Title: A cost-effective measure to prevent hemorrhage in ultrasound-guided percutaneous liver
biopsy
Version: 0 Date: 14 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-Although the patients were divided into observation and control groups based on the order
of puncture, the method of randomization is not described. Understanding how patients were
randomly assigned to each group is crucial for ensuring that selection bias did not influence the
results. A more detailed explanation of the randomization process would strengthen the study's
internal validity.
-The method of dividing participants into two groups based on the order of puncture could
introduce bias if the groups are not balanced in terms of pre-existing characteristics (e.g., severity
of liver disease, comorbidities). A more thorough randomization method, such as computer-
generated randomization, would help ensure more balanced groups.
-The study does not mention blinding of either the patients or the operators. Blinding is
important in clinical trials to reduce the risk of bias in data collection, especially with subjective
measurements like the assessment of bleeding complications. The absence of blinding could
introduce observer bias in assessing outcomes such as hemostasis time and bleeding severity.
-Although the study is well-designed for the hospital setting, the methods may not be
generalizable to all healthcare environments. The fact that the study was conducted by a single,
experienced operator raises the question of whether the results could be replicated with less
experienced clinicians or in hospitals with different resources.
-While the discussion reports the effectiveness of AGS-SFA in achieving hemostasis, it could
benefit from a more detailed exploration of how AGS-SFA works at a physiological level.
Understanding the mechanisms of AGS-SFA (e.g., how it absorbs blood or promotes clotting)
would help further solidify its role in liver biopsy and make the findings more robust from a
scientific perspective.
-The observation group had three cases of post-biopsy bleeding, which is acknowledged, but the
explanation remains somewhat speculative. The study suggests this may be due to insufficient
AGS-SFA or overly deep filling, but it would be helpful to explore these cases in more depth.
For instance, was there a specific trend (e.g., liver condition, coagulation status) that could
explain these three instances? A more in-depth investigation of these outliers could strengthen
the findings.
-The discussion focuses on immediate post-biopsy bleeding and hemostasis, but there is little
mention of the longer-term outcomes. It would be useful to know whether there were any delayed
complications (e.g., late bleeding, infection, or other adverse effects) in either group. Including
this information would provide a more complete picture of the safety and effectiveness of AGS-
SFA.
Title: A cost-effective measure to prevent hemorrhage in ultrasound-guided percutaneous liver
biopsy
Version: 0 Date: 14 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-Although the patients were divided into observation and control groups based on the order
of puncture, the method of randomization is not described. Understanding how patients were
randomly assigned to each group is crucial for ensuring that selection bias did not influence the
results. A more detailed explanation of the randomization process would strengthen the study's
internal validity.
-The method of dividing participants into two groups based on the order of puncture could
introduce bias if the groups are not balanced in terms of pre-existing characteristics (e.g., severity
of liver disease, comorbidities). A more thorough randomization method, such as computer-
generated randomization, would help ensure more balanced groups.
-The study does not mention blinding of either the patients or the operators. Blinding is
important in clinical trials to reduce the risk of bias in data collection, especially with subjective
measurements like the assessment of bleeding complications. The absence of blinding could
introduce observer bias in assessing outcomes such as hemostasis time and bleeding severity.
-Although the study is well-designed for the hospital setting, the methods may not be
generalizable to all healthcare environments. The fact that the study was conducted by a single,
experienced operator raises the question of whether the results could be replicated with less
experienced clinicians or in hospitals with different resources.
-While the discussion reports the effectiveness of AGS-SFA in achieving hemostasis, it could
benefit from a more detailed exploration of how AGS-SFA works at a physiological level.
Understanding the mechanisms of AGS-SFA (e.g., how it absorbs blood or promotes clotting)
would help further solidify its role in liver biopsy and make the findings more robust from a
scientific perspective.
-The observation group had three cases of post-biopsy bleeding, which is acknowledged, but the
explanation remains somewhat speculative. The study suggests this may be due to insufficient
AGS-SFA or overly deep filling, but it would be helpful to explore these cases in more depth.
For instance, was there a specific trend (e.g., liver condition, coagulation status) that could
explain these three instances? A more in-depth investigation of these outliers could strengthen
the findings.
-The discussion focuses on immediate post-biopsy bleeding and hemostasis, but there is little
mention of the longer-term outcomes. It would be useful to know whether there were any delayed
complications (e.g., late bleeding, infection, or other adverse effects) in either group. Including
this information would provide a more complete picture of the safety and effectiveness of AGS-
SFA.
Please review this paper.
user
Title: A cost-effective measure to prevent hemorrhage in ultrasound-guided percutaneous liver
biopsy
Version: 0 Date: 14 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-Although the patients were divided into observation and control groups based on the order
of puncture, the method of randomization is not described. Understanding how patients were
randomly assigned to each group is crucial for ensuring that selection bias did not influence the
results. A more detailed explanation of the randomization process would strengthen the study's
internal validity.
-The method of dividing participants into two groups based on the order of puncture could
introduce bias if the groups are not balanced in terms of pre-existing characteristics (e.g., severity
of liver disease, comorbidities). A more thorough randomization method, such as computer-
generated randomization, would help ensure more balanced groups.
-The study does not mention blinding of either the patients or the operators. Blinding is
important in clinical trials to reduce the risk of bias in data collection, especially with subjective
measurements like the assessment of bleeding complications. The absence of blinding could
introduce observer bias in assessing outcomes such as hemostasis time and bleeding severity.
-Although the study is well-designed for the hospital setting, the methods may not be
generalizable to all healthcare environments. The fact that the study was conducted by a single,
experienced operator raises the question of whether the results could be replicated with less
experienced clinicians or in hospitals with different resources.
-While the discussion reports the effectiveness of AGS-SFA in achieving hemostasis, it could
benefit from a more detailed exploration of how AGS-SFA works at a physiological level.
Understanding the mechanisms of AGS-SFA (e.g., how it absorbs blood or promotes clotting)
would help further solidify its role in liver biopsy and make the findings more robust from a
scientific perspective.
-The observation group had three cases of post-biopsy bleeding, which is acknowledged, but the
explanation remains somewhat speculative. The study suggests this may be due to insufficient
AGS-SFA or overly deep filling, but it would be helpful to explore these cases in more depth.
For instance, was there a specific trend (e.g., liver condition, coagulation status) that could
explain these three instances? A more in-depth investigation of these outliers could strengthen
the findings.
-The discussion focuses on immediate post-biopsy bleeding and hemostasis, but there is little
mention of the longer-term outcomes. It would be useful to know whether there were any delayed
complications (e.g., late bleeding, infection, or other adverse effects) in either group. Including
this information would provide a more complete picture of the safety and effectiveness of AGS-
SFA.
assistant