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0 | 0 | Review for 10.1186/s12893-025-02827-7 | Reviewed - bmc_surgery | Title: Impact of Pulmonary Infection on Thoracoscopic Surgery Outcomes in Children with
CPAM: A Retrospective Study
Version: 3 Date: 14 Jan 2025
Reviewer: Rachid Eduardo Noleto da Nobrega Oliveira
Reviewer's report:
The ethics committee text provided for the patients is in Chinese. Unfortunately, I do not speak
or read Chinese, and I am therefore unable to evaluate it. I kindly request that you provide a
translated version in English.
Thank you for your understanding. | Title: Impact of Pulmonary Infection on Thoracoscopic Surgery Outcomes in Children with
CPAM: A Retrospective Study
Version: 3 Date: 14 Jan 2025
Reviewer: Rachid Eduardo Noleto da Nobrega Oliveira
Reviewer's report:
The ethics committee text provided for the patients is in Chinese. Unfortunately, I do not speak
or read Chinese, and I am therefore unable to evaluate it. I kindly request that you provide a
translated version in English.
Thank you for your understanding. | BMC | 12893_2025_2827_ReviewerReport_V3_R1.pdf | {
"criticism": 1,
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"role": "user"
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"content": "Title: Impact of Pulmonary Infection on Thoracoscopic Surgery Outcomes in Children with\nCPAM: A Retrospective Study\nVersion: 3 Date: 14 Jan 2025\nReviewer: Rachid Eduardo Noleto da Nobrega Oliveira\nReviewer's report:\nThe ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02827-7 | Reviewed - bmc_surgery | Title: Impact of Pulmonary Infection on Thoracoscopic Surgery Outcomes in Children with
CPAM: A Retrospective Study
Version: 3 Date: 21 Jan 2025
Reviewer: Paolo Scanagatta
Reviewer's report:
Manuscript Title: Effects Of Pulmonary Infection On Total Thoracoscopic Surgery In Children
With Congenital Pulmonary Airway Malformation - A Single-center Retrospective Study
General Assessment
The study provides a valuable retrospective analysis of the impact of pulmonary infection on
total thoracoscopic surgery outcomes in children with CPAM. The dataset is well-structured, and
the statistical approach is generally sound. The authors have effectively responded to editorial
requests regarding ethical compliance and informed consent, which now appear adequately
addressed.
However, beyond these ethical aspects, there are still several areas where the manuscript
could benefit from further refinements in terms of methodological clarity, statistical reporting,
language precision, and discussion depth.
Key Areas for Revision
1. Study Design and Methodology
# Clarifications on Infection Categories
The distinction between Non-infection (NI), Hidden infection (HI), and Pulmonary infection
(PI) is critical to the study. While the authors have provided definitions, it would be helpful to
explicitly detail:
Diagnostic criteria used to differentiate HI from PI (e.g., histopathology, inflammatory markers,
imaging findings).
Any potential overlap between categories and how borderline cases were classified.
# Flowchart for Patient Selection
If not already included, adding a flowchart that outlines patient inclusion/exclusion criteria
would improve transparency and help readers understand the cohort formation.
# Surgical Protocol Details
The manuscript would benefit from a clearer description of:
The surgical approach and standard procedure across all cases.
Whether perioperative infection control strategies (e.g., antibiotic prophylaxis) were
standardized across groups.
2. Statistical Analysis and Interpretation
# Analysis of Conversion to Open Thoracotomy
The manuscript reports that conversion rates differed among groups (14.8%, 23.2%, and 29.2%),
but no statistical comparison (p-value) is provided.
If not already included, a statistical test (e.g., chi-square or Fisher’s exact test) should be applied
here.
# Clarification of Non-Significant Trends
Some non-significant findings (e.g., ventilator duration, hospital stay) are discussed in a way
that implies trends.
Ensure that interpretations remain strictly aligned with statistical results and avoid
overinterpretation.
# Effect Size and Confidence Intervals
If feasible, adding effect sizes or confidence intervals for key comparisons (e.g., operative time,
blood loss) would strengthen the robustness of the results.
3. Figures and Tables
# Tables
Tables are well-structured but could benefit from:
- More consistent formatting (ensure uniform decimal places in reported values).
- Footnotes defining all abbreviations and statistical tests used.
# Figures
If not yet included, box plots or bar graphs for operative time, blood loss, and pneumothorax
incidence could enhance data visualization.
4. Language and Clarity
# Grammar and Syntax Improvements
The manuscript contains some awkward phrasing and minor grammatical errors.
A professional language revision is highly recommended for final clarity.
# Refinement of the Title
The title could be slightly revised for conciseness:
"Impact of Pulmonary Infection on Thoracoscopic Surgery Outcomes in Children with CPAM:
A Retrospective Study"
5. Discussion and Clinical Implications
# Clinical Relevance
The discussion does a good job of contextualizing the findings, but further refinement would
enhance clarity:
More emphasis on the practical implications for surgical decision-making in children with
suspected infection.
Consideration of alternative management strategies (e.g., delaying surgery vs. early
intervention).
# Addressing Study Limitations
The single-center nature of the study and potential selection bias should be acknowledged.
The potential variability in CPAM severity across infection groups should be discussed.
The manuscript is scientifically sound, and the revisions have strengthened the ethical
compliance and methodological transparency. However, further refinements in methodology,
statistical reporting, and language precision will improve clarity and impact. | Title: Impact of Pulmonary Infection on Thoracoscopic Surgery Outcomes in Children with
CPAM: A Retrospective Study
Version: 3 Date: 21 Jan 2025
Reviewer: Paolo Scanagatta
Reviewer's report:
Manuscript Title: Effects Of Pulmonary Infection On Total Thoracoscopic Surgery In Children
With Congenital Pulmonary Airway Malformation - A Single-center Retrospective Study
General Assessment
The study provides a valuable retrospective analysis of the impact of pulmonary infection on
total thoracoscopic surgery outcomes in children with CPAM. The dataset is well-structured, and
the statistical approach is generally sound. The authors have effectively responded to editorial
requests regarding ethical compliance and informed consent, which now appear adequately
addressed.
However, beyond these ethical aspects, there are still several areas where the manuscript
could benefit from further refinements in terms of methodological clarity, statistical reporting,
language precision, and discussion depth.
Key Areas for Revision
1. Study Design and Methodology
# Clarifications on Infection Categories
The distinction between Non-infection (NI), Hidden infection (HI), and Pulmonary infection
(PI) is critical to the study. While the authors have provided definitions, it would be helpful to
explicitly detail:
Diagnostic criteria used to differentiate HI from PI (e.g., histopathology, inflammatory markers,
imaging findings).
Any potential overlap between categories and how borderline cases were classified.
# Flowchart for Patient Selection
If not already included, adding a flowchart that outlines patient inclusion/exclusion criteria
would improve transparency and help readers understand the cohort formation.
# Surgical Protocol Details
The manuscript would benefit from a clearer description of:
The surgical approach and standard procedure across all cases.
Whether perioperative infection control strategies (e.g., antibiotic prophylaxis) were
standardized across groups.
2. Statistical Analysis and Interpretation
# Analysis of Conversion to Open Thoracotomy
The manuscript reports that conversion rates differed among groups (14.8%, 23.2%, and 29.2%),
but no statistical comparison (p-value) is provided.
If not already included, a statistical test (e.g., chi-square or Fisher’s exact test) should be applied
here.
# Clarification of Non-Significant Trends
Some non-significant findings (e.g., ventilator duration, hospital stay) are discussed in a way
that implies trends.
Ensure that interpretations remain strictly aligned with statistical results and avoid
overinterpretation.
# Effect Size and Confidence Intervals
If feasible, adding effect sizes or confidence intervals for key comparisons (e.g., operative time,
blood loss) would strengthen the robustness of the results.
3. Figures and Tables
# Tables
Tables are well-structured but could benefit from:
- More consistent formatting (ensure uniform decimal places in reported values).
- Footnotes defining all abbreviations and statistical tests used.
# Figures
If not yet included, box plots or bar graphs for operative time, blood loss, and pneumothorax
incidence could enhance data visualization.
4. Language and Clarity
# Grammar and Syntax Improvements
The manuscript contains some awkward phrasing and minor grammatical errors.
A professional language revision is highly recommended for final clarity.
# Refinement of the Title
The title could be slightly revised for conciseness:
"Impact of Pulmonary Infection on Thoracoscopic Surgery Outcomes in Children with CPAM:
A Retrospective Study"
5. Discussion and Clinical Implications
# Clinical Relevance
The discussion does a good job of contextualizing the findings, but further refinement would
enhance clarity:
More emphasis on the practical implications for surgical decision-making in children with
suspected infection.
Consideration of alternative management strategies (e.g., delaying surgery vs. early
intervention).
# Addressing Study Limitations
The single-center nature of the study and potential selection bias should be acknowledged.
The potential variability in CPAM severity across infection groups should be discussed.
The manuscript is scientifically sound, and the revisions have strengthened the ethical
compliance and methodological transparency. However, further refinements in methodology,
statistical reporting, and language precision will improve clarity and impact. | BMC | 12893_2025_2827_ReviewerReport_V3_R2.pdf | {
"criticism": 2,
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"total": 31
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} | 2.16129 | 0 | [
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"content": "Title: Impact of Pulmonary Infection on Thoracoscopic Surgery Outcomes in Children with\nCPAM: A Retrospective Study\nVersion: 3 Date: 21 Jan 2025\nReviewer: Paolo Scanagatta\nReviewer's report:\nManuscript Title: Effects Of ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02827-7 | Reviewed - bmc_surgery | Title: Impact of Pulmonary Infection on Thoracoscopic Surgery Outcomes in Children with
CPAM: A Retrospective Study
Version: 4 Date: 17 Feb 2025
Reviewer: Fazl# Yanik
Reviewer's report:
Dear authors,
Thank you for the revised article.
The revised article can be accepted now. | Title: Impact of Pulmonary Infection on Thoracoscopic Surgery Outcomes in Children with
CPAM: A Retrospective Study
Version: 4 Date: 17 Feb 2025
Reviewer: Fazl# Yanik
Reviewer's report:
Dear authors,
Thank you for the revised article.
The revised article can be accepted now. | BMC | 12893_2025_2827_ReviewerReport_V4_R4.pdf | {
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"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Impact of Pulmonary Infection on Thoracoscopic Surgery Outcomes in Children with\nCPAM: A Retrospective Study\nVersion: 4 Date: 17 Feb 2025\nReviewer: Fazl# Yanik\nReviewer's report:\nDear authors,\nThank you for the r... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02827-7 | Reviewed - bmc_surgery | Title: Impact of Pulmonary Infection on Thoracoscopic Surgery Outcomes in Children with
CPAM: A Retrospective Study
Version: 4 Date: 17 Feb 2025
Reviewer: Paolo Scanagatta
Reviewer's report:
Dear Authors,
Thank you for your detailed revisions and for addressing the reviewers' comments
comprehensively. Your updates have significantly improved the clarity and robustness of the
manuscript.
The methodology is now well-defined, with clearer explanations regarding the classification of
patients into NI, HI, and PI groups.
The additional statistical details strengthen the reliability of the findings.
Ethical considerations are now fully addressed, ensuring compliance with international research
standards.
The language has been improved, making the text more readable and precise.
I appreciate your efforts in refining the manuscript, and I have no further concerns.
Best regards | Title: Impact of Pulmonary Infection on Thoracoscopic Surgery Outcomes in Children with
CPAM: A Retrospective Study
Version: 4 Date: 17 Feb 2025
Reviewer: Paolo Scanagatta
Reviewer's report:
Dear Authors,
Thank you for your detailed revisions and for addressing the reviewers' comments
comprehensively. Your updates have significantly improved the clarity and robustness of the
manuscript.
The methodology is now well-defined, with clearer explanations regarding the classification of
patients into NI, HI, and PI groups.
The additional statistical details strengthen the reliability of the findings.
Ethical considerations are now fully addressed, ensuring compliance with international research
standards.
The language has been improved, making the text more readable and precise.
I appreciate your efforts in refining the manuscript, and I have no further concerns.
Best regards | BMC | 12893_2025_2827_ReviewerReport_V4_R2.pdf | {
"criticism": 0,
"example": 0,
"importance_and_relevance": 0,
"materials_and_methods": 1,
"praise": 5,
"presentation_and_reporting": 1,
"results_and_discussion": 1,
"suggestion_and_solution": 1,
"total": 8
} | {
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"results_and_discussion": 0.125,
"suggestion_and_solution": 0.125
} | 1.125 | 0 | [
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"role": "user"
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{
"content": "Title: Impact of Pulmonary Infection on Thoracoscopic Surgery Outcomes in Children with\nCPAM: A Retrospective Study\nVersion: 4 Date: 17 Feb 2025\nReviewer: Paolo Scanagatta\nReviewer's report:\nDear Authors,\nThank you for ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02827-7 | Reviewed - bmc_surgery | Title: Impact of Pulmonary Infection on Thoracoscopic Surgery Outcomes in Children with
CPAM: A Retrospective Study
Version: 4 Date: 19 Feb 2025
Reviewer's report:
The authors are thanked to have submitted their interesting work to the journal. The strength of
the article consists in the correct methodology and the wide series, considering the rarity of the
presented condition. Results are promising and tables are attractive. Some few comments below.
1. Results are promising but the Authors do not state definitive conclusions at the end, so the
real indication and the primary aim of the study is difficult to understand and a brief discussion/
comment on that should be added, to improve the current literature on the topic.
2. Considering the Results, what are the final indication of the Authors for the clinical practice
management of these subcategories of patients?
3. Some figures (CT scan, pathology) should be added to make the work more attractive.
4. Literature could be improved with recent works discussing on the topic (Marinucci, B.T.;
Menna, C.; Scanagatta, P.; Fiorelli, S.; Tiracorrendo, M.; Naldi, G.; Inserra, A.; Macchini,
F.; Rendina, E.A.; Ibrahim, M. Do More with Less? Lobectomy vs. Segmentectomy for
Patients with Congenital Pulmonary Malformations. J. Clin. Med. 2023, 12, 5237. https://
doi.org/10.3390/ jcm12165237). | Title: Impact of Pulmonary Infection on Thoracoscopic Surgery Outcomes in Children with
CPAM: A Retrospective Study
Version: 4 Date: 19 Feb 2025
Reviewer's report:
The authors are thanked to have submitted their interesting work to the journal. The strength of
the article consists in the correct methodology and the wide series, considering the rarity of the
presented condition. Results are promising and tables are attractive. Some few comments below.
1. Results are promising but the Authors do not state definitive conclusions at the end, so the
real indication and the primary aim of the study is difficult to understand and a brief discussion/
comment on that should be added, to improve the current literature on the topic.
2. Considering the Results, what are the final indication of the Authors for the clinical practice
management of these subcategories of patients?
3. Some figures (CT scan, pathology) should be added to make the work more attractive.
4. Literature could be improved with recent works discussing on the topic (Marinucci, B.T.;
Menna, C.; Scanagatta, P.; Fiorelli, S.; Tiracorrendo, M.; Naldi, G.; Inserra, A.; Macchini,
F.; Rendina, E.A.; Ibrahim, M. Do More with Less? Lobectomy vs. Segmentectomy for
Patients with Congenital Pulmonary Malformations. J. Clin. Med. 2023, 12, 5237. https://
doi.org/10.3390/ jcm12165237). | BMC | 12893_2025_2827_ReviewerReport_V4_R3.pdf | {
"criticism": 1,
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"total": 18
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} | 0.888889 | 0 | [
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"role": "user"
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{
"content": "Title: Impact of Pulmonary Infection on Thoracoscopic Surgery Outcomes in Children with\nCPAM: A Retrospective Study\nVersion: 4 Date: 19 Feb 2025\nReviewer's report:\nThe authors are thanked to have submitted their interestin... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02827-7 | Reviewed - bmc_surgery | Title: Impact of Pulmonary Infection on Thoracoscopic Surgery Outcomes in Children with
CPAM: A Retrospective Study
Version: 4 Date: 19 Feb 2025
Reviewer: Rachid Eduardo Noleto da Nobrega Oliveira
Reviewer's report:
The authors have reviewed the requested corrections, and the article is now ready for acceptance. | Title: Impact of Pulmonary Infection on Thoracoscopic Surgery Outcomes in Children with
CPAM: A Retrospective Study
Version: 4 Date: 19 Feb 2025
Reviewer: Rachid Eduardo Noleto da Nobrega Oliveira
Reviewer's report:
The authors have reviewed the requested corrections, and the article is now ready for acceptance. | BMC | 12893_2025_2827_ReviewerReport_V4_R1.pdf | {
"criticism": 0,
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"role": "user"
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"content": "Title: Impact of Pulmonary Infection on Thoracoscopic Surgery Outcomes in Children with\nCPAM: A Retrospective Study\nVersion: 4 Date: 19 Feb 2025\nReviewer: Rachid Eduardo Noleto da Nobrega Oliveira\nReviewer's report:\nThe ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02826-8 | Reviewed - bmc_surgery | Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of
surgery to reduce bleeding after gastrectomy: a propensity score–matched analysis
Version: 1 Date: 27 Jan 2025
Reviewer's report:
Thank you for your valuable article, and it is my pleasure to review the manuscript entitled
“Analysis of the efficiency of a prophylactic increasing blood pressure before the end of surgery
to reduce bleeding after gastrectomy: a propensity score–matched analysis”. The authors stated,
in this retrospective study, that Increasing the blood pressure before the end of gastrectomy
can effectively reduce the incidence of postoperative primary hemorrhage. I totally agree with
this issue. This paper gives us the important information, however it has also a number of
weaknesses. Thus, I would provide the following comments and queries.
Major comment #1) The authors stated that “Increasing the blood pressure before the end of
gastrectomy can effectively reduce the incidence of postoperative primary hemorrhage”. I totally
agree with this conclusion. However, what can directly reduce postoperative bleeding is, above
all, preventing intraoperative bleeding events. The authors overlooked these issues and should
add these issues to the discussion. For example, near-infrared (NIR) light has longer wavelengths
and allows greater penetration into tissues. ICG-guided NIR imaging navigational surgery can
provide better visualization of lymph nodes and lymphatic channels than other dying materials
under visible light. Fluorescent image-guided surgery can help surgeons obtain additional
anatomical information, such as identifying lymph nodes in thick fatty tissues, discerning
lymphatic channels from vasculatures, identifying the origin and shape of a vessel (Reference
#1). These actually made less bleeding events during infra-pyloric lymphatic dissection during
gastrectomy. In addition, deep neuromuscular block (method of anesthesia) prevented bleeding
events than moderate neuromuscular block during gastric cancer surgery (Reference #2).
Therefore, I hope the authors should add the issues and cite the references as follows
in discussion part, that "To reduce postoperative bleeding, it is also important to reduce
intraoperative bleeding. Deep neuromuscular block and NIR-guided surgery are also considered
necessary in efforts to reduce intraoperative bleeding, ultimately reducing postoperative
bleeding."
Reference #1) Park SH, Berlth F, Choi JH, Park JH, Suh YS, Kong SH, Park DJ, Lee HJ,
Yang HK. Near-infrared fluorescence-guided surgery using indocyanine green facilitates secure
infrapyloric lymph node dissection during laparoscopic distal gastrectomy. Surg Today. 2020
Oct;50(10):1187-1196.
Reference #2) Park SH, Huh H, Choi SI, Kim JH, Jang YJ, Park JM, Kwon OK, Jung MR, Jeong
O, Lee CM, Min JS, Kim JJ, An L, Yang KS, Park S, Lee IO; Deep Neuromuscular Block on
Oncologic Quality of Laparoscopic Surgery in Obese Gastric Cancer Patients (DEBLOQS_GC)
Study Group. Impact of the Deep Neuromuscular Block on Oncologic Quality of Laparoscopic
Surgery in Obese Gastric Cancer Patients: A Randomized Clinical Trial. J Am Coll Surg. 2022
Mar 1;234(3):326-339. doi: 10.1097/XCS.0000000000000061.
Minor comment #1) Check whether the p-value of 0.045 (type of gastrectomy) in table 2 is
correct. The rate of type of gastrectomy (Disal / Total / Proximal) seems similar between two
groups. | Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of
surgery to reduce bleeding after gastrectomy: a propensity score–matched analysis
Version: 1 Date: 27 Jan 2025
Reviewer's report:
Thank you for your valuable article, and it is my pleasure to review the manuscript entitled
“Analysis of the efficiency of a prophylactic increasing blood pressure before the end of surgery
to reduce bleeding after gastrectomy: a propensity score–matched analysis”. The authors stated,
in this retrospective study, that Increasing the blood pressure before the end of gastrectomy
can effectively reduce the incidence of postoperative primary hemorrhage. I totally agree with
this issue. This paper gives us the important information, however it has also a number of
weaknesses. Thus, I would provide the following comments and queries.
Major comment #1) The authors stated that “Increasing the blood pressure before the end of
gastrectomy can effectively reduce the incidence of postoperative primary hemorrhage”. I totally
agree with this conclusion. However, what can directly reduce postoperative bleeding is, above
all, preventing intraoperative bleeding events. The authors overlooked these issues and should
add these issues to the discussion. For example, near-infrared (NIR) light has longer wavelengths
and allows greater penetration into tissues. ICG-guided NIR imaging navigational surgery can
provide better visualization of lymph nodes and lymphatic channels than other dying materials
under visible light. Fluorescent image-guided surgery can help surgeons obtain additional
anatomical information, such as identifying lymph nodes in thick fatty tissues, discerning
lymphatic channels from vasculatures, identifying the origin and shape of a vessel (Reference
#1). These actually made less bleeding events during infra-pyloric lymphatic dissection during
gastrectomy. In addition, deep neuromuscular block (method of anesthesia) prevented bleeding
events than moderate neuromuscular block during gastric cancer surgery (Reference #2).
Therefore, I hope the authors should add the issues and cite the references as follows
in discussion part, that "To reduce postoperative bleeding, it is also important to reduce
intraoperative bleeding. Deep neuromuscular block and NIR-guided surgery are also considered
necessary in efforts to reduce intraoperative bleeding, ultimately reducing postoperative
bleeding."
Reference #1) Park SH, Berlth F, Choi JH, Park JH, Suh YS, Kong SH, Park DJ, Lee HJ,
Yang HK. Near-infrared fluorescence-guided surgery using indocyanine green facilitates secure
infrapyloric lymph node dissection during laparoscopic distal gastrectomy. Surg Today. 2020
Oct;50(10):1187-1196.
Reference #2) Park SH, Huh H, Choi SI, Kim JH, Jang YJ, Park JM, Kwon OK, Jung MR, Jeong
O, Lee CM, Min JS, Kim JJ, An L, Yang KS, Park S, Lee IO; Deep Neuromuscular Block on
Oncologic Quality of Laparoscopic Surgery in Obese Gastric Cancer Patients (DEBLOQS_GC)
Study Group. Impact of the Deep Neuromuscular Block on Oncologic Quality of Laparoscopic
Surgery in Obese Gastric Cancer Patients: A Randomized Clinical Trial. J Am Coll Surg. 2022
Mar 1;234(3):326-339. doi: 10.1097/XCS.0000000000000061.
Minor comment #1) Check whether the p-value of 0.045 (type of gastrectomy) in table 2 is
correct. The rate of type of gastrectomy (Disal / Total / Proximal) seems similar between two
groups. | BMC | 12893_2025_2826_ReviewerReport_V1_R2.pdf | {
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} | 0.846154 | 0 | [
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"role": "user"
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{
"content": "Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of\nsurgery to reduce bleeding after gastrectomy: a propensity score–matched analysis\nVersion: 1 Date: 27 Jan 2025\nReviewer's repor... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02826-8 | Reviewed - bmc_surgery | Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of
surgery to reduce bleeding after gastrectomy: a propensity score–matched analysis
Version: 1 Date: 31 Jan 2025
Reviewer: Tutkun Talih
Reviewer's report:
The study is well designed and carefully written.
The images are appropriate and well chosen.
But I don't think it contributes to the literature. | Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of
surgery to reduce bleeding after gastrectomy: a propensity score–matched analysis
Version: 1 Date: 31 Jan 2025
Reviewer: Tutkun Talih
Reviewer's report:
The study is well designed and carefully written.
The images are appropriate and well chosen.
But I don't think it contributes to the literature. | BMC | 12893_2025_2826_ReviewerReport_V1_R4.pdf | {
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"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of\nsurgery to reduce bleeding after gastrectomy: a propensity score–matched analysis\nVersion: 1 Date: 31 Jan 2025\nReviewer: Tutku... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02826-8 | Reviewed - bmc_surgery | Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of
surgery to reduce bleeding after gastrectomy: a propensity score–matched analysis
Version: 1 Date: 31 Jan 2025
Reviewer: Hilmi Yazici
Reviewer's report:
Dear Authors,
Congratulations on your effort in this research. The topic is interesting, and increasing blood
pressure has been used in some fields of surgery. However, there are some issues that need to
be acknowledged.
1- In my opinion, the abstract is quite long. Consider to shorten it. Especially, the specific
technique is unnecessarily long in the methods section.
2- Backgrounds in the introduction section are insufficient. It should mention how the bleedings
mostly occur, how it can be managed, and what are the consuquences?
3- The authors need to fully redesign the methods section. The subheadings are wrong, and
mixed. 'Methods and group ' unnecessary. Why is there a dot at the and?
4- In the specific surgical methods part, the authors declared hemostasis was stopped. Do you
mean hemostasis was achieved or was bleeding stopped?
5- In the statistical analysis section, please clarify how you perform propensity score matching
in detail.
6- Please clarify why you performed this blood pressure method on this 157 patient. What are
the selection criteria? Please clarify to avoid selection biases.
7- Why did you not include the type of gastrectomy in the PSM analysis? The purpose of PSM
was to homogenize the groups; however, the type of surgery differed significantly after PSM.
Please clarify.
8- Please also give the results of Table 2 before PSM.
9- In Table 4, the number of cases was given as 175. Is it correct? Please clarify.
10- In 157 patients of the experimental group, how many cases did you need extra hemostasis
during the surgery? How you explain this difference between the groups?
11- The discussion section is very superficial. It mostly not discussed, but explain how bleeding
occurs. A deeper evaluation with existing studies is needed in discussion section. | Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of
surgery to reduce bleeding after gastrectomy: a propensity score–matched analysis
Version: 1 Date: 31 Jan 2025
Reviewer: Hilmi Yazici
Reviewer's report:
Dear Authors,
Congratulations on your effort in this research. The topic is interesting, and increasing blood
pressure has been used in some fields of surgery. However, there are some issues that need to
be acknowledged.
1- In my opinion, the abstract is quite long. Consider to shorten it. Especially, the specific
technique is unnecessarily long in the methods section.
2- Backgrounds in the introduction section are insufficient. It should mention how the bleedings
mostly occur, how it can be managed, and what are the consuquences?
3- The authors need to fully redesign the methods section. The subheadings are wrong, and
mixed. 'Methods and group ' unnecessary. Why is there a dot at the and?
4- In the specific surgical methods part, the authors declared hemostasis was stopped. Do you
mean hemostasis was achieved or was bleeding stopped?
5- In the statistical analysis section, please clarify how you perform propensity score matching
in detail.
6- Please clarify why you performed this blood pressure method on this 157 patient. What are
the selection criteria? Please clarify to avoid selection biases.
7- Why did you not include the type of gastrectomy in the PSM analysis? The purpose of PSM
was to homogenize the groups; however, the type of surgery differed significantly after PSM.
Please clarify.
8- Please also give the results of Table 2 before PSM.
9- In Table 4, the number of cases was given as 175. Is it correct? Please clarify.
10- In 157 patients of the experimental group, how many cases did you need extra hemostasis
during the surgery? How you explain this difference between the groups?
11- The discussion section is very superficial. It mostly not discussed, but explain how bleeding
occurs. A deeper evaluation with existing studies is needed in discussion section. | BMC | 12893_2025_2826_ReviewerReport_V1_R1.pdf | {
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"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of\nsurgery to reduce bleeding after gastrectomy: a propensity score–matched analysis\nVersion: 1 Date: 31 Jan 2025\nReviewer: Hilmi... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02826-8 | Reviewed - bmc_surgery | Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of
surgery to reduce bleeding after gastrectomy: a propensity score–matched analysis
Version: 1 Date: 31 Jan 2025
Reviewer: Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the study uses propensity score matching to reduce confounding, the lack of
randomization limits the ability to draw definitive causal conclusions. Randomized controlled
trials (RCTs) are generally considered the gold standard for testing interventions like this.
Propensity score matching, while useful in observational studies, cannot fully eliminate selection
bias.
-The study distinguishes between early and delayed bleeding, but the exact mechanisms or
clinical factors contributing to these types of bleeding are not fully explored. A deeper dive into
what differentiates these two categories, especially in terms of risk factors, could provide more
context for why the intervention worked (or didn’t work) in specific cases. For example, how
does the timing of bleeding correlate with different surgical or patient characteristics?
-The norepinephrine dosing (2–10 µg/kg·min) is mentioned, but further details on how the dose
was adjusted intraoperatively based on patient-specific parameters (e.g., weight, baseline BP,
or response to norepinephrine) would provide a clearer understanding of the intervention’s
implementation. Was there a specific goal for BP increase beyond just raising it by 20%?
Understanding this would be useful for clinical application and replication in future studies.
-While postoperative bleeding within the first 48 hours is critical to address, the lack of long-
term follow-up (beyond 48 hours) is a limitation. Delayed bleeding, especially at the 1-week
mark, may be an important outcome to investigate more thoroughly. Longer follow-up would
help assess whether early bleeding reduction translates into better long-term outcomes or if the
initial BP increase might have secondary effects that manifest later.
-While the authors appropriately acknowledge that prophylactic blood pressure increase did not
significantly affect delayed bleeding (P = 0.156), there could be more discussion on why this
intervention does not impact delayed bleeding. Delayed bleeding often involves more complex
issues such as ruptured large blood vessels, anastomotic ulceration, or infections—issues that
would not necessarily be addressed by increasing blood pressure before the end of surgery. A
more in-depth exploration of the mechanisms behind delayed bleeding and why this intervention
is not effective for it would be valuable for the reader’s understanding.
-The discussion provides a general explanation of potential bleeding mechanisms, especially for
early bleeding. However, it would be beneficial to discuss the underlying mechanisms of delayed
bleeding in more detail. For example, the authors mention the rupture of a pseudoaneurysm near
the gastroduodenal artery and how infection contributed to delayed bleeding, but there could
be a deeper dive into how these complications develop. This could help the reader understand
that the prophylactic increase in blood pressure is unlikely to affect these more complex and
delayed issues.
-The discussion mentions the use of ultrasonic knives for hemostasis and how they can lead to an
unstable protein pseudomembrane that might detach postoperatively, causing bleeding. While
this is an important point, the connection between this phenomenon and the study’s intervention
could be made more explicit. How exactly does the blood pressure increase help detect this
unstable pseudomembrane? A more detailed explanation of this mechanism—how BP increase
could identify vulnerable areas formed by the ultrasonic knife—would help the reader fully
appreciate the proposed intervention’s utility. | Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of
surgery to reduce bleeding after gastrectomy: a propensity score–matched analysis
Version: 1 Date: 31 Jan 2025
Reviewer: Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the study uses propensity score matching to reduce confounding, the lack of
randomization limits the ability to draw definitive causal conclusions. Randomized controlled
trials (RCTs) are generally considered the gold standard for testing interventions like this.
Propensity score matching, while useful in observational studies, cannot fully eliminate selection
bias.
-The study distinguishes between early and delayed bleeding, but the exact mechanisms or
clinical factors contributing to these types of bleeding are not fully explored. A deeper dive into
what differentiates these two categories, especially in terms of risk factors, could provide more
context for why the intervention worked (or didn’t work) in specific cases. For example, how
does the timing of bleeding correlate with different surgical or patient characteristics?
-The norepinephrine dosing (2–10 µg/kg·min) is mentioned, but further details on how the dose
was adjusted intraoperatively based on patient-specific parameters (e.g., weight, baseline BP,
or response to norepinephrine) would provide a clearer understanding of the intervention’s
implementation. Was there a specific goal for BP increase beyond just raising it by 20%?
Understanding this would be useful for clinical application and replication in future studies.
-While postoperative bleeding within the first 48 hours is critical to address, the lack of long-
term follow-up (beyond 48 hours) is a limitation. Delayed bleeding, especially at the 1-week
mark, may be an important outcome to investigate more thoroughly. Longer follow-up would
help assess whether early bleeding reduction translates into better long-term outcomes or if the
initial BP increase might have secondary effects that manifest later.
-While the authors appropriately acknowledge that prophylactic blood pressure increase did not
significantly affect delayed bleeding (P = 0.156), there could be more discussion on why this
intervention does not impact delayed bleeding. Delayed bleeding often involves more complex
issues such as ruptured large blood vessels, anastomotic ulceration, or infections—issues that
would not necessarily be addressed by increasing blood pressure before the end of surgery. A
more in-depth exploration of the mechanisms behind delayed bleeding and why this intervention
is not effective for it would be valuable for the reader’s understanding.
-The discussion provides a general explanation of potential bleeding mechanisms, especially for
early bleeding. However, it would be beneficial to discuss the underlying mechanisms of delayed
bleeding in more detail. For example, the authors mention the rupture of a pseudoaneurysm near
the gastroduodenal artery and how infection contributed to delayed bleeding, but there could
be a deeper dive into how these complications develop. This could help the reader understand
that the prophylactic increase in blood pressure is unlikely to affect these more complex and
delayed issues.
-The discussion mentions the use of ultrasonic knives for hemostasis and how they can lead to an
unstable protein pseudomembrane that might detach postoperatively, causing bleeding. While
this is an important point, the connection between this phenomenon and the study’s intervention
could be made more explicit. How exactly does the blood pressure increase help detect this
unstable pseudomembrane? A more detailed explanation of this mechanism—how BP increase
could identify vulnerable areas formed by the ultrasonic knife—would help the reader fully
appreciate the proposed intervention’s utility. | BMC | 12893_2025_2826_ReviewerReport_V1_R5.pdf | {
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"total": 23
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} | 1.782609 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of\nsurgery to reduce bleeding after gastrectomy: a propensity score–matched analysis\nVersion: 1 Date: 31 Jan 2025\nReviewer: Anwar... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02826-8 | Reviewed - bmc_surgery | Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of
surgery to reduce bleeding after gastrectomy: a propensity score–matched analysis
Version: 1 Date: 01 Feb 2025
Reviewer's report: | Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of
surgery to reduce bleeding after gastrectomy: a propensity score–matched analysis
Version: 1 Date: 01 Feb 2025
Reviewer's report: | BMC | 12893_2025_2826_ReviewerReport_V1_R3.pdf | {
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"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of\nsurgery to reduce bleeding after gastrectomy: a propensity score–matched analysis\nVersion: 1 Date: 01 Feb 2025\nReviewer's repor... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02826-8 | Reviewed - bmc_surgery | Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of
surgery to reduce bleeding after gastrectomy: a propensity score–matched analysis
Version: 2 Date: 11 Feb 2025
Reviewer: Hilmi Yazici
Reviewer's report:
Dear Authors,
Thank you for your revisions. There are still some issues that need to be acknowledged.
Please give your responses in a point-by-point manner. A total answer is making them hard to
understand.
1- The abstract is still too long. 447 words are too much for an abstract. Please shorten the
methods section especially.
2- Methods section, The exclusion criteri:Contraindications , please correct this sentence.
3- There are numerous typo errors throughout the manuscript. Please revise them.
4- in your responses paper, you declared that intraoperative hemostasis in the experimental group
is not the main focus of the study. If increasing blood pressure shows you the potential bleeding
in the operating room, I think that should be the mechanism; then, it must be further analyzed.
If you say no, this is not the main focus of this study, then please explain the mechanism of
preventing bleeding in the experimental group. | Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of
surgery to reduce bleeding after gastrectomy: a propensity score–matched analysis
Version: 2 Date: 11 Feb 2025
Reviewer: Hilmi Yazici
Reviewer's report:
Dear Authors,
Thank you for your revisions. There are still some issues that need to be acknowledged.
Please give your responses in a point-by-point manner. A total answer is making them hard to
understand.
1- The abstract is still too long. 447 words are too much for an abstract. Please shorten the
methods section especially.
2- Methods section, The exclusion criteri:Contraindications , please correct this sentence.
3- There are numerous typo errors throughout the manuscript. Please revise them.
4- in your responses paper, you declared that intraoperative hemostasis in the experimental group
is not the main focus of the study. If increasing blood pressure shows you the potential bleeding
in the operating room, I think that should be the mechanism; then, it must be further analyzed.
If you say no, this is not the main focus of this study, then please explain the mechanism of
preventing bleeding in the experimental group. | BMC | 12893_2025_2826_ReviewerReport_V2_R1.pdf | {
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"total": 13
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} | 2.153846 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of\nsurgery to reduce bleeding after gastrectomy: a propensity score–matched analysis\nVersion: 2 Date: 11 Feb 2025\nReviewer: Hilmi... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02826-8 | Reviewed - bmc_surgery | Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of
surgery to reduce bleeding after gastrectomy: a propensity score–matched analysis
Version: 2 Date: 12 Feb 2025
Reviewer: Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory. | Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of
surgery to reduce bleeding after gastrectomy: a propensity score–matched analysis
Version: 2 Date: 12 Feb 2025
Reviewer: Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory. | BMC | 12893_2025_2826_ReviewerReport_V2_R5.pdf | {
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{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of\nsurgery to reduce bleeding after gastrectomy: a propensity score–matched analysis\nVersion: 2 Date: 12 Feb 2025\nReviewer: Anwar... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02826-8 | Reviewed - bmc_surgery | Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of
surgery to reduce bleeding after gastrectomy: a propensity score–matched analysis
Version: 2 Date: 12 Feb 2025
Reviewer's report:
I decided acceptance, because the manuscript was well revised. | Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of
surgery to reduce bleeding after gastrectomy: a propensity score–matched analysis
Version: 2 Date: 12 Feb 2025
Reviewer's report:
I decided acceptance, because the manuscript was well revised. | BMC | 12893_2025_2826_ReviewerReport_V2_R2.pdf | {
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} | 2 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of\nsurgery to reduce bleeding after gastrectomy: a propensity score–matched analysis\nVersion: 2 Date: 12 Feb 2025\nReviewer's repor... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02826-8 | Reviewed - bmc_surgery | Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of
surgery to reduce bleeding after gastrectomy: a propensity score–matched analysis
Version: 3 Date: 19 Feb 2025
Reviewer: Hilmi Yazici
Reviewer's report:
Well done. No more comments | Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of
surgery to reduce bleeding after gastrectomy: a propensity score–matched analysis
Version: 3 Date: 19 Feb 2025
Reviewer: Hilmi Yazici
Reviewer's report:
Well done. No more comments | BMC | 12893_2025_2826_ReviewerReport_V3_R1.pdf | {
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} | 1 | 0 | [
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"role": "user"
},
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"content": "Title: Analysis of the efficiency of a prophylactic increasing blood pressure before the end of\nsurgery to reduce bleeding after gastrectomy: a propensity score–matched analysis\nVersion: 3 Date: 19 Feb 2025\nReviewer: Hilmi... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02819-7 | Reviewed - bmc_surgery | Title: Efficacy of Metronidazole in Reducing Pain After Hemorrhoidectomy: A Meta-Analysis
of Randomized Controlled Trials
Version: 0 Date: 14 Dec 2024
Reviewer's report:
see the uploaded file | Title: Efficacy of Metronidazole in Reducing Pain After Hemorrhoidectomy: A Meta-Analysis
of Randomized Controlled Trials
Version: 0 Date: 14 Dec 2024
Reviewer's report:
see the uploaded file | BMC | 12893_2025_2819_ReviewerReport_V0_R1.pdf | {
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} | 1 | 0 | [
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"role": "user"
},
{
"content": "Title: Efficacy of Metronidazole in Reducing Pain After Hemorrhoidectomy: A Meta-Analysis\nof Randomized Controlled Trials\nVersion: 0 Date: 14 Dec 2024\nReviewer's report:\nsee the uploaded file",
"role": "assistant"
}
... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02819-7 | Reviewed - bmc_surgery | Title: Efficacy of Metronidazole in Reducing Pain After Hemorrhoidectomy: A Meta-Analysis
of Randomized Controlled Trials
Version: 0 Date: 16 Dec 2024
Reviewer's report:
Reviewer comments to authors
Overall, this is a clear and well-written manuscript. The authors make a systematic contribution
to the research literature in this area of investigation. I have some concerns and suggestions
for each aspect of the manuscript. I also recommend that the authors to get an English editing
service.
Abstracts
Overall, the abstracts is clear, concise, and well-written.
Introduction
The introduction is relevant and theory based. Sufficient information about the previous study
findings is presented for readers to follow the present study rationale. However, it is redundant
and I recommend that you revise it to be shorter and more concise.
Material and methods
Overall, this is well-written and I have no suggestions.
Results
In general, the results are reasonable and logically consistent. Although the sample size is small,
the statistical results are expected to be somewhat reliable because the authors included only
randomized controlled trials that included placebo group in their statistical analysis. In ‘3.3.6
the Overall incidence of complications’ section, it would be good to briefly mention the types of
complications. Although the classification of complications varies by study, but it is necessary
to briefly mention them. No additional statistical analysis is required for this.
Discussion
The discussion section provides a relatively well-described scientific background supporting the
efficacy of metronidazole in reducing pain after hemorrhoid surgery. As the authors pointed
out, we cannot overlook the concerns about complications and the occurrence of resistant
strains after metronidazole administration. However, the authors' research results do not include
information about resistant strains after metronidazole administration, I recommend removing
the risk of ‘potential metronidazole resistance’ from the conclusion. In the abstract, the authors
wrote that metronidazole can significantly improve postoperative pain in patients undergoing
hemorrhoidectomy and is ‘safe’. The abstract and conclusion sections of the main manuscript
should be consistent. | Title: Efficacy of Metronidazole in Reducing Pain After Hemorrhoidectomy: A Meta-Analysis
of Randomized Controlled Trials
Version: 0 Date: 16 Dec 2024
Reviewer's report:
Reviewer comments to authors
Overall, this is a clear and well-written manuscript. The authors make a systematic contribution
to the research literature in this area of investigation. I have some concerns and suggestions
for each aspect of the manuscript. I also recommend that the authors to get an English editing
service.
Abstracts
Overall, the abstracts is clear, concise, and well-written.
Introduction
The introduction is relevant and theory based. Sufficient information about the previous study
findings is presented for readers to follow the present study rationale. However, it is redundant
and I recommend that you revise it to be shorter and more concise.
Material and methods
Overall, this is well-written and I have no suggestions.
Results
In general, the results are reasonable and logically consistent. Although the sample size is small,
the statistical results are expected to be somewhat reliable because the authors included only
randomized controlled trials that included placebo group in their statistical analysis. In ‘3.3.6
the Overall incidence of complications’ section, it would be good to briefly mention the types of
complications. Although the classification of complications varies by study, but it is necessary
to briefly mention them. No additional statistical analysis is required for this.
Discussion
The discussion section provides a relatively well-described scientific background supporting the
efficacy of metronidazole in reducing pain after hemorrhoid surgery. As the authors pointed
out, we cannot overlook the concerns about complications and the occurrence of resistant
strains after metronidazole administration. However, the authors' research results do not include
information about resistant strains after metronidazole administration, I recommend removing
the risk of ‘potential metronidazole resistance’ from the conclusion. In the abstract, the authors
wrote that metronidazole can significantly improve postoperative pain in patients undergoing
hemorrhoidectomy and is ‘safe’. The abstract and conclusion sections of the main manuscript
should be consistent. | BMC | 12893_2025_2819_ReviewerReport_V0_R2.pdf | {
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} | 2.210526 | 0 | [
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{
"content": "Title: Efficacy of Metronidazole in Reducing Pain After Hemorrhoidectomy: A Meta-Analysis\nof Randomized Controlled Trials\nVersion: 0 Date: 16 Dec 2024\nReviewer's report:\nReviewer comments to authors\nOverall, this is a cle... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02819-7 | Reviewed - bmc_surgery | Title: Efficacy of Metronidazole in Reducing Pain After Hemorrhoidectomy: A Meta-Analysis
of Randomized Controlled Trials
Version: 0 Date: 21 Jan 2025
Reviewer's report:
Review of the Manuscript:
Efficacy of Metronidazole in Reducing Pain After Hemorrhoidectomy: A Meta-Analysis of
Randomized Controlled Trials
Adherence to Guidelines
The manuscript should align with PRISMA guidelines for systematic reviews and meta-
analyses. Key points to consider:
• PRISMA checklist inclusion.
• Adequate reporting of the selection process (PRISMA flowchart).
• Clear statement of the rationale for the review.
Identified Issues
1. Methodological Flaws
• Heterogeneity Issues: High heterogeneity (e.g., I2=88%I^2 = 88\%I2=88% for Day 1 pain
scores) undermines the reliability of findings. The random-effects model is appropriately used,
but subgroup analyses or meta-regression are absent. These methods could clarify sources of
heterogeneity.
• TSA Analysis: While TSA was performed, it indicated that while the sample size met the
required information size (RIS), the boundary was reached only with additional studies. This
suggests that further data may alter conclusions.
• GRADE Evidence Quality: Most outcomes have low GRADE ratings. This reflects limited
confidence in results, possibly due to bias or small sample sizes.
2. Data Presentation Issues
• Pain Scores: Sensitivity analysis reveals instability in Day 1 pain score findings, particularly
after removing a single study. This should be emphasized in the abstract and conclusion as a
major limitation.
• Complications and Safety: Although no significant difference in complications was found, the
lack of subgroup analyses for different administration routes (oral, intravenous, topical) raises
questions about generalizability.
3. Conclusion Validity
The conclusion that metronidazole "can significantly improve postoperative pain" is strong,
despite the outlined limitations. A more tempered conclusion is warranted, acknowledging the
low evidence quality and heterogeneity.
4. Structural and Logical Integrity
• Introduction: Strong rationale and well-contextualized background. However, the review focus
(metronidazole vs. placebo) should be better highlighted in relation to the broader literature on
pain management.
• Discussion: While comprehensive, the limitations section could more thoroughly address
potential biases (e.g., risk of publication bias, selection bias).
5. Ethical Considerations
The ethical section is missing. PRISMA-compliant reviews should state whether patient consent
or ethical approval is necessary for included trials. While this is typically reported in primary
studies, the lack of explicit mention here weakens ethical transparency.
Recommendations
Major Revisions
1. Heterogeneity Exploration: Conduct subgroup or sensitivity analyses focusing on:
o Administration routes.
o Surgery types (e.g., Milligan-Morgan vs. Ferguson).
o Variations in study quality.
2. GRADE Reporting: Provide detailed tables for GRADE assessments to justify low evidence
ratings. Include a discussion on how these ratings impact clinical applicability.
3. Abstract Revision: Highlight key limitations in the results section, particularly the sensitivity
analysis findings and heterogeneity.
Minor Revisions
1. Include a supplementary table detailing the characteristics of excluded studies (with reasons
for exclusion).
2. Ensure proper ethical disclosure about included studies (e.g., informed consent, ethical
approval).
Overall Assessment
The manuscript presents important findings on a clinically relevant topic. However, issues
related to heterogeneity, evidence quality, and conclusions need to be addressed to strengthen
the reliability and clinical applicability of the results. | Title: Efficacy of Metronidazole in Reducing Pain After Hemorrhoidectomy: A Meta-Analysis
of Randomized Controlled Trials
Version: 0 Date: 21 Jan 2025
Reviewer's report:
Review of the Manuscript:
Efficacy of Metronidazole in Reducing Pain After Hemorrhoidectomy: A Meta-Analysis of
Randomized Controlled Trials
Adherence to Guidelines
The manuscript should align with PRISMA guidelines for systematic reviews and meta-
analyses. Key points to consider:
• PRISMA checklist inclusion.
• Adequate reporting of the selection process (PRISMA flowchart).
• Clear statement of the rationale for the review.
Identified Issues
1. Methodological Flaws
• Heterogeneity Issues: High heterogeneity (e.g., I2=88%I^2 = 88\%I2=88% for Day 1 pain
scores) undermines the reliability of findings. The random-effects model is appropriately used,
but subgroup analyses or meta-regression are absent. These methods could clarify sources of
heterogeneity.
• TSA Analysis: While TSA was performed, it indicated that while the sample size met the
required information size (RIS), the boundary was reached only with additional studies. This
suggests that further data may alter conclusions.
• GRADE Evidence Quality: Most outcomes have low GRADE ratings. This reflects limited
confidence in results, possibly due to bias or small sample sizes.
2. Data Presentation Issues
• Pain Scores: Sensitivity analysis reveals instability in Day 1 pain score findings, particularly
after removing a single study. This should be emphasized in the abstract and conclusion as a
major limitation.
• Complications and Safety: Although no significant difference in complications was found, the
lack of subgroup analyses for different administration routes (oral, intravenous, topical) raises
questions about generalizability.
3. Conclusion Validity
The conclusion that metronidazole "can significantly improve postoperative pain" is strong,
despite the outlined limitations. A more tempered conclusion is warranted, acknowledging the
low evidence quality and heterogeneity.
4. Structural and Logical Integrity
• Introduction: Strong rationale and well-contextualized background. However, the review focus
(metronidazole vs. placebo) should be better highlighted in relation to the broader literature on
pain management.
• Discussion: While comprehensive, the limitations section could more thoroughly address
potential biases (e.g., risk of publication bias, selection bias).
5. Ethical Considerations
The ethical section is missing. PRISMA-compliant reviews should state whether patient consent
or ethical approval is necessary for included trials. While this is typically reported in primary
studies, the lack of explicit mention here weakens ethical transparency.
Recommendations
Major Revisions
1. Heterogeneity Exploration: Conduct subgroup or sensitivity analyses focusing on:
o Administration routes.
o Surgery types (e.g., Milligan-Morgan vs. Ferguson).
o Variations in study quality.
2. GRADE Reporting: Provide detailed tables for GRADE assessments to justify low evidence
ratings. Include a discussion on how these ratings impact clinical applicability.
3. Abstract Revision: Highlight key limitations in the results section, particularly the sensitivity
analysis findings and heterogeneity.
Minor Revisions
1. Include a supplementary table detailing the characteristics of excluded studies (with reasons
for exclusion).
2. Ensure proper ethical disclosure about included studies (e.g., informed consent, ethical
approval).
Overall Assessment
The manuscript presents important findings on a clinically relevant topic. However, issues
related to heterogeneity, evidence quality, and conclusions need to be addressed to strengthen
the reliability and clinical applicability of the results. | BMC | 12893_2025_2819_ReviewerReport_V0_R4.pdf | {
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"content": "Title: Efficacy of Metronidazole in Reducing Pain After Hemorrhoidectomy: A Meta-Analysis\nof Randomized Controlled Trials\nVersion: 0 Date: 21 Jan 2025\nReviewer's report:\nReview of the Manuscript:\nEfficacy of Metronidazole... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02819-7 | Reviewed - bmc_surgery | Title: Efficacy of Metronidazole in Reducing Pain After Hemorrhoidectomy: A Meta-Analysis
of Randomized Controlled Trials
Version: 1 Date: 04 Feb 2025
Reviewer's report:
Thank you for your thorough revisions. All my concerns have been addressed adequately, and
the manuscript is now suitable for publication. | Title: Efficacy of Metronidazole in Reducing Pain After Hemorrhoidectomy: A Meta-Analysis
of Randomized Controlled Trials
Version: 1 Date: 04 Feb 2025
Reviewer's report:
Thank you for your thorough revisions. All my concerns have been addressed adequately, and
the manuscript is now suitable for publication. | BMC | 12893_2025_2819_ReviewerReport_V1_R4.pdf | {
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"content": "Title: Efficacy of Metronidazole in Reducing Pain After Hemorrhoidectomy: A Meta-Analysis\nof Randomized Controlled Trials\nVersion: 1 Date: 04 Feb 2025\nReviewer's report:\nThank you for your thorough revisions. All my concer... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02819-7 | Reviewed - bmc_surgery | Title: Efficacy of Metronidazole in Reducing Pain After Hemorrhoidectomy: A Meta-Analysis
of Randomized Controlled Trials
Version: 1 Date: 10 Feb 2025
Reviewer's report:
Reviewer comments to authors
I have reviewed the authors' revised manuscript. I have no further comments on the revised
manuscript. | Title: Efficacy of Metronidazole in Reducing Pain After Hemorrhoidectomy: A Meta-Analysis
of Randomized Controlled Trials
Version: 1 Date: 10 Feb 2025
Reviewer's report:
Reviewer comments to authors
I have reviewed the authors' revised manuscript. I have no further comments on the revised
manuscript. | BMC | 12893_2025_2819_ReviewerReport_V1_R2.pdf | {
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"content": "Title: Efficacy of Metronidazole in Reducing Pain After Hemorrhoidectomy: A Meta-Analysis\nof Randomized Controlled Trials\nVersion: 1 Date: 10 Feb 2025\nReviewer's report:\nReviewer comments to authors\nI have reviewed the au... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02813-z | Reviewed - bmc_surgery | Title: Accuracy in navigated percutaneous sacroiliac screw fixation: a systematic review and
meta-analysis
Version: 3 Date: 20 Jun 2024
Reviewer's report:
I applaud the authors for this well conducted study.
However, the results section is very heterogeneous. It is like mixing apples and oranges. I see
that a reduction of this heterogeneity was attempted by doing a sub-analysis. But there are too
many sub-analysis.
I think it would be better to remove the in-vitro studies and keep the clinical studies only and
redo everything Accordingly.
I will be happy to review the manuscript after that | Title: Accuracy in navigated percutaneous sacroiliac screw fixation: a systematic review and
meta-analysis
Version: 3 Date: 20 Jun 2024
Reviewer's report:
I applaud the authors for this well conducted study.
However, the results section is very heterogeneous. It is like mixing apples and oranges. I see
that a reduction of this heterogeneity was attempted by doing a sub-analysis. But there are too
many sub-analysis.
I think it would be better to remove the in-vitro studies and keep the clinical studies only and
redo everything Accordingly.
I will be happy to review the manuscript after that | BMC | 12893_2025_2813_ReviewerReport_V3_R1.pdf | {
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} | 1.428571 | 0 | [
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"role": "user"
},
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"content": "Title: Accuracy in navigated percutaneous sacroiliac screw fixation: a systematic review and\nmeta-analysis\nVersion: 3 Date: 20 Jun 2024\nReviewer's report:\nI applaud the authors for this well conducted study.\nHowever, the ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02813-z | Reviewed - bmc_surgery | Title: Accuracy in navigated percutaneous sacroiliac screw fixation: a systematic review and
meta-analysis
Version: 3 Date: 21 Sep 2024
Reviewer: Hui-Min Li
Reviewer's report:
1. What standard is used for nail placement accuracy? According to most literature, the Gertzbin
Robbins classification is used, Group A: screw position is within the paper#Group B: cortical
breach of less than 2 mm, Group C: cortical breach of 2 mm or more but less than 4 mm, Group
D: cortical breach of 4 mm or more but less than 6 mm, and Group E: cortical breach of 6 mm or
more)# The article does not differentiate based on levels, and this result needs to be reanalyzed.
2.“more advanced techniques (O-arm, 3D CT and robot) showed a greater beneficial effect
regarding accuracy (Figure 1).” The inclusion of relatively few comparative literatures in this
result requires further discussion regarding the conclusion reached.
3. The literature quality assessment criteria for RCTs require the use of Cochrane risk of bias
criteria.
4. There may be incomplete display of references, such as the eighth one. | Title: Accuracy in navigated percutaneous sacroiliac screw fixation: a systematic review and
meta-analysis
Version: 3 Date: 21 Sep 2024
Reviewer: Hui-Min Li
Reviewer's report:
1. What standard is used for nail placement accuracy? According to most literature, the Gertzbin
Robbins classification is used, Group A: screw position is within the paper#Group B: cortical
breach of less than 2 mm, Group C: cortical breach of 2 mm or more but less than 4 mm, Group
D: cortical breach of 4 mm or more but less than 6 mm, and Group E: cortical breach of 6 mm or
more)# The article does not differentiate based on levels, and this result needs to be reanalyzed.
2.“more advanced techniques (O-arm, 3D CT and robot) showed a greater beneficial effect
regarding accuracy (Figure 1).” The inclusion of relatively few comparative literatures in this
result requires further discussion regarding the conclusion reached.
3. The literature quality assessment criteria for RCTs require the use of Cochrane risk of bias
criteria.
4. There may be incomplete display of references, such as the eighth one. | BMC | 12893_2025_2813_ReviewerReport_V3_R3.pdf | {
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} | 1.5 | 0 | [
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"content": "Title: Accuracy in navigated percutaneous sacroiliac screw fixation: a systematic review and\nmeta-analysis\nVersion: 3 Date: 21 Sep 2024\nReviewer: Hui-Min Li\nReviewer's report:\n1. What standard is used for nail placement ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02813-z | Reviewed - bmc_surgery | Title: Accuracy in navigated percutaneous sacroiliac screw fixation: a systematic review and
meta-analysis
Version: 6 Date: 01 Jan 2025
Reviewer's report:
The manuscript was revised according to the reviewers comments | Title: Accuracy in navigated percutaneous sacroiliac screw fixation: a systematic review and
meta-analysis
Version: 6 Date: 01 Jan 2025
Reviewer's report:
The manuscript was revised according to the reviewers comments | BMC | 12893_2025_2813_ReviewerReport_V6_R1.pdf | {
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"content": "Title: Accuracy in navigated percutaneous sacroiliac screw fixation: a systematic review and\nmeta-analysis\nVersion: 6 Date: 01 Jan 2025\nReviewer's report:\nThe manuscript was revised according to the reviewers comments",
... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02813-z | Reviewed - bmc_surgery | Title: Accuracy in navigated percutaneous sacroiliac screw fixation: a systematic review and
meta-analysis
Version: 6 Date: 08 Jan 2025
Reviewer: Yu-Ning Peng
Reviewer's report: | Title: Accuracy in navigated percutaneous sacroiliac screw fixation: a systematic review and
meta-analysis
Version: 6 Date: 08 Jan 2025
Reviewer: Yu-Ning Peng
Reviewer's report: | BMC | 12893_2025_2813_ReviewerReport_V6_R6.pdf | {
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"content": "Title: Accuracy in navigated percutaneous sacroiliac screw fixation: a systematic review and\nmeta-analysis\nVersion: 6 Date: 08 Jan 2025\nReviewer: Yu-Ning Peng\nReviewer's report:",
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] | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02813-z | Reviewed - bmc_surgery | Title: Accuracy in navigated percutaneous sacroiliac screw fixation: a systematic review and
meta-analysis
Version: 6 Date: 19 Jan 2025
Reviewer's report:
1. Rich research literature and clear categorization: the study involves more related studies and
is categorized more meticulously, reflecting a broad understanding of the field and sufficient
literature collection work, which is worthy of recognition.
2. The discussion part is slightly simple: although the results of the study are analyzed in
the discussion part of the article, the depth is insufficient. It is recommended that the authors
combine the results of various studies to analyze and elaborate the advantages and shortcomings
of various new technologies in depth, so as to enhance the persuasiveness and academic value
of the article. In addition, the discussion of the research results should be sufficient and avoid
overly subjective and exaggerated claims. For example, the advantages of the technology can
be expressed as “Compared with traditional methods, the technology has greater advantages in
some aspects, but there are some limitations”. | Title: Accuracy in navigated percutaneous sacroiliac screw fixation: a systematic review and
meta-analysis
Version: 6 Date: 19 Jan 2025
Reviewer's report:
1. Rich research literature and clear categorization: the study involves more related studies and
is categorized more meticulously, reflecting a broad understanding of the field and sufficient
literature collection work, which is worthy of recognition.
2. The discussion part is slightly simple: although the results of the study are analyzed in
the discussion part of the article, the depth is insufficient. It is recommended that the authors
combine the results of various studies to analyze and elaborate the advantages and shortcomings
of various new technologies in depth, so as to enhance the persuasiveness and academic value
of the article. In addition, the discussion of the research results should be sufficient and avoid
overly subjective and exaggerated claims. For example, the advantages of the technology can
be expressed as “Compared with traditional methods, the technology has greater advantages in
some aspects, but there are some limitations”. | BMC | 12893_2025_2813_ReviewerReport_V6_R7.pdf | {
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"role": "user"
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"content": "Title: Accuracy in navigated percutaneous sacroiliac screw fixation: a systematic review and\nmeta-analysis\nVersion: 6 Date: 19 Jan 2025\nReviewer's report:\n1. Rich research literature and clear categorization: the study inv... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02817-9 | Reviewed - bmc_surgery | Title: Development and validation of a clinical prediction model for dialysis-requiring acute
kidney injury following heart transplantation: a single-center study from China
Version: 1 Date: 11 Dec 2024
Reviewer's report:
In the manuscript, “Development and validation of a clinical prediction model for acute renal
failure requiring dialysis following heart transplantation: a retrospective study from China”
Qian and authors propose a model to predict acute renal failure requiring dialysis following
heart transplantation. Developed using logistic regression, the model consists of six indicators:
diabetes, stroke, gout, prognostic nutritional index, estimated glomerular filtration rate, and
cardiopulmonary bypass duration and has a C-statistic of 0.792 in the derivation cohort and
0.834 in the validation cohort.
Qian et al.’s methods are well described and technically sound. Though a small dataset is used,
their conclusions are supported by their work. Their statistical analysis of the data is sound;
however, as the authors note in their limitations, no external or test set is used. This limits the
broader application of this prediction model. The location of the heart transplant recipients is
also unclear in the main manuscript. Are all patients from a single center? Where is the center
located in China?
Overall, this is a technically sound and interesting paper. I would suggest the authors include
more details regarding their cohort and, if possible, determine their model’s fit using a broader
test set. Finally, they should address minor spelling and syntax errors. | Title: Development and validation of a clinical prediction model for dialysis-requiring acute
kidney injury following heart transplantation: a single-center study from China
Version: 1 Date: 11 Dec 2024
Reviewer's report:
In the manuscript, “Development and validation of a clinical prediction model for acute renal
failure requiring dialysis following heart transplantation: a retrospective study from China”
Qian and authors propose a model to predict acute renal failure requiring dialysis following
heart transplantation. Developed using logistic regression, the model consists of six indicators:
diabetes, stroke, gout, prognostic nutritional index, estimated glomerular filtration rate, and
cardiopulmonary bypass duration and has a C-statistic of 0.792 in the derivation cohort and
0.834 in the validation cohort.
Qian et al.’s methods are well described and technically sound. Though a small dataset is used,
their conclusions are supported by their work. Their statistical analysis of the data is sound;
however, as the authors note in their limitations, no external or test set is used. This limits the
broader application of this prediction model. The location of the heart transplant recipients is
also unclear in the main manuscript. Are all patients from a single center? Where is the center
located in China?
Overall, this is a technically sound and interesting paper. I would suggest the authors include
more details regarding their cohort and, if possible, determine their model’s fit using a broader
test set. Finally, they should address minor spelling and syntax errors. | BMC | 12893_2025_2817_ReviewerReport_V1_R1.pdf | {
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"role": "user"
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"content": "Title: Development and validation of a clinical prediction model for dialysis-requiring acute\nkidney injury following heart transplantation: a single-center study from China\nVersion: 1 Date: 11 Dec 2024\nReviewer's report:\n... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02817-9 | Reviewed - bmc_surgery | Title: Development and validation of a clinical prediction model for dialysis-requiring acute
kidney injury following heart transplantation: a single-center study from China
Version: 1 Date: 20 Dec 2024
Reviewer's report:
Comment 1: I recommend that the authors replace "acute renal failure" with "dialysis-requiring
acute kidney injury" throughout the article, as the primary outcome is specifically focused on
this scenario. Additionally, "acute kidney injury (AKI)" is a more commonly used term in recent
years, replacing the "acute renal failure."
Comment 2: The criteria for initiating kidney replacement therapy do not appear to include
metabolic acidosis and uremia, which are widely recognized and commonly used criteria in
randomized controlled trials (RCTs) for AKI-related kidney replacement therapy. Could the
authors clarify or elaborate on this point?
": 1) SCr #400 µmol/L or 2-fold or more increase from the baseline; 2) oliguria, defined as
a urine flow #0.5 ml/kg/hour for #3 hours, despite optimization of systemic and pulmonary
hemodynamic; 3) serum potassium #6.0 mmol/L and unresponsive to insulin and diuretic
therapy."
Comment 3: The secondary outcome is all-cause mortality, but the observation period for this
outcome is not specified. In critical care studies, commonly used timeframes are in-hospital,
30-day, 60-day, or 90-day mortality. Please clarify the observation period for consistency and
comparability with other studies.
Comment 4: I recommend reorganizing the supplementary table to present the data as a word
document rather than an Excel file, as this format may be easier for readers to interpret.
Comment 5: Please provide a comparison of baseline characteristics between the dialysis-
requiring AKI and non-dialysis-requiring AKI cohorts. If feasible, include this as a
supplementary table or a table in the main text for a more comprehensive understanding of the
study population.
Comment 6: The authors demonstrated that a lower Prognostic Nutritional Index (PNI) was
associated with cardiac surgery-associated AKI. Other studies have reported similar findings
regarding the usefulness of PNI or the Neutrophil-to-Lymphocyte Ratio (NLR). I suggest citing
the below 3 references and discussing this evidence in the discussion section, as PNI is a readily
available and cost-effective tool for AKI risk stratification. This could enhance the clinical
relevance of your findings.
ref 1: The neutrophil to lymphocyte ratio and serum albumin as predictors of acute kidney injury
after coronary artery bypass grafting. Sci Rep. 2022 Sep 14;12(1):15438.
ref 2:Prognostic nutritional index as a predictive marker for acute kidney injury in adult critical
illness population: a systematic review and diagnostic test accuracy meta-analysis. J Intensive
Care. 2024 Apr 26;12(1):16.
ref 3:Association of Preoperative Prognostic Nutritional Index with Risk of Postoperative Acute
Kidney Injury: A Meta-Analysis of Observational Studies. Nutrients. 2023 Jun 28;15(13):2929.
doi: 10.3390/nu15132929
Comment 7: Both gout and uric acid levels were included in the analysis, but only gout was
identified as a risk factor. Could the authors elaborate on this finding? Additionally, consider
discussing why uric acid levels were not significant as a risk factor despite their known
association with gout and kidney disease.
Comment 8: The definitions of underlying conditions such as CKD, chronic liver disease,
and others should be explicitly provided. This ensures clarity and reproducibility of the study
methodology.
Comment 9: For an AKI study, it is essential to include the definition of baseline creatinine.
Comment 10: The secondary outcome is reported as all-cause mortality. However, the results
section does not include an evaluation of the model's prediction accuracy for this outcome. Please
provide the relevant metrics | Title: Development and validation of a clinical prediction model for dialysis-requiring acute
kidney injury following heart transplantation: a single-center study from China
Version: 1 Date: 20 Dec 2024
Reviewer's report:
Comment 1: I recommend that the authors replace "acute renal failure" with "dialysis-requiring
acute kidney injury" throughout the article, as the primary outcome is specifically focused on
this scenario. Additionally, "acute kidney injury (AKI)" is a more commonly used term in recent
years, replacing the "acute renal failure."
Comment 2: The criteria for initiating kidney replacement therapy do not appear to include
metabolic acidosis and uremia, which are widely recognized and commonly used criteria in
randomized controlled trials (RCTs) for AKI-related kidney replacement therapy. Could the
authors clarify or elaborate on this point?
": 1) SCr #400 µmol/L or 2-fold or more increase from the baseline; 2) oliguria, defined as
a urine flow #0.5 ml/kg/hour for #3 hours, despite optimization of systemic and pulmonary
hemodynamic; 3) serum potassium #6.0 mmol/L and unresponsive to insulin and diuretic
therapy."
Comment 3: The secondary outcome is all-cause mortality, but the observation period for this
outcome is not specified. In critical care studies, commonly used timeframes are in-hospital,
30-day, 60-day, or 90-day mortality. Please clarify the observation period for consistency and
comparability with other studies.
Comment 4: I recommend reorganizing the supplementary table to present the data as a word
document rather than an Excel file, as this format may be easier for readers to interpret.
Comment 5: Please provide a comparison of baseline characteristics between the dialysis-
requiring AKI and non-dialysis-requiring AKI cohorts. If feasible, include this as a
supplementary table or a table in the main text for a more comprehensive understanding of the
study population.
Comment 6: The authors demonstrated that a lower Prognostic Nutritional Index (PNI) was
associated with cardiac surgery-associated AKI. Other studies have reported similar findings
regarding the usefulness of PNI or the Neutrophil-to-Lymphocyte Ratio (NLR). I suggest citing
the below 3 references and discussing this evidence in the discussion section, as PNI is a readily
available and cost-effective tool for AKI risk stratification. This could enhance the clinical
relevance of your findings.
ref 1: The neutrophil to lymphocyte ratio and serum albumin as predictors of acute kidney injury
after coronary artery bypass grafting. Sci Rep. 2022 Sep 14;12(1):15438.
ref 2:Prognostic nutritional index as a predictive marker for acute kidney injury in adult critical
illness population: a systematic review and diagnostic test accuracy meta-analysis. J Intensive
Care. 2024 Apr 26;12(1):16.
ref 3:Association of Preoperative Prognostic Nutritional Index with Risk of Postoperative Acute
Kidney Injury: A Meta-Analysis of Observational Studies. Nutrients. 2023 Jun 28;15(13):2929.
doi: 10.3390/nu15132929
Comment 7: Both gout and uric acid levels were included in the analysis, but only gout was
identified as a risk factor. Could the authors elaborate on this finding? Additionally, consider
discussing why uric acid levels were not significant as a risk factor despite their known
association with gout and kidney disease.
Comment 8: The definitions of underlying conditions such as CKD, chronic liver disease,
and others should be explicitly provided. This ensures clarity and reproducibility of the study
methodology.
Comment 9: For an AKI study, it is essential to include the definition of baseline creatinine.
Comment 10: The secondary outcome is reported as all-cause mortality. However, the results
section does not include an evaluation of the model's prediction accuracy for this outcome. Please
provide the relevant metrics | BMC | 12893_2025_2817_ReviewerReport_V1_R2.pdf | {
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"role": "user"
},
{
"content": "Title: Development and validation of a clinical prediction model for dialysis-requiring acute\nkidney injury following heart transplantation: a single-center study from China\nVersion: 1 Date: 20 Dec 2024\nReviewer's report:\n... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02817-9 | Reviewed - bmc_surgery | Title: Development and validation of a clinical prediction model for dialysis-requiring acute
kidney injury following heart transplantation: a single-center study from China
Version: 2 Date: 15 Jan 2025
Reviewer's report:
my comments have been responded appropriately | Title: Development and validation of a clinical prediction model for dialysis-requiring acute
kidney injury following heart transplantation: a single-center study from China
Version: 2 Date: 15 Jan 2025
Reviewer's report:
my comments have been responded appropriately | BMC | 12893_2025_2817_ReviewerReport_V2_R2.pdf | {
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"content": "Title: Development and validation of a clinical prediction model for dialysis-requiring acute\nkidney injury following heart transplantation: a single-center study from China\nVersion: 2 Date: 15 Jan 2025\nReviewer's report:\n... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02820-0 | Reviewed - bmc_surgery | Title: Clinical effect analysis of unilateral percutaneous vertebral cement distribution in the
repair of osteoporotic thoracolumbar vertebral compression fractures
Version: 1 Date: 23 Jun 2024
Reviewer's report:
Thank you for giving me the opportunity of reading your paper.
I believe your paper shows that compared to the poor dispersion group, patients in the good
dispersion group have a better short-term clinical response, and in addition, the good dispersion
group can significantly reduce the incidence of fracture and re-fracture rates of the entire injured
vertebral body, thus achieving better surgical outcomes, clinical effectiveness, and prognosis.
Would you please tell me your thought to my question? I am looking forward to seeing it.
1 As stated in the Limitation, is there truly a consensus to classify good or poor vertebral
distribution based solely on the cement spread in the coronal plane of the x-ray?
2 There is no mention of when surgical treatment was performed after the fracture occurred. Is
there any difference in the timing of the surgical procedure performed?
It is not clear in this paper whether the difference in intravertebral widening is technical, surgical
timing, or otherwise. Please specify the reason for the difference in cement distribution. | Title: Clinical effect analysis of unilateral percutaneous vertebral cement distribution in the
repair of osteoporotic thoracolumbar vertebral compression fractures
Version: 1 Date: 23 Jun 2024
Reviewer's report:
Thank you for giving me the opportunity of reading your paper.
I believe your paper shows that compared to the poor dispersion group, patients in the good
dispersion group have a better short-term clinical response, and in addition, the good dispersion
group can significantly reduce the incidence of fracture and re-fracture rates of the entire injured
vertebral body, thus achieving better surgical outcomes, clinical effectiveness, and prognosis.
Would you please tell me your thought to my question? I am looking forward to seeing it.
1 As stated in the Limitation, is there truly a consensus to classify good or poor vertebral
distribution based solely on the cement spread in the coronal plane of the x-ray?
2 There is no mention of when surgical treatment was performed after the fracture occurred. Is
there any difference in the timing of the surgical procedure performed?
It is not clear in this paper whether the difference in intravertebral widening is technical, surgical
timing, or otherwise. Please specify the reason for the difference in cement distribution. | BMC | 12893_2025_2820_ReviewerReport_V1_R1.pdf | {
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"content": "Title: Clinical effect analysis of unilateral percutaneous vertebral cement distribution in the\nrepair of osteoporotic thoracolumbar vertebral compression fractures\nVersion: 1 Date: 23 Jun 2024\nReviewer's report:\nThank you... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02820-0 | Reviewed - bmc_surgery | Title: Clinical effect analysis of unilateral percutaneous vertebral cement distribution in the
repair of osteoporotic thoracolumbar vertebral compression fractures
Version: 1 Date: 26 Nov 2024
Reviewer's report:
Vertebroplasty is a very effective surgical procedure for osteoporotic vertebral fractures. It is
widely used today. Increasing cases of osteoporosis due to the increase in the elderly population
cause these fractures to be seen more. The article is very meaningful in this respect. In addition,
its purpose is very well-designed. The short and medium term results are promising as expected.
It would be useful to see the long term results. My only criticism about the article is my concerns
about the good distribution of percutaneous injection performed unilaterally. | Title: Clinical effect analysis of unilateral percutaneous vertebral cement distribution in the
repair of osteoporotic thoracolumbar vertebral compression fractures
Version: 1 Date: 26 Nov 2024
Reviewer's report:
Vertebroplasty is a very effective surgical procedure for osteoporotic vertebral fractures. It is
widely used today. Increasing cases of osteoporosis due to the increase in the elderly population
cause these fractures to be seen more. The article is very meaningful in this respect. In addition,
its purpose is very well-designed. The short and medium term results are promising as expected.
It would be useful to see the long term results. My only criticism about the article is my concerns
about the good distribution of percutaneous injection performed unilaterally. | BMC | 12893_2025_2820_ReviewerReport_V1_R2.pdf | {
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"role": "user"
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"content": "Title: Clinical effect analysis of unilateral percutaneous vertebral cement distribution in the\nrepair of osteoporotic thoracolumbar vertebral compression fractures\nVersion: 1 Date: 26 Nov 2024\nReviewer's report:\nVertebrop... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02820-0 | Reviewed - bmc_surgery | Title: Clinical effect analysis of unilateral percutaneous vertebral cement distribution in the
repair of osteoporotic thoracolumbar vertebral compression fractures
Version: 2 Date: 07 Feb 2025
Reviewer's report:
I am pleased to review the paper entitled "Clinical effect analysis of unilateral percutaneous
vertebral cement distribution in the repair of osteoporotic thoracolumbar vertebral compression
fractures". This article is of great interest because it focuses on orthopedic-related clinical
scenarios that may affect the clinical practice of thoracolumbar fracture management. This study
is innovative and scientific nature.
Here is my secondary opinion on this article#
1.For the diffusion distribution of bone cement, the author only evaluated the coronal dispersion,
but did not mention the sagittal dispersion, whether the conclusions can be used by other
clinicians, and suggested to explain the reasons for not including the sagittal dispersion
distribution;
2.In the process of postoperative treatment, the author mentioned that "both groups of patients
were given zoledronic acid", without the improvement of bone metabolism examination,
whether it is advisable to directly give zoledronic acid, and whether the patients have received
bisphosphonate drugs in the past, and whether the above variables affect the presentation of the
conclusion;
3.What are the main causes of poor or uniform cement distribution: the surgical technique or the
type of fracture (including compression characteristics, time after injury, bone density, defect
of the cortical bone margin)?
4.(1) Does the fracture type affect the bone cement distribution?(2) Is the type of fracture (injury
mechanism, degree and type of vertebral injury) related to the prognosis under conservative
treatment? Before clarifying the above two issues, the logical relationship between the surgical
technique-cement distribution and prognosis should be carefully inferred. Avoid the emergence,
but there is a related relationship, but not a direct relationship, but a companion relationship.
5.Is the vertebral body height recovery rate in the unit of%?
6.In the statistical method, combined with the author's data presentation, the repeated
measurement variance analysis should be improved;
7.Figure 3 suggests that the author use the original image; | Title: Clinical effect analysis of unilateral percutaneous vertebral cement distribution in the
repair of osteoporotic thoracolumbar vertebral compression fractures
Version: 2 Date: 07 Feb 2025
Reviewer's report:
I am pleased to review the paper entitled "Clinical effect analysis of unilateral percutaneous
vertebral cement distribution in the repair of osteoporotic thoracolumbar vertebral compression
fractures". This article is of great interest because it focuses on orthopedic-related clinical
scenarios that may affect the clinical practice of thoracolumbar fracture management. This study
is innovative and scientific nature.
Here is my secondary opinion on this article#
1.For the diffusion distribution of bone cement, the author only evaluated the coronal dispersion,
but did not mention the sagittal dispersion, whether the conclusions can be used by other
clinicians, and suggested to explain the reasons for not including the sagittal dispersion
distribution;
2.In the process of postoperative treatment, the author mentioned that "both groups of patients
were given zoledronic acid", without the improvement of bone metabolism examination,
whether it is advisable to directly give zoledronic acid, and whether the patients have received
bisphosphonate drugs in the past, and whether the above variables affect the presentation of the
conclusion;
3.What are the main causes of poor or uniform cement distribution: the surgical technique or the
type of fracture (including compression characteristics, time after injury, bone density, defect
of the cortical bone margin)?
4.(1) Does the fracture type affect the bone cement distribution?(2) Is the type of fracture (injury
mechanism, degree and type of vertebral injury) related to the prognosis under conservative
treatment? Before clarifying the above two issues, the logical relationship between the surgical
technique-cement distribution and prognosis should be carefully inferred. Avoid the emergence,
but there is a related relationship, but not a direct relationship, but a companion relationship.
5.Is the vertebral body height recovery rate in the unit of%?
6.In the statistical method, combined with the author's data presentation, the repeated
measurement variance analysis should be improved;
7.Figure 3 suggests that the author use the original image; | BMC | 12893_2025_2820_ReviewerReport_V2_R4.pdf | {
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"role": "user"
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"content": "Title: Clinical effect analysis of unilateral percutaneous vertebral cement distribution in the\nrepair of osteoporotic thoracolumbar vertebral compression fractures\nVersion: 2 Date: 07 Feb 2025\nReviewer's report:\nI am plea... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02820-0 | Reviewed - bmc_surgery | Title: Clinical effect analysis of unilateral percutaneous vertebral cement distribution in the
repair of osteoporotic thoracolumbar vertebral compression fractures
Version: 2 Date: 08 Feb 2025
Reviewer's report:
This study aims to investigate the impact of bone cement distribution on the efficacy of
vertebral compression fracture repair, to provide effective preventive and therapeutic measures,
prevent postoperative vertebral re-fracture, and improve surgical outcomes.I think this is a very
interesting article, but the following points need to be clarified.
Is there a statistical difference in the recovery rate of vertebral height, vertebral local kyphosis
angle and preoperative comparison at 1 week between the two groups?
2.Abstract: The author mentioned that "there are statistical difference between the refracture
and overall fracture incidence of the two groups", and then "refracture" was described as no
statistical difference between the two groups;
3.The exclusion criteria should be more rigorous, such as the contents of serious basic diseases,
whether tumors and immune system diseases are excluded, the criteria for osteoporosis in the
inclusion criteria, and whether to compare or consider osteoporosis and patients with reduced
bone mass within the group? Is the expression of postoperative vitamin D medication during
postoperative treatment correct? Are there other self-administered drugs?
4.In the table, the results of the comparison between the two groups should be marked with
special symbols such as *, #, and marked with the P-value range.
5.Comments on the results: a distinction should be made between osteoporosis and bone loss,
because the follow-up period is only 12 months, and the long-term prognosis in the full text
should be modified, which is still an observation of short-term efficacy overall. | Title: Clinical effect analysis of unilateral percutaneous vertebral cement distribution in the
repair of osteoporotic thoracolumbar vertebral compression fractures
Version: 2 Date: 08 Feb 2025
Reviewer's report:
This study aims to investigate the impact of bone cement distribution on the efficacy of
vertebral compression fracture repair, to provide effective preventive and therapeutic measures,
prevent postoperative vertebral re-fracture, and improve surgical outcomes.I think this is a very
interesting article, but the following points need to be clarified.
Is there a statistical difference in the recovery rate of vertebral height, vertebral local kyphosis
angle and preoperative comparison at 1 week between the two groups?
2.Abstract: The author mentioned that "there are statistical difference between the refracture
and overall fracture incidence of the two groups", and then "refracture" was described as no
statistical difference between the two groups;
3.The exclusion criteria should be more rigorous, such as the contents of serious basic diseases,
whether tumors and immune system diseases are excluded, the criteria for osteoporosis in the
inclusion criteria, and whether to compare or consider osteoporosis and patients with reduced
bone mass within the group? Is the expression of postoperative vitamin D medication during
postoperative treatment correct? Are there other self-administered drugs?
4.In the table, the results of the comparison between the two groups should be marked with
special symbols such as *, #, and marked with the P-value range.
5.Comments on the results: a distinction should be made between osteoporosis and bone loss,
because the follow-up period is only 12 months, and the long-term prognosis in the full text
should be modified, which is still an observation of short-term efficacy overall. | BMC | 12893_2025_2820_ReviewerReport_V2_R3.pdf | {
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"role": "user"
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"content": "Title: Clinical effect analysis of unilateral percutaneous vertebral cement distribution in the\nrepair of osteoporotic thoracolumbar vertebral compression fractures\nVersion: 2 Date: 08 Feb 2025\nReviewer's report:\nThis stud... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02820-0 | Reviewed - bmc_surgery | Title: Clinical effect analysis of unilateral percutaneous vertebral cement distribution in the
repair of osteoporotic thoracolumbar vertebral compression fractures
Version: 4 Date: 15 Feb 2025
Reviewer's report:
Excellent! It is recommended to accept publication. | Title: Clinical effect analysis of unilateral percutaneous vertebral cement distribution in the
repair of osteoporotic thoracolumbar vertebral compression fractures
Version: 4 Date: 15 Feb 2025
Reviewer's report:
Excellent! It is recommended to accept publication. | BMC | 12893_2025_2820_ReviewerReport_V4_R3.pdf | {
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"role": "user"
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"content": "Title: Clinical effect analysis of unilateral percutaneous vertebral cement distribution in the\nrepair of osteoporotic thoracolumbar vertebral compression fractures\nVersion: 4 Date: 15 Feb 2025\nReviewer's report:\nExcellent... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02820-0 | Reviewed - bmc_surgery | Title: Clinical effect analysis of unilateral percutaneous vertebral cement distribution in the
repair of osteoporotic thoracolumbar vertebral compression fractures
Version: 4 Date: 15 Feb 2025
Reviewer's report:
good#Accept | Title: Clinical effect analysis of unilateral percutaneous vertebral cement distribution in the
repair of osteoporotic thoracolumbar vertebral compression fractures
Version: 4 Date: 15 Feb 2025
Reviewer's report:
good#Accept | BMC | 12893_2025_2820_ReviewerReport_V4_R4.pdf | {
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"content": "Title: Clinical effect analysis of unilateral percutaneous vertebral cement distribution in the\nrepair of osteoporotic thoracolumbar vertebral compression fractures\nVersion: 4 Date: 15 Feb 2025\nReviewer's report:\ngood#Acce... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02821-z | Reviewed - bmc_surgery | Title: Clinical Progression Following Acellular Dermal Matrix Use for Volume Replacement
after Breast-Conserving Surgery
Version: 3 Date: 29 Jul 2024
Reviewer: Badria Aljohani
Reviewer's report:
The manuscript titled "Clinical Progression Following Acellular Dermal Matrix Use for Volume
Replacement after Breast-Conserving Surgery" by JinAh Kwon et al. provides a retrospective
analysis of the use of acellular dermal matrix (ADM) in breast-conserving surgery (BCS) to
improve cosmetic outcomes. The study is valuable for its focus on quantifying ADM volume
retention and the associated complications, offering critical insights into the utility of ADM in
oncoplastic surgery.
Abstract
The abstract adequately summarizes the study's aims, methods, and key findings. However, it
can be enhanced by ;
Mentioning the percentage decrease in ADM volume and the exact rate of complications
observed.
The statistical significance (p-value) and its implications should be explicitly stated.
Discussing how the findings impact clinical decisions or patient outcomes would strengthen the
abstract.
Introduction;
The introduction effectively contextualizes the study within the field of breast surgery and ADM
use. However, it can be improved by:
Including a broader range of studies on ADM use in breast surgery and its alternatives would
provide a more comprehensive background.
Clearly articulating the gaps in current research that this study addresses, especially the lack of
quantitative data on ADM volume retention over time.
Methods
The methodology is well-described, but there are areas that require additional details:
The criteria for including patients need more detail, including any exclusion criteria and potential
biases introduced by the selection process.
A more thorough description of the CT-based volumetric analysis, including any validation
of the method and inter-observer reliability assessments, would enhance the robustness of the
findings.
Justify the choice of statistical tests used and discuss any adjustments made for potential
confounding factors, such as differences in patient demographics or treatment modalities (e.g.,
radiotherapy).
Results
The results section presents comprehensive data but could be further refined:
A deeper analysis of the complications, including a comparison with rates from other studies,
would provide context and highlight the safety profile of ADM use.
Including analyses based on different patient characteristics (e.g., age, tumor location, adjuvant
therapy) could provide more nuanced insights.
Clearly stating the clinical significance of the findings, beyond statistical significance, would
help readers understand the practical implications.
Discussion
The discussion provides a reasonable interpretation of the results but would benefit from:
A more detailed comparison with similar studies, especially regarding ADM volume retention
and cosmetic outcomes, would help situate the study's findings within the broader research
landscape.
Discussing specific clinical recommendations based on the findings, such as patient selection
criteria for ADM use, would be valuable for practitioners.
While the study's limitations are acknowledged, a more detailed discussion on potential biases,
the impact of the single-center design, and areas for future research (e.g., long-term outcomes)
would strengthen the manuscript.
Conclusion
The conclusion succinctly summarizes the study's findings but should:
Clearly state how the findings can influence clinical practice, particularly in terms of improving
cosmetic outcomes and patient satisfaction.
Propose specific areas for future studies, such as exploring alternative materials or techniques
for ADM placement and longer follow-up periods to assess long-term outcomes.
Tables
Table 1: Characteristics of Included Patients
Consider adding a footnote to clarify the method used for calculating specimen volume and
weight, as this might influence the interpretation of the data.
Ensure that the formatting is consistent, especially in how ranges are presented (e.g., consistently
using parentheses).
Table 2: Biopsy on Subsequent Follow-Up Examination
Consider specifying whether the imaging modalities used were consistent across all patients, or
if there were variations depending on the clinical scenario.
Adding a summary statistic, such as the percentage of patients with benign vs. malignant
findings, would provide a quick reference for readers.
General Recommendations for All Tables
Uniform Formatting:
Ensure that all tables use a consistent style, including font size, heading format, and the
presentation of numerical data.
Statistical Information:
Where applicable, include p-values or other statistical measures to indicate the significance of
differences or findings.
Footnotes and Abbreviations:
Always define abbreviations and include explanatory notes for any complex terms or
classifications used in the tables.
Consistency with Text:
Ensure that the data presented in the tables is consistent with the descriptions and interpretations
provided in the main text of the manuscript.
References
Some entries might lack complete information, such as issue numbers for journals. For instance:
Reference 3: "Kim SY, Ph D. Comparison of wound closure using ADM with primary wound
closure after BCS in breast cancer patients. J Breast Dis. 2022;10:12-7." It's unclear if "Ph D"
is part of the author name or a designation; it should be consistent with the rest of the author
list. Additionally, ensure that all elements like volume, issue, and page numbers are present and
correct.
Ensure that DOIs are included where available, as they provide a direct link to the sources.
Verify each reference against the original publication to ensure all details (authors, titles, journal
name, volume, issue, pages) are accurate. For instance:
Reference 10: "An J, Kwon H, Lim W, Moon BI, Paik NS. The comparison of breast
reconstruction using two types of acellular dermal matrix after breast-conserving surgery. J Clin
Med. 2021;10:3430." Ensure that the volume number and page range are accurate and that the
correct article title is used.
Ensure that all journal names are consistently abbreviated or written in full and are italicized if
required by the citation style.
For example, some references have "J Breast Cancer" while others use full titles. Choose one
format and apply it uniformly.
For references with multiple authors, list the first six followed by "et al." if there are more than
six authors, unless the journal's citation style requires listing all authors.
Overall Recommendations for Revision
Enhance the Abstract and Introduction: Include more specific details and context to better frame
the study's significance.
Clarify and Expand Methodological Details: Provide comprehensive information on patient
selection, ADM measurement techniques, and statistical analysis.
Provide Detailed Results and Discussion: Offer a more in-depth analysis of the results and their
implications, including a thorough comparison with existing literature and detailed discussion
of limitations.
Acknowledge Limitations and Suggest Future Research: Address potential biases and propose
directions for future studies.
Recommendation | Title: Clinical Progression Following Acellular Dermal Matrix Use for Volume Replacement
after Breast-Conserving Surgery
Version: 3 Date: 29 Jul 2024
Reviewer: Badria Aljohani
Reviewer's report:
The manuscript titled "Clinical Progression Following Acellular Dermal Matrix Use for Volume
Replacement after Breast-Conserving Surgery" by JinAh Kwon et al. provides a retrospective
analysis of the use of acellular dermal matrix (ADM) in breast-conserving surgery (BCS) to
improve cosmetic outcomes. The study is valuable for its focus on quantifying ADM volume
retention and the associated complications, offering critical insights into the utility of ADM in
oncoplastic surgery.
Abstract
The abstract adequately summarizes the study's aims, methods, and key findings. However, it
can be enhanced by ;
Mentioning the percentage decrease in ADM volume and the exact rate of complications
observed.
The statistical significance (p-value) and its implications should be explicitly stated.
Discussing how the findings impact clinical decisions or patient outcomes would strengthen the
abstract.
Introduction;
The introduction effectively contextualizes the study within the field of breast surgery and ADM
use. However, it can be improved by:
Including a broader range of studies on ADM use in breast surgery and its alternatives would
provide a more comprehensive background.
Clearly articulating the gaps in current research that this study addresses, especially the lack of
quantitative data on ADM volume retention over time.
Methods
The methodology is well-described, but there are areas that require additional details:
The criteria for including patients need more detail, including any exclusion criteria and potential
biases introduced by the selection process.
A more thorough description of the CT-based volumetric analysis, including any validation
of the method and inter-observer reliability assessments, would enhance the robustness of the
findings.
Justify the choice of statistical tests used and discuss any adjustments made for potential
confounding factors, such as differences in patient demographics or treatment modalities (e.g.,
radiotherapy).
Results
The results section presents comprehensive data but could be further refined:
A deeper analysis of the complications, including a comparison with rates from other studies,
would provide context and highlight the safety profile of ADM use.
Including analyses based on different patient characteristics (e.g., age, tumor location, adjuvant
therapy) could provide more nuanced insights.
Clearly stating the clinical significance of the findings, beyond statistical significance, would
help readers understand the practical implications.
Discussion
The discussion provides a reasonable interpretation of the results but would benefit from:
A more detailed comparison with similar studies, especially regarding ADM volume retention
and cosmetic outcomes, would help situate the study's findings within the broader research
landscape.
Discussing specific clinical recommendations based on the findings, such as patient selection
criteria for ADM use, would be valuable for practitioners.
While the study's limitations are acknowledged, a more detailed discussion on potential biases,
the impact of the single-center design, and areas for future research (e.g., long-term outcomes)
would strengthen the manuscript.
Conclusion
The conclusion succinctly summarizes the study's findings but should:
Clearly state how the findings can influence clinical practice, particularly in terms of improving
cosmetic outcomes and patient satisfaction.
Propose specific areas for future studies, such as exploring alternative materials or techniques
for ADM placement and longer follow-up periods to assess long-term outcomes.
Tables
Table 1: Characteristics of Included Patients
Consider adding a footnote to clarify the method used for calculating specimen volume and
weight, as this might influence the interpretation of the data.
Ensure that the formatting is consistent, especially in how ranges are presented (e.g., consistently
using parentheses).
Table 2: Biopsy on Subsequent Follow-Up Examination
Consider specifying whether the imaging modalities used were consistent across all patients, or
if there were variations depending on the clinical scenario.
Adding a summary statistic, such as the percentage of patients with benign vs. malignant
findings, would provide a quick reference for readers.
General Recommendations for All Tables
Uniform Formatting:
Ensure that all tables use a consistent style, including font size, heading format, and the
presentation of numerical data.
Statistical Information:
Where applicable, include p-values or other statistical measures to indicate the significance of
differences or findings.
Footnotes and Abbreviations:
Always define abbreviations and include explanatory notes for any complex terms or
classifications used in the tables.
Consistency with Text:
Ensure that the data presented in the tables is consistent with the descriptions and interpretations
provided in the main text of the manuscript.
References
Some entries might lack complete information, such as issue numbers for journals. For instance:
Reference 3: "Kim SY, Ph D. Comparison of wound closure using ADM with primary wound
closure after BCS in breast cancer patients. J Breast Dis. 2022;10:12-7." It's unclear if "Ph D"
is part of the author name or a designation; it should be consistent with the rest of the author
list. Additionally, ensure that all elements like volume, issue, and page numbers are present and
correct.
Ensure that DOIs are included where available, as they provide a direct link to the sources.
Verify each reference against the original publication to ensure all details (authors, titles, journal
name, volume, issue, pages) are accurate. For instance:
Reference 10: "An J, Kwon H, Lim W, Moon BI, Paik NS. The comparison of breast
reconstruction using two types of acellular dermal matrix after breast-conserving surgery. J Clin
Med. 2021;10:3430." Ensure that the volume number and page range are accurate and that the
correct article title is used.
Ensure that all journal names are consistently abbreviated or written in full and are italicized if
required by the citation style.
For example, some references have "J Breast Cancer" while others use full titles. Choose one
format and apply it uniformly.
For references with multiple authors, list the first six followed by "et al." if there are more than
six authors, unless the journal's citation style requires listing all authors.
Overall Recommendations for Revision
Enhance the Abstract and Introduction: Include more specific details and context to better frame
the study's significance.
Clarify and Expand Methodological Details: Provide comprehensive information on patient
selection, ADM measurement techniques, and statistical analysis.
Provide Detailed Results and Discussion: Offer a more in-depth analysis of the results and their
implications, including a thorough comparison with existing literature and detailed discussion
of limitations.
Acknowledge Limitations and Suggest Future Research: Address potential biases and propose
directions for future studies.
Recommendation | BMC | 12893_2025_2821_ReviewerReport_V3_R2.pdf | {
"criticism": 0,
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"praise": 7,
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"results_and_discussion": 14,
"suggestion_and_solution": 36,
"total": 52
} | {
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} | 2.307692 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Clinical Progression Following Acellular Dermal Matrix Use for Volume Replacement\nafter Breast-Conserving Surgery\nVersion: 3 Date: 29 Jul 2024\nReviewer: Badria Aljohani\nReviewer's report:\nThe manuscript titled \"C... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02821-z | Reviewed - bmc_surgery | Title: Clinical Progression Following Acellular Dermal Matrix Use for Volume Replacement
after Breast-Conserving Surgery
Version: 3 Date: 28 Sep 2024
Reviewer: Alberto Rancati
Reviewer's report:
Exciting report, Congratulations to the authors.
just two observations: integration of the ADM into the tissue and why volume change of the
ADM | Title: Clinical Progression Following Acellular Dermal Matrix Use for Volume Replacement
after Breast-Conserving Surgery
Version: 3 Date: 28 Sep 2024
Reviewer: Alberto Rancati
Reviewer's report:
Exciting report, Congratulations to the authors.
just two observations: integration of the ADM into the tissue and why volume change of the
ADM | BMC | 12893_2025_2821_ReviewerReport_V3_R5.pdf | {
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} | 1 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Clinical Progression Following Acellular Dermal Matrix Use for Volume Replacement\nafter Breast-Conserving Surgery\nVersion: 3 Date: 28 Sep 2024\nReviewer: Alberto Rancati\nReviewer's report:\nExciting report, Congratu... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02821-z | Reviewed - bmc_surgery | Title: Clinical Progression Following Acellular Dermal Matrix Use for Volume Replacement
after Breast-Conserving Surgery
Version: 4 Date: 18 Nov 2024
Reviewer: Hyukjai Shin
Reviewer's report:
After breast conservation surgery using sheet-shaped ADM, the degree of volume reduction after
radiation therapy was measured using CT, and this is a clinically important paper that presents
follow-up results on the impact of ADM on diagnosing local recurrence. It's worth it.
However, it requires some proofreading before it can be published.
"ADM was inserted after BCS for patients who were likely to develop a deformity of the breast
contour after BCS, according to the surgeon’s judgment. Regardless of tumor size and location,
patients who underwent insertion of a 5×7-cm sheet-type ADM were included in the study." The
above is a very subjective judgment. Objective indications are needed.
1. An explanation of the indications for applying artificial dermis after breast conservation
surgery is needed.
2. Please add photos of the artificial dermis insertion surgery and photos after the surgery.
Especially in cases of local recurrence, ultrasonography and MRI images of the lesion are very
helpful. | Title: Clinical Progression Following Acellular Dermal Matrix Use for Volume Replacement
after Breast-Conserving Surgery
Version: 4 Date: 18 Nov 2024
Reviewer: Hyukjai Shin
Reviewer's report:
After breast conservation surgery using sheet-shaped ADM, the degree of volume reduction after
radiation therapy was measured using CT, and this is a clinically important paper that presents
follow-up results on the impact of ADM on diagnosing local recurrence. It's worth it.
However, it requires some proofreading before it can be published.
"ADM was inserted after BCS for patients who were likely to develop a deformity of the breast
contour after BCS, according to the surgeon’s judgment. Regardless of tumor size and location,
patients who underwent insertion of a 5×7-cm sheet-type ADM were included in the study." The
above is a very subjective judgment. Objective indications are needed.
1. An explanation of the indications for applying artificial dermis after breast conservation
surgery is needed.
2. Please add photos of the artificial dermis insertion surgery and photos after the surgery.
Especially in cases of local recurrence, ultrasonography and MRI images of the lesion are very
helpful. | BMC | 12893_2025_2821_ReviewerReport_V4_R1.pdf | {
"criticism": 1,
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"materials_and_methods": 5,
"praise": 2,
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"results_and_discussion": 0,
"suggestion_and_solution": 4,
"total": 12
} | {
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} | 1.166667 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Clinical Progression Following Acellular Dermal Matrix Use for Volume Replacement\nafter Breast-Conserving Surgery\nVersion: 4 Date: 18 Nov 2024\nReviewer: Hyukjai Shin\nReviewer's report:\nAfter breast conservation su... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02815-x | Reviewed - bmc_surgery | Title: Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint injuries: a
systematic review
Version: 0 Date: 09 Jan 2025
Reviewer's report:
The article provides a review of a rare injury pattern. The authors have put significant effort
into searching the literature and presenting their findings. However, a major revision is needed
to enhance its scientific value and readability.
a. In the abstract, consider adopting a structured abstract format (e.g., Background, Objectives,
Methods, Results, Conclusions). This will improve clarity and highlight key takeaways for
readers.
b. In the introduction, avoid overemphasizing first authorship of such a review. Focus instead
on why the topic is clinically important. What gap does this study fill? What are the potential
implications of missed ACJ injuries on patient outcomes?
c. Add details about the review methodology, including PICO criteria, keywords used, and the
number of reviewers involved. A flowchart summarizing the search process would improve
transparency and reproducibility.
d. The anatomy section feels redundant for such a niche review. Instead, put relevant anatomical
details (e.g., coracoclavicular ligament and energy transfer) into the mechanism of injury section.
e. In the Mechanism of Injury section, the hypotheses are presented well but remain anecdotal.
Emphasize this limitation and suggest that future biomechanical studies are needed to validate
your concept.
f. Please, improve sentence flow and correct grammatical errors to make the pathoanatomy
section smoother and more professional. This will ensure its impact is not undermined.
g. Avoid repeating key points, such as the diagnostic challenges and the Allman and Rockwood
classification's limitations, as impairs your narrative and risks losing the reader’s focus.
h. The detailed discussion of each reviewed study’s treatment and prognosis could be condensed.
A summary table of treatment options and corresponding prognoses would be more digestible.
i. Highlight the short follow-up periods as a limitation and suggest a call for long-term research.
j. Strengthen the conclusion by suggesting specific clinical actions such as the importance of
reevaluating ACJ injuries after clavicle fixation and diagnostic red flags for combined injuries,
such as unusual displacement patterns or comorbidities. | Title: Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint injuries: a
systematic review
Version: 0 Date: 09 Jan 2025
Reviewer's report:
The article provides a review of a rare injury pattern. The authors have put significant effort
into searching the literature and presenting their findings. However, a major revision is needed
to enhance its scientific value and readability.
a. In the abstract, consider adopting a structured abstract format (e.g., Background, Objectives,
Methods, Results, Conclusions). This will improve clarity and highlight key takeaways for
readers.
b. In the introduction, avoid overemphasizing first authorship of such a review. Focus instead
on why the topic is clinically important. What gap does this study fill? What are the potential
implications of missed ACJ injuries on patient outcomes?
c. Add details about the review methodology, including PICO criteria, keywords used, and the
number of reviewers involved. A flowchart summarizing the search process would improve
transparency and reproducibility.
d. The anatomy section feels redundant for such a niche review. Instead, put relevant anatomical
details (e.g., coracoclavicular ligament and energy transfer) into the mechanism of injury section.
e. In the Mechanism of Injury section, the hypotheses are presented well but remain anecdotal.
Emphasize this limitation and suggest that future biomechanical studies are needed to validate
your concept.
f. Please, improve sentence flow and correct grammatical errors to make the pathoanatomy
section smoother and more professional. This will ensure its impact is not undermined.
g. Avoid repeating key points, such as the diagnostic challenges and the Allman and Rockwood
classification's limitations, as impairs your narrative and risks losing the reader’s focus.
h. The detailed discussion of each reviewed study’s treatment and prognosis could be condensed.
A summary table of treatment options and corresponding prognoses would be more digestible.
i. Highlight the short follow-up periods as a limitation and suggest a call for long-term research.
j. Strengthen the conclusion by suggesting specific clinical actions such as the importance of
reevaluating ACJ injuries after clavicle fixation and diagnostic red flags for combined injuries,
such as unusual displacement patterns or comorbidities. | BMC | 12893_2025_2815_ReviewerReport_V0_R1.pdf | {
"criticism": 2,
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"materials_and_methods": 5,
"praise": 2,
"presentation_and_reporting": 8,
"results_and_discussion": 4,
"suggestion_and_solution": 14,
"total": 26
} | {
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"results_and_discussion": 0.15384615384615385,
"suggestion_and_solution": 0.5384615384615384
} | 1.5 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint injuries: a\nsystematic review\nVersion: 0 Date: 09 Jan 2025\nReviewer's report:\nThe article provides a review of a rare injury pattern. ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02815-x | Reviewed - bmc_surgery | Title: Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint injuries: a
systematic review
Version: 0 Date: 10 Jan 2025
Reviewer: Mohammed Elmajee
Reviewer's report: | Title: Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint injuries: a
systematic review
Version: 0 Date: 10 Jan 2025
Reviewer: Mohammed Elmajee
Reviewer's report: | BMC | 12893_2025_2815_ReviewerReport_V0_R3.pdf | {
"criticism": 0,
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"total": 1
} | {
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} | 0 | 0 | [
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"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint injuries: a\nsystematic review\nVersion: 0 Date: 10 Jan 2025\nReviewer: Mohammed Elmajee\nReviewer's report:",
"role": "assistant"
}... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02815-x | Reviewed - bmc_surgery | Title: Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint injuries: a
systematic review
Version: 0 Date: 12 Jan 2025
Reviewer's report:
This study aims to raise awareness about midshaft clavicle fractures associated with ipsilateral
ACJ injuries and to provide insights into their diagnosis, mechanisms of injury, classification,
treatment options, and prognosis. The other studies in the literature are case reports or case series,
and being the first review on this topic makes this study valuable. First of all, congratulations
to the authors who contributed to this study. However, I have some criticisms about the text,
which I am listing below.
1) A total of 37 studies related to midshaft clavicle fractures with associated ipsilateral
ACJ injuries, for which the full text was accessed, were reviewed. Adding a general table
summarizing the number of cases reported in these studies, the characteristics of the cases, the
described trauma mechanisms, the injury classification, the treatment methods, and the clinical
outcomes would make the study more comprehensible.
2) The illustrations explaining the mechanism of injury are well-done. I believe adding
postoperative X-ray images of different treatment methods as figures would further enhance the
value of the study
3) The sentence, “There is no classification for such combined injuries of midshaft clavicles and
ipsilateral ACJs available.” under the “Classification” subheading is incorrect.
In the study referenced as number 22 (Bakir MS, Carbon R, Ekkernkamp A, Schulz-Drost
S. Monopolar and Bipolar Combination Injuries of the Clavicle: Retrospective Incidence
Analysis and Proposal of a New Classification System. J Clin Med 2021;10(24):5764. https://
doi.org/10.3390/jcm10245764), Bakir et al. described a new classification system. In the
"Classification of Clavicular Combination Injuries" they proposed, "midshaft clavicle fractures
associated with ipsilateral ACJ injuries" are classified as "type 1b monopolar and midshaft
injuries". This should also be mentioned in the relevant paragraph of the review. | Title: Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint injuries: a
systematic review
Version: 0 Date: 12 Jan 2025
Reviewer's report:
This study aims to raise awareness about midshaft clavicle fractures associated with ipsilateral
ACJ injuries and to provide insights into their diagnosis, mechanisms of injury, classification,
treatment options, and prognosis. The other studies in the literature are case reports or case series,
and being the first review on this topic makes this study valuable. First of all, congratulations
to the authors who contributed to this study. However, I have some criticisms about the text,
which I am listing below.
1) A total of 37 studies related to midshaft clavicle fractures with associated ipsilateral
ACJ injuries, for which the full text was accessed, were reviewed. Adding a general table
summarizing the number of cases reported in these studies, the characteristics of the cases, the
described trauma mechanisms, the injury classification, the treatment methods, and the clinical
outcomes would make the study more comprehensible.
2) The illustrations explaining the mechanism of injury are well-done. I believe adding
postoperative X-ray images of different treatment methods as figures would further enhance the
value of the study
3) The sentence, “There is no classification for such combined injuries of midshaft clavicles and
ipsilateral ACJs available.” under the “Classification” subheading is incorrect.
In the study referenced as number 22 (Bakir MS, Carbon R, Ekkernkamp A, Schulz-Drost
S. Monopolar and Bipolar Combination Injuries of the Clavicle: Retrospective Incidence
Analysis and Proposal of a New Classification System. J Clin Med 2021;10(24):5764. https://
doi.org/10.3390/jcm10245764), Bakir et al. described a new classification system. In the
"Classification of Clavicular Combination Injuries" they proposed, "midshaft clavicle fractures
associated with ipsilateral ACJ injuries" are classified as "type 1b monopolar and midshaft
injuries". This should also be mentioned in the relevant paragraph of the review. | BMC | 12893_2025_2815_ReviewerReport_V0_R4.pdf | {
"criticism": 2,
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"praise": 3,
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"results_and_discussion": 0,
"suggestion_and_solution": 3,
"total": 13
} | {
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"results_and_discussion": 0,
"suggestion_and_solution": 0.23076923076923078
} | 1.846154 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint injuries: a\nsystematic review\nVersion: 0 Date: 12 Jan 2025\nReviewer's report:\nThis study aims to raise awareness about midshaft clavicl... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02815-x | Reviewed - bmc_surgery | Title: Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint injuries: a
systematic review
Version: 1 Date: 22 Jan 2025
Reviewer's report:
The revision has adequately addressed previous concerns. The study is well-conducted and
informative. Well done. I recommend to accept. The paper is relevant and worth publishing
in BMC Surgery. | Title: Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint injuries: a
systematic review
Version: 1 Date: 22 Jan 2025
Reviewer's report:
The revision has adequately addressed previous concerns. The study is well-conducted and
informative. Well done. I recommend to accept. The paper is relevant and worth publishing
in BMC Surgery. | BMC | 12893_2025_2815_ReviewerReport_V1_R4.pdf | {
"criticism": 0,
"example": 0,
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"suggestion_and_solution": 2,
"total": 5
} | {
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"suggestion_and_solution": 0.4
} | 1.6 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint injuries: a\nsystematic review\nVersion: 1 Date: 22 Jan 2025\nReviewer's report:\nThe revision has adequately addressed previous concerns. ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02815-x | Reviewed - bmc_surgery | Title: Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint injuries: a
systematic review
Version: 1 Date: 27 Jan 2025
Reviewer's report:
This revision is a substantial improvement to the previous version. With a few more changes,
I believe the article may be publishable.
Specifically:
1. Abstract: The structured format is better. In the sentence "Moreover, there was no consensus
on the injury mechanism, classification, and treatment, and the prognosis following different
treatments had not been well summarized.: , I would use the present tense instead of the past
tense, currently used. Also on the methods section please elaborate more on what you did. On
the other hand, the results section could be condensed so that you meet the word limit.
2. Methods section: Please include the subheading "Methods". Please include a statistics section.
If no statistics was done, and a rather qualitative approach was used, elaborate on why the latter
method was chosen.
3. Results: You mention on the methods section that quality assessment was done; however I
cannot find the results of this assessment. Also, the pathoanatomy section, although educational,
makes the article too lengthy, it could be streamlined along with the mechanism of injury one. | Title: Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint injuries: a
systematic review
Version: 1 Date: 27 Jan 2025
Reviewer's report:
This revision is a substantial improvement to the previous version. With a few more changes,
I believe the article may be publishable.
Specifically:
1. Abstract: The structured format is better. In the sentence "Moreover, there was no consensus
on the injury mechanism, classification, and treatment, and the prognosis following different
treatments had not been well summarized.: , I would use the present tense instead of the past
tense, currently used. Also on the methods section please elaborate more on what you did. On
the other hand, the results section could be condensed so that you meet the word limit.
2. Methods section: Please include the subheading "Methods". Please include a statistics section.
If no statistics was done, and a rather qualitative approach was used, elaborate on why the latter
method was chosen.
3. Results: You mention on the methods section that quality assessment was done; however I
cannot find the results of this assessment. Also, the pathoanatomy section, although educational,
makes the article too lengthy, it could be streamlined along with the mechanism of injury one. | BMC | 12893_2025_2815_ReviewerReport_V1_R1.pdf | {
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"role": "user"
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"content": "Title: Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint injuries: a\nsystematic review\nVersion: 1 Date: 27 Jan 2025\nReviewer's report:\nThis revision is a substantial improvement to the previou... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02815-x | Reviewed - bmc_surgery | Title: Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint injuries: a
systematic review
Version: 1 Date: 31 Jan 2025
Reviewer: Mohammed Elmajee
Reviewer's report:
Thanks for revising your work, it is a slightly better version than the one before. | Title: Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint injuries: a
systematic review
Version: 1 Date: 31 Jan 2025
Reviewer: Mohammed Elmajee
Reviewer's report:
Thanks for revising your work, it is a slightly better version than the one before. | BMC | 12893_2025_2815_ReviewerReport_V1_R3.pdf | {
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"role": "user"
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"content": "Title: Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint injuries: a\nsystematic review\nVersion: 1 Date: 31 Jan 2025\nReviewer: Mohammed Elmajee\nReviewer's report:\nThanks for revising your wor... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02822-y | Reviewed - bmc_surgery | Title: Neutrophil Percentage-to-Albumin Ratio as a Predictor of Conservative Treatment Failure
in Acute Cholecystitis: A Retrospective Cohort Study
Version: 0 Date: 02 Jan 2025
Reviewer: Fabio Cesare Campanile
Reviewer's report:
This case-control study explores the potential role of the Neutrophil Percentage-to-Albumin
Ratio (NPAR) in decision-making for acute cholecystitis. While the study presents an intriguing
hypothesis, concerns arise regarding the composition of the study population and the role of
conservative treatment in their series.
Both major guidelines on acute cholecystitis, the Tokyo and the WSES guidelines (the
authors only reference the former in their introduction), advocate for early laparoscopic
cholecystectomy as the first-line treatment for the disease. The WSES guidelines are the
most recent and recommend conservative therapy only for patients who either refuse surgery
or are deemed unsuitable candidates for it. This includes high-risk patients, for whom
laparoscopic cholecystectomy remains the first-line treatment. The 2018 Tokyo guidelines
consider conservative treatment for high-risk Grade I and II cases, with the goal of risk reduction.
Patients benefiting from conservative treatment may eventually undergo surgery. However, if
non-operative treatment fails and risks do not improve, both guidelines recommend alternative
therapies rather than surgery, as a risk for cholecystectomy is even worse than at the beginning.
It is critical to distinguish between “conservative treatment” and “initial medical treatment” as
outlined in the Tokyo guidelines. The latter is a temporary measure initiated during surgical
indications and severity assessment, but the guidelines' flowcharts can be confusing.
The study by Yodying et al. lacks key data on its patient series and appears to have applied
conservative treatment more liberally than current guidelines suggest. This may have led to
the use of it as a first line in several cases, with surgery being performed after the condition
deteriorated rather than improved, which could significantly influence its findings.
1. For their study, Yodying et al. selected a group of patients admitted with a primary
diagnosis of acute cholecystitis based on the Tokyo Guidelines 2018 criteria and initially
managed conservatively. However, the methodology for assigning patients to immediate
surgery versus conservative treatment requires clarification. Out of 980 patients diagnosed with
acute cholecystitis, only 390 underwent immediate surgery. In clinical practice, most acute
cholecystitis cases should undergo immediate surgery, with conservative management reserved
for a minority. If the Tokyo criteria were used to select patients for conservative treatment,
the authors should provide data on Charlson Comorbidity Index (CCI) and ASA-PS scores. If
the stricter WSES criteria were employed, this should also be stated explicitly. Otherwise, the
selection criteria need clarification.
3. Additional details regarding the outcomes of conservative treatment failures are also
necessary. Specifically, what treatment was administered after failure? How many patients
underwent surgery or percutaneous drainage?
4. The process for assessing severity warrants elaboration. While patients were stratified using
the Tokyo grading system, the authors note in the discussion that C-reactive protein (CRP) was
not included in standard admission labs, potentially leading to misclassification of Grade II
cases.
5. Figure 1 (Patient Flow Diagram) needs some explanation. The diagram does not show any
severe cholecystitis. Still, it should include the severe (Grade III) cholecystitis excluded because
they needed immediate treatment, as stated at the end of the patient characteristics paragraph.
Also, the diagram does not report any cholecystostomy.
6. Additionally, the criteria for defining conservative treatment failure are vague. The Methods
section’s definition of “worsening of symptoms after 48-72 hours” is generic and lacks
specificity. What symptoms were monitored, and what thresholds were used to determine
failure?
7. Table 4 highlights a notable issue: in 3 cases, conservative treatment was interrupted within
the first 24 hours, and in 80 cases, within the subsequent 24 hours. Thus, 77.6% of the
series experienced treatment interruption before the stated 48-72-hour limit. This discrepancy
introduces a significant confounding factor, as such a brief interval might reflect changes in
therapeutic strategy unrelated to actual treatment failure, thereby introducing bias.
In conclusion, while the study raises an essential question about NPAR’s role in acute
cholecystitis management, the lack of clarity and potential biases in patient selection and
treatment protocols necessitate further investigation and refinement of their methodology. | Title: Neutrophil Percentage-to-Albumin Ratio as a Predictor of Conservative Treatment Failure
in Acute Cholecystitis: A Retrospective Cohort Study
Version: 0 Date: 02 Jan 2025
Reviewer: Fabio Cesare Campanile
Reviewer's report:
This case-control study explores the potential role of the Neutrophil Percentage-to-Albumin
Ratio (NPAR) in decision-making for acute cholecystitis. While the study presents an intriguing
hypothesis, concerns arise regarding the composition of the study population and the role of
conservative treatment in their series.
Both major guidelines on acute cholecystitis, the Tokyo and the WSES guidelines (the
authors only reference the former in their introduction), advocate for early laparoscopic
cholecystectomy as the first-line treatment for the disease. The WSES guidelines are the
most recent and recommend conservative therapy only for patients who either refuse surgery
or are deemed unsuitable candidates for it. This includes high-risk patients, for whom
laparoscopic cholecystectomy remains the first-line treatment. The 2018 Tokyo guidelines
consider conservative treatment for high-risk Grade I and II cases, with the goal of risk reduction.
Patients benefiting from conservative treatment may eventually undergo surgery. However, if
non-operative treatment fails and risks do not improve, both guidelines recommend alternative
therapies rather than surgery, as a risk for cholecystectomy is even worse than at the beginning.
It is critical to distinguish between “conservative treatment” and “initial medical treatment” as
outlined in the Tokyo guidelines. The latter is a temporary measure initiated during surgical
indications and severity assessment, but the guidelines' flowcharts can be confusing.
The study by Yodying et al. lacks key data on its patient series and appears to have applied
conservative treatment more liberally than current guidelines suggest. This may have led to
the use of it as a first line in several cases, with surgery being performed after the condition
deteriorated rather than improved, which could significantly influence its findings.
1. For their study, Yodying et al. selected a group of patients admitted with a primary
diagnosis of acute cholecystitis based on the Tokyo Guidelines 2018 criteria and initially
managed conservatively. However, the methodology for assigning patients to immediate
surgery versus conservative treatment requires clarification. Out of 980 patients diagnosed with
acute cholecystitis, only 390 underwent immediate surgery. In clinical practice, most acute
cholecystitis cases should undergo immediate surgery, with conservative management reserved
for a minority. If the Tokyo criteria were used to select patients for conservative treatment,
the authors should provide data on Charlson Comorbidity Index (CCI) and ASA-PS scores. If
the stricter WSES criteria were employed, this should also be stated explicitly. Otherwise, the
selection criteria need clarification.
3. Additional details regarding the outcomes of conservative treatment failures are also
necessary. Specifically, what treatment was administered after failure? How many patients
underwent surgery or percutaneous drainage?
4. The process for assessing severity warrants elaboration. While patients were stratified using
the Tokyo grading system, the authors note in the discussion that C-reactive protein (CRP) was
not included in standard admission labs, potentially leading to misclassification of Grade II
cases.
5. Figure 1 (Patient Flow Diagram) needs some explanation. The diagram does not show any
severe cholecystitis. Still, it should include the severe (Grade III) cholecystitis excluded because
they needed immediate treatment, as stated at the end of the patient characteristics paragraph.
Also, the diagram does not report any cholecystostomy.
6. Additionally, the criteria for defining conservative treatment failure are vague. The Methods
section’s definition of “worsening of symptoms after 48-72 hours” is generic and lacks
specificity. What symptoms were monitored, and what thresholds were used to determine
failure?
7. Table 4 highlights a notable issue: in 3 cases, conservative treatment was interrupted within
the first 24 hours, and in 80 cases, within the subsequent 24 hours. Thus, 77.6% of the
series experienced treatment interruption before the stated 48-72-hour limit. This discrepancy
introduces a significant confounding factor, as such a brief interval might reflect changes in
therapeutic strategy unrelated to actual treatment failure, thereby introducing bias.
In conclusion, while the study raises an essential question about NPAR’s role in acute
cholecystitis management, the lack of clarity and potential biases in patient selection and
treatment protocols necessitate further investigation and refinement of their methodology. | BMC | 12893_2025_2822_ReviewerReport_V0_R1.pdf | {
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"content": "Title: Neutrophil Percentage-to-Albumin Ratio as a Predictor of Conservative Treatment Failure\nin Acute Cholecystitis: A Retrospective Cohort Study\nVersion: 0 Date: 02 Jan 2025\nReviewer: Fabio Cesare Campanile\nReviewer's ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02822-y | Reviewed - bmc_surgery | Title: Neutrophil Percentage-to-Albumin Ratio as a Predictor of Conservative Treatment Failure
in Acute Cholecystitis: A Retrospective Cohort Study
Version: 0 Date: 11 Jan 2025
Reviewer: Ana González-Castillo
Reviewer's report:
Congratulations on your work and contribution to science with new information that may be
very valid in the context of cholecystitis, a very prevalent disease.
My first question is about the clinical relevance and real usefulness, because it is not possible
to request albumin in all emergency departments to perform the calculation. And then, to apply
this calculation, there is a need to make it easy and facilitate calculators.
In conclusion, while NPAR holds promise, its real-world application will depend on how
practical it is to integrate into routine clinical workflows.
Regarding the methods, you mention that continuous variables were presented as mean ±
standard deviation or median with interquartile range, and categorical variables as frequencies
and percentages. Could you please specify which test was used to assess the normal distribution,
and which statistical test was applied for comparing these variables to obtain the p-value?
We will be waiting for your prospective validation of NPAR. | Title: Neutrophil Percentage-to-Albumin Ratio as a Predictor of Conservative Treatment Failure
in Acute Cholecystitis: A Retrospective Cohort Study
Version: 0 Date: 11 Jan 2025
Reviewer: Ana González-Castillo
Reviewer's report:
Congratulations on your work and contribution to science with new information that may be
very valid in the context of cholecystitis, a very prevalent disease.
My first question is about the clinical relevance and real usefulness, because it is not possible
to request albumin in all emergency departments to perform the calculation. And then, to apply
this calculation, there is a need to make it easy and facilitate calculators.
In conclusion, while NPAR holds promise, its real-world application will depend on how
practical it is to integrate into routine clinical workflows.
Regarding the methods, you mention that continuous variables were presented as mean ±
standard deviation or median with interquartile range, and categorical variables as frequencies
and percentages. Could you please specify which test was used to assess the normal distribution,
and which statistical test was applied for comparing these variables to obtain the p-value?
We will be waiting for your prospective validation of NPAR. | BMC | 12893_2025_2822_ReviewerReport_V0_R2.pdf | {
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"content": "Title: Neutrophil Percentage-to-Albumin Ratio as a Predictor of Conservative Treatment Failure\nin Acute Cholecystitis: A Retrospective Cohort Study\nVersion: 0 Date: 11 Jan 2025\nReviewer: Ana González-Castillo\nReviewer's r... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02802-2 | Reviewed - bmc_surgery | Title: Axillary lymph node metastasis in breast cancer: from historical axillary surgery to
updated advances in the preoperative diagnosis and axillary management
Version: 0 Date: 03 Dec 2024
Reviewer: Julie Wecsler
Reviewer's report: | Title: Axillary lymph node metastasis in breast cancer: from historical axillary surgery to
updated advances in the preoperative diagnosis and axillary management
Version: 0 Date: 03 Dec 2024
Reviewer: Julie Wecsler
Reviewer's report: | BMC | 12893_2025_2802_ReviewerReport_V0_R2.pdf | {
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"role": "user"
},
{
"content": "Title: Axillary lymph node metastasis in breast cancer: from historical axillary surgery to\nupdated advances in the preoperative diagnosis and axillary management\nVersion: 0 Date: 03 Dec 2024\nReviewer: Julie Wecsler\nRevie... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02802-2 | Reviewed - bmc_surgery | Title: Axillary lymph node metastasis in breast cancer: from historical axillary surgery to
updated advances in the preoperative diagnosis and axillary management
Version: 0 Date: 08 Dec 2024
Reviewer: Richard K. Orr
Reviewer's report:
I congratulate the authors for providing an excellent summary of the available literature
regarding staging of the axilla in breast cancer patients and future prospects for machine learning
and prediction models. The authors clearly show that there has been a major evolution in axillary
surgery over the last several decades. Based on Halstedian theories of cancer spread a complete
axillary dissection was initially proposed as a means of improving cure rates and a meta-
analysis of several early randomized controlled studies did show a small survival advantage
to axillary dissection. (The impact of prophylactic axillary node dissection on breast cancer
survival--a Bayesian meta-analysis. Orr RK. Ann Surg Oncol. 1999 Jan-Feb;6(1):109-16). Since
these studies were published, breast cancer and its treatment have changed radically. Originally
patients presented with palpable, often large tumors, now mammography and education have
enabled diagnosis at an early stage, and the majority of women now have node negative
breast cancer. Furthermore, chemotherapy was in its infancy when these randomized trials
were accruing, and thus, those studies have no validity in the current era of smaller tumors
and chemotherapy. At the present time, therefore there is no evidence that axillary dissection
improves survival.
But axillary dissection remains relevant for prognostic and treatment stratification. Complete
axillary dissection continued to be in vogue until sentinel node biopsy was developed, enabling
a good (but not perfect) assessment of nodal status with much less morbidity. However, it is
inconvenient for patients and a smaller number suffer lymphedema or chronic axillary numbness
or pain. The authors site studies that show sentinel node biopsy may be eliminated for small
breast cancers and negative imaging and physical examination.
The next step in evolution is to eliminate axillary staging in patients with an excellent clinical
response to neoadjuvant chemotherapy, as a significant number of women will have complete
clinical response and fail to benefit from the additional surgery.
As the authors show, our existing modalities (US, MRI and PET/CT) are not sensitive enough
to detect all patients who will have positive nodes. They suggest that the addition of machine
learning and clinical prediction models may be useful tools in our goal to decrease morbidity
without decreasing survival rates. I agree completely with the authors that combining the
various modalities will allow more precise application of axillary surgery for staging. I see a
time, not too distant from now, that axillary surgery may be reserved for a small group of patients
that require it for removal of recalcitrant nodal disease and will not be needed for staging.
I have only one suggestion for the authors. I am not sure if the readers will be conversant with
the terms radiomics and CNN and I would recommend expanding that section a bit more to
make those techniques more accessible to clinicians. | Title: Axillary lymph node metastasis in breast cancer: from historical axillary surgery to
updated advances in the preoperative diagnosis and axillary management
Version: 0 Date: 08 Dec 2024
Reviewer: Richard K. Orr
Reviewer's report:
I congratulate the authors for providing an excellent summary of the available literature
regarding staging of the axilla in breast cancer patients and future prospects for machine learning
and prediction models. The authors clearly show that there has been a major evolution in axillary
surgery over the last several decades. Based on Halstedian theories of cancer spread a complete
axillary dissection was initially proposed as a means of improving cure rates and a meta-
analysis of several early randomized controlled studies did show a small survival advantage
to axillary dissection. (The impact of prophylactic axillary node dissection on breast cancer
survival--a Bayesian meta-analysis. Orr RK. Ann Surg Oncol. 1999 Jan-Feb;6(1):109-16). Since
these studies were published, breast cancer and its treatment have changed radically. Originally
patients presented with palpable, often large tumors, now mammography and education have
enabled diagnosis at an early stage, and the majority of women now have node negative
breast cancer. Furthermore, chemotherapy was in its infancy when these randomized trials
were accruing, and thus, those studies have no validity in the current era of smaller tumors
and chemotherapy. At the present time, therefore there is no evidence that axillary dissection
improves survival.
But axillary dissection remains relevant for prognostic and treatment stratification. Complete
axillary dissection continued to be in vogue until sentinel node biopsy was developed, enabling
a good (but not perfect) assessment of nodal status with much less morbidity. However, it is
inconvenient for patients and a smaller number suffer lymphedema or chronic axillary numbness
or pain. The authors site studies that show sentinel node biopsy may be eliminated for small
breast cancers and negative imaging and physical examination.
The next step in evolution is to eliminate axillary staging in patients with an excellent clinical
response to neoadjuvant chemotherapy, as a significant number of women will have complete
clinical response and fail to benefit from the additional surgery.
As the authors show, our existing modalities (US, MRI and PET/CT) are not sensitive enough
to detect all patients who will have positive nodes. They suggest that the addition of machine
learning and clinical prediction models may be useful tools in our goal to decrease morbidity
without decreasing survival rates. I agree completely with the authors that combining the
various modalities will allow more precise application of axillary surgery for staging. I see a
time, not too distant from now, that axillary surgery may be reserved for a small group of patients
that require it for removal of recalcitrant nodal disease and will not be needed for staging.
I have only one suggestion for the authors. I am not sure if the readers will be conversant with
the terms radiomics and CNN and I would recommend expanding that section a bit more to
make those techniques more accessible to clinicians. | BMC | 12893_2025_2802_ReviewerReport_V0_R1.pdf | {
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"role": "user"
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{
"content": "Title: Axillary lymph node metastasis in breast cancer: from historical axillary surgery to\nupdated advances in the preoperative diagnosis and axillary management\nVersion: 0 Date: 08 Dec 2024\nReviewer: Richard K. Orr\nRevi... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02802-2 | Reviewed - bmc_surgery | Title: Axillary lymph node metastasis in breast cancer: from historical axillary surgery to
updated advances in the preoperative diagnosis and axillary management
Version: 1 Date: 17 Jan 2025
Reviewer's report:
I like the comprehensive analysis of the history of axillary surgery in breast cancer.
I think the chart with all the studies was a great addition to understand the evolution.
No edits. | Title: Axillary lymph node metastasis in breast cancer: from historical axillary surgery to
updated advances in the preoperative diagnosis and axillary management
Version: 1 Date: 17 Jan 2025
Reviewer's report:
I like the comprehensive analysis of the history of axillary surgery in breast cancer.
I think the chart with all the studies was a great addition to understand the evolution.
No edits. | BMC | 12893_2025_2802_ReviewerReport_V1_R6.pdf | {
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"role": "user"
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"content": "Title: Axillary lymph node metastasis in breast cancer: from historical axillary surgery to\nupdated advances in the preoperative diagnosis and axillary management\nVersion: 1 Date: 17 Jan 2025\nReviewer's report:\nI like the ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02802-2 | Reviewed - bmc_surgery | Title: Axillary lymph node metastasis in breast cancer: from historical axillary surgery to
updated advances in the preoperative diagnosis and axillary management
Version: 1 Date: 20 Jan 2025
Reviewer's report:
Thank you for inviting me to review the paper. Wu et al. summarize the axillary management
for patients with breast cancer, including an imaging-based approach for axillary lymph nodes, a
clinical prediction model, and the history of axillary surgery and local management. The contents
are well-written and informative.
However, the author did not mention several famous trials related to axillary management in
patients with breast cancer. I have some comments, as follows.
On page 2, lines 41-43, the author states, “For patients with initially clinically node-
positive (cN1/2) breast cancer who become clinically node-negative (cN0) after neoadjuvant
chemotherapy (NAC), ALND can be safely omitted.” This sentence appears to be misleading to
readers as it can be considered safe only when some requirements ( more than 2 SLND removed,
and so on) are met.
ACOSOG Z0011 trial is mentioned in the “SLNB for cN0” section in Fig.2, however, this trial
should be included in the “SLNB±RT for pN+” section.
It would be nice to mention the other famous studies like the SENTINA trial and SN FNAC
study for SLNB for cN1/2 patients undergoing NAC in Table1 and Fig.2.
It would be nice to mention the other famous studies like the SENOMAC study for the omission
of SLNB in Table1 and Fig.2.
On page 16, lines 347-359, the author explains the TAD approach. The TAD approach is used
in patients after NAC because this approach reduces FNR after NAC.
I would suggest adding this point of view in these sections because the author’s statement can
be misleading. The benefit of TAD has been shown primarily in post-NAC patients, and Fig. 2
would need to be modified accordingly. | Title: Axillary lymph node metastasis in breast cancer: from historical axillary surgery to
updated advances in the preoperative diagnosis and axillary management
Version: 1 Date: 20 Jan 2025
Reviewer's report:
Thank you for inviting me to review the paper. Wu et al. summarize the axillary management
for patients with breast cancer, including an imaging-based approach for axillary lymph nodes, a
clinical prediction model, and the history of axillary surgery and local management. The contents
are well-written and informative.
However, the author did not mention several famous trials related to axillary management in
patients with breast cancer. I have some comments, as follows.
On page 2, lines 41-43, the author states, “For patients with initially clinically node-
positive (cN1/2) breast cancer who become clinically node-negative (cN0) after neoadjuvant
chemotherapy (NAC), ALND can be safely omitted.” This sentence appears to be misleading to
readers as it can be considered safe only when some requirements ( more than 2 SLND removed,
and so on) are met.
ACOSOG Z0011 trial is mentioned in the “SLNB for cN0” section in Fig.2, however, this trial
should be included in the “SLNB±RT for pN+” section.
It would be nice to mention the other famous studies like the SENTINA trial and SN FNAC
study for SLNB for cN1/2 patients undergoing NAC in Table1 and Fig.2.
It would be nice to mention the other famous studies like the SENOMAC study for the omission
of SLNB in Table1 and Fig.2.
On page 16, lines 347-359, the author explains the TAD approach. The TAD approach is used
in patients after NAC because this approach reduces FNR after NAC.
I would suggest adding this point of view in these sections because the author’s statement can
be misleading. The benefit of TAD has been shown primarily in post-NAC patients, and Fig. 2
would need to be modified accordingly. | BMC | 12893_2025_2802_ReviewerReport_V1_R8.pdf | {
"criticism": 3,
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"suggestion_and_solution": 6,
"total": 15
} | {
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"results_and_discussion": 0,
"suggestion_and_solution": 0.4
} | 1.933333 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Axillary lymph node metastasis in breast cancer: from historical axillary surgery to\nupdated advances in the preoperative diagnosis and axillary management\nVersion: 1 Date: 20 Jan 2025\nReviewer's report:\nThank you f... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02804-0 | Reviewed - bmc_surgery | Title: The Impact of Sleeve Gastrectomy on Pulmonary Function Tests and Physical Activity
One-year After Surgery
Version: 2 Date: 28 Dec 2024
Reviewer: Mohamed Hany
Reviewer's report:
Dear Authors, please address the following points below
-The discussion on how obesity alters respiratory function could benefit from more specific
details. For instance, while the introduction mentions changes in lung capacity, forced expiratory
volume and forced vital capacity in obese individuals, it would be helpful to mention whether
these changes are due to mechanical restrictions, inflammatory processes, or both. Additionally,
a more direct connection between these changes and the potential benefits of bariatric surgery
(SG) could strengthen the argument for the study's relevance.
-The mention of LBM loss due to bariatric surgery is important, but it feels somewhat abrupt. A
more in-depth discussion of the potential risks associated with LBM loss (e.g., muscle weakness,
functional decline) could help frame the need to evaluate changes in physical activity post-
surgery. Also, while the study acknowledges that LBM loss can negatively impact physical
function and quality of life, it would be beneficial to include a brief explanation of the
mechanisms by which bariatric surgery might influence LBM (e.g., changes in metabolic rate,
and hormonal fluctuations).
-The introduction emphasizes respiratory function but provides less context on the effects of
SG on physical activity (PA). More references to studies on how bariatric surgery affects PA
or functional capacity in the long term would be beneficial. Specifically, how does weight loss
contribute to improvements in PA and functional capacity, and how might this relate to the
preservation of lean body mass?
-The explanation of the respiratory muscle strength assessment using the Powerbreathe® digital
mouth pressure meter is clear. However, a bit more detail on the methodology, such as the
number of measurements taken and how consistency was ensured, would be useful. Was the
highest value taken for each patient, or was the average of multiple attempts used?
-Similarly, a brief mention of whether participants were asked to refrain from certain activities
(e.g., strenuous exercise) before assessments would add transparency to the measurement
protocols.
-The conversion of weekly activity into MET minutes based on the GPAQ guidelines is an
effective approach to quantifying physical activity. However, it would be helpful to explain the
rationale for categorizing participants into three groups based on MET minutes per week and
how this classification impacts the interpretation of PA changes. Are these groups based on the
existing literature, or is this a novel categorization method for this study?
-The increase in 6MWT distance (53.71 ± 75.17 meters, p < 0.001) is significant and relevant;
however, a bit more context on the clinical relevance of this change would be helpful. Is
an increase of approximately 54 meters a meaningful improvement in functional capacity for
patients with obesity, or would a larger change be expected to have a more substantial impact
on physical function?
-While the changes in fat mass and lean body mass are reported, the clinical significance of the
loss in lean body mass (7.26 ± 4.09 kg) could be further explored. How does this loss in LBM
relate to changes in physical function, particularly concerning 6MWT and PA? Does the loss of
lean mass raise concerns about muscle preservation in the postoperative period? These questions
might warrant brief discussion.
-While the study found a reduction in the FEV1/FVC ratio, this change was not statistically
significant. However, the discussion does not provide much insight into the clinical significance
(or lack thereof) of this finding.
-It would be helpful to briefly explain why a reduction in the FEV1/FVC ratio might be seen
after surgery, and whether this represents a clinically meaningful change or just a statistical
fluctuation. For example, a slight decrease in the FEV1/FVC ratio could indicate a small change
in airflow or lung mechanics, but the clinical relevance of this change could be questioned,
particularly given the lack of statistical significance.
-While the increase in MIP (7.24 cm H2O) is statistically significant, the discussion could benefit
from further elaboration on what this means clinically. Is this increase in MIP sufficient to
significantly enhance the respiratory capacity of the patient? Is it enough to reverse the muscle
weakness typically seen in individuals with obesity?
-While the discussion mentions that physical activity improvements are associated with
enhanced functional capacity (6MWT), it could further address the lack of correlation between
changes in physical activity (MET-minutes) and weight loss (TWL, EWL). This is a central
finding of the study, and a more detailed exploration of why this correlation was not observed
could provide useful insights | Title: The Impact of Sleeve Gastrectomy on Pulmonary Function Tests and Physical Activity
One-year After Surgery
Version: 2 Date: 28 Dec 2024
Reviewer: Mohamed Hany
Reviewer's report:
Dear Authors, please address the following points below
-The discussion on how obesity alters respiratory function could benefit from more specific
details. For instance, while the introduction mentions changes in lung capacity, forced expiratory
volume and forced vital capacity in obese individuals, it would be helpful to mention whether
these changes are due to mechanical restrictions, inflammatory processes, or both. Additionally,
a more direct connection between these changes and the potential benefits of bariatric surgery
(SG) could strengthen the argument for the study's relevance.
-The mention of LBM loss due to bariatric surgery is important, but it feels somewhat abrupt. A
more in-depth discussion of the potential risks associated with LBM loss (e.g., muscle weakness,
functional decline) could help frame the need to evaluate changes in physical activity post-
surgery. Also, while the study acknowledges that LBM loss can negatively impact physical
function and quality of life, it would be beneficial to include a brief explanation of the
mechanisms by which bariatric surgery might influence LBM (e.g., changes in metabolic rate,
and hormonal fluctuations).
-The introduction emphasizes respiratory function but provides less context on the effects of
SG on physical activity (PA). More references to studies on how bariatric surgery affects PA
or functional capacity in the long term would be beneficial. Specifically, how does weight loss
contribute to improvements in PA and functional capacity, and how might this relate to the
preservation of lean body mass?
-The explanation of the respiratory muscle strength assessment using the Powerbreathe® digital
mouth pressure meter is clear. However, a bit more detail on the methodology, such as the
number of measurements taken and how consistency was ensured, would be useful. Was the
highest value taken for each patient, or was the average of multiple attempts used?
-Similarly, a brief mention of whether participants were asked to refrain from certain activities
(e.g., strenuous exercise) before assessments would add transparency to the measurement
protocols.
-The conversion of weekly activity into MET minutes based on the GPAQ guidelines is an
effective approach to quantifying physical activity. However, it would be helpful to explain the
rationale for categorizing participants into three groups based on MET minutes per week and
how this classification impacts the interpretation of PA changes. Are these groups based on the
existing literature, or is this a novel categorization method for this study?
-The increase in 6MWT distance (53.71 ± 75.17 meters, p < 0.001) is significant and relevant;
however, a bit more context on the clinical relevance of this change would be helpful. Is
an increase of approximately 54 meters a meaningful improvement in functional capacity for
patients with obesity, or would a larger change be expected to have a more substantial impact
on physical function?
-While the changes in fat mass and lean body mass are reported, the clinical significance of the
loss in lean body mass (7.26 ± 4.09 kg) could be further explored. How does this loss in LBM
relate to changes in physical function, particularly concerning 6MWT and PA? Does the loss of
lean mass raise concerns about muscle preservation in the postoperative period? These questions
might warrant brief discussion.
-While the study found a reduction in the FEV1/FVC ratio, this change was not statistically
significant. However, the discussion does not provide much insight into the clinical significance
(or lack thereof) of this finding.
-It would be helpful to briefly explain why a reduction in the FEV1/FVC ratio might be seen
after surgery, and whether this represents a clinically meaningful change or just a statistical
fluctuation. For example, a slight decrease in the FEV1/FVC ratio could indicate a small change
in airflow or lung mechanics, but the clinical relevance of this change could be questioned,
particularly given the lack of statistical significance.
-While the increase in MIP (7.24 cm H2O) is statistically significant, the discussion could benefit
from further elaboration on what this means clinically. Is this increase in MIP sufficient to
significantly enhance the respiratory capacity of the patient? Is it enough to reverse the muscle
weakness typically seen in individuals with obesity?
-While the discussion mentions that physical activity improvements are associated with
enhanced functional capacity (6MWT), it could further address the lack of correlation between
changes in physical activity (MET-minutes) and weight loss (TWL, EWL). This is a central
finding of the study, and a more detailed exploration of why this correlation was not observed
could provide useful insights | BMC | 12893_2025_2804_ReviewerReport_V2_R1.pdf | {
"criticism": 4,
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"total": 31
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"suggestion_and_solution": 0.5483870967741935
} | 1.806452 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: The Impact of Sleeve Gastrectomy on Pulmonary Function Tests and Physical Activity\nOne-year After Surgery\nVersion: 2 Date: 28 Dec 2024\nReviewer: Mohamed Hany\nReviewer's report:\nDear Authors, please address the fol... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02804-0 | Reviewed - bmc_surgery | Title: The Impact of Sleeve Gastrectomy on Pulmonary Function Tests and Physical Activity
One-year After Surgery
Version: 2 Date: 14 Jan 2025
Reviewer's report:
The manuscript provides a valuable investigation into the effects of sleeve gastrectomy on
pulmonary function and physical activity. However, the manuscript can be improved by
addressing the following points.
Major Concerns
- Sample Size: The study includes only 32 patients, which limits its statistical power and
generalizability. Was a power calculation performed? If not, this should be acknowledged as
a limitation.
- Postoperative Regimen: The nutritional and physical activity habits of these patients are
important potential confounders. Were patients placed on specific diets or given exercise
recommendations post-surgery? If so, these details should be included. If not controlled for, this
should be discussed as a limitation.
- Impact on Clinical Practice: The discussion should elaborate on how these findings can
be integrated into clinical practice. What are the implications for post-surgical rehabilitation
programs or exercise recommendations?
Influence of Lean Body Mass: The introduction provides a detailed discussion on LBM loss
and its potential impact on postoperative physical activity or vice versa. This creates an
expectation for an analysis of the correlation between LBM and outcomes like the 6MWT.
However, the manuscript does not include further results or discussion on this topic. Did you
consider analyzing the correlation between LBM and 6MWT? Including such an analysis could
strengthen the study and provide additional insights into the relationship between LBM and
functional capacity post-surgery.
Minor Concerns
- Ethics: Include details about whether ethics committee approval was sought for this study. If
so, provide the approval number or institution details.
- Grammar: Replace "rule of bariatric surgery" with "role of bariatric surgery" for grammatical
accuracy. Avoid using "LFTs" for lung function tests to prevent confusion with liver function
tests. Please note that you have not actually abbreviated "LFT". Use "PFT" for pulmonary or
otherwise maintain consistency with "FEV1" and "FVC".
- Lean body mass is abbreviated as "LBM" multiple times. Ensure consistency throughout.
- Body Impedance Analyzer: While useful, the body impedance analyzer is not the gold standard
for measuring body composition compared to DXA. Acknowledge this limitation.
- Figures and Tables: Figures are informative, but Table 1 could benefit from an additional
column indicating percentage changes for key metrics. | Title: The Impact of Sleeve Gastrectomy on Pulmonary Function Tests and Physical Activity
One-year After Surgery
Version: 2 Date: 14 Jan 2025
Reviewer's report:
The manuscript provides a valuable investigation into the effects of sleeve gastrectomy on
pulmonary function and physical activity. However, the manuscript can be improved by
addressing the following points.
Major Concerns
- Sample Size: The study includes only 32 patients, which limits its statistical power and
generalizability. Was a power calculation performed? If not, this should be acknowledged as
a limitation.
- Postoperative Regimen: The nutritional and physical activity habits of these patients are
important potential confounders. Were patients placed on specific diets or given exercise
recommendations post-surgery? If so, these details should be included. If not controlled for, this
should be discussed as a limitation.
- Impact on Clinical Practice: The discussion should elaborate on how these findings can
be integrated into clinical practice. What are the implications for post-surgical rehabilitation
programs or exercise recommendations?
Influence of Lean Body Mass: The introduction provides a detailed discussion on LBM loss
and its potential impact on postoperative physical activity or vice versa. This creates an
expectation for an analysis of the correlation between LBM and outcomes like the 6MWT.
However, the manuscript does not include further results or discussion on this topic. Did you
consider analyzing the correlation between LBM and 6MWT? Including such an analysis could
strengthen the study and provide additional insights into the relationship between LBM and
functional capacity post-surgery.
Minor Concerns
- Ethics: Include details about whether ethics committee approval was sought for this study. If
so, provide the approval number or institution details.
- Grammar: Replace "rule of bariatric surgery" with "role of bariatric surgery" for grammatical
accuracy. Avoid using "LFTs" for lung function tests to prevent confusion with liver function
tests. Please note that you have not actually abbreviated "LFT". Use "PFT" for pulmonary or
otherwise maintain consistency with "FEV1" and "FVC".
- Lean body mass is abbreviated as "LBM" multiple times. Ensure consistency throughout.
- Body Impedance Analyzer: While useful, the body impedance analyzer is not the gold standard
for measuring body composition compared to DXA. Acknowledge this limitation.
- Figures and Tables: Figures are informative, but Table 1 could benefit from an additional
column indicating percentage changes for key metrics. | BMC | 12893_2025_2804_ReviewerReport_V2_R2.pdf | {
"criticism": 1,
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"materials_and_methods": 14,
"praise": 3,
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"results_and_discussion": 6,
"suggestion_and_solution": 14,
"total": 27
} | {
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"suggestion_and_solution": 0.5185185185185185
} | 2.074074 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: The Impact of Sleeve Gastrectomy on Pulmonary Function Tests and Physical Activity\nOne-year After Surgery\nVersion: 2 Date: 14 Jan 2025\nReviewer's report:\nThe manuscript provides a valuable investigation into the eff... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02804-0 | Reviewed - bmc_surgery | Title: The Impact of Sleeve Gastrectomy on Pulmonary Function Tests and Physical Activity
One-year After Surgery
Version: 3 Date: 29 Jan 2025
Reviewer's report:
The authors have addressed previous reviewer comments with substantial revisions,
strengthening the discussion on obesity-related respiratory changes, lean body mass (LBM) loss,
PA, and study limitations. The methodological transparency has also been improved. | Title: The Impact of Sleeve Gastrectomy on Pulmonary Function Tests and Physical Activity
One-year After Surgery
Version: 3 Date: 29 Jan 2025
Reviewer's report:
The authors have addressed previous reviewer comments with substantial revisions,
strengthening the discussion on obesity-related respiratory changes, lean body mass (LBM) loss,
PA, and study limitations. The methodological transparency has also been improved. | BMC | 12893_2025_2804_ReviewerReport_V3_R2.pdf | {
"criticism": 0,
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"total": 2
} | {
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} | 2 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: The Impact of Sleeve Gastrectomy on Pulmonary Function Tests and Physical Activity\nOne-year After Surgery\nVersion: 3 Date: 29 Jan 2025\nReviewer's report:\nThe authors have addressed previous reviewer comments with su... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02804-0 | Reviewed - bmc_surgery | Title: The Impact of Sleeve Gastrectomy on Pulmonary Function Tests and Physical Activity
One-year After Surgery
Version: 3 Date: 29 Jan 2025
Reviewer: Mohamed Hany
Reviewer's report:
Thabk you for addressing comments. | Title: The Impact of Sleeve Gastrectomy on Pulmonary Function Tests and Physical Activity
One-year After Surgery
Version: 3 Date: 29 Jan 2025
Reviewer: Mohamed Hany
Reviewer's report:
Thabk you for addressing comments. | BMC | 12893_2025_2804_ReviewerReport_V3_R1.pdf | {
"criticism": 0,
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} | 0 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: The Impact of Sleeve Gastrectomy on Pulmonary Function Tests and Physical Activity\nOne-year After Surgery\nVersion: 3 Date: 29 Jan 2025\nReviewer: Mohamed Hany\nReviewer's report:\nThabk you for addressing comments.",... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02791-2 | Reviewed - bmc_surgery | Title: Main Features and Treatments of Cervical Cysts in Children from a Single-center
Experience
Version: 0 Date: 24 Dec 2024
Reviewer's report:
Interesting and well written article.
However, I would suggest Authors to cite and discuss recent relevant literature, such as:
Congenital nonvascular neck masses: a retrospective analysis. Oral Surg Oral Med Oral Pathol
Oral Radiol. 2020 Mar;129(3):192-199.
A single-center experience in the management of head and neck lymphangiomas. Oral
Maxillofac Surg. 2020 Mar;24(1):109-115. | Title: Main Features and Treatments of Cervical Cysts in Children from a Single-center
Experience
Version: 0 Date: 24 Dec 2024
Reviewer's report:
Interesting and well written article.
However, I would suggest Authors to cite and discuss recent relevant literature, such as:
Congenital nonvascular neck masses: a retrospective analysis. Oral Surg Oral Med Oral Pathol
Oral Radiol. 2020 Mar;129(3):192-199.
A single-center experience in the management of head and neck lymphangiomas. Oral
Maxillofac Surg. 2020 Mar;24(1):109-115. | BMC | 12893_2025_2791_ReviewerReport_V0_R3.pdf | {
"criticism": 0,
"example": 0,
"importance_and_relevance": 1,
"materials_and_methods": 2,
"praise": 1,
"presentation_and_reporting": 2,
"results_and_discussion": 0,
"suggestion_and_solution": 1,
"total": 7
} | {
"criticism": 0,
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"results_and_discussion": 0,
"suggestion_and_solution": 0.14285714285714285
} | 1 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Main Features and Treatments of Cervical Cysts in Children from a Single-center\nExperience\nVersion: 0 Date: 24 Dec 2024\nReviewer's report:\nInteresting and well written article.\nHowever, I would suggest Authors to c... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02791-2 | Reviewed - bmc_surgery | Title: Main Features and Treatments of Cervical Cysts in Children from a Single-center
Experience
Version: 0 Date: 25 Dec 2024
Reviewer: Thangaraj Mohanapriya
Reviewer's report:
1) In Materials and methods, the term neoplasm in"history of cervical neoplasm" - Can be
changed to a better terminology to represent cysts.
2) Add atleast one clinical picture of any ofthe cervical cyst
3) Include atleast 2 operative images if possible of different pathology of cervical cyst.
4) The proximity of the cervical cysts with the major vessels and nerves has been generally
described in the Surgical procedure part. Describe this is better detail to explain the relation of
these vessels and nerves to each cervical cysts - The table is not that self explanatory. Include
explanation about the table in the manuscript.
5) "Nerve monitor is adopted during surgery to prevent possible damage to nerves. In our center,
nerve monitor was used in 45 (11.7%) patients as a preventive maneuver for possible facial
and recurrent laryngeal nerve damage". These 2 lines in the manuscript contradict each other.
Clearly state whether nerve monitor was adopted for all patients or only for 45 patients.
6) The operative procedure and post operative complications for all the different types of cervical
cysts has been generalised and written. It has to be rewritten properly with proper clarity and
few images preferably for each type of cervical cysts. | Title: Main Features and Treatments of Cervical Cysts in Children from a Single-center
Experience
Version: 0 Date: 25 Dec 2024
Reviewer: Thangaraj Mohanapriya
Reviewer's report:
1) In Materials and methods, the term neoplasm in"history of cervical neoplasm" - Can be
changed to a better terminology to represent cysts.
2) Add atleast one clinical picture of any ofthe cervical cyst
3) Include atleast 2 operative images if possible of different pathology of cervical cyst.
4) The proximity of the cervical cysts with the major vessels and nerves has been generally
described in the Surgical procedure part. Describe this is better detail to explain the relation of
these vessels and nerves to each cervical cysts - The table is not that self explanatory. Include
explanation about the table in the manuscript.
5) "Nerve monitor is adopted during surgery to prevent possible damage to nerves. In our center,
nerve monitor was used in 45 (11.7%) patients as a preventive maneuver for possible facial
and recurrent laryngeal nerve damage". These 2 lines in the manuscript contradict each other.
Clearly state whether nerve monitor was adopted for all patients or only for 45 patients.
6) The operative procedure and post operative complications for all the different types of cervical
cysts has been generalised and written. It has to be rewritten properly with proper clarity and
few images preferably for each type of cervical cysts. | BMC | 12893_2025_2791_ReviewerReport_V0_R2.pdf | {
"criticism": 1,
"example": 1,
"importance_and_relevance": 0,
"materials_and_methods": 6,
"praise": 0,
"presentation_and_reporting": 8,
"results_and_discussion": 0,
"suggestion_and_solution": 6,
"total": 11
} | {
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} | 2 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Main Features and Treatments of Cervical Cysts in Children from a Single-center\nExperience\nVersion: 0 Date: 25 Dec 2024\nReviewer: Thangaraj Mohanapriya\nReviewer's report:\n1) In Materials and methods, the term neop... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02791-2 | Reviewed - bmc_surgery | Title: Main Features and Treatments of Cervical Cysts in Children from a Single-center
Experience
Version: 1 Date: 22 Jan 2025
Reviewer's report:
hello
thank you fpr this original paper
cysts in juvenile patients its a very special topic
this improved paper is sufficient for publication
authors present their own experience on cysts in juvenile patients
title is sound, abstract is sufficient
key words are ok, used references are good
this article structure is sufficient - a clear aim and methodology is set
patients own experience on a very large sample is briefly presented
used and implemented changes in the manuscript file - marker in yellow are very good and are
greatly improving papers value
used references and discussion is sufficient
authors describe the most typical cystic necck lesions in children in a very good manner
paper should be published when small language errors are corrected as well as the improved
figure description
thank you | Title: Main Features and Treatments of Cervical Cysts in Children from a Single-center
Experience
Version: 1 Date: 22 Jan 2025
Reviewer's report:
hello
thank you fpr this original paper
cysts in juvenile patients its a very special topic
this improved paper is sufficient for publication
authors present their own experience on cysts in juvenile patients
title is sound, abstract is sufficient
key words are ok, used references are good
this article structure is sufficient - a clear aim and methodology is set
patients own experience on a very large sample is briefly presented
used and implemented changes in the manuscript file - marker in yellow are very good and are
greatly improving papers value
used references and discussion is sufficient
authors describe the most typical cystic necck lesions in children in a very good manner
paper should be published when small language errors are corrected as well as the improved
figure description
thank you | BMC | 12893_2025_2791_ReviewerReport_V1_R5.pdf | {
"criticism": 0,
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"total": 1
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} | 4 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Main Features and Treatments of Cervical Cysts in Children from a Single-center\nExperience\nVersion: 1 Date: 22 Jan 2025\nReviewer's report:\nhello\nthank you fpr this original paper\ncysts in juvenile patients its a v... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02791-2 | Reviewed - bmc_surgery | Title: Main Features and Treatments of Cervical Cysts in Children from a Single-center
Experience
Version: 1 Date: 23 Jan 2025
Reviewer's report:
This study is considered a valuable investigation that analyzes pediatric cervical cysts from a
surgical perspective with the large number of cases.
Upon reading the abstract, I found that all the points I intended to address in my review were
thoroughly discussed in the main text. These include the breakdown of recurrence patterns
and recurrence rate, whether all cases of TGDC involved hyoid bone resection (Sistrunk
procedure), and the challenges posed by LM, which can sometimes extend significantly into the
parapharyngeal space, making surgery more complex.
The manuscript is highly readable, with a vast amount of information and key points effectively
summarized using tables where appropriate.
I believe this manuscript has already been suitable for publication.
Below are not revision requests but questions arising from my interest as a reviewer:
#This might be my personal perspective, but I believe that in some cases where thyroglossal
duct cyst (TGDC) is suspected based on preoperative ultrasound and/or MRI, preoperative CT
may sometimes be deemed necessary, even in pediatric cases, to more accurately evaluate the
relationship between the cyst and the hyoid bone based on its size and shape. Were there any
cases in which preoperative CT was performed for this purpose?
#Fine-needle aspiration cytology (FNAC) might not be performed preoperatively in some cases
due to concerns that puncturing the cyst capsule could weaken its integrity, increasing the risk
of rupture during surgery. However, in other cases, FNAC might be performed, including for
the purpose of draining an infected cyst. Were there any cases where preoperative FNAC (or
aspiration for treating cyst infection) was performed? I understand that all cases in this study had
benign postoperative pathology; however, if there were any cases where FNAC was performed
preoperatively, including for the purpose of drainage, I would be interested to know whether it
had any impact on the rupture of the cyst during surgery.
I would be grateful if the authors could provide me the insights on these questions.
Overall, this is a well-prepared manuscript with significant clinical relevance. I look forward
to seeing it published. | Title: Main Features and Treatments of Cervical Cysts in Children from a Single-center
Experience
Version: 1 Date: 23 Jan 2025
Reviewer's report:
This study is considered a valuable investigation that analyzes pediatric cervical cysts from a
surgical perspective with the large number of cases.
Upon reading the abstract, I found that all the points I intended to address in my review were
thoroughly discussed in the main text. These include the breakdown of recurrence patterns
and recurrence rate, whether all cases of TGDC involved hyoid bone resection (Sistrunk
procedure), and the challenges posed by LM, which can sometimes extend significantly into the
parapharyngeal space, making surgery more complex.
The manuscript is highly readable, with a vast amount of information and key points effectively
summarized using tables where appropriate.
I believe this manuscript has already been suitable for publication.
Below are not revision requests but questions arising from my interest as a reviewer:
#This might be my personal perspective, but I believe that in some cases where thyroglossal
duct cyst (TGDC) is suspected based on preoperative ultrasound and/or MRI, preoperative CT
may sometimes be deemed necessary, even in pediatric cases, to more accurately evaluate the
relationship between the cyst and the hyoid bone based on its size and shape. Were there any
cases in which preoperative CT was performed for this purpose?
#Fine-needle aspiration cytology (FNAC) might not be performed preoperatively in some cases
due to concerns that puncturing the cyst capsule could weaken its integrity, increasing the risk
of rupture during surgery. However, in other cases, FNAC might be performed, including for
the purpose of draining an infected cyst. Were there any cases where preoperative FNAC (or
aspiration for treating cyst infection) was performed? I understand that all cases in this study had
benign postoperative pathology; however, if there were any cases where FNAC was performed
preoperatively, including for the purpose of drainage, I would be interested to know whether it
had any impact on the rupture of the cyst during surgery.
I would be grateful if the authors could provide me the insights on these questions.
Overall, this is a well-prepared manuscript with significant clinical relevance. I look forward
to seeing it published. | BMC | 12893_2025_2791_ReviewerReport_V1_R4.pdf | {
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} | 1.642857 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Main Features and Treatments of Cervical Cysts in Children from a Single-center\nExperience\nVersion: 1 Date: 23 Jan 2025\nReviewer's report:\nThis study is considered a valuable investigation that analyzes pediatric ce... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02791-2 | Reviewed - bmc_surgery | Title: Main Features and Treatments of Cervical Cysts in Children from a Single-center
Experience
Version: 1 Date: 24 Jan 2025
Reviewer's report:
Dear authors,
kindly view the attached manuscript for comments.
Best regards. | Title: Main Features and Treatments of Cervical Cysts in Children from a Single-center
Experience
Version: 1 Date: 24 Jan 2025
Reviewer's report:
Dear authors,
kindly view the attached manuscript for comments.
Best regards. | BMC | 12893_2025_2791_ReviewerReport_V1_R6.pdf | {
"criticism": 0,
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} | 1.5 | 0 | [
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"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Main Features and Treatments of Cervical Cysts in Children from a Single-center\nExperience\nVersion: 1 Date: 24 Jan 2025\nReviewer's report:\nDear authors,\nkindly view the attached manuscript for comments.\nBest regar... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02805-z | Reviewed - bmc_surgery | Title: Robotic versus Laparoscopic Surgery for Rectal Cancer: An Updated Systematic Review
and Meta-Analysis of Randomized Controlled Trials
Version: 3 Date: 24 Dec 2024
Reviewer's report:
Your manuscript provides a detailed and insightful meta-analysis of robotic surgery (RS) versus
laparoscopic surgery (LS) for rectal cancer, but there are several areas for potential improvement.
Here’s detailed feedback:
Focus and Clarity: Streamline the introduction and discussion by reducing redundancy
and avoiding overstatements about the superiority of robotic surgery. Emphasize clinically
significant findings (e.g., reduced conversion rates, faster recovery metrics) and provide
balanced interpretations without overstating outcomes.
Presentation and Structure: Ensure consistency in tables, figures, and formatting. Clearly
separate primary and secondary outcomes, and add concise visual summaries (e.g., flow
diagram, outcome comparisons). Avoid repetition, especially in methods and results.
Context and Limitations: Expand on cost implications, long-term outcomes, and heterogeneity
across included studies. Highlight the need for future research to address these gaps, including
cost-effectiveness and patient-specific benefits (e.g., elderly or anatomically complex cases). | Title: Robotic versus Laparoscopic Surgery for Rectal Cancer: An Updated Systematic Review
and Meta-Analysis of Randomized Controlled Trials
Version: 3 Date: 24 Dec 2024
Reviewer's report:
Your manuscript provides a detailed and insightful meta-analysis of robotic surgery (RS) versus
laparoscopic surgery (LS) for rectal cancer, but there are several areas for potential improvement.
Here’s detailed feedback:
Focus and Clarity: Streamline the introduction and discussion by reducing redundancy
and avoiding overstatements about the superiority of robotic surgery. Emphasize clinically
significant findings (e.g., reduced conversion rates, faster recovery metrics) and provide
balanced interpretations without overstating outcomes.
Presentation and Structure: Ensure consistency in tables, figures, and formatting. Clearly
separate primary and secondary outcomes, and add concise visual summaries (e.g., flow
diagram, outcome comparisons). Avoid repetition, especially in methods and results.
Context and Limitations: Expand on cost implications, long-term outcomes, and heterogeneity
across included studies. Highlight the need for future research to address these gaps, including
cost-effectiveness and patient-specific benefits (e.g., elderly or anatomically complex cases). | BMC | 12893_2025_2805_ReviewerReport_V3_R1.pdf | {
"criticism": 0,
"example": 0,
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"materials_and_methods": 2,
"praise": 1,
"presentation_and_reporting": 2,
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"suggestion_and_solution": 7,
"total": 8
} | {
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} | 2.375 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Robotic versus Laparoscopic Surgery for Rectal Cancer: An Updated Systematic Review\nand Meta-Analysis of Randomized Controlled Trials\nVersion: 3 Date: 24 Dec 2024\nReviewer's report:\nYour manuscript provides a detail... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02805-z | Reviewed - bmc_surgery | Title: Robotic versus Laparoscopic Surgery for Rectal Cancer: An Updated Systematic Review
and Meta-Analysis of Randomized Controlled Trials
Version: 3 Date: 30 Dec 2024
Reviewer's report:
Dear Author,
I read with great interest the work titled “Comprehensive Meta-Analysis of Robotic Surgery
versus Laparoscopic Surgery for Rectal Cancer: Insights from Eleven Randomized Controlled
Trials” currently under evaluation in the BMC Surgery Journal. As stated in the introduction,
previous systematic reviews and meta-analyses have predominantly relied on observational
comparative studies. More recent reports have shifted their focus to a limited number of
randomized controlled trials (RCTs), often constrained by inadequate sample sizes. In contrast,
this meta-analysis exclusively includes RCTs with a robust sample size of 3,107 patients,
offering higher-quality evidence compared to the current body of literature. This highlights the
significance and relevance of the study. The authors assessed most of the clinically relevant
outcomes, providing a comprehensive comparative overview of robotic and laparoscopic
techniques. The reporting of results is clear and well-structured. However, I have some concerns
regarding the study:
Comments for the Authors:
1. Title: The term "Comprehensive" in the title does not enhance clarity or effectively highlight
the critical aspects of the study. While it implies thoroughness, it does not convey the specific
objective or unique contribution of the meta-analysis. I suggest revising the title to better reflect
the focus of the work. For example: "Robotic versus Laparoscopic Surgery for Rectal Cancer:
An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials."
2. Prospective Registration: One limitation of the study is the absence of prospective
registration on platforms such as the International Prospective Register of Systematic Reviews
(PROSPERO), as recommended by Section 2.4.1 of the Cochrane Handbook for Systematic
Reviews of Interventions. Prospective registration enhances transparency, minimizes the risk of
bias, and aligns with best practices for conducting systematic reviews and meta-analyses. This
limitation should be explicitly addressed in the limitations section of the manuscript.
3. Search Strategy: While the study provides information about the databases searched, the
time frame, and the terms used, the search strategy remains insufficiently detailed for full
transparency and reproducibility. The manuscript does not include the exact query syntax or
describe the use of Boolean operators and search filters applied in each database. According to
the Cochrane Handbook for Systematic Reviews of Interventions (Chapter 4.4) and PRISMA
guidelines, the complete search strings for at least one database should be reported, either in the
main text or as an appendix. Including this information would enhance methodological rigor.
4. Flow Diagram: The flow diagram (Figure 1) provides a clear overview of the study selection
process; however, it does not specify the reasons for exclusion at the full-text screening stage.
According to PRISMA guidelines, providing explicit reasons for exclusion after the full-
text review step is essential for transparency and reproducibility. Common reasons, such as
population not meeting inclusion criteria, irrelevant interventions or comparators, or unsuitable
study designs, should be detailed. I recommend including this information, either in the flow
diagram or as a supplementary table, to enhance clarity and rigor.
5. Risk of Bias Tool: The risk-of-bias assessment presented in the manuscript appears to use
the original Cochrane Risk of Bias tool. While this tool has been widely used, the updated
RoB-2 tool (introduced in 2019 by the Cochrane Collaboration) is generally preferred for
randomized controlled trials due to its structured approach, use of signaling questions, and
focus on outcome-specific bias. I recommend considering the use of RoB-2 for the risk-of-bias
assessment. If switching tools is not feasible, the authors should justify the use of the original
tool and acknowledge its limitations, such as the ambiguity of the "unclear risk of bias" category.
This clarification would strengthen the study's methodological rigor.
6. GRADE Assessment: The authors have not performed a GRADE (Grading of
Recommendations Assessment, Development, and Evaluation) evaluation to assess the certainty
of evidence. GRADE is a widely recognized framework for evaluating the quality of evidence
and determining the strength of recommendations. I suggest conducting a GRADE evaluation
to better understand the level of recommendation for the findings. This would provide valuable
insights into the reliability of the evidence and enhance methodological rigor. Additionally, if
GRADE is conducted, it would justify retaining the term "Quality" in the title of Section 2.5
("Quality and Bias Risk Assessment").
7. Abbreviation (CRM): Although the abbreviation "CRM" (Circumferential Resection Margin)
is defined in the abstract, it should also be defined the first time it appears in the main text, such
as in Section 2.6. This ensures clarity for readers who may not refer back to the abstract.
8. Terminology Consistency: In Section 3.1, the authors use the term "bias risk assessment." I
suggest changing this to "risk of bias assessment" to maintain consistency with the terminology
adopted throughout the text.
9. Table 1: In Table 1, the column titled “Number” should be clarified to “Number of Patients”
to ensure precision and avoid ambiguity. Additionally, the abbreviations RS, LS, SD, and BMI
are used in the table but are not defined in the legend. Adding these definitions would enhance
clarity and accessibility for readers. In addition, providing information on the number of centers
involved (single or multicentric), the specific robotic system used, and the level of surgeon
expertise would significantly enhance the study. These factors could influence the outcomes and
would provide valuable context for interpreting the results.
10. Units of Measurement: In the Secondary Outcomes section, the authors report outcomes such
as time to first autonomous urination, time to first defecation, time to first flatus, operating time,
estimated blood loss, and hospital stay. However, the unit of measurement (e.g., hours, days)
is not specified for these outcomes. Clearly stating the units would ensure clarity and allow for
accurate interpretation.
11. Sensitivity Analysis: In the sensitivity analysis section, the authors present results only for
postoperative complications. Firstly, the appropriate place to describe the method for conducting
the sensitivity analysis is in the Statistical Analysis subsection within the Methods section. The
Results section should focus solely on the findings. Secondly, displaying the results of the leave-
one-out analysis in the supplementary material would allow readers to observe which studies
contributed more or less to heterogeneity. Lastly, since many outcomes exhibited moderate or
high heterogeneity (e.g., overall postoperative complications I² = 54%, short-term postoperative
complications I² = 64%, time to first autonomous urination I² = 85%, time to first defecation
I² = 54%, time to first flatus I² = 96%, operating time I² = 97%, preventive ostomy rates I² =
53%, estimated blood loss I² = 89%, hospital stays I² = 85%), conducting leave-one-out analyses
for these outcomes is recommended to better understand heterogeneity sources and enhance
robustness.
12. Publication Bias: Publication bias is typically recommended to be assessed when there are
at least 10 studies for a specific outcome, as per Cochrane guidelines. The authors reported the
funnel plot for overall postoperative complications, which includes only 9 studies. I suggest
generating funnel plots for all outcomes with at least 10 studies and including them in the
supplementary material for transparency. For outcomes with fewer than 10 studies, presenting
funnel plots is acceptable but should include a note about the statistical insufficiency and
limitations of the analysis. | Title: Robotic versus Laparoscopic Surgery for Rectal Cancer: An Updated Systematic Review
and Meta-Analysis of Randomized Controlled Trials
Version: 3 Date: 30 Dec 2024
Reviewer's report:
Dear Author,
I read with great interest the work titled “Comprehensive Meta-Analysis of Robotic Surgery
versus Laparoscopic Surgery for Rectal Cancer: Insights from Eleven Randomized Controlled
Trials” currently under evaluation in the BMC Surgery Journal. As stated in the introduction,
previous systematic reviews and meta-analyses have predominantly relied on observational
comparative studies. More recent reports have shifted their focus to a limited number of
randomized controlled trials (RCTs), often constrained by inadequate sample sizes. In contrast,
this meta-analysis exclusively includes RCTs with a robust sample size of 3,107 patients,
offering higher-quality evidence compared to the current body of literature. This highlights the
significance and relevance of the study. The authors assessed most of the clinically relevant
outcomes, providing a comprehensive comparative overview of robotic and laparoscopic
techniques. The reporting of results is clear and well-structured. However, I have some concerns
regarding the study:
Comments for the Authors:
1. Title: The term "Comprehensive" in the title does not enhance clarity or effectively highlight
the critical aspects of the study. While it implies thoroughness, it does not convey the specific
objective or unique contribution of the meta-analysis. I suggest revising the title to better reflect
the focus of the work. For example: "Robotic versus Laparoscopic Surgery for Rectal Cancer:
An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials."
2. Prospective Registration: One limitation of the study is the absence of prospective
registration on platforms such as the International Prospective Register of Systematic Reviews
(PROSPERO), as recommended by Section 2.4.1 of the Cochrane Handbook for Systematic
Reviews of Interventions. Prospective registration enhances transparency, minimizes the risk of
bias, and aligns with best practices for conducting systematic reviews and meta-analyses. This
limitation should be explicitly addressed in the limitations section of the manuscript.
3. Search Strategy: While the study provides information about the databases searched, the
time frame, and the terms used, the search strategy remains insufficiently detailed for full
transparency and reproducibility. The manuscript does not include the exact query syntax or
describe the use of Boolean operators and search filters applied in each database. According to
the Cochrane Handbook for Systematic Reviews of Interventions (Chapter 4.4) and PRISMA
guidelines, the complete search strings for at least one database should be reported, either in the
main text or as an appendix. Including this information would enhance methodological rigor.
4. Flow Diagram: The flow diagram (Figure 1) provides a clear overview of the study selection
process; however, it does not specify the reasons for exclusion at the full-text screening stage.
According to PRISMA guidelines, providing explicit reasons for exclusion after the full-
text review step is essential for transparency and reproducibility. Common reasons, such as
population not meeting inclusion criteria, irrelevant interventions or comparators, or unsuitable
study designs, should be detailed. I recommend including this information, either in the flow
diagram or as a supplementary table, to enhance clarity and rigor.
5. Risk of Bias Tool: The risk-of-bias assessment presented in the manuscript appears to use
the original Cochrane Risk of Bias tool. While this tool has been widely used, the updated
RoB-2 tool (introduced in 2019 by the Cochrane Collaboration) is generally preferred for
randomized controlled trials due to its structured approach, use of signaling questions, and
focus on outcome-specific bias. I recommend considering the use of RoB-2 for the risk-of-bias
assessment. If switching tools is not feasible, the authors should justify the use of the original
tool and acknowledge its limitations, such as the ambiguity of the "unclear risk of bias" category.
This clarification would strengthen the study's methodological rigor.
6. GRADE Assessment: The authors have not performed a GRADE (Grading of
Recommendations Assessment, Development, and Evaluation) evaluation to assess the certainty
of evidence. GRADE is a widely recognized framework for evaluating the quality of evidence
and determining the strength of recommendations. I suggest conducting a GRADE evaluation
to better understand the level of recommendation for the findings. This would provide valuable
insights into the reliability of the evidence and enhance methodological rigor. Additionally, if
GRADE is conducted, it would justify retaining the term "Quality" in the title of Section 2.5
("Quality and Bias Risk Assessment").
7. Abbreviation (CRM): Although the abbreviation "CRM" (Circumferential Resection Margin)
is defined in the abstract, it should also be defined the first time it appears in the main text, such
as in Section 2.6. This ensures clarity for readers who may not refer back to the abstract.
8. Terminology Consistency: In Section 3.1, the authors use the term "bias risk assessment." I
suggest changing this to "risk of bias assessment" to maintain consistency with the terminology
adopted throughout the text.
9. Table 1: In Table 1, the column titled “Number” should be clarified to “Number of Patients”
to ensure precision and avoid ambiguity. Additionally, the abbreviations RS, LS, SD, and BMI
are used in the table but are not defined in the legend. Adding these definitions would enhance
clarity and accessibility for readers. In addition, providing information on the number of centers
involved (single or multicentric), the specific robotic system used, and the level of surgeon
expertise would significantly enhance the study. These factors could influence the outcomes and
would provide valuable context for interpreting the results.
10. Units of Measurement: In the Secondary Outcomes section, the authors report outcomes such
as time to first autonomous urination, time to first defecation, time to first flatus, operating time,
estimated blood loss, and hospital stay. However, the unit of measurement (e.g., hours, days)
is not specified for these outcomes. Clearly stating the units would ensure clarity and allow for
accurate interpretation.
11. Sensitivity Analysis: In the sensitivity analysis section, the authors present results only for
postoperative complications. Firstly, the appropriate place to describe the method for conducting
the sensitivity analysis is in the Statistical Analysis subsection within the Methods section. The
Results section should focus solely on the findings. Secondly, displaying the results of the leave-
one-out analysis in the supplementary material would allow readers to observe which studies
contributed more or less to heterogeneity. Lastly, since many outcomes exhibited moderate or
high heterogeneity (e.g., overall postoperative complications I² = 54%, short-term postoperative
complications I² = 64%, time to first autonomous urination I² = 85%, time to first defecation
I² = 54%, time to first flatus I² = 96%, operating time I² = 97%, preventive ostomy rates I² =
53%, estimated blood loss I² = 89%, hospital stays I² = 85%), conducting leave-one-out analyses
for these outcomes is recommended to better understand heterogeneity sources and enhance
robustness.
12. Publication Bias: Publication bias is typically recommended to be assessed when there are
at least 10 studies for a specific outcome, as per Cochrane guidelines. The authors reported the
funnel plot for overall postoperative complications, which includes only 9 studies. I suggest
generating funnel plots for all outcomes with at least 10 studies and including them in the
supplementary material for transparency. For outcomes with fewer than 10 studies, presenting
funnel plots is acceptable but should include a note about the statistical insufficiency and
limitations of the analysis. | BMC | 12893_2025_2805_ReviewerReport_V3_R2.pdf | {
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} | 1.953846 | 0 | [
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"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Robotic versus Laparoscopic Surgery for Rectal Cancer: An Updated Systematic Review\nand Meta-Analysis of Randomized Controlled Trials\nVersion: 3 Date: 30 Dec 2024\nReviewer's report:\nDear Author,\nI read with great i... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02805-z | Reviewed - bmc_surgery | Title: Robotic versus Laparoscopic Surgery for Rectal Cancer: An Updated Systematic Review
and Meta-Analysis of Randomized Controlled Trials
Version: 4 Date: 31 Jan 2025
Reviewer's report:
The authors have addressed all comments, and the manuscript is now ready for publication. I
appreciate their effort and dedication throughout this process. Congratulations on the excellent
work! | Title: Robotic versus Laparoscopic Surgery for Rectal Cancer: An Updated Systematic Review
and Meta-Analysis of Randomized Controlled Trials
Version: 4 Date: 31 Jan 2025
Reviewer's report:
The authors have addressed all comments, and the manuscript is now ready for publication. I
appreciate their effort and dedication throughout this process. Congratulations on the excellent
work! | BMC | 12893_2025_2805_ReviewerReport_V4_R2.pdf | {
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"role": "user"
},
{
"content": "Title: Robotic versus Laparoscopic Surgery for Rectal Cancer: An Updated Systematic Review\nand Meta-Analysis of Randomized Controlled Trials\nVersion: 4 Date: 31 Jan 2025\nReviewer's report:\nThe authors have addressed all co... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02805-z | Reviewed - bmc_surgery | Title: Robotic versus Laparoscopic Surgery for Rectal Cancer: An Updated Systematic Review
and Meta-Analysis of Randomized Controlled Trials
Version: 4 Date: 01 Feb 2025
Reviewer's report:
acceptable revisions | Title: Robotic versus Laparoscopic Surgery for Rectal Cancer: An Updated Systematic Review
and Meta-Analysis of Randomized Controlled Trials
Version: 4 Date: 01 Feb 2025
Reviewer's report:
acceptable revisions | BMC | 12893_2025_2805_ReviewerReport_V4_R1.pdf | {
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"role": "user"
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"content": "Title: Robotic versus Laparoscopic Surgery for Rectal Cancer: An Updated Systematic Review\nand Meta-Analysis of Randomized Controlled Trials\nVersion: 4 Date: 01 Feb 2025\nReviewer's report:\nacceptable revisions",
"role"... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02808-w | Reviewed - bmc_surgery | Title: The gender gap in academic surgery: the electronic health record
Version: 1 Date: 20 Sep 2024
Reviewer's report:
The authors present single-institution retrospective data highlighting a discrepancy in EHR
utilization between male and female surgeons across multiple surgical specialties. I applaud
the authors for using a relatively large sample representing many specialties and creativity in
identifying salient utilization metrics to highlight this difference.
1. Should the adjustment for gender differences also account for percentage of a physician’s time
dedicated to clinical activity (i.e. FTE allocation)? Surgeons with leadership responsibilities may
conceivably have less time for clinical documentation during regular hours due to administrative
tasks. How may this impact this analysis given that there are disproportionately fewer women
in leadership positions?
2. It is important to emphasis that the data presented here pertaining surgeon clinical activity are
limited to the ambulatory setting. While the authors seem to appropriately control for surgical
specialty, we should be cautious about generalizing these results about EHR utilization patterns
to documentation and time spent for admitted patients and on surgical dictation, which is likely
much more difficult to capture. While ambulatory encounters are a significant component of
most surgical practices, they still only represent a portion of the lived experience for a surgeon
and the multitude of pain points that may contribute to burnout or difficulty with professional
advancement.
3. Is there any way to more directly account for ancillary clinical support? Given that the
difference between men and women is derived from time spent on notes and on written
communication without differences in the proportion of notes started or written by other team
members, is there a direct way to capture how much PA/APN/APP support a given surgeon
receives? In other words, do men and women surgeons get equal provider support (or rotating
trainee help)?
4. It would be interesting to extend the idea of EHR utilization efficiency to time spent on
documentation relative to RVU generation. Could the additional time spent by women on clinical
review, notes and inbox messages also come at a cost to productivity?
5. It may also be illuminating to show which specialties had the greatest discrepancies in time
spent in the EHR to further highlight areas for targeted intervention.
6. There is a typo in the abbreviation definition for Table 2.
7. I would strongly recommend including either the mean number of minutes or absolute
differences where reporting results in the results section of the abstract instead of just stating
the variable and significance values. | Title: The gender gap in academic surgery: the electronic health record
Version: 1 Date: 20 Sep 2024
Reviewer's report:
The authors present single-institution retrospective data highlighting a discrepancy in EHR
utilization between male and female surgeons across multiple surgical specialties. I applaud
the authors for using a relatively large sample representing many specialties and creativity in
identifying salient utilization metrics to highlight this difference.
1. Should the adjustment for gender differences also account for percentage of a physician’s time
dedicated to clinical activity (i.e. FTE allocation)? Surgeons with leadership responsibilities may
conceivably have less time for clinical documentation during regular hours due to administrative
tasks. How may this impact this analysis given that there are disproportionately fewer women
in leadership positions?
2. It is important to emphasis that the data presented here pertaining surgeon clinical activity are
limited to the ambulatory setting. While the authors seem to appropriately control for surgical
specialty, we should be cautious about generalizing these results about EHR utilization patterns
to documentation and time spent for admitted patients and on surgical dictation, which is likely
much more difficult to capture. While ambulatory encounters are a significant component of
most surgical practices, they still only represent a portion of the lived experience for a surgeon
and the multitude of pain points that may contribute to burnout or difficulty with professional
advancement.
3. Is there any way to more directly account for ancillary clinical support? Given that the
difference between men and women is derived from time spent on notes and on written
communication without differences in the proportion of notes started or written by other team
members, is there a direct way to capture how much PA/APN/APP support a given surgeon
receives? In other words, do men and women surgeons get equal provider support (or rotating
trainee help)?
4. It would be interesting to extend the idea of EHR utilization efficiency to time spent on
documentation relative to RVU generation. Could the additional time spent by women on clinical
review, notes and inbox messages also come at a cost to productivity?
5. It may also be illuminating to show which specialties had the greatest discrepancies in time
spent in the EHR to further highlight areas for targeted intervention.
6. There is a typo in the abbreviation definition for Table 2.
7. I would strongly recommend including either the mean number of minutes or absolute
differences where reporting results in the results section of the abstract instead of just stating
the variable and significance values. | BMC | 12893_2025_2808_ReviewerReport_V1_R1.pdf | {
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0 | 0 | Review for 10.1186/s12893-025-02808-w | Reviewed - bmc_surgery | Title: The gender gap in academic surgery: the electronic health record
Version: 1 Date: 19 Dec 2024
Reviewer's report:
Well done and interesting study. In particular, I think the presence of analysis of the provider
efficiency tracking tool strengthens the findings that the differences seen between genders is not
due to women surgeons being less facile with EHR. Overall no significant edits recommended.
The only thing that was a bit confusing and can maybe be reworded for clarity was the connection
between women surgeons doing more EHR work outside of working hours and the fact that they
often carry more family and household duties compared to male surgeons. I would think that if
the women have more responsibilities at home, they would be less likely to have time at home
for EHR work. Otherwise, recommend accepting without edits. | Title: The gender gap in academic surgery: the electronic health record
Version: 1 Date: 19 Dec 2024
Reviewer's report:
Well done and interesting study. In particular, I think the presence of analysis of the provider
efficiency tracking tool strengthens the findings that the differences seen between genders is not
due to women surgeons being less facile with EHR. Overall no significant edits recommended.
The only thing that was a bit confusing and can maybe be reworded for clarity was the connection
between women surgeons doing more EHR work outside of working hours and the fact that they
often carry more family and household duties compared to male surgeons. I would think that if
the women have more responsibilities at home, they would be less likely to have time at home
for EHR work. Otherwise, recommend accepting without edits. | BMC | 12893_2025_2808_ReviewerReport_V1_R4.pdf | {
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0 | 0 | Review for 10.1186/s12893-025-02808-w | Reviewed - bmc_surgery | Title: The gender gap in academic surgery: the electronic health record
Version: 2 Date: 10 Jan 2025
Reviewer's report:
Thank you for taking the time to revise. | Title: The gender gap in academic surgery: the electronic health record
Version: 2 Date: 10 Jan 2025
Reviewer's report:
Thank you for taking the time to revise. | BMC | 12893_2025_2808_ReviewerReport_V2_R1.pdf | {
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0 | 0 | Review for 10.1186/s12893-025-02808-w | Reviewed - bmc_surgery | Title: The gender gap in academic surgery: the electronic health record
Version: 2 Date: 05 Feb 2025
Reviewer: Heather J. Logghe
Reviewer's report:
The article explores gender differences in time spent with the EHR. While more extensive
literature exist on this topic among other medical specialities, it is one of the first to explore
ERH use among surgeons.
Limited to a single institution, the scope of the study impressive--covering numerous
subspecialties. The study design explores multiple facets of EHR use, including hours spent
in and outside of scheduled work time. It also includes useful related metrics such as EHR
proficiency and EHR support. Methods and statistical analysis are clearly described.
The article provides a thorough discussion highlighting the importance of this work citing gender
disparities in burnout, leadership, and compensation of female surgeons. It also offers useful
insight for futures studies and potential areas for further research. | Title: The gender gap in academic surgery: the electronic health record
Version: 2 Date: 05 Feb 2025
Reviewer: Heather J. Logghe
Reviewer's report:
The article explores gender differences in time spent with the EHR. While more extensive
literature exist on this topic among other medical specialities, it is one of the first to explore
ERH use among surgeons.
Limited to a single institution, the scope of the study impressive--covering numerous
subspecialties. The study design explores multiple facets of EHR use, including hours spent
in and outside of scheduled work time. It also includes useful related metrics such as EHR
proficiency and EHR support. Methods and statistical analysis are clearly described.
The article provides a thorough discussion highlighting the importance of this work citing gender
disparities in burnout, leadership, and compensation of female surgeons. It also offers useful
insight for futures studies and potential areas for further research. | BMC | 12893_2025_2808_ReviewerReport_V2_R3.pdf | {
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"content": "Title: The gender gap in academic surgery: the electronic health record\nVersion: 2 Date: 05 Feb 2025\nReviewer: Heather J. Logghe\nReviewer's report:\nThe article explores gender differences in time spent with the EHR. While... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02809-9 | Reviewed - bmc_surgery | Title: Role of Wound Protectors in Preventing Surgical Site Infection in Patients Undergoing
Abdominal Surgery: A Meta-Analysis of Randomized Controlled Trials
Version: 2 Date: 04 Nov 2024
Reviewer: Julien Hasselmann
Reviewer's report:
Well-organized and relevant meta-analysis. The manuscript needs linguistic editing. Words like
“meticulous” and “careful” should not be used in materials and results, same goes for “our”
Introduction
„It is reported that the SSI rate is about 0.5%- 5% in patients undergoing surgery…”
- What types of surgery are you referring to here that has a 0,5-5% SSI rate? Please specify.
“It is believed that the reduction in exposure to bacteria would decrease the SSI after surgery.12,
13”
- You´re missing the word “rate” after SSI.
“Thus, the wound protector (WP) device was designed to form a barrier between the wound
edge and the operative site to isolate the potential bacteria that may be exposed to the wound.”
- I think it is the other way around: you isolate the wound edges from bacterial exposure.
METHODS:
- Do you think that excluding studies that only presented the data in poster form may introduce
publication bias?
RESULTS:
- Subgroup analysis – why did you exclude open appendectomies if they did not meet your
exclusion criteria? Even though the preferred mode is laparoscopy, this is not yet a global fact
and the results | Title: Role of Wound Protectors in Preventing Surgical Site Infection in Patients Undergoing
Abdominal Surgery: A Meta-Analysis of Randomized Controlled Trials
Version: 2 Date: 04 Nov 2024
Reviewer: Julien Hasselmann
Reviewer's report:
Well-organized and relevant meta-analysis. The manuscript needs linguistic editing. Words like
“meticulous” and “careful” should not be used in materials and results, same goes for “our”
Introduction
„It is reported that the SSI rate is about 0.5%- 5% in patients undergoing surgery…”
- What types of surgery are you referring to here that has a 0,5-5% SSI rate? Please specify.
“It is believed that the reduction in exposure to bacteria would decrease the SSI after surgery.12,
13”
- You´re missing the word “rate” after SSI.
“Thus, the wound protector (WP) device was designed to form a barrier between the wound
edge and the operative site to isolate the potential bacteria that may be exposed to the wound.”
- I think it is the other way around: you isolate the wound edges from bacterial exposure.
METHODS:
- Do you think that excluding studies that only presented the data in poster form may introduce
publication bias?
RESULTS:
- Subgroup analysis – why did you exclude open appendectomies if they did not meet your
exclusion criteria? Even though the preferred mode is laparoscopy, this is not yet a global fact
and the results | BMC | 12893_2025_2809_ReviewerReport_V2_R1.pdf | {
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"content": "Title: Role of Wound Protectors in Preventing Surgical Site Infection in Patients Undergoing\nAbdominal Surgery: A Meta-Analysis of Randomized Controlled Trials\nVersion: 2 Date: 04 Nov 2024\nReviewer: Julien Hasselmann\nRevi... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02809-9 | Reviewed - bmc_surgery | Title: Role of Wound Protectors in Preventing Surgical Site Infection in Patients Undergoing
Abdominal Surgery: A Meta-Analysis of Randomized Controlled Trials
Version: 2 Date: 08 Dec 2024
Reviewer's report:
Dear authors
Overall, the meta-analysis seems sound and well-conducted, however, the reporting can be
improved and the use of GRADE and Cochrane RoB2, I suspect has not been done correctly,
please see comments below. However, with thorough revisions this can be improved.
Comments:
0. Abbstract: please report date of last search, risk of bias tool in line with PRISMA abstract
guidance.
1. Methods: Please delete space in the registration number for PROSPERO, it should be
“CRD42024576426”.
2. Methods: Please specify “respective inceptions” for databases such as PubMed, Embase and
Web of Science as these may vary (especially Embase).
3. Methods: Did you search Cochrane Library (several databases including Cochrane protocols
and reviews) or Cochrane CENTRAL (RCT database)?
4. Methods. Did you conduct forward or backward citation searching? (PRISMA #6)
5. Methods: Please state in the manuscript that the search string differs from the planned search
string in the protocol. I also advise that you write more specifically which terms that were used
in each database, e.g. MeSH terms are not clear from the current reporting. (PRISMA #7)
6. Methods: Please clearly report if fulltext screening was also done independently by two
reviewers? (PRISMA #8)
7. Methods: Were there any restrictions on the participants, e.g. adults only?
8. Methods: Did you extract data on funding or potential conflict of interest as a medical device
was tested by the RCTs?
9. Methods. What was the thresholds for heterogeneity based on? (NB! Cochrane Handbook has
been updated and new thresholds now apply).
10. Methods: Analysis for reporting bias is not described (PRISMA #14)
11. Methods: You present more subgroups in the result section than reported in the methods and
planned in the protocol, please report this. (PRISMA #24)
12. Figure 1: The numbers do not add up, please revise.
13. Results: Please consider a short summary on the overall characteristics of the included RCTs
presented in Table 1 e.g., x% colorecta, % appedectomy, etc. The use of i.v. antibiotics as a
prophylactic measure would also be relevant to summarize.
14. Figure 2: It is quite seldom for surgical studies to receive such many domains with low
risk of bias when using RoB2. I would for instance expect that fewer of the included articles
had published protocol and/or trial registrations making it possible to gain a low risk of bias.
Also, missing data is usually a problem even when date of follow-up is 30 days after surgery.
Furthermore, you should not present both and evaluation of intervention-to-treat and per-
protocol. You should consider which is relevant for your review question and present that bias
assessment. Please see guidance at www.riskofbias.info.
15. Risk of bias: please also present the overall risk of bias, see guidance at www.riskofbias.info.
16. GRADE: Please revise the summary of findings table, so it is written in English, and the
intervention version is used (it does not have an “importance column, but includes comments),
include the number of participants as well and consider including this as a main figure due to
its importance.
17. Results and table 1: Please cite all included RCTs so they can easily be found the reference
list.
Results: did you consider heterogeneity due time of conduct? Your trials were published from
199 to 2024.
18. Discussion: Please moderate your key findings in the first paragraph of the discussion – you
have low or very low certainty of evidence for most outcomes, thus, you should take this into
account when concluding n your findings.
19. Discussion: Please discuss your result in comparison with other reviews examining the same
review question – why are your results important, what do you address that others did not?
20. Discussion: please also consider the limitations of your review conduct in the discussion
section.
21. Figures: Please check the spelling. | Title: Role of Wound Protectors in Preventing Surgical Site Infection in Patients Undergoing
Abdominal Surgery: A Meta-Analysis of Randomized Controlled Trials
Version: 2 Date: 08 Dec 2024
Reviewer's report:
Dear authors
Overall, the meta-analysis seems sound and well-conducted, however, the reporting can be
improved and the use of GRADE and Cochrane RoB2, I suspect has not been done correctly,
please see comments below. However, with thorough revisions this can be improved.
Comments:
0. Abbstract: please report date of last search, risk of bias tool in line with PRISMA abstract
guidance.
1. Methods: Please delete space in the registration number for PROSPERO, it should be
“CRD42024576426”.
2. Methods: Please specify “respective inceptions” for databases such as PubMed, Embase and
Web of Science as these may vary (especially Embase).
3. Methods: Did you search Cochrane Library (several databases including Cochrane protocols
and reviews) or Cochrane CENTRAL (RCT database)?
4. Methods. Did you conduct forward or backward citation searching? (PRISMA #6)
5. Methods: Please state in the manuscript that the search string differs from the planned search
string in the protocol. I also advise that you write more specifically which terms that were used
in each database, e.g. MeSH terms are not clear from the current reporting. (PRISMA #7)
6. Methods: Please clearly report if fulltext screening was also done independently by two
reviewers? (PRISMA #8)
7. Methods: Were there any restrictions on the participants, e.g. adults only?
8. Methods: Did you extract data on funding or potential conflict of interest as a medical device
was tested by the RCTs?
9. Methods. What was the thresholds for heterogeneity based on? (NB! Cochrane Handbook has
been updated and new thresholds now apply).
10. Methods: Analysis for reporting bias is not described (PRISMA #14)
11. Methods: You present more subgroups in the result section than reported in the methods and
planned in the protocol, please report this. (PRISMA #24)
12. Figure 1: The numbers do not add up, please revise.
13. Results: Please consider a short summary on the overall characteristics of the included RCTs
presented in Table 1 e.g., x% colorecta, % appedectomy, etc. The use of i.v. antibiotics as a
prophylactic measure would also be relevant to summarize.
14. Figure 2: It is quite seldom for surgical studies to receive such many domains with low
risk of bias when using RoB2. I would for instance expect that fewer of the included articles
had published protocol and/or trial registrations making it possible to gain a low risk of bias.
Also, missing data is usually a problem even when date of follow-up is 30 days after surgery.
Furthermore, you should not present both and evaluation of intervention-to-treat and per-
protocol. You should consider which is relevant for your review question and present that bias
assessment. Please see guidance at www.riskofbias.info.
15. Risk of bias: please also present the overall risk of bias, see guidance at www.riskofbias.info.
16. GRADE: Please revise the summary of findings table, so it is written in English, and the
intervention version is used (it does not have an “importance column, but includes comments),
include the number of participants as well and consider including this as a main figure due to
its importance.
17. Results and table 1: Please cite all included RCTs so they can easily be found the reference
list.
Results: did you consider heterogeneity due time of conduct? Your trials were published from
199 to 2024.
18. Discussion: Please moderate your key findings in the first paragraph of the discussion – you
have low or very low certainty of evidence for most outcomes, thus, you should take this into
account when concluding n your findings.
19. Discussion: Please discuss your result in comparison with other reviews examining the same
review question – why are your results important, what do you address that others did not?
20. Discussion: please also consider the limitations of your review conduct in the discussion
section.
21. Figures: Please check the spelling. | BMC | 12893_2025_2809_ReviewerReport_V2_R4.pdf | {
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{
"content": "Title: Role of Wound Protectors in Preventing Surgical Site Infection in Patients Undergoing\nAbdominal Surgery: A Meta-Analysis of Randomized Controlled Trials\nVersion: 2 Date: 08 Dec 2024\nReviewer's report:\nDear authors\n... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02809-9 | Reviewed - bmc_surgery | Title: Role of Wound Protectors in Preventing Surgical Site Infection in Patients Undergoing
Abdominal Surgery: A Meta-Analysis of Randomized Controlled Trials
Version: 3 Date: 03 Jan 2025
Reviewer: Julien Hasselmann
Reviewer's report:
Thank you for addressing my comments. I am fully satisfied with your answers and changes and
do not have any more comments at this time. | Title: Role of Wound Protectors in Preventing Surgical Site Infection in Patients Undergoing
Abdominal Surgery: A Meta-Analysis of Randomized Controlled Trials
Version: 3 Date: 03 Jan 2025
Reviewer: Julien Hasselmann
Reviewer's report:
Thank you for addressing my comments. I am fully satisfied with your answers and changes and
do not have any more comments at this time. | BMC | 12893_2025_2809_ReviewerReport_V3_R1.pdf | {
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"content": "Title: Role of Wound Protectors in Preventing Surgical Site Infection in Patients Undergoing\nAbdominal Surgery: A Meta-Analysis of Randomized Controlled Trials\nVersion: 3 Date: 03 Jan 2025\nReviewer: Julien Hasselmann\nRevi... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02809-9 | Reviewed - bmc_surgery | Title: Role of Wound Protectors in Preventing Surgical Site Infection in Patients Undergoing
Abdominal Surgery: A Meta-Analysis of Randomized Controlled Trials
Version: 3 Date: 25 Jan 2025
Reviewer's report:
Since the previous reviewer has already described the statistical methods, I would like to present
some questions from a general clinical surgeon.
1. As stated in the text as “Introduction,” there are various SSI countermeasures other than WP
specification, such as prophylactic antimicrobial administration, pre-closure wound cleansing,
warming, blood glucose control, etc., which would be constructed as a care bundle. Please tell
me if all the patient groups extracted in this study find only WP useful. If not, I think you need
to explain the rationale for focusing only on WP.
2. I think that laparoscopic surgery has a significant impact on the reduction of SSI. I think it is
unreasonable to analyze studies on laparotomy and laparoscopy equally.
3. Please let me know if there are any studies that refer to wound length.
4. Since you mentioned developing countries, I think it would be good to mention a little more
about the cost of using WP itself. | Title: Role of Wound Protectors in Preventing Surgical Site Infection in Patients Undergoing
Abdominal Surgery: A Meta-Analysis of Randomized Controlled Trials
Version: 3 Date: 25 Jan 2025
Reviewer's report:
Since the previous reviewer has already described the statistical methods, I would like to present
some questions from a general clinical surgeon.
1. As stated in the text as “Introduction,” there are various SSI countermeasures other than WP
specification, such as prophylactic antimicrobial administration, pre-closure wound cleansing,
warming, blood glucose control, etc., which would be constructed as a care bundle. Please tell
me if all the patient groups extracted in this study find only WP useful. If not, I think you need
to explain the rationale for focusing only on WP.
2. I think that laparoscopic surgery has a significant impact on the reduction of SSI. I think it is
unreasonable to analyze studies on laparotomy and laparoscopy equally.
3. Please let me know if there are any studies that refer to wound length.
4. Since you mentioned developing countries, I think it would be good to mention a little more
about the cost of using WP itself. | BMC | 12893_2025_2809_ReviewerReport_V3_R5.pdf | {
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} | 1.083333 | 0 | [
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"content": "Title: Role of Wound Protectors in Preventing Surgical Site Infection in Patients Undergoing\nAbdominal Surgery: A Meta-Analysis of Randomized Controlled Trials\nVersion: 3 Date: 25 Jan 2025\nReviewer's report:\nSince the prev... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02809-9 | Reviewed - bmc_surgery | Title: Role of Wound Protectors in Preventing Surgical Site Infection in Patients Undergoing
Abdominal Surgery: A Meta-Analysis of Randomized Controlled Trials
Version: 3 Date: 30 Jan 2025
Reviewer: Tiago Filipe Santos Cunha
Reviewer's report:
I would like the congratulate the authors for selecting this interesting topic to study. The role of
wound protectors has been increasingly reported in literature and their use has been included in
some surgical site infection prevention care bundles in colorectal cancer surgery.
This study is interesting, valid, with an appropriate introduction and is methodologically sound.
The study’s results are well reported, and the conclusions are valid. It is without a doubt an
interesting study, that brings a useful insight in the role of wound protectors in surgical site
infection prevention.
The results were well documented in a clear and concise manner, however, it might prove helpful
for the reader, a report on how many records were identified in each database, as well as how
many duplicates were removed before screening.
The study’s limitations were well pointed out, as well as the necessity of further studies to better
understand the role of wound protectors in surgical site infection reduction in certain contexts,
such as minimal invasive wounds during laparoscopic surgery. Further studies could also help
increase the certainty of evidence level in this topic.
The study’s conclusions are concise and reasonable. | Title: Role of Wound Protectors in Preventing Surgical Site Infection in Patients Undergoing
Abdominal Surgery: A Meta-Analysis of Randomized Controlled Trials
Version: 3 Date: 30 Jan 2025
Reviewer: Tiago Filipe Santos Cunha
Reviewer's report:
I would like the congratulate the authors for selecting this interesting topic to study. The role of
wound protectors has been increasingly reported in literature and their use has been included in
some surgical site infection prevention care bundles in colorectal cancer surgery.
This study is interesting, valid, with an appropriate introduction and is methodologically sound.
The study’s results are well reported, and the conclusions are valid. It is without a doubt an
interesting study, that brings a useful insight in the role of wound protectors in surgical site
infection prevention.
The results were well documented in a clear and concise manner, however, it might prove helpful
for the reader, a report on how many records were identified in each database, as well as how
many duplicates were removed before screening.
The study’s limitations were well pointed out, as well as the necessity of further studies to better
understand the role of wound protectors in surgical site infection reduction in certain contexts,
such as minimal invasive wounds during laparoscopic surgery. Further studies could also help
increase the certainty of evidence level in this topic.
The study’s conclusions are concise and reasonable. | BMC | 12893_2025_2809_ReviewerReport_V3_R6.pdf | {
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"content": "Title: Role of Wound Protectors in Preventing Surgical Site Infection in Patients Undergoing\nAbdominal Surgery: A Meta-Analysis of Randomized Controlled Trials\nVersion: 3 Date: 30 Jan 2025\nReviewer: Tiago Filipe Santos Cun... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02794-z | Reviewed - bmc_surgery | Title: A nomogram for postoperative pulmonary infections in esophageal cancer patients: a two-
center retrospective clinical study
Version: 1 Date: 25 Dec 2024
Reviewer's report:
This is a retrospective review of patients from two separate institutions who have undergone
esophagectomy for esophageal cancer and their risk of developing postoperative pulmonary
infection. The authors should be commended on their diligence in trying to create a nomogram
that is applicable across not just their institution, but others as well. I have a couple of questions.
1. The acronym PPI (postoperative pulmonary infection) is not a common one and can be
confused with proton pump inhibitor in the literature. I suggest the authors use a different
acronym.
2. The timing of when the patients develop postoperative pulmonary infection is important. Do
these occur within the first 30 days? Do they occur just in the hospital stay? What is the length
of hospital stay?
3. I would suggest that the authors keep the continuous variables as continuous variables in their
nomogram/analysis (e.g. age, BMI, duration of surgery).
4. How do the authors define "minimally invasive surgery"? Is it thoracoscopic and
laparoscopic? Is it thoracoscopic and mini-laparotomy? Is it thoracotomy and laparoscopic?
5. When were the PaO2 and PCO2 drawn? Is this at the time of surgery? Is it immediately
postop?
6. Can you better explain Figures 5 and 6 in the methods and headers? Admittedly, this is a
difficult graph to interpret.
7. Overall this manuscript is reasonably written despite it not being the native language of the
majority of the authors. However, there are still spelling errors throughout the manuscript that
can easily be adjudicated.
The purpose of creating a nomogram is to help surgeons better predict who will develop
pulmonary infections. However, timing of when to apply the nomogram is also important. That
is one major point that I would like to see addressed in the manuscript. I would like to know as
a surgeon in another country, can I apply this nomogram on postoperative day 1? Or is it better
suited for postoperative day 4? Or is it too late to use by then? Should I be screening patients
with this in the preoperative clinic? If so, what can I do to optimize the patients and prevent
pulmonary complications? | Title: A nomogram for postoperative pulmonary infections in esophageal cancer patients: a two-
center retrospective clinical study
Version: 1 Date: 25 Dec 2024
Reviewer's report:
This is a retrospective review of patients from two separate institutions who have undergone
esophagectomy for esophageal cancer and their risk of developing postoperative pulmonary
infection. The authors should be commended on their diligence in trying to create a nomogram
that is applicable across not just their institution, but others as well. I have a couple of questions.
1. The acronym PPI (postoperative pulmonary infection) is not a common one and can be
confused with proton pump inhibitor in the literature. I suggest the authors use a different
acronym.
2. The timing of when the patients develop postoperative pulmonary infection is important. Do
these occur within the first 30 days? Do they occur just in the hospital stay? What is the length
of hospital stay?
3. I would suggest that the authors keep the continuous variables as continuous variables in their
nomogram/analysis (e.g. age, BMI, duration of surgery).
4. How do the authors define "minimally invasive surgery"? Is it thoracoscopic and
laparoscopic? Is it thoracoscopic and mini-laparotomy? Is it thoracotomy and laparoscopic?
5. When were the PaO2 and PCO2 drawn? Is this at the time of surgery? Is it immediately
postop?
6. Can you better explain Figures 5 and 6 in the methods and headers? Admittedly, this is a
difficult graph to interpret.
7. Overall this manuscript is reasonably written despite it not being the native language of the
majority of the authors. However, there are still spelling errors throughout the manuscript that
can easily be adjudicated.
The purpose of creating a nomogram is to help surgeons better predict who will develop
pulmonary infections. However, timing of when to apply the nomogram is also important. That
is one major point that I would like to see addressed in the manuscript. I would like to know as
a surgeon in another country, can I apply this nomogram on postoperative day 1? Or is it better
suited for postoperative day 4? Or is it too late to use by then? Should I be screening patients
with this in the preoperative clinic? If so, what can I do to optimize the patients and prevent
pulmonary complications? | BMC | 12893_2025_2794_ReviewerReport_V1_R1.pdf | {
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0 | 0 | Review for 10.1186/s12893-025-02794-z | Reviewed - bmc_surgery | Title: A nomogram for postoperative pulmonary infections in esophageal cancer patients: a two-
center retrospective clinical study
Version: 1 Date: 26 Dec 2024
Reviewer's report:
Shuang Li et al. showed that the nomogram, which incorporates six key factors, effectively
predicts the risk of PPIs and can serve as a valuable tool for clinicians in identifying high-risk
patients.
There are several concerns.
Major comments
1) Lack of information on the potential predictor.
Sarcopenia is an important predictor for PPIs. However, there is no information.
Authors have to add the information.
2) Lack of information on treatment procedures and postoperative courses
There is no information on treatment procedures, such as neoadjuvant therapy, regimen, surgery
procedure, perioperative care (early mobilization, use of feeding tube, etc.), and postoperative
course in the methods section
The information is important for the generalizability. | Title: A nomogram for postoperative pulmonary infections in esophageal cancer patients: a two-
center retrospective clinical study
Version: 1 Date: 26 Dec 2024
Reviewer's report:
Shuang Li et al. showed that the nomogram, which incorporates six key factors, effectively
predicts the risk of PPIs and can serve as a valuable tool for clinicians in identifying high-risk
patients.
There are several concerns.
Major comments
1) Lack of information on the potential predictor.
Sarcopenia is an important predictor for PPIs. However, there is no information.
Authors have to add the information.
2) Lack of information on treatment procedures and postoperative courses
There is no information on treatment procedures, such as neoadjuvant therapy, regimen, surgery
procedure, perioperative care (early mobilization, use of feeding tube, etc.), and postoperative
course in the methods section
The information is important for the generalizability. | BMC | 12893_2025_2794_ReviewerReport_V1_R3.pdf | {
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"content": "Title: A nomogram for postoperative pulmonary infections in esophageal cancer patients: a two-\ncenter retrospective clinical study\nVersion: 1 Date: 26 Dec 2024\nReviewer's report:\nShuang Li et al. showed that the nomogram, ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02794-z | Reviewed - bmc_surgery | Title: A nomogram for postoperative pulmonary infections in esophageal cancer patients: a two-
center retrospective clinical study
Version: 1 Date: 29 Dec 2024
Reviewer: Maohui Chen
Reviewer's report:
Due to the complexity and difficulty of esophagectomy, the incidence of postoperative
pulmonary complications is relatively high. The authors constructed a nomogram to predict the
occurrence of lung infections based on data from two centers. I appreciate the extensive work
done by the authors, but there are still some revisions that need to be made before publication.
1.In this study PPIs were defined as the presence of new chest X-ray infiltrates plus one of the
three clinical variables (fever >38°C, leucocytosis or leucopenia and purulent secretions). This
definition should be explained in more detail. For example, when a chest X-ray is done, and
whether all patients routinely receive chest X-rays.
2. In Table 1, the prevalence of COPD is not consistent with the results of pulmonary function
tests. In addition, COPD is a well-recognized risk factor for postoperative lung infections.
However, COPD was not a risk factor in this study and the authors need to explain this.
3. In addition, the percentage of abnormal arterial partial pressures of oxygen and carbon dioxide
is too high. Does this mean that the patients already had respiratory failure before the operation.
If so, why did these patients still undergo esophagectomy. Also respiratory failure should lead to
a significantly higher rate of pulmonary infections, but the results of this study are not consistent
with this.
4. There are some variables that appear to be contrary to clinical practice. For example, is it
true that 79 of the patients in this study had a history of stroke; that the prevalence of anemia
was as high as 35.1%.
5. Thoracic adhesions are one of the risk factors identified in the study. However, the definition
of thoracic adhesions is too broad to be used as a dichotomous variable. This is because thoracic
adhesions of very small size are the most common in clinical practice, and this does not have an
impact on the surgical procedure or postoperative complications. | Title: A nomogram for postoperative pulmonary infections in esophageal cancer patients: a two-
center retrospective clinical study
Version: 1 Date: 29 Dec 2024
Reviewer: Maohui Chen
Reviewer's report:
Due to the complexity and difficulty of esophagectomy, the incidence of postoperative
pulmonary complications is relatively high. The authors constructed a nomogram to predict the
occurrence of lung infections based on data from two centers. I appreciate the extensive work
done by the authors, but there are still some revisions that need to be made before publication.
1.In this study PPIs were defined as the presence of new chest X-ray infiltrates plus one of the
three clinical variables (fever >38°C, leucocytosis or leucopenia and purulent secretions). This
definition should be explained in more detail. For example, when a chest X-ray is done, and
whether all patients routinely receive chest X-rays.
2. In Table 1, the prevalence of COPD is not consistent with the results of pulmonary function
tests. In addition, COPD is a well-recognized risk factor for postoperative lung infections.
However, COPD was not a risk factor in this study and the authors need to explain this.
3. In addition, the percentage of abnormal arterial partial pressures of oxygen and carbon dioxide
is too high. Does this mean that the patients already had respiratory failure before the operation.
If so, why did these patients still undergo esophagectomy. Also respiratory failure should lead to
a significantly higher rate of pulmonary infections, but the results of this study are not consistent
with this.
4. There are some variables that appear to be contrary to clinical practice. For example, is it
true that 79 of the patients in this study had a history of stroke; that the prevalence of anemia
was as high as 35.1%.
5. Thoracic adhesions are one of the risk factors identified in the study. However, the definition
of thoracic adhesions is too broad to be used as a dichotomous variable. This is because thoracic
adhesions of very small size are the most common in clinical practice, and this does not have an
impact on the surgical procedure or postoperative complications. | BMC | 12893_2025_2794_ReviewerReport_V1_R2.pdf | {
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"role": "user"
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"content": "Title: A nomogram for postoperative pulmonary infections in esophageal cancer patients: a two-\ncenter retrospective clinical study\nVersion: 1 Date: 29 Dec 2024\nReviewer: Maohui Chen\nReviewer's report:\nDue to the complexi... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02794-z | Reviewed - bmc_surgery | Title: A nomogram for postoperative pulmonary infections in esophageal cancer patients: a two-
center retrospective clinical study
Version: 2 Date: 07 Jan 2025
Reviewer's report:
The authors have answered my questions, but still require some clarification.
For question 4, the authors should explicitly state if both thoracic and abdominal portions of
the minimally invasive esophagectomy were performed minimally invasively, or if there is a
hybrid approach.
For question 5, the authors state that paO2 and paCO2 are obtained preoperatively. Do the
authors routinely obtain ABGs on patients before they intubate for surgery?
If age and duration of surgery were truly important variables, I suspect that they would still be
significant if treated as continuous variables. As the current nomogram stands, a patient who
is 69 and has a surgery that is 329 minutes long, would have a vastly different risk of POPI
compared to a patient who is 70 and undergoes a surgery that is 331 minutes long.
the nomogram should again make sense clinically and be useful to clinicians. I believe that the
authors can better describe what they do after they have identified patients at high risk for POPI.
I appreciate the explanations of the CIC and DCA plots. Overall the manuscript is improved but
could still use some minor adjustments before publication. | Title: A nomogram for postoperative pulmonary infections in esophageal cancer patients: a two-
center retrospective clinical study
Version: 2 Date: 07 Jan 2025
Reviewer's report:
The authors have answered my questions, but still require some clarification.
For question 4, the authors should explicitly state if both thoracic and abdominal portions of
the minimally invasive esophagectomy were performed minimally invasively, or if there is a
hybrid approach.
For question 5, the authors state that paO2 and paCO2 are obtained preoperatively. Do the
authors routinely obtain ABGs on patients before they intubate for surgery?
If age and duration of surgery were truly important variables, I suspect that they would still be
significant if treated as continuous variables. As the current nomogram stands, a patient who
is 69 and has a surgery that is 329 minutes long, would have a vastly different risk of POPI
compared to a patient who is 70 and undergoes a surgery that is 331 minutes long.
the nomogram should again make sense clinically and be useful to clinicians. I believe that the
authors can better describe what they do after they have identified patients at high risk for POPI.
I appreciate the explanations of the CIC and DCA plots. Overall the manuscript is improved but
could still use some minor adjustments before publication. | BMC | 12893_2025_2794_ReviewerReport_V2_R1.pdf | {
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"role": "user"
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"content": "Title: A nomogram for postoperative pulmonary infections in esophageal cancer patients: a two-\ncenter retrospective clinical study\nVersion: 2 Date: 07 Jan 2025\nReviewer's report:\nThe authors have answered my questions, but... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02794-z | Reviewed - bmc_surgery | Title: A nomogram for postoperative pulmonary infections in esophageal cancer patients: a two-
center retrospective clinical study
Version: 2 Date: 10 Jan 2025
Reviewer: Maohui Chen
Reviewer's report:
The authors responsibly made the appropriate revisions. This study has a definite clinical
relevance worthy of publication, albeit with some minor limitations. | Title: A nomogram for postoperative pulmonary infections in esophageal cancer patients: a two-
center retrospective clinical study
Version: 2 Date: 10 Jan 2025
Reviewer: Maohui Chen
Reviewer's report:
The authors responsibly made the appropriate revisions. This study has a definite clinical
relevance worthy of publication, albeit with some minor limitations. | BMC | 12893_2025_2794_ReviewerReport_V2_R2.pdf | {
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"role": "user"
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"content": "Title: A nomogram for postoperative pulmonary infections in esophageal cancer patients: a two-\ncenter retrospective clinical study\nVersion: 2 Date: 10 Jan 2025\nReviewer: Maohui Chen\nReviewer's report:\nThe authors respons... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02794-z | Reviewed - bmc_surgery | Title: A nomogram for postoperative pulmonary infections in esophageal cancer patients: a two-
center retrospective clinical study
Version: 2 Date: 14 Jan 2025
Reviewer's report:
Authors revised it well.
No additional comments. | Title: A nomogram for postoperative pulmonary infections in esophageal cancer patients: a two-
center retrospective clinical study
Version: 2 Date: 14 Jan 2025
Reviewer's report:
Authors revised it well.
No additional comments. | BMC | 12893_2025_2794_ReviewerReport_V2_R3.pdf | {
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"role": "user"
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"content": "Title: A nomogram for postoperative pulmonary infections in esophageal cancer patients: a two-\ncenter retrospective clinical study\nVersion: 2 Date: 14 Jan 2025\nReviewer's report:\nAuthors revised it well.\nNo additional com... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02794-z | Reviewed - bmc_surgery | Title: A nomogram for postoperative pulmonary infections in esophageal cancer patients: a two-
center retrospective clinical study
Version: 3 Date: 24 Jan 2025
Reviewer's report:
The authors have adequately addressed my concerns. | Title: A nomogram for postoperative pulmonary infections in esophageal cancer patients: a two-
center retrospective clinical study
Version: 3 Date: 24 Jan 2025
Reviewer's report:
The authors have adequately addressed my concerns. | BMC | 12893_2025_2794_ReviewerReport_V3_R1.pdf | {
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"role": "user"
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"content": "Title: A nomogram for postoperative pulmonary infections in esophageal cancer patients: a two-\ncenter retrospective clinical study\nVersion: 3 Date: 24 Jan 2025\nReviewer's report:\nThe authors have adequately addressed my co... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02810-2 | Reviewed - bmc_surgery | Title: Thyroidectomy Under Local Versus General Anesthesia in Health Camp Settings in
Uganda: A Randomized Prospective Equivalence Single-Blind Controlled Trial
Version: 4 Date: 02 Apr 2024
Reviewer's report:
This is an interesting study on the use of local (LA) vs general anesthesia (GA) for
thyroidectomy. I congratulate the authors for completing an RCT. It appears to be the first
of its kind in East Africa despite other studies demonstrating feasibility and safety with local
anesthesia.
The introduction provides a solid background on the surgical management of endemic goiter in
Uganda. However, the rationale for the study could be strengthened by explicitly stating the gap
in the literature about the comparison of LA and GA in this context. Additionally, the research
hypothesis should be clearly articulated to guide the reader's expectations for the study outcomes.
Despite the interest, there are some concerns with the Methods of the study to reach the stated
conclusions.
My biggest problem with the study is in the Methods to determine the sample size.
Unfortunately, this is a crucial aspect of the RCT to determine equivalence. The authors have
cited Myles et al. to state a patient acceptable symptom rate of 33%. However, the study from
Myles et al. states, "Analgesic interventions that provide a change of 10 for the 100 mm pain
VAS signify a clinically important improvement or deterioration." I would like for the authors
to explain how they determined to have a threshold of 33%, which seems like a large variation,
and thus a small sample size calculated to underpower their study.
When no difference is detected between the two groups, we can only conclude that the sample
size was not large enough.
Furthermore, two participants were excluded due to "respiratory distress." That sounds like a
miserable patient experience and should be included in the analysis. If 28 experienced respiratory
distress would that argue against the use of LA? If so, why exclude the two? Their experiences
would provide valuable insight into LA compared to GA. The authors planned to use an intention
to treat analysis in their protocol, and this should be performed by keeping these two excluded
patients in the analysis. These two patients should be highlighted for why they are excluded and
their experience included.
It appears that this study happened during a "camp". As a surgeon in Kenya, there are numerous
ethical concerns with surgical camps. Perhaps, this is different than Uganda, but my concern
needs to be voiced here.
How many participants refused to be a part of the study? This is valuable information for the
acceptability of LA vs GA. If there were numerous who refused to enroll, what did they elect to
do? GA or LA? If no one refused, I have concerns about the coercion to participate in the study
in order to access free care at a camp.
The mention of reducing costs for postoperative monitoring while providing “free” care seems
concerning.
"During draping, the patient's mouth and nose remained exposed to facilitate communication
and spontaneous breathing, ensuring recurrent laryngeal nerve safety(5).” Kindly explain how
this keeps the nerve safe. Perhaps you could identify an injury immediately, but it does not
protect the nerve.
There is no mention of endotracheal nerve monitoring and how this is impossible with local
anesthesia.
The trial protocol, introduction, and discussion mention costs. This should be mentioned in the
Methods and Results to drive the Discussion. Were there any differences in costs between LA
and GA? If so, what were they?
Ethically, it seems that performing thyroidectomies under local anesthesia should require MORE
involvement from an anesthesiologist to appropriately monitor the airway during the case. I am
concerned with the message that is potentially being communicated that resource limitations
should compromise care.
An additional ethical dilemma is performing thyroidectomy in a setting where thyroid hormone
replacement may be inaccessible. The authors should comment further on these challenges. The
limited follow up described is concerning for adequate postoperative care of patients undergoing
thyroidectomy.
Overall, there are numerous concerns with this study, but it remains potentially interesting. | Title: Thyroidectomy Under Local Versus General Anesthesia in Health Camp Settings in
Uganda: A Randomized Prospective Equivalence Single-Blind Controlled Trial
Version: 4 Date: 02 Apr 2024
Reviewer's report:
This is an interesting study on the use of local (LA) vs general anesthesia (GA) for
thyroidectomy. I congratulate the authors for completing an RCT. It appears to be the first
of its kind in East Africa despite other studies demonstrating feasibility and safety with local
anesthesia.
The introduction provides a solid background on the surgical management of endemic goiter in
Uganda. However, the rationale for the study could be strengthened by explicitly stating the gap
in the literature about the comparison of LA and GA in this context. Additionally, the research
hypothesis should be clearly articulated to guide the reader's expectations for the study outcomes.
Despite the interest, there are some concerns with the Methods of the study to reach the stated
conclusions.
My biggest problem with the study is in the Methods to determine the sample size.
Unfortunately, this is a crucial aspect of the RCT to determine equivalence. The authors have
cited Myles et al. to state a patient acceptable symptom rate of 33%. However, the study from
Myles et al. states, "Analgesic interventions that provide a change of 10 for the 100 mm pain
VAS signify a clinically important improvement or deterioration." I would like for the authors
to explain how they determined to have a threshold of 33%, which seems like a large variation,
and thus a small sample size calculated to underpower their study.
When no difference is detected between the two groups, we can only conclude that the sample
size was not large enough.
Furthermore, two participants were excluded due to "respiratory distress." That sounds like a
miserable patient experience and should be included in the analysis. If 28 experienced respiratory
distress would that argue against the use of LA? If so, why exclude the two? Their experiences
would provide valuable insight into LA compared to GA. The authors planned to use an intention
to treat analysis in their protocol, and this should be performed by keeping these two excluded
patients in the analysis. These two patients should be highlighted for why they are excluded and
their experience included.
It appears that this study happened during a "camp". As a surgeon in Kenya, there are numerous
ethical concerns with surgical camps. Perhaps, this is different than Uganda, but my concern
needs to be voiced here.
How many participants refused to be a part of the study? This is valuable information for the
acceptability of LA vs GA. If there were numerous who refused to enroll, what did they elect to
do? GA or LA? If no one refused, I have concerns about the coercion to participate in the study
in order to access free care at a camp.
The mention of reducing costs for postoperative monitoring while providing “free” care seems
concerning.
"During draping, the patient's mouth and nose remained exposed to facilitate communication
and spontaneous breathing, ensuring recurrent laryngeal nerve safety(5).” Kindly explain how
this keeps the nerve safe. Perhaps you could identify an injury immediately, but it does not
protect the nerve.
There is no mention of endotracheal nerve monitoring and how this is impossible with local
anesthesia.
The trial protocol, introduction, and discussion mention costs. This should be mentioned in the
Methods and Results to drive the Discussion. Were there any differences in costs between LA
and GA? If so, what were they?
Ethically, it seems that performing thyroidectomies under local anesthesia should require MORE
involvement from an anesthesiologist to appropriately monitor the airway during the case. I am
concerned with the message that is potentially being communicated that resource limitations
should compromise care.
An additional ethical dilemma is performing thyroidectomy in a setting where thyroid hormone
replacement may be inaccessible. The authors should comment further on these challenges. The
limited follow up described is concerning for adequate postoperative care of patients undergoing
thyroidectomy.
Overall, there are numerous concerns with this study, but it remains potentially interesting. | BMC | 12893_2025_2810_ReviewerReport_V4_R1.pdf | {
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} | 1.431818 | 0 | [
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"content": "Please review this paper.",
"role": "user"
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{
"content": "Title: Thyroidectomy Under Local Versus General Anesthesia in Health Camp Settings in\nUganda: A Randomized Prospective Equivalence Single-Blind Controlled Trial\nVersion: 4 Date: 02 Apr 2024\nReviewer's report:\nThis is an in... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02810-2 | Reviewed - bmc_surgery | Title: Thyroidectomy Under Local Versus General Anesthesia in Health Camp Settings in
Uganda: A Randomized Prospective Equivalence Single-Blind Controlled Trial
Version: 4 Date: 04 Apr 2024
Reviewer's report:
Thank you for the opportunity to review the manuscript entitled “Euthyroidectomy Under Local
Versus General Anesthesia in Health Camp Settings in Uganda: A Randomized Prospective
Equivalence Single-Blind Controlled Trial” by Kabuye and colleagues.
The study assessed 56 patients randomized to thyroid surgery with either local or general
anesthesia. It is nicely written, and I have only a few minor edits/questions:
Do you have any data on the number of thyroidectomies performed by the senior surgeons
annually (both under GA and LA)? I support the article’s conclusions, however I would argue
that the technique should not be attempted by inexperienced surgeons or in an ultra low-resource
setting for the first time.
Did any patients cross over to GA, and if so, why?
Could you provide a bit more information about the health camps and setup within each,
particularly in regards to length of time surgery is available, patient recruitment, operative
conditions, and availability of follow up?
Results paragraph 3; please clarify that the mean duration of symptoms refers to preoperative
symptoms.
For readers unfamiliar with goiter classification, a sentence or two describing grading of the
thyroid enlargement would be helpful.
Table 1: Were the reported voice changes subjective only, or was there any objective
confirmation? | Title: Thyroidectomy Under Local Versus General Anesthesia in Health Camp Settings in
Uganda: A Randomized Prospective Equivalence Single-Blind Controlled Trial
Version: 4 Date: 04 Apr 2024
Reviewer's report:
Thank you for the opportunity to review the manuscript entitled “Euthyroidectomy Under Local
Versus General Anesthesia in Health Camp Settings in Uganda: A Randomized Prospective
Equivalence Single-Blind Controlled Trial” by Kabuye and colleagues.
The study assessed 56 patients randomized to thyroid surgery with either local or general
anesthesia. It is nicely written, and I have only a few minor edits/questions:
Do you have any data on the number of thyroidectomies performed by the senior surgeons
annually (both under GA and LA)? I support the article’s conclusions, however I would argue
that the technique should not be attempted by inexperienced surgeons or in an ultra low-resource
setting for the first time.
Did any patients cross over to GA, and if so, why?
Could you provide a bit more information about the health camps and setup within each,
particularly in regards to length of time surgery is available, patient recruitment, operative
conditions, and availability of follow up?
Results paragraph 3; please clarify that the mean duration of symptoms refers to preoperative
symptoms.
For readers unfamiliar with goiter classification, a sentence or two describing grading of the
thyroid enlargement would be helpful.
Table 1: Were the reported voice changes subjective only, or was there any objective
confirmation? | BMC | 12893_2025_2810_ReviewerReport_V4_R2.pdf | {
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"total": 9
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"suggestion_and_solution": 0.4444444444444444
} | 2.111111 | 0 | [
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"content": "Please review this paper.",
"role": "user"
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{
"content": "Title: Thyroidectomy Under Local Versus General Anesthesia in Health Camp Settings in\nUganda: A Randomized Prospective Equivalence Single-Blind Controlled Trial\nVersion: 4 Date: 04 Apr 2024\nReviewer's report:\nThank you for... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02810-2 | Reviewed - bmc_surgery | Title: Thyroidectomy Under Local Versus General Anesthesia in Health Camp Settings in
Uganda: A Randomized Prospective Equivalence Single-Blind Controlled Trial
Version: 5 Date: 10 Nov 2024
Reviewer's report:
Thank you for the thoughtful response to all reviewer comments. I have no additional concerns
about the paper. | Title: Thyroidectomy Under Local Versus General Anesthesia in Health Camp Settings in
Uganda: A Randomized Prospective Equivalence Single-Blind Controlled Trial
Version: 5 Date: 10 Nov 2024
Reviewer's report:
Thank you for the thoughtful response to all reviewer comments. I have no additional concerns
about the paper. | BMC | 12893_2025_2810_ReviewerReport_V5_R4.pdf | {
"criticism": 1,
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} | 1.5 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Thyroidectomy Under Local Versus General Anesthesia in Health Camp Settings in\nUganda: A Randomized Prospective Equivalence Single-Blind Controlled Trial\nVersion: 5 Date: 10 Nov 2024\nReviewer's report:\nThank you for... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02810-2 | Reviewed - bmc_surgery | Title: Thyroidectomy Under Local Versus General Anesthesia in Health Camp Settings in
Uganda: A Randomized Prospective Equivalence Single-Blind Controlled Trial
Version: 5 Date: 17 Nov 2024
Reviewer's report:
The authors have made some revisions, but the article is still flawed with its sample size to detect
a difference. All of the articles cited by the authors to determine effect size are much much
smaller than the 33% the authors used.
The authors should comment on the two patients who converted from LA to GA. When stating
that they would choose the same anesthesia again, does that mean they would prefer GA instead
of LA (because that is the anesthesia they received)? | Title: Thyroidectomy Under Local Versus General Anesthesia in Health Camp Settings in
Uganda: A Randomized Prospective Equivalence Single-Blind Controlled Trial
Version: 5 Date: 17 Nov 2024
Reviewer's report:
The authors have made some revisions, but the article is still flawed with its sample size to detect
a difference. All of the articles cited by the authors to determine effect size are much much
smaller than the 33% the authors used.
The authors should comment on the two patients who converted from LA to GA. When stating
that they would choose the same anesthesia again, does that mean they would prefer GA instead
of LA (because that is the anesthesia they received)? | BMC | 12893_2025_2810_ReviewerReport_V5_R3.pdf | {
"criticism": 1,
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"total": 4
} | {
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} | 1 | 0 | [
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"content": "Please review this paper.",
"role": "user"
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{
"content": "Title: Thyroidectomy Under Local Versus General Anesthesia in Health Camp Settings in\nUganda: A Randomized Prospective Equivalence Single-Blind Controlled Trial\nVersion: 5 Date: 17 Nov 2024\nReviewer's report:\nThe authors h... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02810-2 | Reviewed - bmc_surgery | Title: Thyroidectomy Under Local Versus General Anesthesia in Health Camp Settings in
Uganda: A Randomized Prospective Equivalence Single-Blind Controlled Trial
Version: 6 Date: 11 Dec 2024
Reviewer's report:
Review: Euthyroidectomy under local versus general anesthesia in health camp settings in
Uganda: a randomized prospective equivalence single-blind controlled trial
Thank you for the opportunity to review this manuscript. I commend the authors for undertaking
this challenging research and considering alternative systems to offer patients thyroidectomy
in Uganda.
I have three main comments and added tracked changes and comments to the Word document/
manuscript.
1. There is an inconsistency between the aims according to the introduction, methodology,
results, and conclusion. These should be aligned (see comments in the manuscript, e.g. cost
analysis only included later, not in methodology).
2. The data analysis should be checked by a professional statistician. The data analysis should
be written systematically (see comments in manuscript).
3. The two LA patients who ‘crossed over’ to the GA group can be included in the analysis
(acknowledged a previous reviewer’s request), but they should form part of the GA group when
comparing outcomes.
Would the authors be able to submit the material they used for:
1. Example of the informed consent form
2. Visual analogue scale for pain
3. Nausea and vomiting scale – reported as yes/no in Table 2, how is it a scale?
4. Likert scale used at 30-day follow-up
Please refer to the attached Word document for further input. | Title: Thyroidectomy Under Local Versus General Anesthesia in Health Camp Settings in
Uganda: A Randomized Prospective Equivalence Single-Blind Controlled Trial
Version: 6 Date: 11 Dec 2024
Reviewer's report:
Review: Euthyroidectomy under local versus general anesthesia in health camp settings in
Uganda: a randomized prospective equivalence single-blind controlled trial
Thank you for the opportunity to review this manuscript. I commend the authors for undertaking
this challenging research and considering alternative systems to offer patients thyroidectomy
in Uganda.
I have three main comments and added tracked changes and comments to the Word document/
manuscript.
1. There is an inconsistency between the aims according to the introduction, methodology,
results, and conclusion. These should be aligned (see comments in the manuscript, e.g. cost
analysis only included later, not in methodology).
2. The data analysis should be checked by a professional statistician. The data analysis should
be written systematically (see comments in manuscript).
3. The two LA patients who ‘crossed over’ to the GA group can be included in the analysis
(acknowledged a previous reviewer’s request), but they should form part of the GA group when
comparing outcomes.
Would the authors be able to submit the material they used for:
1. Example of the informed consent form
2. Visual analogue scale for pain
3. Nausea and vomiting scale – reported as yes/no in Table 2, how is it a scale?
4. Likert scale used at 30-day follow-up
Please refer to the attached Word document for further input. | BMC | 12893_2025_2810_ReviewerReport_V6_R5.pdf | {
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"total": 18
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} | 1.388889 | 0 | [
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"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Thyroidectomy Under Local Versus General Anesthesia in Health Camp Settings in\nUganda: A Randomized Prospective Equivalence Single-Blind Controlled Trial\nVersion: 6 Date: 11 Dec 2024\nReviewer's report:\nReview: Euthy... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02810-2 | Reviewed - bmc_surgery | Title: Thyroidectomy Under Local Versus General Anesthesia in Health Camp Settings in
Uganda: A Randomized Prospective Equivalence Single-Blind Controlled Trial
Version: 6 Date: 12 Dec 2024
Reviewer's report:
Appreciate the thoughtful revisions. I do not have any additional concerns with the paper and
feel it is reasonable to consider acceptance at this point. | Title: Thyroidectomy Under Local Versus General Anesthesia in Health Camp Settings in
Uganda: A Randomized Prospective Equivalence Single-Blind Controlled Trial
Version: 6 Date: 12 Dec 2024
Reviewer's report:
Appreciate the thoughtful revisions. I do not have any additional concerns with the paper and
feel it is reasonable to consider acceptance at this point. | BMC | 12893_2025_2810_ReviewerReport_V6_R4.pdf | {
"criticism": 0,
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} | 1.5 | 0 | [
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"role": "user"
},
{
"content": "Title: Thyroidectomy Under Local Versus General Anesthesia in Health Camp Settings in\nUganda: A Randomized Prospective Equivalence Single-Blind Controlled Trial\nVersion: 6 Date: 12 Dec 2024\nReviewer's report:\nAppreciate th... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02810-2 | Reviewed - bmc_surgery | Title: Thyroidectomy Under Local Versus General Anesthesia in Health Camp Settings in
Uganda: A Randomized Prospective Equivalence Single-Blind Controlled Trial
Version: 6 Date: 14 Dec 2024
Reviewer's report:
Although I cannot find a tracked changes version of the manuscript for this round of review, I
do not think there were substantial changes made to need it.
Re: this comment
"The authors are happy to learn
by the authors to determine effect size are much smaller than the
from the reviewer of a larger study which could have been
33% the authors used.
missed but applicable for the authors' research and settings at that
time"
The authors have cited the article (11) which they say has a difference of 4% (83% of
euthyroidectomy patients under LA had no complications compared to 79% under GA). So, if
that is the baseline difference they are trying to detect (4%) then a study powered on a 33%
difference will be inaccurate. About the 33%, the authors used a patient-acceptable symptom
state of 33% but cited an article (18) that does not justify 33%, but instead a 10 point change
in the VAS. I do not think this study was powered to detect an appropriate difference, and the
justification should be changed. Perhaps, the authors could state that they decided on the sample
size to mirror the study (11) from Snyder et al. But, in their limitations they could state that the
study was underpowered to detect a difference.
Also, the authors could consider:
Instead of an equivalence study, the authors could reframe to a feasibility study. This would be
more consistent with what they have set out to do.
Correction:
The authors mention that both LA converted to GA participants would not desire to LA again
(because they preferred GA). This is not reflected in Table 2 where "repeat with the same
anesthesia is N=1. This would likely be N=3 for the LA group (since two had GA and they
preferred that). | Title: Thyroidectomy Under Local Versus General Anesthesia in Health Camp Settings in
Uganda: A Randomized Prospective Equivalence Single-Blind Controlled Trial
Version: 6 Date: 14 Dec 2024
Reviewer's report:
Although I cannot find a tracked changes version of the manuscript for this round of review, I
do not think there were substantial changes made to need it.
Re: this comment
"The authors are happy to learn
by the authors to determine effect size are much smaller than the
from the reviewer of a larger study which could have been
33% the authors used.
missed but applicable for the authors' research and settings at that
time"
The authors have cited the article (11) which they say has a difference of 4% (83% of
euthyroidectomy patients under LA had no complications compared to 79% under GA). So, if
that is the baseline difference they are trying to detect (4%) then a study powered on a 33%
difference will be inaccurate. About the 33%, the authors used a patient-acceptable symptom
state of 33% but cited an article (18) that does not justify 33%, but instead a 10 point change
in the VAS. I do not think this study was powered to detect an appropriate difference, and the
justification should be changed. Perhaps, the authors could state that they decided on the sample
size to mirror the study (11) from Snyder et al. But, in their limitations they could state that the
study was underpowered to detect a difference.
Also, the authors could consider:
Instead of an equivalence study, the authors could reframe to a feasibility study. This would be
more consistent with what they have set out to do.
Correction:
The authors mention that both LA converted to GA participants would not desire to LA again
(because they preferred GA). This is not reflected in Table 2 where "repeat with the same
anesthesia is N=1. This would likely be N=3 for the LA group (since two had GA and they
preferred that). | BMC | 12893_2025_2810_ReviewerReport_V6_R3.pdf | {
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} | 1.538462 | 0 | [
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"role": "user"
},
{
"content": "Title: Thyroidectomy Under Local Versus General Anesthesia in Health Camp Settings in\nUganda: A Randomized Prospective Equivalence Single-Blind Controlled Trial\nVersion: 6 Date: 14 Dec 2024\nReviewer's report:\nAlthough I ca... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02795-y | Reviewed - bmc_surgery | Title: Preoperative Inflammatory Markers and Tumor Markers in Predicting Lymphatic
Metastasis and Postoperative Complications in Colorectal Cancer: A Retrospective Study
Version: 1 Date: 03 Dec 2024
Reviewer's report:
Congratulations to the authors for their efforts. Here are some ideas and comments for reference:
1.In the "Statistical Methods" section, the statistical methods and research process are mixed
together and should be described in separate sections.
2.In the section on the predictive value of lymph node metastasis, a further tabular analysis
should be performed to explore whether factors such as medical history also influence lymph
node metastasis.
3.When analyzing short-term prognosis, it should be clarified whether overall survival or
progression-free survival is being used.
4.The discussion should further analyze the correlation between each complication and
inflammation indicators.
5.Some images display as garbled text in the Word document; please ensure the correct image
format is used.
6.In Figure 6, the correlation analysis between mortality and inflammation indicators has not
been conducted. | Title: Preoperative Inflammatory Markers and Tumor Markers in Predicting Lymphatic
Metastasis and Postoperative Complications in Colorectal Cancer: A Retrospective Study
Version: 1 Date: 03 Dec 2024
Reviewer's report:
Congratulations to the authors for their efforts. Here are some ideas and comments for reference:
1.In the "Statistical Methods" section, the statistical methods and research process are mixed
together and should be described in separate sections.
2.In the section on the predictive value of lymph node metastasis, a further tabular analysis
should be performed to explore whether factors such as medical history also influence lymph
node metastasis.
3.When analyzing short-term prognosis, it should be clarified whether overall survival or
progression-free survival is being used.
4.The discussion should further analyze the correlation between each complication and
inflammation indicators.
5.Some images display as garbled text in the Word document; please ensure the correct image
format is used.
6.In Figure 6, the correlation analysis between mortality and inflammation indicators has not
been conducted. | BMC | 12893_2025_2795_ReviewerReport_V1_R1.pdf | {
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} | 2.428571 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Preoperative Inflammatory Markers and Tumor Markers in Predicting Lymphatic\nMetastasis and Postoperative Complications in Colorectal Cancer: A Retrospective Study\nVersion: 1 Date: 03 Dec 2024\nReviewer's report:\nCong... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02795-y | Reviewed - bmc_surgery | Title: Preoperative Inflammatory Markers and Tumor Markers in Predicting Lymphatic
Metastasis and Postoperative Complications in Colorectal Cancer: A Retrospective Study
Version: 1 Date: 05 Jan 2025
Reviewer's report:
This manuscipt titled “Preoperative Inflammatory Markers and Tumor Markers in Predicting
Lymphatic Metastasis and Postoperative Complications in Colorectal Cancer: A Retrospective
Study” analyzes the impact of preoperative inflammatory and tumor markers on lymph node
metastasis and postoperative complications in CRC patients and constructs predictive models
based on these markers. The study design and methodology are solid, and the findings are
clinically relevant. However, there are some areas where further clarification and refinement are
needed to improve the overall quality and readability of the manuscript.
1.The abstract currently provides a brief overview of the study methods and results but
could benefit from additional detail. Specifically, the methods section should include a short
description of the statistical analysis techniques (e.g., logistic regression, ROC curve analysis),
emphasizing their clinical significance. In the results section, key data points (such as AUC
values and correlation coefficients) should be included to make the findings more accessible and
informative at a glance. 2. The background briefly mentions that "inflammation is one of the
hallmarks of cancer," but this point could be expanded with more context. Consider providing
a deeper discussion of the role of inflammation in cancer progression, and include more
relevant references to strengthen this argument. Although the manuscript mentions the novelty
of incorporating inflammatory markers into predictive models, this argument could be further
emphasized to underline the innovation of the study. 3. More details are needed on the statistical
analysis, especially regarding the process of variable selection for the logistic regression model
and any handling of multicollinearity. Providing more transparency on how the variables were
selected would improve the rigor of the analysis. For the ROC curve analysis, it would be
beneficial to include the exact AUC values and the optimal cutoff values in the methods section,
as this will provide readers with a clearer understanding of the model’s performance. 4. The
results can be more logically structured. For example, when discussing the prediction of lymph
node metastasis, it would be helpful to categorize the data by inflammatory markers and tumor
markers separately, and then discuss their correlation and regression analysis results. 5. Tables
and figures are well included, but their explanations could be more concise and clearer. Ensure
that each table and figure has a descriptive title, and that the legends provide necessary context
without redundancy. 6. The discussion could benefit from a deeper exploration of the clinical
applicability and limitations of the predictive models. While the study highlights the value of
inflammatory and tumor markers, it would be useful to discuss the generalizability of these
models in different hospital settings or patient populations. A more detailed acknowledgment
of the study’s limitations, particularly regarding the sample size and the retrospective design,
would be beneficial. Additionally, it might be worth discussing whether other variables (such as
genomic data) could have been included to improve the model. 7. Figures could be simplified
and optimized for clarity. While the Nomogram and ROC curve figures effectively display the
model's predictive ability, they could be made more visually accessible with a less cluttered
layout and clearer labels. Ensure that the figure legends and table headers are detailed enough to
make the data easy to interpret without requiring extensive reference to the main text. 8. Some
of the references cited in the manuscript are outdated. It would strengthen the manuscript to
include more recent studies, particularly those published in the last 3 years, to reflect the current
state of research in this area. Overall, the manuscript requires some minor revisions in terms of
structure, clarity, and statistical analysis to improve its overall quality and scientific rigor. | Title: Preoperative Inflammatory Markers and Tumor Markers in Predicting Lymphatic
Metastasis and Postoperative Complications in Colorectal Cancer: A Retrospective Study
Version: 1 Date: 05 Jan 2025
Reviewer's report:
This manuscipt titled “Preoperative Inflammatory Markers and Tumor Markers in Predicting
Lymphatic Metastasis and Postoperative Complications in Colorectal Cancer: A Retrospective
Study” analyzes the impact of preoperative inflammatory and tumor markers on lymph node
metastasis and postoperative complications in CRC patients and constructs predictive models
based on these markers. The study design and methodology are solid, and the findings are
clinically relevant. However, there are some areas where further clarification and refinement are
needed to improve the overall quality and readability of the manuscript.
1.The abstract currently provides a brief overview of the study methods and results but
could benefit from additional detail. Specifically, the methods section should include a short
description of the statistical analysis techniques (e.g., logistic regression, ROC curve analysis),
emphasizing their clinical significance. In the results section, key data points (such as AUC
values and correlation coefficients) should be included to make the findings more accessible and
informative at a glance. 2. The background briefly mentions that "inflammation is one of the
hallmarks of cancer," but this point could be expanded with more context. Consider providing
a deeper discussion of the role of inflammation in cancer progression, and include more
relevant references to strengthen this argument. Although the manuscript mentions the novelty
of incorporating inflammatory markers into predictive models, this argument could be further
emphasized to underline the innovation of the study. 3. More details are needed on the statistical
analysis, especially regarding the process of variable selection for the logistic regression model
and any handling of multicollinearity. Providing more transparency on how the variables were
selected would improve the rigor of the analysis. For the ROC curve analysis, it would be
beneficial to include the exact AUC values and the optimal cutoff values in the methods section,
as this will provide readers with a clearer understanding of the model’s performance. 4. The
results can be more logically structured. For example, when discussing the prediction of lymph
node metastasis, it would be helpful to categorize the data by inflammatory markers and tumor
markers separately, and then discuss their correlation and regression analysis results. 5. Tables
and figures are well included, but their explanations could be more concise and clearer. Ensure
that each table and figure has a descriptive title, and that the legends provide necessary context
without redundancy. 6. The discussion could benefit from a deeper exploration of the clinical
applicability and limitations of the predictive models. While the study highlights the value of
inflammatory and tumor markers, it would be useful to discuss the generalizability of these
models in different hospital settings or patient populations. A more detailed acknowledgment
of the study’s limitations, particularly regarding the sample size and the retrospective design,
would be beneficial. Additionally, it might be worth discussing whether other variables (such as
genomic data) could have been included to improve the model. 7. Figures could be simplified
and optimized for clarity. While the Nomogram and ROC curve figures effectively display the
model's predictive ability, they could be made more visually accessible with a less cluttered
layout and clearer labels. Ensure that the figure legends and table headers are detailed enough to
make the data easy to interpret without requiring extensive reference to the main text. 8. Some
of the references cited in the manuscript are outdated. It would strengthen the manuscript to
include more recent studies, particularly those published in the last 3 years, to reflect the current
state of research in this area. Overall, the manuscript requires some minor revisions in terms of
structure, clarity, and statistical analysis to improve its overall quality and scientific rigor. | BMC | 12893_2025_2795_ReviewerReport_V1_R2.pdf | {
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"role": "user"
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"content": "Title: Preoperative Inflammatory Markers and Tumor Markers in Predicting Lymphatic\nMetastasis and Postoperative Complications in Colorectal Cancer: A Retrospective Study\nVersion: 1 Date: 05 Jan 2025\nReviewer's report:\nThis... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02795-y | Reviewed - bmc_surgery | Title: Preoperative Inflammatory Markers and Tumor Markers in Predicting Lymphatic
Metastasis and Postoperative Complications in Colorectal Cancer: A Retrospective Study
Version: 2 Date: 13 Jan 2025
Reviewer's report:
The author has made the necessary revisions based on the suggestions; however, the references
are somewhat outdated. Including more recent studies, especially those from the last 3 years,
would enhance the manuscript and better reflect the current state of research in this field. | Title: Preoperative Inflammatory Markers and Tumor Markers in Predicting Lymphatic
Metastasis and Postoperative Complications in Colorectal Cancer: A Retrospective Study
Version: 2 Date: 13 Jan 2025
Reviewer's report:
The author has made the necessary revisions based on the suggestions; however, the references
are somewhat outdated. Including more recent studies, especially those from the last 3 years,
would enhance the manuscript and better reflect the current state of research in this field. | BMC | 12893_2025_2795_ReviewerReport_V2_R2.pdf | {
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"content": "Title: Preoperative Inflammatory Markers and Tumor Markers in Predicting Lymphatic\nMetastasis and Postoperative Complications in Colorectal Cancer: A Retrospective Study\nVersion: 2 Date: 13 Jan 2025\nReviewer's report:\nThe ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02795-y | Reviewed - bmc_surgery | Title: Preoperative Inflammatory Markers and Tumor Markers in Predicting Lymphatic
Metastasis and Postoperative Complications in Colorectal Cancer: A Retrospective Study
Version: 2 Date: 18 Jan 2025
Reviewer's report:
The author has answered all my questions and I have no further questions. | Title: Preoperative Inflammatory Markers and Tumor Markers in Predicting Lymphatic
Metastasis and Postoperative Complications in Colorectal Cancer: A Retrospective Study
Version: 2 Date: 18 Jan 2025
Reviewer's report:
The author has answered all my questions and I have no further questions. | BMC | 12893_2025_2795_ReviewerReport_V2_R1.pdf | {
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"content": "Title: Preoperative Inflammatory Markers and Tumor Markers in Predicting Lymphatic\nMetastasis and Postoperative Complications in Colorectal Cancer: A Retrospective Study\nVersion: 2 Date: 18 Jan 2025\nReviewer's report:\nThe ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02795-y | Reviewed - bmc_surgery | Title: Preoperative Inflammatory Markers and Tumor Markers in Predicting Lymphatic
Metastasis and Postoperative Complications in Colorectal Cancer: A Retrospective Study
Version: 3 Date: 27 Jan 2025
Reviewer's report:
The author has answered all my questions and I have no further questions. | Title: Preoperative Inflammatory Markers and Tumor Markers in Predicting Lymphatic
Metastasis and Postoperative Complications in Colorectal Cancer: A Retrospective Study
Version: 3 Date: 27 Jan 2025
Reviewer's report:
The author has answered all my questions and I have no further questions. | BMC | 12893_2025_2795_ReviewerReport_V3_R2.pdf | {
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"content": "Title: Preoperative Inflammatory Markers and Tumor Markers in Predicting Lymphatic\nMetastasis and Postoperative Complications in Colorectal Cancer: A Retrospective Study\nVersion: 3 Date: 27 Jan 2025\nReviewer's report:\nThe ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02797-w | Reviewed - bmc_surgery | Title: Impact of Rosenthal Effect-Based Nursing Intervention on Self-Care Ability and Hope
Level in Patients Undergoing Breast Surgery
Version: 1 Date: 28 Mar 2024
Reviewer's report:
Dear authors,
In the material and method section, the sample selection method of the research, when the data
collection phase was carried out - when the scales were applied to the patients, etc. Adding the
information will make it more understandable.
Suggestions are stated as explanations in the word file. | Title: Impact of Rosenthal Effect-Based Nursing Intervention on Self-Care Ability and Hope
Level in Patients Undergoing Breast Surgery
Version: 1 Date: 28 Mar 2024
Reviewer's report:
Dear authors,
In the material and method section, the sample selection method of the research, when the data
collection phase was carried out - when the scales were applied to the patients, etc. Adding the
information will make it more understandable.
Suggestions are stated as explanations in the word file. | BMC | 12893_2025_2797_ReviewerReport_V1_R1.pdf | {
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} | 1.666667 | 0 | [
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"role": "user"
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{
"content": "Title: Impact of Rosenthal Effect-Based Nursing Intervention on Self-Care Ability and Hope\nLevel in Patients Undergoing Breast Surgery\nVersion: 1 Date: 28 Mar 2024\nReviewer's report:\nDear authors,\nIn the material and meth... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02797-w | Reviewed - bmc_surgery | Title: Impact of Rosenthal Effect-Based Nursing Intervention on Self-Care Ability and Hope
Level in Patients Undergoing Breast Surgery
Version: 1 Date: 07 May 2024
Reviewer's report: | Title: Impact of Rosenthal Effect-Based Nursing Intervention on Self-Care Ability and Hope
Level in Patients Undergoing Breast Surgery
Version: 1 Date: 07 May 2024
Reviewer's report: | BMC | 12893_2025_2797_ReviewerReport_V1_R3.pdf | {
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"content": "Title: Impact of Rosenthal Effect-Based Nursing Intervention on Self-Care Ability and Hope\nLevel in Patients Undergoing Breast Surgery\nVersion: 1 Date: 07 May 2024\nReviewer's report:",
"role": "assistant"
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] | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02797-w | Reviewed - bmc_surgery | Title: Impact of Rosenthal Effect-Based Nursing Intervention on Self-Care Ability and Hope
Level in Patients Undergoing Breast Surgery
Version: 2 Date: 23 Jul 2024
Reviewer's report:
Dear author/authors;
Thank you for the detailed corrections. There are some minor correction suggestions;
1-statistical p values in the manuscript should be written in lowercase (p<00.5 etc.), the main
text should be checked in this respect.
2-Abreviations such as SAS, SAD etc. should not be included in the summary section and the
full names of the scales should be written instead.
3-In abstract section or method section; the term "our hospital" should not be used for the place
where the research is conducted.
3-In methods section, intervation that you used for observation group was written in details,
thank you for the details. It would be appropriate to cite references for the content of this
rosenthal effect-based intervention, from which references did you get the content of this method
or itervention?
Thank you for your patience and interest.
Kind regards. | Title: Impact of Rosenthal Effect-Based Nursing Intervention on Self-Care Ability and Hope
Level in Patients Undergoing Breast Surgery
Version: 2 Date: 23 Jul 2024
Reviewer's report:
Dear author/authors;
Thank you for the detailed corrections. There are some minor correction suggestions;
1-statistical p values in the manuscript should be written in lowercase (p<00.5 etc.), the main
text should be checked in this respect.
2-Abreviations such as SAS, SAD etc. should not be included in the summary section and the
full names of the scales should be written instead.
3-In abstract section or method section; the term "our hospital" should not be used for the place
where the research is conducted.
3-In methods section, intervation that you used for observation group was written in details,
thank you for the details. It would be appropriate to cite references for the content of this
rosenthal effect-based intervention, from which references did you get the content of this method
or itervention?
Thank you for your patience and interest.
Kind regards. | BMC | 12893_2025_2797_ReviewerReport_V2_R5.pdf | {
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"content": "Title: Impact of Rosenthal Effect-Based Nursing Intervention on Self-Care Ability and Hope\nLevel in Patients Undergoing Breast Surgery\nVersion: 2 Date: 23 Jul 2024\nReviewer's report:\nDear author/authors;\nThank you for the... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02797-w | Reviewed - bmc_surgery | Title: Impact of Rosenthal Effect-Based Nursing Intervention on Self-Care Ability and Hope
Level in Patients Undergoing Breast Surgery
Version: 4 Date: 08 Dec 2024
Reviewer's report:
Dear author/s, corrections for the recommendations have been made appropriately. | Title: Impact of Rosenthal Effect-Based Nursing Intervention on Self-Care Ability and Hope
Level in Patients Undergoing Breast Surgery
Version: 4 Date: 08 Dec 2024
Reviewer's report:
Dear author/s, corrections for the recommendations have been made appropriately. | BMC | 12893_2025_2797_ReviewerReport_V4_R5.pdf | {
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"content": "Title: Impact of Rosenthal Effect-Based Nursing Intervention on Self-Care Ability and Hope\nLevel in Patients Undergoing Breast Surgery\nVersion: 4 Date: 08 Dec 2024\nReviewer's report:\nDear author/s, corrections for the reco... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02798-9 | Reviewed - bmc_surgery | Title: Does thoracoscopic repair of type C esophageal atresia require emergency treatment?
Version: 0 Date: 09 Nov 2024
Reviewer: Hesham Sheir
Reviewer's report:
1- Introduction (Background):
- Well written with clear gap of knowledge justifies performing this study.
2- Patients and methods:
- Description of the perioperative care is too long and not different from the standard care of such
cases. I think you need to be more concise stressing on the respiratory care to avoid aspiration.
e.g: No need to mention: the multidisciplinary team, placing the patient in incubator, fasting
prior to surgery & IV fluids & corrections. Also, the operative and postoperative details can be
written more shortly.
3- Results:
- Results are clear and informative with proper statistical methods.
4- Discussion:
- Lines 300-302: In this study, the incidence of anastomotic stricture in delayed age group was
not higher than that in early age group, which was helpful in reducing incidence of anastomotic
leakage in delayed age group.
Correction: In this study, the incidence of anastomotic leakage in delayed age group was not
higher than that in early age group, which was helpful in reducing incidence of anastomotic
stricture in delayed age group.
5- Conclusion:
- Line 329: Appropriately delayed surgery appropriately (repeated) can provide …….
- I think you need to stress more in your conclusion on what is meant by appropriately delayed
surgery (i.e: Efficient preoperative care (especially respiratory care) in a well-equipped neonatal
ICU). Because, otherwise the delay in surgery will be harmful.
6- Overall Conclusion:
- The study is well designed and well directed to answer an important research inquiry. The
methods are reproducible, statistics used properly, results are clear & informative, and discussion
is well directed. | Title: Does thoracoscopic repair of type C esophageal atresia require emergency treatment?
Version: 0 Date: 09 Nov 2024
Reviewer: Hesham Sheir
Reviewer's report:
1- Introduction (Background):
- Well written with clear gap of knowledge justifies performing this study.
2- Patients and methods:
- Description of the perioperative care is too long and not different from the standard care of such
cases. I think you need to be more concise stressing on the respiratory care to avoid aspiration.
e.g: No need to mention: the multidisciplinary team, placing the patient in incubator, fasting
prior to surgery & IV fluids & corrections. Also, the operative and postoperative details can be
written more shortly.
3- Results:
- Results are clear and informative with proper statistical methods.
4- Discussion:
- Lines 300-302: In this study, the incidence of anastomotic stricture in delayed age group was
not higher than that in early age group, which was helpful in reducing incidence of anastomotic
leakage in delayed age group.
Correction: In this study, the incidence of anastomotic leakage in delayed age group was not
higher than that in early age group, which was helpful in reducing incidence of anastomotic
stricture in delayed age group.
5- Conclusion:
- Line 329: Appropriately delayed surgery appropriately (repeated) can provide …….
- I think you need to stress more in your conclusion on what is meant by appropriately delayed
surgery (i.e: Efficient preoperative care (especially respiratory care) in a well-equipped neonatal
ICU). Because, otherwise the delay in surgery will be harmful.
6- Overall Conclusion:
- The study is well designed and well directed to answer an important research inquiry. The
methods are reproducible, statistics used properly, results are clear & informative, and discussion
is well directed. | BMC | 12893_2025_2798_ReviewerReport_V0_R3.pdf | {
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"content": "Title: Does thoracoscopic repair of type C esophageal atresia require emergency treatment?\nVersion: 0 Date: 09 Nov 2024\nReviewer: Hesham Sheir\nReviewer's report:\n1- Introduction (Background):\n- Well written with clear ga... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02798-9 | Reviewed - bmc_surgery | Title: Does thoracoscopic repair of type C esophageal atresia require emergency treatment?
Version: 0 Date: 12 Nov 2024
Reviewer's report:
Thank you for giving me the opportunity to review this paper. This is an interesting study that
examines the appropriate timing of surgery for esophageal atresia. However, the study divides
the patients into two groups, one with a short waiting period before surgery and the other with
a long waiting period, but it is generally considered difficult to wait for more than five days.
It is difficult to understand why there is such a wide range in the timing of surgery, as in this
study. Also, in the section on preoperative management, there is no description of the criteria for
when surgery is performed. It would be clearer if there were some description. There is almost
no difference in the surgical outcomes between the two groups, so what is the significance of
waiting so long for surgery in this study?
Major
#Preoperative management: Is there a kind of standard for deciding when to go ahead with
surgery? | Title: Does thoracoscopic repair of type C esophageal atresia require emergency treatment?
Version: 0 Date: 12 Nov 2024
Reviewer's report:
Thank you for giving me the opportunity to review this paper. This is an interesting study that
examines the appropriate timing of surgery for esophageal atresia. However, the study divides
the patients into two groups, one with a short waiting period before surgery and the other with
a long waiting period, but it is generally considered difficult to wait for more than five days.
It is difficult to understand why there is such a wide range in the timing of surgery, as in this
study. Also, in the section on preoperative management, there is no description of the criteria for
when surgery is performed. It would be clearer if there were some description. There is almost
no difference in the surgical outcomes between the two groups, so what is the significance of
waiting so long for surgery in this study?
Major
#Preoperative management: Is there a kind of standard for deciding when to go ahead with
surgery? | BMC | 12893_2025_2798_ReviewerReport_V0_R4.pdf | {
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"content": "Title: Does thoracoscopic repair of type C esophageal atresia require emergency treatment?\nVersion: 0 Date: 12 Nov 2024\nReviewer's report:\nThank you for giving me the opportunity to review this paper. This is an interesting... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02798-9 | Reviewed - bmc_surgery | Title: Does thoracoscopic repair of type C esophageal atresia require emergency treatment?
Version: 0 Date: 16 Nov 2024
Reviewer: Toru Shimizu
Reviewer's report:
General comments:
The authors included only successful one-stage anastomosis and excluded these two-stage cases.
And the average gap was 1.77 cm. How do they decide on one stage or two stages? If they only
do thoracoscopically for small gaps and straightforward cases, there is small clinical meaning
to compare the surgical timing between > and < 5 days.
In summary, the paper does not provide high-quality evidence for several reasons. The duration
of each group's surgical timing is unclear, the conclusion is vague, and there is no such value
comparing groups who have surgery before and after 5 days in small gap patients. In addition,
authors need proper English screening. There are too many grammar mistakes.
Individual comments are below.
Line 58, reported in 2002, not 2000?
Line 131-145, 154, 158, 167, 175, 177,
English grammar error. No subjects and verbs.
Line 170
Is it about the specific patient mentioning “he”? If they try to say it in general, they should use
pleural. It looks like they are copying and pasting the discharge summary of a certain patient.
Line 174
Chin shaped “shap”?
Line 184
Criterion? Criteria?
Line 185
Revealed? Revealing?
Line 204
How many surgeons?
Line 215, 217, 314
The numbers should be rounded off to one decimal place.
Line 82, 85, Table 1
The days of surgery in each group are not defined, which is the main topic of this article. The
abstract says the range is “1-16 days,” but what is the distribution of these numbers in each
group?
Type IIIa and IIIb – are they Vogt classification? If so, they should clearly mention it as they
are not using Vogt, not Gross. They used Gross on Lines 70 and 312.
Line 261
There are a number of other articles showing the optimal timing for operation, such as DOI:
10.1016/j.jpedsurg.2023.10.013
Line 264-271
I am not sure what they are trying to discuss in these lines. References 18 and 19 showed that
delayed surgery was better for children with severe heart disease or lower birth weight, but
the authors mentioned their study regarding respiratory tract infections and ventilation. It lacks
persuasiveness.
Line 282
Given?
Line 293
Increases 100-200 grams in how long?
Line 329
Repeating the word “appropriately”.
Line 328-332
This conclusion does not come from their study result. This is their expression, not the scientific
result. Was there any relationship between thoracoscopic and open in terms of the results of
the study? | Title: Does thoracoscopic repair of type C esophageal atresia require emergency treatment?
Version: 0 Date: 16 Nov 2024
Reviewer: Toru Shimizu
Reviewer's report:
General comments:
The authors included only successful one-stage anastomosis and excluded these two-stage cases.
And the average gap was 1.77 cm. How do they decide on one stage or two stages? If they only
do thoracoscopically for small gaps and straightforward cases, there is small clinical meaning
to compare the surgical timing between > and < 5 days.
In summary, the paper does not provide high-quality evidence for several reasons. The duration
of each group's surgical timing is unclear, the conclusion is vague, and there is no such value
comparing groups who have surgery before and after 5 days in small gap patients. In addition,
authors need proper English screening. There are too many grammar mistakes.
Individual comments are below.
Line 58, reported in 2002, not 2000?
Line 131-145, 154, 158, 167, 175, 177,
English grammar error. No subjects and verbs.
Line 170
Is it about the specific patient mentioning “he”? If they try to say it in general, they should use
pleural. It looks like they are copying and pasting the discharge summary of a certain patient.
Line 174
Chin shaped “shap”?
Line 184
Criterion? Criteria?
Line 185
Revealed? Revealing?
Line 204
How many surgeons?
Line 215, 217, 314
The numbers should be rounded off to one decimal place.
Line 82, 85, Table 1
The days of surgery in each group are not defined, which is the main topic of this article. The
abstract says the range is “1-16 days,” but what is the distribution of these numbers in each
group?
Type IIIa and IIIb – are they Vogt classification? If so, they should clearly mention it as they
are not using Vogt, not Gross. They used Gross on Lines 70 and 312.
Line 261
There are a number of other articles showing the optimal timing for operation, such as DOI:
10.1016/j.jpedsurg.2023.10.013
Line 264-271
I am not sure what they are trying to discuss in these lines. References 18 and 19 showed that
delayed surgery was better for children with severe heart disease or lower birth weight, but
the authors mentioned their study regarding respiratory tract infections and ventilation. It lacks
persuasiveness.
Line 282
Given?
Line 293
Increases 100-200 grams in how long?
Line 329
Repeating the word “appropriately”.
Line 328-332
This conclusion does not come from their study result. This is their expression, not the scientific
result. Was there any relationship between thoracoscopic and open in terms of the results of
the study? | BMC | 12893_2025_2798_ReviewerReport_V0_R8.pdf | {
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"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Does thoracoscopic repair of type C esophageal atresia require emergency treatment?\nVersion: 0 Date: 16 Nov 2024\nReviewer: Toru Shimizu\nReviewer's report:\nGeneral comments:\nThe authors included only successful one... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02798-9 | Reviewed - bmc_surgery | Title: Does thoracoscopic repair of type C esophageal atresia require emergency treatment?
Version: 0 Date: 17 Nov 2024
Reviewer: Krystian Toczewski
Reviewer's report:
Dear All,
thank you for the opportunity to review this study.
This is a manuscript on timing of EA repair. Strong sides of this study are sample size, matching
of the groups and interesting thesis.
Here are some comments and questions which I believe will make the manuscript more precise
and versatile.
Whole manuscript needs extensive language editing, I will not mention all these errors in this
review.
Title – is grammatically incorrect; moreover the study is based solely on type C EA, so that
should be reflected in the title.
Abstract
Line 26 – insert type C thoracoscopic treatment (not ALL EA)
Line 30 – “The patients were divided into early age group (group A) and delayed age group
(group B) according” - early repair group (< 5 days) and delayed repair (>5d)?
Introduction
Line 76 – type C EA…
Methods
80 - How was the length of esophageal gap measured?
114 – define booseter drugs
117 – length of hospital stay – define total or postoperatively?
138 – “By positioning the end of the tracheal intubation at the distal end of the tracheoesophageal
fistula entrance” – do you mean positioning the ET below the tracheal opening of TEF?
150 – off note - consider lowering the pressure to 5mmHg in new cases – in our experience it
is sufficient and believed to be safer for the baby
152 – you use 4 trocars? What is the “assistive device” and for what purpose?
154-55 - electrocoagulate the blood vessels – what vessels? azygos vein?
164-5 – “Fix the stomach tube and insert the chest tube through the casing” – what do you mean
by casing?
Results
Fig 2 and 3 – what are treated and control units? Group A and B?
Discussion
281-8 – “However, delayed surgery may contribute to reducing the incidence of anastomotic
leakage. Given that the water content of newborns is rather high, ranging from 75 to 80%
[32]. This causes the tissue structure to become more fragile and prone to tearing at the suture,
which is detrimental to anastomotic healing [11]. Delayed surgery can appropriately reduce
neonatal moisture content (approximately 4-5% reduction in one week) [32], which may enhance
the neonate's tolerance to injuries from dissection and sutures, thereby improving their overall
healing ability.” – could you please cite a proof or explain how lower water content improves
healing ability or tolerance to injuries from sutures?
300-302 – “In this study, the incidence of anastomotic stricture in delayed age group was not
higher than that in early age group, which was helpful in reducing incidence of anastomotic
leakage in delayed age group.” – the second part does not make sense to me.
Conclusions
330-1 – “to plan treatment more effectively and schedule surgeries appropriately,” – in the
manuscript you do not explain how the planning changes with each day before the surgery; this
conclusion is not supported by the study.
General comment
Why 5 days as a cut-off? As mentioned in the introduction, usually the surgery happens in the
first 3 days of life. What advantages after 3 days in surgery preparations, in terms of technical /
surgical considerations do you see? What benefit does the sixth day of life give the surgeon?
Nowadays all diagnostics and consultations probably can happen in 3 days.
You mention “surgeons comprehensive assessment” – what exact steps and gains do the surgeon
get in the 4th, 5th, 6th day of life of the baby? I understand the value of being ready and familiar
with the case, but I cannot think of any benefits of waiting for more than 2-3 days from the
surgeons point of view (I mean in terms of technique, approach etc.). Could you please expand
in the text the surgical advantages you mention?
My point is, maybe, if you compare surgery in 1-3 days and >3 days, the differences would be
more clear. Probably patients operated on 4-5 days do not differ from those operated on 6-7.
Also, comparing only postoperative ventilator days, you ignore the days spent in sedation on
ventilator prior to surgery. I would love to see total days on ventilator and total days in hospital
(or age at discharge) in both groups. Whether there is a difference or nor, this is relevant
information and should be considered in the discussion as well.
Best regards,
K. | Title: Does thoracoscopic repair of type C esophageal atresia require emergency treatment?
Version: 0 Date: 17 Nov 2024
Reviewer: Krystian Toczewski
Reviewer's report:
Dear All,
thank you for the opportunity to review this study.
This is a manuscript on timing of EA repair. Strong sides of this study are sample size, matching
of the groups and interesting thesis.
Here are some comments and questions which I believe will make the manuscript more precise
and versatile.
Whole manuscript needs extensive language editing, I will not mention all these errors in this
review.
Title – is grammatically incorrect; moreover the study is based solely on type C EA, so that
should be reflected in the title.
Abstract
Line 26 – insert type C thoracoscopic treatment (not ALL EA)
Line 30 – “The patients were divided into early age group (group A) and delayed age group
(group B) according” - early repair group (< 5 days) and delayed repair (>5d)?
Introduction
Line 76 – type C EA…
Methods
80 - How was the length of esophageal gap measured?
114 – define booseter drugs
117 – length of hospital stay – define total or postoperatively?
138 – “By positioning the end of the tracheal intubation at the distal end of the tracheoesophageal
fistula entrance” – do you mean positioning the ET below the tracheal opening of TEF?
150 – off note - consider lowering the pressure to 5mmHg in new cases – in our experience it
is sufficient and believed to be safer for the baby
152 – you use 4 trocars? What is the “assistive device” and for what purpose?
154-55 - electrocoagulate the blood vessels – what vessels? azygos vein?
164-5 – “Fix the stomach tube and insert the chest tube through the casing” – what do you mean
by casing?
Results
Fig 2 and 3 – what are treated and control units? Group A and B?
Discussion
281-8 – “However, delayed surgery may contribute to reducing the incidence of anastomotic
leakage. Given that the water content of newborns is rather high, ranging from 75 to 80%
[32]. This causes the tissue structure to become more fragile and prone to tearing at the suture,
which is detrimental to anastomotic healing [11]. Delayed surgery can appropriately reduce
neonatal moisture content (approximately 4-5% reduction in one week) [32], which may enhance
the neonate's tolerance to injuries from dissection and sutures, thereby improving their overall
healing ability.” – could you please cite a proof or explain how lower water content improves
healing ability or tolerance to injuries from sutures?
300-302 – “In this study, the incidence of anastomotic stricture in delayed age group was not
higher than that in early age group, which was helpful in reducing incidence of anastomotic
leakage in delayed age group.” – the second part does not make sense to me.
Conclusions
330-1 – “to plan treatment more effectively and schedule surgeries appropriately,” – in the
manuscript you do not explain how the planning changes with each day before the surgery; this
conclusion is not supported by the study.
General comment
Why 5 days as a cut-off? As mentioned in the introduction, usually the surgery happens in the
first 3 days of life. What advantages after 3 days in surgery preparations, in terms of technical /
surgical considerations do you see? What benefit does the sixth day of life give the surgeon?
Nowadays all diagnostics and consultations probably can happen in 3 days.
You mention “surgeons comprehensive assessment” – what exact steps and gains do the surgeon
get in the 4th, 5th, 6th day of life of the baby? I understand the value of being ready and familiar
with the case, but I cannot think of any benefits of waiting for more than 2-3 days from the
surgeons point of view (I mean in terms of technique, approach etc.). Could you please expand
in the text the surgical advantages you mention?
My point is, maybe, if you compare surgery in 1-3 days and >3 days, the differences would be
more clear. Probably patients operated on 4-5 days do not differ from those operated on 6-7.
Also, comparing only postoperative ventilator days, you ignore the days spent in sedation on
ventilator prior to surgery. I would love to see total days on ventilator and total days in hospital
(or age at discharge) in both groups. Whether there is a difference or nor, this is relevant
information and should be considered in the discussion as well.
Best regards,
K. | BMC | 12893_2025_2798_ReviewerReport_V0_R1.pdf | {
"criticism": 4,
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"importance_and_relevance": 1,
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"praise": 1,
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} | 1.105263 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Does thoracoscopic repair of type C esophageal atresia require emergency treatment?\nVersion: 0 Date: 17 Nov 2024\nReviewer: Krystian Toczewski\nReviewer's report:\nDear All,\nthank you for the opportunity to review t... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02798-9 | Reviewed - bmc_surgery | Title: Does thoracoscopic repair of type C esophageal atresia require emergency treatment?
Version: 1 Date: 01 Dec 2024
Reviewer: Hesham Sheir
Reviewer's report:
Thanks. I find that all previous recommendations were fulfilled appropriately. | Title: Does thoracoscopic repair of type C esophageal atresia require emergency treatment?
Version: 1 Date: 01 Dec 2024
Reviewer: Hesham Sheir
Reviewer's report:
Thanks. I find that all previous recommendations were fulfilled appropriately. | BMC | 12893_2025_2798_ReviewerReport_V1_R3.pdf | {
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{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Does thoracoscopic repair of type C esophageal atresia require emergency treatment?\nVersion: 1 Date: 01 Dec 2024\nReviewer: Hesham Sheir\nReviewer's report:\nThanks. I find that all previous recommendations were fulfi... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02798-9 | Reviewed - bmc_surgery | Title: Does thoracoscopic repair of type C esophageal atresia require emergency treatment?
Version: 1 Date: 07 Dec 2024
Reviewer's report:
Thank you for the opportunity to review this paper. This study provides an interesting analysis
of the appropriate timing for surgery in esophageal atresia. However, I have significant concerns
regarding the methodology for determining surgical timing and its justification.
Major Comments:
1. Preoperative Management and Surgical Timing
#The reported time to surgery varies considerably, ranging from 1 to 16 days. While it is possible
to explain the decision-making process for surgical timing within the context of a single-center
study, this critical information is not presented in the manuscript.
#Although the authors have set a cutoff of 5 days to define "early" and "late" surgical
intervention, the rationale for this threshold is unclear. Without an explanation for how this
specific cutoff was chosen, the clinical significance of dividing patients into these two groups
remains ambiguous.
#Furthermore, I would like to know whether any cases experienced preoperative respiratory
deterioration, necessitating endotracheal intubation before surgery. Such information would
offer valuable insights into the preoperative management strategies and the urgency of surgical
intervention in this population.
Conclusion:
As the key questions regarding the rationale for surgical timing and preoperative management
remain unanswered, my evaluation of the manuscript remains unchanged. I encourage the
authors to address these points comprehensively to clarify the study's findings and strengthen
its clinical relevance. | Title: Does thoracoscopic repair of type C esophageal atresia require emergency treatment?
Version: 1 Date: 07 Dec 2024
Reviewer's report:
Thank you for the opportunity to review this paper. This study provides an interesting analysis
of the appropriate timing for surgery in esophageal atresia. However, I have significant concerns
regarding the methodology for determining surgical timing and its justification.
Major Comments:
1. Preoperative Management and Surgical Timing
#The reported time to surgery varies considerably, ranging from 1 to 16 days. While it is possible
to explain the decision-making process for surgical timing within the context of a single-center
study, this critical information is not presented in the manuscript.
#Although the authors have set a cutoff of 5 days to define "early" and "late" surgical
intervention, the rationale for this threshold is unclear. Without an explanation for how this
specific cutoff was chosen, the clinical significance of dividing patients into these two groups
remains ambiguous.
#Furthermore, I would like to know whether any cases experienced preoperative respiratory
deterioration, necessitating endotracheal intubation before surgery. Such information would
offer valuable insights into the preoperative management strategies and the urgency of surgical
intervention in this population.
Conclusion:
As the key questions regarding the rationale for surgical timing and preoperative management
remain unanswered, my evaluation of the manuscript remains unchanged. I encourage the
authors to address these points comprehensively to clarify the study's findings and strengthen
its clinical relevance. | BMC | 12893_2025_2798_ReviewerReport_V1_R4.pdf | {
"criticism": 4,
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"results_and_discussion": 0.07692307692307693,
"suggestion_and_solution": 0.15384615384615385
} | 1.692308 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Does thoracoscopic repair of type C esophageal atresia require emergency treatment?\nVersion: 1 Date: 07 Dec 2024\nReviewer's report:\nThank you for the opportunity to review this paper. This study provides an interesti... | 2,025 |
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