Reviewer ’s report  
 
Title: Clinical characteristics of Hepatic Arterioportal S hunts Associated with Hepatocellular 
Carcinoma  
 
Version: 1 Date: 05 Feb 2018  
 
Reviewer: Giacomo Batignani  
 
Reviewer's report:  
 
First of all I like to question the authors about the use of the term "emboli" which they use 
frequently throughout their manuscript. I think that the term should be changed with "thrombus" 
because emboli it mea n  to me something that usually detaches from the thrombus and migrates 
elsewhere (that it is not what the Authors probably intend).  
The following part of the introduction, results not quite understandable to me, and I think to the 
Readers, try to explain  it better also adding with some citation if possible.  
It has been a general understanding that HCC directly invade into portal vein system through 
vein walls, leading to AP -shunts. However, that is not fully true. With histology observation, 
portal vei n walls were complete without gap. Tumor tissue locally broke through portal vein wall 
to grow at the base of portal vein cavity, spread along the vessel lumen. The growth was not easy 
to break through venous intima, which, therefore, produced the spaces  between the venous wall 
and intima. Based on the hepatic artery angiography imaging, no direct circulation between 
hepatic artery and portal vein caused with tumor tissue was observed.  
In the results section, it appeared  suddenly, without any previous mention in the "introduction" 
and in "patients and methods", a patients division into "typical and atypical shunts" and a further 
stratification in grade 1 -3. I think that this division should be reported in the Patients and method 
section and the presence  in literature  (if any) along with its meaning, in the introduction.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, p lease specify which controls are required in your comments to the authors.  
 
Yes 
 
  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to 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.  
 
I am able to assess the statistics  
 
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 inter ests, 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 c ontent 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 com peting interests.  
 
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  
inclu ding any attachments I upload will be posted on the website 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 a ny 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: Clinical characteristics of Hepatic Arterioportal S hunts Associated with Hepatocellular 
Carcinoma  
 
Version: 1 Date: 05 Feb 2018  
 
Reviewer: Giacomo Batignani  
 
Reviewer's report:  
 
First of all I like to question the authors about the use of the term "emboli" which they use 
frequently throughout their manuscript. I think that the term should be changed with "thrombus" 
because emboli it mea n  to me something that usually detaches from the thrombus and migrates 
elsewhere (that it is not what the Authors probably intend).  
The following part of the introduction, results not quite understandable to me, and I think to the 
Readers, try to explain  it better also adding with some citation if possible.  
It has been a general understanding that HCC directly invade into portal vein system through 
vein walls, leading to AP -shunts. However, that is not fully true. With histology observation, 
portal vei n walls were complete without gap. Tumor tissue locally broke through portal vein wall 
to grow at the base of portal vein cavity, spread along the vessel lumen. The growth was not easy 
to break through venous intima, which, therefore, produced the spaces  between the venous wall 
and intima. Based on the hepatic artery angiography imaging, no direct circulation between 
hepatic artery and portal vein caused with tumor tissue was observed.  
In the results section, it appeared  suddenly, without any previous mention in the "introduction" 
and in "patients and methods", a patients division into "typical and atypical shunts" and a further 
stratification in grade 1 -3. I think that this division should be reported in the Patients and method 
section and the presence  in literature  (if any) along with its meaning, in the introduction.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, p lease specify which controls are required in your comments to the authors.  
 
Yes 
 
  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to 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.  
 
I am able to assess the statistics  
 
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 inter ests, 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 c ontent 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 com peting interests.  
 
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  
inclu ding any attachments I upload will be posted on the website 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 a ny 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: Clinical characteristics of Hepatic Arterioportal S hunts Associated with Hepatocellular 
Carcinoma  
 
Version: 1 Date: 05 Feb 2018  
 
Reviewer: Giacomo Batignani  
 
Reviewer's report:  
 
First of all I like to question the authors about the use of the term "emboli" which they use 
frequently throughout their manuscript. I think that the term should be changed with "thrombus" 
because emboli it mea n  to me something that usually detaches from the thrombus and migrates 
elsewhere (that it is not what the Authors probably intend).  
The following part of the introduction, results not quite understandable to me, and I think to the 
Readers, try to explain  it better also adding with some citation if possible.  
It has been a general understanding that HCC directly invade into portal vein system through 
vein walls, leading to AP -shunts. However, that is not fully true. With histology observation, 
portal vei n walls were complete without gap. Tumor tissue locally broke through portal vein wall 
to grow at the base of portal vein cavity, spread along the vessel lumen. The growth was not easy 
to break through venous intima, which, therefore, produced the spaces  between the venous wall 
and intima. Based on the hepatic artery angiography imaging, no direct circulation between 
hepatic artery and portal vein caused with tumor tissue was observed.  
In the results section, it appeared  suddenly, without any previous mention in the "introduction" 
and in "patients and methods", a patients division into "typical and atypical shunts" and a further 
stratification in grade 1 -3. I think that this division should be reported in the Patients and method 
section and the presence  in literature  (if any) along with its meaning, in the introduction.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, p lease specify which controls are required in your comments to the authors.  
 
Yes 
 
  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to 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.  
 
I am able to assess the statistics  
 
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 inter ests, 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 c ontent 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 com peting interests.  
 
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  
inclu ding any attachments I upload will be posted on the website 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 a ny 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