Reviewer ’s report  
 
Title: Case report: Acute abdominal pain in a 37 -year-old patient and the consequences for 
his family  
 
Version: 2 Date: 27 Dec 2019  
 
Reviewer: Robert Sitarz  
 
Reviewer's report:  
 
Please include all comments for the authors in this box rather than uploading your report as 
an attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be  included in a text 
format.  
Please overwrite this text when adding your comments to the authors.  
 
 Dear authors and editor,  
 
 The manuscript  titled ''Acute abdomen in a 37 -year-old patient and the consequences for his 
family ''  describes a case of a young  man with stomach cancer based on the CDH1 gene 
mutation and provided consequences for his family. The idea of writing a manuscript/ cause 
report on this topic is interesting. I believe they add some contribution to the literature.  
The paper requires more work,  particularly for discussion part, the language is correct and 
the content is understandable.  
 
Literature very poor, does not contain already developed diagrams for diagnosis and 
treatment of gastric cancer with CDH mutation. 4 items presented are pr operly selected and 
mostly up to date.  
 
However the manuscript  is good, I have some comments that should be clarified.  
 
1. Loss of CDH function/ mutation is also a metastatic model of EMT process.  
This is the basic model of metastasis in cancer progressio n. I did not notice the sentence on 
this topic.  
 
2. During surgery it is very difficult to determine the type of cancer( in particular 
linitis plastic) - the answer to this question is possible after histopathological analysis.  
 
3. pT1a pN0(0/8) cM0 - eight a nalyzed lymph nodes for complete gastrectomy are 
definitely not enough!  
 
4. Lack of information on the type of operation and its scope.  
 
5. ,….As diffuse gastric cancer is difficult to detect at an early, treatable stage  
current recommendations suggest proph ylactic gastrectomy in healthy CDH1 mutation 
carriers rather than endoscopic surveillance…." - there is a lack of literature confirming this 
thesis.!  This phase is very much debatable(however surgery is the definitive treatment). 
Usually, we leave the deci sion to the patient, presenting everything for and against.  
 
6. The photos should be of better quality.  
 
7. The  discussion part  requires extension and refinement .  
 
 
The lack of these elements definitely reduces the value of work.  
 
In conclusion, the manuscript needs some improvements.  
 
Thank you for your choice me as a reviewer.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the neces sary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able t o assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to t his manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering  the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from 
an organisation that may in any way gain or lose financially from the publication of 
this manuscript, either now or in the future?  
 
2. Do you  hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of 
the manuscript?  
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interes ts. 
 
I agree to the open peer review policy of the journal. I understand that my name will be 
included  on my report to the authors and, if the manuscript is accepted for publication, my 
named report  including any attachments I upload will be posted on the w ebsite along with the 
authors'  responses. I agree for my report to be made available under an Open Access Creative 
Commons  CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that 
any comments  which I do not wish to be included in my named report can be included as 
confidential comments  to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Case report: Acute abdominal pain in a 37 -year-old patient and the consequences for 
his family  
 
Version: 2 Date: 27 Dec 2019  
 
Reviewer: Robert Sitarz  
 
Reviewer's report:  
 
Please include all comments for the authors in this box rather than uploading your report as 
an attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be  included in a text 
format.  
Please overwrite this text when adding your comments to the authors.  
 
 Dear authors and editor,  
 
 The manuscript  titled ''Acute abdomen in a 37 -year-old patient and the consequences for his 
family ''  describes a case of a young  man with stomach cancer based on the CDH1 gene 
mutation and provided consequences for his family. The idea of writing a manuscript/ cause 
report on this topic is interesting. I believe they add some contribution to the literature.  
The paper requires more work,  particularly for discussion part, the language is correct and 
the content is understandable.  
 
Literature very poor, does not contain already developed diagrams for diagnosis and 
treatment of gastric cancer with CDH mutation. 4 items presented are pr operly selected and 
mostly up to date.  
 
However the manuscript  is good, I have some comments that should be clarified.  
 
1. Loss of CDH function/ mutation is also a metastatic model of EMT process.  
This is the basic model of metastasis in cancer progressio n. I did not notice the sentence on 
this topic.  
 
2. During surgery it is very difficult to determine the type of cancer( in particular 
linitis plastic) - the answer to this question is possible after histopathological analysis.  
 
3. pT1a pN0(0/8) cM0 - eight a nalyzed lymph nodes for complete gastrectomy are 
definitely not enough!  
 
4. Lack of information on the type of operation and its scope.  
 
5. ,….As diffuse gastric cancer is difficult to detect at an early, treatable stage  
current recommendations suggest proph ylactic gastrectomy in healthy CDH1 mutation 
carriers rather than endoscopic surveillance…." - there is a lack of literature confirming this 
thesis.!  This phase is very much debatable(however surgery is the definitive treatment). 
Usually, we leave the deci sion to the patient, presenting everything for and against.  
 
6. The photos should be of better quality.  
 
7. The  discussion part  requires extension and refinement .  
 
 
The lack of these elements definitely reduces the value of work.  
 
In conclusion, the manuscript needs some improvements.  
 
Thank you for your choice me as a reviewer.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the neces sary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able t o assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to t his manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering  the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from 
an organisation that may in any way gain or lose financially from the publication of 
this manuscript, either now or in the future?  
 
2. Do you  hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of 
the manuscript?  
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interes ts. 
 
I agree to the open peer review policy of the journal. I understand that my name will be 
included  on my report to the authors and, if the manuscript is accepted for publication, my 
named report  including any attachments I upload will be posted on the w ebsite along with the 
authors'  responses. I agree for my report to be made available under an Open Access Creative 
Commons  CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that 
any comments  which I do not wish to be included in my named report can be included as 
confidential comments  to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Case report: Acute abdominal pain in a 37 -year-old patient and the consequences for 
his family  
 
Version: 2 Date: 27 Dec 2019  
 
Reviewer: Robert Sitarz  
 
Reviewer's report:  
 
Please include all comments for the authors in this box rather than uploading your report as 
an attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be  included in a text 
format.  
Please overwrite this text when adding your comments to the authors.  
 
 Dear authors and editor,  
 
 The manuscript  titled ''Acute abdomen in a 37 -year-old patient and the consequences for his 
family ''  describes a case of a young  man with stomach cancer based on the CDH1 gene 
mutation and provided consequences for his family. The idea of writing a manuscript/ cause 
report on this topic is interesting. I believe they add some contribution to the literature.  
The paper requires more work,  particularly for discussion part, the language is correct and 
the content is understandable.  
 
Literature very poor, does not contain already developed diagrams for diagnosis and 
treatment of gastric cancer with CDH mutation. 4 items presented are pr operly selected and 
mostly up to date.  
 
However the manuscript  is good, I have some comments that should be clarified.  
 
1. Loss of CDH function/ mutation is also a metastatic model of EMT process.  
This is the basic model of metastasis in cancer progressio n. I did not notice the sentence on 
this topic.  
 
2. During surgery it is very difficult to determine the type of cancer( in particular 
linitis plastic) - the answer to this question is possible after histopathological analysis.  
 
3. pT1a pN0(0/8) cM0 - eight a nalyzed lymph nodes for complete gastrectomy are 
definitely not enough!  
 
4. Lack of information on the type of operation and its scope.  
 
5. ,….As diffuse gastric cancer is difficult to detect at an early, treatable stage  
current recommendations suggest proph ylactic gastrectomy in healthy CDH1 mutation 
carriers rather than endoscopic surveillance…." - there is a lack of literature confirming this 
thesis.!  This phase is very much debatable(however surgery is the definitive treatment). 
Usually, we leave the deci sion to the patient, presenting everything for and against.  
 
6. The photos should be of better quality.  
 
7. The  discussion part  requires extension and refinement .  
 
 
The lack of these elements definitely reduces the value of work.  
 
In conclusion, the manuscript needs some improvements.  
 
Thank you for your choice me as a reviewer.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the neces sary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able t o assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to t his manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering  the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from 
an organisation that may in any way gain or lose financially from the publication of 
this manuscript, either now or in the future?  
 
2. Do you  hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of 
the manuscript?  
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interes ts. 
 
I agree to the open peer review policy of the journal. I understand that my name will be 
included  on my report to the authors and, if the manuscript is accepted for publication, my 
named report  including any attachments I upload will be posted on the w ebsite along with the 
authors'  responses. I agree for my report to be made available under an Open Access Creative 
Commons  CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that 
any comments  which I do not wish to be included in my named report can be included as 
confidential comments  to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant