Review for 10.1186/s12876-025-03704-6 (2025)

Title: Factors influencing the cure of pseudolithiasis: A retrospective study of 264 patients
Version: 2 Date: 22 Dec 2024
Reviewer's report:
The study aims to identify independent predictive factors for the complete resolution of
pseudolithiasis and evaluate the effectiveness of different therapeutic strategies through a
retrospective analysis of clinical data from 264 hospitalized patients. Here are my peer review
comments:
Sample size and statistical power: Although the study included a total of 264 patients, only
43 patients in the complete resolution group may lead to insufficient statistical power when
performing multivariate logistic regression analysis. It is recommended that the authors provide
calculations of statistical power to demonstrate whether the sample size is sufficient to support
the conclusions drawn.
Limitations of a single-center study: As a single-center study, the sample may not represent
a broader patient population, which may limit the generalizability of the study's results. It is
suggested that the authors discuss this limitation in more detail in the discussion section and
consider how future multi-center studies could enhance the universality of the conclusions.
Limitations of follow-up time: The study's follow-up time is limited to the period of
hospitalization, which may not be sufficient to assess the long-term prognosis of pseudolithiasis.
It is recommended that the authors consider extending the follow-up time or at least discuss the
impact of this limitation on the results.
In-depth analysis of contrast agent effects: The study identifies iodinated contrast agents as an
independent risk factor for the persistence of pseudolithiasis but does not provide an in-depth
analysis of their potential mechanisms of action. It is suggested that the authors further explore
how contrast agents affect bile metabolism and the specific mechanisms of this effect.
Detailed analysis of therapeutic interventions: The article mentions the protective effects of
cefoperazone and mezlocillin but does not provide an in-depth analysis of the mechanisms of
action of these drugs. It is recommended that the authors discuss how these drugs affect the
prognosis of pseudolithiasis and provide possible biological explanations.
Consideration of underlying patient diseases: The study does not fully consider the impact of
underlying patient diseases on the occurrence of pseudolithiasis. It is suggested that the authors
include more data on underlying patient diseases in future studies and discuss how these factors
affect the development of pseudolithiasis.
Absence of long-term prognosis data: The study does not provide data on the improvement of
quality of life after patient treatment. It is recommended that the authors consider including
long-term prognosis assessments in future studies to more comprehensively evaluate the effects
of treatment.
Transparency of statistical methods: Although the article provides a detailed description of the
statistical analysis, some parts, especially the specific implementation of multiple imputation
and the results of sensitivity analysis, could be more transparent. It is suggested that the authors
provide more details so that readers can better understand the process and results of the statistical
analysis.
Depth of the discussion section: The discussion section could be further expanded, especially
regarding the comparison of study results with existing literature and how these findings impact
clinical practice. It is recommended that the authors delve deeper into these aspects and propose
specific clinical application suggestions.
Overall, the study provides valuable insights, particularly in identifying prognostic factors for
pseudolithiasis. However, to enhance the quality and impact of the research, it is recommended
that the authors consider the above comments and make corresponding revisions where possible.