Effects of microbeam radiation therapy on normal and tumoral blood vessels

Microbeam radiation therapy (MRT) is a new form of preclinical radiotherapy using quasi-parallel arrays of synchrotron X-ray microbeams. While the deposition of several hundred Grays in the microbeam paths, the normal brain tissues presents a high tolerance which is accompanied by the permanence of apparently normal vessels. Conversely, the efficiency of MRT on tumor growth control is thought to be related to a preferential damaging of tumor blood vessels. The high resistance of the healthy vascular network was demonstrated in different animal models by in vivo biphoton microscopy, magnetic resonance imaging, and histological studies. While a transient increase in permeability was shown, the structure of the vessels remained intact. The use of a chick chorioallantoic membrane at different stages of development showed that the damages induced by microbeams depend on vessel maturation. In vivo and ultrastructural observations showed negligible effects of microbeams on the mature vasculature at late stages of development; nevertheless a complete destruction of the immature capillary plexus was found in the microbeam paths. The use of MRT in rodent models revealed a preferential effect on tumor vessels. Although no major modification was observed in the vasculature of normal brain tissue, tumors showed a denudation of capillaries accompanied by transient increased permeability followed by reduced tumor perfusion and finally, a decrease in number of tumor vessels. Thus, MRT is a very promising treatment strategy with pronounced tumor control effects most likely based on the anti-vascular effects of MRT.

Loss of p21 increases sensitivity to ionizing radiation and delays the onset of lymphoma in atm-deficient mice

Ataxia telangiectasia (AT) is an autosomal recessive disorder characterized by growth retardation, cerebellar ataxia, oculocutaneous telangiectasias, and a high incidence of lymphomas and leukemias. In addition, AT patients are sensitive to ionizing radiation. Atm-deficient mice recapitulate most of the AT phenotype. p21cip1/waf1 (p21 hereafter), an inhibitor of cyclin-dependent kinases, has been implicated in cellular senescence and response to γ-radiation-induced DNA damage. To study the role of p21 in ATM-mediated signal transduction pathways, we examined the combined effect of the genetic loss of atm and p21 on growth control, radiation sensitivity, and tumorigenesis. As might have been expected, our data provide evidence that p21 modifies the in vitro senescent response seen in AT fibroblasts. Further, it is a downstream effector of ATM-mediated growth control. In addition, however, we find that loss of p21 in the context of an atm-deficient mouse leads to a delay in thymic lymphomagenesis and an increase in acute radiation sensitivity in vivo (the latter principally because of effects on the gut epithelium). Modification of these two crucial aspects of the ATM phenotype can be related to an apparent increase in spontaneous apoptosis seen in tumor cells and in the irradiated intestinal epithelium of mice doubly null for atm and p21. Thus, loss of p21 seems to contribute to tumor suppression by a mechanism that operates via a sensitized apoptotic response. These results have implications for cancer therapy in general and AT patients in particular.

Increased IGF-II protein affects p57kip2 expression in vivo and in vitro: Implications for Beckwith–Wiedemann syndrome

In both human and mouse, the Igf2 gene, localized on chromosomes 11 and 7, respectively, is expressed from the paternally inherited chromosome in the majority of tissues. Insulin-like growth factor-II (IGF-II) plays an important role in embryonic growth, and aberrant IGF2 expression has been documented in several human pathologies, such as Beckwith–Wiedemann syndrome (BWS), and a wide variety of tumors. Human and mouse genetic data strongly implicate another gene, CDKN1C (p57kip2), located in the same imprinted gene cluster on human chromosome II, in BWS. p57KIP2 is a cyclin-dependent kinase inhibitor and is required for normal mouse embryonic development. Mutations in CDKN1C (p57kip2) have been identified in a small proportion of patients with BWS, and removal of the gene from mice by targeted mutagenesis produces a phenotype with elements in common with this overgrowth syndrome. Patients with BWS with biallelic expression of IGF2 or with a CDKN1C (p57kip2) mutation, as well as overlapping phenotypes observed in two types of mutant mice, the p57kip2 knockout and IGF-II-overexpressing mice, strongly suggest that the genes may act in a common pathway of growth control in situations where Igf2 expression is abnormal. Herein, we show that p57kip2 expression is reduced on IGF-II treatment of primary embryo fibroblasts in a dose-dependent manner. In addition, p57kip2 expression is down-regulated in mice with high serum levels of IGF-II. These data suggest that the effects of increased IGF-II in BWS may, in part, be mediated through a decrease in p57kip2 gene expression.

Identification of the vitamin K-dependent carboxylase active site: Cys-99 and Cys-450 are required for both epoxidation and carboxylation

The vitamin K-dependent carboxylase modifies and renders active vitamin K-dependent proteins involved in hemostasis, cell growth control, and calcium homeostasis. Using a novel mechanism, the carboxylase transduces the free energy of vitamin K hydroquinone (KH2) oxygenation to convert glutamate into a carbanion intermediate, which subsequently attacks CO2, generating the γ-carboxylated glutamate product. How the carboxylase effects this conversion is poorly understood because the active site has not been identified. Dowd and colleagues [Dowd, P., Hershline, R., Ham, S. W. & Naganathan, S. (1995) Science 269, 1684–1691] have proposed that a weak base (cysteine) produces a strong base (oxygenated KH2) capable of generating the carbanion. To define the active site and test this model, we identified the amino acids that participate in these reactions. N-ethyl maleimide inhibited epoxidation and carboxylation, and both activities were equally protected by KH2 preincubation. Amino acid analysis of 14C- N-ethyl maleimide-modified human carboxylase revealed 1.8–2.3 reactive residues and a specific activity of 7 × 108 cpm/hr per mg. Tryptic digestion and liquid chromatography electrospray mass spectrometry identified Cys-99 and Cys-450 as active site residues. Mutation to serine reduced both epoxidation and carboxylation, to 0.2% (Cys-99) or 1% (Cys-450), and increased the Kms for a glutamyl substrate 6- to 8-fold. Retention of some activity indicates a mechanism for enhancing cysteine/serine nucleophilicity, a property shared by many active site thiol enzymes. These studies, which represent a breakthrough in defining the carboxylase active site, suggest a revised model in which the glutamyl substrate indirectly coordinates at least one thiol, forming a catalytic complex that ionizes a thiol to initiate KH2 oxygenation.

The transcriptional program of a human B cell line in response to Myc

The proto-oncogene c-myc (myc) encodes a transcription factor (Myc) that promotes growth, proliferation and apoptosis. Myc has been suggested to induce these effects by induction/repression of downstream genes. Here we report the identification of potential Myc target genes in a human B cell line that grows and proliferates depending on conditional myc expression. Oligonucleotide microarrays were applied to identify downstream genes of Myc at the level of cytoplasmic mRNA. In addition, we identified potential Myc target genes in nuclear run-on experiments by changes in their transcription rate. The identified genes belong to gene classes whose products are involved in amino acid/protein synthesis, lipid metabolism, protein turnover/folding, nucleotide/DNA synthesis, transport, nucleolus function/RNA binding, transcription and splicing, oxidative stress and signal transduction. The identified targets support our current view that myc acts as a master gene for growth control and increases transcription of a large variety of genes.

Genomic structure of the human retinoblastoma-related Rb2/p130 gene.

The human Rb2/p130 gene shares many structural and functional features with the retinoblastoma gene and the retinoblastoma-related p107 gene. In the present study, we have cloned and partially sequenced the gene coding for the Rb2/p130 protein from human genomic libraries. The complete intron-exon organization of this gene has been elucidated. The gene contains 22 exons spanning over 50 kb of genomic DNA. The length of individual exons ranges from 65 to 1517 bp. The largest intron spans over 9 kb, and the smallest has only 82 bp. The 5' flanking region revealed a structural organization characteristic of promoters of "housekeeping" and growth control-related genes. A typical TATA or CAAT box is not present, but there are several GC boxes and potential binding sites for numerous transcription factors. This study provides the molecular basis for understanding the transcriptional control of the Rb2/p130 gene and for implementing a comprehensive Rb2/p130 mutation screen using genomic DNA as a template.

Muscarinic acetylcholine receptor down-regulation limits the extent of inhibition of cell cycle progression in Chinese hamster ovary cells.

Cellular desensitization is believed to be important for growth control but direct evidence is lacking. In the current study we compared effects of wild-type and down-regulation-resistant mutant m3 muscarinic receptors on Chinese hamster ovary (CHO-K1) cell desensitization, proliferation, and transformation. We found that down-regulation of m3 muscarinic acetylcholine receptors was the principal mechanism of desensitization of receptor-activated inositol phosphate phospholipid hydrolysis in these cells. Activation of wild-type and mutant receptors inhibited anchorage-independent growth as assayed by colony formation in agar. However, the potency for inhibition of anchorage-independent growth was greater for cells expressing the mutant receptor. Activation of either receptor also initially inhibited anchorage-dependent cell proliferation in randomly growing populations. Rates of DNA synthesis and cell division were profoundly reduced by carbachol in cells expressing either receptor at early time points. Analysis of cell cycle parameters indicated that cell cycle progression was inhibited at transitions from G1 to S and G2/M to G1 phases. However, mutant receptor effects on anchorage-dependent growth were sustained, whereas wild-type receptor effects were transient. Thus, receptor down-regulation restored cell cycle progression. In contrast, activation of either receptor blocked entry into the cell cycle from quiescence, and this response was not reduced by receptor down-regulation. Therefore, activation of m3 muscarinic acetylcholine receptors inhibited CHO cell anchorage-dependent and -independent growth. In anchored cells carbachol inhibited the cell cycle at three distinct points. Inhibitions at two of these points were eliminated by wild-type receptor down-regulation while the other was not. These results directly demonstrate that desensitization mechanisms can act as principal determinants of cellular growth responses.

Immortalization of human primary B lymphocytes in vitro with DNA.

Epstein-Barr virus (EBV) is a human DNA tumor virus that efficiently immortalizes human primary B lymphocytes in vitro. Although viral genes that are expressed in latently infected B lymphocytes have been shown to function in cellular growth control, their detailed genetic analysis has been cumbersome for two reasons. The viral genome is too large to permit genetic engineering and human primary B lymphocytes, the only targets for infection by EBV in vitro, are both intractable in culture and recalcitrant to DNA transfection. To overcome these obstacles, we have assembled all the essential genes of EBV on a single recombinant vector molecule in Escherichia coli. We show here that this mini-EBV plasmid can yield immortalized B cells upon transfer of its naked DNA into human primary B lymphocytes. Established cell lines carry recombinant vector DNA and cannot support virus production. Because this DNA can be easily manipulated in E. coli, mutant mini-EBVs as well as foreign genes can now be introduced and studied successfully in recipient B lymphocytes from any human donors. These mini-EBVs therefore are potentially useful for human gene therapy.

Phenotypic knockout of the high-affinity human interleukin 2 receptor by intracellular single-chain antibodies against the alpha subunit of the receptor.

The experimental manipulation of peptide growth hormones and their cellular receptors is central to understanding the pathways governing cellular signaling and growth control. Previous work has shown that intracellular antibodies targeted to the endoplasmic reticulum (ER) can be used to capture specific proteins as they enter the ER, preventing their transport to the cell surface. Here we have used this technology to inhibit the cell surface expression of the alpha subunit of the high-affinity interleukin 2 receptor (IL-2R alpha). A single-chain variable-region fragment of the anti-Tac monoclonal antibody was constructed with a signal peptide and a C-terminal ER retention signal. Intracellular expression of the single-chain antibody was found to completely abrogate cell surface expression of IL-2R alpha in stimulated Jurkat T cells. IL-2R alpha was detectable within the Jurkat cells as an immature 40-kDa form that was sensitive to endoglycosidase H, consistent with its retention in a pre- or early Golgi compartment. A single-chain antibody lacking the ER retention signal was also able to inhibit cell surface expression of IL-2R alpha although the mechanism appeared to involve rapid degradation of the receptor chain within the ER. These intracellular antibodies will provide a valuable tool for examining the role of IL-2R alpha in T-cell activation, IL-2 signal transduction, and the deregulated growth of leukemic cells which overexpress IL-2R alpha.

Avaliação da contaminação conjunta de Dekkera bruxellensis e Lactobacillus fermentum sobre a fermentação alcoólica: efeito do substrato e formas de controle

As contaminações por leveduras selvagens e por bactérias no processo de produção de etanol combustível no Brasil causam prejuízos ao rendimento fermentativo e aumento de custos pelo uso de biocidas. No entanto, poucos estudos tem focado no efeito das contaminações conjuntas de leveduras selvagens e bactérias e as possíveis interações entre os micro-organismos, especialmente em função dos diferentes substratos de fermentação e das formas de controle. Este trabalho teve por objetivos verificar o efeito do substrato (caldo de cana e melaço) sobre o desenvolvimento das contaminações pela levedura da espécie Dekkera bruxellensis e pela bactéria Lactobacillus fermentum, em co-culturas com Saccharomyces cerevisiae (linhagem industrial PE-2) e possíveis formas de controle do crescimento dos contaminantes (pelo uso de metabissulfito de potássio e adição de etanol ao tratamento ácido) sem afetar a levedura do processo. Os testes foram realizados em condições de crescimento (substrato com 4 °Brix, culturas agitadas) e fermentação com reciclo celular (substrato com 16 °Brix, culturas estáticas). Houve interação entre as leveduras e a bactéria quando crescidas em caldo de cana 4 °Brix. A levedura industrial não foi afetada pela presença dos micro-organismos contaminantes, no entanto, para D. bruxellensis a presença de L. fermentum interferiu positivamente no crescimento, com aumento no número de UFC, e consequentemente inibição do crescimento da bactéria. Em melaço, houve um estímulo ao crescimento de L. fermentum quando em co-cultura com S. cerevisiae. Houve influência das contaminações sobre os parâmetros avaliados no experimento (pH, açúcar redutor total, etanol, glicerol e crescimento das células) e a contaminação conjunta de L. fermentum e D. bruxellensis potencializou o efeito das contaminações pelos micro-organismos isoladamente, tanto em caldo quanto em melaço. A adição de 13% de etanol à solução de ácido sulfúrico pH 2,0 no tratamento celular resultou em uma diminuição significativa no número de UFC de D. bruxellensis (entre 90-99%). A levedura PE-2 foi pouco afetada pelo tratamento proposto. A bactéria L. fermentum teve seu crescimento afetado em todas as combinações testadas. Como os experimentos foram feitos em co-culturas, verificouse que pode haver influência de um micro-organismo sobre a viabilidade do outro, dependendo da reação ao tratamento ácido-etanol. O metabissulfito de potássio (MBP), no intervalo entre 200-400 mg/L, foi eficaz para controlar o crescimento de D. bruxellensis dependendo do meio de cultura e linhagem. Quando adicionado (250 mg/L) à solução ácida (pH 2,0) no tratamento celular, um efeito significativo foi observado nas culturas mistas, pois ocorreu a inativação do SO2 pela S. cerevisiae e uma provável proteção das células de D. bruxellensis, não sendo essa levedura prejudicada pelo MBP. A resposta fisiológica de S. cerevisiae na presença de MBP pode explicar a diminuição significativa na produção de etanol. Quando o MBP foi adicionado ao meio de fermentação, resultou no controle da D. bruxellensis mas não em sua morte, com efeito menos intensivo sobre a eficiência fermentativa. Em cocultura com a adição de MBP, a eficiência fermentativa foi significativamente menor do que na ausência de MBP.

Efeito do substrato e das condições de tratamento do fermento sobre a fermentação etanólica contaminada com leveduras Saccharomyces cerevisiae selvagens e Lactobacillus fermentum

Pouco se sabe sobre o efeito do substrato e a interação entre as leveduras selvagens e bactérias do gênero Lactobacillus na fermentação alcoólica, pois os estudos tem se concentrado na avaliação dos efeitos da contaminação por um ou outro contaminante separadamente. Diante disso, este trabalho teve como objetivos estudar o efeito do substrato e das condições de tratamento do fermento sobre as fermentações contaminadas com ambos os micro-organismos, leveduras S. cerevisiae selvagens (três linhagens apresentando colônias rugosas e células dispostas em pseudohifas) e Lactobacillus fermentum, tendo a linhagem industrial de S. cerevisiae PE-2 como levedura do processo. Foram realizadas fermentações em batelada em mosto de caldo e de melaço, sem reciclo e com reciclo celular, utilizando tanto a cultura pura da linhagem PE-2 quanto as culturas mistas com as linhagens rugosas e ou L. fermentum. Foram avaliadas modificações no tratamento ácido do fermento, visando o controle do crescimento dos contaminantes sem afetar a levedura do processo. Em seguida, foram conduzidas fermentações contaminadas e não contaminadas submetidas ao tratamento ácido combinado com adição de etanol, tanto em caldo quanto em melaço, utilizando-se PE-2, uma das linhagens rugosas e L. fermentum. A atividade da invertase extracelular foi também avaliada em ambos os substratos para os micro-organismos estudados, em condições de crescimento. Concluiu-se que o tipo de substrato de fermentação, caldo de cana ou melaço, influenciou o desempenho da linhagem industrial PE-2 assim como afetou o desenvolvimento das contaminações com as leveduras rugosas S. cerevisiae na presença ou ausência da bactéria L. fermentum, em fermentações sem reciclo celular. O efeito da contaminação foi mais evidente quando se utilizou caldo de cana do que melaço como substrato, no caso da contaminação com leveduras rugosas, e o inverso no caso da contaminação com L. fermentum. O efeito da contaminação sobre a eficiência fermentativa foi maior na presença da levedura rugosa do que com a bactéria, e a contaminação dupla (tanto com a levedura rugosa quanto com a bactéria) não teve efeito maior sobre a eficiência fermentativa do que a contaminação simples, por um ou por outro micro-organismo isoladamente, especialmente na fermentação em batelada com reciclo celular, independentemente do substrato. Nas fermentações com reciclo de células, o efeito do substrato foi menos evidente. O controle do crescimento das linhagens rugosas pode ser realizado modificando o tratamento ácido normalmente realizado na indústria, seja pela adição de etanol à solução ácida ou pelo abaixamento do pH, dependendo da linhagem rugosa. O tratamento combinado baixo pH (2,0) + 13% etanol afetou a fisiologia da linhagem industrial, trazendo prejuízos à fermentação com reciclo celular, com pequeno controle sobre o crescimento da levedura rugosa e causando morte celular à L. fermentum. A diferença na atividade invertásica entre as linhagens rugosas e industrial de S. cerevisiae pode ser a responsável pela fermentação lenta apresentada pelas linhagens rugosas quando presentes na fermentação, sendo não significativa a influência do substrato sobre a atividade dessa enzima.

La influencia normativa y de los propietarios del suelo en la formación del barrio de Benalúa, Alicante (1883)

El presente artículo plantea el doble objetivo de subsanar, por un lado, el vacío documental existente en relación a cómo influyeron los condicionantes sociopolíticos y económicos, normativas del momento y exigencias de los propietarios del suelo en la concepción del singular barrio de Benalúa de Alicante (España), proyectado por el arquitecto José Guardiola Picó (1883); y, por otro, difundir en el ámbito internacional el conocimiento de esta actuación relevante que, anticipándose a la ejecución del ensanche de la ciudad (1898), encabezó los primeros intentos de industrialización y control del crecimiento urbano, para que sirva de base a futuras investigaciones y estudios comparativos con actuaciones semejantes de Europa y América. De la exposición se concluyen las cualidades e identidad de un barrio pionero en atender, por iniciativa particular y de modo sectorial, la necesidad higienista y reflexión urbanística que precisaba la ciudad, reflejo de la calidad arquitectónica manifiesta desde su proyecto. Asimismo, el porqué de la aparición de ciertas variaciones dimensionales en la coherencia de su trazado, el origen de la parcela y manzana tipo que lo configuraron y otras influencias en el programa y diseño de la vivienda, que sólo pueden explicarse desde regulaciones e intereses externos a la propia génesis proyectual. Reflexiones que constatan las claves del proyecto que confirieron al barrio la capacidad de asumir, sin perder su cualidad, los sucesivos procesos de adaptación y transformación impuestos.

The effect of manipulations to target contrast on emmetropization in chick

Emmetropization is dependent on visual feedback and presumably some measure of the optical and image quality of the eye. We investigated the effect of simple alterations to image contrast on eye growth and refractive development. A 1.6 cyc/deg square-wave-grating target was located at the end of a 3.3 cm cone,, imaged by a +30 D lens and applied monocularly to the eyes of 8-day-old chicks. Eleven different contrast targets were tested: 95, 67, 47.5, 33.5, 24, 17, 12, 8.5, 4.2, 2.1, and 0%. Refractive error (RE), vitreous chamber depth (VC) and axial length (AL) varied with the contrast of the image (RE diff. F-10.86 = 12.420, p < 0.0005; VC diff. F-10.86 = 8.756, p < 0.0005; AL diff. F-10.86 = 9.240, p < 0.0005). Target contrasts 4.2% and lower produced relative myopia (4.2%: RE diff = -7.48 +/- 2.26 D, p = 0.987; 2.1%: RE diff = -7.22 +/- 2.77 D, p = 0.951) of similar amount to that observed in response to a featureless 0% contrast target (RE diff = -9.11 +/- 4.68 D). For target contrast levels 47.5% and greater isometropia was maintained (95%: RE diff = 1.83 +/- 2.78 D; 67%: RE diff = 0.14 +/- 1.84 D; 47.5% RE diff = 0.25 +/- 1.82 D). Contrasts in between produced an intermediate amount of myopia (33.5%: RE diff = -2.81 +/- 1.80 D; 24%: RE diff = -3.45 +/- 1.64 D; 17%: RE diff = -3.19 +/- 1.54 D; 12%: RE diff = -4.08 +/- 3.56 D; 8.5%: RE diff = -4.09 +/- 3.60 D). We conclude that image contrast provides important visual information for the eye growth control system or that contrast must reach a threshold value for some other emmetropization signal to function. (c) 2005 Elsevier Ltd. All rights reserved.

Estudo da sinterização do aço inox 316L reforçado com 3% Carbeto de Tântalo - TaC

The present work shows a contribution to the studies of development and solid sinterization of a metallic matrix composite MMC that has as starter materials 316L stainless steel atomized with water, and two different Tantalum Carbide TaC powders, with averages crystallite sizes of 13.78 nm and 40.66 nm. Aiming the metallic matrix s density and hardness increase was added different nanometric sizes of TaC by dispersion. The 316L stainless steel is an alloy largely used because it s high resistance to corrosion property. Although, its application is limited by the low wear resistance, consequence of its low hardness. Besides this, it shows low sinterability and it cannot be hardened by thermal treatments traditional methods because of the austenitic structure, face centered cubic, stabilized mainly in nickel presence. Steel samples added with TaC 3% wt (each sample with different type of carbide), following a mechanical milling route using conventional mill for 24 hours. Each one of the resulted samples, as well as the pure steel sample, were compacted at 700 MPa, room temperature, without any addictive, uniaxial tension, using a 5 mm diameter cylindrical mold, and quantity calculated to obtain compacted final average height of 5 mm. Subsequently, were sintered in vacuum atmosphere, temperature of 1290ºC, heating rate of 20ºC/min, using different soaking times of 30 and 60 min and cooled at room temperature. The sintered samples were submitted to density and micro-hardness analysis. The TaC reforced samples showed higher density values and an expressive hardness increase. The complementary analysis in optical microscope, scanning electronic microscope and X ray diffractometer, showed that the TaC, processed form, contributed with the hardness increase, by densification, itself hardness and grains growth control at the metallic matrix, segregating itself to the grain boarders

Perforin and interferon-gamma activities independently control tumor initiation, growth, and metastasis

Perforin (pfp) and interferon-gamma (IFN-gamma) together in C57BL/6 (B6) and BALB/c mouse strains provided optimal protection in 3 separate tumor models controlled by innate immunity. Using experimental (B6, RM-1 prostate carcinoma) and spontaneous (BALB/c, DA3 mammary carcinoma) models of metastatic cancer, mice deficient in both pfp and IFN-gamma were significantly less proficient than pfp- or IFN-gamma -deficient mice in preventing metastasis of tumor cells to the lung. Pfp and IFN-gamma -deficient mice were as susceptible as mice depleted of natural killer (NK) cells in both tumor metastasis models, and IFN-gamma appeared to play an early role in protection from metastasis, Previous experiments in a model of fibrosarcoma induced by the chemical carcinogen methylcholanthrene indicated an important role for NK1.1(+) T cells, Herein, both pfp and IFN-gamma played critical and independent roles in providing the host with protection equivalent to that mediated by NK1.1+ T cells, Further analysis demonstrated that IFN-gamma, but not pfp, controlled the growth rate of sarcomas arising in these mice. Thus, this is the first study to demonstrate that host IFN-gamma, and direct cytotoxicity mediated by cytotoxic lymphocytes expressing pfp independently contribute antitumor effector functions that together control the initiation, growth, and spread of tumors in mice, (C) 2001 by The American Society of Hematology.