JerMa88/BMC_Gastroenterology_Peer_Reviews huggingface dataset:
Review for 10.1186/s12876-024-03555-7 (2025)

Title: Deep Learning-based CT Radiomics Predicts Prognosis of Unresectable Hepatocellular
Carcinoma Treated with TACE-HAIC combined with PD-1 Inhibitors and Tyrosine Kinase
Inhibitors
Version: 2 Date: 09 Oct 2024
Reviewer's report:
This retrospective study investigated a CT-based radiomics model to predict PFS of unresectable
hepatocellular carcinoma treated with TACE±HAIC combined with PD-1 Inhibitors and
tyrosine kinase inhibitors. The results are solid and support the conclusion. I would recommend
it for publication if the authors could improve the manuscript from the following aspects:
1. The language of the manuscript needs improvement. I found some grammar mistakes and
unprofessional terms.
2. The references need to be updated with the most recent literature in the field of combined
therapy.
3. The result will be more convincing with a larger sample size and longer follow-up time to
investigate whether the model can predict the OS.
Review for 10.1186/s12876-024-03555-7 (2025)

Title: Deep Learning-based CT Radiomics Predicts Prognosis of Unresectable Hepatocellular
Carcinoma Treated with TACE-HAIC combined with PD-1 Inhibitors and Tyrosine Kinase
Inhibitors
Version: 3 Date: 31 Oct 2024
Reviewer's report:
This study presents a deep learning-based radiomics model for predicting treatment response
and PFS in unresectable HCC patients receiving TACE-HAIC combined with TKIs and PD-1
inhibitors. The retrospective analysis includes 172 patients, demonstrating the model's potential
with a median PFS of 14.0 months and OS of 26.2 months. The ResNet50 + MLP architecture
shows promising predictive performance. However, the study is limited by its retrospective
design and small sample size, reducing reliability. A prospective, multicenter study with a
larger sample is needed for validation. Overall, the author has answered the reviewer's questions
reasonably, with good reasoning and explanation, and the study provides a valuable tool
for clinical decision-making, warranting further investigation.  I would recommend it for
publication.
Review for 10.1186/s12876-024-03555-7 (2025)

Title: Deep Learning-based CT Radiomics Predicts Prognosis of Unresectable Hepatocellular
Carcinoma Treated with TACE-HAIC combined with PD-1 Inhibitors and Tyrosine Kinase
Inhibitors
Version: 3 Date: 04 Nov 2024
Reviewer's report:
This retrospective study investigated a CT-based radiomics model to predict PFS of unresectable
hepatocellular carcinoma treated with TACE±HAIC combined with PD-1 Inhibitors and
tyrosine kinase inhibitors. The results are solid and support the conclusion. The authors have
addressed most of my concerns, and I would recommend it for publication.
Review for 10.1186/s12876-025-03612-9 (2025)

Title: Association Between Neutrophil-Albumin Ratio and Ultrasound-Defined Metabolic
Dysfunction-Associated Fatty Liver Disease in U.S. Adults: Evidence from NHANES
2017-2018
Version: 0 Date: 26 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the introduction sets the stage well, it could be made clearer that the study aims to explore
NAR’s predictive power for NAFLD specifically in a broader population (NHANES dataset) to
support targeted prevention and treatment strategies.
-The introduction could provide more insight into the potential mechanisms linking systemic
inflammation (as reflected by NAR) and liver fat accumulation or liver injury, which would be
helpful for readers who are less familiar with the concept.
-The description of the GLM and GAM methods could benefit from a more detailed explanation
of how the models were selected and the assumptions behind these choices. For instance, what
was the rationale for the specific covariates included in each model? This additional detail would
help readers understand why these specific covariates (such as ALT, AST, BUN) were chosen
for adjustment.
-The discussion touches on the nonlinear relationship between NAR and CAP but could expand
on the biological rationale for this pattern. Why is the risk of NAFLD most strongly affected at
lower NAR levels, and what does this imply for clinical practice? A more in-depth exploration
of the threshold effect could be helpful.
-While the potential clinical applications of NAR are mentioned, the manuscript could benefit
from a clearer step-by-step outline of how NAR would be integrated into clinical workflows.
For example, how would NAR be used alongside other markers like ALT or triglycerides in a
real-world clinical setting to identify at-risk individuals?
Review for 10.1186/s12876-025-03612-9 (2025)

Title: Association Between Neutrophil-Albumin Ratio and Ultrasound-Defined Metabolic
Dysfunction-Associated Fatty Liver Disease in U.S. Adults: Evidence from NHANES
2017-2018
Version: 1 Date: 10 Jan 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory.
Review for 10.1186/s12876-025-03612-9 (2025)

Title: Association Between Neutrophil-Albumin Ratio and Ultrasound-Defined Metabolic
Dysfunction-Associated Fatty Liver Disease in U.S. Adults: Evidence from NHANES
2017-2018
Version: 1 Date: 11 Jan 2025
Reviewer:  Amira A A Othman
Reviewer's report:
I want to extend my congratulations to all those involved in this work. All the required
amendments have already been made carefully and satisfactorily. I hope that the research will
be presented to science.
Review for 10.1186/s12876-025-03603-w (2025)

Title: Correlation and Diagnostic Significance of CD4 T Cell Subsets and NLRP3
Inflammasome in Ulcerative Colitis: The Role of the NLRP3/T-bet/GATA3 Axis
Version: 1 Date: 18 Nov 2024
Reviewer's report:
This scientific paper provides information regarding the relation between CD4 T cell subsets
and the activation of NLRP3 inflammasome in IBD patients, more specifically in UC patients,
and its therapeutic potential as biomarkers of the disease diagnosis, severity and response to
treatment. It was well written and adequately executed, and the assumption was supported by
analyzing the serum and colonic expression of CD4 T cell cytokines and proteins of the NLRP3/
T-bet/GATA3 Axis, which are known to be involved in the etiopathology of UC, which showed
distinct levels between the controls and the UC-LM and UC-MH patients, and in addition a
correlation between some of those factors was proven.
Having said that, however, there is still room for improvement.
Specifically, in the Results section, throughout all the paragraphs, the P values are mistakenly
written as “P>0.05” etc., instead of "P<0.05” etc. as shown in the Figure legends and is usually
presented. It should be corrected. In addition, I believe that it would benefit the text in the Results
section if it included the Medians as well as the IQRs of each statistically significant result,
in order to give more detailed results and provide a better understanding of their significance,
instead of just mentioning the P values.
Last but not least, some minor points include:
1) In the line 95 of the Introduction, where it is presented as “NLRP3 inflammasome has
identified as a pivotal element” while it should be “NLRP3 inflammasome was identified as a
pivotal element”.
2) In the line 319 of the Discussion, where it is presented as “differences among the groupsa”
while it should be "differences among the groups”.
3) In the line 324 of the Discussion, where it is presented as “increased IL-2 exacerbats
inflammation” while it should be “increased IL-2 exacerbates inflammation”.
Review for 10.1186/s12876-025-03603-w (2025)

Title: Correlation and Diagnostic Significance of CD4 T Cell Subsets and NLRP3
Inflammasome in Ulcerative Colitis: The Role of the NLRP3/T-bet/GATA3 Axis
Version: 1 Date: 18 Nov 2024
Reviewer:  Aleksandra Piechota-Polanczyk
Reviewer's report:
The article entitled „Correlation and Diagnostic Significance of CD4 T Cell Subsets and
NLRP3 Inflammasome in Ulcerative Colitis: The Role of the NLRP3/T-bet/GATA3 Axis”  is
an interesting original paper on Chinees population with UC. The authors analyse relatively
big cohorts with two stages of UC and control patients. They measure several markers of
inflammation using different immunoenzymatic methods. The results are clearly presented and
discussed but could be improved. My detailed comments are below.
Methods:
IHC- the authors should specify how many areas per patient were analyse, and how the positive
signal was analysed.
The authors should add drug history of analysed patients and discuss if taken medications should
influence T cells cohorts.
Results:
Figures with IHC stainings- the authors should reduce the pinkish background which shades
DAB staining and strongly interrupts with data interpretation.
Figure 2- IFN-gamma- there are two outliers- did the authors use Grubb’s test to exclude
significant outliers. It looks like this could be significant outliers.
Figure 4- there is no description of panel B
The authors could analyse the populations of T cells in the blood and add this information to
correlation studies.
The authors should clarify what they mean by “UC-LM”, “UC-S”, “UC-L”, and “UC-MH” on
each figure.
Results and discussion:
The authors have equal number of males and females- they should consider doing additional
analysis in sex-divided subgroups and fluctuating hormonal levels in females could influence
inflammatory reaction within the colon tissue.
There is no rationale behind panel Fig 4B. How the authors determined binding affinity? It is
not visible in a created panel.
The authors conclude that “By suppressing T-bet, IL-6 hinders Th1 responses and upregulates
GATA3, suggesting that targeting this axis could effectively manage UC by addressing both
inflammation and regulation”. Does it have clinical value? Can the authors suggest any drug
which could target this axis?
Review for 10.1186/s12876-025-03603-w (2025)

Title: Correlation and Diagnostic Significance of CD4 T Cell Subsets and NLRP3
Inflammasome in Ulcerative Colitis: The Role of the NLRP3/T-bet/GATA3 Axis
Version: 4 Date: 09 Dec 2024
Reviewer:  Aleksandra Piechota-Polanczyk
Reviewer's report:
THe authors answered to all my questions and significantly improved their paper.
Review for 10.1186/s12876-025-03603-w (2025)

Title: Correlation and Diagnostic Significance of CD4 T Cell Subsets and NLRP3
Inflammasome in Ulcerative Colitis: The Role of the NLRP3/T-bet/GATA3 Axis
Version: 4 Date: 09 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the manuscript specifies the number of UC (42) and control (30) subjects, there is no
mention of how these sample sizes were determined. For increased rigor, a power calculation
should be provided to justify the sample size, especially given the complexity of the immune
markers and the potential for inter-individual variation.
-The tissue processing steps, including the drying of colon specimens at 60°C, might need further
justification. High-temperature drying may affect protein preservation or conformation, which
could influence the results of IHC. It would be useful to mention whether this step was validated
or optimized for tissue preservation in previous studies or experiments.
-The methods section does not address potential confounding factors, such as medication use
(e.g., corticosteroids, immunosuppressants), comorbid conditions, or diet, that might influence
the expression of the immune markers studied. A brief mention of how such factors were
controlled for or accounted for would strengthen the study's design.
-The control group consists of patients with colon polyps, which is a reasonable choice for
comparing to UC patients. However, it would be beneficial to include a "healthy control" group
to establish a baseline for biomarker levels in individuals without any colonic pathology. This
would help to further isolate the effects of UC from those associated with any potential pre-
cancerous or benign polyp-related immune alterations.
-While the authors present a compelling correlation between immune markers and UC severity,
the mechanistic understanding of how the NLRP3 inflammasome regulates T-bet and GATA3,
and vice versa, could be expanded. The study mentions that NLRP3-P correlates with T-bet
and GATA3, but the precise molecular mechanisms behind this interaction remain unclear. A
more detailed exploration of how NLRP3 activation directly influences Th1/Th2 differentiation
or how it might affect the transcriptional activity of T-bet and GATA3 would add depth to the
discussion.
-Including a more detailed discussion on how IL-6 might influence the balance between Th1
and Th2 (e.g., by suppressing IFN-# and promoting GATA3) would enhance understanding of
these regulatory circuits in UC.
Review for 10.1186/s12876-025-03603-w (2025)

Title: Correlation and Diagnostic Significance of CD4 T Cell Subsets and NLRP3
Inflammasome in Ulcerative Colitis: The Role of the NLRP3/T-bet/GATA3 Axis
Version: 4 Date: 18 Dec 2024
Reviewer's report:
I have no access to supplementary table and Figure, which appear to be corrupted.
I apologize, but unfortunately I cannot proceed with my review without them.
Review for 10.1186/s12876-025-03603-w (2025)

Title: Correlation and Diagnostic Significance of CD4 T Cell Subsets and NLRP3
Inflammasome in Ulcerative Colitis: The Role of the NLRP3/T-bet/GATA3 Axis
Version: 5 Date: 30 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory, can be accepted for publication
Review for 10.1186/s12876-025-03603-w (2025)

Title: Correlation and Diagnostic Significance of CD4 T Cell Subsets and NLRP3
Inflammasome in Ulcerative Colitis: The Role of the NLRP3/T-bet/GATA3 Axis
Version: 5 Date: 01 Jan 2025
Reviewer:  Aleksandra Piechota-Polanczyk
Reviewer's report:
The authors answered all my questions. I have no further comments.
Review for 10.1186/s12876-025-03618-3 (2025)

Title: PPAR# activation attenuates neonatal CRD-induced visceral pain sensitization and
anxiety in male rats by alleviating oxidative stress
Version: 4 Date: 23 Nov 2024
Reviewer's report:
Dear editor,
On the manuscript entitled: PPAR# activation attenuates neonatal CRD-induced visceral pain
sensitization and anxiety in male rats by alleviating oxidative stress
1- There are several spelling errors in the text that need to be corrected.
2- In the methods section of the abstract, it should be specified in which tissue SOD and MDA
were measured.
3- Sentence “In addition, rosiglitazone inhibited the upregulation of MDA and the
downregulation of SOD in the spinal cord” should be written better in the results section of
abstract.
4- In line 77, the number 2 should be deleted from the “Hasegawa2”.
5- Enough information regarding that CRD create symptoms of IBS should be added to the
introduction.
6- How many rats were tested?
7- Was the angioplasty balloon placed in the descending colon for only 60 seconds each day from
day 7 to 13? Is this enough time to induce IBS models? please insert appropriate references?
8- What was your rationale for choosing the dosage of the medications?
9- Why the GW9662 did not inject before the single doses of rosiglitazone? Did GW9662 inject
at single dose? please clarify.
10- The caption of the figure 1 is too long. It is better to remove the content that can be written
in the method section.
11- It is better to allocate a section in the Materials and methods section for grouping animals.
12- The caption of the figure 1A states that 20 neonatal rats were randomly divided into 2 groups
of 10 rats each: the Sham and the IBS group, but in figure 1B it says that 24 mice were divided
into 4 groups. Your writing style is confusing. Please write more clearly. Why different number
of rats were aligned to each group?
13- What was your rationale for choosing the pressures of 40 and 60 mmHg for
electromyography? I suggest that appropriate references putted for all methods.
14- Did you anesthetize the mice twice? Once for electromyography and once for SOD and
MDA measurements? Method of anesthesia and sacrificing need to be stated clearly.
15- In the results section on line 206, it would be better to remove SD from “SD rats”.
16- What is meant secondary CRD in line 207 in the phrase “On 50 d, secondary CRD was
performed on rats that had undergone neonatal CRD”? please clarify.
17- SOD, MDA and were only measured in animals that received repeated injections of
rosiglitazone, why were not measured in animals that received single dose of rosiglitazone?
18- Discussion is too long. Please also concise conclusion based on your core finding.
Review for 10.1186/s12876-025-03618-3 (2025)

Title: PPAR# activation attenuates neonatal CRD-induced visceral pain sensitization and
anxiety in male rats by alleviating oxidative stress
Version: 4 Date: 03 Dec 2024
Reviewer's report:
In Study Design and Methodology Section:
1. The sham group design method for inducing IBS does not appear to be appropriate. It would be
more logical to insert the angioplasty balloon into the colon without applying distention pressure.
2. Reference number 21 describes performing distention on days 8, 10, and 12 with varying
pressures to create the IBS model. Please address the modifications made to the model in your
study and, if possible, explain the rationale behind these changes.
3. To enhance the comparison of results, particularly in the nociceptive test section, it would
have been beneficial to include a naive group in this study.
4. Reconsider the electromyography (EMG) recording method used in the nociceptive test
section. Provide detailed information on the recording frequency, device specifications for
amplifying and filtering signals, high-frequency filter set point, time constant, sampling
frequency, device sensitivity voltage, and scanning speed.
5. Clarify whether spike-to-spike measurements were taken during the evaluation of
electromyography activity.
6. Explain the method used to calculate the percentage of EMG amplitude.
7. Indicate whether the EMG results were statistically analyzed using two-way or one-way
repeated measures ANOVA.
8. Specify the statistical method used for each part of the results in the text and the caption
of the corresponding graph. If two-way repeated measures ANOVA was employed, report the
significance of the interaction between treatment and pressure and the F-value.
9. The internal standard protein and its measurement method were not mentioned in the Western
blot section. Provide a more detailed description of the protein quantification method used.
In Discussion Section:
1. Article No. 51 is a comprehensive review on the role of PPAR-gamma in irritable
bowel syndrome. Numerous experimental studies have induced IBS using various methods
and demonstrated the role of PPAR-gamma and its agonists in controlling allodynia and
inflammation. These findings were not reviewed or compared in the discussion of the current
article. It would be beneficial to highlight the possible advantages or disadvantages of your study
by referring to these other studies.
2. One of the findings of the present study is anxiety-like symptoms in mice. The discussion of
this result is inadequately written, and the cited reference (No. 55) is not strongly related. This
section should be rewritten to better discuss the observed anxiety-like symptoms.
Review for 10.1186/s12876-025-03618-3 (2025)

Title: PPAR# activation attenuates neonatal CRD-induced visceral pain sensitization and
anxiety in male rats by alleviating oxidative stress
Version: 5 Date: 05 Jan 2025
Reviewer's report:
The majority of the comments have been addressed within the text of the article, and the
responses provided are generally persuasive.
Review for 10.1186/s12876-025-03606-7 (2025)

Title: Association of Daily Step Counts and Step Intensity with Mortality Among US Adults:
a cross–sectional study of NHANES 2005–2006
Version: 0 Date: 09 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The study concludes that there is no significant association between step intensity and mortality
after controlling for confounding variables; however, this finding merits further examination.
Initially, the hypothesis suggested that higher step intensity would correlate with reduced
mortality rates, yet the study does not sufficiently clarify why this association dissipated post-
adjustment. The absence of significant findings in the highest intensity group (e.g., #107 steps
per minute) warrants additional investigation. Factors such as overexertion, increased fatigue,
and potential reverse causality—where individuals with poorer health may naturally gravitate
toward lower-intensity physical activities—could influence these results.
-Although the study indicates that it has adjusted for various covariates, it would be
advantageous to provide more detailed information regarding the specific factors included in
the analysis. It would enhance the study's rigor to clarify whether lifestyle factors such as diet,
alcohol consumption, medication adherence, and the presence of comorbid conditions were
considered. These variables are critical in understanding how they may affect the relationship
between step count, intensity, and mortality risk.
-Moreover, the study does not sufficiently explore the underlying mechanisms that could explain
the lack of significant associations between step intensity and mortality risk. While moderate-
intensity activity is often associated with improved cardiovascular health, vigorous-intensity
activity may not confer the same benefits across all populations, particularly among those with
chronic conditions such as metabolic associated fatty liver disease (MASLD). Thus, providing
additional mechanistic insights into why step intensity did not serve as a predictor of mortality
would be beneficial.
-Lastly, the authors acknowledge that the study found no significant results regarding low step
counts due to a lack of data at these levels. This limitation is a pivotal aspect that requires a more
comprehensive discussion. The authors should address the implications of this limitation for the
interpretation of the findings, particularly whether the results are applicable to individuals who
are extremely sedentary or if further data at lower activity levels would be necessary to draw
more definitive conclusions about the benefits of minimal physical activity.
Review for 10.1186/s12876-025-03606-7 (2025)

Title: Association of Daily Step Counts and Step Intensity with Mortality Among US Adults:
a cross–sectional study of NHANES 2005–2006
Version: 1 Date: 23 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory, the manuscript can be accepted for publication.
Review for 10.1186/s12876-025-03606-7 (2025)

Title: Association of Daily Step Counts and Step Intensity with Mortality Among US Adults:
a cross–sectional study of NHANES 2005–2006
Version: 1 Date: 26 Dec 2024
Reviewer:  Amira A A Othman
Reviewer's report:
I want to extend my congratulations to all those involved in this work. All the required
amendments have already been made carefully and satisfactorily. I hope that the research will
be presented to science.
Review for 10.1186/s12876-025-03601-y (2025)

Title: Investigating Neutropenic Enterocolitis: A Systematic Review of Case Reports and
Clinical Insights
Version: 1 Date: 18 Nov 2024
Reviewer:  Abeera Mehmood
Reviewer's report:
Congratulations on your effort. The manuscript is overal very well written, with clear objectives
and rigorous methodology. PRISMA guidelines are appropriately followed. Athough this
systematic review is based on case reports, still provides relevant information on characteristics
of a clinically important condition and summarizes clinical presentation, and management
startegies empolyed accross different parts of the world.
A few points which I think will help to improve the overall presentation and impact of the paper
are as follows:
1. Certain sentences need re-phrasing to make it more presentable e.g. clinically siginificant
is more appropriate than "clinically meaningful" , "chemotherapeutic agents" instead of
"chemotherapy treatments", imaging findings or simply results of investigations instaed of
"investigative findings" etc.
2. The choice of the GEE: it would help to provide a brief rationale for using this model,
particularly given the unique nature of the data.
3. Since many results did not reach statistical significance, a sentence discussing why certain
associations might lack statistical power (e.g., due to a small sample size for subgroups) could
strengthen the interpretation.
4.There is an inconsistency in reporting the data, i.e. percentages vs actual numbers  in various
sections.  try to keep the same format.
5. The "Results" section, while thorough, could benefit from slight restructuring to make it
more digestible. For example, combining or summarizing some statistical findings into fewer
paragraphs for the most important numerical findings (like percentages) could enhance clarity.
6.  A combined table with the patient demographics, clinical presentation and imaging findings,
treatment and complications to summarize the data in a visual format will improve the
readability.
7.  Including a comparative table for imaging techniques or for treatment modalities
(conservative vs. surgical) with outcomes could be especially valuable. (*if that data is available
ofcourse).
8.  in results section, "Among NE cases, the most common chemotherapy treatments were
daunorubicin (42 cases), doxorubicin (19 cases), prednisolone (40 cases), cytarabine (39 cases),
cyclophosphamide (37 cases), and vincristine (37 cases). Antibiotics and antifungals were
preventatively used in 25 and 16 patients, respectively. In terms of disease status at presentation,
remission was reported in 77 cases, relapse in 21, and refractory disease in 29."
Please explain if this means remission of NE sec. to use of prophylactic antibiotics, receiving
chemotherapy? if yes how does it differ to the treatment in the next section.
9. please clarify incidence in male vs female "More than half of the patients were female, with
ages ranging from 6 months to 83 years. We observed an almost 2.5-fold increase in incidence
in male patients."
I hope this this helps .
Review for 10.1186/s12876-025-03601-y (2025)

Title: Investigating Neutropenic Enterocolitis: A Systematic Review of Case Reports and
Clinical Insights
Version: 1 Date: 19 Nov 2024
Reviewer:  Amira A A Othman
Reviewer's report:
This comprehensive systematic review and meta-analysis provides valuable insights into
the epidemiology, clinical presentation, management approaches, outcomes, and risk factors
associated with neutropenic enterocolitis (NE).
The study performed a comprehensive analysis, it aggregates 227 cases from 159 publications,
representing one of the largest reviews on this topic, following the PRISMA guidelines for
systematic reviews. The study provides a detailed description of NE risk factors, symptoms,
microbiological findings, treatment approaches, prognosis, and potential predictors of mortality
to enhance clinical awareness and management of this condition. The study also emphasizes
geographical variations in reported cases, aiding the understanding of global NE patterns.
The authors tried to contribute to this field of research with new findings, nevertheless, there is
an observation for which sufficient justification must be obtained.
1. The study's reliance on case reports and series, which are prone to selection bias and lack
cross-study consistency, is the reason for its low level of evidence.
2. The robustness of mortality risk projections was diminished since the generalized estimating
equations (GEE) analysis did not yield statistically significant results.
3. Because of the length of cases, older diagnostic and treatment techniques might not be
applicable in modern situations.
4. Insufficient microbiological data, with positive stool or blood cultures in only a small
percentage of cases, and a lack of severity rating and thorough treatment regimens in many
studies are examples of data gaps.
5. Limited microbiological data, with positive stool or blood cultures in only a small percentage
of cases, and a lack of severity rating and thorough treatment regimens in many studies are
examples of data gaps.
To address these limitations, the authors advise carrying up prospective studies with uniform
data collecting and reporting to address these shortcomings and offer a higher degree of proof.
The effects of more recent diagnostic techniques and therapeutic modalities on the management
and results of NE also require investigation. However, this systematic analysis provides
insightful information that can help clinicians identify this potentially fatal complication early
and treat it aggressively.
Review for 10.1186/s12876-025-03601-y (2025)

Title: Investigating Neutropenic Enterocolitis: A Systematic Review of Case Reports and
Clinical Insights
Version: 4 Date: 20 Dec 2024
Reviewer:  Amira A A Othman
Reviewer's report:
I want to extend my congratulations to all those involved in this work. All the required
amendments have already been made carefully and satisfactorily. I hope that the research will
be presented to science.
Review for 10.1186/s12876-025-03601-y (2025)

Title: Investigating Neutropenic Enterocolitis: A Systematic Review of Case Reports and
Clinical Insights
Version: 4 Date: 20 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the review mentions broad-spectrum antibiotics and bowel rest as the mainstay of
treatment, a deeper exploration of more recent or advanced management strategies could
strengthen the manuscript. For example, new therapies, such as the use of antifungal agents,
biologics, or surgical interventions in severe cases, could be discussed if these were noted in
the included case reports.
-The manuscript mentions that some cases underwent surgical treatments, but these are not
discussed in depth. Given the serious nature of NE, it would be beneficial to provide more detail
on the role of surgery in the management of NE, such as indications for surgery (e.g., perforation,
bowel necrosis) and outcomes related to surgical interventions.
-While the statistical findings are mentioned (e.g., odds ratios for risk factors), the discussion
could benefit from a more detailed interpretation of these results. For example, while
antibacterial prophylaxis and broad-spectrum antibiotics were associated with a reduced risk
of death, it would be helpful to explain the clinical significance of the adjusted odds ratios
(aOR) and discuss any potential confounders that might explain these associations. A deeper
exploration of non-significant findings, such as the relationship between bowel wall thickening
and mortality, could also add more nuance to the interpretation.
-The association between granulocyte-colony stimulating factor (G-CSF) treatment and reduced
mortality is mentioned, but the explanation of how G-CSF impacts NE specifically is somewhat
brief. A more detailed discussion of the mechanism of action of G-CSF and its potential role in
improving immune function in neutropenic patients could provide additional context. Moreover,
it would be helpful to discuss the uncertainty surrounding its role in managing NE, as its efficacy
is not universally agreed upon.
-The chemotherapeutic agents most commonly associated with NE (e.g., cytarabine, vincristine,
and doxorubicin) are mentioned in the context of pathophysiology, but a more detailed analysis
of which agents are particularly high-risk for NE development and how they contribute to
mucosal injury would be beneficial. More data on specific chemotherapeutic regimens and their
relationship with NE could help clinicians make more informed decisions when considering the
risk of NE in chemotherapy planning.
Review for 10.1186/s12876-025-03596-6 (2025)

Title: Prognostic value of albumin-bilirubin grade in patients with cholangiocarcinoma: A
systematic review and meta-analysis
Version: 2 Date: 17 Aug 2024
Reviewer:  Zhaohui Tang
Reviewer's report:
The study conducted a comprehensive search across multiple databases, ultimately including 14
studies with a total of 3,543 patients in the meta-analysis. The results show that a higher ALBI
grade is significantly associated with lower overall survival (OS) and lower recurrence-free
survival (RFS). Subgroup analyses indicate that the results of different ALBI grade comparisons
are consistent with the aggregated data. The study concludes that ALBI grade is an effective
prognostic indicator for patients with cholangiocarcinoma. Below are my detailed review
comments on the manuscript:
In the heterogeneity analysis, it is recommended to combine the Cochran's Q test to provide a
more comprehensive assessment of heterogeneity and to select an appropriate effect size model
based on the degree of heterogeneity.
The comparative analysis with other prognostic indicators (such as the Child-Pugh score) lacks
depth; it is suggested to include more relevant studies for citation and discussion.
The article mentions that the application of ALBI grades in different types of
cholangiocarcinoma is limited, but it does not discuss their specific performance in different
subtypes in detail. It is recommended to supplement this with relevant content, such as separately
analyzing the prognostic value of ALBI grades for intrahepatic cholangiocarcinoma (iCCA) and
extrahepatic cholangiocarcinoma (eCCA).
Regarding the detection of publication bias, it is suggested to include funnel plot analysis to
more intuitively demonstrate the presence of bias.
Review for 10.1186/s12876-025-03596-6 (2025)

Title: Prognostic value of albumin-bilirubin grade in patients with cholangiocarcinoma: A
systematic review and meta-analysis
Version: 2 Date: 13 Nov 2024
Reviewer:  Hongfeng Gou
Reviewer's report:
This meta-analysis evaluates the prognostic significance of the albumin-bilirubin (ALBI) grade
in cholangiocarcinoma (CCA), an aggressive cancer with poor outcomes. However, I would like
to highlight several points for improvement to enhance the clarity and impact of the paper.
1. Excluding ECCA study: As the majority of patients had intrahepatic cholangiocarcinoma
(ICCA), and only one study included patients with extrahepatic cholangiocarcinoma (ECCA),
we recommend excluding this single ECCA study to focus on the prognostic value of ALBI
specifically in extrahepatic ICCA.
2.Clarify ALBI Grade# It would be beneficial to provide a more detailed explanation of how
the ALBI grade quantifies liver function. This would help readers better understand its specific
application and calculation in clinical practice.
3.Add Background on ALBI Advantages: In the introduction section, consider adding the main
advantages of the ALBI grade, especially regarding why it may be a relevant and potentially
superior prognostic marker compared to existing markers for CCA.
4. Grammar and Formatting Consistency: Adjust minor formatting issues, such as replacing the
underscore in “10%_15%” with a dash (“10%-15%”), to ensure consistency throughout the text.
5.Pay Attention to the Use of Abbreviations: When the NOS score is first mentioned in Methods
2.3, spell out the full term.
Review for 10.1186/s12876-025-03596-6 (2025)

Title: Prognostic value of albumin-bilirubin grade in patients with cholangiocarcinoma: A
systematic review and meta-analysis
Version: 4 Date: 06 Jan 2025
Reviewer:  Zhaohui Tang
Reviewer's report:
The authors’ revisions comprehensively address the reviewers’ and editors’ feedback,
showcasing a marked improvement in both methodological rigor and clarity. They strengthened
the research design by adding detailed statistical checks, such as Cochran's Q test and
funnel plots, to assess heterogeneity and publication bias. They also refined the discussion
with in-depth comparisons between ALBI, Child-Pugh, and MELD scoring systems, and
included a nuanced analysis of ECCA and ICCA subtypes, thereby broadening the clinical
perspective. In strict adherence to PRISMA guidelines, they enhanced transparency by clearly
disclosing data availability and the study's registration number. Overall, these improvements
significantly elevate the scientific robustness, reproducibility, and comprehensiveness of the
paper, reinforcing its merit for publication.
Review for 10.1186/s12876-025-03602-x (2025)

Title: Preoperative CT Lymph Node Size as a Predictor of Nodal Metastasis in Resectable Colon
Cancer: A Retrospective Study of 694 Patients
Version: 2 Date: 10 Dec 2024
Reviewer's report:
1.
The measurements of lymph node size mentioned in the article were performed by an
experienced surgical oncologist, but were measures taken to evaluate and ensure consistency
and repeatability of the measurements? Was a blind test conducted by a second independent
evaluator to verify these measurements?
2.
How can I ensure that the lymph nodes measured on CT images are consistent with the lymph
nodes in the pathology report? Is it possible that some lymph nodes were missed on CT, or that
all metastatic lymph nodes were not identified in the pathology report?
3.
Did the paper consider building a predictive model that included other clinical and pathological
parameters besides lymph node size? For example, were tumor T-stage, patient BMI, tumor
location, etc. included in the model, and how did they affect model performance?
4.
Does the difference in the predicted truncation of lymph node metastasis between the right and
left colon in the article agree with known biological differences in colorectal cancer? Did the
study explore the underlying biological mechanisms for these differences?
5.
Is D3 lymph node dissection mentioned in the article appropriate for all patients? Does the extent
of lymph node dissection influence the detection rate and prognosis of lymph node metastasis?
Review for 10.1186/s12876-025-03602-x (2025)

Title: Preoperative CT Lymph Node Size as a Predictor of Nodal Metastasis in Resectable Colon
Cancer: A Retrospective Study of 694 Patients
Version: 2 Date: 18 Dec 2024
Reviewer's report:
This manuscript by T. Kawazoe et al. explores the predictive value of lymph node size on
preoperative CT for identifying nodal metastasis in resectable colon cancer. The study highlights
region-specific differences in cutoff values and demonstrates clinical relevance for treatment
planning. The authors provide valuable insights into preoperative diagnostics and their role in
colon cancer management. However, several aspects require clarification and further discussion:
1. In Materials and Methods (page 2, lines 16–28), excluding patients who received preoperative
therapies or non-curative surgeries may introduce selection bias. Does this exclusion limit the
cohort’s representativeness, especially for advanced or atypical disease cases that could affect
lymph node size or metastasis rates?
2. The Results section (page 5, lines 1–6) shows diagnostic performance differences based on
CT slice thickness (#2 mm vs. >2 mm). Can the authors recommend optimal imaging protocols
for institutions with varying capabilities or provide further analysis to guide practice?
3. In Results (page 6, lines 1–15), cutoff values differ between right-sided and left-sided colon
cancers (e.g., 7.7 mm vs. 5.8 mm for maximum long diameter). What anatomical or biological
factors might explain this difference? How could these findings guide preoperative assessments
or surgical strategies tailored to tumor location?
4. In Discussion (page 8, lines 5–10), the manuscript proposes new cutoff values for lymph
node size by tumor location. How do these compare with guidelines like NCCN or JSCCR? A
discussion on integrating these findings into clinical workflows would enhance applicability.
5. In Conclusion (page 11, lines 1–5), combining long and short diameters is suggested to
be clinically useful. Could the authors provide specific examples of its impact on staging or
treatment planning? What barriers might clinicians encounter when adopting these methods?
Review for 10.1186/s12876-025-03591-x (2025)

Title: Evaluation of Double-Balloon Enteroscopy in the Management of Type 1 Small Bowel
Vascular Lesions (angioectasia): A Retrospective Cohort Study
Version: 2 Date: 04 Nov 2024
Reviewer's report:
The authors proposed a retrospective study evaluating the rebleeding risk in patients with
vascular lesions treated by double balloon enteroscopy.
Statistics and methods are appropriate and the results are well presented, however, I have some
suggestions reported below:
1. It could be interesting evaluate the follow up time and rebleeding time.
2. In literature are reported two scores evaluating the rebleeding risk in patients with small bowel
bleeding: RHEMITT Score and the work published by Ohmiya. The results are similar to the
current study so it must be reported in the discussion.
Review for 10.1186/s12876-025-03591-x (2025)

Title: Evaluation of Double-Balloon Enteroscopy in the Management of Type 1 Small Bowel
Vascular Lesions (angioectasia): A Retrospective Cohort Study
Version: 3 Date: 25 Nov 2024
Reviewer's report:
Dear authors,
Thanks for your responses
Although some limitations in your manuscript as the following:
Retrospective Design: As a retrospective single-center study, the results may not be
generalizable to broader populations. A multi-center, prospective study would improve the
robustness of the conclusions.
Small Sample Size: The relatively small sample size (67 patients with SBVL) limits the strength
and statistical power of the findings, especially in subgroup analyses.
Lack of Standardized Treatment Protocol: The variability in the choice of treatment techniques
(e.g., APC, injection therapy, clipping) based on the endoscopist's discretion introduces some
variability that could affect the consistency and comparability of the results.
Follow-up Variability: The variability in follow-up duration may impact the observed rebleeding
rates. A standardized follow-up period across patients would provide a more accurate assessment
of long-term outcomes.
But, this study makes a significant contribution to the understanding of SBVLs and the role
of DBE in their management. While the study has its limitations, its findings are valuable for
guiding clinical practice, particularly in predicting rebleeding risk and tailoring patient care. The
authors' use of a structured classification system and their analysis of clinical predictors offer
important insights that can enhance the management of patients with small bowel bleeding.
Review for 10.1186/s12876-025-03591-x (2025)

Title: Evaluation of Double-Balloon Enteroscopy in the Management of Type 1 Small Bowel
Vascular Lesions (angioectasia): A Retrospective Cohort Study
Version: 3 Date: 28 Nov 2024
Reviewer's report:
The authors solved all the issues addressed; however, I have a last consideration
- to define rebleeding in method section and discuss why your rebreeding rate is so low (in
literature it ranges from 30-50%), maybe you considered only patients with overt bleeding and
not patients who continued to have anaemia.
Review for 10.1186/s12876-025-03591-x (2025)

Title: Evaluation of Double-Balloon Enteroscopy in the Management of Type 1 Small Bowel
Vascular Lesions (angioectasia): A Retrospective Cohort Study
Version: 4 Date: 10 Dec 2024
Reviewer:  Daniel Wild
Reviewer's report:
The authors have satisfactorily addressed the majority of my concerns and comments though I
still question the applicability of this study to a broader clinical context given the issues raised
previously.
The only additional points that I think still warrant further clarification are:
1) What this means, "In addition, untreated SBVL requiring additional endoscopic treatment in
first DBE were not included in our study."  Why were these pts excluded.  And if the SBVL
was "untreated" than why would it then require "additional endoscopic treatment."  And what
additional treatment were provided and when / how if not during their initial DBE.
2) Since they maintain that their was a strict protocol to always reach the ileum, it is still not clear
how this was defined during the DBE.  How did the endoscopist always confirm he / she reached
the ileum on antegrade exams?  Timing, fold or reduction counting, fluoro, mucosal appearance?
Or just the gestalt of an experienced endoscopist?  And the ileum is a long segment so did he /
she always stop as soon as he / she thought he / she was in the proximal ileum, mid ileum?
Review for 10.1186/s12876-025-03591-x (2025)

Title: Evaluation of Double-Balloon Enteroscopy in the Management of Type 1 Small Bowel
Vascular Lesions (angioectasia): A Retrospective Cohort Study
Version: 4 Date: 14 Dec 2024
Reviewer's report:
Dear authors,
Thanks for your responses
This study presents a comprehensive analysis of small bowel vascular lesions (SBVLs)
diagnosed through double-balloon enteroscopy (DBE) and their management. It highlights
the prevalence and clinical relevance of small bowel bleeding, with SBVLs, especially
angioectasias, being a significant contributor. The study also emphasizes the role of DBE not
only in diagnosing but also in providing therapeutic interventions for SBVLs, including various
endoscopic techniques such as argon plasma coagulation, injection therapy, and clipping.
The study's findings are particularly important for understanding the risk factors associated
with recurrent bleeding in SBVL patients. Anticoagulant use, cardiovascular disease, chronic
renal failure, diabetes mellitus, and specific lesion locations, such as in the duodenum and
ileum, were identified as significant predictors of rebleeding. These insights contribute to better
clinical decision-making by providing predictors for recurrence, which can guide the intensity
and frequency of follow-up treatments.
Additionally, the study effectively addresses the lack of standardized terminology in the field by
using the Yano classification for SBVLs. This approach helps to clarify lesion categorization,
reducing ambiguity in diagnosis and treatment planning.
Overall, the research provides valuable data that can enhance patient outcomes through
improved identification, treatment, and monitoring of SBVLs, especially those that are prone to
rebleeding. However, the retrospective nature of the study, and the fact that it was conducted in
a single center, suggests that further multicenter, prospective studies may be needed to validate
these findings and refine treatment protocols.
Review for 10.1186/s12876-025-03591-x (2025)

Title: Evaluation of Double-Balloon Enteroscopy in the Management of Type 1 Small Bowel
Vascular Lesions (angioectasia): A Retrospective Cohort Study
Version: 5 Date: 27 Dec 2024
Reviewer:  Daniel Wild
Reviewer's report:
Thank you for addressing some of my concerns in this revised version.
I am still not convinced that that ileum was reliably reached on all exams, in light of the mean
time the DBE's took and because there was no prospective protocol insisting on this.  As such, I
would consider removing this claim from the paper as I don't think reaching or not reaching the
ileum alters and affects the results of this study which are aimed only at reporting the outcomes
of pt's with SBVL treated during DBE.  This would also allow you to remove the recently added
section that has several English grammar errors including the following sentences: "In oral DBE
procedures, it was insisted to reach the ileum localization.   The endoscopist relied heavily on
mucosal characteristics to identify the ileum.  The duration of insertion and depth achieved were
noted as supporting measures, although they were not definitive on their own because of patient
variability in bowel anatomy."