Serum tests, liver stiffness and artificial neural networks for diagnosing cirrhosis and portal hypertension

BACKGROUND The diagnostic performance of biochemical scores and artificial neural network models for portal hypertension and cirrhosis is not well established. AIMS To assess diagnostic accuracy of six serum scores, artificial neural networks and liver stiffness measured by transient elastography, for diagnosing cirrhosis, clinically significant portal hypertension and oesophageal varices. METHODS 202 consecutive compensated patients requiring liver biopsy and hepatic venous pressure gradient measurement were included. Several serum tests (alone and combined into scores) and liver stiffness were measured. Artificial neural networks containing or not liver stiffness as input variable were also created. RESULTS The best non-invasive method for diagnosing cirrhosis, portal hypertension and oesophageal varices was liver stiffness (C-statistics=0.93, 0.94, and 0.90, respectively). Among serum tests/scores the best for diagnosing cirrhosis and portal hypertension and oesophageal varices were, respectively, Fibrosis-4, and Lok score. Artificial neural networks including liver stiffness had high diagnostic performance for cirrhosis, portal hypertension and oesophageal varices (accuracy>80%), but were not statistically superior to liver stiffness alone. CONCLUSIONS Liver stiffness was the best non-invasive method to assess the presence of cirrhosis, portal hypertension and oesophageal varices. The use of artificial neural networks integrating different non-invasive tests did not increase the diagnostic accuracy of liver stiffness alone.

The recent eutrophication of Baldeggersee (Switzerland) as assessed by fossil diatom assemblages

Diatom analyses with an annual resolution were carried out on varves of the hypertrophic Baldeggersee (Central Swiss Plateau) for the timespan ad 1885 to 1993. They reveal seven major changes in the dominant planktonic diatoms. As a result of progressive nutrient enrichment, Baldeggersee changed in the 1910s from a Cyclotella to a Tabellaria fenestrata dominated assemblage, and eventually in the 1950s to a Stephanodiscus parvus dominated diatom assemblage. The timing and direction of diatom-assemblage changes in the varved sediment compare well with sedimentological and limnological observations. Partitioning of the variance in the diatom data revealed that TP is a stronger explanatory variable than temperature for these changes. A diatom-inferred total phosphorus (TP) reconstruction indicates three major steps in eutrophication, occurring at 1909, the mid-1950s and the mid-1970s. Comparison with TP measurements in the water column demonstrates that the diatom-TP inference model used is able to hindcast past TP concentrations reliably. The major steps in eutrophication led to decreases in diatom diversity and also resulted in a progressive increase of calcite grain-size. The lake restoration programme established since 1982 shows no direct impact on the composition of the diatom assemblages. However, the decrease in phosphorus loads since the mid-1970s is reflected in the diatom assemblages and in decreasing diatom-inferred TP concentrations.

Stable isotope response to lake eutrophication: Calibration of a high-resolution lacustrine sequence from Baldeggersee, Switzerland

Stable isotope analyses of discrete seasonal layers from a 108-yr annually laminated freeze-core from Baldeg-gersee, a small, eutrophic lake in central Switzerland, provide information on the climatological and environmental factors, including lake eutrophication, that control oxygen and carbon isotopic composition of epilimnic biologically induced calcite precipitate. During the last 100 yr, Baldeggersee has undergone major increases in productivity and eutrophication in response to nutrient loading from agriculture and industrialization in the lake's watershed. Calibration of the isotopic signal in Baldeggersee to historical limnological data quantitatively links evidence of isotopic depletion in the sedimented calcite to trophic state of the lake. δ18O values from the spring/summer “light” sediment layers steadily diverged to more depleted values in response to historical eutrophication: measured δ18O values were up to 21.5‰ more negative than calculated equilibrium δ18O values. Evidence for 13C depletion in the calcite, relative to equilibrium values, is more difficult to ascertain because of an overall dominance of isotopic enrichment in the dissolved inorganic pool as productivity in Baldeggersee increases. A positive association exists between the degree of oxygen-18 depletion and the calcite crystal size. Thus, large amorphous calcite grains can be used as a proxy for recognizing apparent isotopic nonequilibrium in sediment sequences from highly productive lacustrine environments from all geologic time scales. In contrast to the light layers, the oxygen isotopic composition of the calcite in the late summer/fall “dark” sediment layers is unaffected by the apparent isotope nonequilibrium. Oxygen and carbon isotope values from the dark laminae in the Baldeggersee sediment therefore provide environmental and climatological proxies that can be calibrated with known environmental and regional climate data for the last century.