of MDS megakaryocytopoiesis seemed important to understand the further heterogeneity of pathophysiology in MDS subtypes.

Aged↗
PubMedDate not supplied

PMA induces shift from chondroitin to heparan sulphate on proteoglycans correlating with fibronectin adhesion of MDS human leukemia cells.

We have analysed the mechanism of PMA-induced adhesion of the MDS human leukemia cell line. Affinity to various matrix ligands indicated that PMA induced fibronectin adhesion of MDS cells. This interaction could not be inhibited by RGDS-peptide, therefore it was most probably not mediated by integrins. Rather, both the basal and PMA-induced fibronectin adhesion of MDS cells could be inhibited by heparin and much less efficiently by chondroitin sulphate, suggesting that glycosaminoglycans of proteoglycans may be responsible for the change in adhesive phenotype. PMA stimulation of MDS cells induced a significant increase in proteoglycan biosynthesis. Studies on the glycosaminoglycan pattern of the proteoglycans showed that PMA treatment initiated a shift in glycanation of the MDS-proteoglycans from the predominant chondroitin sulphate-proteoglycans in control cells to a predominant heparan sulphateproteoglycans in adherent cells. These data indicate that protein kinase C, the main target of PMA, may have a profound role in the regulation of glycanation pattern of proteoglycans. Furthermore, such alterations in the cellular proteoglycans may significantly affect the matrix adhesion potential of hematopoietic cells.

Cell Adhesion↗
PubMed1994

[Allogeneic bone marrow transplantation for two patients with acute myeloid leukemia with trilineage myelodysplasia (T-MDS)].

Case 1: A 26-year-old female was admitted because of leukocytosis with 43.6% myeloblasts and 33.6% monocytes, and trilineage myelodysplasia (T-MDS) was detected on bone marrow (BM) smear. She was diagnosed as having acute myeloid leukemia (AML) (M4) with T-MDS and was treated with the Japan Adult Leukemia Study Group (JALSG) AML87 protocol. After completion of chemotherapy, leukemic myeloblasts remained minimally and myelodysplastic changes were still detected on BM smear. She underwent allo-BMT from an HLA-identical sibling. The conditioning regimen consisted of busulfan and cyclophosphamide. Cyclosporine A and short term methotrexate were administered prophylactically for graft-versus-host disease (GVHD). She developed slight veno-occlusive disease and pancytopenia, which improved soon. She is surviving free of disease for 37 months from BMT. Case 2: A 41-year-old male was diagnosed as having T-MDS AML (M2) and achieved complete remission with the AML89 protocol, but relapsed soon. He underwent allo-BMT from an HLA-identical sibling. The conditioning regimen and prophylaxis against GVHD were the same as in case 1. He developed mild acute GVHD, pleural effusion and later mild chronic GVHD. These improved soon. He is surviving free of disease for 21 months from BMT. Some reports suggest that intensive chemotherapy can induce CR in 40%-70% of patients with T-MDS AML, but most of them tend to relapse and rarely survive long. We consider that the best strategy for treatment of T-MDS AML is allo-BMT at present, if suitable donors are available.

Adult↗
PubMed1996

[Apoptosis in MDS].

We examined the endonuclease activity capable of inducing internucleosomal DNA fragmentation in hematopoietic cells. Mg(2+)-dependent nuclease activity was high in hematopoietic progenitor cells and the activity decreased with myeloid or erythroid differentiation. This was the case in MDS as well as in normal hematopoiesis. In contrast, Ca2+/Mg(2+)-dependent nuclease activity varied widely in the samples from MDS and the possibility was indicated that the activity of Glycophorin A+ cells was related to the degree of anemia. We also investigated DNA strand breaks in bone marrow samples from 16 patients with MDS and 10 with other diseases by an in situ end labeling (ISEL) technique. The reactivity in ISEL tended to increase parallel to disease progression of MDS. The high ISEL-positivity was also observed in some samples from patients with MPD and other diseases. Though ISEL is a useful technique for quantification of apoptosis, our results suggested that MDS cells with ISEL positive staining are not necessarily in the process of apoptosis.

Apoptosis↗
PubMed1997

MDS and AML with trisomy 8 as the sole chromosome aberration show different sex ratios and prognostic profiles: a study of 115 published cases.

A number of chromosome aberrations occur nonrandomly as the sole aberration in malignant and premalignant hematological disorders. They imply very different prognoses. For most of them the survival consequences have been established. For trisomy 8, which is the most frequent numerical aberration in myeloid disorders, the prognostic implications have not been investigated. In order to clarify survival in patients with trisomy 8 as the sole aberration, the literature was searched for such cases. In 115 patients survival data were available. In 103 (89.6%), a myeloid disorder had been diagnosed. Acute myeloid leukemia (AML) or a myelodysplastic syndrome (MDS) occurred in 100 cases (87.0%). The median survival was found to be 17.1 months. On multivariate survival analysis (Cox), age above 60 and a leukemic diagnosis were found to be independent adverse prognostic indicators. MDS patients survived significantly longer (median 21 months) than AML patients (median 15 months). In MDS age and in AML the trisomy 8 clonal size was an independent prognostic factor. An unexpected observation was a clear male preponderance in trisomy 8 MDS (about two-thirds of cases). In trisomy 8 AML an approximate 1:1 ratio was found. Browsing of Mitelman's catalog confirmed these ratios.

Adolescent↗
PubMed2004

The effect of LIGHT in inducing maturation of monocyte-derived dendritic cells from MDS patients.

LIGHT is a recently cloned novel cytokine belonging to the TNF family that is selectively expressed on immature dendritic cells (iDCs) generated from monocytes isolated from human PBMCs. In these studies, we demonstrate that exogenous soluble LIGHT or soluble CD40 ligand (CD40L) can promote monocyte-derived dendritic cell maturation in vitro by the up-regulation of CD86, CD80, CD83, and HLA-DR antigen expression. Immature dendritic cells differentiated from monocytes of MDS patients displayed lower levels of costimulatory and HLA-DR molecules compared with iDCs differentiated from monocytes of normal subjects. However, upon induction of maturation by LIGHT or CD40L, the expression of costimulatory and HLA-DR molecules is comparable between DCs from MDS and normal subjects. Exogenous LIGHT- and CD40L-stimulated mature DCs (mDCs) also displayed increased antigen presentation to autologous T lymphocytes (tetanus toxin) or allogeneic T lymphocytes in mixed lymphocyte reactions. DCs matured by LIGHT showed increased secretion of IL-6, IL-12p75, and TNF-alpha, but not IL-1beta. We conclude that both LIGHT and CD40L are immunoregulating factors that induce monocyte-derived iDCs from MDS patients to undergo maturation resulting in increased antigen presentation and T-cell activation. Monocyte-derived DCs can be stimulated to undergo phenotypic and functional changes with LIGHT that might be applied in the development of a DC-based vaccine for MDS treatment.

Antigen Presentation↗
PubMed1995

Responsiveness to stem cell factor (SCF) of peripheral blood colony-forming cells from patients with myelodysplastic syndromes (MDS).

We have previously reported that serum stem factor (SCF) levels are significantly lower in patients with myelodysplastic syndrome (MDS) than normal controls. We have now studied the effects of adding SCF to cultures of blood mononuclear cells from patients with MDS and normal subjects. Three of 17 patients with MDS showed marked increases in erythroid colony numbers with SCF + erythropoietin compared to interleukin-3 + erythropoietin. In two cases (1RA and 1ISA) the erythroid colony numbers became normal. The same RA patient also showed a marked increase in myeloid colony numbers, which were undetectable with granulocyte-macrophage colony-stimulating factor alone, but within the normal range when SCF was added. A fourth patient (ISA) showed a 4.7-fold increase in myeloid colonies with SCF, but no erythroid response. The normal subjects showed a trend towards increased numbers of myeloid colonies with SCF; erythroid colonies did not increase. A correlation was found between the MDS patients' haemoglobin levels and erythroid colony numbers with and without SCF, but there was no correlation between erythroid or myeloid colonies in the presence of SCF and their serum SCF level.

Adult↗
PubMed1998

Molecular features of primary MDS with cytogenetic changes.

Cytogenetic changes in primary myelodysplastic syndromes (MDS) have been extremely useful to identify clonality and to define specific clinico-pathological entities. More recently, with the development of DNA technology, a bulk of new information has been added to classical cytogenetics. Genes corresponding to chromosomal breakpoints implicated in reciprocal translocations have been cloned. Search for the minimal lost region has been the aim of the so-called deletion mapping approach to pick up the hypothetical suppressor gene(s) critical for typical deletions of MDS. Correlation has been found between gene mutations, deletions, expression, and clinical-hematological or cytogenetic features of MDS. Integration of fluorescence in situ hybridization at DNA level and of immunophenotyping at cellular level is an elegant tool to investigate clonal affiliation in MDS with distinct genetic changes.

Chromosome Aberrations↗