Deep Learning Bridged Bioactivity, Structure, and GC-HRMS-Readable Evidence to Decipher Nontarget Toxicants in Sediments.

Identifying causative toxicants in mixtures is critical, but this task is challenging when mixtures contain multiple chemical classes. Effect-based methods are used to complement chemical analyses to identify toxicants, yet conventional bioassays typically rely on an apical and/or single endpoint, providing limited diagnostic potential to guide chemical prioritization. We proposed an event-driven taxonomy framework for mixture risk assessment that relied on high-throughput screening bioassays and toxicant identification integrated by deep learning. In this work, the framework was evaluated using chemical mixtures in sediments eliciting aryl-hydrocarbon receptor activation and oxidative stress response. Mixture prediction using target analysis explained <10% of observed sediment bioactivity. To identify additional contaminants, two deep learning models were developed to predict fingerprints of a pool of bioactive substances (event driver fingerprint, EDFP) and convert these candidates to MS-readable information (event driver ion, EDION) for nontarget analysis. Two libraries with 121 and 118 fingerprints were established, and 247 bioactive compounds were identified at confidence level 2 or 3 in sediment extract using GC-qToF-MS. Among them, 12 toxicants were analytically confirmed using reference standards. Collectively, we present a "bioactivity-signature-toxicant" strategy to deconvolute mixtures and to connect patchy data sets and guide nontarget analysis for diverse chemicals that elicit the same bioactivity.

The treatment process of a giant phyllodes tumor of the breast: a case report and review of the literature.

Giant phyllodes tumors are rare fibroepithelial tumors that are usually larger than 10 cm in diameter, have rapid tumor growth, and are easily recurrent. They are frequently accompanied by skin necrosis and infection, particularly in malignant phyllodes tumors. This case report presents a 50-year-old woman who presented to the hospital with a huge left breast mass that was ruptured and infected. The patient received anti-infective treatment and underwent mastectomy and skin grafting, which indicated a malignant phyllodes tumor. The tumor was completely excised after a local recurrence in the chest wall 6 months post-surgery. Unfortunately, one year later, the patient pass away due to multiple organ failure. Giant phyllodes tumor management presents challenges to the surgeon. This case is being presented to enhance understanding and treatment of phyllodes tumors, specifically giant malignant phyllodes tumors, with the aim of improving patients' quality of life.

Occurrence, Spatial Distribution, and Bioaccumulation of Dissolved Synthetic Musks in Freshwaters across China.

Commercial chemicals, such as synthetic musks, are of global concern, but data on their occurrence and spatial distribution in aquatic environments of large scale are scarce. Two sampling campaigns were conducted in the present study to measure freely dissolved synthetic musks in freshwaters across China using passive samplers, along with biological coexposure at selected sites. Polycyclic musks (PCMs) dominated synthetic musks, with a detection frequency of 95%. Higher concentrations of PCMs were observed in densely populated Mid, East, and South China compared to less populated regions, indicating the significance of anthropogenic activities for synthetic musks in water. The concentration ratios of galaxolide (HHCB)/tonalide (AHTN) were significantly higher in low-latitude areas than in high-latitude areas from June to September, suggesting that solar radiation played an important role in the degradation of HHCB/AHTN. Significant correlations were found between dissolved concentrations of HHCB and AHTN and their lipid-normalized concentrations in coexposed fish and clam. The estimated hazard quotients for HHCB and AHTN in freshwater fish consumed by humans were less than 0.01 at all sampling sites except the Yangtze River Basin. These results help to understand the environmental fate and ecological risks of synthetic musks on a large geographical scale.

Combined pollution characteristics and ecological risks of multi-pollutants in Poyang Lake.

Poyang Lake, the largest freshwater lake in China, faced severe ecological degradation in the past decade. Combined pollution of multi-pollutants may be one of the contributing factors. However, the characteristics of combined pollution and the ecological risks are still not clear. In this study, we used Polar Organic Chemical Integrative Sampler (POCIS), In Situ Bioassay Passive Sampling Device (ISBPSD) and conventional sampling methods, to study the toxic pollutants levels and the combined biological toxicity effects. The results showed that high levels of organochlorine pesticides (OCPs, averaged 162 ng/g) and polycyclic musk (PCM, averaged 53.6 ng/g) residues, as well as some metals such as nickel (Ni), lead (Pb) concentrations exceeded the relevant standard level in the sediment. The risk of combined pollution in the water was relatively low, but high risk was found in the sediments. According to the ISBPSD studies, the survival rates of species in the water and sediments were only 10.0-45.0% and 1.67-11.7% respectively, which was much lower than that reported in other typical basins of China. OCPs, PCMs, and certain metals such as Pb and Ni may be the key toxic pollutants causing biological toxicity effects in Poyang Lake.

Toxicity and chemical characterization of shale gas wastewater discharged to the receiving water: Evidence from toxicity identification evaluation.

Flowback and produced water (FPW) generated from shale gas extraction is a complex mixture consisting of injected drilling fluid, deep formation water, and byproducts of downhole reactions. Limited knowledge is available regarding the impact of discharged FPW on surface water in China. With the development of shale gas exploitation, this emphasizes an urgent need for comprehensive assessments and stringent regulations to ensure the safe disposal of shale gas extraction-related wastewater. Herein, we explored potential impacts of treated shale gas wastewater discharged into a local river in southwest China through toxicity identification evaluation (TIE). Results revealed that organics and particulates significantly contributed to the overall toxicity of the treated FPW wastewater. Through target and suspect chemical analyses, various categories of organic contaminants were detected, including alkanes, aromatic hydrocarbons, biocides, phenols, and phthalates. Furthermore, non-target analysis uncovered the presence of surfactant-related contaminants in tissues of exposed organisms, but their contribution to the observed toxicity was unclear due to the lack of effect data for these compounds. Higher toxicity was found at the discharge point compared with upstream sites; however, the toxicity was rapidly mitigated due to dilution in the receiving river, posing little impact on downstream areas. Our study highlighted the importance of monitoring toxicity and water quality of FPW effluent even though dilution could be a viable approach when the water volume in the discharge was small.

Cellular angiolipoma: a case report and review of the literature.

Cellular angiolipoma is a rare subtype of angiolipoma, with vascular density approaching 95%. This case report describes a 55-year-old female that presented for treatment of a mass in her left breast that had been tender to slightly painful on palpation for nearly 2 years The patient underwent surgical excision of the mass, which was pathologically confirmed as a cellular angiolipoma. As of the 3-year follow-up, the patient reported no recurrence of the lesion. It is important to report this case and refresh knowledge of this and similar lesions to raise awareness of this diagnosis and treatment and improve future management of cellular angiolipoma cases.

Occurrence of emerging contaminants in pet hair and indoor air: integrative health risk assessment using multiple ToxCast endpoints.

Indoor exposome is a growing concern, including a mixture of legacy and emerging contaminants. Recent studies suggest that indoor pollutants may accumulate in pet hair, a part of indoor exposome, increasing health risks to pet owners; however, the source and hazards of pollutants associated with pet hair are largely unknown. Here, we found that hydrophobic pollutants often had higher indoor concentrations than hydrophilic ones, and polycyclic aromatic hydrocarbons (PAHs) were the most dominant fractions (61.1%) in indoor air exposome while polycyclic musks (PCMs) had the highest concentrations among all contaminant classes in indoor dust (1559 ± 1598 ng g-1 dw) and pet hair (2831 ± 2458 ng g-1 dw). The levels of hygiene-related contaminants (PCMs, current-use pesticides (CUPs), and antibiotics) were higher in pet hair than dust due to direct contact during applications. Health risk assessment using toxicity thresholds from high-throughput screening data showed that human health risks from the five classes of indoor contaminants (PAHs, PCMs, organophosphate esters, CUPs, and antibiotics) via inhalation, ingestion, and dermal contact were within acceptable limits, but the children may be exposed to a higher risk than the adults. The thresholds estimated from the ToxCast data using endpoint sensitivity distribution make the exposome risk assessment feasible in the absence of benchmarks, which is beneficial for including a mixture of emerging pollutants in risk assessment.

Toxicity identification evaluation for hydraulic fracturing flowback and produced water during shale gas exploitation in China: Evidence from tissue residues and gene expression.

Hydraulic fracturing flowback and produced water (HF-FPW) from shale gas extraction processes is a highly complex medium with potential threats to the environment. Current research on ecological risks of FPW in China is limited, and the link between major components of FPW and their toxicological effects on freshwater organisms is largely unknown. By integrating chemical and biological analyses, toxicity identification evaluation (TIE) was used to reveal causality between toxicity and contaminants, potentially disentangling the complex toxicological nature of FPW. Here, FPW from different shale gas wells, treated FPW effluent, and a leachate from HF sludge were collected from southwest China, and TIE was applied to obtain a comprehensive toxicity evaluation in freshwater organisms. Our results showed that FPW from the same geographic zone could cause significantly different toxicity. Salinity, solid phase particulates, and organic contaminants were identified as the main contributors to the toxicity of FPW. In addition to water chemistry, internal alkanes, PAHs, and HF additives (e.g., biocides and surfactants) were quantified in exposed embryonic fish by target and non-target tissue analyses. The treated FPW failed to mitigate the toxicity associated with organic contaminants. Transcriptomic results illustrated that organic compounds induced toxicity pathways in FPW-exposed embryonic zebrafish. Similar zebrafish gene ontologies were affected between treated and untreated FPW, again confirming that sewage treatment did not effectively remove organic chemicals from FPW. Thus, zebrafish transcriptome analyses revealed organic toxicant-induced adverse outcome pathways and served as evidence for TIE confirmation in complex mixtures under data-poor scenarios.

Making a Bird AI Expert Work for You and Me.

As powerful as fine-grained visual classification (FGVC) is, responding your query with a bird name of "Whip-poor-will" or "Mallard" probably does not make much sense. This however commonly accepted in the literature, underlines a fundamental question interfacing AI and human - what constitutes transferable knowledge for human to learn from AI? This paper sets out to answer this very question using FGVC as a test bed. Specifically, we envisage a scenario where a trained FGVC model (the AI expert) functions as a knowledge provider in enabling average people (you and me) to become better domain experts ourselves. Assuming an AI expert trained using expert human labels, we anchor our focus on asking and providing solutions for two questions: (i) what is the best transferable knowledge we can extract from AI, and (ii) what is the most practical means to measure the gains in expertise given that knowledge? We propose to represent knowledge as highly discriminative visual regions that are expert-exclusive and instantiate it via a novel multi-stage learning framework. A human study of 15,000 trials shows our method is able to consistently improve people of divergent bird expertise to recognise once unrecognisable birds. We further propose a crude but benchmarkable metric TEMI and therefore allow future efforts in this direction to be comparable to ours without the need of large-scale human studies.

Dynamic changes in mental health status related to the COVID-19 pandemic among health care workers and inpatients in China.

Background: Exposure to coronavirus disease 2019 (COVID-19) can cause severe mental health problems, the dynamics of which remain unclear. This study evaluated the mental status of frontline health care workers (FHWs) and suspected infected patients (SIPs) during different periods of the COVID-19 outbreak. Materials and methods: Demographic and psychological data were collected through a cross-sectional survey of 409 participants in a hospital from 20 January to 7 August 2020. COVID-19 outbreaks were divided into three periods owing to the time, place, and scale, including the national outbreak period (a nationwide pandemic period from 20 January to 8 April 2020), sporadic period (a stable period from 9 April to 10 June), and local epidemic period (a local pandemic in Beijing from 11 June to 7 August 2020). Acute psychological disorders (APDs), including symptoms of anxiety and depression, were assessed using the Zung Self-Rating Anxiety/Depression Scale (SAS/SDS). Results: A total of 206 FHWs and 203 SIPs completed the electronic questionnaire. Overall, the prevalence rates of anxiety and depression among SIPs were 3.9 and 19.4%, respectively, while significantly higher prevalence rates (17.7 and 25.1%) were found among FHWs, P-value < 0.05. Psychological status among SIPs did not differ significantly across the three periods. The FHWs were more vulnerable, as their SAS and SDS scores and almost all the dimension scores were significantly higher during the local epidemic period than during the national outbreak and sporadic periods (all P-values < 0.001). The prevalence of anxiety (34.41%) and depression (41.94%) was significantly higher during the local epidemic period (P < 0.001). Logistic and linear mixed models showed that age, sex, and doctor-patient ratio especially, independently influenced most dimension scores of SAS and SDS among FHWs (P < 0.05). Conclusion: Compared to the COVID-19 epidemic at the national level, the local epidemic had a greater influence on FHWs' mental health. More attention should be given to the workload of FHWs.

Spatial distribution of benthic toxicity and sediment-bound metals and arsenic in Guangzhou urban waterways: Influence of land use.

The effects of land use on pollutant loads in sediments have been well documented; however, its influence on spatial variations in sediment toxicity remains largely unknown. In the present study, the toxicological effects of 17 sediments collected from Guangzhou waterways were evaluated using two benthic invertebrates (Chironomus dilutus and Hyalella azteca), along with quantification of heavy metals and arsenic in the sediments. The impacts of land-use configuration on sediment toxicity and occurrence of heavy metals and arsenic were analyzed. The sediments presented moderate lethality (<40 %) in the two test species and significantly altered their enzymatic activity, including the activities of oxidative stress biomarkers and acetylcholine esterase. Metals (Ag, Cd, Cr, Cu, Hg, Ni, Pb, and Zn) and arsenic were detected in all the sediments, with total concentrations ranging from 238 to 1019 mg/kg of dry weight. Both the toxicity and chemical results displayed spatially dependent patterns but were related to different land use types. Toxicity was most influenced by agricultural and aquacultural activities, while metal and arsenic pollution was most influenced by urban land areas. The present findings are expected to provide essential knowledge for developing strategies that reduce the chemical pollution and ecotoxicological risk in sediments.

The predictive accuracy of preoperative erythrocyte count and maximum tumor diameter to maximum kidney diameter ratio in renal cell carcinoma.

Background: The purpose of this study was to investigate the predictive accuracy of erythrocyte count and maximum tumor diameter to maximum kidney diameter ratio (TKR) in patients with renal cell carcinoma (RCC). Methods: We retrospectively analyzed the clinicopathological epidemiological characteristics of patients with RCC in the First Hospital of Shanxi Medical University from 2010 to 2014. Among them, 295 cases with complete follow-up data at the time of visit were selected. We collected data including erythrocyte counts and length of each diameter line of the tumor and kidney. To predict the prognosis of RCC, receiver operating characteristic (ROC) curve analysis was used to calculate the cutoff value of each parameter. Results: Of the 295 included patients, 199 (67.5%) were male, 96 (32.5%) were female, and the mean (± SD) age was 56.45±11.03 years. The area under the curve (AUC) of the erythrocyte count and the TKR for predicting the prognosis of RCC were 0.672 (SD 0.031; P<0.001) and 0.800 (SD 0.030; P<0.001), respectively. When the cutoff value of the erythrocyte count and TKR count were 3.975 and 0.452, the highest Youden index values were 0.309 and 0.685, and the corresponding sensitivity and specificity were 0.826 and 0.685, and 0.483 and 1.000, respectively. Conclusions: An erythrocyte count <3.975×1012/L and a TKR >0.452 were found to be risk factors for poor prognosis in patients with RCC.

Bioassay-based identification and removal of target and suspect toxicants in municipal wastewater: Impacts of chemical properties and transformation.

Municipal wastewater contains numerous chemicals and transformation products with highly diverse physiochemical properties and intrinsic toxicity; thus, it is imperative but challenging to identify major toxicants. Herein, toxicity identification evaluation (TIE) was applied to identify major toxicants in a typical municipal wastewater treatment plant (WWTP). Impacts of chemical properties on the removal of contaminants and toxicity at individual treatment stages were also examined. The WWTP influent caused 100% death of Daphnia magna and zebrafish embryos, and toxicity characterization suggested that organics, metals, and volatiles all contributed to the toxicity. Toxicity identification based on 189 target and approximately one-thousand suspect chemicals showed that toxicity contributions of organic contaminants, metals, and ammonia to D. magna were 77%, 4%, and 19%, respectively. Galaxolide, pyrene, phenanthrene, benzo[a]anthracene, fluoranthene, octinoxate, silver, and ammonia were identified as potential toxicants. Comparatively, the detected transformation products elicited lower toxicity than their respective parent contaminants. In contrast, the analyzed contaminants showed negligible contributions to the toxicity of zebrafish embryos. Removal efficiencies of these toxicants in WWTP were highly related to their hydrophobicity. Diverse transformation and removal efficiencies of contaminants in WWTPs may influence the chemical compositions in effluent and ultimately the risk to aquatic organisms in the receiving waterways.

Using homing pigeons to monitor atmospheric organic pollutants in a city heavily involving in coal mining industry.

Coal is the most extensively used fossil fuel in China. It is well documented that coal combustion detrimentally affected air quality, yet the contribution of coal mining activity to air pollution is still largely unknown. Homing pigeons have been applied to assess the occurrence of atmospheric pollutants within cities. Herein, we sampled homing pigeons from both urban and mining areas in a typical coal industry city (Datong, China) as biomonitors for assessing local air pollution. Target organic contaminants, including polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), and organochlorine pesticides (OCPs) were frequently detected in lung, liver, and fat tissues of the pigeons. The pollutants were predominately accumulated in lung, validating that respiration was the main accumulation route for these compounds in homing pigeons. In addition, pathological damage examination in lung and liver tissues revealed that the exposure to atmospheric pollutants impaired pigeon health. While the concentrations of PCBs and OCPs were similar in pigeons from urban and mining areas, the concentrations of PAHs were higher in pigeons from urban area. In contrast, more elevated levels of PBDEs (particularly BDE-209) were found in the mining area, which was consistent with the greater pathological damages and particulate matter levels. Unlike coal combustion, coal mining activities did not increase atmospheric PAH exposure to homing pigeons, but intensified PBDE contamination along with increasing emission of particulate matters. Overall, homing pigeons are promising biomonitors for assessing the respiratory exposure and risk of atmospheric pollutants within cities.

Legacy and Emerging Per- and Polyfluoroalkyl Substances Behave Distinctly in Spatial Distribution and Multimedia Partitioning: A Case Study in the Pearl River, China.

Per- and polyfluoroalkyl substances (PFASs) have attracted worldwide attention due to their ubiquitous occurrence, bioaccumulation, and toxicological effects, yet the fate of PFASs in a lotic ecosystem is largely unknown. To elucidate spatial distribution and multimedia partitioning of legacy and emerging PFASs in a lotic river flowing into an estuary, PFASs were synchronously analyzed in water, suspended particulate matter (SPM), sediment, and biota samples collected along Guangzhou reach of the Pearl River, South China. Geographically, the concentrations of PFASs in the water phase showed a decreasing trend from the upper and middle sections (urban area) to the down section (suburban area close to estuary) of the river. While perfluorooctanoic acid predominated in water and SPM, more diverse compositions were observed in sediment and biota with the increase in contributions of long-chain PFASs. Field-derived sediment-water partitioning coefficients (Kd) and bioaccumulation factors (BAFs) of PFASs increased with the increase in perfluorinated carbons. Besides hydrophobicity, water pH and salinity significantly affected the multimedia partitioning of PFASs in a lotic ecosystem. In addition, 87 homologues (63 classes) were identified as emerging PFASs in four media using suspect analysis. Interestingly, Kd and BAF of the emerging PFASs were often higher than legacy PFASs containing the same perfluorinated carbons, raising a special concern on the environmental risk of emerging PFASs.

In-situ biological effects, bioaccumulation, and multi-media distribution of organic contaminants in a shallow lake.

Anthropogenic activity-impacted aquatic environment contains a complex mixture of contaminants, and ecological risk assessment solely based on chemical analysis is insufficient and biological assessment is required. However, traditional assessment heavily relies on laboratory bioassays, which may cause uncertainty due to inevitable laboratory-related artifact. A self-designed in-situ bioassay system was successfully applied to simultaneously evaluate water and sediment toxicity by co-exposure of two native species, Chinese rare minnows (Gobiocypris rarus) and Asian clams (Corbicula fluminea) in Tai Lake Basin, China. In-situ exposure caused pronouncedly lethal and sublethal effects (i.e., metabolic and oxidative stress, neurotoxicity, reproductive toxicity) on both fish and clams. Meanwhile, multi-media distribution of organic contaminants in water-sediment-biota system was analyzed. Besides hydrophobicity, metabolism was recognized as an influential factor on phase distribution of contaminants in water-fish and sediment-clam systems. Traditional hazard quotient (HQ) method based on environmental concentrations of 98 contaminants showed bias in risk assessment. Instead, a weight of evidence method by integrating three lines of evidence, including in-situ survival, enhanced integrated biomarker response values and environmental concentrations, successfully differentiate high- and moderate-risk sites in the shallow lakes. The present study incorporated in-situ bioassays into risk assessment using a weight of evidence approach, which reduced uncertainty in decision-making.

Identifying Organic Toxicants in Sediment Using Effect-Directed Analysis: A Combination of Bioaccessibility-Based Extraction and High-Throughput Midge Toxicity Testing.

Toxicity identification evaluation (TIE) and effect-directed analysis (EDA) were integrated to diagnose toxicity drivers in a complex system, such as sediment. In TIE manipulation, XAD resin was utilized as an amending agent for characterizing organic toxicants, which also facilitate a large-volume bioaccessibility-based extraction for EDA purposes. Both raw sediments in TIE and extract fractions in EDA were tested with Chironomus dilutus for toxicity using whole-sediment testing and a high-throughput microplate assay. This allowed for a direct link between whole-sediment TIE and EDA, which strongly strengthened the characterization and identification of toxicants. Sediments amended with XAD resin, as part of the TIE, significantly reduced midge mortality compared with unamended sediments, suggesting that organics were one class of main toxicants. On the basis of bioaccessible concentrations in sediment measured by XAD extraction, a group of previously unidentified contaminants, synthetic polycyclic musks (versalide, tonalide, and galaxolide), were found to explain 32-73% of the observed toxicity in test sediments. Meanwhile, three pyrethroids contributed to an additional 17-35% of toxicity. Surprisingly, the toxicity contribution of musks and pyrethroids reached 58-442 and 56-1625%, respectively, based on total sediment concentrations measured by exhaustive extraction. This suggested that total sediment concentrations significantly overestimated toxicity and that bioavailability should be considered in toxicity identification. Identifying nontarget toxicants sheds a light on application of the integrated TIE and EDA method in defining causality in a complex environment.

[Clinical analysis of acute renal failure after allogeneic hematopoietic stem cell transplantation].

The aim of this study was to investigate the incidence, risk factors of acute renal failure (ARF) after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and evaluate its effect on the prognosis of patients after allo-HSCT. A retrospective analysis was performed in 86 patients undergoing allo-HSCT at Peking University First Hospital from June 2003 to April 2007. ARF is defined as a doubling of baseline serum creatinine at any time during the first 100 days post-transplant. The risks of ARF and mortality after ARF were examined using univariate analysis and multivariate unconditional logistic regression. The correlation of ARF and survival was examined using Cox regression. The results indicated that 27 patients (31.40%) developed ARF at a median of 59.5 days after transplant (range 1 to 93 days). The univariate analysis showed that elevated risks were severe acute GVHD (OR 6.196; 95% CI 1.121 - 34.249, p = 0.033), sepsis or septic shock (OR 4.184; 95% CI 1.314 - 13.325, p = 0.018) and hyperbilirubinemia (OR 3.709; 95% CI 1.428 - 9.635, p = 0.006). Renal disease before transplant (OR 6.711; 95% CI 1.199 - 37.564, p = 0.027), hypertension (OR 2.067; 95% CI 0.739 - 5.782, p = 0.165), the use of vancomycin (OR 2.133; 95% CI 0.844 - 5.392, p = 0.106) or foscarnet sodium (OR 2.133; 95% CI 0.844 - 5.392, p = 0.106) may be potential risks. Multivariate logistic regression analysis showed that renal disease before transplant (OR 6.288; 95% CI 1.218 - 32.455, p = 0.028), sepsis or septic shock (OR 3.614; 95% CI 1.040 - 12.544, p = 0.043) and hyperbilirubinemia (OR 4.448; 95% CI 1.563 - 12.665, p = 0.005) appear to be independently associated with an increased risk of ARF. Age, gender, baseline serum creatinine level, advanced malignant disease, unrelated-donor, total body irradiation (TBI) and cyclosporine levels were not associated with the development of ARF. Cox regression showed that ARF (RR 2.124; 95% CI 1.016 - 4.441, p = 0.045) was independently associated with survival of patients after allo-HSCT. The mortality of patients with ARF within 6 months post-transplant was significantly higher than that of those without ARF (44.4% vs 8.47%, p < 0.001). It is concluded that the cumulative incidence of ARF after allo-HSCT remains high. Renal disease before transplant, hyperbilirubinemia and sepsis or septic shock are all related factors which can increase the risk of ARF. ARF appears to be independent factor influencing survival of patients after allo-HSCT.