JerMa88/BMC_Gastroenterology_Peer_Reviews huggingface dataset:
Review for 10.1186/s12876-025-03902-2 (2025)

Title: The prognostic significance of tumor-specific growth factor in colorectal cancer: An
observation study
Version: 3 Date: 06 Apr 2025
Reviewer's report:
The revised manuscript presents a well-structured and relevant retrospective cohort study
assessing the prognostic value of serum tumor-specific growth factor (TSGF) in patients with
stage I–III colorectal cancer. The authors have adequately addressed the key methodological
and interpretative concerns raised in the initial round of review.
Strengths of the manuscript:
The study is based on a large patient cohort (n=2223), which increases the statistical power of
the analysis.
The inclusion of TSGF as a prognostic biomarker is clinically relevant and offers potential
utility, especially in settings where low-cost and easily accessible markers are essential.
The authors have clarified the methodology, added essential details regarding ethics approval,
assay technique, and statistical analysis, and restructured the discussion to better contextualize
findings within the existing literature.
Suggestions for improvement:
Introduction and Background: Consider briefly mentioning the current limitations of CEA and
CA19-9 as prognostic markers earlier in the introduction to better justify the need for exploring
TSGF.
Results: It may be helpful to include a clearer summary paragraph at the end of the Results
section to highlight the main findings before moving into the Discussion.
Clinical relevance: While the clinical utility of TSGF is mentioned in the Discussion, further
elaboration on how it could be practically integrated into existing CRC risk stratification or
follow-up protocols would strengthen the impact of the study.
Language: Although the manuscript is mostly well-written, a final proofread by a native English
speaker or professional editing service is recommended to improve fluency and polish.
Conclusion:
The authors have responded thoughtfully and thoroughly to previous reviewer comments. The
revised version substantially improves clarity, methodological transparency, and the framing
of results. With minor editorial adjustments and clarification of clinical implications, the
manuscript will be suitable for publication.
Review for 10.1186/s12876-025-03893-0 (2025)

Title: Safety of Early Feeding after Endoscopic Ultrasound-Guided Fine Needle Biopsy: A
Retrospective Study.
Version: 0 Date: 09 Mar 2025
Reviewer's report:
Thank you for the opportunity to review the original submission by Lee et al., titled “Efficacy and
safety of early feeding after endoscopic ultrasound-guided fine needle aspiration: A retrospective
study.” This study investigates the safety of early feeding after EUS-FNA.
Review for 10.1186/s12876-025-03893-0 (2025)

Title: Safety of Early Feeding after Endoscopic Ultrasound-Guided Fine Needle Biopsy: A
Retrospective Study.
Version: 0 Date: 16 Mar 2025
Reviewer's report:
The study investigates the safety of early feeding after EUS-FNA, which is a relevant and
clinically significant topic. However, several critical methodological concerns need to be
addressed before the findings can be considered reliable.
Major Comments
1. The title mentions "efficacy," but is efficacy actually evaluated in the study? The introduction
suggests potential benefits such as shortened hospital stay and improved nutrition, yet it is
unclear how "efficacy" is specifically assessed. If efficacy is not explicitly measured, we
recommend revising the title for accuracy.
2. The study includes only 110 patients, which is relatively small given the low incidence
of complications associated with EUS-FNA. In fact, only three complications were observed
across both groups. This raises a significant concern regarding statistical power. A proper
power analysis should be conducted to determine whether the sample size is sufficient to detect
clinically meaningful differences.
3. This study does not clearly define what constitutes a complication of EUS-FNA. While the
text mentions that some patients developed pancreatitis as a complication, it remains unclear
whether other known complications of EUS-FNA, such as bleeding, perforation, or infection,
occurred. Furthermore, the severity of complications should also be reported. Providing a precise
definition of complications is essential for ensuring the reproducibility and clinical relevance
of the results.
4. The basis for assigning patients to the Early Feeding group and the 24-h Fasting group is
not clearly stated. Were the patients randomly assigned, or were there specific inclusion criteria
for each group? Furthermore, did any patients undergo additional endoscopic procedures on the
same day, such as ERCP? The criteria for group allocation are critically important in ensuring
the validity of the comparisons made in this study.
5. The most frequent number of needle passes in this study is reported as five, which is relatively
high compared to previous studies. Studies should clearly describe how the number of needle
passes was determined, particularly with regard to the use of Macroscopic on-site evaluation
(MOSE) or Rapid on-site evaluation (ROSE).
Review for 10.1186/s12876-025-03893-0 (2025)

Title: Safety of Early Feeding after Endoscopic Ultrasound-Guided Fine Needle Biopsy: A
Retrospective Study.
Version: 1 Date: 31 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory
Review for 10.1186/s12876-025-03885-0 (2025)

Title: A randomized, controlled trial of oral sulfate solution versus polyethylene glycol for
bowel preparation for colonoscopy
Version: 1 Date: 10 Mar 2025
Reviewer's report:
The study addresses a clinically significant issue in gastroenterology, optimal bowel preparation
by comparing a newly approved agent (OSS) with a widely used standard (PEG). However,
there are serious corrections need to be followed-up or mentioned as limitations or included in
the future directions:
• Although the study was single-blinded, endoscopists assessing images may have a limit
knowledge of the preparation utilized. Additional measures, such as double-blinding or
automated BBPS scoring, may enhance objectivity.
• The study lacks pre- and post-preparation electrolyte evaluations, which are critical for
determining the safety of OSS. A future research needs to involve electrolyte monitoring.
• The study mainly focuses on immediate outcomes. The patients should be followed-up post-
colonoscopy to evaluate any delayed adverse effects
• As a single-center study was carried out in Beijing, the findings may not be generalizable
to different populations with different dietary habits and healthcare access. A multicenter trial
would increase external validity.
• Although tolerability is mentioned, more structured information on patient-reported
experiences such as validated questionnaires about taste, bloating, nausea) could offer a more
patient-centric viewpoint.
• While comparative studies on OSS and PEG are mentioned, a more critical appraisal of
conflicting results from other trials would provide a balanced perspective.
Review for 10.1186/s12876-025-03885-0 (2025)

Title: A randomized, controlled trial of oral sulfate solution versus polyethylene glycol for
bowel preparation for colonoscopy
Version: 1 Date: 16 Mar 2025
Reviewer's report:
Dear Authors,
Thank you for submitting your manuscript to BMC Gastroenterology. Your study on comparing
the efficacy, safety, and tolerability of oral sulfate solution (OSS) and polyethylene glycol (PEG)
for bowel preparation before colonoscopy is of great interest and clinical relevance.
However, before we can consider accepting your manuscript, several issues need to be
addressed:
Research Design: Please provide more details about the randomization process and blinding
procedures.
Results: Consider including more detailed information about the distribution of BBPS scores,
such as mean and standard deviation values.
Discussion: Focus more on the clinical implications of your findings and how they can influence
clinical practice.
Limitations: Acknowledge and discuss the lack of blood electrolyte tests before and after bowel
preparation.
Language: Correct minor language issues to improve readability.
Once these revisions are made, your manuscript will be more suitable for publication in BMC
Gastroenterology.
Sincerely,
Dr shifu hu
Reviewer, BMC Gastroenterology
Review for 10.1186/s12876-025-03877-0 (2025)

Title: Associations between non-insulin-based insulin resistance surrogate markers and liver-
related outcomes in metabolic dysfunction-associated steatotic liver disease: a nationwide cohort
study in South Korea
Version: 3 Date: 24 Feb 2025
Reviewer's report:
The study investigated the link between insulin resistance (IR) surrogate markers and liver-
related outcomes in 66,334 MASLD patients over 9.4 years. Using the TyG index, TG/HDL
ratio, and METS - IR as IR markers, it was found that lower levels of these markers were
associated with a higher risk of liver-related outcomes. The markers increased from F0 - F2 and
decreased from F3 - F4 in liver fibrosis. This indicates the importance of monitoring metabolic
changes in MASLD patients. Nevertheless, certain limitations in this study need to be noted.
1. Insufficient sample size in the liver biopsy cohort
The number of patients with advanced fibrosis (F3 - F4) in the liver biopsy cohort (n = 361) is
relatively small (n = 59), which may reduce the statistical power. It is recommended to expand
the sample size of the liver biopsy cohort or combine data from multiple centers to improve the
reliability of the results.
2. Inadequate explanation of biological mechanisms
The hypotheses proposed in the discussion (such as liver fibrosis leading to a decline in
metabolic parameters) lack direct evidence (e.g., correlation analysis between liver function
indicators and IR markers). It is necessary to supplement the correlation analysis between liver
function indicators (such as albumin, and coagulation function) and IR markers in the liver
biopsy cohort to support the mechanistic hypotheses.
3. Accuracy of disease diagnosis
The use of non-invasive biochemical scores (fatty liver index # 30) to define fatty liver disease
may lead to misdiagnosis compared with liver biopsy or imaging examinations, affecting the
accuracy of the research sample and the reliability of the research conclusions.
4. Assessment of liver-related outcomes
The primary outcomes only include hepatocellular carcinoma and decompensated liver cirrhosis,
without covering other important liver-related outcomes, such as liver failure and the need
for liver transplantation. This may not comprehensively reflect the severity and impact of the
disease.
5. Insufficient subgroup analysisThere is a lack of in-depth analysis of subgroups based on
different genders, ages, and disease severities. This may mask the differences in the relationships
between IR surrogate markers and liver-related outcomes among different subgroups.
6. Impact of drug factors
The study did not consider the effects of drugs that affect metabolism or liver function (such as
statins, and antidiabetic drugs) on IR surrogate markers and liver-related outcomes.
Review for 10.1186/s12876-025-03877-0 (2025)

Title: Associations between non-insulin-based insulin resistance surrogate markers and liver-
related outcomes in metabolic dysfunction-associated steatotic liver disease: a nationwide cohort
study in South Korea
Version: 3 Date: 05 Mar 2025
Reviewer:  Kyoko Sakai
Reviewer's report:
This was an interesting study based on valuable data. I have commented on the arguments for
the conclusions .
Review for 10.1186/s12876-025-03877-0 (2025)

Title: Associations between non-insulin-based insulin resistance surrogate markers and liver-
related outcomes in metabolic dysfunction-associated steatotic liver disease: a nationwide cohort
study in South Korea
Version: 3 Date: 07 Mar 2025
Reviewer's report:
The risks between MASLD and IR has been discussed a lot and well recognized, the novelty of
this paper is low and did not provide any new insight in this fie
1.a study using HOMA-IR and METS-IR as predictors of NAFLD prevalence indicated that both
markers demonstrated high predictive accuracy (HOMA-IR area under the receiver operating
characteristic [AUROC] 0.831, METS-IR AUROC 0.824).[15] The TyG index and TG/HDL
ratio demonstrated similar results (HOMA-IR AUROC 0.782, TyG index AUROC 0.738, TG/
HDL ratio AUROC 0.738), Therefore, did METS-IR presented statistic higher AUROC?
2. This study focus on the change of TyG index, TG/HDL ratio and METS-IR and prognosis ofd
MASLD, HOWEVER, it did not reveal the interaction effects of steatosis changes or fibrosis
regression.
3. It did not perform a regular monitoring of IR markers, therefore the change of IR markers in
such a long period  between 1 January 2013 and 31 December 2019 did not truly reveal their
relationship.
Review for 10.1186/s12876-025-03877-0 (2025)

Title: Associations between non-insulin-based insulin resistance surrogate markers and liver-
related outcomes in metabolic dysfunction-associated steatotic liver disease: a nationwide cohort
study in South Korea
Version: 5 Date: 19 Mar 2025
Reviewer's report:
The author has meticulously revised each of the problems in the paper.
Review for 10.1186/s12876-025-03877-0 (2025)

Title: Associations between non-insulin-based insulin resistance surrogate markers and liver-
related outcomes in metabolic dysfunction-associated steatotic liver disease: a nationwide cohort
study in South Korea
Version: 6 Date: 30 Mar 2025
Reviewer:  Kyoko Sakai
Reviewer's report:
Thank you for the opportunity to peer review this interesting article.
The authors have provided scientifically valid explanations in their peer review comments and
have revised the paper appropriately.
I therefore consider the article to be worthy of publication.
Review for 10.1186/s12876-025-03910-2 (2025)

Title: Effectiveness and safety evaluation of terlipressin in the treatment of intestinal paralysis
in end-stage liver disease
Version: 0 Date: 24 Feb 2025
Reviewer:  Asem Elfert
Reviewer's report:
It is not clear what type of intestinal obstruction is included and what is excluded. Jumping into
conclusions is evident. Overestimating safety in this vulnerable group of patients has a huge
threat.
Review for 10.1186/s12876-025-03910-2 (2025)

Title: Effectiveness and safety evaluation of terlipressin in the treatment of intestinal paralysis
in end-stage liver disease
Version: 0 Date: 25 Feb 2025
Reviewer's report:
This is a non-controlled study on whether terlipressin is effective and safe in patients with
ESLD with intestinal non-mechanical bowel obstruction. The authors describe two parts: one
retrospective and the other prospective, but the methodology and treatment arm assignment are
difficult to disentangle. Main issues:
1. The article refers to dynamic intestinal obstruction. I strongly believe the authors actually
mean adynamic obstruction or intestinal paralysis which makes sense in the context. Dynamic
intestinal obstruction is mechanical and generally requires surgery.
2. If I understand correctly the methodology describes a prospective observational study in which
assignment to intervention (i.e. terlipressin) happened according to patient choice ("Patients
were assigned to either the terlipressin group or the conventional treatment group according to
their wishes."). This significantly reduces any validity for the findings
3. Inclusion/exclusion criteria and outcomes are unclear and pose significant risk of bias
Review for 10.1186/s12876-025-03910-2 (2025)

Title: Effectiveness and safety evaluation of terlipressin in the treatment of intestinal paralysis
in end-stage liver disease
Version: 0 Date: 06 Mar 2025
Reviewer's report:
The application of terlipressin for intestinal obstruction represents a novel approach,
highlighting its potential therapeutic innovation.
This is a highly intriguing topic. I have noted several points of concern, which I will outline
in the text.
Review for 10.1186/s12876-025-03910-2 (2025)

Title: Effectiveness and safety evaluation of terlipressin in the treatment of intestinal paralysis
in end-stage liver disease
Version: 1 Date: 27 Mar 2025
Reviewer's report:
The retrospectively and exploratorily reviewed cases represent reliable data, suggesting the
potential efficacy of terlipressin for intestinal paralysis.
However, in the prospective interventional study, treatment interventions were administered
based on patient choice, introducing a possible bias that cannot be overlooked and potentially
undermining the validity of the results.
If the study is to be positioned as an interventional trial, the design must be reconsidered using
a methodology that minimizes bias.
Review for 10.1186/s12876-025-03852-9 (2025)

Title: Autoimmune Liver Diseases, Autoantibodies, and Their Associations and liver disease
outcome, a single- center Retrospective Study heir Associations and liver disease outcome, a
single-center Retrospective Study
Version: 6 Date: 16 Jan 2025
Reviewer's report:
the manuscript is well written . results and discussion responds perfectly to objectives. the
subject although not innovative, was well carried out
Review for 10.1186/s12876-025-03852-9 (2025)

Title: Autoimmune Liver Diseases, Autoantibodies, and Their Associations and liver disease
outcome, a single- center Retrospective Study heir Associations and liver disease outcome, a
single-center Retrospective Study
Version: 6 Date: 19 Jan 2025
Reviewer:  Ilkay Ergenc
Reviewer's report:
Dear Authors,
Thank you for your efforts in conducting this study and preparing the manuscript.
While the study provides additional evidence to the existing literature, it does not present any
novel findings. The manuscript is overly lengthy, which affects its clarity and impact. I would
recommend the following improvements:
Title: Consider revising the title to make it shorter and more focused, highlighting the key
message of the study.
Introduction: Streamline the introduction by focusing primarily on the knowledge gap in the
literature and clearly stating what your study aims to contribute.
Results: The results section is unnecessarily long, with repetitive information presented in both
the text and tables/figures. I suggest summarizing only the key findings in the text and referring
readers to the tables/figures for additional details.
Discussion: The discussion section is overly extensive and includes a considerable amount of
literature summary that is beyond the scope of this study. I recommend focusing on interpreting
your findings in the context of the existing literature and their implications, while keeping the
discussion concise and relevant.
Thank you for your hard work, and I hope these suggestions help improve the manuscript.
Review for 10.1186/s12876-025-03852-9 (2025)

Title: Autoimmune Liver Diseases, Autoantibodies, and Their Associations and liver disease
outcome, a single- center Retrospective Study heir Associations and liver disease outcome, a
single-center Retrospective Study
Version: 6 Date: 06 Feb 2025
Reviewer's report:
Mohammad et al. investigated the association between autoimmune liver disease (AILD),
autoantibodies, systemic rheumatic diseases, and prognosis. However, several concerns need to
be addressed in this article:
1.The sections on “Introduction” and “Discussion” are too long. These sections need to be more
concise.
2.A flow chart of this study is recommended.
3.It is unclear whether the authors used statistical software. If they did, it should be indicated
in the “Methods” section.
4.It is unclear whether the authors used a two-tailed P-value in this study.
5.In Table 4, the authors compared liver function indicators in AILD patients. They noted that
“Liver function data were extracted from laboratory tests taken close to the data collection
period.” However, liver function results may be influenced by treatment. Therefore, more
detailed treatment information for the included AILD patients should be provided.
6.Many studies have revealed that genetic factors may be associated with autoimmune diseases.
It is recommended that the authors discuss the association between AILD and systemic
rheumatic diseases from a genetic perspective.
Review for 10.1186/s12876-025-03852-9 (2025)

Title: Autoimmune Liver Diseases, Autoantibodies, and Their Associations and liver disease
outcome, a single- center Retrospective Study heir Associations and liver disease outcome, a
single-center Retrospective Study
Version: 7 Date: 03 Mar 2025
Reviewer's report:
The authors have taken into consideration all the comments made by the various reviewers, in
my opinion the article can be accepted in its current form.
Review for 10.1186/s12876-025-03852-9 (2025)

Title: Autoimmune Liver Diseases, Autoantibodies, and Their Associations and liver disease
outcome, a single- center Retrospective Study heir Associations and liver disease outcome, a
single-center Retrospective Study
Version: 7 Date: 02 Apr 2025
Reviewer's report:
Authors have resolved all problems. There were no new comments.
Review for 10.1186/s12876-025-03896-x (2025)

Title: Association of Periampullary Diverticulum Types on Post-ERCP Hyperamylasemia: A
Retrospective Observational Study
Version: 3 Date: 07 Feb 2025
Reviewer's report:
This is a paper that examined the incidence of post-ERCP pancreatitis due to diverticula of the
papilla. This is not a new topic, and it is a retrospective study. The number of cases with and
without the papilla is different, and the ERCP procedure content (especially EST) and procedure
time are unknown.
Review for 10.1186/s12876-025-03896-x (2025)

Title: Association of Periampullary Diverticulum Types on Post-ERCP Hyperamylasemia: A
Retrospective Observational Study
Version: 3 Date: 18 Feb 2025
Reviewer's report:
Review Akca et al February 2025
This is a good study.  I have some suggestions..
General comments
(1) Data about the appropriate classification of PAD were derived from pictures which were
subsequently scrutinized by the investigators.  The authors seem to be quite certain about the
appropriate classification of each of the patients.  This seems a little surprising.  It would be hard
to be sure based on a single photograph.  Could the authors comment?
(2) A diagram/cartoon picture would be useful in which the classification system, which would
not be familiar to all readers of the journal, is explained pictorially.  If possible coloured
photographs of an example of each type of PAD type would be useful as well.
(3) The rate of PAD seems quite high.  Is the centre where the study was conducted a referral
centre for other ERCPists?  Could this have led to a higher than expected rate of PAD in the
cohort described?
(4) The discussion rambles on.  The first half could be reduced to a few sentences and the second
last paragraph of the second last page of text could be omitted.
(5) The explanation of the most important finding of the study (the association of PAD type
IIb periampullary diverticula with a reduced post ERCP hyperamylasaemia rate is reasonable
although one would have thought that the type III ampullae there would also have a “good
position of the ampulla entrance” and “better axial alignment of the common bile duct” compared
to those in the I and IIa groups.  Indeed some IIB cases depending on which part of the
diverticular rim the ampulla was, may not have had such a great position for cannulation.
Perhaps it is the sphincter dysfunction that is critical here in explaining why IIBs were easier/
less prone to complications than PAD III cases.  It might be better to use a different terminology
depending on what the authors are trying to say.  Perhaps the word “patulous” would be better
or it might be that the most distal few mms of the bile duct are straighter than is the case in the
standard non PAD/PAD III cases.  In this sense, III cases are probably more akin to standard
non PAD cases.    Certainly, the discussion about this should be more cogent and expansive.
(6) Maybe I missed it but what was the rate of post ERCP pancreatiits in each of the subgroups?
Minor comments
(1) Title page – it might be better to re phrase the title “Association of ….” The word impact
implies causation which is presumptuous in a retrospective study of this nature
(2) Introduction – I would omit “Therefore” – third last line
(3) Introduction – the last sentence does not make sense and should be revised (again without
the use of the word “impact”)
(4) Material and methods – why were outpatients excluded?  And how many were excluded for
this reason?
(5) Materials and methods – why was the use of PD stents avoided when it has been shown that
they reduce post ERCP pancreatitis?
Review for 10.1186/s12876-025-03896-x (2025)

Title: Association of Periampullary Diverticulum Types on Post-ERCP Hyperamylasemia: A
Retrospective Observational Study
Version: 5 Date: 27 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory
Review for 10.1186/s12876-025-03896-x (2025)

Title: Association of Periampullary Diverticulum Types on Post-ERCP Hyperamylasemia: A
Retrospective Observational Study
Version: 5 Date: 28 Mar 2025
Reviewer's report:
This paper has been revised for the better. However, because the rates of CBD stones in patients
with and without PAD are different, I recommend that a propensity score matched analysis be
performed on this as well.
Review for 10.1186/s12876-025-03896-x (2025)

Title: Association of Periampullary Diverticulum Types on Post-ERCP Hyperamylasemia: A
Retrospective Observational Study
Version: 6 Date: 07 Apr 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory
Review for 10.1186/s12876-025-03886-z (2025)

Title: The relationship between the eradication of Helicobacter pylori and the occurrence of
stomach cancer: an updated meta-analysis and systemic review
Version: 4 Date: 25 Mar 2025
Reviewer's report:
Overall, the authors have provided detailed answers to my questions and made the corresponding
revisions. In my opinion, the minor revisions that are still needed should include considering
the reduction of the article's length where appropriate (possible methods include simplifying
sentence structures and word choices, as well as abbreviating results already presented in figures
or tables) to improve readability for the readers, even though the journal to which the manuscript
is submitted is an open-access journal.
Review for 10.1186/s12876-025-03886-z (2025)

Title: The relationship between the eradication of Helicobacter pylori and the occurrence of
stomach cancer: an updated meta-analysis and systemic review
Version: 4 Date: 25 Mar 2025
Reviewer's report:
Thank you to the author for providing a positive response to the questions I raised.
Two minor issues necessitate further refinement:
1. The term "Helicobacter pylori" in the title and keywords of the manuscript should be
italicized. 2. In the last paragraph of the statistical analysis section, please elucidate the precise
interpretations of NNT and ACR.
Review for 10.1186/s12876-025-03887-y (2025)

Title: Independent effects of the hemoglobin-to-red blood cell distribution width ratio on 180-
day mortality in critically ill patients with gastrointestinal bleeding: analysis from the MIMIC-
IV database
Version: 4 Date: 22 Feb 2025
Reviewer:  Toshiya Mitsunaga
Reviewer's report:
Thank you for giving the chance to review this research. It is very interesting to consider the
prediction of death by HRR, and I think that it may be possible to deepen our understanding
of the severity and pathology of severely ill patients in particular. In that respect, I believe that
this is an important study that evaluated the relationship between severe GIB patients and HRR.
However, I would like to point out some corrections before publishing.
[Major points]
1. The authors commented that the purpose of their study was to 'examine critically ill patients,'
but the inclusion criteria did not include any items indicating the severity of the condition, so
what kind of patients were they. Authors have to comment of severity score in inclusion criteria
(SOFA, APACH# et).
2. The authors state in their inclusion criteria that they had 'diagnosed GIB' but do not describe
how they made the diagnosis of GIB. It is better for the authors to comment on this point.
3. Patients with missing HRR information were excluded from this study, but cases with missing
values need to be treated appropriately and, in some cases, data should be repaired using multiple
imputation. The authors might want to comment on this point.
4. The authors only had  heart rate and SpO2 as vital sign information; however, studies on
prognostic assessment may benefit from including information on level of consciousness, blood
pressure, and temperature. Moreover, CRP should be included as laboratory data.
5. This is biggest problem that there was no comment of sample size calculation.
Review for 10.1186/s12876-025-03887-y (2025)

Title: Independent effects of the hemoglobin-to-red blood cell distribution width ratio on 180-
day mortality in critically ill patients with gastrointestinal bleeding: analysis from the MIMIC-
IV database
Version: 4 Date: 22 Feb 2025
Reviewer:  Takahiro Masuda
Reviewer's report:
Thank you for your meaningful article.
The authors' discussion are based on their data, and the statistical analysis are proper and
comprehensive.
Review for 10.1186/s12876-025-03887-y (2025)

Title: Independent effects of the hemoglobin-to-red blood cell distribution width ratio on 180-
day mortality in critically ill patients with gastrointestinal bleeding: analysis from the MIMIC-
IV database
Version: 4 Date: 01 Mar 2025
Reviewer's report:
Thank you for the opportunity to review your manuscript. Overall, the study is well-conceived
and presents an innovative evaluation of the hemoglobin-to-RDW ratio (HRR) as a prognostic
marker for 180-day mortality in critically ill patients with gastrointestinal bleeding (GIB) using
the MIMIC-IV database. Your findings that higher HRR is associated with reduced mortality,
even after adjusting for multiple confounders, are intriguing and may have important clinical
implications. I appreciate the effort in exploring non-linear relationships through restricted
cubic spline (RCS) analysis, as well as the subgroup analyses that enhance the depth of the
investigation.
I have several comments and questions that I hope you can address in a revision:
1. Could you please specify how GIB was defined in your study? For instance, which ICD codes
were used to identify these patients, and have these codes been validated in previous research?
This clarification is essential for understanding the cohort selection and ensuring reproducibility.
2. Please elaborate on your RCS methodology. Specifically, how many knots were used, and
what criteria were applied for their placement? This detail is important to assess the robustness
of your non-linear modeling approach.
3. Have you considered applying a piecewise linear model with a single change point? Presenting
two different hazard ratios for segments before and after the change point could offer additional
insights into the relationship between HRR and mortality.
4. It appears that Figures 2 and 3 may be reversed. Could you confirm the intended order and
ensure that each figure is correctly labeled and referenced in the text?
5. The manuscript would benefit from a more detailed interpretation of the RCS findings. Could
you specify the approximate location of the changing point and explain the magnitude and
direction of the effect before and after this threshold?
6. In the limitations section, you mention selection and information biases. Could you provide
more detailed explanations regarding the sources of these biases and how they might influence
the study’s conclusions?
Review for 10.1186/s12876-025-03887-y (2025)

Title: Independent effects of the hemoglobin-to-red blood cell distribution width ratio on 180-
day mortality in critically ill patients with gastrointestinal bleeding: analysis from the MIMIC-
IV database
Version: 5 Date: 22 Mar 2025
Reviewer:  Takahiro Masuda
Reviewer's report:
I have confirmed the response the authors made to the reviewer's comment and revised article.
Their article is improved, and I have no additional comment.
Review for 10.1186/s12876-025-03887-y (2025)

Title: Independent effects of the hemoglobin-to-red blood cell distribution width ratio on 180-
day mortality in critically ill patients with gastrointestinal bleeding: analysis from the MIMIC-
IV database
Version: 5 Date: 22 Mar 2025
Reviewer's report:
The authors adequately improve the manuscript. I have no further comments.
Review for 10.1186/s12876-025-03856-5 (2025)

Title: Comparison of the predictive value of TyG index and METS-IR for OSA combined wit
h NAFLD: a retrospective observational study based on a physical examination population
Version: 3 Date: 28 Mar 2025
Reviewer's report:
I am satisfied with the authors' responses to my previous comments. The revisions have
adequately addressed my concerns, and the manuscript now meets the standards for publication.
I recommend that it be accepted for publication.
Review for 10.1186/s12876-025-03817-y (2025)

Title: Iceball Growth 3D Simulation Model Based on Finite Element Method for Hepatic
Cryoablation Planning
Version: 0 Date: 02 Aug 2024
Reviewer's report:
It is one of the basic model to work with. The comparison results are good. However, the
vessel structure could be added to the model because the effect of the vessel presenting near the
tumour causes large damage to the model with respect to raising or freezing temperature. Further,
the assumption of single perfusion for all patients can be modified with different perfusion or
clinically obtained perfusion rates based on the retrospective data availability. Also, tumor has
different thermal conductivity, density, specific heat capacity compared to the liver tissue (frozen
or unfrozen), which could be added to the parameter study. There is no clarity on the location of
the tumour (near vessels or far from vessels, near the liver wall or far from liver wall, fatty cells
nearby), and the size of the tumour. Clinically, it is also important to know how many healthy and
tumour cells are alive or dead. Including these information and simulating could provide more
insights into this study. Further comparison of the simulated lesion vs tumour size using MAE,
HD and DSC also provides more details about the lesion size and the significant optimization
required on including additional parameters or controlling the freezing cycles etc as the size
predictions in rapid and continuous monitoring is possible, this could be added in this study.
Apart from this, there are a few typos and article usage mistakes are available. To name a few,
Acknowledgement, the finite element method, the number of freezing cycles etc.
Review for 10.1186/s12876-025-03817-y (2025)

Title: Iceball Growth 3D Simulation Model Based on Finite Element Method for Hepatic
Cryoablation Planning
Version: 0 Date: 30 Jan 2025
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (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?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used 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 - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: This is an excellent manuscript on a 3D simulation model for hepatic
cry-ablation planning.  The paper has been written well and the descriptions are accurate.
However, my concerns are related to the real life use of this technology.  The formulas that
were used seem to be pretty complicated for an average physician.  With these technologies, the
devices come with a guide for ablation sizes based on ablation parameters, which are generally
approximate, as the authors data also showed. so, it is difficult to understand how this study will
change our day  to day care.  Who will be calculating these? my other specific questions would
be:1. Please explain the parameters used for calculations in a simple fashion, if can be brought
to that level. 2.Do the calculation incorporate patient specific parameters, like tumor type,
underlying liver condition and vessel proximity? 3.  Why do the authors thing the variability was
related? 4. Taking into account  that all ablation devices come with similar ablation parameter
vs ablation zone calculations, how do they think this will be different to change how we do
ablations? 5.  The Discussion is too long and can be shortened about 20-30% at least.
ADDITIONAL REQUESTS/SUGGESTIONS:
The main issue is how this will change our routine in real life.
Review for 10.1186/s12876-025-03817-y (2025)

Title: Iceball Growth 3D Simulation Model Based on Finite Element Method for Hepatic
Cryoablation Planning
Version: 1 Date: 11 Feb 2025
Reviewer's report:
The following points are addressed clearly:
(1) Density, heat capacity, and conductivity for tumors separately given
(2) The Arrhenius model is added for computing the amount of dead cells.
(3) MAE, HD, and DSC values are computed properly and authors provided good justifications.
However, the revised article has the following confusion which has to be clearly addressed.
The article leads to more confusion now with respect to vasculature and blood perfusion. The
initial paper by the author did not include Equations given in line numbers 261 and 262 whereas
the current one includes that, but no details of the omega_b are specified in table 1. However,
the author claims that the blood perfusion and metabolic heat generation were eliminated in ex
vivo simulations (Line numbers:  357 and 358).  Another text states that
The heat-sink effect of blood vessels was simulated based on the combination of the fluid
dynamic equation and the heat transfer equation (257 and 258). Equations represented in
233, 261, and 262 are misleading, which equation is exactly used? Different parts of the text
claim different models. Further, without introducing any vasculature on the domain, the usage
of equations represented in 267 and 268 is meaningless. The value of Pressure,  viscosity
of the blood, and volume force are left without any further details or their impact on the
simulation. These equations are useful only when vasculature is present. The article lacks in the
mathematical model part or misleads on incorrect model with simulations.
The following points are still missing which could be addressed:
Since the blood perfusion is added to the model, the value of omega_b is missing in the entire
context. If omega_b and Q_m are assumed to be zero, this boils down to a simple model without
the effect of blood vessels.  So, the model has to be corrected.  Whether any vessel is present
near the tumor or not is not clear. A large vessel present near the tumor has more impact on the
lesion size. Therefore, the authors are requested to change the model appropriately with proper
values specified for each parameter given in the model.
Review for 10.1186/s12876-025-03817-y (2025)

Title: Iceball Growth 3D Simulation Model Based on Finite Element Method for Hepatic
Cryoablation Planning
Version: 1 Date: 13 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?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used 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?
Yes - current version is technically sound
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: The authors have responded to the comments and have revised the
manuscript accordingly.  I am happy with the revisions.
Review for 10.1186/s12876-025-03817-y (2025)

Title: Iceball Growth 3D Simulation Model Based on Finite Element Method for Hepatic
Cryoablation Planning
Version: 2 Date: 25 Feb 2025
Reviewer's report:
Still, the model is not correct and the figure is not updated with modification of vessels
introduced.
Let us consider these two equations:
#C #T/#t=#·K#T+#_b #_b c_b (T_b-T)+Q_hs+Q_m
#C #T/#t=#·K#T+Q_hs-#_b#_b u_b·#T+Q_m
The difference between these two equations are on #_b #_b c_b (T_b-T) and #_b#_b u_b·#T
The first equation is a Netwonian heat exchange between T and T_b whereas the second equation
has a convective heat transfer term.
The first equation is an approximate model of the second equation. Researchers approximate
#_b#_b u_b·#T by #_b #_b c_b (T_b-T) because solving  u_b is time consuming.
The first equation is the Standard Pennes Bioheat equation (1948)
The second equation is the Chen & Holmes model (1980) where microvascular contributions
in tissue heat transfer are provided.
Similarly, there are other models such as distributed convection by Wuff (1974), and Kotte
model (1999) on hybrid bioheat equation. Two-phase models for tissue and blood (1992) are
also available.
The author is using either the microvascular model or the Wuff model. Therefore, the model
section has to be re-organized as follows:
Option (1)
Move the first equation after line number 233. Keep the second equation in line number 240.
State that the first equation is modified as the second equation.
Option(2)
No need to specify the first equation, you can specify only the second equation directly at line
241.
In both cases, the proper citation is required.
The citation for the Arrhenius model is missing. The reference [23] can be replaced by the
reference of
https://www.sciencedirect.com/science/article/pii/S0017931018348786?
pes=vor&utm_source=tfo&getft_integrator=tfo
Citation [25] states that the Machine learning model for the equation has no connection to the
vascular system. Please provide the proper reference for it.
The same is applicable for the 261 to 264.
Regarding the simulation and figures:
The author claims that "To model the vascular structure adjacent to the tumor, a cylindrical tube
with a 3 mm diameter and  20mm away from and parallel to the cryoprobe was introduced into
the domain to simulate the hepatic artery with the velocity of blood flow of 44.3 cm/s, consistent
with measurements from human liver anatomy"
This is not visible in any of the figures. The previous submission figure and this figure look the
same. Please check this figure if it was wrongly uploaded.
Review for 10.1186/s12876-025-03817-y (2025)

Title: Iceball Growth 3D Simulation Model Based on Finite Element Method for Hepatic
Cryoablation Planning
Version: 3 Date: 19 Mar 2025
Reviewer's report:
You can modify the following sentences:
Lines 381-384: The segmentation for cryoprobe and frozen regions was performed by a senior
radiologist (Dr. S. L.) using ITK-SNAP 3.6 software, and subsequently double-checked and
refined by an expert radiologist (Prof. X. L., with more than 20 years of experience in abdominal
radiology).
Modifications:
The segmentation for cryoprobe and frozen regions was performed using ITK-SNAP 3.6
software and subsequently refined.
Lines 431-433: The cryoprobe type was selected by an expert interventionist (Prof. X. L.) with
CT-guided tumor cryoablation experience for more than 15 years based on lesion size and
adjacent critical structures.
Modifications:
Lines 431-433: The cryoprobe type was selected based on lesion size and adjacent critical
structures.
The rest are fine.
This is to avoid bias toward mentioning the experience. Being an experienced professor in the
field does not mean the professor should be correct. Anyhow author contribution section informs
about their contributions.
Review for 10.1186/s12876-025-03838-7 (2025)

Title: Three-to-Six Month Post-POEM Timed Barium Esophagram Can Predict Esophageal
Contents and May Stratify Aspiration Risk on Follow-up EGD
Version: 2 Date: 03 Mar 2025
Reviewer's report:
Thank you for giving me the opportunity to review this paper.
This study examines whether esophagram findings before endoscopy can predict the presence
of esophageal contents three months after POEM, aiming to ensure the safe performance of
endoscopy. I believe this provides clinically valuable information.
Comments:
• Regarding Table 1:
It would be clearer to present patient background factors in one table and the outcomes
comparing pre- and post-POEM in a separate table.
• Regarding the ROC curve:
While the study sets 7 cm of the barium column as the cutoff value for residual esophageal
contents based on the ROC curve, the actual median barium column height after POEM is 0
cm. It would be beneficial to include interquartile range (IQR) data to provide a more detailed
distribution of the results.
• Regarding the indication for endotracheal intubation during endoscopy:
In Japan, endotracheal intubation is not performed during endoscopy. What criteria are used to
determine the need for endotracheal intubation?