JerMa88/BMC_Gastroenterology_Peer_Reviews huggingface dataset:
Review for 10.1186/s12876-025-04032-5 (2025)

Title: Colorectal Polyp Prevalence and Adenoma Detection Rates in an Iranian Cohort: A
Prospective Study
Version: 1 Date: 21 Apr 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
I appreciate the authors’ thoughtful and comprehensive responses to the comments raised. The
revisions have strengthened the manuscript, and several concerns were adequately addressed,
particularly regarding the limitations of a single-center study and the rationale for participant
exclusions. The acknowledgment of ongoing follow-up studies is also appreciated.
However, I would recommend the manuscript undergo  revision to address the following
remaining points:
Confounding Variables:
While the authors acknowledged regional and lifestyle differences, the impact of other potential
confounding factors—such as family history of colorectal cancer, dietary habits, physical
activity, or genetic predispositions—remains insufficiently discussed. Even if these variables
were not collected, a brief mention of their potential influence and a suggestion for their inclusion
in future studies would improve the manuscript.
Histological Characteristics of Polyps:
The authors declined to elaborate further on the pathological characteristics of the polyps, citing
existing literature. While I understand this point, a concise summary of key histological features
(e.g., proportion of high-risk adenomas or those with dysplasia) would enhance the clinical
relevance of the findings and provide valuable context for readers, especially given the focus
on ADR and PDR.
Observer Bias in Pathology:
The explanation regarding the use of two GI pathologists is reasonable. Nonetheless, a brief
acknowledgment in the manuscript of the possibility of observer bias and the potential benefits
of blinded or additional reviews would provide a balanced perspective.
Review for 10.1186/s12876-025-04076-7 (2025)

Title: The nomograph predicting the recurrence of Solid Pseudopapillary Neoplasm of the
Pancreas: a study of the SEER database and a Chinese cohort
Version: 1 Date: 18 Jan 2025
Reviewer's report:
In this manuscript, the authors demonstrated the details of SPN recurrence. SPN is very rare
tumor, so this manuscript is meaningful. However, this manuscript need to improve some
content.
1. The surgical procedures (for example, PD, DP, TP, MP, enucleation, and so on), the range of
lymphadenectomy (D0, D1 or D2), and the regimen of chemotherapy should have been shown.
2. Please provide the recurrence rate and the recurrent-free survival time in R0 resection cases.
3. This manuscript showed the chemoradiotherapy can reduce the risk of recurrence. Dose this
mean that performing both chemotherapy and radiotherapy can reduce the risk of recurrence?
Does the chemoradiotherapy perform preoperatively or postoperatively?   The details of
chemoradiotherapy should have been shown.
Review for 10.1186/s12876-025-04076-7 (2025)

Title: The nomograph predicting the recurrence of Solid Pseudopapillary Neoplasm of the
Pancreas: a study of the SEER database and a Chinese cohort
Version: 1 Date: 24 Jan 2025
Reviewer:  Yukiyasu Okamura
Reviewer's report:
Thank you for the opportunity to review a manuscript entitled "The nomograph predicting the
recurrence of Solid Pseudopapillary Neoplasm of the Pancreas: a study of the SEER database
and a Chinese cohort” for BMC Gastroenterology.
The manuscript was well written, but I think that the nomogram contains inappropriate factors
for predicting recurrence rate. This is a critical point of this manuscript.
There were several points which should be addressed by authors.
Major comments
1. The nomogram includes the factors for “surgery” and “Chemoradiotherapy”. If surgery is not
performed, the tumor remains in the first place, so isn't the recurrence rate 100%?
Does the factor of “Chemoradiotherapy” mean whether or not chemoradiotherapy was
performed perioperatively?
2. SPN is a low-grade malignant tumor with a relatively low recurrence rate. The authors should
mention how this nomogram can be used in clinical practice in the Discussion section.
3. Synchronous metastasis seems to be a risk factor for recurrence. Why is it listed as NA in
Table 2?
4. The text showed Fig. 5A, but isn't there only one Fig. 5? What are Figure A and Figure B
in the legends in Figure 5?
Minor comments
1. In page 8 line 14, Lymphadenectomy should be shown lymphadenectomy.
Review for 10.1186/s12876-025-04076-7 (2025)

Title: The nomograph predicting the recurrence of Solid Pseudopapillary Neoplasm of the
Pancreas: a study of the SEER database and a Chinese cohort
Version: 2 Date: 26 Feb 2025
Reviewer's report:
The authors have adequately addressed the recommendations from the previous reviews.
Review for 10.1186/s12876-025-04076-7 (2025)

Title: The nomograph predicting the recurrence of Solid Pseudopapillary Neoplasm of the
Pancreas: a study of the SEER database and a Chinese cohort
Version: 2 Date: 17 Mar 2025
Reviewer's report:
Comments to author,
The author has appropriately responded to almost all of the previous reviewer's questions;
however, the current manuscript is still insufficient. Therefore, the author must adequately
address the following comments.
Major comments
1. The term "synchronous metastasis" in this manuscript is highly ambiguous and must be
defined more precisely. Does this refer to distant metastasis detected on preoperative imaging,
such as CT or MRI? Or does it refer to the presence of enlarged lymph nodes suspected of
metastasis? In Supplemental Table 1, the "synchronous metastasis" column for Case 3 is marked
as "vascular invasion." Does the author define vascular invasion in pathological findings as
"synchronous metastasis"? Or does this indicate a finding of direct invasions on preoperative
imaging? These findings represent ”invasion,” and "metastasis" is inappropriate. Generally,
"synchronous metastasis" refers to distant metastasis, such as to the liver or lungs, detected
before pancreatic resection. The definition of "synchronous metastasis" must be explicitly stated
in the Materials and Methods section.
2. In the section "Analysis of recurrence factors," "chemoradiotherapy" is listed as a univariate
risk factor. However, it must be clearly specified whether this refers to cases that underwent
chemoradiotherapy or those that did not.
3. In Figure 3, the p-value for age is 0.193, indicating no significant difference. Therefore, the
figure legend in Figure 3 is incorrect. The authors must create an appropriate Figure 3 in the
revised manuscript.
Minor comments
1. In Figure 4, appropriate spacing should be added between "tumorsize" and
"regionalnodespositive."
Review for 10.1186/s12876-025-04076-7 (2025)

Title: The nomograph predicting the recurrence of Solid Pseudopapillary Neoplasm of the
Pancreas: a study of the SEER database and a Chinese cohort
Version: 2 Date: 17 Mar 2025
Reviewer:  Yukiyasu Okamura
Reviewer's report:
To the authors:
The revision manuscript has been corrected well. I have no comments for the revised version.
Congratulation!
Review for 10.1186/s12876-025-04076-7 (2025)

Title: The nomograph predicting the recurrence of Solid Pseudopapillary Neoplasm of the
Pancreas: a study of the SEER database and a Chinese cohort
Version: 3 Date: 16 Apr 2025
Reviewer's report:
Comments to the author,
While the authors have responded to the reviewers’ queries point by point, the revisions and
explanations remain inadequate. At this stage, the manuscript does not meet the acceptance
criteria.
Major comments
1. Although the authors believed the portal vein tumor thrombus was a synchronous
hematogenous metastasis, this interpretation cannot be accepted, as it does not align with current
staging definitions. The portal vein tumor thrombus from a pancreatic tumor should not be
classified as distant metastasis, but rather as direct vascular invasion. The AJCC Cancer Staging
Manual, 8th Edition, and the UICC TNM Classification of Malignant Tumors, 8th Edition
support this interpretation. T4 includes tumor invasion into major vessels, such as the celiac
axis, superior mesenteric artery, superior mesenteric vein, and portal vein. In other words, portal
vein tumor thrombus arises from a direct invasion of the primary tumor into the vessel lumen,
rather than dissemination through the bloodstream. This mechanism differs from hematogenous
metastasis to distant organs such as the liver or lungs. The authors have to revise the terminology,
manuscript, and tables. Otherwise, the term “synchronous metastasis” appears to be a source
of misunderstanding throughout the manuscript. The reviewer recommends removing this term
from all tables and relevant sections to avoid misinterpretation.
2. The authors seem to have misunderstood the previous comment #3. In the legend of Figure
3, they claim that significant differences were observed in age and tumor size between the
recurrence and non-recurrence groups. However, the p-value of age in Figure 3 is 0.193, which
is insignificant. The authors have to revise the figure legend.
Minor comment,
In the authors’ response to the previous minor comment #1, the authors have inserted a space
accompanied by an underline rather than a standard space. This formatting choice is not
appropriate and introduces unnecessary visual elements. The reviewer recommends removing
the underline entirely.
Review for 10.1186/s12876-025-04076-7 (2025)

Title: The nomograph predicting the recurrence of Solid Pseudopapillary Neoplasm of the
Pancreas: a study of the SEER database and a Chinese cohort
Version: 5 Date: 29 May 2025
Reviewer's report:
Comments to authors,
The draft has been revised well. All concerns raised in the previous manuscript have been
adequately addressed, and the manuscript has undergone substantial improvement. The authors’
detailed responses and the revised content demonstrate their careful consideration of the
reviewers’ suggestions. The reviewer has no further comments and supports the acceptance of
this manuscript in its current form.
Review for 10.1186/s12876-025-04090-9 (2025)

Title: Post-surgical morbidity in early versus late closure of defunctioning ileostomy after rectal
cancer surgery: A systematic review and meta-analysis of randomised controlled trials
Version: 1 Date: 23 Jun 2024
Reviewer's report:
This is a well conducted review that is similar to one undertaken by Mauro Podda et. al "Early
versus delayed defunctioning ileostomy closure after low anterior resection for rectal cancer: a
meta-analysis and trial sequential analysis of safety and functional outcomes". The paper is well
written and advises caution against EC due to risk of increased morbidity. I would suggest that
the discussion could more relevant if focussed on patients by groups i.e. those having resection
without neoadjuvant therapy where complications could delay post operative adjuvant therapy if
necessary and those where EC after neoadjuvant therapy does have possible increased morbidity.
In both groups a cautious approach is relevant and the patient needs counselling about the likely
risks associated with EC given the lack of definite evidence.
I am not sure why the review by Mauro Podda et al is not referenced.
Review for 10.1186/s12876-025-04090-9 (2025)

Title: Post-surgical morbidity in early versus late closure of defunctioning ileostomy after rectal
cancer surgery: A systematic review and meta-analysis of randomised controlled trials
Version: 1 Date: 16 Dec 2024
Reviewer:  Dario Parini
Reviewer's report:
Dear Authors, your paper is well written and your primary and secondary aims are clear. The
choice to consider only patients with ileostomy after surgery for cancer has limited the number
of RCTs that could be included, but, at the same time, in this way the population was more
homogeneous.
I think the discussion is well done and analyzes all the aspects that can help decide whether to
close the stoma early or not. If we consider the EC population, it would be interesting to verify
if it's possible to extract data about a possible delay in closure due to a complication of the first
intervention (eg: anastomotic leak), and how many days these complications delayed the closure.
A limitation for reviewing this specific argument is the heterogeneity in definition of early
closure, but you have well underlined this bias.
Review for 10.1186/s12876-025-04090-9 (2025)

Title: Post-surgical morbidity in early versus late closure of defunctioning ileostomy after rectal
cancer surgery: A systematic review and meta-analysis of randomised controlled trials
Version: 4 Date: 11 May 2025
Reviewer:  Dario Parini
Reviewer's report:
For me the  article  is ok
Review for 10.1186/s12876-025-04090-9 (2025)

Title: Post-surgical morbidity in early versus late closure of defunctioning ileostomy after rectal
cancer surgery: A systematic review and meta-analysis of randomised controlled trials
Version: 4 Date: 19 May 2025
Reviewer's report:
The authors must be complemented for this well conducted review and for their decision to
restrict the inclusion criteria to rectal cancer. The discussion is relevant for different patient
groups and helps with informed consent with respect to timing of closure of the ileostomy.
The review acknowledges the paucity of data and recommends caution when undertaking early
closure and appears very relevant to surgeons and patients.
Review for 10.1186/s12876-025-03928-6 (2025)

Title: Ultrasound-Derived Fat Fraction: A Novel Approach for Assessing Wilson's Disease-
Related Hepatic Steatosis
Version: 1 Date: 08 Mar 2025
Reviewer's report:
This study is interesting and organized by aims to investigate Ultrasound-Derived Fat Fraction:
A Novel Approach for Assessing Wilson's Disease-Related Hepatic Steatosis. However, there
are serious correction needs to be followed-up:
• The study aims to determine the if UDFF is an effective indicator in patients with WD, but
it would be helpful to justify why this threshold is clinically important and how it might differ
from NAFLD.
• A word of “citation” in the beginning of the text should be replaced by a word “Introduction”
• The introduction does not mention potential confounding factors that could affect UDFF
measurements, such as hepatic fibrosis, dietary habits, metabolic factors, or genetic modifiers
that might influence hepatic steatosis in WD. A brief discussion of these factors would improve
the study’s transparency.
• While the study focuses on WD, does it have potential implications for other liver diseases
associated with metabolic abnormalities?
• While prior studies have validated UDFF against MRI-PDFF in NAFLD, Why it does not
compare UDFF in WD patients with MRI-PDFF directly to further validate its accuracy?
• The sample size (n=89) is relatively modest. Larger cohorts across multiple centers could
enhance the generalizability of findings.
• The study provides cross-sectional data; however, longitudinal follow-up should be suggested
for future direction as it could assess the effectiveness of UDFF in monitoring disease
progression and response to treatment.
• While a useful semi-quantitative method, the Hamaguchi score may introduce observer bias.
Consider discussing potential limitations and alternative validation methods for the future
directions.
Review for 10.1186/s12876-025-03928-6 (2025)

Title: Ultrasound-Derived Fat Fraction: A Novel Approach for Assessing Wilson's Disease-
Related Hepatic Steatosis
Version: 1 Date: 11 Mar 2025
Reviewer:  Ioan Sporea
Reviewer's report:
Very interesting paper, because the cohort of patients with this quite rare disease is very large.
To use NIT for fat assessment in such disease is very important for practice, maybe including the
screening of such rare disease. But the paper have one main concern: using a semi-quantitative
measurement like Hamaguchi score for steatosis quantification like a comparative method. MRI-
PDFF is now a substitutive for liver biopsy and maybe this is the ideal non-invasive method for
this comparison. Otherwise the paper is good, with good cohort of patients, with inter and intra-
observers variability. Only one mistake in the abstract (please correct!)
Review for 10.1186/s12876-025-03928-6 (2025)

Title: Ultrasound-Derived Fat Fraction: A Novel Approach for Assessing Wilson's Disease-
Related Hepatic Steatosis
Version: 1 Date: 11 Mar 2025
Reviewer's report:
This study aimed to evaluate the clinical utility and measurement consistency of ultrasound-
derived fat fraction (UDFF) in assessing hepatic steatosis in patients with Wilson’s disease
(WD).
While the study explores an important topic and provides interesting insights into the application
of UDFF in WD, the use of the Hamaguchi score (a qualitative and operator-dependent
method with limited reproducibility) as the reference standard for diagnosing hepatic steatosis
is unacceptable.
Review for 10.1186/s12876-025-04034-3 (2025)

Title: Gastric cancer risk after Helicobacter pylori eradication in gastritis and peptic ulcer: a
retrospective cohort study in Japan
Version: 1 Date: 20 Feb 2025
Reviewer's report:
General:
In this article, authors aimed to investigate differences in gastric cancer risk among patients
with gastritis, gastric ulcer, duodenal ulcer, and gastric ulcer and duodenal ulcer after H. pylori
eradication. Authors showed that patients with H. pylori–associated gastritis and gastric ulcer
had a higher risk of gastric cancer than patients with duodenal ulcer.
Comments:
1. Patients with H. pylori–associated gastritis and gastric ulcer had a higher risk of gastric cancer
than patients with duodenal ulcer. Authors should show risk of gastric cancer for patients with
diseases by using risk of patients with gastritis alone as reference. If authors use risk of gastric
cancer for patients with diseases by using risk of patients with duodenal ulcer as reference, it
may confuse to understand. Please cut above parts of Table 2.
2. Authors concluded that endoscopic examination is required after successful eradication of H.
pylori in patients with severe baseline gastric atrophy. However, in abstract, there was no data
supported this evidence.
3. Evaluation of the difference in gastric cancer risk among patients with HPAG, GU, DU, and
gastric ulcer and duodenal ulcer after H. pylori eradication is limited. Authors should be carefully
researched. In addition, authors should show previous brief summary in Introduction.
4. Authors included patients received the first-line eradication therapy. Why did not authors
include patients received the second-line eradication therapy?
5. Authors excluded patients diagnosed with cancer within 1 year before or after index month.
Because patients with past history of gastric cancer have higher risk of gastric cancer, authors
should exclude patients with past history of gastric cancer, irrespective periods.
6. Please add p values in Table 1
7. Most of patients had no endoscopy (77~90%) (table 1). How were patients diagnosed peptic
ulcers?
8. How did authors check eradication success? Eradication rates may differ between patients
with gastric ulcer and duodenal ulcer. If so, this study may have bias.
9. This is Japanese cohort data. How about Western countries?
Review for 10.1186/s12876-025-04034-3 (2025)

Title: Gastric cancer risk after Helicobacter pylori eradication in gastritis and peptic ulcer: a
retrospective cohort study in Japan
Version: 1 Date: 20 Feb 2025
Reviewer's report:
This is a large-sized retrospective study on gastric cancer (GC) risk after Helicobacter pylori
(Hp) eradication in gastritis and peptic ulcer patients. Although it is well analyzed, several
concerns were raised as follow:
1. Conclusion, Abstract “Endoscopic examination is required after successful eradication of H.
pylori in patients with severe baseline gastric atrophy.” – Consider revising this sentence because
there is no data on atrophy score in the results.
2. Introduction - The study aim was to determine the difference in GC development between the
four groups (Hp gastritis, GU, DU, and synchronous GU with DU patients). Nonetheless, final
conclusions stick to gastric atrophy. Then, why is the GC incidence of the synchronous GU and
DU group low as sole DU group? Please mention about different characteristics between the
GU group and the synchronous GU/DU group  from the beginning.
3. Methods – In the patient demographics, data on alcohol drinking history, antithrombotics
other than aspirin, and nonsteroidal anti-inflammatory drug (NSAID) are missing. NSAID is the
most common drug that may induce peptic ulcer disease, and is more dangerous than low-dose
aspirin. So please consider adding data on the use of NSAID.
4. Results – If the authors want to mention about atrophy in the conclusions, add data on the
severity of atrophy. This is important because not all Hp-induced GU patients show permanent
atrophy after Hp eradication.
5. Discussion – Discuss about the low incidence of GC found in DU and synchronous GU and
DU patients found in this study. Mention more about the primary outcome of this study instead
of describing about other issues.
6. Discussion - If the degree of gastric atrophy is greater in patients with chronic gastritis and
GU compared with patients with DU [7, 8, 18, 19], why is the GC incidence of the synchronous
GU and DU group low? Please explain.
Review for 10.1186/s12876-025-04034-3 (2025)

Title: Gastric cancer risk after Helicobacter pylori eradication in gastritis and peptic ulcer: a
retrospective cohort study in Japan
Version: 1 Date: 21 Feb 2025
Reviewer:  Francesco di Mario
Reviewer's report:
This is an excellent work on a huge DB in a country where gastric cancer represents an important
burden for public health and where Hp infection exerts an important role as risk factor.
The investigated period (10 years) is of absolute importance to determining the trend lasting the
years after HP eradication, and the results are certainly outstanding for research in this field.
Review for 10.1186/s12876-025-04034-3 (2025)

Title: Gastric cancer risk after Helicobacter pylori eradication in gastritis and peptic ulcer: a
retrospective cohort study in Japan
Version: 1 Date: 28 Feb 2025
Reviewer's report:
This study examined the association between H. pylori-related atrophic gastritis, gastric ulcer,
and duodenal ulcer with the incidence of gastric cancer in patients who received H. pylori
eradication treatment. This relatively large cohort study confirmed previous findings that
patients with H. pylori-associated gastritis remain at an increased risk of gastric cancer, even
after eradication therapy.
Additionally, the authors evaluated the cumulative cancer risk in patients with H. pylori infection
who underwent eradication treatment. While the study relies on ICD coding for cohort selection,
which may introduce some bias, the large sample size strengthens the validity of the findings.
Few minor suggestions.
1. Please rewrite the results section in the abstract to include findings on cumulative cancer risk,
and shorten the methods section for conciseness.
2. Multiple comparisons among HPAG, GU, DU, and GDU may not be necessary. Consider
presenting only the key findings in the manuscript for better clarity.
Review for 10.1186/s12876-025-04025-4 (2025)

Title: Clinical significance of contrast extravasation on computed tomography immediately after
thermal ablation for hepatic tumors
Version: 2 Date: 29 Mar 2025
Reviewer:  Jin Chen
Reviewer's report:
The paper is well-written by authors. The paper focused on clinical significance of contrast
extravasation on computed tomography immediately after thermal ablation for hepatic tumors
and made the conclusion that "The presence of contrast extravasation on post-ablation CT
was not clinically significant. However, transarterial embolization is required if contrast
extravasation is detected in the extrahepatic arteries." The paper still has some major problems.
1# The flow chart is needed to explain the enrollment of the study.
2# Please add the standard of endpoint of ablation based on the US-guided and CT enhancement.
3# As you used US-guided ablation in most cases in this study, why do not you use contrast-
enhanced ultrasound to evaluate the efficacy and assess the complication such as bleeding
immediately after the ablation?  And the difference between these two methods. Please discuss
in detail.
4# Did the authors use the contrast-enhance CT in all patients after liver ablation? Whether
allergic reactions and contrast media nephropathy happened in the study?
5# What is the manifestation of bleeding in the study before contrast-enhance CT assessment?
Whether there are patients with intrahepatic hematoma#Most patients with intrahepatic
hematoma are caused by hepatic artery injury, and the hematoma is easy to progress and break
into the abdominal cavity leading to shock, so embolization intervention is needed as soon as
possible.
6# Can you further locate target vascular injury, artery or vein in contrast extravasation
patients with immediate postoperative CT enhancement? To further guide whether to embolize
decisions?
7# Consider whether to try ablation to stop bleeding#Thermal ablation is a method for
hemostasis.
8# Whether follow-up bleeding needs drainage and other treatment?
9# In our center, intrahepatic artery injuries, especially those associated with intrahepatic
hematoma, generally require further embolization. Hemothorax or abdominal hemorrhage
caused by phrenic artery injury generally requires active embolization or surgical intervention.
Most conservative treatment of intercostal artery injury can stop bleeding. There is some
discrepancy with the conclusion of the study, please explain further.
Review for 10.1186/s12876-025-04038-z (2025)

Title: Association between cumulative uric acid exposure and metabolic dysfunction-associated
fatty liver disease
Version: 1 Date: 10 Feb 2025
Reviewer's report:
This manuscript is interesting and used very huge data to analyse relationship  UA cumulative
exposure to incidence of MAFLD, but unfortunately the author did not explain in backgrounds
clearly about the patogenesis and why we should aware or concern about this relationship.
Please make the additional with the simple explanation to become the novelty of study.
Please revision the language and written especially in abstracts.
Please make the conclusion in abstract and manuscript similar , and included of all of the results.
Some results in contrary with previous study such as abdominal obesity and physical
examination, please check again why this happen, it is because of the wrong statistical analysis ,
or because of data imbalance such as the total subjects of male very different with woman.
there is so many statistical issue but if we looked at the results ,it is almost the same results.
could you make it more simple .
Review for 10.1186/s12876-025-04038-z (2025)

Title: Association between cumulative uric acid exposure and metabolic dysfunction-associated
fatty liver disease
Version: 2 Date: 11 Mar 2025
Reviewer's report:
The revision is somewhat better than the first version but still inadequate to be
recommended for publication. Authors neglected important reseacrh linking serum uric
acid to metabolic and inflammatory disorders such as hypertension (Postgraduate Medicine
2022;134(3): 297-302. DOI: 10.1080/00325481.2022.2039007), hepatosteatosis (Rev Assoc
Med Bras 2021;67(4):549-554. DOI: 10.1590/1806-9282.20201005.), type 2 DM (Aging Male.
2020;23(5):1098-1102. DOI: 10.1080/13685538.2019.1678126), thyroiditis (Rom. J. Intern.
Med. 2021;59(4):403-408. DOI: 10.2478/rjim-2021-0023.), metabolic syndrome (Rev Assoc
Med Bras 2019; 65(1):9-15.  DOI: 10.1590/1806-9282.65.1.9), prediabetes (Bratisl Med J
2024;125(3): 145–148. DOI: 10.4149/BLL_2023_130.),  diabetic kidney disease (Postgraduate
Medicine 2023;135(5):519-523. DOI:10.1080/00325481.2023.2214058), and even new onset
diabetes (Acta Clin Croat 2023;62:277-282. doi: 10.20471/acc.2023.62.02.04.).  Discuss please.
Other parts of the revised file is ok.
Review for 10.1186/s12876-025-04038-z (2025)

Title: Association between cumulative uric acid exposure and metabolic dysfunction-associated
fatty liver disease
Version: 2 Date: 04 May 2025
Reviewer's report:
The author has changed the manuscript based on reviewer comments that make the manuscript
more understandable and more easier to read.
Last comment please  add summary from  the results and  discussion in the conclusion  that
showed more specific of  your findings. The conclusion is too short.
Please remove the limitation of study from conclusion to discussion.
Review for 10.1186/s12876-025-04084-7 (2025)

Title: Abnormal anorectal manometric and sensory functions in patients with functional
anorectal pain
Version: 4 Date: 07 Apr 2025
Reviewer's report:
FINAL SUGGESTION. Write three papers, one for each type of FARP (proctalgia fugax,
unspecified FARP, and levator ani syndrome), or one paper with patients selected and divided
into the three FARP types
Review for 10.1186/s12876-025-04084-7 (2025)

Title: Abnormal anorectal manometric and sensory functions in patients with functional
anorectal pain
Version: 6 Date: 29 May 2025
Reviewer's report:
Thank you for making the correction and your explanations.
There are a few small grammar and spelling errors so please check for those and it is acceptable
for me.
Review for 10.1186/s12876-025-03911-1 (2025)

Title: Risk Factors Affecting the Incidence of CMV Infection in Recipients after Living Donor
Liver Transplantation
Version: 2 Date: 26 Mar 2025
Reviewer's report:
1. In a retrospective study, commenting on the incidence of CMV infection is inappropriate.
2. CMV viremia and CMV disease has been used interchangeably, however they both are
different. CMV Disease diagnosis requires histopathological diagnosis along with CMV
DNAmia.
3. All patients with viremia, whether or not they have CMV disease, were treated with
ganciclovir for three months or until two consecutive negative CMV PCRs. The treatment period
for three month is too long . What was the criteria to stop treatment after 3 months is not clear.
4.  Almost one third   of patient were on cyclosporine-based immunosuppression. was it due to
neurological complications in this group of patient.
5. The univariate regression analysis for potential risk factors for acquiring CMV infection
postoperatively revealed that a younger age of recipients was statistically significantly associated
with CMV infection, with a p-value of 0.016 and an odds ratio (OR) of 0.945 (0.902–0.989)
(95% CI). It appears that in the univariate analysis, younger age patients had lesser odds of
getting CMV infection. This significance was although lost on multivariate analysis, this point
has not been highlighted by the authors. It may be that in the presence of  cyclosporine based
immunosuppression, age doesn't matter.
6. Most prevalent risk factor for CMV infection was cyclosporine-based immunosuppression. It
is well known that degree of immunosuppression leads to reactivation of CMV posttransplant.
Given the high prevalence of postoperative infections others than CMV infection,  this might
point to the possibility of excessive immunosuppression in this group of patients.
7. There is a substantially significant relationship between CMV infection and positive CMV
IgM status of Donors. However, it would be interesting to know that how many of the
corresponding recipients had preoperative CMV IgM status positive. Also, whether, Donors
with positive preoperative CMV IgM , DNA PCR was performed or not.
Review for 10.1186/s12876-025-03911-1 (2025)

Title: Risk Factors Affecting the Incidence of CMV Infection in Recipients after Living Donor
Liver Transplantation
Version: 2 Date: 03 Apr 2025
Reviewer's report:
Major Comments
1.  The single-center design (Ain Shams University, Egypt) limits generalizability to broader
populations. Regional practices (e.g., lack of CMV prophylaxis) and a homogeneous cohort
(HCV-related ESLD) may not reflect global LT populations.
2. Retrospective Design Limitations:
- Potential selection bias and unmeasured confounders (e.g., immunosuppression trough levels,
viral load dynamics) are not addressed. A discussion on how confounders were controlled (e.g.,
multivariate adjustments) is needed.
3. The absence of CMV prophylaxis deviates from international guidelines. This critical
omission should be highlighted as a limitation, as it may explain higher infection rates compared
to studies using prophylaxis.
4. Focus on CMV IgM Over IgG:
- CMV IgG serostatus (donor/recipient mismatch) is a well-established risk factor, yet the study
focuses on IgM. Justification for prioritizing IgM (prone to false positives) and its clinical
relevance post-LT requires elaboration.
5. While CMV infection precedes rejection, causality is not proven. The bidirectional
relationship (CMV reactivation due to rejection treatment vs. CMV-triggered rejection) needs
nuanced discussion.
Minor Comments
1.  Clarify the rationale for test selection (e.g., Mann-Whitney vs. t-test). Borderline significant
p-values (e.g., MELD score: p=0.041) should be interpreted cautiously to avoid overstatement.
2. Differentiate "CMV infection" (viremia) from "CMV disease" (symptomatic) consistently, as
outcomes and management differ.
3. Tables 1–3 have alignment issues (e.g., merged cells, inconsistent spacing). Streamlining
these would enhance readability.
4. Figures 1–3 are referenced but not sufficiently described in the text. A brief summary of key
findings (e.g., timing of infections in Figure 3) would strengthen the results section.
Limitations Not Acknowledged
1. The study protocol’s omission of CMV prophylaxis (unusual in modern LT care) likely
elevates infection rates, skewing comparisons with other studies.
2. Results may not apply to non-HCV ESLD etiologies (e.g., NASH, ALD) or regions with
differing donor/recipient CMV serostatus profiles.
3. IgM Reliability:
- Preoperative CMV IgM was confirmed by PCR only in positive cases. False negatives/positives
in IgM testing could bias results; this limitation is unaddressed.
4.  Follow-up duration ranged widely (12–84 months). Late CMV infections or delayed rejection
events may be underrepresented.
Review for 10.1186/s12876-025-04083-8 (2025)

Title: The disease course in microscopic colitis may be influenced by hormonal factors
Version: 2 Date: 05 Feb 2025
Reviewer's report:
Main critique is around the contraceptive data. Not sure it makes physiologic sense to combine
all contraceptives into one group, though I understand it makes statistical sense. IUDs, for
example, have very little systemic effects in theory. Also this would benefit from description of
what the "other" contraceptives were to ensure they were hormonal based methods.
Not sure what authors mean in discussion "Since the age at study inclusion was higher in patients
that had bilateral oophorectomy the longer duration and more treatment rounds could very
well be explained by this fact. " In the results, authors state "Even though the age at inclusion
was higher; 75 compared to 71 years (in line with the longer disease duration), respectively
(p=0.001)., the age at diagnosis was the same in both groups; 60 years." These sentences seem
to be contradictory? Please reword/rewrite.
Overall an interesting paper. Some rewording would be beneficial to help reader more easily
understand.
Review for 10.1186/s12876-025-04083-8 (2025)

Title: The disease course in microscopic colitis may be influenced by hormonal factors
Version: 2 Date: 13 Apr 2025
Reviewer:  Sara Ghoneim
Reviewer's report:
Thank you for submitting your manuscript. I would like to commend you on a well-written,
clearly structured, and scientifically sound paper. The topic is both timely and relevant, and the
manuscript is well-supported by current literature and presented with clarity. I have no major
concerns and believe it makes a valuable contribution to the field.
Review for 10.1186/s12876-025-03696-3 (2025)

Title: Title: Prospective randomized, placebo-controlled study: Role of branched-chain amino
acids infusion as adjunct therapy post-liver surgery for patients in the intensive care unit
Version: 3 Date: 01 Sep 2024
Reviewer:  Ahmed Hammad
Reviewer's report:
1-please change name of groups to higher BCAA group,and classic(or lower) BCAA group
2-Please diagrams for better elaboration of results( at least 2 diagrams)
Review for 10.1186/s12876-025-03696-3 (2025)

Title: Title: Prospective randomized, placebo-controlled study: Role of branched-chain amino
acids infusion as adjunct therapy post-liver surgery for patients in the intensive care unit
Version: 5 Date: 17 Dec 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
No - manuscript has some fundamental flaw(s)
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: Although the authors have adequately addressed some of the
comments and clarified the manuscript, the main concerns regarding the validity and application
of the findings of this manuscript (loss of follow-up and basal differences that may impact
outcomes) still remain.
REQUESTED REVISIONS:
The authors have clarified several points of this manuscript, but there are still two main questions
that impact the validity and application of the findings:
It is understandable that patients are discharged early to other centers and, although possible,
that follow-up cannot be performed in other centers. However, this is a major bias of the study
since patients who are not discharged may be sicker than those discharged, and thus the authors
are only analyzing the worst patients (at the end of the follow-up, only 10 patients remained in
the placebo arm and six patients in the BCAA arm). Considering the nature of the outcomes, it
is unlikely that a reliable sensitivity or intention-to-treat analysis could be performed.
If the basal analysis was performed before the administration of BCAA, there is a relevant
baseline difference in several liver enzyme tests, such as ALT (albeit non significant). Apart
from providing an explanation for this finding, there is the risk of having included sicker patients
in the placebo group. Thus, the most appropriate marker would be a proportional value according
to baseline analysis or the reduction from baseline as the best marker.
In addition, the SOFA score was worse in the BCAA group, not “improved,” and thus patients
with BCAA did worse, despite the reliability of this comparison considering the low number
of patients in each group.
Review for 10.1186/s12876-025-03696-3 (2025)

Title: Title: Prospective randomized, placebo-controlled study: Role of branched-chain amino
acids infusion as adjunct therapy post-liver surgery for patients in the intensive care unit
Version: 5 Date: 13 Jan 2025
Reviewer:  Ahmed Hammad
Reviewer's report:
And additional work with multi center study  in the future may a good idea to reduce  limitations
Review for 10.1186/s12876-025-03696-3 (2025)

Title: Title: Prospective randomized, placebo-controlled study: Role of branched-chain amino
acids infusion as adjunct therapy post-liver surgery for patients in the intensive care unit
Version: 6 Date: 28 Jan 2025
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
No - manuscript has some fundamental flaw(s)
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: The authors have addressed two of the three main concerns raised
in the previous review of the manuscript. However, there are still doubts regarding one of the
main results, which is the reduction in transaminase and bilirubin levels.
REQUESTED REVISIONS:
Given the relevant difference in baseline values (albeit non-significant), the authors cannot
analyze the raw values without any adjustment. Instead, they could analyze the percentage of
reduction or a proportion. Indeed, AST transaminase values were reduced by 60% in the placebo
group and only 70% in the treatment group. Thus, although the impact on this biomarker may be
real, the authors must present the results in a way that addresses the prior baseline differences,
even if the result is non-significant. Additionally, the difference in PT at day 7 is very small
(12.5 (11–23.5) vs. 12.9 (11–27.9)) to justify a statistically significant difference.
Review for 10.1186/s12876-025-03696-3 (2025)

Title: Title: Prospective randomized, placebo-controlled study: Role of branched-chain amino
acids infusion as adjunct therapy post-liver surgery for patients in the intensive care unit
Version: 7 Date: 03 Feb 2025
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
No - manuscript has some fundamental flaw(s)
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: The authors have addressed the comments that I raised, although
some concerns about potential bias and the validity of the manuscript still remain.
REQUESTED REVISIONS:
The authors have included the reduction in liver enzyme levels, as well as bilirubin and PT, in
the text, but it should also be indicated whether these changes are not statistically significant (if
this is the case, as it seems from the data).
Review for 10.1186/s12876-025-04053-0 (2025)

Title: Feasibility, effectiveness, and safety of simultaneous side-by-side deployment of
uncovered self-expandable metal stents for malignant hilar biliary obstruction: a retrospective
single- center study
Version: 0 Date: 30 Aug 2024
Reviewer:  Zhaohui Tang
Reviewer's report:
By observing the feasibility, effectiveness and safety indexes of simultaneous side-by-side
deployment of uncovered self-expandable metal stents, the paper concludes that this technique is
a promising choice. The author made a good choice of evaluation indicators for security, which
solved most of my doubts. I think there are still the following things that need to be revised
before publication:
1.Mere retrospective observation is difficult to fully explain the problem. The authors should
consider whether there are differences between the indicators of complementary simultaneous
and traditional side-by-side deployment
2.Authors should consider describing the procedure in more detail, highlighting some of the
technical points in order to provide a single-center experience for repeating and optimizing the
technique
3.Some references are outdated and authors should consider updating them
Review for 10.1186/s12876-025-04053-0 (2025)

Title: Feasibility, effectiveness, and safety of simultaneous side-by-side deployment of
uncovered self-expandable metal stents for malignant hilar biliary obstruction: a retrospective
single- center study
Version: 0 Date: 03 Sep 2024
Reviewer:  Irfan Koruk
Reviewer's report:
This manuscript will add new horizons for the readers
Review for 10.1186/s12876-025-04053-0 (2025)

Title: Feasibility, effectiveness, and safety of simultaneous side-by-side deployment of
uncovered self-expandable metal stents for malignant hilar biliary obstruction: a retrospective
single- center study
Version: 0 Date: 11 Sep 2024
Reviewer's report:
This retrospective single centre case series of 15 patients found a high clinical and technical
success for biliary drainage of bismuth III and IV hilar malignant strictures using the 5.9Fr
Hanarostent.
The challenge of bilateral drainage was explained.
More details would have been valuable regarding the following:
-Case selection, including other hilar strictures during this time period that did not undergo
biliary drainage under this technique. Eg. evident of single lobe atrophy
- the specific techniques of simultaneous double stent deploy would be valuable, given that
technical challenges remain a primary reason bilateral drainage is often not attempted.
Review for 10.1186/s12876-025-04053-0 (2025)

Title: Feasibility, effectiveness, and safety of simultaneous side-by-side deployment of
uncovered self-expandable metal stents for malignant hilar biliary obstruction: a retrospective
single- center study
Version: 1 Date: 14 Jan 2025
Reviewer:  Zhaohui Tang
Reviewer's report:
This paper presents a retrospective, single-center study investigating the feasibility,
effectiveness, and safety of a novel endoscopic approach—simultaneous side-by-side
deployment of uncovered self-expandable metal stents (SEMS)—for the palliation of malignant
hilar biliary obstruction. The study reports excellent technical (100%) and clinical (100%)
success rates, with a relatively low complication rate (13.3%) and promising stent patency.
Additionally, the authors show that combining this approach with the percutaneous-endoscopic
rendezvous technique can be particularly advantageous in challenging anatomical situations.
Overall, the findings suggest that simultaneous side-by-side SEMS placement is a viable and
safe option for biliary drainage in unresectable malignant hilar biliary obstruction.
However, there are still some issues to be addressed before it’s suitable for publication:
1.With only 15 patients and data collected at a single institution, the generalizability of this
study’s findings may be limited.
2.The paper does not compare the proposed technique directly against other established
strategies (e.g., unilateral stenting, sequential stent-in-stent placement), making it difficult to
quantify the benefits over conventional approaches.
3.The retrospective design, along with relatively short and varied patient follow-up durations,
may not fully capture long-term complications or outcomes, thus calling for further prospective
validation.
Review for 10.1186/s12876-025-04053-0 (2025)

Title: Feasibility, effectiveness, and safety of simultaneous side-by-side deployment of
uncovered self-expandable metal stents for malignant hilar biliary obstruction: a retrospective
single- center study
Version: 1 Date: 14 Apr 2025
Reviewer's report:
The point by point response is satisfactory and all the necessary additions have been made.
I recommend an additional table of summary of all previous studies of bilateral hilar drainage.
This will help the reader for a quick comparative review.