Reviewer’s report
Title: 
Lower ultra-short-term heart rate variability can predict worse mucosal
healing in ulcerative colitis
Version: 
1 
Date: 
12 Jan 2023
Reviewer's report:
This is an interesting study on the relationship between ultra-short-term heart rate
variability (HRV) and mucosal inflammation in ulcerative colitis.
The study objective is of scientific interest. The sample size is adequate.
But there are several points that need to be addressed.
1.According to the results of this study, "HRV is a risk factor" does not seem
appropriate.
The design of this study is a case control study. HRV was measured only once at
the time of admission, and changes over time were not observed. Therefore, the
results of this study show an association between HRV and mucosal findings,
but do not tell us which is the cause, and which is the result. HRV changes may
not be the cause of inflammation of UC but may be the result of an autonomic
nervous system's response to systemic inflammation. If so, it would make sense
that HRV responded to endoscopic inflammation with systemic inflammation,
but not to histological inflammation without systemic effects.
Based on the results of this study, it can be said that there is an association
between HRV and endoscopic findings, but HRV may not be a "risk factor" for
mucosal flare. Please re-consider your title and discussion.
2.It would be good if you could discuss the reasons why RMSSD
(parasympathetic nervous system) was extracted and SDNN and SDSD (both
sympathetic and parasympathetic) were not extracted, based on their respective
mechanisms.
3.In the discussion section, the contents of the introduction section are repeated.
This is redundant.
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 interests.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Web of Science Reviewer Recognition
. Springer Nature can send verification
of this review directly to a Web of Science researcher profile (a subsidiary of
Clarivate Analytics). If you would like to take advantage of this service, please
click on the “Yes” option below. Your name, email address, title of the reviewed
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“Review Data”) will then be transmitted to Web of Science after the final
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Web of Science for a 
Web of Science researcher profile (this service was
previously known as “Publons”), they will notify you of the receipt of this
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not registered with Web of Science, you will receive an email from them asking
you to register in order for them to be able to recognize your review on your new
profile page. Web of Science may use the Review Data to generate derivative
metadata for the benefit of Web of Science and you as a reviewer, carefully
considering the sensitivity of such information. For example, Web of Science
may verify your record as a reviewer by updating your profile published on its
webservice if you have registered for such service or help editors to identify
candidate reviewers. Please find the details of processing in Web of Science’s
privacy policy 
https://clarivate.com/privacy-center/notices-policies/privacy-
policy/
No
Reviewer’s report
Title: 
Lower ultra-short-term heart rate variability can predict worse mucosal
healing in ulcerative colitis
Version: 
1 
Date: 
12 Jan 2023
Reviewer's report:
This is an interesting study on the relationship between ultra-short-term heart rate
variability (HRV) and mucosal inflammation in ulcerative colitis.
The study objective is of scientific interest. The sample size is adequate.
But there are several points that need to be addressed.
1.According to the results of this study, "HRV is a risk factor" does not seem
appropriate.
The design of this study is a case control study. HRV was measured only once at
the time of admission, and changes over time were not observed. Therefore, the
results of this study show an association between HRV and mucosal findings,
but do not tell us which is the cause, and which is the result. HRV changes may
not be the cause of inflammation of UC but may be the result of an autonomic
nervous system's response to systemic inflammation. If so, it would make sense
that HRV responded to endoscopic inflammation with systemic inflammation,
but not to histological inflammation without systemic effects.
Based on the results of this study, it can be said that there is an association
between HRV and endoscopic findings, but HRV may not be a "risk factor" for
mucosal flare. Please re-consider your title and discussion.
2.It would be good if you could discuss the reasons why RMSSD
(parasympathetic nervous system) was extracted and SDNN and SDSD (both
sympathetic and parasympathetic) were not extracted, based on their respective
mechanisms.
3.In the discussion section, the contents of the introduction section are repeated.
This is redundant.
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 interests.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Web of Science Reviewer Recognition
. Springer Nature can send verification
of this review directly to a Web of Science researcher profile (a subsidiary of
Clarivate Analytics). If you would like to take advantage of this service, please
click on the “Yes” option below. Your name, email address, title of the reviewed
manuscript, name of the journal, and date of your review submission (the
“Review Data”) will then be transmitted to Web of Science after the final
decision on the manuscript has been made. If you have already registered with
Web of Science for a 
Web of Science researcher profile (this service was
previously known as “Publons”), they will notify you of the receipt of this
review and update your profile as per your settings and their policy. If you are
not registered with Web of Science, you will receive an email from them asking
you to register in order for them to be able to recognize your review on your new
profile page. Web of Science may use the Review Data to generate derivative
metadata for the benefit of Web of Science and you as a reviewer, carefully
considering the sensitivity of such information. For example, Web of Science
may verify your record as a reviewer by updating your profile published on its
webservice if you have registered for such service or help editors to identify
candidate reviewers. Please find the details of processing in Web of Science’s
privacy policy 
https://clarivate.com/privacy-center/notices-policies/privacy-
policy/
No
Please review this paper.
user
Reviewer’s report
Title: 
Lower ultra-short-term heart rate variability can predict worse mucosal
healing in ulcerative colitis
Version: 
1 
Date: 
12 Jan 2023
Reviewer's report:
This is an interesting study on the relationship between ultra-short-term heart rate
variability (HRV) and mucosal inflammation in ulcerative colitis.
The study objective is of scientific interest. The sample size is adequate.
But there are several points that need to be addressed.
1.According to the results of this study, "HRV is a risk factor" does not seem
appropriate.
The design of this study is a case control study. HRV was measured only once at
the time of admission, and changes over time were not observed. Therefore, the
results of this study show an association between HRV and mucosal findings,
but do not tell us which is the cause, and which is the result. HRV changes may
not be the cause of inflammation of UC but may be the result of an autonomic
nervous system's response to systemic inflammation. If so, it would make sense
that HRV responded to endoscopic inflammation with systemic inflammation,
but not to histological inflammation without systemic effects.
Based on the results of this study, it can be said that there is an association
between HRV and endoscopic findings, but HRV may not be a "risk factor" for
mucosal flare. Please re-consider your title and discussion.
2.It would be good if you could discuss the reasons why RMSSD
(parasympathetic nervous system) was extracted and SDNN and SDSD (both
sympathetic and parasympathetic) were not extracted, based on their respective
mechanisms.
3.In the discussion section, the contents of the introduction section are repeated.
This is redundant.
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 interests.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Web of Science Reviewer Recognition
. Springer Nature can send verification
of this review directly to a Web of Science researcher profile (a subsidiary of
Clarivate Analytics). If you would like to take advantage of this service, please
click on the “Yes” option below. Your name, email address, title of the reviewed
manuscript, name of the journal, and date of your review submission (the
“Review Data”) will then be transmitted to Web of Science after the final
decision on the manuscript has been made. If you have already registered with
Web of Science for a 
Web of Science researcher profile (this service was
previously known as “Publons”), they will notify you of the receipt of this
review and update your profile as per your settings and their policy. If you are
not registered with Web of Science, you will receive an email from them asking
you to register in order for them to be able to recognize your review on your new
profile page. Web of Science may use the Review Data to generate derivative
metadata for the benefit of Web of Science and you as a reviewer, carefully
considering the sensitivity of such information. For example, Web of Science
may verify your record as a reviewer by updating your profile published on its
webservice if you have registered for such service or help editors to identify
candidate reviewers. Please find the details of processing in Web of Science’s
privacy policy 
https://clarivate.com/privacy-center/notices-policies/privacy-
policy/
No
assistant