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0 | 0 | Review for 10.1186/s12893-025-02789-w | Reviewed - bmc_surgery | Title: The Surgical Time-Out: The Relationship Between Perceptions of a Safety-task Anchor
and Surgical Team Workflow
Version: 2 Date: 27 Sep 2024
Reviewer's report:
My feedback from the review was well addressed in the responses from the authors. | Title: The Surgical Time-Out: The Relationship Between Perceptions of a Safety-task Anchor
and Surgical Team Workflow
Version: 2 Date: 27 Sep 2024
Reviewer's report:
My feedback from the review was well addressed in the responses from the authors. | BMC | 12893_2025_2789_ReviewerReport_V2_R3.pdf | {
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"content": "Title: The Surgical Time-Out: The Relationship Between Perceptions of a Safety-task Anchor\nand Surgical Team Workflow\nVersion: 2 Date: 27 Sep 2024\nReviewer's report:\nMy feedback from the review was well addressed in the re... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02789-w | Reviewed - bmc_surgery | Title: The Surgical Time-Out: The Relationship Between Perceptions of a Safety-task Anchor
and Surgical Team Workflow
Version: 2 Date: 06 Nov 2024
Reviewer: Ebru Önler
Reviewer's report:
Thanks for your revisions and additional files according to the reviewers' suggestions. | Title: The Surgical Time-Out: The Relationship Between Perceptions of a Safety-task Anchor
and Surgical Team Workflow
Version: 2 Date: 06 Nov 2024
Reviewer: Ebru Önler
Reviewer's report:
Thanks for your revisions and additional files according to the reviewers' suggestions. | BMC | 12893_2025_2789_ReviewerReport_V2_R5.pdf | {
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"content": "Title: The Surgical Time-Out: The Relationship Between Perceptions of a Safety-task Anchor\nand Surgical Team Workflow\nVersion: 2 Date: 06 Nov 2024\nReviewer: Ebru Önler\nReviewer's report:\nThanks for your revisions and add... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02789-w | Reviewed - bmc_surgery | Title: The Surgical Time-Out: The Relationship Between Perceptions of a Safety-task Anchor
and Surgical Team Workflow
Version: 2 Date: 07 Nov 2024
Reviewer: Anette Storesund
Reviewer's report:
First, I would like to express that I am happy to get the chance to review this research work.
It has been a pleasure to see a study on circulating nurses’ role in the WHO surgical checklist
team performance.
This study has had several reviewers involved already. I would recommend the manuscript to
make more changes to make it more solid and reader friendly.
On a general basis it would be recommended to fresh up the references with up-dated literature.
The WHO surgical safety checklist is a highly researched field of surgery and there are several
systematic reviews, in addition to meta-analysis that should be integrated in the manuscript.
It will also improve the reader friendliness if the figures and tables are provided with descriptive
headings and legends so that they stand out as self-explanatory without the manuscript text.
On more specific parts:
Page 7 – what about adding that there is evidence that the checklist has improved communication
and teamwork, as it was designed to enhance, adding updated publications?
Page 7-8 – would the reader friendliness be improved if there is a description on different reasons
for circulating nurses to leave the OR during surgery? And to link this to performing the Time-
out? Do they leave the OR because change of plans – too little or incorrect information before
surgery, or new information revealed while performing the Time-out? Was it because of weak
planning a head of surgery or excellent communication and information sharing during Time-
out? Describe reasons for leaving the OR: Is it because new info came up under the Time-out
or is it because the time-out revealed that more equipment was needed?
Choice of words throughout – perceived Time-out utility – I would recommend changing the
word to perceived Time-out usefulness.
In abstract and manuscript conclusion – change the word beliefs to attitude?
I also wonder if you are exploring implementation of the time-out or is it the performance/
utilization of the time-out procedure?
Page 8 – I question if you are measuring effects of the time-out checklist? Is it more correct
that you examined the impact of the collective perceptions of the usefulness of the time-out
procedure? Quantifying the strength better words than effect (when describing why they used
bivariate regression/multiple regression)?
Page 9 – please provide information on inclusion and exclusion criteria for recruitment in this
study.
Page 11 – Please provide the short information on the different levels of ASA classification.
This will make the readers not familiar with the classification to understand what kind of patient
are involved and then the level of complexity to expect during surgery.
Page 12 – Please re-write/ change the wording that have been written before: “Circulating
nurses have a critical role when it comes to resource accessibility, equipment malfunctioning,
teamwork, communication, and avoiding extraneous interruptions”.
Control variables: please clarify in the text what it is with surgeons that make them natural as
a control variable – different levels of surgeons, experience, other? And ASA level 4 on all
operations? How come?
Table 3 – It would be clearer if the heading includes information of who scored, how many
scored, the Likert-scale scores. How should we understand a negative score? Is there a mix of
unadjusted and adjusted scores here, this might be clearer.
Table 4 – Please provide more information that help the readership to understand this table. In
legend there is a *, but there is no use of only one star in the table?
Table 5 – this information may be better to explain in the manuscript text.
Page 20-21 – Please elaborate or re-write “However, the model provided useful insights into
the relationship between these variables, suggesting that the perception of timeout effectiveness
may still play a role in influencing outcomes under certain conditions” - to make it clearer for
the readership.
Discussion section should be discussing the studies findings against the published literature. As
it is presented now it is more like an author reflection.
Conclusion section – “Research indicates that front-line leadership behavior and engagement
in safety activities are strongly related to frontline workers’ perceptions of safety (44) and that
safety climate is better when there is a stronger relationship between the leader and members of
the team (45). The buy-in from the organizational and team leadership into safety practices likely
influences the safety behaviors of team members. Healthcare organizations should emphasize
the importance of conducting the time-out as a last check to catch non-routine events early on and
not as a perfunctory checklist”. I would consider removing this part since it is more reflections
and not conclusive directly for the study’s results.
Would it increase the reader friendliness throughout the manuscript to inform of what variables
are regarded as dependent and independent variables, where these words are used? | Title: The Surgical Time-Out: The Relationship Between Perceptions of a Safety-task Anchor
and Surgical Team Workflow
Version: 2 Date: 07 Nov 2024
Reviewer: Anette Storesund
Reviewer's report:
First, I would like to express that I am happy to get the chance to review this research work.
It has been a pleasure to see a study on circulating nurses’ role in the WHO surgical checklist
team performance.
This study has had several reviewers involved already. I would recommend the manuscript to
make more changes to make it more solid and reader friendly.
On a general basis it would be recommended to fresh up the references with up-dated literature.
The WHO surgical safety checklist is a highly researched field of surgery and there are several
systematic reviews, in addition to meta-analysis that should be integrated in the manuscript.
It will also improve the reader friendliness if the figures and tables are provided with descriptive
headings and legends so that they stand out as self-explanatory without the manuscript text.
On more specific parts:
Page 7 – what about adding that there is evidence that the checklist has improved communication
and teamwork, as it was designed to enhance, adding updated publications?
Page 7-8 – would the reader friendliness be improved if there is a description on different reasons
for circulating nurses to leave the OR during surgery? And to link this to performing the Time-
out? Do they leave the OR because change of plans – too little or incorrect information before
surgery, or new information revealed while performing the Time-out? Was it because of weak
planning a head of surgery or excellent communication and information sharing during Time-
out? Describe reasons for leaving the OR: Is it because new info came up under the Time-out
or is it because the time-out revealed that more equipment was needed?
Choice of words throughout – perceived Time-out utility – I would recommend changing the
word to perceived Time-out usefulness.
In abstract and manuscript conclusion – change the word beliefs to attitude?
I also wonder if you are exploring implementation of the time-out or is it the performance/
utilization of the time-out procedure?
Page 8 – I question if you are measuring effects of the time-out checklist? Is it more correct
that you examined the impact of the collective perceptions of the usefulness of the time-out
procedure? Quantifying the strength better words than effect (when describing why they used
bivariate regression/multiple regression)?
Page 9 – please provide information on inclusion and exclusion criteria for recruitment in this
study.
Page 11 – Please provide the short information on the different levels of ASA classification.
This will make the readers not familiar with the classification to understand what kind of patient
are involved and then the level of complexity to expect during surgery.
Page 12 – Please re-write/ change the wording that have been written before: “Circulating
nurses have a critical role when it comes to resource accessibility, equipment malfunctioning,
teamwork, communication, and avoiding extraneous interruptions”.
Control variables: please clarify in the text what it is with surgeons that make them natural as
a control variable – different levels of surgeons, experience, other? And ASA level 4 on all
operations? How come?
Table 3 – It would be clearer if the heading includes information of who scored, how many
scored, the Likert-scale scores. How should we understand a negative score? Is there a mix of
unadjusted and adjusted scores here, this might be clearer.
Table 4 – Please provide more information that help the readership to understand this table. In
legend there is a *, but there is no use of only one star in the table?
Table 5 – this information may be better to explain in the manuscript text.
Page 20-21 – Please elaborate or re-write “However, the model provided useful insights into
the relationship between these variables, suggesting that the perception of timeout effectiveness
may still play a role in influencing outcomes under certain conditions” - to make it clearer for
the readership.
Discussion section should be discussing the studies findings against the published literature. As
it is presented now it is more like an author reflection.
Conclusion section – “Research indicates that front-line leadership behavior and engagement
in safety activities are strongly related to frontline workers’ perceptions of safety (44) and that
safety climate is better when there is a stronger relationship between the leader and members of
the team (45). The buy-in from the organizational and team leadership into safety practices likely
influences the safety behaviors of team members. Healthcare organizations should emphasize
the importance of conducting the time-out as a last check to catch non-routine events early on and
not as a perfunctory checklist”. I would consider removing this part since it is more reflections
and not conclusive directly for the study’s results.
Would it increase the reader friendliness throughout the manuscript to inform of what variables
are regarded as dependent and independent variables, where these words are used? | BMC | 12893_2025_2789_ReviewerReport_V2_R6.pdf | {
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"content": "Title: The Surgical Time-Out: The Relationship Between Perceptions of a Safety-task Anchor\nand Surgical Team Workflow\nVersion: 2 Date: 07 Nov 2024\nReviewer: Anette Storesund\nReviewer's report:\nFirst, I would like to expr... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02789-w | Reviewed - bmc_surgery | Title: The Surgical Time-Out: The Relationship Between Perceptions of a Safety-task Anchor
and Surgical Team Workflow
Version: 3 Date: 20 Dec 2024
Reviewer: Anette Storesund
Reviewer's report:
Thank you for the very much improved manuscript. You are nearly ready to publish, but it still
needs som more adjustments. | Title: The Surgical Time-Out: The Relationship Between Perceptions of a Safety-task Anchor
and Surgical Team Workflow
Version: 3 Date: 20 Dec 2024
Reviewer: Anette Storesund
Reviewer's report:
Thank you for the very much improved manuscript. You are nearly ready to publish, but it still
needs som more adjustments. | BMC | 12893_2025_2789_ReviewerReport_V3_R6.pdf | {
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"content": "Title: The Surgical Time-Out: The Relationship Between Perceptions of a Safety-task Anchor\nand Surgical Team Workflow\nVersion: 3 Date: 20 Dec 2024\nReviewer: Anette Storesund\nReviewer's report:\nThank you for the very much... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02789-w | Reviewed - bmc_surgery | Title: The Surgical Time-Out: The Relationship Between Perceptions of a Safety-task Anchor
and Surgical Team Workflow
Version: 4 Date: 09 Jan 2025
Reviewer: Anette Storesund
Reviewer's report:
I will congratulate the authors on finishing a good manuscript. I have only a final comment:
Please make sure that the Supplementary material links are in line with titles in the documents
that are linked to.
I recommend this manuscript for publication after the final comment has been addressed. | Title: The Surgical Time-Out: The Relationship Between Perceptions of a Safety-task Anchor
and Surgical Team Workflow
Version: 4 Date: 09 Jan 2025
Reviewer: Anette Storesund
Reviewer's report:
I will congratulate the authors on finishing a good manuscript. I have only a final comment:
Please make sure that the Supplementary material links are in line with titles in the documents
that are linked to.
I recommend this manuscript for publication after the final comment has been addressed. | BMC | 12893_2025_2789_ReviewerReport_V4_R6.pdf | {
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0 | 0 | Review for 10.1186/s12893-024-02752-1 | Reviewed - bmc_surgery | Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision
surgery after artificial total hip arthroplasty
Version: 3 Date: 24 Jun 2024
Reviewer's report:
This paper has a novel idea. Through the pre-planning of artificial intelligence, the difficulty
of total hip revision surgery can be reduced, and the revision surgery can be completed better.
Moreover, the subject of this study has certain prospective and practical, which provides certain
theoretical value for clinical practice. | Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision
surgery after artificial total hip arthroplasty
Version: 3 Date: 24 Jun 2024
Reviewer's report:
This paper has a novel idea. Through the pre-planning of artificial intelligence, the difficulty
of total hip revision surgery can be reduced, and the revision surgery can be completed better.
Moreover, the subject of this study has certain prospective and practical, which provides certain
theoretical value for clinical practice. | BMC | 12893_2024_2752_ReviewerReport_V3_R1.pdf | {
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"content": "Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision\nsurgery after artificial total hip arthroplasty\nVersion: 3 Date: 24 Jun 2024\nReviewer's report:\nThis paper has a novel id... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02752-1 | Reviewed - bmc_surgery | Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision
surgery after artificial total hip arthroplasty
Version: 3 Date: 24 Jun 2024
Reviewer: Ryohei Takada
Reviewer's report:
This manuscript was well-written and included interesting topic. AIhip will get improved if the
system would learn more revision cases. | Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision
surgery after artificial total hip arthroplasty
Version: 3 Date: 24 Jun 2024
Reviewer: Ryohei Takada
Reviewer's report:
This manuscript was well-written and included interesting topic. AIhip will get improved if the
system would learn more revision cases. | BMC | 12893_2024_2752_ReviewerReport_V3_R2.pdf | {
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"content": "Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision\nsurgery after artificial total hip arthroplasty\nVersion: 3 Date: 24 Jun 2024\nReviewer: Ryohei Takada\nReviewer's report:\... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02752-1 | Reviewed - bmc_surgery | Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision
surgery after artificial total hip arthroplasty
Version: 3 Date: 03 Sep 2024
Reviewer's report:
Although this is considered an interesting and innovative study, I believe that including the
time intervals between the initial surgery and the revision would be necessary to enhance
the study's value and provide a more comprehensive analysis. Additionally, it is essential
to include the patients' comorbidities (such as diabetes, hypertension, osteoporosis) and the
medications they were using (especially anticoagulant use and how long before surgery these
medications were discontinued). While it is mentioned that the patients were treated with anti-
infection, anticoagulation, gastric protection, expectorants, anti-inflammatory, analgesic, anti-
osteoporosis, and other treatments, providing more detailed information on these treatments
would increase the study's relevance to clinical practice.
The limitations of the system should also be more thoroughly discussed in the discussion section.
For example, similar to AI-based programs like ChatGPT, which can always generate a result—
whether correct or incorrect—it is important to consider whether this system might have similar
issues. Adding these potential challenges to the discussion would enrich the depth of the study. | Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision
surgery after artificial total hip arthroplasty
Version: 3 Date: 03 Sep 2024
Reviewer's report:
Although this is considered an interesting and innovative study, I believe that including the
time intervals between the initial surgery and the revision would be necessary to enhance
the study's value and provide a more comprehensive analysis. Additionally, it is essential
to include the patients' comorbidities (such as diabetes, hypertension, osteoporosis) and the
medications they were using (especially anticoagulant use and how long before surgery these
medications were discontinued). While it is mentioned that the patients were treated with anti-
infection, anticoagulation, gastric protection, expectorants, anti-inflammatory, analgesic, anti-
osteoporosis, and other treatments, providing more detailed information on these treatments
would increase the study's relevance to clinical practice.
The limitations of the system should also be more thoroughly discussed in the discussion section.
For example, similar to AI-based programs like ChatGPT, which can always generate a result—
whether correct or incorrect—it is important to consider whether this system might have similar
issues. Adding these potential challenges to the discussion would enrich the depth of the study. | BMC | 12893_2024_2752_ReviewerReport_V3_R5.pdf | {
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"content": "Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision\nsurgery after artificial total hip arthroplasty\nVersion: 3 Date: 03 Sep 2024\nReviewer's report:\nAlthough this is consider... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02752-1 | Reviewed - bmc_surgery | Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision
surgery after artificial total hip arthroplasty
Version: 4 Date: 10 Sep 2024
Reviewer's report:
The revisions made to the study have been appropriately completed. The study can be accepted. | Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision
surgery after artificial total hip arthroplasty
Version: 4 Date: 10 Sep 2024
Reviewer's report:
The revisions made to the study have been appropriately completed. The study can be accepted. | BMC | 12893_2024_2752_ReviewerReport_V4_R5.pdf | {
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0 | 0 | Review for 10.1186/s12893-024-02752-1 | Reviewed - bmc_surgery | Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision
surgery after artificial total hip arthroplasty
Version: 4 Date: 22 Nov 2024
Reviewer: Won Yong Shon
Reviewer's report:
Overall, this is an innovative study focusing on the efficiency of artificial intelligence in
planning complex hip revision surgeries. The following observations have been made:
1. The author has mentioned that AI helps in improving accuracy of preoperative planning and
reducing intro operative errors. Including another group for comparison would contribute better
to the study.
2. The study would benefit from including more patients with type III defects.
3. The author has already mentioned that soft tissue condition, specific access & intra operative
prosthesis management are difficult things to be assessed by AI. But it is important to make
emphasis on this point as they are different for each patient.
In summary, this is a valuable study which will be a foundation for further research into the
applications of artificial intelligence in surgeries. | Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision
surgery after artificial total hip arthroplasty
Version: 4 Date: 22 Nov 2024
Reviewer: Won Yong Shon
Reviewer's report:
Overall, this is an innovative study focusing on the efficiency of artificial intelligence in
planning complex hip revision surgeries. The following observations have been made:
1. The author has mentioned that AI helps in improving accuracy of preoperative planning and
reducing intro operative errors. Including another group for comparison would contribute better
to the study.
2. The study would benefit from including more patients with type III defects.
3. The author has already mentioned that soft tissue condition, specific access & intra operative
prosthesis management are difficult things to be assessed by AI. But it is important to make
emphasis on this point as they are different for each patient.
In summary, this is a valuable study which will be a foundation for further research into the
applications of artificial intelligence in surgeries. | BMC | 12893_2024_2752_ReviewerReport_V4_R9.pdf | {
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"content": "Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision\nsurgery after artificial total hip arthroplasty\nVersion: 4 Date: 22 Nov 2024\nReviewer: Won Yong Shon\nReviewer's report:\... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02752-1 | Reviewed - bmc_surgery | Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision
surgery after artificial total hip arthroplasty
Version: 4 Date: 22 Nov 2024
Reviewer's report:
Dear Author,
I am writing in reference to your manuscript entitled "Efficacy of an Artificial Intelligence
Preoperative Planning System for Assisting in Revision Surgery After Artificial Total Hip
Arthroplasty."
I appreciate the opportunity to review your work. Please consider the following comments and
suggestions as constructive criticism aimed at enhancing the quality of your research.
1. The primary issue with your study is the absence of a control group. Comparing the AI
software against traditional 2D planning methods or a more advanced 3D planning model is
essential for accurately evaluating its efficacy. Without this comparison, the study lacks a solid
foundation for drawing conclusions about the AI system's performance.
2. There are significant language and grammatical errors throughout the manuscript. For
instance, the term "aseptic infection" reflects a fundamental misunderstanding of terminology.
3. The clinical outcomes presented cannot be solely attributed to preoperative planning,
especially given the variability observed in your case series. This undermines the reliability of
your findings.
4. The discussion section appears overly biased and attributes characteristics to the AIHIP
system that have not been adequately demonstrated or substantiated by the results.
5. There are instances where citations are included that bear no relevance to the corresponding
text. This is a serious issue that compromises the integrity of the manuscript. | Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision
surgery after artificial total hip arthroplasty
Version: 4 Date: 22 Nov 2024
Reviewer's report:
Dear Author,
I am writing in reference to your manuscript entitled "Efficacy of an Artificial Intelligence
Preoperative Planning System for Assisting in Revision Surgery After Artificial Total Hip
Arthroplasty."
I appreciate the opportunity to review your work. Please consider the following comments and
suggestions as constructive criticism aimed at enhancing the quality of your research.
1. The primary issue with your study is the absence of a control group. Comparing the AI
software against traditional 2D planning methods or a more advanced 3D planning model is
essential for accurately evaluating its efficacy. Without this comparison, the study lacks a solid
foundation for drawing conclusions about the AI system's performance.
2. There are significant language and grammatical errors throughout the manuscript. For
instance, the term "aseptic infection" reflects a fundamental misunderstanding of terminology.
3. The clinical outcomes presented cannot be solely attributed to preoperative planning,
especially given the variability observed in your case series. This undermines the reliability of
your findings.
4. The discussion section appears overly biased and attributes characteristics to the AIHIP
system that have not been adequately demonstrated or substantiated by the results.
5. There are instances where citations are included that bear no relevance to the corresponding
text. This is a serious issue that compromises the integrity of the manuscript. | BMC | 12893_2024_2752_ReviewerReport_V4_R8.pdf | {
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"content": "Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision\nsurgery after artificial total hip arthroplasty\nVersion: 4 Date: 22 Nov 2024\nReviewer's report:\nDear Author,\nI am writin... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02752-1 | Reviewed - bmc_surgery | Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision
surgery after artificial total hip arthroplasty
Version: 4 Date: 23 Nov 2024
Reviewer: Nicolò Fabbri
Reviewer's report:
Dear Author,
thank you for your responses; no further revisions are necessary. | Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision
surgery after artificial total hip arthroplasty
Version: 4 Date: 23 Nov 2024
Reviewer: Nicolò Fabbri
Reviewer's report:
Dear Author,
thank you for your responses; no further revisions are necessary. | BMC | 12893_2024_2752_ReviewerReport_V4_R4.pdf | {
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0 | 0 | Review for 10.1186/s12893-024-02752-1 | Reviewed - bmc_surgery | Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision
surgery after artificial total hip arthroplasty
Version: 4 Date: 24 Nov 2024
Reviewer's report:
I appreciate the work you submitted.
Some suggestions:
If AI was the major variable being studied, I would suggest looking at various aspects such as
prosthetic placement, length of hospital stays, and revisions that compare to surgeries without
AI. This would certainly add values to the claims in the manuscript. The assessment tool (Harris
Hip Score) was not the best choice of assessment for measuring efficacy of AI. | Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision
surgery after artificial total hip arthroplasty
Version: 4 Date: 24 Nov 2024
Reviewer's report:
I appreciate the work you submitted.
Some suggestions:
If AI was the major variable being studied, I would suggest looking at various aspects such as
prosthetic placement, length of hospital stays, and revisions that compare to surgeries without
AI. This would certainly add values to the claims in the manuscript. The assessment tool (Harris
Hip Score) was not the best choice of assessment for measuring efficacy of AI. | BMC | 12893_2024_2752_ReviewerReport_V4_R6.pdf | {
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} | 1.5 | 0 | [
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0 | 0 | Review for 10.1186/s12893-024-02752-1 | Reviewed - bmc_surgery | Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision
surgery after artificial total hip arthroplasty
Version: 5 Date: 15 Dec 2024
Reviewer's report:
interesting study
discussion is pretty poor
maybe a wider approach in the discussion section on AI should be faced
consider to discuss more papers
some examples :
doi 10.3390/healthcare12030300
10.3390/healthcare12020153 | Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision
surgery after artificial total hip arthroplasty
Version: 5 Date: 15 Dec 2024
Reviewer's report:
interesting study
discussion is pretty poor
maybe a wider approach in the discussion section on AI should be faced
consider to discuss more papers
some examples :
doi 10.3390/healthcare12030300
10.3390/healthcare12020153 | BMC | 12893_2024_2752_ReviewerReport_V5_R3.pdf | {
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"role": "user"
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"content": "Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision\nsurgery after artificial total hip arthroplasty\nVersion: 5 Date: 15 Dec 2024\nReviewer's report:\ninteresting study\ndiscus... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02752-1 | Reviewed - bmc_surgery | Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision
surgery after artificial total hip arthroplasty
Version: 5 Date: 18 Dec 2024
Reviewer's report:
Thank you for allowing me the opportunity to review the article.
I appreciate that the author took the time and individually addressed the previous feedback to
the reviewers.
Fundamental concern:
These is an efficacy study. However, it is unclear what exactly the research question is and
how efficacy is being measured. It would have added value to the manuscript to provided a
clear connection throughout the paper. The results provided aren't specifically addressed in the
discussion. The discussion continues to emphasize the literature, and less on the results of the
study. | Title: Efficacy of an artificial intelligence preoperative planning system for assisting in revision
surgery after artificial total hip arthroplasty
Version: 5 Date: 18 Dec 2024
Reviewer's report:
Thank you for allowing me the opportunity to review the article.
I appreciate that the author took the time and individually addressed the previous feedback to
the reviewers.
Fundamental concern:
These is an efficacy study. However, it is unclear what exactly the research question is and
how efficacy is being measured. It would have added value to the manuscript to provided a
clear connection throughout the paper. The results provided aren't specifically addressed in the
discussion. The discussion continues to emphasize the literature, and less on the results of the
study. | BMC | 12893_2024_2752_ReviewerReport_V5_R6.pdf | {
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"total": 7
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0 | 0 | Review for 10.1186/s12893-025-02792-1 | Reviewed - bmc_surgery | Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic
Scoping Review
Version: 1 Date: 04 Dec 2024
Reviewer: Julien Epailly
Reviewer's report: | Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic
Scoping Review
Version: 1 Date: 04 Dec 2024
Reviewer: Julien Epailly
Reviewer's report: | BMC | 12893_2025_2792_ReviewerReport_V1_R2.pdf | {
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0 | 0 | Review for 10.1186/s12893-025-02792-1 | Reviewed - bmc_surgery | Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic
Scoping Review
Version: 1 Date: 15 Dec 2024
Reviewer's report:
The impact of patient death on surgeons is worthy to discuss. The content to discussion is
changing in accordance with times.
This article is well written.
I found some points to be changed.
1: Please add (SSR) after “a systematic scoping review” in the methods section in the abstract,
because the SSR abbreviation is used in the conclusion. | Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic
Scoping Review
Version: 1 Date: 15 Dec 2024
Reviewer's report:
The impact of patient death on surgeons is worthy to discuss. The content to discussion is
changing in accordance with times.
This article is well written.
I found some points to be changed.
1: Please add (SSR) after “a systematic scoping review” in the methods section in the abstract,
because the SSR abbreviation is used in the conclusion. | BMC | 12893_2025_2792_ReviewerReport_V1_R3.pdf | {
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"content": "Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic\nScoping Review\nVersion: 1 Date: 15 Dec 2024\nReviewer's report:\nThe impact of patient death on surgeons is worthy to discuss. The co... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02792-1 | Reviewed - bmc_surgery | Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic
Scoping Review
Version: 1 Date: 19 Dec 2024
Reviewer: Hisayoshi Kawahara
Reviewer's report:
Seven Singapore possibly physicians addressed a question “what is known of the effects
of caring for the dying and the impact of patient’s death on surgeons?’ in this systematic
scoping review with an assistance of ChatGPT 4o and Notebook LM using the Ring Theory of
Personhood(RToP). My concerns are as follows.
1. As the corresponding author of this manuscript, Lalit Kumar Radha Krishna, described
in Bioethics 2015;29:171-81, the Ring Theory of Personhood captures the nuances of local
conceptions of personhood and that was based on clinical experience in Confucian-inspired
Singapore. I wonder how RToP could be understood by international readers, especially those
in western countries, and whether the authors’ analyses could be accurately assessed without an
enough knowledge of Confucian. That is the most crucial point in this manuscript.
2. I wonder whether surgeons were included in this study as authors. If not, I wonder why the
authors had attempted to investigate the effects of caring for the dying and the impact of patient’s
death on surgeons in spite of poor clinical perspective and experiences of patient’s death as
surgeons.
3. I wonder how the Use of AI had contributed to produce this systematic scoping review(SSR).
It is necessary to describe more details of how the authors used AI in the analyses of 26
articles. Actually, it is described “The themes identified by Notebook LM were 1) the impact
on personhood, 2) implications” and “The themes identified through ChatGPT were 1) current
theories impacting death and dying 2) overarching theories impacting death and dying”.
However, “The research and expert teams reviewed the data and determined that the finalized
domains were 1) the impact on personhood, 2) predisposing factors”. It was not clarified how the
finalized domains were determined with the relationships of the themes identified by Notebook
LM and ChatGPT.
4. I hardly agree with the conclusive message “AI assisted SSR in SEBA provides new insights
into the wider influences of death and dying upon a surgeon’s identity and personhood and
impact on patient care and safety” because of a lack of appropriate evidence for it.
5. The sections of Results, Discussion and Conclusion were described too subjectively and were
lacking correct evidences. Especially, Conclusion are redundant and should be correctly based
on the authors’ SSR. | Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic
Scoping Review
Version: 1 Date: 19 Dec 2024
Reviewer: Hisayoshi Kawahara
Reviewer's report:
Seven Singapore possibly physicians addressed a question “what is known of the effects
of caring for the dying and the impact of patient’s death on surgeons?’ in this systematic
scoping review with an assistance of ChatGPT 4o and Notebook LM using the Ring Theory of
Personhood(RToP). My concerns are as follows.
1. As the corresponding author of this manuscript, Lalit Kumar Radha Krishna, described
in Bioethics 2015;29:171-81, the Ring Theory of Personhood captures the nuances of local
conceptions of personhood and that was based on clinical experience in Confucian-inspired
Singapore. I wonder how RToP could be understood by international readers, especially those
in western countries, and whether the authors’ analyses could be accurately assessed without an
enough knowledge of Confucian. That is the most crucial point in this manuscript.
2. I wonder whether surgeons were included in this study as authors. If not, I wonder why the
authors had attempted to investigate the effects of caring for the dying and the impact of patient’s
death on surgeons in spite of poor clinical perspective and experiences of patient’s death as
surgeons.
3. I wonder how the Use of AI had contributed to produce this systematic scoping review(SSR).
It is necessary to describe more details of how the authors used AI in the analyses of 26
articles. Actually, it is described “The themes identified by Notebook LM were 1) the impact
on personhood, 2) implications” and “The themes identified through ChatGPT were 1) current
theories impacting death and dying 2) overarching theories impacting death and dying”.
However, “The research and expert teams reviewed the data and determined that the finalized
domains were 1) the impact on personhood, 2) predisposing factors”. It was not clarified how the
finalized domains were determined with the relationships of the themes identified by Notebook
LM and ChatGPT.
4. I hardly agree with the conclusive message “AI assisted SSR in SEBA provides new insights
into the wider influences of death and dying upon a surgeon’s identity and personhood and
impact on patient care and safety” because of a lack of appropriate evidence for it.
5. The sections of Results, Discussion and Conclusion were described too subjectively and were
lacking correct evidences. Especially, Conclusion are redundant and should be correctly based
on the authors’ SSR. | BMC | 12893_2025_2792_ReviewerReport_V1_R4.pdf | {
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"content": "Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic\nScoping Review\nVersion: 1 Date: 19 Dec 2024\nReviewer: Hisayoshi Kawahara\nReviewer's report:\nSeven Singapore possibly physicians a... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02792-1 | Reviewed - bmc_surgery | Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic
Scoping Review
Version: 1 Date: 21 Dec 2024
Reviewer: Julien Hasselmann
Reviewer's report:
This manuscript has the potential to make a meaningful contribution to the literature on surgeon
well-being and professional identity.
BACKGROUND
- I would suggest adding a reference to ‘Ring Theory of Personhood‘ where you first use it.
METHODS
- Nous: The term is used repeatedly but is not clearly defined in the introduction or methods.
A brief definition or clarification would enhance understanding for readers unfamiliar with this
concept.
- The manuscript heavily focuses on descriptive accounts. If available, validation through
measurable outcomes (e.g., burnout rates, PTSD prevalence where available) might add some
objectivity.
- The description of the SEBA methodology, though comprehensive, lacks clarity in some areas.
For example:
# How were the independent reviewers trained to ensure consistent quality appraisal?
# What measures were taken to minimize bias during the “negotiated consensual validation”
process?
- The manuscript mentions the use of AI tools like ChatGPT and Notebook LM but provides no
detailed explanation of their specific roles or how their outputs were validated against traditional
methods.
RESULTS
Quantitative Data: While the SSR approach is qualitative, numerical data (e.g., the percentage
of studies identifying specific themes) could add weight to the findings.
DISCUSSION
- The discussion could better contextualize findings within existing literature. For example:
How do the identified themes compare with those in other professions (e.g., palliative care
physicians, nurses)?
What unique challenges do surgeons face, and why are they particularly vulnerable?
- Consider emphasizing practical implications more prominently. For example:
# What structural or systemic changes could mitigate the negative effects on surgeons?
# How can medical education integrate support systems for coping with patient death? | Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic
Scoping Review
Version: 1 Date: 21 Dec 2024
Reviewer: Julien Hasselmann
Reviewer's report:
This manuscript has the potential to make a meaningful contribution to the literature on surgeon
well-being and professional identity.
BACKGROUND
- I would suggest adding a reference to ‘Ring Theory of Personhood‘ where you first use it.
METHODS
- Nous: The term is used repeatedly but is not clearly defined in the introduction or methods.
A brief definition or clarification would enhance understanding for readers unfamiliar with this
concept.
- The manuscript heavily focuses on descriptive accounts. If available, validation through
measurable outcomes (e.g., burnout rates, PTSD prevalence where available) might add some
objectivity.
- The description of the SEBA methodology, though comprehensive, lacks clarity in some areas.
For example:
# How were the independent reviewers trained to ensure consistent quality appraisal?
# What measures were taken to minimize bias during the “negotiated consensual validation”
process?
- The manuscript mentions the use of AI tools like ChatGPT and Notebook LM but provides no
detailed explanation of their specific roles or how their outputs were validated against traditional
methods.
RESULTS
Quantitative Data: While the SSR approach is qualitative, numerical data (e.g., the percentage
of studies identifying specific themes) could add weight to the findings.
DISCUSSION
- The discussion could better contextualize findings within existing literature. For example:
How do the identified themes compare with those in other professions (e.g., palliative care
physicians, nurses)?
What unique challenges do surgeons face, and why are they particularly vulnerable?
- Consider emphasizing practical implications more prominently. For example:
# What structural or systemic changes could mitigate the negative effects on surgeons?
# How can medical education integrate support systems for coping with patient death? | BMC | 12893_2025_2792_ReviewerReport_V1_R5.pdf | {
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"content": "Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic\nScoping Review\nVersion: 1 Date: 21 Dec 2024\nReviewer: Julien Hasselmann\nReviewer's report:\nThis manuscript has the potential to m... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02792-1 | Reviewed - bmc_surgery | Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic
Scoping Review
Version: 4 Date: 06 Jan 2025
Reviewer's report:
I would like to express my appreciation for your innovative endeavor in conducting an AI-
assisted scoping review examining the effects of caring for dying patients and patient death
on surgeons. As the fifth reviewer joining this evaluation process, I will focus on aspects that
require additional attention while acknowledging the thorough work already completed through
previous reviews.
Background Section:
Your manuscript effectively presents the social context and prior research for readers unfamiliar
with the topic. However, the rationale for selecting this specific theme for a scoping review
requires further elaboration. Should your team possess experience in observational studies or
intervention trials in this domain, it would be valuable to incorporate these experiences through
appropriate self-citations, demonstrating your team's expertise and natural progression to this
review. Alternatively, if this represents a new research direction, please articulate the compelling
motivations that led to the formation of your review team and the selection of this particular
topic.
Methodological Considerations:
The AI assistance section requires more comprehensive documentation to ensure
reproducibility. While Additional File 4 contains the input-output details, the rapidly evolving
nature of AI technology necessitates more precise documentation. The manuscript would
benefit from specific version information for both ChatGPT and Notebook LM. Furthermore,
please document the hardware and software configurations utilized, the specific time period
during which AI interactions occurred, and the methods employed to ensure reproducibility.
Additionally, please describe any quality control measures implemented to validate the AI-
generated outputs.
These enhancements would substantially strengthen the methodological rigor of your innovative
approach to systematic scoping review while maintaining its groundbreaking nature in utilizing
AI assistance for academic research. | Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic
Scoping Review
Version: 4 Date: 06 Jan 2025
Reviewer's report:
I would like to express my appreciation for your innovative endeavor in conducting an AI-
assisted scoping review examining the effects of caring for dying patients and patient death
on surgeons. As the fifth reviewer joining this evaluation process, I will focus on aspects that
require additional attention while acknowledging the thorough work already completed through
previous reviews.
Background Section:
Your manuscript effectively presents the social context and prior research for readers unfamiliar
with the topic. However, the rationale for selecting this specific theme for a scoping review
requires further elaboration. Should your team possess experience in observational studies or
intervention trials in this domain, it would be valuable to incorporate these experiences through
appropriate self-citations, demonstrating your team's expertise and natural progression to this
review. Alternatively, if this represents a new research direction, please articulate the compelling
motivations that led to the formation of your review team and the selection of this particular
topic.
Methodological Considerations:
The AI assistance section requires more comprehensive documentation to ensure
reproducibility. While Additional File 4 contains the input-output details, the rapidly evolving
nature of AI technology necessitates more precise documentation. The manuscript would
benefit from specific version information for both ChatGPT and Notebook LM. Furthermore,
please document the hardware and software configurations utilized, the specific time period
during which AI interactions occurred, and the methods employed to ensure reproducibility.
Additionally, please describe any quality control measures implemented to validate the AI-
generated outputs.
These enhancements would substantially strengthen the methodological rigor of your innovative
approach to systematic scoping review while maintaining its groundbreaking nature in utilizing
AI assistance for academic research. | BMC | 12893_2025_2792_ReviewerReport_V4_R8.pdf | {
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"content": "Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic\nScoping Review\nVersion: 4 Date: 06 Jan 2025\nReviewer's report:\nI would like to express my appreciation for your innovative endeavor... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02792-1 | Reviewed - bmc_surgery | Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic
Scoping Review
Version: 4 Date: 06 Jan 2025
Reviewer: Sarra Saad
Reviewer's report:
Dear authors,
I would like to extend my congratulations on the high quality of the scientific data presented in
your article. It constitutes a highly interesting and comprehensive review.
Furthermore, it would be more pertinent to present the results according to surgical specialty.
While you have begun to address this aspect in the current paragraph ‘’ Indeed, by virtue of the
nature of certain surgical subspecialities of relatively lower risk and higher elective caseloads
(e.g. orthopedics) that some surgeons have little exposure to death leaving them less experienced
and equipped to confront the death of their patients (10, 45). On the other hand, surgeons
participating in high-risk procedures like aortic aneurysm surgeries (10), treatment of critically
ill patients and practice in surgical oncology that face more death and dying do not have effective
support (10, 46, 49)’’ it could be further refined by including a discussion of other specialties,
such as obstetric surgery, post-traumatic surgery, and neurological surgery.
We could also examine the differences in results based on the duration of care and the time of
work, such as the number of hours on call and the number of surgeons per team. | Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic
Scoping Review
Version: 4 Date: 06 Jan 2025
Reviewer: Sarra Saad
Reviewer's report:
Dear authors,
I would like to extend my congratulations on the high quality of the scientific data presented in
your article. It constitutes a highly interesting and comprehensive review.
Furthermore, it would be more pertinent to present the results according to surgical specialty.
While you have begun to address this aspect in the current paragraph ‘’ Indeed, by virtue of the
nature of certain surgical subspecialities of relatively lower risk and higher elective caseloads
(e.g. orthopedics) that some surgeons have little exposure to death leaving them less experienced
and equipped to confront the death of their patients (10, 45). On the other hand, surgeons
participating in high-risk procedures like aortic aneurysm surgeries (10), treatment of critically
ill patients and practice in surgical oncology that face more death and dying do not have effective
support (10, 46, 49)’’ it could be further refined by including a discussion of other specialties,
such as obstetric surgery, post-traumatic surgery, and neurological surgery.
We could also examine the differences in results based on the duration of care and the time of
work, such as the number of hours on call and the number of surgeons per team. | BMC | 12893_2025_2792_ReviewerReport_V4_R7.pdf | {
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"content": "Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic\nScoping Review\nVersion: 4 Date: 06 Jan 2025\nReviewer: Sarra Saad\nReviewer's report:\nDear authors,\nI would like to extend my cong... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02792-1 | Reviewed - bmc_surgery | Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic
Scoping Review
Version: 4 Date: 07 Jan 2025
Reviewer: Vincenzo Lizzi
Reviewer's report:
First of all, thank you so much for involving me in the review of this manuscript.
Very interesting and original topic that is always talked about too little. The serenity of surgeons
is fundamental to improve results and increase surgical evolution.
Clear and easily understandable English language with easy reading.
Adequate and recent bibliography with a number of valid references.
Clear and understandable tables and images.
The things I can add are:
- In the discussion you could add the table that was sent in excel where all the articles used in
the review are cited, obviously summarizing the Key findings section. | Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic
Scoping Review
Version: 4 Date: 07 Jan 2025
Reviewer: Vincenzo Lizzi
Reviewer's report:
First of all, thank you so much for involving me in the review of this manuscript.
Very interesting and original topic that is always talked about too little. The serenity of surgeons
is fundamental to improve results and increase surgical evolution.
Clear and easily understandable English language with easy reading.
Adequate and recent bibliography with a number of valid references.
Clear and understandable tables and images.
The things I can add are:
- In the discussion you could add the table that was sent in excel where all the articles used in
the review are cited, obviously summarizing the Key findings section. | BMC | 12893_2025_2792_ReviewerReport_V4_R9.pdf | {
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"content": "Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic\nScoping Review\nVersion: 4 Date: 07 Jan 2025\nReviewer: Vincenzo Lizzi\nReviewer's report:\nFirst of all, thank you so much for invol... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02792-1 | Reviewed - bmc_surgery | Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic
Scoping Review
Version: 5 Date: 13 Jan 2025
Reviewer's report:
I would like to commend the authors for their thoughtful revisions. The manuscript now
demonstrates enhanced clarity, methodological rigor, and depth, particularly in addressing prior
feedback. It effectively explores an underexamined yet critical topic, and I am confident that it
meets the standards for acceptance and publication. | Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic
Scoping Review
Version: 5 Date: 13 Jan 2025
Reviewer's report:
I would like to commend the authors for their thoughtful revisions. The manuscript now
demonstrates enhanced clarity, methodological rigor, and depth, particularly in addressing prior
feedback. It effectively explores an underexamined yet critical topic, and I am confident that it
meets the standards for acceptance and publication. | BMC | 12893_2025_2792_ReviewerReport_V5_R8.pdf | {
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"role": "user"
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"content": "Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic\nScoping Review\nVersion: 5 Date: 13 Jan 2025\nReviewer's report:\nI would like to commend the authors for their thoughtful revisions. ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02792-1 | Reviewed - bmc_surgery | Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic
Scoping Review
Version: 5 Date: 15 Jan 2025
Reviewer: Vincenzo Lizzi
Reviewer's report:
I read the article again and the changes I suggested were made. For me the article can be accepted. | Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic
Scoping Review
Version: 5 Date: 15 Jan 2025
Reviewer: Vincenzo Lizzi
Reviewer's report:
I read the article again and the changes I suggested were made. For me the article can be accepted. | BMC | 12893_2025_2792_ReviewerReport_V5_R9.pdf | {
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"content": "Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic\nScoping Review\nVersion: 5 Date: 15 Jan 2025\nReviewer: Vincenzo Lizzi\nReviewer's report:\nI read the article again and the changes ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02792-1 | Reviewed - bmc_surgery | Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic
Scoping Review
Version: 5 Date: 19 Jan 2025
Reviewer's report:
I appreciate authors effort to organize and summarize various aspects about the impact of death
and dying on surgeons using the modern AI tool. This paper is worthy to publish. | Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic
Scoping Review
Version: 5 Date: 19 Jan 2025
Reviewer's report:
I appreciate authors effort to organize and summarize various aspects about the impact of death
and dying on surgeons using the modern AI tool. This paper is worthy to publish. | BMC | 12893_2025_2792_ReviewerReport_V5_R3.pdf | {
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} | 2 | 0 | [
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"role": "user"
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"content": "Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic\nScoping Review\nVersion: 5 Date: 19 Jan 2025\nReviewer's report:\nI appreciate authors effort to organize and summarize various aspect... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02792-1 | Reviewed - bmc_surgery | Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic
Scoping Review
Version: 5 Date: 22 Jan 2025
Reviewer's report:
I can appreciate your inquiry regarding this subject. I appreciate the opportunity to review the
manuscript and enjoyed reading it. I have provided general comments regarding each sections.
Most of the comments are related to aspects that were unclear, or did not explicitly connect
throughout the manuscript. | Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic
Scoping Review
Version: 5 Date: 22 Jan 2025
Reviewer's report:
I can appreciate your inquiry regarding this subject. I appreciate the opportunity to review the
manuscript and enjoyed reading it. I have provided general comments regarding each sections.
Most of the comments are related to aspects that were unclear, or did not explicitly connect
throughout the manuscript. | BMC | 12893_2025_2792_ReviewerReport_V5_R10.pdf | {
"criticism": 1,
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} | 0.75 | 0 | [
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"role": "user"
},
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"content": "Title: The Impact of Death and Caring for the Dying on Surgeons- An AI assisted Systematic\nScoping Review\nVersion: 5 Date: 22 Jan 2025\nReviewer's report:\nI can appreciate your inquiry regarding this subject. I appreciate t... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02754-z | Reviewed - bmc_surgery | Title: Clinical advances in kidney autotransplantation:a review
Version: 2 Date: 03 Nov 2024
Reviewer's report:
Excellent review of KAT | Title: Clinical advances in kidney autotransplantation:a review
Version: 2 Date: 03 Nov 2024
Reviewer's report:
Excellent review of KAT | BMC | 12893_2024_2754_ReviewerReport_V2_R3.pdf | {
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} | 1 | 0 | [
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"role": "user"
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"content": "Title: Clinical advances in kidney autotransplantation:a review\nVersion: 2 Date: 03 Nov 2024\nReviewer's report:\nExcellent review of KAT",
"role": "assistant"
}
] | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02754-z | Reviewed - bmc_surgery | Title: Clinical advances in kidney autotransplantation:a review
Version: 2 Date: 10 Nov 2024
Reviewer: Abhinav Seth
Reviewer's report:
This is an excellent and well-written review on kidney autotransplantation. I would greatly
appreciate it if you could incorporate the following additional information into the manuscript:
1. Contraindications for Kidney Autotransplantation (KAT): What are the contraindications
for KAT? Could you elaborate on the cut-off values for split eGFR below which KAT is not
advisable?
2. Post-KAT Changes in eGFR: What happens to the split and overall eGFR after KAT?
3. eGFR Calculation and Monitoring in Reviewed Studies: In the 106 studies included in your
review, how was eGFR calculated, and how frequently was it monitored?
4. Post-KAT Monitoring Tests: After KAT, what specific tests are performed to monitor graft
function, and how often are these tests conducted?
Thank you for considering these suggestions to further enrich your already comprehensive
review. | Title: Clinical advances in kidney autotransplantation:a review
Version: 2 Date: 10 Nov 2024
Reviewer: Abhinav Seth
Reviewer's report:
This is an excellent and well-written review on kidney autotransplantation. I would greatly
appreciate it if you could incorporate the following additional information into the manuscript:
1. Contraindications for Kidney Autotransplantation (KAT): What are the contraindications
for KAT? Could you elaborate on the cut-off values for split eGFR below which KAT is not
advisable?
2. Post-KAT Changes in eGFR: What happens to the split and overall eGFR after KAT?
3. eGFR Calculation and Monitoring in Reviewed Studies: In the 106 studies included in your
review, how was eGFR calculated, and how frequently was it monitored?
4. Post-KAT Monitoring Tests: After KAT, what specific tests are performed to monitor graft
function, and how often are these tests conducted?
Thank you for considering these suggestions to further enrich your already comprehensive
review. | BMC | 12893_2024_2754_ReviewerReport_V2_R1.pdf | {
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} | 0.6 | 0 | [
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"role": "user"
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"content": "Title: Clinical advances in kidney autotransplantation:a review\nVersion: 2 Date: 10 Nov 2024\nReviewer: Abhinav Seth\nReviewer's report:\nThis is an excellent and well-written review on kidney autotransplantation. I would gr... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02754-z | Reviewed - bmc_surgery | Title: Clinical advances in kidney autotransplantation:a review
Version: 3 Date: 04 Dec 2024
Reviewer's report:
Done at time of initial review | Title: Clinical advances in kidney autotransplantation:a review
Version: 3 Date: 04 Dec 2024
Reviewer's report:
Done at time of initial review | BMC | 12893_2024_2754_ReviewerReport_V3_R3.pdf | {
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} | 0 | 0 | [
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"role": "user"
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"content": "Title: Clinical advances in kidney autotransplantation:a review\nVersion: 3 Date: 04 Dec 2024\nReviewer's report:\nDone at time of initial review",
"role": "assistant"
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] | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02754-z | Reviewed - bmc_surgery | Title: Clinical advances in kidney autotransplantation:a review
Version: 3 Date: 12 Dec 2024
Reviewer's report:
The purpose of this study was to review kidney autotransplantation and provide consolidated
updates on clinical advance in the practice. Overall, the authors accomplished their intent well
and thoroughly. For the most part the presentation of the information is well written, concise,
and well organized. Albeit, there are some stylistic language nuances suggesting the authors are
not native English writers, over all they are subtle and few. I would recommend this manuscript
for publication. | Title: Clinical advances in kidney autotransplantation:a review
Version: 3 Date: 12 Dec 2024
Reviewer's report:
The purpose of this study was to review kidney autotransplantation and provide consolidated
updates on clinical advance in the practice. Overall, the authors accomplished their intent well
and thoroughly. For the most part the presentation of the information is well written, concise,
and well organized. Albeit, there are some stylistic language nuances suggesting the authors are
not native English writers, over all they are subtle and few. I would recommend this manuscript
for publication. | BMC | 12893_2024_2754_ReviewerReport_V3_R4.pdf | {
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} | 1.4 | 0 | [
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"role": "user"
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"content": "Title: Clinical advances in kidney autotransplantation:a review\nVersion: 3 Date: 12 Dec 2024\nReviewer's report:\nThe purpose of this study was to review kidney autotransplantation and provide consolidated\nupdates on clinica... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02754-z | Reviewed - bmc_surgery | Title: Clinical advances in kidney autotransplantation:a review
Version: 3 Date: 16 Dec 2024
Reviewer: Richard E. Link
Reviewer's report:
This is a very well written and thorough review article about kidney autotransplantation. It
provides a lot of very clinically relevant information to the reader and is well worthy of
publication.
1. In the abstract, the authors describe the use of autotransplantation to treat central kidney
tumors or hilar tumors. IN the current era of minimally invasive robotic partial nephrectomy,
the need to perform bench surgery for tumor excision and renal repair is exceptionally rare so
this would be a very rare use of autotransplantation in the current era. It might be worthwhile
to stress that this would be a technique of last resort in the modern era of minimally invasive
nephron sparing surgery.
2. The authors describe autotransplantation in the setting of distal ureteral injuries. This would
also be a very unusual indication for autotransplantation since a wide range of approaches that do
not require moving the kidney would be applicable including psoas hitch ureteroneocystostomy,
boari flap, and buccal graft or appendiceal onlay grafting. Most of these approaches can be
performed using minimally invasive regionalized techniques. Autotransplantation is generally
more applicable to large segment ureteral loss rather than to distal ureteral obstruction. In
particularly, the popularization of buccal mucosal onlay grafting has facilitate complex
reconstructions today that might have required autotransplantation in the past.
3. In section 2.5, I found the following statement confusing: “When individuals with either a
solitary kidney or both kidneys are affected by kidney-related diseases, KAT can be considered
as a highly advantageous approach, primarily because of its ability to preserve nephrons and
maintain renal function. Consequently, it is often the preferred option for patients who require
kidney preservation before nephrectomy.” Can the authors clarify what they mean by this last
statement? I think they need to be more specific about what “solitary kidney or bilateral kidney-
related diseases” would be candidates for autotransplantation.
4. With respect to robotic autotransplantation, it may be worthwhile to mention that several
authors are now performing this procedure using the single port da Vinci SP robot using a purely
extraperitoneal approach. This approach would be ideal in terms of minimizing patient morbidity
and likely represents the future of robotic autotransplantation. | Title: Clinical advances in kidney autotransplantation:a review
Version: 3 Date: 16 Dec 2024
Reviewer: Richard E. Link
Reviewer's report:
This is a very well written and thorough review article about kidney autotransplantation. It
provides a lot of very clinically relevant information to the reader and is well worthy of
publication.
1. In the abstract, the authors describe the use of autotransplantation to treat central kidney
tumors or hilar tumors. IN the current era of minimally invasive robotic partial nephrectomy,
the need to perform bench surgery for tumor excision and renal repair is exceptionally rare so
this would be a very rare use of autotransplantation in the current era. It might be worthwhile
to stress that this would be a technique of last resort in the modern era of minimally invasive
nephron sparing surgery.
2. The authors describe autotransplantation in the setting of distal ureteral injuries. This would
also be a very unusual indication for autotransplantation since a wide range of approaches that do
not require moving the kidney would be applicable including psoas hitch ureteroneocystostomy,
boari flap, and buccal graft or appendiceal onlay grafting. Most of these approaches can be
performed using minimally invasive regionalized techniques. Autotransplantation is generally
more applicable to large segment ureteral loss rather than to distal ureteral obstruction. In
particularly, the popularization of buccal mucosal onlay grafting has facilitate complex
reconstructions today that might have required autotransplantation in the past.
3. In section 2.5, I found the following statement confusing: “When individuals with either a
solitary kidney or both kidneys are affected by kidney-related diseases, KAT can be considered
as a highly advantageous approach, primarily because of its ability to preserve nephrons and
maintain renal function. Consequently, it is often the preferred option for patients who require
kidney preservation before nephrectomy.” Can the authors clarify what they mean by this last
statement? I think they need to be more specific about what “solitary kidney or bilateral kidney-
related diseases” would be candidates for autotransplantation.
4. With respect to robotic autotransplantation, it may be worthwhile to mention that several
authors are now performing this procedure using the single port da Vinci SP robot using a purely
extraperitoneal approach. This approach would be ideal in terms of minimizing patient morbidity
and likely represents the future of robotic autotransplantation. | BMC | 12893_2024_2754_ReviewerReport_V3_R2.pdf | {
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} | 1.210526 | 0 | [
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"content": "Title: Clinical advances in kidney autotransplantation:a review\nVersion: 3 Date: 16 Dec 2024\nReviewer: Richard E. Link\nReviewer's report:\nThis is a very well written and thorough review article about kidney autotransplant... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02796-x | Reviewed - bmc_surgery | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 0 Date: 21 Sep 2024
Reviewer: Yossef Ezra
Reviewer's report:
Figure 6 may be confusing for most readers and could be omitted without significantly impacting
the overall understanding. | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 0 Date: 21 Sep 2024
Reviewer: Yossef Ezra
Reviewer's report:
Figure 6 may be confusing for most readers and could be omitted without significantly impacting
the overall understanding. | BMC | 12893_2025_2796_ReviewerReport_V0_R5.pdf | {
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"role": "user"
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{
"content": "Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine\nclosure technique in cesarean delivery: a systematic review and meta-analysis of randomized\ntrials\nVersion: 0 Date: 21 Sep 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02796-x | Reviewed - bmc_surgery | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 0 Date: 26 Sep 2024
Reviewer: Sanjoy Kumar Bhattacharyya
Reviewer's report: | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 0 Date: 26 Sep 2024
Reviewer: Sanjoy Kumar Bhattacharyya
Reviewer's report: | BMC | 12893_2025_2796_ReviewerReport_V0_R6.pdf | {
"criticism": 0,
"example": 0,
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"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine\nclosure technique in cesarean delivery: a systematic review and meta-analysis of randomized\ntrials\nVersion: 0 Date: 26 Sep 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02796-x | Reviewed - bmc_surgery | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 0 Date: 02 Oct 2024
Reviewer's report:
I read with great interest the Manuscript titled “Sonographic and surgical outcomes of the
double-layer purse-string uterine closure technique in cesarean delivery: a systematic review
and meta-analysis of randomized trials” which falls within the aim of BMC Surgery.
In my honest opinion, the topic is interesting enough to attract the readers’ attention.
Methodology is accurate and conclusions are supported by the data analysis . Nevertheless,
authors should clarify some point and improve the discussion citing relevant and novel key
articles about the topic.
Authors should consider the following recommendations:
- Manuscript should be further revised by a native English speaker
- Publication bias must be addressed using Egger's test for each outcome
- High heterogeneity was noted for several outcomes. Authors should discuss it and explain it
using sensitivity analysis and removing outliers.
- Improve discussion by adding comparison with existing literature. Authors should focus on 1)
the reproductive impact of a previous cesarean section (see and cite: PMID: 34414568; PMID:
39004471)
2) Pain related to cesarean sections and how to manage it (PMID: 33368204; PMID: 30683083) | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 0 Date: 02 Oct 2024
Reviewer's report:
I read with great interest the Manuscript titled “Sonographic and surgical outcomes of the
double-layer purse-string uterine closure technique in cesarean delivery: a systematic review
and meta-analysis of randomized trials” which falls within the aim of BMC Surgery.
In my honest opinion, the topic is interesting enough to attract the readers’ attention.
Methodology is accurate and conclusions are supported by the data analysis . Nevertheless,
authors should clarify some point and improve the discussion citing relevant and novel key
articles about the topic.
Authors should consider the following recommendations:
- Manuscript should be further revised by a native English speaker
- Publication bias must be addressed using Egger's test for each outcome
- High heterogeneity was noted for several outcomes. Authors should discuss it and explain it
using sensitivity analysis and removing outliers.
- Improve discussion by adding comparison with existing literature. Authors should focus on 1)
the reproductive impact of a previous cesarean section (see and cite: PMID: 34414568; PMID:
39004471)
2) Pain related to cesarean sections and how to manage it (PMID: 33368204; PMID: 30683083) | BMC | 12893_2025_2796_ReviewerReport_V0_R1.pdf | {
"criticism": 0,
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} | {
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} | 2.875 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine\nclosure technique in cesarean delivery: a systematic review and meta-analysis of randomized\ntrials\nVersion: 0 Date: 02 Oct 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02796-x | Reviewed - bmc_surgery | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 0 Date: 03 Oct 2024
Reviewer's report:
Thank you for the opportunity to review this article on an interesting closure technique at the
time of cesarean section. Overall, this is a thorough systematic review and meta analysis, and
is benefited by the fact that only RCTs are included. The general approach to SR/MA study
design is followed, along with approach and reporting of risk of bias. I have a few comments
and suggestions:
1. General Formatting:
- I would recommend the use of the term “cesarean scar defect” rather than “cesarean scar niche”
to align with recent high impact publications on the topic in Fertility and Sterility, JMIG, AJOG,
etc. I would make this change throughout the manuscript. (“Defect” is already used in your
discussion, but “niche” in the first part of your manuscript).
2. Methods:
- Secondary outcomes measures – were cesarean scar defect symptoms described in any of the
articles assessed, and if so what was the rationale for not including this in your manuscript?
- Page 8 line 2 – I assume it was meant to say the number of studies did not exceed 10
- In your forest plots, cesarean scar defect is categorized as an “event”, as such you need to
clearly outline how cesarean scar defects are being defined here. There is no accepted consensus
on what defines a cesarean scar defect – is there consensus across the RCTs included in your
SR/MA?
3. Results:
- Secondary outcomes can likely be presented much more concisely in table format rather than
free text.
4. Discussion:
- Thorough, but should be shortened.
5. General Comments:
- Realistically, you cannot combine these 8 studies as different control groups are used. In 6
studies the control group uses double layer closure, and in 2 studies the control group uses single
layer closure. While your subgroup analysis doesn’t indicate a difference in findings here, you
cannot perform a meta analysis on these 8 studies. You also mention a number of times that
double layer closure is preferred over single layer closure, and cite relevant studies as to why.
Your primary outcome can remain the same, but it should be on a meta-analysis of 6 studies
(PSUS vs double layer closure). You can report the meta-analysis of the 2 studies (PSUS vs
double layer closure) separately.
- Also, I would stress in your manuscript that you are reporting on CSD “events”, but not
on clinical symptoms. AUB/pain was not addressed, nor were adverse obstetrical outcomes
like cesarean scar pregnancy, placenta accreta spectrum, or uterine rupture. Given there is no
accepted definition of a CSD, while the PSUS may result in improved measurements on TVUS,
this does not mean that there is necessarily improvements or differences in clinical symptoms
or Gyne/OB outcomes. This should be clearly stated in the discussion. | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 0 Date: 03 Oct 2024
Reviewer's report:
Thank you for the opportunity to review this article on an interesting closure technique at the
time of cesarean section. Overall, this is a thorough systematic review and meta analysis, and
is benefited by the fact that only RCTs are included. The general approach to SR/MA study
design is followed, along with approach and reporting of risk of bias. I have a few comments
and suggestions:
1. General Formatting:
- I would recommend the use of the term “cesarean scar defect” rather than “cesarean scar niche”
to align with recent high impact publications on the topic in Fertility and Sterility, JMIG, AJOG,
etc. I would make this change throughout the manuscript. (“Defect” is already used in your
discussion, but “niche” in the first part of your manuscript).
2. Methods:
- Secondary outcomes measures – were cesarean scar defect symptoms described in any of the
articles assessed, and if so what was the rationale for not including this in your manuscript?
- Page 8 line 2 – I assume it was meant to say the number of studies did not exceed 10
- In your forest plots, cesarean scar defect is categorized as an “event”, as such you need to
clearly outline how cesarean scar defects are being defined here. There is no accepted consensus
on what defines a cesarean scar defect – is there consensus across the RCTs included in your
SR/MA?
3. Results:
- Secondary outcomes can likely be presented much more concisely in table format rather than
free text.
4. Discussion:
- Thorough, but should be shortened.
5. General Comments:
- Realistically, you cannot combine these 8 studies as different control groups are used. In 6
studies the control group uses double layer closure, and in 2 studies the control group uses single
layer closure. While your subgroup analysis doesn’t indicate a difference in findings here, you
cannot perform a meta analysis on these 8 studies. You also mention a number of times that
double layer closure is preferred over single layer closure, and cite relevant studies as to why.
Your primary outcome can remain the same, but it should be on a meta-analysis of 6 studies
(PSUS vs double layer closure). You can report the meta-analysis of the 2 studies (PSUS vs
double layer closure) separately.
- Also, I would stress in your manuscript that you are reporting on CSD “events”, but not
on clinical symptoms. AUB/pain was not addressed, nor were adverse obstetrical outcomes
like cesarean scar pregnancy, placenta accreta spectrum, or uterine rupture. Given there is no
accepted definition of a CSD, while the PSUS may result in improved measurements on TVUS,
this does not mean that there is necessarily improvements or differences in clinical symptoms
or Gyne/OB outcomes. This should be clearly stated in the discussion. | BMC | 12893_2025_2796_ReviewerReport_V0_R4.pdf | {
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} | 1.615385 | 0 | [
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"role": "user"
},
{
"content": "Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine\nclosure technique in cesarean delivery: a systematic review and meta-analysis of randomized\ntrials\nVersion: 0 Date: 03 Oct 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02796-x | Reviewed - bmc_surgery | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 1 Date: 09 Oct 2024
Reviewer: Yossef Ezra
Reviewer's report:
No comments. | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 1 Date: 09 Oct 2024
Reviewer: Yossef Ezra
Reviewer's report:
No comments. | BMC | 12893_2025_2796_ReviewerReport_V1_R5.pdf | {
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} | 1 | 0 | [
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"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine\nclosure technique in cesarean delivery: a systematic review and meta-analysis of randomized\ntrials\nVersion: 1 Date: 09 Oct 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02796-x | Reviewed - bmc_surgery | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 1 Date: 15 Oct 2024
Reviewer: Sanjoy Kumar Bhattacharyya
Reviewer's report: | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 1 Date: 15 Oct 2024
Reviewer: Sanjoy Kumar Bhattacharyya
Reviewer's report: | BMC | 12893_2025_2796_ReviewerReport_V1_R6.pdf | {
"criticism": 0,
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} | {
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} | 1 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine\nclosure technique in cesarean delivery: a systematic review and meta-analysis of randomized\ntrials\nVersion: 1 Date: 15 Oct 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02796-x | Reviewed - bmc_surgery | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 1 Date: 16 Oct 2024
Reviewer: Panagiotis Peitsidis
Reviewer's report:
This is an excellent systematic review and metanalysis of studies that are related with
the sonographic outcomes and the surgical parameters of the double uterine closure in
cesarean sections . The study selection, analysis and interpretation of results is appropriate. No
grammatical mistakes . I believe that the paper should be accepted in present form | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 1 Date: 16 Oct 2024
Reviewer: Panagiotis Peitsidis
Reviewer's report:
This is an excellent systematic review and metanalysis of studies that are related with
the sonographic outcomes and the surgical parameters of the double uterine closure in
cesarean sections . The study selection, analysis and interpretation of results is appropriate. No
grammatical mistakes . I believe that the paper should be accepted in present form | BMC | 12893_2025_2796_ReviewerReport_V1_R7.pdf | {
"criticism": 1,
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"total": 4
} | {
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} | 2.5 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine\nclosure technique in cesarean delivery: a systematic review and meta-analysis of randomized\ntrials\nVersion: 1 Date: 16 Oct 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02796-x | Reviewed - bmc_surgery | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 1 Date: 18 Oct 2024
Reviewer's report:
Prior concerns are adequately addressed and the manuscript can be published | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 1 Date: 18 Oct 2024
Reviewer's report:
Prior concerns are adequately addressed and the manuscript can be published | BMC | 12893_2025_2796_ReviewerReport_V1_R4.pdf | {
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} | 2 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine\nclosure technique in cesarean delivery: a systematic review and meta-analysis of randomized\ntrials\nVersion: 1 Date: 18 Oct 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02796-x | Reviewed - bmc_surgery | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 1 Date: 19 Oct 2024
Reviewer's report:
I read with great interest the Manuscript titled “Sonographic outcomes and surgical parameters
of the double-layer purse-string uterine closure technique in cesarean delivery: a systematic
review and meta-analysis of randomized trials ” which falls within the aim of BMC Surgery.
In my honest opinion, the topic is interesting enough to attract the readers’ attention.
Methodology is accurate and conclusions are supported by the data analysis . Nevertheless,
authors should clarify some points and improve the discussion citing relevant and novel key
articles about the topic.
Authors should consider the following recommendations:
-The manuscript should be further revised by a native English speaker
-A picture of the PSUS technique would be useful to help the readers
-Discussion needs to be implemented with some comparison with existing literature , especially
a) the role of a previous cesarean section on postsurgical infertility (see and cite PMID:
34414568; PMID: 36107032)
b) techniques to reduce postoperative pain (PMID: 33368204; PMID: 37083664) | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 1 Date: 19 Oct 2024
Reviewer's report:
I read with great interest the Manuscript titled “Sonographic outcomes and surgical parameters
of the double-layer purse-string uterine closure technique in cesarean delivery: a systematic
review and meta-analysis of randomized trials ” which falls within the aim of BMC Surgery.
In my honest opinion, the topic is interesting enough to attract the readers’ attention.
Methodology is accurate and conclusions are supported by the data analysis . Nevertheless,
authors should clarify some points and improve the discussion citing relevant and novel key
articles about the topic.
Authors should consider the following recommendations:
-The manuscript should be further revised by a native English speaker
-A picture of the PSUS technique would be useful to help the readers
-Discussion needs to be implemented with some comparison with existing literature , especially
a) the role of a previous cesarean section on postsurgical infertility (see and cite PMID:
34414568; PMID: 36107032)
b) techniques to reduce postoperative pain (PMID: 33368204; PMID: 37083664) | BMC | 12893_2025_2796_ReviewerReport_V1_R1.pdf | {
"criticism": 0,
"example": 0,
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"total": 5
} | {
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"suggestion_and_solution": 0.4
} | 2.8 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine\nclosure technique in cesarean delivery: a systematic review and meta-analysis of randomized\ntrials\nVersion: 1 Date: 19 Oct 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02796-x | Reviewed - bmc_surgery | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 2 Date: 30 Oct 2024
Reviewer: Panagiotis Peitsidis
Reviewer's report:
The article has been revised according to the reviewers remark. No issues are confronted
therefore i suggest acceptance . | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 2 Date: 30 Oct 2024
Reviewer: Panagiotis Peitsidis
Reviewer's report:
The article has been revised according to the reviewers remark. No issues are confronted
therefore i suggest acceptance . | BMC | 12893_2025_2796_ReviewerReport_V2_R7.pdf | {
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} | 1 | 0 | [
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"role": "user"
},
{
"content": "Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine\nclosure technique in cesarean delivery: a systematic review and meta-analysis of randomized\ntrials\nVersion: 2 Date: 30 Oct 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02796-x | Reviewed - bmc_surgery | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 2 Date: 30 Oct 2024
Reviewer: Sanjoy Kumar Bhattacharyya
Reviewer's report: | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 2 Date: 30 Oct 2024
Reviewer: Sanjoy Kumar Bhattacharyya
Reviewer's report: | BMC | 12893_2025_2796_ReviewerReport_V2_R6.pdf | {
"criticism": 0,
"example": 0,
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} | 1 | 0 | [
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"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine\nclosure technique in cesarean delivery: a systematic review and meta-analysis of randomized\ntrials\nVersion: 2 Date: 30 Oct 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02796-x | Reviewed - bmc_surgery | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 2 Date: 04 Nov 2024
Reviewer's report:
General: a systematic review and meta-analyses of RCTs analyzing the effects of PSUS on
ultrasound outcomes after caesarean section. It is a rather new technique, so no previous meta-
analyses have been published on this topic. It is very up to date and performed according to the
right guidelines. I would advise to double-check for typo's and grammar mistakes.
Abstract: I would advise to 1) explain cesarean scar defect a bit more and 2) to keep the
background shorter. The authors should avoid the use of adverbs and adjectives in the abstract
(e.g. rigourously, exhaustive). In the results section: it is not clear to me in which direction of
the reduction of CSD rate + uterine incision length was found (positive for PSUS or control).
Page 3, line 2: group instead of groups?
Background: The authors should try to shorten this section, it is way too extensive in my opinion.
Page 4, line 17: asymptomatic doesn't need an explanation, right (so I would suggest to remove
the rest of the sentence ...'meaning...symptoms'). Line 23: maybe add cesarean scar pregnancy.
Page 5, first lines about diagnostics: I would say that the preferred method is contrast enhanced
(saline/gel) ultrasound, but that ultrasound without contrast can also be used. MRI of HSG is
not better, or even worse. So you should mention the preferred method of making the diagnosis.
Methods: Page 7, lines 1-7: was the endometrial/decidual layer included or excluded in the
deepest suture, when double-layered sutured? And what about studies that only sutured in 1
layer, how was this performed?
Page 7 lines 15-19: by whom and how were the ultrasounds performed? How was the length
of the uterine incision defined, and measured? What is the differences between uterine incision
and incision defect? In what plane on US were the ultrasound measurements performed?
Results: page 11 line 18: four studies performed in Egypt but only 3 references. Line 23, same
page: 7 with only primary CS, and 2 with prior CS, makes 9. But only 8 RCTs were included.
Please clarify.
Page 12 line 17: is this a subparagraph title?
Page 15, line 10 and further: what was the difference in this subgroup? More/larger defects in
what group, and after how many weeks?
Page 17, lines 7 and 14: ...'the effect of ...was highly uncertain' sounds better to me, instead of
the plural form.
In general, I'm not sure whether you should keep al the different sensitivity analyses regarding
all different sorts of outcomes in the results section/main text. It becomes less readable by it,
and contains a lot of repetition.
Discussion: general: in my opinion, the discussion section is way too long and should be
shortened. Too much information in this section, focus on the most important aspects.
page 19 lines 3-10: this sounds as new information, I'm not sure what this adds to the manuscript.
Page22 line 12: including a lack of long-term and clinical follow-up, I would add 'clinical'
because there was no mentioning of symptoms/future fertility/pregnancies.
The lack of generalizability should be emphasized more, since these studies were only performed
in countries in Northern Africa/Turkey.
I miss a part where inconsistency with previous literature is mentioned, where saline or gel
sonography reveals more and larger defect compared to 'standard' ultrasound withou saline or
gel. | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 2 Date: 04 Nov 2024
Reviewer's report:
General: a systematic review and meta-analyses of RCTs analyzing the effects of PSUS on
ultrasound outcomes after caesarean section. It is a rather new technique, so no previous meta-
analyses have been published on this topic. It is very up to date and performed according to the
right guidelines. I would advise to double-check for typo's and grammar mistakes.
Abstract: I would advise to 1) explain cesarean scar defect a bit more and 2) to keep the
background shorter. The authors should avoid the use of adverbs and adjectives in the abstract
(e.g. rigourously, exhaustive). In the results section: it is not clear to me in which direction of
the reduction of CSD rate + uterine incision length was found (positive for PSUS or control).
Page 3, line 2: group instead of groups?
Background: The authors should try to shorten this section, it is way too extensive in my opinion.
Page 4, line 17: asymptomatic doesn't need an explanation, right (so I would suggest to remove
the rest of the sentence ...'meaning...symptoms'). Line 23: maybe add cesarean scar pregnancy.
Page 5, first lines about diagnostics: I would say that the preferred method is contrast enhanced
(saline/gel) ultrasound, but that ultrasound without contrast can also be used. MRI of HSG is
not better, or even worse. So you should mention the preferred method of making the diagnosis.
Methods: Page 7, lines 1-7: was the endometrial/decidual layer included or excluded in the
deepest suture, when double-layered sutured? And what about studies that only sutured in 1
layer, how was this performed?
Page 7 lines 15-19: by whom and how were the ultrasounds performed? How was the length
of the uterine incision defined, and measured? What is the differences between uterine incision
and incision defect? In what plane on US were the ultrasound measurements performed?
Results: page 11 line 18: four studies performed in Egypt but only 3 references. Line 23, same
page: 7 with only primary CS, and 2 with prior CS, makes 9. But only 8 RCTs were included.
Please clarify.
Page 12 line 17: is this a subparagraph title?
Page 15, line 10 and further: what was the difference in this subgroup? More/larger defects in
what group, and after how many weeks?
Page 17, lines 7 and 14: ...'the effect of ...was highly uncertain' sounds better to me, instead of
the plural form.
In general, I'm not sure whether you should keep al the different sensitivity analyses regarding
all different sorts of outcomes in the results section/main text. It becomes less readable by it,
and contains a lot of repetition.
Discussion: general: in my opinion, the discussion section is way too long and should be
shortened. Too much information in this section, focus on the most important aspects.
page 19 lines 3-10: this sounds as new information, I'm not sure what this adds to the manuscript.
Page22 line 12: including a lack of long-term and clinical follow-up, I would add 'clinical'
because there was no mentioning of symptoms/future fertility/pregnancies.
The lack of generalizability should be emphasized more, since these studies were only performed
in countries in Northern Africa/Turkey.
I miss a part where inconsistency with previous literature is mentioned, where saline or gel
sonography reveals more and larger defect compared to 'standard' ultrasound withou saline or
gel. | BMC | 12893_2025_2796_ReviewerReport_V2_R10.pdf | {
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"total": 37
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"suggestion_and_solution": 0.35135135135135137
} | 2.108108 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine\nclosure technique in cesarean delivery: a systematic review and meta-analysis of randomized\ntrials\nVersion: 2 Date: 04 Nov 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02796-x | Reviewed - bmc_surgery | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 3 Date: 25 Nov 2024
Reviewer: Dazhi Fan
Reviewer's report:
Thanks for your invitation to review.
The authors aimed to assess the impact of PSUS on ultrasound outcomes and surgical parameters
related to cesarean scars. And they found that the use of PSUS during cesarean sections appears
to be beneficial in decreasing the occurrence of cesarean scar defects.
I carefully read the full text and the author's reply letter.
Overall, it was a good study, logical, fluent, comfortable to read, and very valuable.
All my concerns are explained by the author in this manuscript.
I think the manuscript is good and support its publishing. | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 3 Date: 25 Nov 2024
Reviewer: Dazhi Fan
Reviewer's report:
Thanks for your invitation to review.
The authors aimed to assess the impact of PSUS on ultrasound outcomes and surgical parameters
related to cesarean scars. And they found that the use of PSUS during cesarean sections appears
to be beneficial in decreasing the occurrence of cesarean scar defects.
I carefully read the full text and the author's reply letter.
Overall, it was a good study, logical, fluent, comfortable to read, and very valuable.
All my concerns are explained by the author in this manuscript.
I think the manuscript is good and support its publishing. | BMC | 12893_2025_2796_ReviewerReport_V3_R13.pdf | {
"criticism": 0,
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} | 1.142857 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine\nclosure technique in cesarean delivery: a systematic review and meta-analysis of randomized\ntrials\nVersion: 3 Date: 25 Nov 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02796-x | Reviewed - bmc_surgery | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 3 Date: 01 Dec 2024
Reviewer: Marco la Verde
Reviewer's report:
This manuscript covers an important clinically relevant topic and assesses the effect of purse-
string uterine closure technique during cesarean deliveries. The underlying systematic review
and meta-analysis are generally well-conceived, with authors thoroughly describing their
methodology. Several aspects of this submission, however, require improvement for clarity,
completeness, and adherence to reporting standards. Please see detailed suggestions for revisions
numbered below.
Abstract
Clarity Results: While it is true that main and secondary outcomes are all covered, the abstract
does present a lack of balance regarding specificity. For instance, the heterogeneity-I2 values-
should be discussed in the aspect of the abstract with other findings towards better contextual
interpretation1.11
2.0Conclusions: Should be more concise and to the point. The clinical implications for PSUS
must be brought out much more because the benefits may seem quite subtle.
Introduction
3.0 Contextual Depth: Background is fairly well given in the introduction, but it should
also include current research on other methods of uterine closure. Some study citations from
2022-2024 would be beneficial to contextualize to the present day. In addition authors reported
in page 4: "Various diagnostic imaging techniques are used to assess these defects, including
transvaginal ultrasound, hysterosalpingography, saline infusion sonography, and magnetic
resonance imaging (MRI). Among these, contrast-enhanced ultrasound (saline/gel) is preferred
for its effectiveness, while non-contrast ultrasound typically provides less detail". I reccomend
to cite novel findings about the ultrasound evaluation of the uterine flow, this novel original
article could help this sentence:
DOI: 10.1055/a-2075-3021
https://doi.org/10.1080/14767050600852510
4.0 Hypothesis Statement: Clearly spell out the hypothesis of the systematic review to give the
reader a clear focus.
Methods
5.0 Searching: Transparency of Search Strategy: The search string has not been completely
provided with database-specific alterations. Specify exact words and Boolean operators used to
allow reproducibility.
6.0Risk of Bias and GRADE Criteria: Describe how any disagreements among reviewers
regarding the presence of bias or certainty of evidence (if applicable) were resolved.
7.0Inclusion/exclusion criteria: While a number of factors excluded the study of those cases
with emergency cesarean sections, there was superficial justification for that action. Further
explanation for these exclusions, because many such exclusions can limit generalisability of
results.
8.0Trial Registration: The identification number from the PROSPERO registration is provided;
however, the protocol document has not been attached. Attachment would be assuring to make
transparent as well as to allow reviewers to evaluate if there is compliance with an analysis as
planned done .
Results
9.0 Subgroup Analyses: While the heterogeneity of the outcomes, such as RMT, was pointed
out, no sufficient discussion of its causes was done in the manuscript. Sensitivity analyses or
subgroup analyses, as applicable, should have been presented to explain the variation in the
results obtained in some of the individual trials included.
Discussion
Discussion: 10.0 Interpretation of Findings: More attention could have been given to nuance
regarding why PSUS is or is not showing a significant improvement in certain outcomes.
11.0 Limitations: As this is a literature review, the limitation section must expand from
discussing some of the biases that could have taken place, to what high heterogeneity means in
various analyses. To support the sentence ,page 21:"Additionally, evaluating outcomes such as
scar tissue formation, fertility, postoperative recovery, and complications in future pregnancies
(such as cesarean scar pregnancy, placenta accreta spectrum, and uterine rupture) would provide
a more comprehensive understanding of the technique's impacts. " I reccomend to cite related
articles:
https://doi.org/10.1080/08941939.2020.1836289
https://doi.org/10.1111/aogs.12920
https://doi.org/10.1007/s10397-014-0842-8
12.0 Clinical Implications: State actionable recommendations for practitioners if appropriate,
based on your findings; OR describe why the available evidence was not sufficient at this time
to guide practice.
13.0 Conclusions: Tighten the conclusions to focus on most robust findings. Emphasize where
further research most urgently is needed.
14.0 Language and Grammar: Some sentences are not very clear, particularly in the method and
result sections. I would definitely recommend a serious copy editing by an experienced editor
or EN speaker.
I look forward to seeing an improved version that addresses the above concerns. Best regards | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 3 Date: 01 Dec 2024
Reviewer: Marco la Verde
Reviewer's report:
This manuscript covers an important clinically relevant topic and assesses the effect of purse-
string uterine closure technique during cesarean deliveries. The underlying systematic review
and meta-analysis are generally well-conceived, with authors thoroughly describing their
methodology. Several aspects of this submission, however, require improvement for clarity,
completeness, and adherence to reporting standards. Please see detailed suggestions for revisions
numbered below.
Abstract
Clarity Results: While it is true that main and secondary outcomes are all covered, the abstract
does present a lack of balance regarding specificity. For instance, the heterogeneity-I2 values-
should be discussed in the aspect of the abstract with other findings towards better contextual
interpretation1.11
2.0Conclusions: Should be more concise and to the point. The clinical implications for PSUS
must be brought out much more because the benefits may seem quite subtle.
Introduction
3.0 Contextual Depth: Background is fairly well given in the introduction, but it should
also include current research on other methods of uterine closure. Some study citations from
2022-2024 would be beneficial to contextualize to the present day. In addition authors reported
in page 4: "Various diagnostic imaging techniques are used to assess these defects, including
transvaginal ultrasound, hysterosalpingography, saline infusion sonography, and magnetic
resonance imaging (MRI). Among these, contrast-enhanced ultrasound (saline/gel) is preferred
for its effectiveness, while non-contrast ultrasound typically provides less detail". I reccomend
to cite novel findings about the ultrasound evaluation of the uterine flow, this novel original
article could help this sentence:
DOI: 10.1055/a-2075-3021
https://doi.org/10.1080/14767050600852510
4.0 Hypothesis Statement: Clearly spell out the hypothesis of the systematic review to give the
reader a clear focus.
Methods
5.0 Searching: Transparency of Search Strategy: The search string has not been completely
provided with database-specific alterations. Specify exact words and Boolean operators used to
allow reproducibility.
6.0Risk of Bias and GRADE Criteria: Describe how any disagreements among reviewers
regarding the presence of bias or certainty of evidence (if applicable) were resolved.
7.0Inclusion/exclusion criteria: While a number of factors excluded the study of those cases
with emergency cesarean sections, there was superficial justification for that action. Further
explanation for these exclusions, because many such exclusions can limit generalisability of
results.
8.0Trial Registration: The identification number from the PROSPERO registration is provided;
however, the protocol document has not been attached. Attachment would be assuring to make
transparent as well as to allow reviewers to evaluate if there is compliance with an analysis as
planned done .
Results
9.0 Subgroup Analyses: While the heterogeneity of the outcomes, such as RMT, was pointed
out, no sufficient discussion of its causes was done in the manuscript. Sensitivity analyses or
subgroup analyses, as applicable, should have been presented to explain the variation in the
results obtained in some of the individual trials included.
Discussion
Discussion: 10.0 Interpretation of Findings: More attention could have been given to nuance
regarding why PSUS is or is not showing a significant improvement in certain outcomes.
11.0 Limitations: As this is a literature review, the limitation section must expand from
discussing some of the biases that could have taken place, to what high heterogeneity means in
various analyses. To support the sentence ,page 21:"Additionally, evaluating outcomes such as
scar tissue formation, fertility, postoperative recovery, and complications in future pregnancies
(such as cesarean scar pregnancy, placenta accreta spectrum, and uterine rupture) would provide
a more comprehensive understanding of the technique's impacts. " I reccomend to cite related
articles:
https://doi.org/10.1080/08941939.2020.1836289
https://doi.org/10.1111/aogs.12920
https://doi.org/10.1007/s10397-014-0842-8
12.0 Clinical Implications: State actionable recommendations for practitioners if appropriate,
based on your findings; OR describe why the available evidence was not sufficient at this time
to guide practice.
13.0 Conclusions: Tighten the conclusions to focus on most robust findings. Emphasize where
further research most urgently is needed.
14.0 Language and Grammar: Some sentences are not very clear, particularly in the method and
result sections. I would definitely recommend a serious copy editing by an experienced editor
or EN speaker.
I look forward to seeing an improved version that addresses the above concerns. Best regards | BMC | 12893_2025_2796_ReviewerReport_V3_R16.pdf | {
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} | 2.16129 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine\nclosure technique in cesarean delivery: a systematic review and meta-analysis of randomized\ntrials\nVersion: 3 Date: 01 Dec 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02796-x | Reviewed - bmc_surgery | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 4 Date: 26 Dec 2024
Reviewer: Dazhi Fan
Reviewer's report:
Congratulations. | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 4 Date: 26 Dec 2024
Reviewer: Dazhi Fan
Reviewer's report:
Congratulations. | BMC | 12893_2025_2796_ReviewerReport_V4_R13.pdf | {
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} | 1 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine\nclosure technique in cesarean delivery: a systematic review and meta-analysis of randomized\ntrials\nVersion: 4 Date: 26 Dec 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02796-x | Reviewed - bmc_surgery | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 4 Date: 27 Dec 2024
Reviewer: Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the methods mention various postoperative imaging modalities (e.g., transvaginal
ultrasound vs. transvaginal sonohysterography), more information could be provided about how
these modalities were standardized across studies. Any potential differences in their diagnostic
accuracy or consistency might influence the outcomes, so it would be beneficial to provide more
clarity on this aspect.
-While the inclusion criteria specify comparing PSUS with other uterine closure techniques, it
would be useful to clarify how studies with single-layer or double-layer closure as controls are
handled in the meta-analysis, particularly about subgroup analysis.
The methods focus on short-term postoperative outcomes (within 6–24 weeks), but future
research could consider expanding the follow-up period to assess longer-term outcomes such as
subsequent pregnancies and maternal health.
-Although the meta-analysis includes fewer than 10 studies, which precludes formal publication
bias testing, a brief discussion about the potential for publication bias due to the small number
of studies included could help contextualize the results.
-While the PSUS technique is presented as beneficial, the discussion may overstate its
advantages, especially when considering the lower certainty in evidence for secondary outcomes
(e.g., incision length, the height of defects, and blood loss). The authors should balance the
presentation of benefits with a more cautious interpretation, acknowledging that these findings
may not be as robust as suggested.
-The discussion oscillates between referring to "statistical significance" and "clinical
significance." A clearer distinction between these terms would improve the clarity of the
discussion. For instance, while PSUS showed a statistically significant reduction in scar defects,
the clinical relevance of other findings (e.g., shorter incisions, RMT) remains uncertain due to
the low certainty of evidence.
-While the authors identify limitations related to generalizability and heterogeneity, they do not
sufficiently discuss the potential methodological flaws within the individual studies included in
the meta-analysis. For example, how different imaging modalities (e.g., sonohysterography vs.
sonography) were used across studies and the potential biases introduced by the lack of blinding
in some trials could be more explicitly discussed.
-The discussion mentions that maternal age did not emerge as a significant factor for scar defects,
but it would benefit from a more thorough exploration of how maternal age and other variables
(e.g., prior cesarean deliveries, BMI) may interact with the PSUS technique. ---While the meta-
regression analysis was included in the results, a more detailed exploration of this aspect would
help clarify whether these factors might influence the technique's effectiveness. | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 4 Date: 27 Dec 2024
Reviewer: Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the methods mention various postoperative imaging modalities (e.g., transvaginal
ultrasound vs. transvaginal sonohysterography), more information could be provided about how
these modalities were standardized across studies. Any potential differences in their diagnostic
accuracy or consistency might influence the outcomes, so it would be beneficial to provide more
clarity on this aspect.
-While the inclusion criteria specify comparing PSUS with other uterine closure techniques, it
would be useful to clarify how studies with single-layer or double-layer closure as controls are
handled in the meta-analysis, particularly about subgroup analysis.
The methods focus on short-term postoperative outcomes (within 6–24 weeks), but future
research could consider expanding the follow-up period to assess longer-term outcomes such as
subsequent pregnancies and maternal health.
-Although the meta-analysis includes fewer than 10 studies, which precludes formal publication
bias testing, a brief discussion about the potential for publication bias due to the small number
of studies included could help contextualize the results.
-While the PSUS technique is presented as beneficial, the discussion may overstate its
advantages, especially when considering the lower certainty in evidence for secondary outcomes
(e.g., incision length, the height of defects, and blood loss). The authors should balance the
presentation of benefits with a more cautious interpretation, acknowledging that these findings
may not be as robust as suggested.
-The discussion oscillates between referring to "statistical significance" and "clinical
significance." A clearer distinction between these terms would improve the clarity of the
discussion. For instance, while PSUS showed a statistically significant reduction in scar defects,
the clinical relevance of other findings (e.g., shorter incisions, RMT) remains uncertain due to
the low certainty of evidence.
-While the authors identify limitations related to generalizability and heterogeneity, they do not
sufficiently discuss the potential methodological flaws within the individual studies included in
the meta-analysis. For example, how different imaging modalities (e.g., sonohysterography vs.
sonography) were used across studies and the potential biases introduced by the lack of blinding
in some trials could be more explicitly discussed.
-The discussion mentions that maternal age did not emerge as a significant factor for scar defects,
but it would benefit from a more thorough exploration of how maternal age and other variables
(e.g., prior cesarean deliveries, BMI) may interact with the PSUS technique. ---While the meta-
regression analysis was included in the results, a more detailed exploration of this aspect would
help clarify whether these factors might influence the technique's effectiveness. | BMC | 12893_2025_2796_ReviewerReport_V4_R19.pdf | {
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"total": 14
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} | 2.714286 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine\nclosure technique in cesarean delivery: a systematic review and meta-analysis of randomized\ntrials\nVersion: 4 Date: 27 Dec 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02796-x | Reviewed - bmc_surgery | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 5 Date: 24 Jan 2025
Reviewer: Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory | Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine
closure technique in cesarean delivery: a systematic review and meta-analysis of randomized
trials
Version: 5 Date: 24 Jan 2025
Reviewer: Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory | BMC | 12893_2025_2796_ReviewerReport_V5_R19.pdf | {
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} | 2 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine\nclosure technique in cesarean delivery: a systematic review and meta-analysis of randomized\ntrials\nVersion: 5 Date: 24 Jan 2025\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02768-1 | Reviewed - bmc_surgery | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 1 Date: 14 Jul 2024
Reviewer's report:
This is a retrospective comparative study between pure transanal endorectal pull-through and
lap-assisted endorectal pull-through in a total of 72 patients (40 vs. 32, respectively) with
Hirschsprung’s disease. Findings suggest younger age, longer operative time for anal stage,
longer colonic resection and longer hospital stay with purely transanal approach, while time
to bowel function return and feeds, missed aganglionosis during resection and postoperative
complications were comparable between the two techniques.
The findings presented herein do not appear to add something new to the existing literature.
The discussion section is quite disarticulated repeating parts of the results section and failing to
justify the added value of the findings (if any, given the amount of articles, including pooled
analysis, available in the published literature e.g., Guerra et al JPS 2016). Both results and
discussion sections resemble a statistical report with no flow.
The paper is somewhat overstuffed. There are many repetitions throughout the text but also
between tables and text. Findings should be limited to those required to justify a clear study
aim rather than self-evident and less relevant data which add nothing new. Furthermore, it
is impossible to judge on long-term functional outcomes with such short follow-up duration
and before toilet training age; current design can only justify inclusion of short-term surgical
complications or follow-up duration should be extended to justify analysis and discussion of
functional outcomes. | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 1 Date: 14 Jul 2024
Reviewer's report:
This is a retrospective comparative study between pure transanal endorectal pull-through and
lap-assisted endorectal pull-through in a total of 72 patients (40 vs. 32, respectively) with
Hirschsprung’s disease. Findings suggest younger age, longer operative time for anal stage,
longer colonic resection and longer hospital stay with purely transanal approach, while time
to bowel function return and feeds, missed aganglionosis during resection and postoperative
complications were comparable between the two techniques.
The findings presented herein do not appear to add something new to the existing literature.
The discussion section is quite disarticulated repeating parts of the results section and failing to
justify the added value of the findings (if any, given the amount of articles, including pooled
analysis, available in the published literature e.g., Guerra et al JPS 2016). Both results and
discussion sections resemble a statistical report with no flow.
The paper is somewhat overstuffed. There are many repetitions throughout the text but also
between tables and text. Findings should be limited to those required to justify a clear study
aim rather than self-evident and less relevant data which add nothing new. Furthermore, it
is impossible to judge on long-term functional outcomes with such short follow-up duration
and before toilet training age; current design can only justify inclusion of short-term surgical
complications or follow-up duration should be extended to justify analysis and discussion of
functional outcomes. | BMC | 12893_2025_2768_ReviewerReport_V1_R3.pdf | {
"criticism": 4,
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"total": 9
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} | 2.222222 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-\nthrough in the management of Hirschsprung’s Disease in pediatric age group; A retrospective\nstudy\nVersion: 1 Date: 14 Jul 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02768-1 | Reviewed - bmc_surgery | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 1 Date: 20 Jul 2024
Reviewer's report:
One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-through in
the management of Hirschsprung’s Disease in pediatric age group; A retrospective study
I appreciate the opportunity to work on this manuscript from the team in Alexandria, Egypt. It's
a sincere study, and the authors boldly presented their results.
The authors used multiple variables to compare transanal versus transanal with lap-assisted pull-
through, including surgery time, bleeding, and feeding time. However, these variables don't
fully define the outcomes and complications of the operations. It would be beneficial to provide
further detail or a synthesis of these variables.
Regardless of the technique used, the most crucial aspect for both parents and the patient is to
have no complications and the best postoperative results in the short and long term. The authors
should focus more on these variables in their comparative study.
It's not just about quickly performing an operation without bleeding and ensuring the patient
eats soon. There could still be issues such as stenotic anastomosis, twisted pull-through, or an
aganglionic pull-through that require re-operation and could even result in mortality.
The study doesn't mention the length of aganglionosis in the patients nor whether all of them
underwent surgery with a Hirschsprung diagnosis and rectal biopsy.
Instead of using names like Group A and Group B, it would be clearer to use TAERPT and
LAERPT to distinguish between the two cohorts. The current naming convention makes the
manuscript difficult to read and understand.
Figures 1, 2, and 3 are unnecessary.
Could you elaborate on the necessity of inserting a rectal tube after the operation in some
patients?
It's important to correctly label Table 2, which is currently labeled as Table 1.
Out of 72 patients, 23 had a rectal biopsy. How was the diagnosis of Hirschsprung confirmed
and how was the pull-through performed for the remaining 68%?
How do you explain the need for a more extended resection in the transanal group but a shorter
resection in the Lap-assisted group?
Was medical management attempted in the four cases of aganglionic pull-throughs?
The title of Table 6 on histopathology should specify aganglionic (not missed) and
normoganglionic (not good).
It seems inconsistent to diagnose patients with Hirschsprung-associated enterocolitis (HAEC) if
they have mechanical obstructions such as stenosis or twisted pull-throughs. HAEC is typically
associated with abscesses, not mechanical obstruction.
Could you clarify the cause of the anastomotic leakage? Was it due to ischemia, tension, or
technical inadequacy in performing the anastomosis?
Have you assessed the anal canal in patients with soiling or fecal incontinence?
It's important to specify whether the same surgeon performed all the operations or if different
surgeons were involved in performing the surgeries. | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 1 Date: 20 Jul 2024
Reviewer's report:
One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-through in
the management of Hirschsprung’s Disease in pediatric age group; A retrospective study
I appreciate the opportunity to work on this manuscript from the team in Alexandria, Egypt. It's
a sincere study, and the authors boldly presented their results.
The authors used multiple variables to compare transanal versus transanal with lap-assisted pull-
through, including surgery time, bleeding, and feeding time. However, these variables don't
fully define the outcomes and complications of the operations. It would be beneficial to provide
further detail or a synthesis of these variables.
Regardless of the technique used, the most crucial aspect for both parents and the patient is to
have no complications and the best postoperative results in the short and long term. The authors
should focus more on these variables in their comparative study.
It's not just about quickly performing an operation without bleeding and ensuring the patient
eats soon. There could still be issues such as stenotic anastomosis, twisted pull-through, or an
aganglionic pull-through that require re-operation and could even result in mortality.
The study doesn't mention the length of aganglionosis in the patients nor whether all of them
underwent surgery with a Hirschsprung diagnosis and rectal biopsy.
Instead of using names like Group A and Group B, it would be clearer to use TAERPT and
LAERPT to distinguish between the two cohorts. The current naming convention makes the
manuscript difficult to read and understand.
Figures 1, 2, and 3 are unnecessary.
Could you elaborate on the necessity of inserting a rectal tube after the operation in some
patients?
It's important to correctly label Table 2, which is currently labeled as Table 1.
Out of 72 patients, 23 had a rectal biopsy. How was the diagnosis of Hirschsprung confirmed
and how was the pull-through performed for the remaining 68%?
How do you explain the need for a more extended resection in the transanal group but a shorter
resection in the Lap-assisted group?
Was medical management attempted in the four cases of aganglionic pull-throughs?
The title of Table 6 on histopathology should specify aganglionic (not missed) and
normoganglionic (not good).
It seems inconsistent to diagnose patients with Hirschsprung-associated enterocolitis (HAEC) if
they have mechanical obstructions such as stenosis or twisted pull-throughs. HAEC is typically
associated with abscesses, not mechanical obstruction.
Could you clarify the cause of the anastomotic leakage? Was it due to ischemia, tension, or
technical inadequacy in performing the anastomosis?
Have you assessed the anal canal in patients with soiling or fecal incontinence?
It's important to specify whether the same surgeon performed all the operations or if different
surgeons were involved in performing the surgeries. | BMC | 12893_2025_2768_ReviewerReport_V1_R1.pdf | {
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} | 1.538462 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-\nthrough in the management of Hirschsprung’s Disease in pediatric age group; A retrospective\nstudy\nVersion: 1 Date: 20 Jul 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02768-1 | Reviewed - bmc_surgery | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 1 Date: 01 Aug 2024
Reviewer's report:
This paper is a retrospective study comparing the two surgical techniques.
In conclusion, although laparoscopic-assisted surgery has its advantages, the authors state that
a shorter hospital stay could be achieved with a more rapid return of bowel movement in the
complete transanal approach. Indeed, the results showed that the group undergoing laparoscopic
surgery had more serious complications.
It is unclear how the resection line was determined (it is unlikely that it was determined based on
length alone, but in the discussion only length was mentioned, and there was little consideration
of whether there was a significant difference in the length of the resected intestine between the
two groups.
It would be desirable to provide a detailed description of both surgical methods at the authors'
institution, as well as how the final colon transection location is determined (pathological
diagnosis, macroscopic findings, etc.). | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 1 Date: 01 Aug 2024
Reviewer's report:
This paper is a retrospective study comparing the two surgical techniques.
In conclusion, although laparoscopic-assisted surgery has its advantages, the authors state that
a shorter hospital stay could be achieved with a more rapid return of bowel movement in the
complete transanal approach. Indeed, the results showed that the group undergoing laparoscopic
surgery had more serious complications.
It is unclear how the resection line was determined (it is unlikely that it was determined based on
length alone, but in the discussion only length was mentioned, and there was little consideration
of whether there was a significant difference in the length of the resected intestine between the
two groups.
It would be desirable to provide a detailed description of both surgical methods at the authors'
institution, as well as how the final colon transection location is determined (pathological
diagnosis, macroscopic findings, etc.). | BMC | 12893_2025_2768_ReviewerReport_V1_R2.pdf | {
"criticism": 1,
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"total": 6
} | {
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} | 1.833333 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-\nthrough in the management of Hirschsprung’s Disease in pediatric age group; A retrospective\nstudy\nVersion: 1 Date: 01 Aug 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02768-1 | Reviewed - bmc_surgery | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 2 Date: 21 Aug 2024
Reviewer's report:
Authors responded properly all questions.
I do not have more comments.
Thanks | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 2 Date: 21 Aug 2024
Reviewer's report:
Authors responded properly all questions.
I do not have more comments.
Thanks | BMC | 12893_2025_2768_ReviewerReport_V2_R1.pdf | {
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} | 0.333333 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-\nthrough in the management of Hirschsprung’s Disease in pediatric age group; A retrospective\nstudy\nVersion: 2 Date: 21 Aug 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02768-1 | Reviewed - bmc_surgery | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 2 Date: 02 Sep 2024
Reviewer's report:
The manuscript is still suffering from major methodological and presentation issues:
-The results and discussion sections still resemble greatly a disarticulated statistical report rather
than an article. The reader can hardly follow such a type of document, while the value of this
work, if any, is greatly obscured. As a result, there are still repetitions of results between text
and tables and between results and discussion.
-Non-significant results are discussed in Discussion as of significance. A statistically non-
significant difference cannot be discussed as a 'slight' difference and such, as this is misleading
for the reader.
-Follow-up and sample size are insufficient for safe conclusions to be drawn in the case of some
results e.g. the authors discuss the lack of difference in incontinence between the two groups,
when one group has 2 incontinent patients and the second group has 1 incontinent patient.
-The rationale of using a rectal tube at the end of all procedures still remains unclear.
Additionally, it is striking that 25% of patients required intraop transfusion, when a pull-through
procedure normally does not require transfusion. | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 2 Date: 02 Sep 2024
Reviewer's report:
The manuscript is still suffering from major methodological and presentation issues:
-The results and discussion sections still resemble greatly a disarticulated statistical report rather
than an article. The reader can hardly follow such a type of document, while the value of this
work, if any, is greatly obscured. As a result, there are still repetitions of results between text
and tables and between results and discussion.
-Non-significant results are discussed in Discussion as of significance. A statistically non-
significant difference cannot be discussed as a 'slight' difference and such, as this is misleading
for the reader.
-Follow-up and sample size are insufficient for safe conclusions to be drawn in the case of some
results e.g. the authors discuss the lack of difference in incontinence between the two groups,
when one group has 2 incontinent patients and the second group has 1 incontinent patient.
-The rationale of using a rectal tube at the end of all procedures still remains unclear.
Additionally, it is striking that 25% of patients required intraop transfusion, when a pull-through
procedure normally does not require transfusion. | BMC | 12893_2025_2768_ReviewerReport_V2_R3.pdf | {
"criticism": 6,
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"total": 9
} | {
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} | 2.222222 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-\nthrough in the management of Hirschsprung’s Disease in pediatric age group; A retrospective\nstudy\nVersion: 2 Date: 02 Sep 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02768-1 | Reviewed - bmc_surgery | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 2 Date: 10 Sep 2024
Reviewer's report:
Revisions and additions have been made in accordance with reviewer comments.
Some tables and figures have been removed in accordance with the reviewer's comments, but
there is a reference to Table 3 in the text(page 7, line 14), which was removed, so this should
be revised. | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 2 Date: 10 Sep 2024
Reviewer's report:
Revisions and additions have been made in accordance with reviewer comments.
Some tables and figures have been removed in accordance with the reviewer's comments, but
there is a reference to Table 3 in the text(page 7, line 14), which was removed, so this should
be revised. | BMC | 12893_2025_2768_ReviewerReport_V2_R2.pdf | {
"criticism": 0,
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} | {
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"suggestion_and_solution": 0.5
} | 1.5 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-\nthrough in the management of Hirschsprung’s Disease in pediatric age group; A retrospective\nstudy\nVersion: 2 Date: 10 Sep 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02768-1 | Reviewed - bmc_surgery | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 3 Date: 05 Oct 2024
Reviewer's report:
There are still several important issues with this manuscript.
Abstract
Results & Conclusions: operative duration was NOT longer (no significant difference)
Introduction
‘ The addition of laparoscopic dissection reduced the peritoneal trauma, the surgical time, and
the anal stretch time and as a result, the whole procedure was associated with morbidities and
consequently reduced the failure rate. (1,2)’ This sentence does not make sense
Results
-Operative duration was NOT longer
-I still have difficulty to understand here the meaningfulness of the results on longer segments
& longer dilated segments resected with the transanal approach. Discussion later on mentions
the blind dissection in the transanal PT but neither in Results nor in the Discussion the actual
meaningfulness/argument of this result is clear. The authors should combine this result with the
fact that the aganglionic segment length was similar between the two groups –hence potentially
more bowel was unnecessarily resected with the transanal approach (if this what the authors are
aiming to say).
-Justification of the rectal tube approach is still lacking. It is a rather unusual thing to do to leave
unjustified.
Discussion
-In my opinion, the format of the Discussion still appears disarticulated and unacceptable for a
publication. The subtitles cannot make up for the lack of flow I am afraid.
-Gender does not appear to be an important factor to include in Discussion
-Operative time was NOT longer –discussion about a non-significant result is meaningless
-The dissection during transanal approach is not blind and can certainly be combined with
point to point haemostasis without transfusion requirements. The authors here generalise and
ultimately fail to provide sufficient justification for the transfusions required.
-‘was slightly and non-significantly faster’ Again, discussing a non-significant difference as a
difference is wrong and meaningless.
-‘ slightly and non-significantly shorter’ This sentence is scientifically wrong. As reiterated
during previous revisions, a non-significant difference is a non-significant difference; no other
interpretation is appropriate, as this approach is misleading for the readers.
-‘The current study reported a non-significant lower incidence of early postoperative
complications in patients treated by TAERPT than in patients treated by LAERPT’ –same
comment
-‘non-significant higher incidence of postoperative enterocolitis’ –same comment
Significant language editing is still needed throughout the text. Some representative examples:
‘ The operative procedure in patients of Group A resected a colonic segment significantly shorter
than the length of the resected bowel segment in Group B’
‘as regards the early’
‘became popularly used’
‘This could be explained to happen in patients with’ | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 3 Date: 05 Oct 2024
Reviewer's report:
There are still several important issues with this manuscript.
Abstract
Results & Conclusions: operative duration was NOT longer (no significant difference)
Introduction
‘ The addition of laparoscopic dissection reduced the peritoneal trauma, the surgical time, and
the anal stretch time and as a result, the whole procedure was associated with morbidities and
consequently reduced the failure rate. (1,2)’ This sentence does not make sense
Results
-Operative duration was NOT longer
-I still have difficulty to understand here the meaningfulness of the results on longer segments
& longer dilated segments resected with the transanal approach. Discussion later on mentions
the blind dissection in the transanal PT but neither in Results nor in the Discussion the actual
meaningfulness/argument of this result is clear. The authors should combine this result with the
fact that the aganglionic segment length was similar between the two groups –hence potentially
more bowel was unnecessarily resected with the transanal approach (if this what the authors are
aiming to say).
-Justification of the rectal tube approach is still lacking. It is a rather unusual thing to do to leave
unjustified.
Discussion
-In my opinion, the format of the Discussion still appears disarticulated and unacceptable for a
publication. The subtitles cannot make up for the lack of flow I am afraid.
-Gender does not appear to be an important factor to include in Discussion
-Operative time was NOT longer –discussion about a non-significant result is meaningless
-The dissection during transanal approach is not blind and can certainly be combined with
point to point haemostasis without transfusion requirements. The authors here generalise and
ultimately fail to provide sufficient justification for the transfusions required.
-‘was slightly and non-significantly faster’ Again, discussing a non-significant difference as a
difference is wrong and meaningless.
-‘ slightly and non-significantly shorter’ This sentence is scientifically wrong. As reiterated
during previous revisions, a non-significant difference is a non-significant difference; no other
interpretation is appropriate, as this approach is misleading for the readers.
-‘The current study reported a non-significant lower incidence of early postoperative
complications in patients treated by TAERPT than in patients treated by LAERPT’ –same
comment
-‘non-significant higher incidence of postoperative enterocolitis’ –same comment
Significant language editing is still needed throughout the text. Some representative examples:
‘ The operative procedure in patients of Group A resected a colonic segment significantly shorter
than the length of the resected bowel segment in Group B’
‘as regards the early’
‘became popularly used’
‘This could be explained to happen in patients with’ | BMC | 12893_2025_2768_ReviewerReport_V3_R3.pdf | {
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"suggestion_and_solution": 3,
"total": 16
} | {
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} | 2.1875 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-\nthrough in the management of Hirschsprung’s Disease in pediatric age group; A retrospective\nstudy\nVersion: 3 Date: 05 Oct 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02768-1 | Reviewed - bmc_surgery | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 3 Date: 10 Oct 2024
Reviewer's report:
It has been revised and edited according to the reviewer's comments.
However, there is little discussion about why there was a significant difference in the length
of the resected intestine between the two groups. There is no description of why there was a
difference, so please consider adding this. Also, is this point influenced by differences in disease
type?
As the disease type diagnosis has not been recorded in this study, please consider adding it. | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 3 Date: 10 Oct 2024
Reviewer's report:
It has been revised and edited according to the reviewer's comments.
However, there is little discussion about why there was a significant difference in the length
of the resected intestine between the two groups. There is no description of why there was a
difference, so please consider adding this. Also, is this point influenced by differences in disease
type?
As the disease type diagnosis has not been recorded in this study, please consider adding it. | BMC | 12893_2025_2768_ReviewerReport_V3_R2.pdf | {
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} | {
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} | 1.4 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-\nthrough in the management of Hirschsprung’s Disease in pediatric age group; A retrospective\nstudy\nVersion: 3 Date: 10 Oct 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02768-1 | Reviewed - bmc_surgery | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 4 Date: 26 Nov 2024
Reviewer's report:
Thanks for the reply regarding the question.
If the extent of the aganglionic lesion was not investigated and it is thought that this could afffect
the results, I think this should be added to the limitation. | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 4 Date: 26 Nov 2024
Reviewer's report:
Thanks for the reply regarding the question.
If the extent of the aganglionic lesion was not investigated and it is thought that this could afffect
the results, I think this should be added to the limitation. | BMC | 12893_2025_2768_ReviewerReport_V4_R2.pdf | {
"criticism": 0,
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} | {
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} | 1 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-\nthrough in the management of Hirschsprung’s Disease in pediatric age group; A retrospective\nstudy\nVersion: 4 Date: 26 Nov 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02768-1 | Reviewed - bmc_surgery | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 4 Date: 30 Nov 2024
Reviewer's report:
The authors have addressed several of the major issues pointed out and the manuscript shows
some improvement. The text however still needs significant editing to be considered eligible
for publication.
-Despite the language issue being flagged during previous revisions, there is still a considerable
number of wrong sentences and phrases throughout the text. Some examples: 'number of bowel
habits', 'as regards to', Results 2nd par 1st sentence, Discussion 3rd par 1st and 2nd sentence.
The authors should seek professional english language editing.
-Editing should include splitting and/or (where feasible) shortening of very long paragraphs.
The last paragraph of Discussion is almost 2 pages long!!!
-The authors should cautiously check for other errors, such as the 40 and 30 patients in the study
groups in Methods instead of 40 and 32 patients elsewhere in text.
-Editing should co-factor the BMC Surgery instructions for authors. Abstract, for example,
should not exceed 350 words (it is currently >400). | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 4 Date: 30 Nov 2024
Reviewer's report:
The authors have addressed several of the major issues pointed out and the manuscript shows
some improvement. The text however still needs significant editing to be considered eligible
for publication.
-Despite the language issue being flagged during previous revisions, there is still a considerable
number of wrong sentences and phrases throughout the text. Some examples: 'number of bowel
habits', 'as regards to', Results 2nd par 1st sentence, Discussion 3rd par 1st and 2nd sentence.
The authors should seek professional english language editing.
-Editing should include splitting and/or (where feasible) shortening of very long paragraphs.
The last paragraph of Discussion is almost 2 pages long!!!
-The authors should cautiously check for other errors, such as the 40 and 30 patients in the study
groups in Methods instead of 40 and 32 patients elsewhere in text.
-Editing should co-factor the BMC Surgery instructions for authors. Abstract, for example,
should not exceed 350 words (it is currently >400). | BMC | 12893_2025_2768_ReviewerReport_V4_R3.pdf | {
"criticism": 1,
"example": 2,
"importance_and_relevance": 0,
"materials_and_methods": 1,
"praise": 1,
"presentation_and_reporting": 9,
"results_and_discussion": 2,
"suggestion_and_solution": 6,
"total": 10
} | {
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"results_and_discussion": 0.2,
"suggestion_and_solution": 0.6
} | 2.2 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-\nthrough in the management of Hirschsprung’s Disease in pediatric age group; A retrospective\nstudy\nVersion: 4 Date: 30 Nov 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02768-1 | Reviewed - bmc_surgery | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 5 Date: 30 Dec 2024
Reviewer's report:
I have confirmed the corrections. Congratulations. | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 5 Date: 30 Dec 2024
Reviewer's report:
I have confirmed the corrections. Congratulations. | BMC | 12893_2025_2768_ReviewerReport_V5_R2.pdf | {
"criticism": 0,
"example": 0,
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"total": 2
} | {
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"suggestion_and_solution": 0
} | 0 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-\nthrough in the management of Hirschsprung’s Disease in pediatric age group; A retrospective\nstudy\nVersion: 5 Date: 30 Dec 2024\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02768-1 | Reviewed - bmc_surgery | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 5 Date: 08 Jan 2025
Reviewer's report:
The authors have now mostly addressed the Reviewers' comments. The manuscript needs some
language editing prior to publication. | Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-
through in the management of Hirschsprung’s Disease in pediatric age group; A retrospective
study
Version: 5 Date: 08 Jan 2025
Reviewer's report:
The authors have now mostly addressed the Reviewers' comments. The manuscript needs some
language editing prior to publication. | BMC | 12893_2025_2768_ReviewerReport_V5_R3.pdf | {
"criticism": 0,
"example": 0,
"importance_and_relevance": 0,
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"total": 2
} | {
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} | 1 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-\nthrough in the management of Hirschsprung’s Disease in pediatric age group; A retrospective\nstudy\nVersion: 5 Date: 08 Jan 2025\nRe... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02708-5 | Reviewed - bmc_surgery | Title: The prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-
lymphocyte ratio (PLR) in colorectal cancer and colorectal anastomotic leakage patients#a
retrospective study
Version: 3 Date: 27 Aug 2024
Reviewer's report:
Xu N et al. investigated the prognostic significance of neutrophil-to-lymphocyte ratio (NLR) and
platelet-to-lymphocyte ratio (PLR) in CRC patients with anastomotic leakage. Their conclusion
was preoperative NLR and PLR can predict the long-term prognosis of CRC and CAL patients.
The manuscript was well written and I have no major criticisms. However, to increase the
comprehensiveness of this article, I would like to suggest the authors to cite and make some
discussions based on the similar studies from the Asian fellow researchers, such as the prognostic
significance of such inflammatory markers in major extensive surgeries (Asian Journal of
Surgery. Volume 45, Issue 12, December 2022, Pages 2676-2685), the comparison with other
inflammatory markers, such as C-reactive protein (Asian Journal of Surgery. Volume 47, Issue 8,
August 2024, Pages 3492-3498), and the surgeries for other organs (1. Asian Journal of Surgery.
Volume 46, Issue 1, January 2023, Pages 192-200; 2. Asian Journal of Surgery. Volume 46,
Issue 1, January 2023, Pages 360-365). | Title: The prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-
lymphocyte ratio (PLR) in colorectal cancer and colorectal anastomotic leakage patients#a
retrospective study
Version: 3 Date: 27 Aug 2024
Reviewer's report:
Xu N et al. investigated the prognostic significance of neutrophil-to-lymphocyte ratio (NLR) and
platelet-to-lymphocyte ratio (PLR) in CRC patients with anastomotic leakage. Their conclusion
was preoperative NLR and PLR can predict the long-term prognosis of CRC and CAL patients.
The manuscript was well written and I have no major criticisms. However, to increase the
comprehensiveness of this article, I would like to suggest the authors to cite and make some
discussions based on the similar studies from the Asian fellow researchers, such as the prognostic
significance of such inflammatory markers in major extensive surgeries (Asian Journal of
Surgery. Volume 45, Issue 12, December 2022, Pages 2676-2685), the comparison with other
inflammatory markers, such as C-reactive protein (Asian Journal of Surgery. Volume 47, Issue 8,
August 2024, Pages 3492-3498), and the surgeries for other organs (1. Asian Journal of Surgery.
Volume 46, Issue 1, January 2023, Pages 192-200; 2. Asian Journal of Surgery. Volume 46,
Issue 1, January 2023, Pages 360-365). | BMC | 12893_2024_2708_ReviewerReport_V3_R3.pdf | {
"criticism": 1,
"example": 4,
"importance_and_relevance": 1,
"materials_and_methods": 3,
"praise": 1,
"presentation_and_reporting": 2,
"results_and_discussion": 1,
"suggestion_and_solution": 1,
"total": 11
} | {
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"results_and_discussion": 0.09090909090909091,
"suggestion_and_solution": 0.09090909090909091
} | 1.272727 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: The prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-\nlymphocyte ratio (PLR) in colorectal cancer and colorectal anastomotic leakage patients#a\nretrospective study\nVersion: 3 Date: 27 Aug ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02708-5 | Reviewed - bmc_surgery | Title: The prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-
lymphocyte ratio (PLR) in colorectal cancer and colorectal anastomotic leakage patients#a
retrospective study
Version: 3 Date: 14 Sep 2024
Reviewer's report:
This is an interesting and well-designed study. The authors postulated link between the survival
prognosis and anastomotic leakage predicting in a patients undergoing colorectal resection
using the inflammatory response markers (NLR, PLR). Furthermore, they demonstrated that
preoperative NLR and PLR can serve as prognostic indicators for long-term outcomes in CAL.
NLR # 2.89 and PLR # 157.62 were significantly linked to a favorable long-term prognosis in
patients with CAL.
I have some comments:
-The title of the study also should be reflect about the oncological outcomes, not only AL.
- Please, provide full name of abbreviated terms in abstract when you first use.
- There’s the sentence with ref.no 2 (introduction) didn’t match. #nstead, you can use following
studies.
PMID: 36352416, PMID: 38554211, PMID: 36198884
- Try to escape some repeated sentences, for example sentence “ A total of 890 patients were
included in this study, of whom 102 (11.5%) presented with AL and 788 (88.5%) with NAL” .
-There’re too many tables and figures, but if it’s not making a sense for journal, it could be
acceptable.
-Paper should check for grammar and typos as well, for example on some tables “Gender”
written as a “Genger”.
- Another important point, in this study most included patients consisting male, and rectal located
patients. And, on univariat analysis also revealed that male gender patients are associated more
CAL, and prognosis also poor. This entity are previously published in following papers as well,
consider use the as a references.
PMID: 34699602 (in this paper, all CAL patients were male patients after the intersphincteric
resection for low-lying rectal cancer).
PMID: 33537982 (in your study, patients operated either open or laparoscopic techniques, no
robotic cases. This study showed that robotic surgery in an experienced hands have superior
outcomes ( OS, local control) in male patients with mid-low rectal cancer , when comparing
with laparoscopic group of patients).
PMID: 36943657, PMID: 37955804 ( this studies demostrated gender (male/female) and
surgical techniques (laparoscopic/robotic) dependent survival and functional outcomes in
patients with rectal cancer).
Consequently, robotic devices may also improve the specimen quality, oncological and
functional outcomes in male patients with rectal cancer ( due to high flexibility advantages of
robotic tools in narrow pelvis with bulky meso in male patients)
PMID: 32634247, PMID: 38147292. | Title: The prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-
lymphocyte ratio (PLR) in colorectal cancer and colorectal anastomotic leakage patients#a
retrospective study
Version: 3 Date: 14 Sep 2024
Reviewer's report:
This is an interesting and well-designed study. The authors postulated link between the survival
prognosis and anastomotic leakage predicting in a patients undergoing colorectal resection
using the inflammatory response markers (NLR, PLR). Furthermore, they demonstrated that
preoperative NLR and PLR can serve as prognostic indicators for long-term outcomes in CAL.
NLR # 2.89 and PLR # 157.62 were significantly linked to a favorable long-term prognosis in
patients with CAL.
I have some comments:
-The title of the study also should be reflect about the oncological outcomes, not only AL.
- Please, provide full name of abbreviated terms in abstract when you first use.
- There’s the sentence with ref.no 2 (introduction) didn’t match. #nstead, you can use following
studies.
PMID: 36352416, PMID: 38554211, PMID: 36198884
- Try to escape some repeated sentences, for example sentence “ A total of 890 patients were
included in this study, of whom 102 (11.5%) presented with AL and 788 (88.5%) with NAL” .
-There’re too many tables and figures, but if it’s not making a sense for journal, it could be
acceptable.
-Paper should check for grammar and typos as well, for example on some tables “Gender”
written as a “Genger”.
- Another important point, in this study most included patients consisting male, and rectal located
patients. And, on univariat analysis also revealed that male gender patients are associated more
CAL, and prognosis also poor. This entity are previously published in following papers as well,
consider use the as a references.
PMID: 34699602 (in this paper, all CAL patients were male patients after the intersphincteric
resection for low-lying rectal cancer).
PMID: 33537982 (in your study, patients operated either open or laparoscopic techniques, no
robotic cases. This study showed that robotic surgery in an experienced hands have superior
outcomes ( OS, local control) in male patients with mid-low rectal cancer , when comparing
with laparoscopic group of patients).
PMID: 36943657, PMID: 37955804 ( this studies demostrated gender (male/female) and
surgical techniques (laparoscopic/robotic) dependent survival and functional outcomes in
patients with rectal cancer).
Consequently, robotic devices may also improve the specimen quality, oncological and
functional outcomes in male patients with rectal cancer ( due to high flexibility advantages of
robotic tools in narrow pelvis with bulky meso in male patients)
PMID: 32634247, PMID: 38147292. | BMC | 12893_2024_2708_ReviewerReport_V3_R2.pdf | {
"criticism": 1,
"example": 2,
"importance_and_relevance": 2,
"materials_and_methods": 12,
"praise": 1,
"presentation_and_reporting": 6,
"results_and_discussion": 1,
"suggestion_and_solution": 8,
"total": 19
} | {
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"results_and_discussion": 0.05263157894736842,
"suggestion_and_solution": 0.42105263157894735
} | 1.736842 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: The prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-\nlymphocyte ratio (PLR) in colorectal cancer and colorectal anastomotic leakage patients#a\nretrospective study\nVersion: 3 Date: 14 Sep ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02708-5 | Reviewed - bmc_surgery | Title: The prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-
lymphocyte ratio (PLR) in colorectal cancer and colorectal anastomotic leakage patients#a
retrospective study
Version: 4 Date: 16 Oct 2024
Reviewer's report:
The current version of the manuscript is acceptable. Congratulation to authors for their valuable
work! | Title: The prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-
lymphocyte ratio (PLR) in colorectal cancer and colorectal anastomotic leakage patients#a
retrospective study
Version: 4 Date: 16 Oct 2024
Reviewer's report:
The current version of the manuscript is acceptable. Congratulation to authors for their valuable
work! | BMC | 12893_2024_2708_ReviewerReport_V4_R2.pdf | {
"criticism": 0,
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} | {
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} | 2 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: The prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-\nlymphocyte ratio (PLR) in colorectal cancer and colorectal anastomotic leakage patients#a\nretrospective study\nVersion: 4 Date: 16 Oct ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02708-5 | Reviewed - bmc_surgery | Title: The prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-
lymphocyte ratio (PLR) in colorectal cancer and colorectal anastomotic leakage patients#a
retrospective study
Version: 4 Date: 22 Nov 2024
Reviewer's report:
Xu N et al. should be commended to investigate the prognostic value of the neutrophil-to-
lymphocyte ratio and platelet-to-lymphocyte ratio. Their conclusion was preoperative NLR and
PLR can predict the long-term prognosis of colorectal cancer (CRC) and CAL patients.
After the perusal of the whole manuscript, I would say, despite the manuscript was well written
and presented and merits publication, the originality of this study was limited because ample
same studies have been reported in the literature. However, to enhance the comprehensiveness
of the present report, I would request the authors to discuss with reference to the fine previous
studies from our Asian fellow researchers on this topic (Asian Journal of Surgery. Volume 45,
Issue 12, December 2022, Pages 2676-2685; Asian Journal of Surgery. Volume 45, Issue 10,
October 2022, Pages 1832-1842); the comparisons of NLR and PLR with other proinflammatory
and nutritional confounding factors (Asian Journal of Surgery. Volume 47, Issue 8, August 2024,
Pages 3492-3498); and the prognostic effect of NLR and PLR in stomach and renal cancers
(Asian Journal of Surgery. Volume 46, Issue 1, January 2023, Pages 192-200; Asian Journal of
Surgery. Volume 46, Issue 1, January 2023, Pages 360-365). | Title: The prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-
lymphocyte ratio (PLR) in colorectal cancer and colorectal anastomotic leakage patients#a
retrospective study
Version: 4 Date: 22 Nov 2024
Reviewer's report:
Xu N et al. should be commended to investigate the prognostic value of the neutrophil-to-
lymphocyte ratio and platelet-to-lymphocyte ratio. Their conclusion was preoperative NLR and
PLR can predict the long-term prognosis of colorectal cancer (CRC) and CAL patients.
After the perusal of the whole manuscript, I would say, despite the manuscript was well written
and presented and merits publication, the originality of this study was limited because ample
same studies have been reported in the literature. However, to enhance the comprehensiveness
of the present report, I would request the authors to discuss with reference to the fine previous
studies from our Asian fellow researchers on this topic (Asian Journal of Surgery. Volume 45,
Issue 12, December 2022, Pages 2676-2685; Asian Journal of Surgery. Volume 45, Issue 10,
October 2022, Pages 1832-1842); the comparisons of NLR and PLR with other proinflammatory
and nutritional confounding factors (Asian Journal of Surgery. Volume 47, Issue 8, August 2024,
Pages 3492-3498); and the prognostic effect of NLR and PLR in stomach and renal cancers
(Asian Journal of Surgery. Volume 46, Issue 1, January 2023, Pages 192-200; Asian Journal of
Surgery. Volume 46, Issue 1, January 2023, Pages 360-365). | BMC | 12893_2024_2708_ReviewerReport_V4_R3.pdf | {
"criticism": 1,
"example": 3,
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"materials_and_methods": 4,
"praise": 1,
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"total": 10
} | {
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"suggestion_and_solution": 0.2
} | 1.4 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: The prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-\nlymphocyte ratio (PLR) in colorectal cancer and colorectal anastomotic leakage patients#a\nretrospective study\nVersion: 4 Date: 22 Nov ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02787-y | Reviewed - bmc_surgery | Title: Pancreatic exocrine insufficiency after pancreatic resection: a systematic review
Version: 1 Date: 04 Dec 2024
Reviewer: Wendy Muircroft
Reviewer's report:
Many thanks for the opportunity to review this quality review paper.
The topic is relevant to the care of patients who frequently experience long-term sequelae from
pancreatic surgery and would benefit from having enzyme replacement therapy and monitoring
of nutritional status.
The comments that I have are minor and do not relate to the study methodology.
With diagnostic testing I would anticipate some discussion of the facts known about the
sensitivity and specificity of the tests. There was no comment about this at all. Where this is
not known it would be worthwhile to state this. When trying to evaluate the utility of a test for
use in clinical practice, a clinician would rely on the reliability or sensitivity and specificity of
tests, as well as cost and local availability to implement guidelines.
To expand on this further:
One of the key aims in the introduction is to "provide a comprehensive overview.... (of) accuracy
of diagnostic tools availability for evaluating PEI." In my view this was only partly done. What
was produced was a comparison of the incidence of PEI using different tests after different
forms of surgery, with incomplete information on test accuracy available from only 6 studies
highlighted in results section , paragraph 2. The reliability/reproducibility of testing is a separate
concept from the reported incidence of a condition.
Both of these concepts contribute to the accuracy of diagnostic tools, and I believe one would
need to comment on both to derive the conclusions stated by the authors that further studies
are required.
The other comments I have are related to editing.
The authors used "showed" consistently where "shown" is used.
? remaining periarterial neural tissue instead of "removal of periarterial neural tissue" in the
introduction bottom first paragraph.
"Comparative studies...... time to recover wight". should be weight in the results section. | Title: Pancreatic exocrine insufficiency after pancreatic resection: a systematic review
Version: 1 Date: 04 Dec 2024
Reviewer: Wendy Muircroft
Reviewer's report:
Many thanks for the opportunity to review this quality review paper.
The topic is relevant to the care of patients who frequently experience long-term sequelae from
pancreatic surgery and would benefit from having enzyme replacement therapy and monitoring
of nutritional status.
The comments that I have are minor and do not relate to the study methodology.
With diagnostic testing I would anticipate some discussion of the facts known about the
sensitivity and specificity of the tests. There was no comment about this at all. Where this is
not known it would be worthwhile to state this. When trying to evaluate the utility of a test for
use in clinical practice, a clinician would rely on the reliability or sensitivity and specificity of
tests, as well as cost and local availability to implement guidelines.
To expand on this further:
One of the key aims in the introduction is to "provide a comprehensive overview.... (of) accuracy
of diagnostic tools availability for evaluating PEI." In my view this was only partly done. What
was produced was a comparison of the incidence of PEI using different tests after different
forms of surgery, with incomplete information on test accuracy available from only 6 studies
highlighted in results section , paragraph 2. The reliability/reproducibility of testing is a separate
concept from the reported incidence of a condition.
Both of these concepts contribute to the accuracy of diagnostic tools, and I believe one would
need to comment on both to derive the conclusions stated by the authors that further studies
are required.
The other comments I have are related to editing.
The authors used "showed" consistently where "shown" is used.
? remaining periarterial neural tissue instead of "removal of periarterial neural tissue" in the
introduction bottom first paragraph.
"Comparative studies...... time to recover wight". should be weight in the results section. | BMC | 12893_2025_2787_ReviewerReport_V1_R2.pdf | {
"criticism": 3,
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"praise": 2,
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"results_and_discussion": 5,
"suggestion_and_solution": 6,
"total": 18
} | {
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"suggestion_and_solution": 0.3333333333333333
} | 1.888889 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Pancreatic exocrine insufficiency after pancreatic resection: a systematic review\nVersion: 1 Date: 04 Dec 2024\nReviewer: Wendy Muircroft\nReviewer's report:\nMany thanks for the opportunity to review this quality rev... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02787-y | Reviewed - bmc_surgery | Title: Pancreatic exocrine insufficiency after pancreatic resection: a systematic review
Version: 1 Date: 11 Dec 2024
Reviewer's report:
as per report | Title: Pancreatic exocrine insufficiency after pancreatic resection: a systematic review
Version: 1 Date: 11 Dec 2024
Reviewer's report:
as per report | BMC | 12893_2025_2787_ReviewerReport_V1_R1.pdf | {
"criticism": 0,
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"total": 1
} | {
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"role": "user"
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{
"content": "Title: Pancreatic exocrine insufficiency after pancreatic resection: a systematic review\nVersion: 1 Date: 11 Dec 2024\nReviewer's report:\nas per report",
"role": "assistant"
}
] | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02787-y | Reviewed - bmc_surgery | Title: Pancreatic exocrine insufficiency after pancreatic resection: a systematic review
Version: 2 Date: 01 Jan 2025
Reviewer's report:
I am happy that my comments have been adequately addressed.
I have made some minor corrections to the latest track changes by the authors. | Title: Pancreatic exocrine insufficiency after pancreatic resection: a systematic review
Version: 2 Date: 01 Jan 2025
Reviewer's report:
I am happy that my comments have been adequately addressed.
I have made some minor corrections to the latest track changes by the authors. | BMC | 12893_2025_2787_ReviewerReport_V2_R1.pdf | {
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"content": "Please review this paper.",
"role": "user"
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{
"content": "Title: Pancreatic exocrine insufficiency after pancreatic resection: a systematic review\nVersion: 2 Date: 01 Jan 2025\nReviewer's report:\nI am happy that my comments have been adequately addressed.\nI have made some minor co... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02779-y | Reviewed - bmc_surgery | Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined
with Distal Tibiofibular Syndesmosis Injuries
Version: 1 Date: 17 Dec 2024
Reviewer: Ioannis Stavrakakis
Reviewer's report:
Dear authors
This is overall a nicely written narrative review of the literature which tends to summarize the
current techniques and tools used to treat syndesmosis and medial ligamentous injuries.
However there are some issues which need to be addressed.
Arthroscopy is not a diagnostic tool and it should be removed from the diagnosis section of the
paper. Arthroscopy is an operative procedure. Clinical examination and imaging can provide
all the information needed in order to identify unstable ankle injuries, which require surgery.
Arthroscopy is a very good way though used to confirm the clinical and radiological findings as
well as to find concurrent lesions, such as osteochondral lesion, loose bodies etc and treat them.
The authors should make clear the absolute and relative indications of operating an acute
syndesmosis injury and/or medial collateral ligament injury. It should be clearly stated that the
absolute indication of operating a syndesmosis injury is instability. Not every high ankle sprain
requires surgery. It should also be reported how to identify unstable injuries. MRI is a good
option in order to identify a lesion of the syndesmosis, but this finding does not necessarily
means that the ankle joint is unstable.
Medial collateral ligament (MCL) injury is another matter of debate. There is still no consensus
regarding the need of repairing MCL in all unstable ankle injuries, provided that all the fractures
as well as the syndesmosis diastasis have been anatomically reduced and fixed. If the MCL
lesion precludes ankle joint reduction, as it can potentially be entrapped between talus and medial
malleolus, then exploration and repair of the ligament is highly recommended.
Syndesmosis and MCL reconstruction techniques should be transferred to the chronic ligament
treatment.
Good English have been used.
It is a review study worth to be published after revising the current version.
My comments for the manuscript have been uploaded and I report them also in details here:
Line 81: write please ligamentous instead of multiple ligament tears.
Line 184: please report the value of weight bearing ankle plain xrays to identify unstable injuries.
Line 190: Mention here the role of weight bearing CT in order to identify subtle instability.
Line 202: MRI is a good option in order to identify a lesion of the syndesmosis, but this finding
does not necessarily means that a complete syndesmotic rupture exists and that the ankle joint
is unstable. This should be mentioned in the manuscript. WB xrays or WB CT scan are more
helpful in order to identify instability.
Line 209: arthroscopy is not a diagnostic tool. The decision of operating an ankle injury should
be taken with the clinical examination and imaging. In cases for which surgery is recommended,
the arthroscopy aids to identify any other coexisting lesion, such as loose body, osteochonral
injury etc and treat them…there is no diagnostic ankle arthroscopy. I would strongly recommend
to remove arthroscopy from the diagnosis section of the paper.
Line 214: Add in brackets (although less reliable than weight bearing xrays as they frequently
overestimate the injury)
Line 224: conservative treatment is not only reserved for non medically fit for surgery patients ,
but it is an option for stable injuries as well. Not every high ankle sprain needs surgery. The
indications of repairing acute MCL injuries should be mentioned here. The absolute indication
of repairing MCL is when the ruptured ligament precludes the reduction of the ankle joint. In
case an anatomical reduction of the syndesmosis and the ankle joint has been achieved, the repair
of the deltoid ligament is optional.
Line 236: Does this statement refers to the stable injuries as well? You should also cite the
information written in this paragraph.
Line 244: Percutanous syndesmosis fixation carries a higher risk of mal reduction and this should
be reported here. The need of clamping or not the joint should be mentioned here as well.
Appropriate citations are obviously needed.
Line 253: What is the suggested distance between the fibula fracture and the ankle joint above
which the fracture does not need to be fixed? Is there a consensus in this topic? Please comment
on that. Recent studies show that fibula fracture should be fixed at any level except the fibular
head, in order to gain the proper length.
Line 260: There are studies showing that screws removal is not absolutely necessary. May be
is better to say that screw removal is optional.
Line 269: Cite please. Any disadvantage of the bioabsorbable screw?
Line 303: This part of the paper should be transferred to the treatment of the chronic injuries
section.
Line 368: This part of the paper should be transferred to the treatment of the chronic injuries
section.
Line 381: Popliteus autologous tendon graft? How can one harvest the popliteus tendon. If you
found something on that please cite.
Line 481: The previous parts regarding tibiofibular and medial ligament reconstruction should
be transferred in this section.
I am looking forward to reading the revised version of this interesting paper | Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined
with Distal Tibiofibular Syndesmosis Injuries
Version: 1 Date: 17 Dec 2024
Reviewer: Ioannis Stavrakakis
Reviewer's report:
Dear authors
This is overall a nicely written narrative review of the literature which tends to summarize the
current techniques and tools used to treat syndesmosis and medial ligamentous injuries.
However there are some issues which need to be addressed.
Arthroscopy is not a diagnostic tool and it should be removed from the diagnosis section of the
paper. Arthroscopy is an operative procedure. Clinical examination and imaging can provide
all the information needed in order to identify unstable ankle injuries, which require surgery.
Arthroscopy is a very good way though used to confirm the clinical and radiological findings as
well as to find concurrent lesions, such as osteochondral lesion, loose bodies etc and treat them.
The authors should make clear the absolute and relative indications of operating an acute
syndesmosis injury and/or medial collateral ligament injury. It should be clearly stated that the
absolute indication of operating a syndesmosis injury is instability. Not every high ankle sprain
requires surgery. It should also be reported how to identify unstable injuries. MRI is a good
option in order to identify a lesion of the syndesmosis, but this finding does not necessarily
means that the ankle joint is unstable.
Medial collateral ligament (MCL) injury is another matter of debate. There is still no consensus
regarding the need of repairing MCL in all unstable ankle injuries, provided that all the fractures
as well as the syndesmosis diastasis have been anatomically reduced and fixed. If the MCL
lesion precludes ankle joint reduction, as it can potentially be entrapped between talus and medial
malleolus, then exploration and repair of the ligament is highly recommended.
Syndesmosis and MCL reconstruction techniques should be transferred to the chronic ligament
treatment.
Good English have been used.
It is a review study worth to be published after revising the current version.
My comments for the manuscript have been uploaded and I report them also in details here:
Line 81: write please ligamentous instead of multiple ligament tears.
Line 184: please report the value of weight bearing ankle plain xrays to identify unstable injuries.
Line 190: Mention here the role of weight bearing CT in order to identify subtle instability.
Line 202: MRI is a good option in order to identify a lesion of the syndesmosis, but this finding
does not necessarily means that a complete syndesmotic rupture exists and that the ankle joint
is unstable. This should be mentioned in the manuscript. WB xrays or WB CT scan are more
helpful in order to identify instability.
Line 209: arthroscopy is not a diagnostic tool. The decision of operating an ankle injury should
be taken with the clinical examination and imaging. In cases for which surgery is recommended,
the arthroscopy aids to identify any other coexisting lesion, such as loose body, osteochonral
injury etc and treat them…there is no diagnostic ankle arthroscopy. I would strongly recommend
to remove arthroscopy from the diagnosis section of the paper.
Line 214: Add in brackets (although less reliable than weight bearing xrays as they frequently
overestimate the injury)
Line 224: conservative treatment is not only reserved for non medically fit for surgery patients ,
but it is an option for stable injuries as well. Not every high ankle sprain needs surgery. The
indications of repairing acute MCL injuries should be mentioned here. The absolute indication
of repairing MCL is when the ruptured ligament precludes the reduction of the ankle joint. In
case an anatomical reduction of the syndesmosis and the ankle joint has been achieved, the repair
of the deltoid ligament is optional.
Line 236: Does this statement refers to the stable injuries as well? You should also cite the
information written in this paragraph.
Line 244: Percutanous syndesmosis fixation carries a higher risk of mal reduction and this should
be reported here. The need of clamping or not the joint should be mentioned here as well.
Appropriate citations are obviously needed.
Line 253: What is the suggested distance between the fibula fracture and the ankle joint above
which the fracture does not need to be fixed? Is there a consensus in this topic? Please comment
on that. Recent studies show that fibula fracture should be fixed at any level except the fibular
head, in order to gain the proper length.
Line 260: There are studies showing that screws removal is not absolutely necessary. May be
is better to say that screw removal is optional.
Line 269: Cite please. Any disadvantage of the bioabsorbable screw?
Line 303: This part of the paper should be transferred to the treatment of the chronic injuries
section.
Line 368: This part of the paper should be transferred to the treatment of the chronic injuries
section.
Line 381: Popliteus autologous tendon graft? How can one harvest the popliteus tendon. If you
found something on that please cite.
Line 481: The previous parts regarding tibiofibular and medial ligament reconstruction should
be transferred in this section.
I am looking forward to reading the revised version of this interesting paper | BMC | 12893_2025_2779_ReviewerReport_V1_R4.pdf | {
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"role": "user"
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"content": "Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined\nwith Distal Tibiofibular Syndesmosis Injuries\nVersion: 1 Date: 17 Dec 2024\nReviewer: Ioannis Stavrakakis\nReviewer's report:\nDear a... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02779-y | Reviewed - bmc_surgery | Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined
with Distal Tibiofibular Syndesmosis Injuries
Version: 1 Date: 19 Dec 2024
Reviewer's report:
First of all, congratulation on a well-written paper. It deals with frequent topic among
orthopaedic surgeons, and frequent injury that we see in daily practice as an orthopaedic
practicioner.
I will make a suggestion to the authors to modifie the abstract so it can be more related to aim
of this study-review.
Number of references are quite enough and contain both older and newer references.
But, considering the topic, types of treatmen of this injury, and many papers about this topic, this
paper -review should serve to young practicioners who are at beginning of carreer as orthopaedic
surgeons, so It should be published in some more common journal. | Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined
with Distal Tibiofibular Syndesmosis Injuries
Version: 1 Date: 19 Dec 2024
Reviewer's report:
First of all, congratulation on a well-written paper. It deals with frequent topic among
orthopaedic surgeons, and frequent injury that we see in daily practice as an orthopaedic
practicioner.
I will make a suggestion to the authors to modifie the abstract so it can be more related to aim
of this study-review.
Number of references are quite enough and contain both older and newer references.
But, considering the topic, types of treatmen of this injury, and many papers about this topic, this
paper -review should serve to young practicioners who are at beginning of carreer as orthopaedic
surgeons, so It should be published in some more common journal. | BMC | 12893_2025_2779_ReviewerReport_V1_R1.pdf | {
"criticism": 0,
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"role": "user"
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"content": "Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined\nwith Distal Tibiofibular Syndesmosis Injuries\nVersion: 1 Date: 19 Dec 2024\nReviewer's report:\nFirst of all, congratulation on a wel... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02779-y | Reviewed - bmc_surgery | Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined
with Distal Tibiofibular Syndesmosis Injuries
Version: 1 Date: 22 Dec 2024
Reviewer: Aleksandar Leši#
Reviewer's report:
to be illustrative this article need illustrations | Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined
with Distal Tibiofibular Syndesmosis Injuries
Version: 1 Date: 22 Dec 2024
Reviewer: Aleksandar Leši#
Reviewer's report:
to be illustrative this article need illustrations | BMC | 12893_2025_2779_ReviewerReport_V1_R2.pdf | {
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"role": "user"
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{
"content": "Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined\nwith Distal Tibiofibular Syndesmosis Injuries\nVersion: 1 Date: 22 Dec 2024\nReviewer: Aleksandar Leši#\nReviewer's report:\nto be il... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02779-y | Reviewed - bmc_surgery | Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined
with Distal Tibiofibular Syndesmosis Injuries
Version: 1 Date: 27 Dec 2024
Reviewer's report:
This is a nattative review on syndesmotic injuries and deltoid injuries.
The authors have covered a wide spectrum of these pathologies and clearly describe the
diagnostic and treatment strategies
However, in my perspective it looks like more like a book chapter than a journal paper | Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined
with Distal Tibiofibular Syndesmosis Injuries
Version: 1 Date: 27 Dec 2024
Reviewer's report:
This is a nattative review on syndesmotic injuries and deltoid injuries.
The authors have covered a wide spectrum of these pathologies and clearly describe the
diagnostic and treatment strategies
However, in my perspective it looks like more like a book chapter than a journal paper | BMC | 12893_2025_2779_ReviewerReport_V1_R5.pdf | {
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"suggestion_and_solution": 0,
"total": 2
} | {
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} | 1.5 | 0 | [
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"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined\nwith Distal Tibiofibular Syndesmosis Injuries\nVersion: 1 Date: 27 Dec 2024\nReviewer's report:\nThis is a nattative review on syndesmo... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02779-y | Reviewed - bmc_surgery | Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined
with Distal Tibiofibular Syndesmosis Injuries
Version: 2 Date: 03 Jan 2025
Reviewer: Ioannis Stavrakakis
Reviewer's report:
Dear authors
Thanks a lot for revising the manuscript.
I think that the current version of your paper is very useful for clinicians.
Hence, I would gladly accept this review for publication.
Regards | Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined
with Distal Tibiofibular Syndesmosis Injuries
Version: 2 Date: 03 Jan 2025
Reviewer: Ioannis Stavrakakis
Reviewer's report:
Dear authors
Thanks a lot for revising the manuscript.
I think that the current version of your paper is very useful for clinicians.
Hence, I would gladly accept this review for publication.
Regards | BMC | 12893_2025_2779_ReviewerReport_V2_R4.pdf | {
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"content": "Please review this paper.",
"role": "user"
},
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"content": "Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined\nwith Distal Tibiofibular Syndesmosis Injuries\nVersion: 2 Date: 03 Jan 2025\nReviewer: Ioannis Stavrakakis\nReviewer's report:\nDear a... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02779-y | Reviewed - bmc_surgery | Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined
with Distal Tibiofibular Syndesmosis Injuries
Version: 2 Date: 08 Jan 2025
Reviewer: Aleksandar Leši#
Reviewer's report:
none | Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined
with Distal Tibiofibular Syndesmosis Injuries
Version: 2 Date: 08 Jan 2025
Reviewer: Aleksandar Leši#
Reviewer's report:
none | BMC | 12893_2025_2779_ReviewerReport_V2_R2.pdf | {
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} | 1 | 0 | [
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"role": "user"
},
{
"content": "Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined\nwith Distal Tibiofibular Syndesmosis Injuries\nVersion: 2 Date: 08 Jan 2025\nReviewer: Aleksandar Leši#\nReviewer's report:\nnone",
... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02779-y | Reviewed - bmc_surgery | Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined
with Distal Tibiofibular Syndesmosis Injuries
Version: 2 Date: 09 Jan 2025
Reviewer's report:
Considering the topic, types of treatmen of this injury, and many papers about this topic, this
paper - review should serve to young practicioners who are at beginning of carreer as orthopaedic
surgeons, so It should be published in some more common journal. | Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined
with Distal Tibiofibular Syndesmosis Injuries
Version: 2 Date: 09 Jan 2025
Reviewer's report:
Considering the topic, types of treatmen of this injury, and many papers about this topic, this
paper - review should serve to young practicioners who are at beginning of carreer as orthopaedic
surgeons, so It should be published in some more common journal. | BMC | 12893_2025_2779_ReviewerReport_V2_R1.pdf | {
"criticism": 0,
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} | 1 | 0 | [
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"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined\nwith Distal Tibiofibular Syndesmosis Injuries\nVersion: 2 Date: 09 Jan 2025\nReviewer's report:\nConsidering the topic, types of treatm... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02779-y | Reviewed - bmc_surgery | Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined
with Distal Tibiofibular Syndesmosis Injuries
Version: 2 Date: 10 Jan 2025
Reviewer's report:
I have read the corrections of the authors in all the comments of all the reviewers and they have
significantly improved the paper
Maybe a diagram or a table with the key points or the main points of interest could make it
even better | Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined
with Distal Tibiofibular Syndesmosis Injuries
Version: 2 Date: 10 Jan 2025
Reviewer's report:
I have read the corrections of the authors in all the comments of all the reviewers and they have
significantly improved the paper
Maybe a diagram or a table with the key points or the main points of interest could make it
even better | BMC | 12893_2025_2779_ReviewerReport_V2_R5.pdf | {
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{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Advancements in Minimally Invasive Treatment of Deltoid Ligament Injuries Combined\nwith Distal Tibiofibular Syndesmosis Injuries\nVersion: 2 Date: 10 Jan 2025\nReviewer's report:\nI have read the corrections of the aut... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02780-5 | Reviewed - bmc_surgery | Title: Allograft Tolerance after Adult Living Donor Liver Transplantation: A Case-Control
Study
Version: 0 Date: 03 Dec 2024
Reviewer's report:
The reasons for tolerance in allogeneic transplantation are not solely due to factors such as
MELD score, indication for liver transplantation (LT), acute cellular rejection (ACR), recurrent
viral hepatitis, and biliary complications. | Title: Allograft Tolerance after Adult Living Donor Liver Transplantation: A Case-Control
Study
Version: 0 Date: 03 Dec 2024
Reviewer's report:
The reasons for tolerance in allogeneic transplantation are not solely due to factors such as
MELD score, indication for liver transplantation (LT), acute cellular rejection (ACR), recurrent
viral hepatitis, and biliary complications. | BMC | 12893_2025_2780_ReviewerReport_V0_R3.pdf | {
"criticism": 0,
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} | 1 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Allograft Tolerance after Adult Living Donor Liver Transplantation: A Case-Control\nStudy\nVersion: 0 Date: 03 Dec 2024\nReviewer's report:\nThe reasons for tolerance in allogeneic transplantation are not solely due to ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02780-5 | Reviewed - bmc_surgery | Title: Allograft Tolerance after Adult Living Donor Liver Transplantation: A Case-Control
Study
Version: 0 Date: 09 Dec 2024
Reviewer's report:
The manuscript is updated and readable, and the authors have well reported and analyzed a single
center experience to investigate the incidence and potential predictors of immune tolerance
among adult living donor liver transplant (LDLT) recipients. Otherwise, a description of surgical
courses is needed especially defining patients’ characteristics and early clinical outcomes.
It is reasonable to conclude that this technique could be suggested, and is not “proved”, as helpful
aftere acute cellular rejection for the establishment of correct choice of hepatic-direct treatment.
I would suggest to report also a critical review of the literature on this topic explaining when
steroid treatment is mandatory, and why recipients’ MELD scores are relevant . May be authors
will come at the conclusion that there is no evidence justifying this step and therefore supporting
their idea.
The paper is quite informative and educational. At the same time, this paper is a retrospective
analysis and does not provide proof or mechanistic insight whether it is safe or not to proceed
without steroid-free immuniosuppressive regimens or in fact any type hepatologic support or
guide. The authors definitely raise the question: do we need to continue this or not?
While I agree with the authors that 'relics' are not scientific, best practice should not change
after a retrospective report. I see this contribution as valuable as it raises several questions and
I would suggest to the authors to include these aspects:
# Major issues
- How did the authors consider the impact of bilialry complication strategy? How did this direct
their clinical management? The order of events and the decision-making regarding this are not
fully clear from the report.
- Description of surgical techniques in terms of hepatic vein anatomy, of surgical experience
and skills, usage of for reducing ischemia reperfusion injuries of remnant liver parenchyma, and
liver preservation solution strategy.
- Can they properly describe theimmunosuppressive treatment after acute cellular rejection?
# Minor observations
- If present, what were their differences in nutritional evalutation in their experiences, such as
body weight, body mass index (BMI) and albumin (ALB)?
- Was the presence of the abnormalities of portal vein anatomy considered prior of surgery?
- Was severe hepatic congestion and/or bleeding from the transection surface noted at as negative
factors for final evaluating process after resection? | Title: Allograft Tolerance after Adult Living Donor Liver Transplantation: A Case-Control
Study
Version: 0 Date: 09 Dec 2024
Reviewer's report:
The manuscript is updated and readable, and the authors have well reported and analyzed a single
center experience to investigate the incidence and potential predictors of immune tolerance
among adult living donor liver transplant (LDLT) recipients. Otherwise, a description of surgical
courses is needed especially defining patients’ characteristics and early clinical outcomes.
It is reasonable to conclude that this technique could be suggested, and is not “proved”, as helpful
aftere acute cellular rejection for the establishment of correct choice of hepatic-direct treatment.
I would suggest to report also a critical review of the literature on this topic explaining when
steroid treatment is mandatory, and why recipients’ MELD scores are relevant . May be authors
will come at the conclusion that there is no evidence justifying this step and therefore supporting
their idea.
The paper is quite informative and educational. At the same time, this paper is a retrospective
analysis and does not provide proof or mechanistic insight whether it is safe or not to proceed
without steroid-free immuniosuppressive regimens or in fact any type hepatologic support or
guide. The authors definitely raise the question: do we need to continue this or not?
While I agree with the authors that 'relics' are not scientific, best practice should not change
after a retrospective report. I see this contribution as valuable as it raises several questions and
I would suggest to the authors to include these aspects:
# Major issues
- How did the authors consider the impact of bilialry complication strategy? How did this direct
their clinical management? The order of events and the decision-making regarding this are not
fully clear from the report.
- Description of surgical techniques in terms of hepatic vein anatomy, of surgical experience
and skills, usage of for reducing ischemia reperfusion injuries of remnant liver parenchyma, and
liver preservation solution strategy.
- Can they properly describe theimmunosuppressive treatment after acute cellular rejection?
# Minor observations
- If present, what were their differences in nutritional evalutation in their experiences, such as
body weight, body mass index (BMI) and albumin (ALB)?
- Was the presence of the abnormalities of portal vein anatomy considered prior of surgery?
- Was severe hepatic congestion and/or bleeding from the transection surface noted at as negative
factors for final evaluating process after resection? | BMC | 12893_2025_2780_ReviewerReport_V0_R1.pdf | {
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} | 1.647059 | 0 | [
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"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Allograft Tolerance after Adult Living Donor Liver Transplantation: A Case-Control\nStudy\nVersion: 0 Date: 09 Dec 2024\nReviewer's report:\nThe manuscript is updated and readable, and the authors have well reported and... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02780-5 | Reviewed - bmc_surgery | Title: Allograft Tolerance after Adult Living Donor Liver Transplantation: A Case-Control
Study
Version: 0 Date: 11 Dec 2024
Reviewer: Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the manuscript defines operational and prope tolerance, more clarity could be provided
on how these categories were determined in clinical practice. Specifically, how were "stable
clinical status" and "normal laboratory values" assessed and validated? Including specific
immune markers, biopsy findings, or clinical protocols used for confirming tolerance would
enhance the robustness of the definition.
-The manuscript provides details on the immunosuppression protocol, it could benefit from
a more detailed description of the process of immunosuppression withdrawal. How did the
immunosuppressive drug reduction or withdrawal occur in practice (e.g., gradual vs. abrupt, and
how frequently did patients experience rejection episodes)? Information on how the protocol
was adjusted over time for specific patients would add depth to the findings.
-Although the authors mention controlling for potential confounders (e.g., recipient/donor
characteristics, preoperative MELD score), it would be useful to more explicitly discuss how
confounders were handled in the statistical analysis. Were there any specific confounding
variables that were difficult to control for? Were interactions between certain predictors
(e.g., age and MELD score) explored? Further elaboration on the confounders would provide
transparency regarding the model's robustness.
-Did all patients in the tolerance group maintain long-term tolerance, or was there a decline
after achieving tolerance? Additional information on how tolerance evolved over time would
be valuable for understanding the long-term stability of grafts and the potential for relapse of
rejection after immunosuppressive minimization.
-The authors mention that older age at the time of LT was associated with an increased likelihood
of developing tolerance. However, this finding is based on a small difference in age between the
tolerance and non-tolerance groups (though statistically significant). Given the minimal clinical
difference in age, the authors should exercise caution when emphasizing this as a major predictor
of tolerance. A more in-depth analysis of why age might play a role (such as immune system
changes with age) would provide more robust evidence.
-While the study uses the terms "operational tolerance" and "prope tolerance," the discussion
could provide more clarity on these definitions. The authors could briefly reiterate the criteria for
these types of tolerance and whether these definitions have evolved or been standardized in the
literature. This would help clarify how the study contributes to the growing body of knowledge
on the subject.
-A more in-depth exploration of how confounders (e.g., liver graft quality, immunosuppression
protocols, post-transplant complications) were controlled for would strengthen the study’s
conclusions. | Title: Allograft Tolerance after Adult Living Donor Liver Transplantation: A Case-Control
Study
Version: 0 Date: 11 Dec 2024
Reviewer: Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the manuscript defines operational and prope tolerance, more clarity could be provided
on how these categories were determined in clinical practice. Specifically, how were "stable
clinical status" and "normal laboratory values" assessed and validated? Including specific
immune markers, biopsy findings, or clinical protocols used for confirming tolerance would
enhance the robustness of the definition.
-The manuscript provides details on the immunosuppression protocol, it could benefit from
a more detailed description of the process of immunosuppression withdrawal. How did the
immunosuppressive drug reduction or withdrawal occur in practice (e.g., gradual vs. abrupt, and
how frequently did patients experience rejection episodes)? Information on how the protocol
was adjusted over time for specific patients would add depth to the findings.
-Although the authors mention controlling for potential confounders (e.g., recipient/donor
characteristics, preoperative MELD score), it would be useful to more explicitly discuss how
confounders were handled in the statistical analysis. Were there any specific confounding
variables that were difficult to control for? Were interactions between certain predictors
(e.g., age and MELD score) explored? Further elaboration on the confounders would provide
transparency regarding the model's robustness.
-Did all patients in the tolerance group maintain long-term tolerance, or was there a decline
after achieving tolerance? Additional information on how tolerance evolved over time would
be valuable for understanding the long-term stability of grafts and the potential for relapse of
rejection after immunosuppressive minimization.
-The authors mention that older age at the time of LT was associated with an increased likelihood
of developing tolerance. However, this finding is based on a small difference in age between the
tolerance and non-tolerance groups (though statistically significant). Given the minimal clinical
difference in age, the authors should exercise caution when emphasizing this as a major predictor
of tolerance. A more in-depth analysis of why age might play a role (such as immune system
changes with age) would provide more robust evidence.
-While the study uses the terms "operational tolerance" and "prope tolerance," the discussion
could provide more clarity on these definitions. The authors could briefly reiterate the criteria for
these types of tolerance and whether these definitions have evolved or been standardized in the
literature. This would help clarify how the study contributes to the growing body of knowledge
on the subject.
-A more in-depth exploration of how confounders (e.g., liver graft quality, immunosuppression
protocols, post-transplant complications) were controlled for would strengthen the study’s
conclusions. | BMC | 12893_2025_2780_ReviewerReport_V0_R4.pdf | {
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} | 2 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Allograft Tolerance after Adult Living Donor Liver Transplantation: A Case-Control\nStudy\nVersion: 0 Date: 11 Dec 2024\nReviewer: Anwar Ashraf Abouelnasr\nReviewer's report:\nDear Authors, please address the following... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02780-5 | Reviewed - bmc_surgery | Title: Allograft Tolerance after Adult Living Donor Liver Transplantation: A Case-Control
Study
Version: 1 Date: 17 Dec 2024
Reviewer: Anwar Ashraf Abouelnasr
Reviewer's report:
changes are satisfactory, can be accepted for publication. | Title: Allograft Tolerance after Adult Living Donor Liver Transplantation: A Case-Control
Study
Version: 1 Date: 17 Dec 2024
Reviewer: Anwar Ashraf Abouelnasr
Reviewer's report:
changes are satisfactory, can be accepted for publication. | BMC | 12893_2025_2780_ReviewerReport_V1_R4.pdf | {
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} | 2 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Allograft Tolerance after Adult Living Donor Liver Transplantation: A Case-Control\nStudy\nVersion: 1 Date: 17 Dec 2024\nReviewer: Anwar Ashraf Abouelnasr\nReviewer's report:\nchanges are satisfactory, can be accepted ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02780-5 | Reviewed - bmc_surgery | Title: Allograft Tolerance after Adult Living Donor Liver Transplantation: A Case-Control
Study
Version: 1 Date: 02 Jan 2025
Reviewer's report:
The manuscript is well-written and easy to understand. A statistical method would be acceptable.
Moreover, round 1 revision was performed point-by-point, and I believe that this enhanced the
manuscript.
The authors should match the percentage between the sentence in the result section and the value
demonstrated in figure 1 (ex. 4.7% and 95.3%).
During the 5-year follow-up period, are there any recipients who experience the rejection after
temporary prope tolerance? If so, please describe in the manuscript.
The percentage of the tolerance in this study seems somewhat higher than other previous studies.
It would be because the authors include the "prope" tolerance in the tolerance group in this
study. The authors should discuss this discrepancy more deeply and highlight this difference
contributed by defining the terminology. Moreover, it would be better if the authors had the
information about HLA mismatch data.
The discussion part would be somewhat redundant. Please simplify the sentence, focusing on
the difference from other literature about "living donor" liver transplantation.
I believe that these revisions would enhance the manuscript and make this study more valuable. | Title: Allograft Tolerance after Adult Living Donor Liver Transplantation: A Case-Control
Study
Version: 1 Date: 02 Jan 2025
Reviewer's report:
The manuscript is well-written and easy to understand. A statistical method would be acceptable.
Moreover, round 1 revision was performed point-by-point, and I believe that this enhanced the
manuscript.
The authors should match the percentage between the sentence in the result section and the value
demonstrated in figure 1 (ex. 4.7% and 95.3%).
During the 5-year follow-up period, are there any recipients who experience the rejection after
temporary prope tolerance? If so, please describe in the manuscript.
The percentage of the tolerance in this study seems somewhat higher than other previous studies.
It would be because the authors include the "prope" tolerance in the tolerance group in this
study. The authors should discuss this discrepancy more deeply and highlight this difference
contributed by defining the terminology. Moreover, it would be better if the authors had the
information about HLA mismatch data.
The discussion part would be somewhat redundant. Please simplify the sentence, focusing on
the difference from other literature about "living donor" liver transplantation.
I believe that these revisions would enhance the manuscript and make this study more valuable. | BMC | 12893_2025_2780_ReviewerReport_V1_R5.pdf | {
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"suggestion_and_solution": 9,
"total": 14
} | {
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"results_and_discussion": 0.14285714285714285,
"suggestion_and_solution": 0.6428571428571429
} | 1.571429 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Allograft Tolerance after Adult Living Donor Liver Transplantation: A Case-Control\nStudy\nVersion: 1 Date: 02 Jan 2025\nReviewer's report:\nThe manuscript is well-written and easy to understand. A statistical method wo... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02780-5 | Reviewed - bmc_surgery | Title: Allograft Tolerance after Adult Living Donor Liver Transplantation: A Case-Control
Study
Version: 2 Date: 07 Jan 2025
Reviewer's report:
The authors clarified some questions in detail. The revised manuscript will be satisfactory for
publication. | Title: Allograft Tolerance after Adult Living Donor Liver Transplantation: A Case-Control
Study
Version: 2 Date: 07 Jan 2025
Reviewer's report:
The authors clarified some questions in detail. The revised manuscript will be satisfactory for
publication. | BMC | 12893_2025_2780_ReviewerReport_V2_R5.pdf | {
"criticism": 0,
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} | 0.5 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Allograft Tolerance after Adult Living Donor Liver Transplantation: A Case-Control\nStudy\nVersion: 2 Date: 07 Jan 2025\nReviewer's report:\nThe authors clarified some questions in detail. The revised manuscript will be... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02740-5 | Reviewed - bmc_surgery | Title: Analysis of feasibility, effectiveness and safety of transvaginal natural orifice transluminal
endoscopic surgery(vNOTES) of ectopic pregnancy: a retrospective study
Version: 3 Date: 17 Jul 2024
Reviewer: Cenk Mustafa Guven
Reviewer's report: | Title: Analysis of feasibility, effectiveness and safety of transvaginal natural orifice transluminal
endoscopic surgery(vNOTES) of ectopic pregnancy: a retrospective study
Version: 3 Date: 17 Jul 2024
Reviewer: Cenk Mustafa Guven
Reviewer's report: | BMC | 12893_2024_2740_ReviewerReport_V3_R1.pdf | {
"criticism": 0,
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"total": 1
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} | 1 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Analysis of feasibility, effectiveness and safety of transvaginal natural orifice transluminal\nendoscopic surgery(vNOTES) of ectopic pregnancy: a retrospective study\nVersion: 3 Date: 17 Jul 2024\nReviewer: Cenk Musta... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02740-5 | Reviewed - bmc_surgery | Title: Analysis of feasibility, effectiveness and safety of transvaginal natural orifice transluminal
endoscopic surgery(vNOTES) of ectopic pregnancy: a retrospective study
Version: 3 Date: 26 Aug 2024
Reviewer's report:
The study is well designed however authors should state the study limitations and strength
To enhance the discussion as more specific to adnexal pathologies and salpingectomies authors
are adviced to refer recent studies ; PMID: 35073493
PMID: 32633168 PMID: 34411729 PMID: 32967055 PMID: 36445449 ) | Title: Analysis of feasibility, effectiveness and safety of transvaginal natural orifice transluminal
endoscopic surgery(vNOTES) of ectopic pregnancy: a retrospective study
Version: 3 Date: 26 Aug 2024
Reviewer's report:
The study is well designed however authors should state the study limitations and strength
To enhance the discussion as more specific to adnexal pathologies and salpingectomies authors
are adviced to refer recent studies ; PMID: 35073493
PMID: 32633168 PMID: 34411729 PMID: 32967055 PMID: 36445449 ) | BMC | 12893_2024_2740_ReviewerReport_V3_R2.pdf | {
"criticism": 0,
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"suggestion_and_solution": 1,
"total": 1
} | {
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"suggestion_and_solution": 1
} | 4 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Analysis of feasibility, effectiveness and safety of transvaginal natural orifice transluminal\nendoscopic surgery(vNOTES) of ectopic pregnancy: a retrospective study\nVersion: 3 Date: 26 Aug 2024\nReviewer's report:\nT... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02740-5 | Reviewed - bmc_surgery | Title: Analysis of feasibility, effectiveness and safety of transvaginal natural orifice transluminal
endoscopic surgery(vNOTES) of ectopic pregnancy: a retrospective study
Version: 4 Date: 24 Oct 2024
Reviewer: Cenk Mustafa Guven
Reviewer's report:
After the revisions, the study has become more clear an poweful in the meaning of scientific
basis. | Title: Analysis of feasibility, effectiveness and safety of transvaginal natural orifice transluminal
endoscopic surgery(vNOTES) of ectopic pregnancy: a retrospective study
Version: 4 Date: 24 Oct 2024
Reviewer: Cenk Mustafa Guven
Reviewer's report:
After the revisions, the study has become more clear an poweful in the meaning of scientific
basis. | BMC | 12893_2024_2740_ReviewerReport_V4_R1.pdf | {
"criticism": 0,
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"total": 1
} | {
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} | 1 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Analysis of feasibility, effectiveness and safety of transvaginal natural orifice transluminal\nendoscopic surgery(vNOTES) of ectopic pregnancy: a retrospective study\nVersion: 4 Date: 24 Oct 2024\nReviewer: Cenk Musta... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02740-5 | Reviewed - bmc_surgery | Title: Analysis of feasibility, effectiveness and safety of transvaginal natural orifice transluminal
endoscopic surgery(vNOTES) of ectopic pregnancy: a retrospective study
Version: 4 Date: 09 Nov 2024
Reviewer's report:
The recent sharp increase in ectopic pregnancies is related to the sharp increase in ART. Many
patients on ART have adhesions from PCDS such as endometriosis, adenomyosis, and other
pelvic adhesions. vNOTES is unlikely to be of much help in patients with adhesions at the entry,
and may actually prolong the operative time and cause other complications. | Title: Analysis of feasibility, effectiveness and safety of transvaginal natural orifice transluminal
endoscopic surgery(vNOTES) of ectopic pregnancy: a retrospective study
Version: 4 Date: 09 Nov 2024
Reviewer's report:
The recent sharp increase in ectopic pregnancies is related to the sharp increase in ART. Many
patients on ART have adhesions from PCDS such as endometriosis, adenomyosis, and other
pelvic adhesions. vNOTES is unlikely to be of much help in patients with adhesions at the entry,
and may actually prolong the operative time and cause other complications. | BMC | 12893_2024_2740_ReviewerReport_V4_R4.pdf | {
"criticism": 0,
"example": 0,
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"total": 3
} | {
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} | 0.333333 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Analysis of feasibility, effectiveness and safety of transvaginal natural orifice transluminal\nendoscopic surgery(vNOTES) of ectopic pregnancy: a retrospective study\nVersion: 4 Date: 09 Nov 2024\nReviewer's report:\nT... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02740-5 | Reviewed - bmc_surgery | Title: Analysis of feasibility, effectiveness and safety of transvaginal natural orifice transluminal
endoscopic surgery(vNOTES) of ectopic pregnancy: a retrospective study
Version: 5 Date: 15 Dec 2024
Reviewer: Cenk Mustafa Guven
Reviewer's report:
The revised form of the study can be accepted for publication | Title: Analysis of feasibility, effectiveness and safety of transvaginal natural orifice transluminal
endoscopic surgery(vNOTES) of ectopic pregnancy: a retrospective study
Version: 5 Date: 15 Dec 2024
Reviewer: Cenk Mustafa Guven
Reviewer's report:
The revised form of the study can be accepted for publication | BMC | 12893_2024_2740_ReviewerReport_V5_R1.pdf | {
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} | 3 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Analysis of feasibility, effectiveness and safety of transvaginal natural orifice transluminal\nendoscopic surgery(vNOTES) of ectopic pregnancy: a retrospective study\nVersion: 5 Date: 15 Dec 2024\nReviewer: Cenk Musta... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02740-5 | Reviewed - bmc_surgery | Title: Analysis of feasibility, effectiveness and safety of transvaginal natural orifice transluminal
endoscopic surgery(vNOTES) of ectopic pregnancy: a retrospective study
Version: 5 Date: 15 Dec 2024
Reviewer's report:
The paper is well revised no further comments | Title: Analysis of feasibility, effectiveness and safety of transvaginal natural orifice transluminal
endoscopic surgery(vNOTES) of ectopic pregnancy: a retrospective study
Version: 5 Date: 15 Dec 2024
Reviewer's report:
The paper is well revised no further comments | BMC | 12893_2024_2740_ReviewerReport_V5_R2.pdf | {
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} | 2 | 0 | [
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"role": "user"
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"content": "Title: Analysis of feasibility, effectiveness and safety of transvaginal natural orifice transluminal\nendoscopic surgery(vNOTES) of ectopic pregnancy: a retrospective study\nVersion: 5 Date: 15 Dec 2024\nReviewer's report:\nT... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02740-5 | Reviewed - bmc_surgery | Title: Analysis of feasibility, effectiveness and safety of transvaginal natural orifice transluminal
endoscopic surgery(vNOTES) of ectopic pregnancy: a retrospective study
Version: 5 Date: 22 Dec 2024
Reviewer's report:
You have done a good job of revising your manuscript to address the reviewers' points. | Title: Analysis of feasibility, effectiveness and safety of transvaginal natural orifice transluminal
endoscopic surgery(vNOTES) of ectopic pregnancy: a retrospective study
Version: 5 Date: 22 Dec 2024
Reviewer's report:
You have done a good job of revising your manuscript to address the reviewers' points. | BMC | 12893_2024_2740_ReviewerReport_V5_R4.pdf | {
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"content": "Title: Analysis of feasibility, effectiveness and safety of transvaginal natural orifice transluminal\nendoscopic surgery(vNOTES) of ectopic pregnancy: a retrospective study\nVersion: 5 Date: 22 Dec 2024\nReviewer's report:\nY... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02757-w | Reviewed - bmc_surgery | Title: Predictive role of the prognostic nutritional index for long-term prognosis among patients
undergoing pancreatoduodenectomy: A meta-analysis
Version: 1 Date: 24 Nov 2024
Reviewer's report: | Title: Predictive role of the prognostic nutritional index for long-term prognosis among patients
undergoing pancreatoduodenectomy: A meta-analysis
Version: 1 Date: 24 Nov 2024
Reviewer's report: | BMC | 12893_2024_2757_ReviewerReport_V1_R1.pdf | {
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"content": "Title: Predictive role of the prognostic nutritional index for long-term prognosis among patients\nundergoing pancreatoduodenectomy: A meta-analysis\nVersion: 1 Date: 24 Nov 2024\nReviewer's report:",
"role": "assistant"
... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02757-w | Reviewed - bmc_surgery | Title: Predictive role of the prognostic nutritional index for long-term prognosis among patients
undergoing pancreatoduodenectomy: A meta-analysis
Version: 1 Date: 02 Dec 2024
Reviewer's report:
Thank you for the opportunity to revise your manuscript. It was very interesting, and I wish you
all the best in your future endeavors. | Title: Predictive role of the prognostic nutritional index for long-term prognosis among patients
undergoing pancreatoduodenectomy: A meta-analysis
Version: 1 Date: 02 Dec 2024
Reviewer's report:
Thank you for the opportunity to revise your manuscript. It was very interesting, and I wish you
all the best in your future endeavors. | BMC | 12893_2024_2757_ReviewerReport_V1_R2.pdf | {
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"content": "Title: Predictive role of the prognostic nutritional index for long-term prognosis among patients\nundergoing pancreatoduodenectomy: A meta-analysis\nVersion: 1 Date: 02 Dec 2024\nReviewer's report:\nThank you for the opportun... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02757-w | Reviewed - bmc_surgery | Title: Predictive role of the prognostic nutritional index for long-term prognosis among patients
undergoing pancreatoduodenectomy: A meta-analysis
Version: 1 Date: 03 Dec 2024
Reviewer: Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The formula for calculating the Prognostic Nutritional Index (PNI), defined as serum albumin
level plus five times the absolute lymphocyte count, is provided; however, the specific cutoff
values for PNI are not detailed within the methods section. The study encompasses a range of
research that utilizes varying PNI cutoffs, and it would greatly benefit readers if the specific
values or thresholds employed in these studies were included. Such information would elucidate
the standardization and potential variability across the research.
-While the exclusion of low-quality studies represents a commendable element of the analysis,
it would be advantageous to discuss the methodology employed for addressing studies that had
missing hazard ratios (HRs) or 95% confidence intervals. Clarifying whether authors of those
studies were contacted for additional data would enhance transparency regarding the reasons for
exclusions and the potential implications of these decisions on the findings.
-Moreover, it is critical to ascertain whether different studies utilized distinct PNI cutoff values
or whether the patient populations, including variables such as cancer stage and comorbidities,
were significantly different. A thorough exploration of these factors would enhance the
interpretability of the disease-free survival (DFS) findings.
-The subgroup analysis for non-pancreatic cancer (HR = 1.30, 95% CI: 0.78–2.16, P = 0.311)
indicates no significant association between preoperative PNI and overall survival (OS) in this
cohort. Notably, despite the inclusion of two studies reporting positive outcomes within this
subgroup, it is essential for the manuscript to acknowledge that such findings lack statistical
significance. A balanced discussion that addresses these negative results is warranted to prevent
misinterpretation.
-Although the manuscript discusses statistical models, such as univariate and multivariate
analyses, it does not adequately address potential confounders that may have influenced the
relationship between PNI and survival outcomes. Variables of importance, including age,
comorbidities, tumor stage, and resection margins, could significantly impact survival rates. A
concise mention of how these factors were accounted for in the reviewed studies would provide
greater clarity.
-Additionally, an exploration of whether variations in study design, patient characteristics, or
the application of different PNI cutoffs contributed to the observed heterogeneity would greatly
assist readers in understanding the variability in results and assessing the generalizability of the
findings.
Addressing these matters would significantly improve the transparency and depth of the
discussion. Overall, this section offers valuable insights into the potential role of PNI as a
prognostic tool; however, a few additional refinements could further strengthen its clarity and
impact. | Title: Predictive role of the prognostic nutritional index for long-term prognosis among patients
undergoing pancreatoduodenectomy: A meta-analysis
Version: 1 Date: 03 Dec 2024
Reviewer: Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The formula for calculating the Prognostic Nutritional Index (PNI), defined as serum albumin
level plus five times the absolute lymphocyte count, is provided; however, the specific cutoff
values for PNI are not detailed within the methods section. The study encompasses a range of
research that utilizes varying PNI cutoffs, and it would greatly benefit readers if the specific
values or thresholds employed in these studies were included. Such information would elucidate
the standardization and potential variability across the research.
-While the exclusion of low-quality studies represents a commendable element of the analysis,
it would be advantageous to discuss the methodology employed for addressing studies that had
missing hazard ratios (HRs) or 95% confidence intervals. Clarifying whether authors of those
studies were contacted for additional data would enhance transparency regarding the reasons for
exclusions and the potential implications of these decisions on the findings.
-Moreover, it is critical to ascertain whether different studies utilized distinct PNI cutoff values
or whether the patient populations, including variables such as cancer stage and comorbidities,
were significantly different. A thorough exploration of these factors would enhance the
interpretability of the disease-free survival (DFS) findings.
-The subgroup analysis for non-pancreatic cancer (HR = 1.30, 95% CI: 0.78–2.16, P = 0.311)
indicates no significant association between preoperative PNI and overall survival (OS) in this
cohort. Notably, despite the inclusion of two studies reporting positive outcomes within this
subgroup, it is essential for the manuscript to acknowledge that such findings lack statistical
significance. A balanced discussion that addresses these negative results is warranted to prevent
misinterpretation.
-Although the manuscript discusses statistical models, such as univariate and multivariate
analyses, it does not adequately address potential confounders that may have influenced the
relationship between PNI and survival outcomes. Variables of importance, including age,
comorbidities, tumor stage, and resection margins, could significantly impact survival rates. A
concise mention of how these factors were accounted for in the reviewed studies would provide
greater clarity.
-Additionally, an exploration of whether variations in study design, patient characteristics, or
the application of different PNI cutoffs contributed to the observed heterogeneity would greatly
assist readers in understanding the variability in results and assessing the generalizability of the
findings.
Addressing these matters would significantly improve the transparency and depth of the
discussion. Overall, this section offers valuable insights into the potential role of PNI as a
prognostic tool; however, a few additional refinements could further strengthen its clarity and
impact. | BMC | 12893_2024_2757_ReviewerReport_V1_R3.pdf | {
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"content": "Title: Predictive role of the prognostic nutritional index for long-term prognosis among patients\nundergoing pancreatoduodenectomy: A meta-analysis\nVersion: 1 Date: 03 Dec 2024\nReviewer: Anwar Ashraf Abouelnasr\nReviewer's... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02757-w | Reviewed - bmc_surgery | Title: Predictive role of the prognostic nutritional index for long-term prognosis among patients
undergoing pancreatoduodenectomy: A meta-analysis
Version: 2 Date: 09 Dec 2024
Reviewer's report:
As mentioned in the conclusion section, a lower PNI is a predictor of worse survival. Can you
provide a specific numerical PNI value to indicate a poor prognosis. | Title: Predictive role of the prognostic nutritional index for long-term prognosis among patients
undergoing pancreatoduodenectomy: A meta-analysis
Version: 2 Date: 09 Dec 2024
Reviewer's report:
As mentioned in the conclusion section, a lower PNI is a predictor of worse survival. Can you
provide a specific numerical PNI value to indicate a poor prognosis. | BMC | 12893_2024_2757_ReviewerReport_V2_R1.pdf | {
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"content": "Title: Predictive role of the prognostic nutritional index for long-term prognosis among patients\nundergoing pancreatoduodenectomy: A meta-analysis\nVersion: 2 Date: 09 Dec 2024\nReviewer's report:\nAs mentioned in the conclu... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02757-w | Reviewed - bmc_surgery | Title: Predictive role of the prognostic nutritional index for long-term prognosis among patients
undergoing pancreatoduodenectomy: A meta-analysis
Version: 2 Date: 16 Dec 2024
Reviewer's report:
I am honored to have the opportunity to revise the manuscript. It was of great interest, and I
wish you all the best for your future endeavors. | Title: Predictive role of the prognostic nutritional index for long-term prognosis among patients
undergoing pancreatoduodenectomy: A meta-analysis
Version: 2 Date: 16 Dec 2024
Reviewer's report:
I am honored to have the opportunity to revise the manuscript. It was of great interest, and I
wish you all the best for your future endeavors. | BMC | 12893_2024_2757_ReviewerReport_V2_R2.pdf | {
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"content": "Title: Predictive role of the prognostic nutritional index for long-term prognosis among patients\nundergoing pancreatoduodenectomy: A meta-analysis\nVersion: 2 Date: 16 Dec 2024\nReviewer's report:\nI am honored to have the o... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-024-02757-w | Reviewed - bmc_surgery | Title: Predictive role of the prognostic nutritional index for long-term prognosis among patients
undergoing pancreatoduodenectomy: A meta-analysis
Version: 3 Date: 23 Dec 2024
Reviewer's report:
The authors have revised the points that I have previously suggested. There were no further
comments on this topic. | Title: Predictive role of the prognostic nutritional index for long-term prognosis among patients
undergoing pancreatoduodenectomy: A meta-analysis
Version: 3 Date: 23 Dec 2024
Reviewer's report:
The authors have revised the points that I have previously suggested. There were no further
comments on this topic. | BMC | 12893_2024_2757_ReviewerReport_V3_R1.pdf | {
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"role": "user"
},
{
"content": "Title: Predictive role of the prognostic nutritional index for long-term prognosis among patients\nundergoing pancreatoduodenectomy: A meta-analysis\nVersion: 3 Date: 23 Dec 2024\nReviewer's report:\nThe authors have revised t... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02778-z | Reviewed - bmc_surgery | Title: Radiofrequency Ablation Combined with Immunotherapy to Treat Hepatocellular
Carcinoma: A comprehensive review
Version: 1 Date: 07 Apr 2024
Reviewer's report:
This is a clinical review of the HCC treatment with radiofrequency ablation and immunotherapy.
The article focused on the beneficial effects of combination therapy and reviewed pre-clinical
and clinical studies to elucidate the underlying immune mechanisms. Several points need to be
addressed:
1. Reference 53: the authors cited totally unrelated literature and did not match the contents of
the article. Please be careful NOT to cite irrelevant articles because it may cause some ethical
concerns.
2. Line 269-286: please add corresponding citations.
3. Line 239-241 the authors wrote “RFA can regulate the Th1/Th2 ratio by stimulating
antigen presentation, inhibiting soluble interleukin-2 receptor and transforming growth factor-
# secretion, so that the Th1/Th2 ratio shifts to Th2……”
But previously the authors mentioned that RFA can decrease the Th2 by driving CD4 T cell
differentiation with IL-4 and IL-10 (line 160-163), and RFA can promote the secretion of
Th1 cytokines and the activation of monocytes, increase the ratio of Th1/Th2 cytokines (line
192-193).
Can you explain the conflict of these observations?
4. Immunotherapy sometimes causes tumor swelling and pseudo-progression. Is there any
literature to discuss this effect with RFA? It will be comprehensive to create a section for this,
and the authors may include their practice experience.
5. Please correct the typos in the article. Please proofread from the beginning to the end. For
example:
Line 63 “system “treatment -> systemic treatment
Line 160 “interfere” -> interferon
Line 387 “histocom#patibility” -> “histocompatibility” This sentence also lacks a verb.
Table 1 “CKI”-> CIK......and many more errors.
Besides the spelling of the words, please give the full name before abbreviations (e.g., HSP-70,
GRC3, DFS), change the initial letter of the words with a capital letter, and remove redundant
words.
Please be aware that too many type errors may weaken the value of the article and hamper its
readability. Please be advised by a native speaker or consider English editing services.
6. Line 433 “topical” immunotherapy
Do you mean “local” immunotherapy?
7. I can’t quite understand the meaning of Figure 1. I think the authors should focus on the
balance between immune cells and tumor cells in the tumor microenvironment, and cut the
redundancy like Treg cells (mentioned twice at the upper left and lower right of the figure). It’s
also weird to put the high cytolytic group with other immunosuppressive groups together. My
opinion is to reorganize the figure, or just remove figure 1.
8. Suggest renaming figure legend 2 “The anti-tumor mechanism of RFA” to” the anti-tumor
immune mechanism of RFA” because in the figure the authors only demonstrated the immune
system. There are other anti-tumor mechanisms of RFA like cytoreduction the authors did not
show in the figure. In addition, please check whether the Th1/Th2 ratio is up or down in this
figure. | Title: Radiofrequency Ablation Combined with Immunotherapy to Treat Hepatocellular
Carcinoma: A comprehensive review
Version: 1 Date: 07 Apr 2024
Reviewer's report:
This is a clinical review of the HCC treatment with radiofrequency ablation and immunotherapy.
The article focused on the beneficial effects of combination therapy and reviewed pre-clinical
and clinical studies to elucidate the underlying immune mechanisms. Several points need to be
addressed:
1. Reference 53: the authors cited totally unrelated literature and did not match the contents of
the article. Please be careful NOT to cite irrelevant articles because it may cause some ethical
concerns.
2. Line 269-286: please add corresponding citations.
3. Line 239-241 the authors wrote “RFA can regulate the Th1/Th2 ratio by stimulating
antigen presentation, inhibiting soluble interleukin-2 receptor and transforming growth factor-
# secretion, so that the Th1/Th2 ratio shifts to Th2……”
But previously the authors mentioned that RFA can decrease the Th2 by driving CD4 T cell
differentiation with IL-4 and IL-10 (line 160-163), and RFA can promote the secretion of
Th1 cytokines and the activation of monocytes, increase the ratio of Th1/Th2 cytokines (line
192-193).
Can you explain the conflict of these observations?
4. Immunotherapy sometimes causes tumor swelling and pseudo-progression. Is there any
literature to discuss this effect with RFA? It will be comprehensive to create a section for this,
and the authors may include their practice experience.
5. Please correct the typos in the article. Please proofread from the beginning to the end. For
example:
Line 63 “system “treatment -> systemic treatment
Line 160 “interfere” -> interferon
Line 387 “histocom#patibility” -> “histocompatibility” This sentence also lacks a verb.
Table 1 “CKI”-> CIK......and many more errors.
Besides the spelling of the words, please give the full name before abbreviations (e.g., HSP-70,
GRC3, DFS), change the initial letter of the words with a capital letter, and remove redundant
words.
Please be aware that too many type errors may weaken the value of the article and hamper its
readability. Please be advised by a native speaker or consider English editing services.
6. Line 433 “topical” immunotherapy
Do you mean “local” immunotherapy?
7. I can’t quite understand the meaning of Figure 1. I think the authors should focus on the
balance between immune cells and tumor cells in the tumor microenvironment, and cut the
redundancy like Treg cells (mentioned twice at the upper left and lower right of the figure). It’s
also weird to put the high cytolytic group with other immunosuppressive groups together. My
opinion is to reorganize the figure, or just remove figure 1.
8. Suggest renaming figure legend 2 “The anti-tumor mechanism of RFA” to” the anti-tumor
immune mechanism of RFA” because in the figure the authors only demonstrated the immune
system. There are other anti-tumor mechanisms of RFA like cytoreduction the authors did not
show in the figure. In addition, please check whether the Th1/Th2 ratio is up or down in this
figure. | BMC | 12893_2025_2778_ReviewerReport_V1_R3.pdf | {
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"role": "user"
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"content": "Title: Radiofrequency Ablation Combined with Immunotherapy to Treat Hepatocellular\nCarcinoma: A comprehensive review\nVersion: 1 Date: 07 Apr 2024\nReviewer's report:\nThis is a clinical review of the HCC treatment with radio... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02778-z | Reviewed - bmc_surgery | Title: Radiofrequency Ablation Combined with Immunotherapy to Treat Hepatocellular
Carcinoma: A comprehensive review
Version: 1 Date: 09 Apr 2024
Reviewer's report:
This is a comprehensive and detail review of RFA and immunotherapy of HCC treatment,
especially in the aspect of molecular mechanism. However, I still have some hesitation of this
article.
First of all, this article generally discussed the mechanism and application of RFA combination
with immunotherapy treatment of HCC, but it’s important to classify early and advanced stage of
HCC in the clinical setting. As far as I know, in the group of potentially resectable HCC, surgery,
especially laparoscopic approach, remains superior treatment option than ablation according to
the suggestion of AASLD and NCCN guidelines. As the result, in the group of early HCC, it
seems that local resection combination with adjuvant therapy is a more feasible field in clinical
application. In a systemic review and meta-analysis in 2021, local resection group showed a
significantly better 5-year recurrence free survival. I was wondering if there is some similar
mechanisms of releasing antigen and immunity regulating effect with surgery.
Second, the research method was local resection or RFA combination with immunotherapy in
the two phase 3 clinical trial in the mentioned articles. Further, local resection accounts about one
third of the sample size in the one of clinical trials. It was convincing that the adjuvant therapy
maybe helpful, but it was not appropriate to prove that RFA combination with immunotherapy
is superior than local resection with immunotherapy.
At last, to consider comprehensively, RFA combination with immunotherapy is more applicable
in the aspect of advanced HCC. Except of the animal experiments, early disease still accounts
more in the phase 3 clinical trial. It is better to review more research about RFA combination with
immunotherapy in advanced HCC which is able to give more suggestion of clinical application
and further direction of future research. | Title: Radiofrequency Ablation Combined with Immunotherapy to Treat Hepatocellular
Carcinoma: A comprehensive review
Version: 1 Date: 09 Apr 2024
Reviewer's report:
This is a comprehensive and detail review of RFA and immunotherapy of HCC treatment,
especially in the aspect of molecular mechanism. However, I still have some hesitation of this
article.
First of all, this article generally discussed the mechanism and application of RFA combination
with immunotherapy treatment of HCC, but it’s important to classify early and advanced stage of
HCC in the clinical setting. As far as I know, in the group of potentially resectable HCC, surgery,
especially laparoscopic approach, remains superior treatment option than ablation according to
the suggestion of AASLD and NCCN guidelines. As the result, in the group of early HCC, it
seems that local resection combination with adjuvant therapy is a more feasible field in clinical
application. In a systemic review and meta-analysis in 2021, local resection group showed a
significantly better 5-year recurrence free survival. I was wondering if there is some similar
mechanisms of releasing antigen and immunity regulating effect with surgery.
Second, the research method was local resection or RFA combination with immunotherapy in
the two phase 3 clinical trial in the mentioned articles. Further, local resection accounts about one
third of the sample size in the one of clinical trials. It was convincing that the adjuvant therapy
maybe helpful, but it was not appropriate to prove that RFA combination with immunotherapy
is superior than local resection with immunotherapy.
At last, to consider comprehensively, RFA combination with immunotherapy is more applicable
in the aspect of advanced HCC. Except of the animal experiments, early disease still accounts
more in the phase 3 clinical trial. It is better to review more research about RFA combination with
immunotherapy in advanced HCC which is able to give more suggestion of clinical application
and further direction of future research. | BMC | 12893_2025_2778_ReviewerReport_V1_R4.pdf | {
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"role": "user"
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"content": "Title: Radiofrequency Ablation Combined with Immunotherapy to Treat Hepatocellular\nCarcinoma: A comprehensive review\nVersion: 1 Date: 09 Apr 2024\nReviewer's report:\nThis is a comprehensive and detail review of RFA and immu... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02778-z | Reviewed - bmc_surgery | Title: Radiofrequency Ablation Combined with Immunotherapy to Treat Hepatocellular
Carcinoma: A comprehensive review
Version: 1 Date: 11 Apr 2024
Reviewer: Kevin M. Sullivan
Reviewer's report:
In this manuscript, Xie et al describe the immunosuppressive tumor immune microenvironment
of the liver and HCC, and the rationale/mechanism for which ablation and immunotherapy are
synergistic (ie the release of tumor associated antigens) and review the effect of combination
RFA and immunotherapy on outcomes in HCC.
1. Overall English language comprehension is not ready for publication at this point and should
be significantly improved. I suggest a professional/proficient English language editor to review
and edit. Many sentences are awkward and detract from the content. Terms like ‘research
hotspot’ and ‘immunocold’ are not frequently used. In Figure 1, “Treg cells are highly express”
and “The body’s immune tolerance” are incomplete sentences. There are also punctuation
issues throughout with uses of colons and semicolons. The section “Immune effects of RFA in
HCC therapy” is has very long paragraphs and should be reorganized for clarity. The section
“Advances in RFA combined with immunotherapy for HCC” seems redundant – recommend
combining with another section.
2. Microwave ablation is probably more often used now than RFA – is there any difference in
the immunogenicity of MWA vs RFA?
3. Abstract: The Methods section is vague – I would suggest including that this a review article
and describe the goal of the article or points to be addressed. The Results section is superficial
and does not actually describe any of the findings from the manuscript.
4. The section “Immunosuppressive Microenvironment of HCC” describes many of the
immunosuppressive signals and cell types in HCC. In order for the tumor associated antigens
to elicit an anti-tumor immune response, there should also be antigen presenting cells and/or
cytotoxic T cells present which may be worth describing (PMID: 35933472)
5. Lines 247-255: mechanisms (2) and (4) are essentially the same, I would suggest combining.
6. Figure 2: There are red effects on the right side of each consequence of RFA except for
sIL-2R and IL-2, recommend adding the effect to match the rest of the figure. Further, Th1/
Th2 ratio decrease suggests an increase in Th2 cytokines which are classically thought of as
immunosuppressive; this is controversial but probably needs further clarification.
7. Table 1 does not appear to be comprehensive with respect to all of the immunotherapy based
studies described in the manuscript. I would re-organize so that animal studies are separate and
human studies are comprehensive with all studies described in the manuscript. For example, the
adoptive therapy/CIK studies which actually compare single vs combined studies against each
other are not summarized in the table.
8. Does HBV and/or HCV infection play a role in inflammation and response to either RFA,
immunotherapy, or combination therapy?
9. One of the conclusions is that RFA and immunotherapy combination is safe – I would add data
from the trials or human studies on morbidity/complications to better support this conclusion. | Title: Radiofrequency Ablation Combined with Immunotherapy to Treat Hepatocellular
Carcinoma: A comprehensive review
Version: 1 Date: 11 Apr 2024
Reviewer: Kevin M. Sullivan
Reviewer's report:
In this manuscript, Xie et al describe the immunosuppressive tumor immune microenvironment
of the liver and HCC, and the rationale/mechanism for which ablation and immunotherapy are
synergistic (ie the release of tumor associated antigens) and review the effect of combination
RFA and immunotherapy on outcomes in HCC.
1. Overall English language comprehension is not ready for publication at this point and should
be significantly improved. I suggest a professional/proficient English language editor to review
and edit. Many sentences are awkward and detract from the content. Terms like ‘research
hotspot’ and ‘immunocold’ are not frequently used. In Figure 1, “Treg cells are highly express”
and “The body’s immune tolerance” are incomplete sentences. There are also punctuation
issues throughout with uses of colons and semicolons. The section “Immune effects of RFA in
HCC therapy” is has very long paragraphs and should be reorganized for clarity. The section
“Advances in RFA combined with immunotherapy for HCC” seems redundant – recommend
combining with another section.
2. Microwave ablation is probably more often used now than RFA – is there any difference in
the immunogenicity of MWA vs RFA?
3. Abstract: The Methods section is vague – I would suggest including that this a review article
and describe the goal of the article or points to be addressed. The Results section is superficial
and does not actually describe any of the findings from the manuscript.
4. The section “Immunosuppressive Microenvironment of HCC” describes many of the
immunosuppressive signals and cell types in HCC. In order for the tumor associated antigens
to elicit an anti-tumor immune response, there should also be antigen presenting cells and/or
cytotoxic T cells present which may be worth describing (PMID: 35933472)
5. Lines 247-255: mechanisms (2) and (4) are essentially the same, I would suggest combining.
6. Figure 2: There are red effects on the right side of each consequence of RFA except for
sIL-2R and IL-2, recommend adding the effect to match the rest of the figure. Further, Th1/
Th2 ratio decrease suggests an increase in Th2 cytokines which are classically thought of as
immunosuppressive; this is controversial but probably needs further clarification.
7. Table 1 does not appear to be comprehensive with respect to all of the immunotherapy based
studies described in the manuscript. I would re-organize so that animal studies are separate and
human studies are comprehensive with all studies described in the manuscript. For example, the
adoptive therapy/CIK studies which actually compare single vs combined studies against each
other are not summarized in the table.
8. Does HBV and/or HCV infection play a role in inflammation and response to either RFA,
immunotherapy, or combination therapy?
9. One of the conclusions is that RFA and immunotherapy combination is safe – I would add data
from the trials or human studies on morbidity/complications to better support this conclusion. | BMC | 12893_2025_2778_ReviewerReport_V1_R1.pdf | {
"criticism": 10,
"example": 3,
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"praise": 0,
"presentation_and_reporting": 11,
"results_and_discussion": 3,
"suggestion_and_solution": 11,
"total": 30
} | {
"criticism": 0.3333333333333333,
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"results_and_discussion": 0.1,
"suggestion_and_solution": 0.36666666666666664
} | 1.566667 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Radiofrequency Ablation Combined with Immunotherapy to Treat Hepatocellular\nCarcinoma: A comprehensive review\nVersion: 1 Date: 11 Apr 2024\nReviewer: Kevin M. Sullivan\nReviewer's report:\nIn this manuscript, Xie et ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02778-z | Reviewed - bmc_surgery | Title: Radiofrequency Ablation Combined with Immunotherapy to Treat Hepatocellular
Carcinoma: A comprehensive review
Version: 1 Date: 14 Apr 2024
Reviewer's report:
It’s a completed and detailed review about the influence on the TME of HCC from RFA.
Studies on the relationship of immunology therapy and RFA in recent years were summarized.
It concluded that RFA and immunotherapy have a good synergistic effect. It’s a nice review but
still have some problems:
1. I suggest the authors to add the corresponding page number at the bottom of each page for
sake of reading.
2. In the section of “Advances in RFA combined with immunotherapy for HCC”, most of the
cited studies were not recently published and the similar problems were also noticed in other
sections. The authors should add several newly published studies to support your points.
3. In the Table 1, several studies about the combination of RFA and immunotherapy were shown.
I suggest that authors could also attach tables listing studies about the combination of RFA and
immunomodulator therapy, immune checkpoint inhibitor therapy, adoptive immunotherapy, and
topical immunotherapy, if possible. | Title: Radiofrequency Ablation Combined with Immunotherapy to Treat Hepatocellular
Carcinoma: A comprehensive review
Version: 1 Date: 14 Apr 2024
Reviewer's report:
It’s a completed and detailed review about the influence on the TME of HCC from RFA.
Studies on the relationship of immunology therapy and RFA in recent years were summarized.
It concluded that RFA and immunotherapy have a good synergistic effect. It’s a nice review but
still have some problems:
1. I suggest the authors to add the corresponding page number at the bottom of each page for
sake of reading.
2. In the section of “Advances in RFA combined with immunotherapy for HCC”, most of the
cited studies were not recently published and the similar problems were also noticed in other
sections. The authors should add several newly published studies to support your points.
3. In the Table 1, several studies about the combination of RFA and immunotherapy were shown.
I suggest that authors could also attach tables listing studies about the combination of RFA and
immunomodulator therapy, immune checkpoint inhibitor therapy, adoptive immunotherapy, and
topical immunotherapy, if possible. | BMC | 12893_2025_2778_ReviewerReport_V1_R2.pdf | {
"criticism": 2,
"example": 0,
"importance_and_relevance": 0,
"materials_and_methods": 6,
"praise": 2,
"presentation_and_reporting": 2,
"results_and_discussion": 1,
"suggestion_and_solution": 3,
"total": 11
} | {
"criticism": 0.18181818181818182,
"example": 0,
"importance_and_relevance": 0,
"materials_and_methods": 0.5454545454545454,
"praise": 0.18181818181818182,
"presentation_and_reporting": 0.18181818181818182,
"results_and_discussion": 0.09090909090909091,
"suggestion_and_solution": 0.2727272727272727
} | 1.454545 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Radiofrequency Ablation Combined with Immunotherapy to Treat Hepatocellular\nCarcinoma: A comprehensive review\nVersion: 1 Date: 14 Apr 2024\nReviewer's report:\nIt’s a completed and detailed review about the influence ... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02778-z | Reviewed - bmc_surgery | Title: Radiofrequency Ablation Combined with Immunotherapy to Treat Hepatocellular
Carcinoma: A comprehensive review
Version: 2 Date: 11 Jul 2024
Reviewer's report:
The author revised the manuscript thoroughly and it is much better than before. But some
responses are inappropriate.
1. The response of Reviewer 1 Comment 4 “Immunotherapy sometimes causes tumor swelling
and pseudo-progression. Is there any literature to discuss this effect with RFA? It will
be comprehensive to create a section for this, and the authors may include their practice
experience.” is inappropriate and impolite. This comment is constructive. Please review
adequate literatures to describe this.
2. The response of Reviewer 2 Comment 1 is also too easy and does not answer the reviewer’s
question. The reviewer wondered if there is some similar mechanisms of releasing antigen and
immunity regulating effect with surgery. Please review adequate literatures to describe this. Do
not make conclusion just by your impression. Besides, please added the advantage of RFA in
the manuscript compared with surgery, such as for specific patient.
3. The language needs to be further polished. | Title: Radiofrequency Ablation Combined with Immunotherapy to Treat Hepatocellular
Carcinoma: A comprehensive review
Version: 2 Date: 11 Jul 2024
Reviewer's report:
The author revised the manuscript thoroughly and it is much better than before. But some
responses are inappropriate.
1. The response of Reviewer 1 Comment 4 “Immunotherapy sometimes causes tumor swelling
and pseudo-progression. Is there any literature to discuss this effect with RFA? It will
be comprehensive to create a section for this, and the authors may include their practice
experience.” is inappropriate and impolite. This comment is constructive. Please review
adequate literatures to describe this.
2. The response of Reviewer 2 Comment 1 is also too easy and does not answer the reviewer’s
question. The reviewer wondered if there is some similar mechanisms of releasing antigen and
immunity regulating effect with surgery. Please review adequate literatures to describe this. Do
not make conclusion just by your impression. Besides, please added the advantage of RFA in
the manuscript compared with surgery, such as for specific patient.
3. The language needs to be further polished. | BMC | 12893_2025_2778_ReviewerReport_V2_R8.pdf | {
"criticism": 4,
"example": 0,
"importance_and_relevance": 0,
"materials_and_methods": 2,
"praise": 2,
"presentation_and_reporting": 4,
"results_and_discussion": 2,
"suggestion_and_solution": 5,
"total": 16
} | {
"criticism": 0.25,
"example": 0,
"importance_and_relevance": 0,
"materials_and_methods": 0.125,
"praise": 0.125,
"presentation_and_reporting": 0.25,
"results_and_discussion": 0.125,
"suggestion_and_solution": 0.3125
} | 1.1875 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Radiofrequency Ablation Combined with Immunotherapy to Treat Hepatocellular\nCarcinoma: A comprehensive review\nVersion: 2 Date: 11 Jul 2024\nReviewer's report:\nThe author revised the manuscript thoroughly and it is mu... | 2,025 | ||
0 | 0 | Review for 10.1186/s12893-025-02778-z | Reviewed - bmc_surgery | Title: Radiofrequency Ablation Combined with Immunotherapy to Treat Hepatocellular
Carcinoma: A comprehensive review
Version: 2 Date: 15 Jul 2024
Reviewer's report:
Overall much of the English language editing is improved, but the new content of the abstract
remains hard to follow from a comprehension perspective.
The reviewer comment about the Lee JH clinical trial is also not adequately addressed. This
trial was evaluating local therapies which included both resection and ablation with or without
adjuvant immunotherapy. It showed adjuvant immunotherapy was beneficial but did not study
ablation vs resection.
The Duffy et al study in lines 369-380 is misrepresented in the manuscript. The methods of this
paper indicate that all patients underwent ablation (either RFA or chemoablation) so it was not
a study of ablation + tremelimumab vs tremelimumab alone as is suggested in line 372.
In Table 1, the column result lists an outcome for several clinical trials, but the comparison or
control arm is important to include. Several of the references do not line up with the updated
manuscript. The 2016 Sawanda et al study indicates it is a phase II trial, not phase III as the
table indicates.
References 11 and 31 relate to colorectal liver metastases and reference 61 is pancreatic cancer,
which are not the subject of this review on HCC. Ref 31 is discussed a disproportunate amount
of time (lines 271-293, 358-369). | Title: Radiofrequency Ablation Combined with Immunotherapy to Treat Hepatocellular
Carcinoma: A comprehensive review
Version: 2 Date: 15 Jul 2024
Reviewer's report:
Overall much of the English language editing is improved, but the new content of the abstract
remains hard to follow from a comprehension perspective.
The reviewer comment about the Lee JH clinical trial is also not adequately addressed. This
trial was evaluating local therapies which included both resection and ablation with or without
adjuvant immunotherapy. It showed adjuvant immunotherapy was beneficial but did not study
ablation vs resection.
The Duffy et al study in lines 369-380 is misrepresented in the manuscript. The methods of this
paper indicate that all patients underwent ablation (either RFA or chemoablation) so it was not
a study of ablation + tremelimumab vs tremelimumab alone as is suggested in line 372.
In Table 1, the column result lists an outcome for several clinical trials, but the comparison or
control arm is important to include. Several of the references do not line up with the updated
manuscript. The 2016 Sawanda et al study indicates it is a phase II trial, not phase III as the
table indicates.
References 11 and 31 relate to colorectal liver metastases and reference 61 is pancreatic cancer,
which are not the subject of this review on HCC. Ref 31 is discussed a disproportunate amount
of time (lines 271-293, 358-369). | BMC | 12893_2025_2778_ReviewerReport_V2_R7.pdf | {
"criticism": 4,
"example": 4,
"importance_and_relevance": 0,
"materials_and_methods": 6,
"praise": 1,
"presentation_and_reporting": 4,
"results_and_discussion": 1,
"suggestion_and_solution": 1,
"total": 11
} | {
"criticism": 0.36363636363636365,
"example": 0.36363636363636365,
"importance_and_relevance": 0,
"materials_and_methods": 0.5454545454545454,
"praise": 0.09090909090909091,
"presentation_and_reporting": 0.36363636363636365,
"results_and_discussion": 0.09090909090909091,
"suggestion_and_solution": 0.09090909090909091
} | 1.909091 | 0 | [
{
"content": "Please review this paper.",
"role": "user"
},
{
"content": "Title: Radiofrequency Ablation Combined with Immunotherapy to Treat Hepatocellular\nCarcinoma: A comprehensive review\nVersion: 2 Date: 15 Jul 2024\nReviewer's report:\nOverall much of the English language editing is improved,... | 2,025 |
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