JerMa88/BMC_Gastroenterology_Peer_Reviews huggingface dataset:
Review for 10.1186/s12876-024-03346-0 (2024)

Title: ncRNA-mediated SOX4 overexpression correlates with unfavorable outcomes and
immune infiltration in hepatocellular carcinoma
Version: 3 Date: 02 Jul 2024
Reviewer's report:
The revised version of the manuscript mainly addressed my previous comments and concerns.
Overall, the manuscript is well written and of interests to readers.
However, even if the Authors have correctly re-described the results at lines 183-190, they did
not discuss the finding that obesity and overweight seem to be associated with increased OS
in their analysis, while different studies have described that obesity is associated with reduced
cancer survivorship.
At line 179, I would suggest the Authors to state that “increased SOX4 expression was inversely
associated with OS, progression-free survival, disease-free survival, and relapse-free survival
(Figure 2A–D).”
The titles of figure 2H and 2I are still inverted. The Gender graph should have 6 groups/color
lines and the Race graph only 4.
I thank the Authors for the new provided original WB results with miha cell line and GAPDH
instead of b-Actin. However, also in these images the KDa ladders are not merged together
with the protein bands. Can they provide a merged image which would confirm the correct
identification of the protein?
Review for 10.1186/s12876-024-03346-0 (2024)

Title: ncRNA-mediated SOX4 overexpression correlates with unfavorable outcomes and
immune infiltration in hepatocellular carcinoma
Version: 5 Date: 22 Jul 2024
Reviewer's report:
The authors have addressed my final comments and concerns in the revised version. Overall,
the manuscript is well written and of interests to readers.
Therefore, I recommend to accept the paper without additional changes.
Review for 10.1186/s12876-024-03329-1 (2024)

Title: Palliative Use of Self-expanding Metal Stents in Initially Anticancer Treatment-intolerant
Patients with Esophageal Cancer
Version: 0 Date: 28 May 2024
Reviewer's report:
I applaud the authors for taking on such a difficult patient population to study.  The study looked
at assessing the impact of stent placement in frail EC patients. The overall methodology and
presentation of the paper is very good.  Some questions for consideration:
1. Were there any QOL metrics captured for these patients?
2. 8 of 46 pts had complications. Were there any predictors identified that would link
complications with type of EC ?
3. Have these results changed the center's approach to these patients in particular, and how do
you approach your patients now with this data/ information?
Review for 10.1186/s12876-024-03329-1 (2024)

Title: Palliative Use of Self-expanding Metal Stents in Initially Anticancer Treatment-intolerant
Patients with Esophageal Cancer
Version: 0 Date: 03 Jun 2024
Reviewer's report:
This was a nicely written paper and good results section.
However, the dysphagia improvement system seems to be an inherent component of any
esophageal stent placement, regardless of the ECOG class score.
Review for 10.1186/s12876-024-03329-1 (2024)

Title: Palliative Use of Self-expanding Metal Stents in Initially Anticancer Treatment-intolerant
Patients with Esophageal Cancer
Version: 1 Date: 03 Jul 2024
Reviewer:  Ahmed Altonbary
Reviewer's report:
Thanks for the authors effort. Clear answers to previous comments. Appropriate discussion with
calrified limitations.
Review for 10.1186/s12876-024-03360-2 (2024)

Title: The association between physical activity and risk of gastric cancer; an umbrella review
Version: 1 Date: 30 May 2024
Reviewer's report:
A very well done work.
Please make corrections to the table margin and  check the orientation.
In the abstract section we usually write conclusions and not discussion.  I suggest to change it.
Also do not start a centence by providing  a number e.g. <<5>>. Just write: Five...
Review for 10.1186/s12876-024-03360-2 (2024)

Title: The association between physical activity and risk of gastric cancer; an umbrella review
Version: 1 Date: 13 Jun 2024
Reviewer's report:
The present manuscript is an overview of systematic reviews assessing the relationship between
physical activity and gastric cancer. Overall, it is a well-written and relevant article. Minor
comments:
Eligibility criteria:
More information regarding the inclusion criteria needs to be provided, i.e. what kind of
systematic reviews were included. Systematic reviews of RCTs, of observational studies, or
both? Furthermore, did you include every systematic review or was there a minimum of studies
that should have been included?
Search methods:
1. I suppose "in November 13, 2022" means until that date? Please clarify (e.g. from inception
to November 13, 2022).
2. An update of the literature search is necessary, as 1,5 year has passed since the search date.
3. The supplementary material is not provided. Please provide the search algorithm.
Search results and screening process:
A list of the excluded full-text studies needs to be provided along with the reasons for exclusion.
Discussion:
Are there any other individual studies (not included in a systematic review) in the field? If so,
please state why they were not included in your review.
Table 1:
Please add a column with the study types that were included in each review (e.g. RCT, cohort,
case-control, etc.)
TYPOS
Abstract: "A systematic search was performed in PubMed, Scopus, Web of Science, and
ProQuest databases in November 13, 2022 through databases with predefined keywords." Please
remove "through databases" for clarity.
Discussion: The sentence beginning with "5 systematic reviews on the effect of physical
activities respectively" looks incomplete.
There are other minor language errors as well. Please correct the text very carefully.
Review for 10.1186/s12876-024-03360-2 (2024)

Title: The association between physical activity and risk of gastric cancer; an umbrella review
Version: 1 Date: 23 Jun 2024
Reviewer's report:
Thank you for the opportunity to review this article. The current study focuses on an important
research topic relevant to the scope of BMC Gastroenterology. Overall, the manuscript is
well-written. However, a few minor comments should be addressed before the manuscript is
published.
1. There is too little description related to physical activity in the introduction section. Please
provide an overview of previous studies.
2. Please describe the importance of conducting an umbrella review in the introduction section.
3. Description in the fifth paragraph of the introduction reads like a summary. Please describe
the purpose of this study.
4. As stated in the Search methods section, some time has passed since the search was conducted.
Were there any systematic reviews published after December 2022?
Review for 10.1186/s12876-024-03348-y (2024)

Title: Accuracy of ChatGPT3.5 in Answering Clinical Questions on Guidelines for Severe
Acute Pancreatitis
Version: 2 Date: 22 Apr 2024
Reviewer's report:
Evaluation of the Accuracy of the ChatGPT3.5 in Answering Clinical Questions in Guidelines
for Severe Acute Pancreatitis
Consider Changing the title to
Accuracy of ChatGPT3.5 in Answering Clinical Questions on Guidelines for Severe Acute
Pancreatitis
This observational study compared the accuracy of chatGPT3.5 in English and Chinese in
answering clinical questions using the 2019 guidelines for severe acute pancreatitis. The authors
formulated 34 short answer questions and 15 true/false questions to test the accuracy of AI,
potentially aiding clinicians in making accurate decisions whilst treating a patient.
What was the rationale for choosing Severe Acute Pancreatitis?
To better assess chatGPT3.5's ability to clarify the guidelines, 15 true/false questions regarding
the recommendations were created.  ChatGPT-3.5 was asked each question in Chinese and
English.
It would be useful to have a table with all the questions as asked and the researchers' responses
to each question, along with their executive decision to categorize some answers as positive or
negative. This would help the reader understand what was deemed correct and which ones were
deemed incorrect, as well as how the determination was made.
Each reviewer independently evaluated reproducibility by comparing the two responses to each
question. In cases of disagreement between the two reviewers, a third senior expert from the
Department of Critical Care Medicine was consulted to resolve the issue. What percentage
required a third reviewer?
ChatGPT demonstrated a higher accuracy rate for short-answer questions (76%) in English
compared to right-or-wrong questions (60%, P value:0.405) (Figure B). In Chinese, no
significant difference in accuracy was found between the right-or-wrong questions (60%) and
the short-answer questions (59%, P value:0.938) (Figure C).  Can they offer an explanation as
to why there was no difference in Chinese?
Why did the authors analyze both in English and in Chinese?
When answering a true/false question, the response is considered correct only if it is an exact
match. If the answer is 'maybe' or 'can be considered', it is considered a 'yes' response. Responses
such as 'Unavailable', 'Difference of opinion', or 'I'm not a doctor' are considered incorrect.
Please clarify what the authors mean by a ‘yes’ response. I feel that to accurately understand, it
would be useful to have a third answer for true or false questions- such as ‘not known’ or ‘don’t
know’ responses than to club it with true or false based on human intelligence. This adds to the
complexity of determining the accuracy of generative AI in this context. The more accurate way
would be to have a third response as described and present the data to the reader.
Review for 10.1186/s12876-024-03348-y (2024)

Title: Accuracy of ChatGPT3.5 in Answering Clinical Questions on Guidelines for Severe
Acute Pancreatitis
Version: 2 Date: 21 Jun 2024
Reviewer's report:
The authors provided an analysis on the accuracy of ChatGPT3.5 in answering questions in
guidelines for severe acute pancreatitis.
The authors asked chatgpt the same questions twice, while other studies eg Kusunose et al. asked
the same question 10 times.
ChatGPT answers can be very random at times, and asking the same question just twice does
not seem to be adequate to establish a strong conclusion on the results.
Review for 10.1186/s12876-024-03353-1 (2024)

Title: Association between serum vitamin D status and severity of liver cirrhosis: Implications
for therapeutic targeting in Nigerian patients
Version: 2 Date: 05 Jul 2024
Reviewer's report:
This cross-sectional study investigated the correlation between serum vitamin D levels and the
severity of liver cirrhosis using Child-Pugh and MELD scores in the Nigerian population. The
results revealed that the serum vitamin D level correlated with the severity of liver cirrhosis and
suggested that serum vitamin D level could be used as a prognostic marker in patients with liver
cirrhosis. Although several studies already reported the relationship between vitamin D and liver
fibrosis or liver cirrhosis, this study was well-designed. The manuscript was well-written and
the results were discussed clearly.
Review for 10.1186/s12876-024-03353-1 (2024)

Title: Association between serum vitamin D status and severity of liver cirrhosis: Implications
for therapeutic targeting in Nigerian patients
Version: 2 Date: 30 Jul 2024
Reviewer's report:
In this manuscript the authors examine the potential association between serum Vit D and
severity of liver cirrhosis in a Nigerian patient population. The authors conduct a cross-sectional
study of 201 patients, 103 of which were diagnosed with liver cirrhosis and assess the severity
of the cirrhosis via child-pugh and MELD scores. They then use spearman correlation to assess
the potential relationship with Vit D levels. The authors identified that Vit D levels showed
strong negative correlation with the severity of cirrhosis, and conclude that low serum Vit D is
correlated with increased liver cirrhosis. They suggest this may be a notable prognostic marker
or therapeutic target in future studies.
Overall the paper is well-written, and of notable value. However, there is some minor changes
that are required.
1) Editing. There are several run-on/long sentences, inconsistent tense used (past and present),
some grammatical inconsistency (using commas vs not), and so on.
2) For the data presented in the graphs, the number inside the bars and the titles are all very small.
I also am not sure if its better to compare the n-values. My preference here would be to compare
to percentages, write the percentage above the respective bars or inside them in large enough
text to see clearly, and on the x-axis below the respective bar titles put the (n = xx) numbers.
This will also align better with the body of the text that presents data in the xx%(n=xx) format.
3) The authors noted that they corrected for confounding variables like BMI, but there are
other confounding variables that can effect access and uptake of Vit D. Some of these can
include access, socio-economic status, educational status and understanding of importance
of supplementation etc. These can have regional differences as well which may lead to
environmental factors also being different between the patient groups. The authors should
discuss this concept further in the limitations. Additionally in the limitations there should be a
view on how generalizable is this data to a global population. Do the authors expect this to be
reflective of only local populations, or of far wider relevance. In either case, it should at least
be noted in the discussion.
Review for 10.1186/s12876-024-03366-w (2024)

Title: Unravelling the role of beta-CGRP in inflammatory bowel disease and its potential role
in gastrointestinal homeostasis
Version: 1 Date: 24 May 2024
Reviewer's report:
Scientific Quality: Grade C (Good)
Novelty of This Manuscript: Grade C (Fair)
Creativity or Innovation of This Manuscript: Grade C (Fair)
Scientific Significance of the Conclusion in This Manuscript: Grade C (Fair)
Language Quality: Grade B (Minor language polishing)
Conclusion: Minor revision
Conclusion:
This experiment tested 96 patients recently diagnosed with IBD and compared their morning
serum # - CGRP levels with 50 matched healthy controls and 50 patients with chronic migraine.
The results showed that the # - CGRP levels in IBD patients were lower than those in healthy
controls and chronic migraine patients. In terms of diagnosing subtypes of IBD, the # - CGRP
levels in ulcerative colitis and Crohn's disease are significantly lower than those in healthy
controls and chronic migraine patients. The conclusion is that compared with healthy controls
and chronic migraine patients, patients diagnosed with various IBDs recently have significantly
reduced serum # - CGRP levels, strongly supporting the role of this neuropeptide in the
pathophysiology of IBD from an early stage onwards. The authors also believe that # - CGRP
has a protective effect in gastrointestinal homeostasis. However, there are still several issues
that need attention:
1. Please describe the reasons for excluding the use of biological agents in the inclusion criteria.
Is there any relevant literature to prove that biological agents have an impact on CGRP? Or does
mesalazine and steroids have no effect on CGRP?
2. As mentioned earlier, # CGRP mainly exists in the intermuscular neurons of the small intestine
and colon. When selecting samples, please explain why not use colon specimens from IBD
patients to explore more accurate local changes, but rather to explore more comprehensive
changes in IBD patients? If it is indeed difficult to obtain specimens, can a small amount of
samples be used to explore the difference between circulating and local CGRP in advance?
3. The author mentioned in the discussion section that existing literature has shown a decrease
in the expression of CGRP and CGRP mRNA in the intestinal mucosa of UC patients. Can the
differences and focuses between this experiment and this literature be understood as differences
in the selection of disease stages for IBD patients? Or rather, focus on proving the causal
relationship between CGRP and IBD? Suggest adding a paragraph to describe the innovation
and highlights of this article.
4. Please carefully verify the accuracy of each cited literature, such as reference 31, which does
not seem to contain the keyword CGRP.
5. Can you add some literature related to basic experiments on the early effects of CGRP on
IBD to enhance the theoretical support of this article. Or provide some description of this in the
outlook section. Alternatively, animal experiments similar to this could be added.
Review for 10.1186/s12876-024-03366-w (2024)

Title: Unravelling the role of beta-CGRP in inflammatory bowel disease and its potential role
in gastrointestinal homeostasis
Version: 1 Date: 29 May 2024
Reviewer's report:
This is an observational study dealing with the circulating levels of beta calcitonin gene-
related peptide (beta-CGRP) measured by ELISA in patients with IBD in comparison with
healthy controls (HC) and chronic migraine (CM) patients. Although the results showed that
the circulating levels of beta-CGRP in both ulcerative colitis (UC) and Crohn's disease (CD)
patients were significantly lower than those in HC and CM it is neither logical nor reasonable to
reach such conclusions that beta-CGRP has a pathophysiological and protective role in patients
with IBD because this study did not perform any experiments regarding the pathophysiological
and protective role of this neuropeptide.  Apart from this, in the patients cohort, there were 5
CD patients with B2 or B3 and 5 with perianal diseases which cannot be regarded as the first
or initial stages of the disease, therefore,  it is also not appropriate to argue that "this reduction
is not secondary to an established chronic damage of the mucosa, but that could have a key
role in the maintenance of wall homeostasis in the initial IBD stages". However, to observe the
circulating levels of beta-CGRP is a good start to study its role in patients with IBD in terms of
biomarkers or therapeutic target in future.
Review for 10.1186/s12876-024-03366-w (2024)

Title: Unravelling the role of beta-CGRP in inflammatory bowel disease and its potential role
in gastrointestinal homeostasis
Version: 3 Date: 20 Jun 2024
Reviewer's report:
This study observed the circulating levels of beta calcitonin gene-related peptide (beta-CGRP)
measured by ELISA in patients with IBD in comparison with healthy controls (HC) and chronic
migraine (CM) patients. The results showed that the circulating levels of beta-CGRP in both
ulcerative colitis (UC) and Crohn's disease (CD) patients were significantly lower than those
in HC and CM. However, this is only an observed phenomenon in IBD patients in this clinical
study which did nothing to deal with the pathophysiological and protective role of beta-CGRP so
that the conclusion regarding the pathophysiological and protective role of this neuropeptide is
somehow groundless. One needs to perform intervention study, for example, to use beta-CGRP
or its agonist during the induction of experimental IBD in order to study its pathophysiological
and protective role. Therefore, it is advisable to reach the conclusion of this paper in a logical
way from its results. Of course, the authors can discuss the pathophysiological and protective
role of beta-CGRP by citing literatures in their discussions.  By the way, apart from ELISA,
another method needs to be used to measure the circulating levels of this neuropeptide for its
reproducibility.
Review for 10.1186/s12876-024-03359-9 (2024)

Title: Mucinous histology is a negative predictor of neoadjuvant chemoradiotherapy for locally
advanced rectal adenocarcinoma
Version: 2 Date: 09 Apr 2024
Reviewer's report:
Good topic for meta analysis.
Please consider in limitations:
-response to neoadjuvant radiation and chemotherapy is association with tumor stage; the
original data for studies used in this meta analysis was not assessed for tumor stage
-definition of tumor response to neoadjuvant radiation and chemotherapy  is not specific for %
change in tumor volume
-radiation dose and details of specific chemotherapy agents was not assessed for tumor response
on mucinous tumors
-whether nodes contained mucin was not asseessed for response
Review for 10.1186/s12876-024-03359-9 (2024)

Title: Mucinous histology is a negative predictor of neoadjuvant chemoradiotherapy for locally
advanced rectal adenocarcinoma
Version: 2 Date: 17 Apr 2024
Reviewer:  Shigeo Toda
Reviewer's report:
Dear authors,
This study investigates the impact of mucinous differentiation on the effectiveness of
preoperative chemoradiation for rectal cancer. The manuscript is well-written in clear and
understandable English. However, the results closely align with those of the meta-analysis
conducted by McCawley et al. (1) in 2016. As a result, it appears that there is limited novelty
in this study.
I have some comments as follows.
While mucinous adenocarcinoma may exhibit resistance to chemoradiation, advanced mucinous
rectal adenocarcinoma still presents as a candidate for preoperative chemoradiotherapy (CRT).
This is supported by a large-scale study utilizing the SEER database, which suggests that patients
with mucinous adenocarcinoma may derive survival benefits from preoperative CRT. (2)
However, if the treatment goal is non-operative management ("watch and wait" strategy), it
may be inappropriate to include patients with mucinous adenocarcinoma, since the rate of
pathological complete response is rare.
In Figures 2, 3, and 4, the forest plot demonstrates that the odds ratios favour mucinous
adenocarcinoma (MAC). However, it contradicts with the results, as adenocarcinoma (AC)
shows greater susceptibility to chemoradiotherapy (CRT) compared to MAC.
Regards,
1. McCawley N, Clancy C, O'Neill BD, Deasy J, McNamara DA, Burke JP. Mucinous Rectal
Adenocarcinoma Is Associated with a Poor Response to Neoadjuvant Chemoradiotherapy: A
Systematic Review and Meta-analysis. Dis Colon Rectum. 2016;59(12):1200-8.
2. Chen C, Chen X, Jiang J. Long-term effect of neoadjuvant radiotherapy in patients with locally
advanced rectal mucinous adenocarcinoma: a population-based study of 1514 patients. Scientific
reports. 2023;13(1):11696.
Review for 10.1186/s12876-024-03359-9 (2024)

Title: Mucinous histology is a negative predictor of neoadjuvant chemoradiotherapy for locally
advanced rectal adenocarcinoma
Version: 2 Date: 25 Apr 2024
Reviewer's report:
The authors have performed a systematic review evaluating the association of mucinous
histology with respons to neoadjuvant therapy for rectal cancer
The topic is not new but relevant to professionals treating rectal Cancer. However i do have
some comments;
The title should include the nature of the study ; a systematic review
It is not an offical meta- analysis
Second numerous small mistakes are present througout teh manuscript; rectal cancer is not the
third most common cancer but CRC is
It is not the effect of MAC on CRT response but is a potential association with a poor response
to CRT
The analysis should inlcude OS and DFS  and not only response to  therapy
How many cases have been progressing throughout CRT
Review for 10.1186/s12876-024-03340-6 (2024)

Title: The effect of cardiovascular disease on the perioperative period of radical surgery in
elderly rectal cancer
Version: 1 Date: 17 Feb 2024
Reviewer's report:
In this paper, the authors discuss the affection of comorbidity for postoperative complication
of elderly patients with rectal cancer. The main contribution of the paper seems to be that the
authors show elderly rectal cancer patients with cardiovascular disease are more likely to develop
severe complications after radical surgery. I recommend that this paper would be accepted after
revision as follows.
Major comments
The good points of this study are that the purpose of the analysis is straightforward and the
conclusions are clear.
It is easy to imagine that patients with cardiovascular comorbidities have a higher risk of
developing perioperative complications, which has been well demonstrated in previous studies.
In this sense, it lacks novelty. Therefore, we propose the following revisions.
First, before this analysis, factors that are likely to cause postoperative complications should
be extracted in the cohort before the main analysis by PSM, and cardiovascular comorbidities
should be included among them. The authors should focus on cardiovascular comorbidity after
examining the difference in odds ratios compared to other factors.
In the case of rectal cancer patients under 75 years of age (younger age), how much of an impact
cardiovascular comorbidity has on the development of complications should also be mentioned;
if there is no difference between patients under 75 years of age and those over 75 years of age,
the analysis of this study would be not meaningful. The difference odds ratios between young
patients and elderly patients should still be shown.
Cardiovascular comorbidities also vary in type and severity, including hypertension,
arrhythmias, ischemic heart disease, and thrombosis, and so on, as mentioned in the manuscript.
Clinical question what we really want to know is whether or not there is difference risks among
the cardiovascular comorbidities. Therefore, additional analysis of the risk of complications for
each type of cardiovascular comorbidity is needed.
Minor comments
Title: The authors focused on rectal cancer, so “CRC” should be changed to “rectal cancer.”
Review for 10.1186/s12876-024-03340-6 (2024)

Title: The effect of cardiovascular disease on the perioperative period of radical surgery in
elderly rectal cancer
Version: 1 Date: 20 Feb 2024
Reviewer's report:
The authors report a retrospective study about the impact of cardiovascular comorbidities in
elderly (>75 years) on postoperative outcomes of radical surgeery for rectal cancer, using
a propensity score. Patients with cardiovascular comorbidities were sgnificantly associated
with severe complications, especially anastomotic leakage and cardiac disorders, in spite of
postoperative ICU admission.
Major comments:
- Why elderly was considered after 75 years?
- It would be interesting to know the proportion of excluded patients, particularly distant
metastasis, palliative surgery and emergency surgery due to intestinal obstruction and intestinal
perforation , which are usually the more important prooportion of elderly patients wiith
colorectal cancer
- The definition of cardiovascular comorbidities does not include vascular diseases such as aortic
aneurism, peripheral arteriopathy, cerebral attack etc..
- neoadjuvant chemoradiotherapy was not indicated for T3 stage, it’s not usual. Please justify.
- Why patients over 80 years of age were not treated with nCRT?
- It’s surprising that ASA score was not significantly different betweeen patients with
cardiovascular disease and those without. Do you have any explanation?
- In table 1: Does Low anterior resection mean with anastomosis?
Is there patients with anastomosis and temporary diverting stoma
- Patients who went to ICU: is it scheduled ou not because intraoperative complication?
Minor comments:
- pathological instead of pathologic
- it’s difficult to obtain written informed consent in a retrospective study starting in 2011. Did
you loss somee patients? If yes, and probably, it would be intresting to know this proportion too.
- outcomes instead of diseases for the definition of postoperative complication
- Tables: from instead of in, in the title
- Tables: significant p value could be in bold
Review for 10.1186/s12876-024-03340-6 (2024)

Title: The effect of cardiovascular disease on the perioperative period of radical surgery in
elderly rectal cancer
Version: 2 Date: 12 Apr 2024
Reviewer's report:
1. Introduction
- Please revise the second to the last sentence in the 1st paragraph "However, elderly patients..."
This sentence  can be improved in the context of grammar.
2. Introduction
- Please revise the 2nd paragraph. There is redundancy in some wording especially in the second
sentence. Grammar can be improved.
3. Materials and methods (Diagnosis and treatment)
- Other cardiovascular diseases were mentioned. Does this include AF and other histories of
cardiac surgeries e.g. valve replacement,  etc.
4. Results
- Please improve the sentences when you are comparing the significant differences before PSM
i.e. in terms of preoperative albumin level
-  Comorbidities were mentioned quite often. What are these comorbidities that strongly affected
the  differences in both cohort.
Review for 10.1186/s12876-024-03340-6 (2024)

Title: The effect of cardiovascular disease on the perioperative period of radical surgery in
elderly rectal cancer
Version: 2 Date: 16 Apr 2024
Reviewer:  Jiayun Nian
Reviewer's report:
his study analyzed the influence of cardiovascular disease or not on postoperative prognosis
in elderly patients with rectal cancer, which has certain clinical significance, but the clinical
guidance value is not strong. But as a clinician, I am more concerned about how to reduce the
proportion of elderly patients with cardiovascular complications entering the ICU after surgery.
This is a new topic, which can establish a case-control study to analyze the reasons why these
patients are not admitted to the ICU after surgery, so as to guide the clinic.
In the process of designing and writing this article, there are some questions that need to be
answered. Although there are a series of candidates for admission to the ICU after surgery, how
can we rule out that it is the subjective choice of the doctor rather than the objective needs of
the condition?
Cardiovascular disease is only one of the manifestations of older patients, and may also
be combined with diabetes, respiratory dysfunction and other diseases, but the baseline
characteristics did not list this key information in the two groups of patients.
The range of cardiovascular diseases is particularly large. Is it necessary to include all relevant
diseases in the analysis? For example, peripheral vascular disease is also a category of
cardiovascular disease, what impact does this have on perioperative recovery? I don't think all
diseases have the same impact on recovery after surgery.
Review for 10.1186/s12876-024-03340-6 (2024)

Title: The effect of cardiovascular disease on the perioperative period of radical surgery in
elderly rectal cancer
Version: 3 Date: 22 Jun 2024
Reviewer's report:
This revision is better. It is easier to follow.
Line 149 -- (4) The operation was complicated and time-consuming...
Question: What was the basis that the procedure was time-consuming. How much longer  was
the procedure from the standard procedure.
Review for 10.1186/s12876-024-03354-0 (2024)

Title: AI Support for Colonoscopy Quality Control Using CNN and Transformer Architectures
Version: 1 Date: 18 Jul 2024
Reviewer's report:
The authors of this paper propose a deep learning method for colonoscopy quality control using
various architectures. Additionally, the authors present methods to explore the black-box nature
of the proposed model for better decision-making. Essentially, this study introduces a method
to detect the cleanliness of the colon given certain frames.
However, the technical novelty of this study is very weak. Using an existing model such as
EfficientNet does not constitute novelty unless significant improvements or changes have been
made to its architecture. I recommend that the authors focus more on the novelty of their method,
specifically detailing the new knowledge or advancements created by this study.
Moreover, based on the results, it seems that the model does not perform very well on the
external dataset, with precision and recall dropping to 0.948 and 0.952, respectively. The authors
should add a discussion on this change in metrics to provide more insight into the performance
discrepancies.
The objective of the study is also quite confusing. Unless the authors are introducing a
comprehensive system to detect polyps as well as assess bowel cleanliness, they should focus
on either one of these two objectives.
Similarly, in Figure 3, it is noted that the softmax function maps to polyps and the cecum,
in addition to two classes related to bowel cleanliness. This is quite confusing and needs
clarification.
Figure 4 does not look professional. Please revise the icons and the flow to enhance the visual
presentation.
The use of TensorFlow, Keras, and PyTorch together is unusual. The authors should provide a
logical explanation for this decision.
Figure 5 does not provide any useful information. Consider using a different type of visualization
to convey the necessary information more effectively.
Given these concerns, I do not recommend this paper for publication at this moment.
Review for 10.1186/s12876-024-03354-0 (2024)

Title: AI Support for Colonoscopy Quality Control Using CNN and Transformer Architectures
Version: 1 Date: 27 Jul 2024
Reviewer's report:
The article is well written with detailed result analysis. There are few minor changes that can
be done to improve the quality of paper.
1. Improve the resolution of the figures 8 and figure 11.
2. Thoroughly revise the article to remove the grammatical and typological errors.
3. Change the alignment of text as justified.
4. Provide a sub-section in section 1 to state the motivation, objective and major contribution.
Review for 10.1186/s12876-024-03354-0 (2024)

Title: AI Support for Colonoscopy Quality Control Using CNN and Transformer Architectures
Version: 1 Date: 27 Jul 2024
Reviewer:  Ishak Paçal
Reviewer's report:
The study uses deep learning techniques for Colonoscopy Quality Control. The important points
that need to be addressed in the study are as follows:
- The abstract is too long and should be shortened.
- The introduction is too brief. It should start with information about CRC, including statistical
data on cases and mortality rates, its development, followed by an overview of colonoscopy,
deep learning, CAD diagnostic systems, and then details on CNN and ViT algorithms. Mention
existing models in the literature, research gaps, and the motivation behind the study. Support
the impact of deep learning on cancer diagnosis with state-of-the-art methods.
- [Reference 1](https://link.springer.com/article/10.1007/s13042-024-02110-w)
- [Reference 2](https://www.sciencedirect.com/science/article/pii/S0950705124001175)
- Add a new section on CRC, i.e., a literature review including SOTA methods.
- [Reference 3](https://www.sciencedirect.com/science/article/pii/S0957417423002427)
- [Reference 4](https://link.springer.com/article/10.1007/s10489-022-04299-1)
- [Reference 5](https://www.sciencedirect.com/science/article/pii/S0010482521008258)
- [Reference 6](https://www.sciencedirect.com/science/article/pii/S0010482521003139)
- In the image preprocessing section, include a table detailing the train-validation-test sets for
both datasets.
- Provide the basic mathematical formulas for CNN and ViT.
- Include a brief paragraph explaining each architecture.
- Clearly explain Grad-CAM and other XAI methods, including their mathematical backgrounds.
- Provide formulas for performance metrics.
- Correct the mention of "Efficient" to specify which EfficientNet model you used. There
is no "Efficient" model; there are EfficientNet models such as EfficientNetB0-B8 and
EfficientNetV2-S, -M, -L. Use all EfficientNet models.
- Consider including other SOTA methods like Swin, DeiT, and MobileViT. Use at least three
models for each architecture.
- Remove the metrics and graphs related to the train set.
- Only use tables and metrics related to the test set, not the validation set. Split your dataset into
train, validation, and test sets.
- The conclusion is too short.
- The discussion is inadequate.
- Specify limitations and future directions.
- Use higher-quality and clearer graphs and images.
- Review the entire study as there are significant errors present.
- Improving these aspects will enhance the quality of the study.
Review for 10.1186/s12876-024-03354-0 (2024)

Title: AI Support for Colonoscopy Quality Control Using CNN and Transformer Architectures
Version: 2 Date: 05 Aug 2024
Reviewer's report:
I thank the authors for revising the manuscript. The content is much clearer now; however, please
revise the typo in Figure 4, section 3 (Polyo detection rate instead of Polyp detection rate).
Review for 10.1186/s12876-024-03342-4 (2024)

Title: Risk factors for pathological upgrading and noncurative resection in patients with gastric
mucosal lesions after endoscopic submucosal dissection
Version: 1 Date: 23 May 2024
Reviewer:  Panagiotis Tsibouris
Reviewer's report:
Evaluation of risk factors for pathologic upgrading and non curative resection of gastric lesions
undergoing ESD is a hot topic in early gastric cancer and HGD  treatment  The authors can
reduce the size of their abstract introduction and provide more details in results and method.
In the results its better to present only the results of multivariate analysis so that their is no
confusion  Conclusions can also be  brief  The authors should define criteria for the number
of speciments recieved from each lesion Was it the practicality, fear of fibrosis, macroscopic
appearance , or any other factor that guided their decision. They should also define if the
endoscopist has given any data on the appearnce of the lesion using any criteria (using Kudo,
NICE  or any other classification) Was there any difference between cases were NBI and WLE
were used in the effeciency and diadnostic precision ? If NBI was used in high enough number
of cases these data should be presented as well .  Diagnostic accuracy for EFB in comparison
to ESD should be calculated as well  ESD tecnique should be described in more details. Were
there any patients excluded due to poor performance status? Possible commorbidities other than
those described  (cognitive impairment, psychosis, lactation, or a history of malignancy) were
included ? Poor life expectancy extreme age or poor performance status not permiting endoscopy
werenot exclusion criteria? Pathologic techniques and biomarkers requested if any should be
defined at least in brief.  Percentages should be calculated for all parameters presenting in the
results Only significant parameters should be presented in the text The others should appear
in the Tables. The last paragraph should present the three factors that are significant and they
appear once. Discussion should be adjusted accordingly The first paragraph should provide a
brief precis and the rest should compare study findings to medical literature  with speculations
about possible causalities
Review for 10.1186/s12876-024-03342-4 (2024)

Title: Risk factors for pathological upgrading and noncurative resection in patients with gastric
mucosal lesions after endoscopic submucosal dissection
Version: 2 Date: 17 Jun 2024
Reviewer:  Panagiotis Tsibouris
Reviewer's report:
I think the authors have successfully answered most of the matters pointed in the first review
and introduced anithing that cannot adressed in the limitations
Review for 10.1186/s12876-024-03342-4 (2024)

Title: Risk factors for pathological upgrading and noncurative resection in patients with gastric
mucosal lesions after endoscopic submucosal dissection
Version: 2 Date: 02 Jul 2024
Reviewer's report:
The authors have revised a manuscript entitled " Risk factors for pathological upgrading and
noncurative resection in patients with gastric mucosal lesions after endoscopic submucosal
dissection". The point-by-point responses to the reviewers' comments were mostly accepted.
However, there is some concern to be addressed for publication.
1. Abstract:
For the first abbreviations, "EGC" and "GIN", the correct full spelling should be written.
2. Materials and Methods :
#P8 line 173-178 “Ensure that the patient has ~ after anesthesia.”
#P9 line 187-188 “After the process, the endoscope was gradually removed to finish the
examination.”
#P10 line 226-228 “If the lesion is ~ , it is separated anally.”
#P10 line 223-225 “The solution was injected ~ for this change.”
# I don’t think this sentence is necessary.
#P9 line 203 “~ to assess the depth of tumor invasion”
# I think endoscopic ultrasonography is usually used to assess the depth of tumor invasion.
Contrast-enhanced CT of the abdomen would be used to evaluate lymph nodes and distant
metastases.
3. Results :
#P15 line 322-323 “intramucosal IC” # intramucosal carcinoma?
#P16 line 351-352 “Most of these risk factors are ~ noncurative resection.”
# I don’t think you can mention so much from Table 4.
#P17 line 379-388, and Table 7.
# Isn't this sentence and Table 7 almost identical to lines 362-378 and Table 6?
Because you analyzed multivariate logistic regression analysis about noncurative resection, I
think this sentence and table 7 are unnecessary.
4. Discussion:
P22 line 480-481. “Consequently, poorly ~ the surrounding mucosa.”
# You said “There was a greater rate of submucosal infiltration in undifferentiated malignancies
than in differentiated cancers.”
And table 7 show no undifferentiated malignancies are horizontal margin positive.
Therefore, I think you cannot say so much like line 480-481.
Review for 10.1186/s12876-024-03342-4 (2024)

Title: Risk factors for pathological upgrading and noncurative resection in patients with gastric
mucosal lesions after endoscopic submucosal dissection
Version: 3 Date: 05 Jul 2024
Reviewer's report:
The authors have revised the manuscript entitled " Risk factors for pathological upgrading
and noncurative resection in patients with gastric mucosal lesions after endoscopic submucosal
dissection". A careful point-by-point responses to the reviewers' comments was accepted.
Review for 10.1186/s12876-024-03342-4 (2024)

Title: Risk factors for pathological upgrading and noncurative resection in patients with gastric
mucosal lesions after endoscopic submucosal dissection
Version: 3 Date: 05 Jul 2024
Reviewer:  Panagiotis Tsibouris
Reviewer's report:
The text is mauch improved I am not sure why the few cases with gastritis on initial biopsies
had an ESD performed I suspect that endoscopic appearance led to the final decision, which can
be included in the text. Results of multivariate analysis should not be repeated in the discussion
Review for 10.1186/s12876-024-03342-4 (2024)

Title: Risk factors for pathological upgrading and noncurative resection in patients with gastric
mucosal lesions after endoscopic submucosal dissection
Version: 4 Date: 10 Jul 2024
Reviewer:  Panagiotis Tsibouris
Reviewer's report:
I think the document can be accepted
Review for 10.1186/s12876-024-03342-4 (2024)

Title: Risk factors for pathological upgrading and noncurative resection in patients with gastric
mucosal lesions after endoscopic submucosal dissection
Version: 4 Date: 18 Jul 2024
Reviewer's report:
I appreciate your point-by-point responses to the reviewer's comments.
I think this paper is well written.
I have no questions regarding this paper.
Review for 10.1186/s12876-024-03349-x (2024)

Title: Uncovering the Gap: Coeliac Disease Knowledge Among Healthcare Professionals in the
Danube Region
Version: 3 Date: 24 May 2024
Reviewer's report:
In this paper Riznik et al studied “coeliac disease knowledge among healthcare professionals in
the Danube region”. They concluded that knowledge is not satisfactory. Although the paper is
clear and well written, my concern is related to what the authors consider a satisfactory level and
what cut-off would be satisfactory. The study is based on a 22 question questionnaire (supplem
1). Some of these questions are very easy, but others are very difficult. Others are debatable. For
example, I wonder what is the right answer to Q7 and 10. I do not understand the reason why
the answer “I do not know” is available in only some questions.
Review for 10.1186/s12876-024-03349-x (2024)

Title: Uncovering the Gap: Coeliac Disease Knowledge Among Healthcare Professionals in the
Danube Region
Version: 4 Date: 17 Jun 2024
Reviewer's report:
In this sentence: "There were significant differences observed among the included regions
overall (Figure 1) and also in different subsections and also in different subsections (p <0.001")
– enter between which countries there was a statistical difference – after all, it is not between
all countries.
Additions, if you add p<0.001 to the Figure 1– mark on the figure which countries it  concerns
this statistical significance
Review for 10.1186/s12876-024-03349-x (2024)

Title: Uncovering the Gap: Coeliac Disease Knowledge Among Healthcare Professionals in the
Danube Region
Version: 4 Date: 17 Jun 2024
Reviewer:  Mauro Congia
Reviewer's report:
Authors responded appropriately to all questions raised by the reviewers. Overall the manuscript
has now improved and some critical points have been adequately highlighted.
Review for 10.1186/s12876-024-03349-x (2024)

Title: Uncovering the Gap: Coeliac Disease Knowledge Among Healthcare Professionals in the
Danube Region
Version: 4 Date: 18 Jun 2024
Reviewer's report:
Sincerely, the manuscript does not seem to have been improved and I am not really satisfied
by the answers to my questions. For example, I did not want to know the correct answer to Q7
and 10, but I wanted to highlight the fact that if I am not able to tell what the right answer is
supposed to be for some of these questions, well, it is not a surprise that the average HCP provide
unsatisfactory results. However, I must confess that I am not really interested in this kind of
survey-based study, and therefore I could be biased.
Review for 10.1186/s12876-024-03349-x (2024)

Title: Uncovering the Gap: Coeliac Disease Knowledge Among Healthcare Professionals in the
Danube Region
Version: 8 Date: 13 Jul 2024
Reviewer:  Mauro Congia
Reviewer's report:
I think that HGCPs in the first line of conclusions is a mistyping error. Please correct it
Review for 10.1186/s12876-024-03344-2 (2024)

Title: Validity of rapid urease test using swab of gastric mucus to mucosal forceps and 13C-
urease breath test: a multicenter prospective observational study
Version: 1 Date: 22 May 2024
Reviewer's report:
In this multicenter prospective study, the authors compared the diagnostic performance of the
rapid urease test (RUT) using gastric wall swabs (Swab-RUT) and conventional RUT for the
diagnosis of H. pylori infection. Swab-RUT showed high sensitivity, specificity, and accuracy
for diagnosing H. pylori infection, suggesting the usefulness of a less-invasive Swab-RUT.
There are some important considerations.
Major
1. A total of 94 patients were enrolled in this study. However, only 41 patients underwent forceps
RUT and Swab-RUT simultaneously. Since the purpose of this study was to compare diagnostic
performance of Swab-RUT and conventional RUT, it would be reasonable to include 41 patients
who underwent both tests upon suspicion of H. pylori infection during endoscopic examination.
2. How was the number of subjects needed to assess the diagnostic performance of Swab-RUT
estimated?
3.  What is diagnostic criteria for diagnosing H. pylori infection in this study? In general, if
multiple tests are performed, a positive result from one of the tests is considered positive for H.
pylori infection, and a negative result from all tests is considered negative for the infection. This
study found that 5 cases were RUT positive but UBT negative. Are these cases positive for H.
pylori infection (UBT false negative) or not (Swab-RUT false positive)?
Minor
1. In this study, only 30 cases (31.9%) showed positive result to urea breath test (UBT). Indeed,
more than half of patients (53 of 94) were not expected to have H. pylori infection based on
Kyoto classification.
2. Although methods were not identical at all institution, detailed description of the cotton swab
preparation protocol and specimen collection methods would be informative (i.e., recommended
number of mucosal sweeping).
3. In this study, specimens for Swab-RUT and forceps RUT were obtained from gastric antrum
and corpus and interpreted separately. What about diagnostic performance of Swab-RUT based
on the location in the stomach?
4. It appears that both pronase and sodium bicarbonate were often used during endoscopic
examination in this study. This means that the effect of pronase or sodium bicarbonate on Swab-
RUT cannot be estimated separately.
5. Although subtle, sensitivity and positive predictive value were lower when using pronate or
sodium bicarbonate.
6. How did you grasp a 1 mm sized cotton swab with forceps and sweep the gastric mucosa?
7. Reference number 3 does not seem to be literature that supports the content described.