Reviewer's report 
 Effects of abdominal hot compresses on indocyanine green elimination - a randomized cross over Title: 
study in healthy subjects 
 1  22 December 2006 Version: Date: 
 Daniel De Backer Reviewer: 
Reviewer's report: 
General 
Although the procedure tested (application of hot compresses) was unknown to me and may be of modest 
interest for the average reader, I should congratulate the authors for having scientifically tested the 
hypothesis that this technique may or may not work. 
The current protocol (2x2 cross over dessign) was adequately performed and the results analyzed using 
apropriate statistical tests. The analysis of 2 different decay cruves allows to better differenciate the elimination processes that may have been affected by hot compresses. 
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Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) The study reports interesting findings, but the discussion needs to cover the potential limitations of the 
study: 
1/ The authors used ICGPDR to evaluate liver blood flow and function. The major pitfall of this test is that it 
does not separate flow and function, and that opposite changes may be missed. As the study was performed in volunteers, it is unlikely that function was unaltered at baseline, but one cannot rule out that 
local heat impaired liver function so that an increase in liver blood flow may be missed. This is a technical 
issue that need to be discussed, but the conclusions will be the same on the usefulness of the intervention. 2/ More importantly, the PDR was normal at baseline. Is there any evidence, that PDR can further increase 
when blood flow is indeed further increased ? 
3/ One patient experienced an increase in bilirubin after 1st measurment. Was it a control or heat study ? 
Please address this important issue in the discussion. How was this increase in bilirubin detected. Did you performed routine biological testing in these volunteers? If yes, these should be reported. 4/ Finally no sick patients were included, and the response may differ in patients compared t healthy 
volunteers. This study does not rule out a potential beneficial effect in patients with liver disease. This 
should be addressed in the discussion. 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author 
can be trusted to correct) 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Unable to decide on acceptance or rejection until the authors have responded to the major What next?: 
compulsory revisions 
 An article of limited interest Level of interest: 
 Acceptable Quality of written English: 
 No, the manuscript does not need to be seen by a statistician. Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests 
Reviewer's report 
 Effects of abdominal hot compresses on indocyanine green elimination - a randomized cross over Title: 
study in healthy subjects 
 1  22 December 2006 Version: Date: 
 Daniel De Backer Reviewer: 
Reviewer's report: 
General 
Although the procedure tested (application of hot compresses) was unknown to me and may be of modest 
interest for the average reader, I should congratulate the authors for having scientifically tested the 
hypothesis that this technique may or may not work. 
The current protocol (2x2 cross over dessign) was adequately performed and the results analyzed using 
apropriate statistical tests. The analysis of 2 different decay cruves allows to better differenciate the elimination processes that may have been affected by hot compresses. 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) The study reports interesting findings, but the discussion needs to cover the potential limitations of the 
study: 
1/ The authors used ICGPDR to evaluate liver blood flow and function. The major pitfall of this test is that it 
does not separate flow and function, and that opposite changes may be missed. As the study was performed in volunteers, it is unlikely that function was unaltered at baseline, but one cannot rule out that 
local heat impaired liver function so that an increase in liver blood flow may be missed. This is a technical 
issue that need to be discussed, but the conclusions will be the same on the usefulness of the intervention. 2/ More importantly, the PDR was normal at baseline. Is there any evidence, that PDR can further increase 
when blood flow is indeed further increased ? 
3/ One patient experienced an increase in bilirubin after 1st measurment. Was it a control or heat study ? 
Please address this important issue in the discussion. How was this increase in bilirubin detected. Did you performed routine biological testing in these volunteers? If yes, these should be reported. 4/ Finally no sick patients were included, and the response may differ in patients compared t healthy 
volunteers. This study does not rule out a potential beneficial effect in patients with liver disease. This 
should be addressed in the discussion. 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author 
can be trusted to correct) 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Unable to decide on acceptance or rejection until the authors have responded to the major What next?: 
compulsory revisions 
 An article of limited interest Level of interest: 
 Acceptable Quality of written English: 
 No, the manuscript does not need to be seen by a statistician. Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests 
Please review this paper.
user
Reviewer's report 
 Effects of abdominal hot compresses on indocyanine green elimination - a randomized cross over Title: 
study in healthy subjects 
 1  22 December 2006 Version: Date: 
 Daniel De Backer Reviewer: 
Reviewer's report: 
General 
Although the procedure tested (application of hot compresses) was unknown to me and may be of modest 
interest for the average reader, I should congratulate the authors for having scientifically tested the 
hypothesis that this technique may or may not work. 
The current protocol (2x2 cross over dessign) was adequately performed and the results analyzed using 
apropriate statistical tests. The analysis of 2 different decay cruves allows to better differenciate the elimination processes that may have been affected by hot compresses. 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) The study reports interesting findings, but the discussion needs to cover the potential limitations of the 
study: 
1/ The authors used ICGPDR to evaluate liver blood flow and function. The major pitfall of this test is that it 
does not separate flow and function, and that opposite changes may be missed. As the study was performed in volunteers, it is unlikely that function was unaltered at baseline, but one cannot rule out that 
local heat impaired liver function so that an increase in liver blood flow may be missed. This is a technical 
issue that need to be discussed, but the conclusions will be the same on the usefulness of the intervention. 2/ More importantly, the PDR was normal at baseline. Is there any evidence, that PDR can further increase 
when blood flow is indeed further increased ? 
3/ One patient experienced an increase in bilirubin after 1st measurment. Was it a control or heat study ? 
Please address this important issue in the discussion. How was this increase in bilirubin detected. Did you performed routine biological testing in these volunteers? If yes, these should be reported. 4/ Finally no sick patients were included, and the response may differ in patients compared t healthy 
volunteers. This study does not rule out a potential beneficial effect in patients with liver disease. This 
should be addressed in the discussion. 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author 
can be trusted to correct) 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Unable to decide on acceptance or rejection until the authors have responded to the major What next?: 
compulsory revisions 
 An article of limited interest Level of interest: 
 Acceptable Quality of written English: 
 No, the manuscript does not need to be seen by a statistician. Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests 
assistant