JerMa88/BMC_Gastroenterology_Peer_Reviews huggingface dataset:
Review for 10.1186/s12876-024-03199-7 (2024)

Title: Circulatory Resistin Levels in Inflammatory Bowel Disease: A Systematic Review and
Meta-Analysis
Version: 0 Date: 27 Jan 2024
Reviewer's report:
The article was well written and the statistics is reliable. I don't have major comments.
My only concern is about the high heterogeneity observed in all the analyses. Meta-regression
doesn't seem able to explore properly the sources of heterogeneity so the the authors should do
more efforts to assess this issue.
The authors could also try to run a ROC analysis to find the best cut-off value to discriminate
between positive and negative outcomes in IBD patients.
Discriminative ability based on an AUC curve 0.66 doesnt seem very high..........does this value
have a clinical meaning?
Review for 10.1186/s12876-024-03195-x (2024)

Title: Effect and potential mechanism of oncometabolite succinate promotes distant metastasis
of colorectal cancer by activating STAT3
Version: 2 Date: 02 Oct 2023
Reviewer's report:
The authors report that succinate could significantly enhance the metastasis and invasion of
colorectal cancer cells and enhance p-STAT3 expression and the EMT process.
I recommend to address following points for the article more informative.
We would like to inquire if there are any results available regarding the analysis of succinate
expression levels in clinical samples and its correlation with prognosis or distant metastasis.
The text states that an increase in succinate concentration leads to a decrease in cell viability
due to the effects of drug toxicity. Kindly, share the supporting evidence.
We would like to know if experiments have been performed to confirm the link between
metabolic pathways, cell cycle, and cell death.
In vivo experiments, it was confirmed that succinate enhances the distant metastasis of colorectal
cancer. We are interested in the effects when inhibiting the phosphorylation of STAT3.
You are conducting in vivo experiments to study the promotion of distant metastasis in colorectal
cancer.
Please let us know if there is a specific reason why you evaluated lung metastasis rather than
liver metastasis.
The notation regarding the presence or absence of significance in the comparison between the
two groups is missing.
There are some spelling mistakes in the text, so please check again.
Review for 10.1186/s12876-024-03195-x (2024)

Title: Effect and potential mechanism of oncometabolite succinate promotes distant metastasis
of colorectal cancer by activating STAT3
Version: 2 Date: 23 Oct 2023
Reviewer's report:
This manuscript describes that succinate can increase p-STAT3 expression, promote the EMT
process, and promote the distant metastasis of colorectal cancer. This report is a bit lacking in
novelty. There are several points in this manuscript that need to be improved, which are listed
below.
1. This report is a bit lacking in novelty. For example, Previous studies have already shown that
succinate activates EMT via the HIF1a-PI3k axis and promotes distant metastasis. However, you
should accurately describe and discuss previous studies on the relationship between succinate
and distant metastasis in the background or discussion section.
2. Could you show the impact of increased succinate content on patient prognosis (overall
survival, DFS, etc.) with the data from your institution and add it to Figure 1? Data relating
succinate content to distant metastasis would be desirable.
3. The reason for focusing on the relationship between succinic acid and STAT3 and EMT
is unclear. Could you indicate the results of any gene expression analysis (e.g. RNA-seq)
or pathway analysis? It has been previously reported that succinic acid promotes STAT3
phosphorylation and that succinic acid activates EMT.
4. In all the figures in Fig. 3, could you add and compare the results of succinate alone added
to SW480 and HCT and the negative control results.
5. In Figure 4, please add the experimental system in which HO-3867 is administered to mice.
This manuscript needs as much novelty as possible in order to be accepted.
6. The description in section 4.10 Statistical Analysis is not accurate. The statistical analyses
used should not be only one-way ANOVA or Kruskal-Wallis test. Moreover, it should be clear
which statistical test was used to generate every P-value. These data should be analyzed using
tests that are adequate for multiple groups, such as analysis of variance (ANOVA) followed by
a post hoc test (e.g. Tukey, Bonferroni, Dunnett, etc.) for parametric data, or Kruskal-Wallis test
followed by Dunn's test for non-parametric data.
Review for 10.1186/s12876-024-03195-x (2024)

Title: Effect and potential mechanism of oncometabolite succinate promotes distant metastasis
of colorectal cancer by activating STAT3
Version: 6 Date: 20 Feb 2024
Reviewer's report:
Thank you for your well response and revision.
The manuscript is in a nice condition.
I think that this paper is suitable for publication.
Review for 10.1186/s12876-024-03188-w (2024)

Title: Symptoms, burden, and unmet needs of patients living with exocrine pancreatic
insufficiency: a narrative review of the patient experience
Version: 0 Date: 22 Jul 2023
Reviewer's report:
This comprehensive review of the literature, on the experience of patient of living with exocrine
pancreatic insufficiency, revealed that there are aspects we still do not know about the patient's
experience with EPI, such as emotional functioning and disease burden. It also shows that we
lack long-term studies on the effects of PERT, on the quality of life and on comorbidities. It is
clear that a large part of the symptoms are taken to one's own disease, and not only to EPI.
As expected, HRQoL is adversely affected by EPI and its symptoms and impacts in all
HRQoL domains. The literature identified indicates that individuals with EPI suffer from
many comorbidities and that treatment with PERT led to a decrease in abdominal pain, aided
significantly in digestion and fat absorption. There was also a lack of studies on the long-term
effects of PERT and studies to explain the disease and its progression.
The manuscript is a highly accomplished literature review, and may help to guide future studies
of the effects of the PEI, taking into account the Patient Reported Outcomes Measures,(PROM)
and Patient Reported Experience, Press) to help build value in health.
I consider the manuscript to be appropriate for publication in BMC Gastroenterology as it is
written.
Review for 10.1186/s12876-024-03188-w (2024)

Title: Symptoms, burden, and unmet needs of patients living with exocrine pancreatic
insufficiency: a narrative review of the patient experience
Version: 0 Date: 25 Jul 2023
Reviewer's report:
Exocrine pancreatic insufficiency (EPI) is a major digestive issue that leads to many long-term
complications from maldigestion and malnutrition. EPI is underdiagnosed and undertreated, so
a focus on EPI is welcome to highlight this, in an effort to improve the treatment of patients.
EPI is present in multiple diseases, however, and therefore a focus on patient experience of
EPI is likely to be confounded by the differences between these multiple diseases and their
symptomatologies. This is analogous to a focus on patient experience of diminished cardiac
output, also from multiple diseases with different symptomatology that would confound attempts
to pinpoint the exact impact on patient experience of diminished cardiac output and its treatment.
The study of Barkin et al identifies pain as the commonest accompaniment of EPI in the studies
identified, which suggests that chronic pancreatitis is a dominant theme in these as this is
typically the most painful condition associated with EPI. The focus on patient experience and
highlighting the need for long-term trials of the treatment of EPI are welcome, the approach
adopted has the major issue of confounding as described. This should be thoroughly and robustly
addressed in the discussion and outlined as a significant limitation of the study. Furthermore,
there are components of the results that would be more appropriate in the discussion, and should
be moved accordingly.
Review for 10.1186/s12876-024-03188-w (2024)

Title: Symptoms, burden, and unmet needs of patients living with exocrine pancreatic
insufficiency: a narrative review of the patient experience
Version: 0 Date: 27 Jul 2023
Reviewer's report:
An interesting review,  and a summary of the impact of PEI on the patient is a much needed
topic for research, however, I have some concerns regarding your methodology.
Within your search terms, you have made some choices that have restricted your search results.
PEI AND pancreas
EPI AND pancreas
The use of the AND within this will exclude any studies that make reference to EPI / PEI and
a disease/surgical procedure, but as we should not see an abbreviation without the full text in a
title or abstract, I doubt this made a difference.
However,  "exocrine pancreas insufficiency" and "pancreas exocrine insufficiency" should have
been included
By not including the treatment within your search criteria you may have excluded interventions
studies, I would recommend the use of pancreatic enzyme replacement therapy, pancreatin,
pancrealipase, and pharmacological product names etc. within your MESH terms.  I assume
from the section within the text that you have done this,  and your table is a mistake (S6)
The inclusion of epigastric pain and the English spelling of diarrhoea / steatorrhoea and
coeliac disease, nutrition, oral intake, patient reported outcomes, mental health,  unmet needs,
osteopathy, would have been more inclusive search terms This is illustrated by the absence
of any studies on anxiety and depression, when these are frequent outcome measures in PEI
intervention trials so should have been identified from your inclusion criteria.  Certainly they
have been identified in other systematic reviews.
Your numbers don't add up, you reference 6 papers in the first section and 18 results in the
second section, but there are only 15 refences used by the time you complete the results section
of section 2.  Even assuming a 100%  cross over you have not described all 18 results
Search S5 and 6 appear to duplicate and should include adverse events, complications, side-
effects and should include aetiology  not just cause/risk.
Line 238 Complications, there are a lot of conflicting  and controversial data on fibrosing
colonopathy, one reference is insufficient to discuss this rare but catastrophic potential
complication. .
Lines 250-260 - please place references next to their appropriate statement rather than leaving
them all at the end of the paragraph.
It would be nice to summarise the results you do have, appreciating there are very different
methodologies and meta-analysis is not applicable, this paper doesn't really tell me very much
about the papers you found.  When you talk about common effects, it would be nice to put some
figures to these  - how common is common?
All in all, I am afraid I do not believe that your literature search is sufficient to have captured all
the relevant literature on this subject, and the provision of data is not specific enough to meet
the requirements for publication at this time.
Review for 10.1186/s12876-024-03188-w (2024)

Title: Symptoms, burden, and unmet needs of patients living with exocrine pancreatic
insufficiency: a narrative review of the patient experience
Version: 2 Date: 02 Nov 2023
Reviewer's report:
I consider the manuscript to be appropriate for publication in BMC
Gastroenterology as it is written now with the new added comments
Review for 10.1186/s12876-024-03188-w (2024)

Title: Symptoms, burden, and unmet needs of patients living with exocrine pancreatic
insufficiency: a narrative review of the patient experience
Version: 2 Date: 23 Nov 2023
Reviewer's report:
In introduction, author state that EPI is caused by maldigestion but this is inaccurate and the
opposite is correct.
There is insufficient references for the long term consequences of EPI.
Need a reference to this statement  (many are not treated with appropriate dosages of pancreatic
enzyme replacement therapy (PERT)).
Methodology:
I have a major concern about the methodology used to obtain literature on the relevant questions.
The author restricted themselves on already predefined setting but the question is on patient
experience ie searching for abdominal pain is relevance but a short snapshot of patient symptoms
rather than experience. To qualify for patient experience you will need a period of observation
and this should be clearly stated whether those papers included were patients on PERT or before
initiating PERT. The title should be something like the most commonly reported symptoms of
PEI or something along these lines
Also authors included paediatric population and this has not been clearly mentioned in the
finding. Why they included paediatric population with PEI as this is most commonly associated
with CF.
Table 1 doesn’t show many exclusion criteria. PEI is included where it is the topic of interest.
The search included outcomes of interest which I am unsure if it should be in this table. I suggest
this table need redesigning with a clear set of inclusion and exclusion criteria. More importantly,
animal studies should’ve excluded from the outset.
Certainly there is extensive search criteria but someone understand the literature on PEI will be
applying less parameters because you put yourself at risk of excluding many relevant papers.
Most papers on PEI discuss methods of diagnosis, associated conditions and effect or PERT and
within the literature you can find symptoms.
What was the reason for including PERT- there has been a number of metanalyses showing
efficacy of PERT in PEI. The majority of papers included in this paper were on PERT which
is 70 and I don’t think you have covered it here extensively. You don’t need to include PERT
papers at all as the paper is describing patient living with PEI. If this chosen then the finding
should describe and differentiate those on PERT and without.
It is vital to include the other comorbidities of patients with PEI because it is relevant here and it
could be causing symptoms ie chronic pancreatitis cause pain. DM patient also have GI symptom
and other systemic symptoms.
This statement is inaccurate (For individuals with CP, EPI therapies include opioids, endoscopy,
and surgery). We don’t perform endoscopy or give opioid to treat PEI. I also disagree that opioid
is the treatment of choice for CP. Authors should read about the guidelines on managing CP
which can be different from PEI.
Again, irritable bowel syndrome doesn’t cause PEI but can be associated with
Review for 10.1186/s12876-024-03188-w (2024)

Title: Symptoms, burden, and unmet needs of patients living with exocrine pancreatic
insufficiency: a narrative review of the patient experience
Version: 3 Date: 15 Feb 2024
Reviewer's report:
"PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
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: - In the revised manuscript the authors have changed the article to
a narrative review, as requested by the editor
- Moreover they answered point-by-point to the several issues raised by the reviewer #4
- According to the editor and reviewer's suggestions and remarks, the authors have extensively
revised the manuscript
ADDITIONAL REQUESTS/SUGGESTIONS:
none"
Review for 10.1186/s12876-024-03166-2 (2024)

Title: Hemorrhoidal Disease among doctors from Grade-A Tertiary Hospitals in Big Cities of
China: results from web-based doctors as patients survey
Version: 2 Date: 28 Jun 2023
Reviewer's report:
The article ,though interesting, is based on a questionnaire where more than 50% of the doctors
who suffered from HD have not had a physical examination. The major symptom experienced
was pain followed by bleeding . In anal fissure too the major symptom is pain followed by
bleeding; so how do we know that the majority of doctors whose main symptom was pain were
not suffering from anal fissure rather than haemorrhoids. The study has assumed that these
doctors were suffering from HD. Further clarification is needed on this point before accepting
the article
Review for 10.1186/s12876-024-03166-2 (2024)

Title: Hemorrhoidal Disease among doctors from Grade-A Tertiary Hospitals in Big Cities of
China: results from web-based doctors as patients survey
Version: 5 Date: 09 Jan 2024
Reviewer's report:
The article is interesting & eye opener. Why were only doctors from Grade A tertiary hospitals
included. Do you think that doctors of similar seniority from other hospitals would have a
different result?
The Grammar needs to be corrected at many places
Review for 10.1186/s12876-024-03153-7 (2024)

Title: Gender Differences in Gastrointestinal, Biopsychosocial and Healthcare-seeking
Behaviors in Chinese Patients with Irritable Bowel Syndrome Predominant with Diarrhea
Version: 1 Date: 12 Nov 2023
Reviewer's report:
The results of this study among Chinese patients with IBS-D showed statistically significant
differences between male and female patients not only in psychosocial factors but in other areas
such as age, BMI, (importantly) education levels, dish styles, and types of food consumed.
The authors would be well advised to provide 95% CI for their data to add more meaning to
these findings, as well as provide similar data in areas other than IBS-D. The latter will tell us
whether the differences extend to the Chinese general population or are restricted to IBS-D
Review for 10.1186/s12876-024-03180-4 (2024)

Title: Construction and validation of a nomogram for cancer specific survival of postoperative
pancreatic cancer based on the SEER and China database
Version: 1 Date: 17 Dec 2023
Reviewer's report:
The poor prognosis associated with pancreatic cancer presents an ongoing therapeutic challenge.
The authors' endeavor to construct a nomogram for predicting pancreatic cancer-specific
survival (CSS) following surgery is a valuable exploration, and the model demonstrates
satisfactory performance. Nevertheless, several questions remain.
Primary concerns:
1. While there are established nomogram studies on pancreatic cancer prognosis, it is crucial
for the authors to highlight the strengths of their study. Comparisons with traditional nomogram
models should be made to elucidate the advantages of this particular investigation.
2. As mentioned by the authors, the model's area under the curve (AUC) value, commonly
referred to as the C-index, is closely linked to the time series. It is recommended that the
authors present the C-index performance for additional cutoffs, such as 3- and 5-year intervals,
in addition to the 1- and 2-year cutoffs provided.
3. The authors' risk stratification employs cutoff values for risk scores. To enhance clarity, a
diagram should be included to illustrate precisely how these two cutoff values were determined.
4. Typically, the C-index increases progressively with longer follow-up durations due to
a decrease in the number of survivors, resulting in higher accuracy in predicting survival.
Moreover, the limited inclusion of clinical indicators within the SEER database constitutes an
inherent flaw. It would be valuable for the authors to explain how the external validation cohort
achieved C-index values of 0.901 and 0.803 for the 1- and 2-year models, respectively, despite
these challenges.
5. The introduction section of the article should be supplemented with a comprehensive review
of previous nomogram studies.
6. The structure of the discussion section requires revision. The first paragraph should not
duplicate information already presented in the introduction section. The significance of the
second paragraph is uncertain, and the third paragraph should primarily focus on the model and
its predictors. The fourth paragraph should address the limitations of the model.
Secondary concerns:
1. The article exhibits some issues with language usage, and it is advisable to have a native
speaker review and revise the wording and language expressions.
2. The rationale behind singling out Figure 1 should be clarified by the authors.
3. It is suggested to rename the "Validation" in the article as the "Internal validation cohort" and
the "Chinese cases" as the "External validation cohort" to enhance clarity and avoid confusion.
Review for 10.1186/s12876-024-03180-4 (2024)

Title: Construction and validation of a nomogram for cancer specific survival of postoperative
pancreatic cancer based on the SEER and China database
Version: 1 Date: 03 Jan 2024
Reviewer's report:
In this study "Construction and validation of a nomogram for cancer specific survival of
postoperative pancreatic cancer Based on SEER and China database." the authors aimed to
construct a nomogram that predicts postoperative cancer-specific survival of pancreatic cancer
patients. The objective here is clear. However, there are some limitations,
Although the authors list factor M and chemotherapy as variables in the nomogram, it is common
knowledge that these are very poor predictors of prognosis. Furthermore, in cases that did not
receive chemotherapy, patients are often too ill to intervene even if they wanted to. Thus, even
if the prognosis of these cases turns out to be poor, no strategy can be formulated. In other
words, the nomogram is expected to be completely useless clinically. It is unclear under what
circumstances the authors intend to use this model.
In order to create such a predictive model, one must fully consider the clinical context and
whether it is relevant to the actual clinical question. To give an example, "Which elderly patients
need surgical treatment?" would be very attractive and useful for clinical decision-making.
External validation in the Chiniese cohort is very important, but the very small number of cases
may overestimate the predictive power of the model.
Review for 10.1186/s12876-024-03180-4 (2024)

Title: Construction and validation of a nomogram for cancer specific survival of postoperative
pancreatic cancer based on the SEER and China database
Version: 3 Date: 22 Jan 2024
Reviewer's report:
The authors have provided thoughtful and logical responses to my concerns, and they have
made appropriate revisions accordingly. At this point, I have no further comments to add, except
for some minor details regarding the images. For instance, in FIGURE 7, I noticed a black
background that may require additional coordinated editorial adjustments.
Review for 10.1186/s12876-024-03171-5 (2024)

Title: Clinical features of inflammatory bowel disease unclassified: a case-control study
Version: 1 Date: 30 Sep 2023
Reviewer's report:
Dear Author,
I read with interest this paper about the clinical features of inflammatory bowel disease
unclassified; the manuscript is well written, but I want to share some considerations:
-The paper doesn’t include patients affected by IBD and in therapy with other biologics except
anti-TNF#: I don’t understand why you didn’t include other therapies, in particular in the era
of the concept of ‘’target therapy’’.
In line 176-179, you say: ‘’The IBDU group had a higher prevalence of upper gastrointestinal
involvement (8.1% vs 0.0%, P<0.05), ileal involvement (21.6% vs 9.5%, P<0.05)and rectal
sparing (59.5% vs 2.7%, P<0.01), compared with the UC group.’’ This is not relevant, since UC
has not an upper GI localization.’’
I’m sorry, but I suggest to reject the work.
Review for 10.1186/s12876-024-03171-5 (2024)

Title: Clinical features of inflammatory bowel disease unclassified: a case-control study
Version: 1 Date: 11 Oct 2023
Reviewer's report:
This reported the disease course of IBDU. Accurate diagnosis of inflammatory bowel disease
is important for appropriate treatment. IBDU includes three types, such as CD, ulcerative
colitis (UC) and true unclassified IBD. Difinitive criteria of CD was proposed in 2000 (Dis
Colon Rectum. 2000;43(10 Suppl):S85-93 ). But the criteria of CD has not been defined in
many reports. CD has been diagnosed comprehensively based on clinical, endoscopic and
histopathologic features. Therefore, diagnosis of IBDU ends up being ambiguous in practice.
The authors pointed out of that episode of hemorrhage implies Crohn’s disease (CD).
The authors showed that many characteristics of IBDU is intermediate of UC and CD. I think
that this just reflects that this group includes both UC and CD. It is better to compare to UC-
reclassified and CD-reclassified patients.
There are some minor points:
There are miss spellings, such as fissing and ulcerationr.
Decrease of 2mg/dL of hemoglobin does not cause anemia.
The duration from symptoms onset to diagnosis of IBDU were weeks or months?
In table 3, descending colon (75.7.5%)?
Review for 10.1186/s12876-024-03171-5 (2024)

Title: Clinical features of inflammatory bowel disease unclassified: a case-control study
Version: 3 Date: 12 Jan 2024
Reviewer's report:
This was revised well.
There is a minor comment. The authors defined GI hemorrhage as a decrease of 200mg/dL in
hemoglobin. However, normal hemoglobin level is 12~18g/dL. I think less than 2% of decrease
is not significant, rather within the margin of error.
Review for 10.1186/s12876-024-03181-3 (2024)

Title: A colonial serrated polyp classification model using white-light ordinary endoscopy
images with an artificial intelligence model and TensorFlow chart
Version: 3 Date: 13 Oct 2023
Reviewer's report:
1. TensorFlow (https://www.tensorflow.org/) and CNN are implemented to construct our deep
learning model.  Although you used CNN based deep learning algorithm by utilizing the
tensforlow framework. Please rewrite it.
2.  This is a very basic study. The novelty lies in the dataset collection. The deep learning
techniques used in the process is not novel.
3. The authors should report the processing speed for the test time.
4. In the conclusion, the authors mention that their model can effectively help physicians
distinguish between TA, SSA, and hyperplastic polyps. I think this is only a study, there are
several advanced studies in the domain of computer science and colonoscopy. Some of the
popular works I know of are ResUNet++, TGANet, DoubleUNet,  Polyp-PVT, and PraNet.
5. The authors should mention that why they used Inception Net for this task. At least try with
ResNet-34 and 5ResNet50. to make the study more comprehensive.
Review for 10.1186/s12876-024-03181-3 (2024)

Title: A colonial serrated polyp classification model using white-light ordinary endoscopy
images with an artificial intelligence model and TensorFlow chart
Version: 3 Date: 18 Jan 2024
Reviewer's report:
Although the authors have done really nice job for the chosen research problem but still the
incorporation of the following points will help in enhancing its quality:
1. There is very less information and discussion about the novelty proposed in the manuscript.
Please focus only on the novelty proposed if any.
2. There is no comparison done with the any State-Of-Art methodologies present in the literature
specifically proposed for the chosen research problem. Please include few of them (mainly of
2022 and 2023) otherwise how would we come to know that there is no biasness is there in
your paper and your proposed methodology has surpassed other proposed techniques. And this
comparison should be done in tabular form after applying them on your datasets or applying
your methodology for the dataset given in them.
3. Please clearly depict the USP and significance of your research work for the chosen research
problem.
4. In section 5 of Conclusion, there is no information given regarding the Limitations and future
work for the proposed methodology. Please include it.
Review for 10.1186/s12876-024-03189-9 (2024)

Title: investigating the mortality trend of gastrointestinal cancers in Babol, North Iran
(2013-2021)
Version: 1 Date: 07 Oct 2023
Reviewer's report:
this article is very interesting and well written and had important epidemiologic information
about GI cancers in high risk region for GI cancers
Review for 10.1186/s12876-024-03189-9 (2024)

Title: investigating the mortality trend of gastrointestinal cancers in Babol, North Iran
(2013-2021)
Version: 1 Date: 30 Jan 2024
Reviewer's report:
This study  is  valuable  for health managers . For getting more valuable of results authors should
be considered following comments.
1- In abstract, in background and aim section, the reasons of why study are important should
be mentioned.
2- According to the title, the type of study is longitudinal.
3- The figures have been drawn with excel and it is necessary to mentioned in statistical packaged
used.
4- In the first paragraph have been mentioned "Men had a higher mortality rate from
gastrointestinal cancers than women (1.62:1 ratio)". But this results that are so important didn't
report in result and abstract. Also it is necessary that report with confidence interval.
5- In page 12, line 8. There are two sentences that are opposite and need the appropriate the
conjunction phrase.
6- In page 12, line 10 to 22 there are too "per hundred thousand" it needs to mention in the way
that do not  destroyed the meaning but remove the extra ones.
7- The discussion is too long, it is necessary to summarize it.
Review for 10.1186/s12876-024-03186-y (2024)

Title: Comparison of Prognostic Outcomes between Endoscopic Submucosal Dissection and
Surgical Treatment for Early Gastric Cancer: A Retrospective Cohort Study
Version: 1 Date: 19 Nov 2023
Reviewer's report:
Dear Author,
This paper compares ESD and surgery as treatment modalities for early gastric cancer. Several
concerns have been raised about this article. Firstly, there is no description of the pathological
investigation methods. Specifically, the mention of vascular invasion raises questions about
whether lymphatic invasion is included and how this is determined. Additionally, the paper lists
only M and SM depths without specifying the depth level of the SM.
The survival and recurrence curves exhibit a notable decline at 3 and 5 years, which is
significantly more pronounced than in previous reports.  (Abdelfatah MM, et al. Long-term
outcomes of endoscopic submucosal dissection versus surgery in early gastric cancer: a
systematic review and meta-analysis Eur J Gastroenterol Hepatol 2019 Apr;31(4):418-424.
Jeon HK, et al. Long-term outcome of endoscopic submucosal dissection is comparable to
that of surgery for early gastric cancer: a propensity-matched analysis Gastric Cancer 2018
21:133–143) Although the lesions in this study are expected to be part of the treated group
with radical resection and a favorable prognosis, factors contributing to this poor outcome need
clarification. It is imperative to address the cause of death and any forms of recurrence, if present.
A comprehensive discussion on these aspects is essential.
The absence of data on metachronous cancer is a notable gap. Given its potential impact on
prognosis, this data should be included. Furthermore, the follow-up observation period needs
to be explicitly stated.
Regarding the concluding statement, "In conclusion, our study provides evidence that ESD may
be a viable option for the treatment of early gastric cancer," comments suggesting that treatment
modalities not aligned with the indications for treatment are equivalent can be misleading to the
reader. Clarification on this point is necessary.
Review for 10.1186/s12876-024-03186-y (2024)

Title: Comparison of Prognostic Outcomes between Endoscopic Submucosal Dissection and
Surgical Treatment for Early Gastric Cancer: A Retrospective Cohort Study
Version: 1 Date: 24 Nov 2023
Reviewer:  Kohei Yamanouchi
Reviewer's report:
Comments to the Author
I enjoyed reading this retrospective cohort study entitled “Comparison of Prognostic Outcomes
between Endoscopic Submucosal Dissection and Surgical Treatment for Early Gastric Cancer:
A Retrospective Cohort Study”.
Furthermore, the following comments should be addressed.
1. The authors indicated over all survival and recurrence-free survival in Figure 2. However,
both rates are considerably lower than those reported in previous studies. This may be due to
the effect of death from non-gastric cancer caused by the patient's underlying disease.
2. Related to question 1, over all survival is low in both the ESD and surgery groups, despite
the inclusion of many patients younger than 60 years and ASA-PS grade I patients. What do the
authors think about this point?
3. It seems somewhat unlikely that there is little difference in baseline characteristics between
patients in the ESD and surgery groups. In the choice of treatment, there usually seems to be a
difference in procedural difficulty, factors related to recurrence (tumor diameter, location, tumor
differentiation, presence of ulceration, etc.) and patient background (age, ASA-PS). How would
you interpret this?
4. In Table 1, the percentage of intramucosal lesions in the ESD group appears to be low. Is this
because the indications for ESD for early gastric cancer are widely defined? I think it should be
noted what percentage of patients are considered to have an indication for ESD or an extended
indication for ESD based on the preoperative diagnosis.
5. In Table 3, the authors use recurrence-free survival (RFS) to evaluate prognostic factors,
but considering that the number of non-gastric cancer deaths would be quite high, it may be
preferable to use disease-specific survival rather than RFS.
6. In this study, were there any cases that were pathologically diagnosed as non-curative
resection after ESD and subsequently incorporated into the surgical group? Or were most of
the patients who had non-curative resection after ESD to be followed up without additional
gastrectomy?
7. In the Materials and methods section, the description of hemostasis in surgery is noticeably
repetitive and should be simplified.
8. The differentiation of gastric cancer is mixed between "high" and "well", so please unify the
description.
Review for 10.1186/s12876-024-03186-y (2024)

Title: Comparison of Prognostic Outcomes between Endoscopic Submucosal Dissection and
Surgical Treatment for Early Gastric Cancer: A Retrospective Cohort Study
Version: 3 Date: 28 Jan 2024
Reviewer:  Kohei Yamanouchi
Reviewer's report:
I appreciate your response to my previous comment.
Additionally, I need a response to the following comment.
1. About (2) Intraoperative Assessment in the Pathological investigation methods section, the
authors describe "During ESD and surgical procedures, real-time intraoperative assessments
were made to confirm and further detail the depth of invasion. During ESD and surgical
procedures, real-time intraoperative assessments were made to confirm and further detail the
depth of invasion”. How do you assess intramucosal or SM invasive cancer in real time during
ESD and surgery? It should be described whether it can be determined by gross or endoscopic
findings.
2. The authors classify the depth of cancer as M1 to M3 and SM1 to SM3. Which guidelines are
these depth criteria taken from? For example, in Japanese gastric cancer guidelines, intramucosal
gastric cancer is described M and SM invasive cancer is SM1 or SM2 according to the distance
of invasion.
3. As reviewer 1 commented, the description of SM depth levels still seems inadequate. Only
M and SM1 cases are included in Table 1, in contrast, there is no case of SM2 and SM3. It
seems unnatural.
4. The authors describe in Response 7 that "We have provided further detailed explanations in
the inclusion and exclusion criteria, emphasizing that all cases We have provided further detailed
explanations in the inclusion and exclusion criteria, emphasizing that all cases underwent
curative resection and explicitly excluding cases from the ESD group that were later included
in the surgery group”. In addition, non-curative resection is mentioned in the Exclusion criteria
section in the revised manuscript. On the other hand, in Table 1, there are 32.1% of cases of
vascular invasion in the ESD group, which we consider to be inconsistent because it seems to
fall under the category of ESD non-curative resection.
5. About survival time in the Results section, how many cases who were only followed up
without additional surgical resection in the ESD groups (262 cases). The authors should clearly
state this.
Review for 10.1186/s12876-024-03182-2 (2024)

Title: The association between hemoglobin level and sarcopenia in Chinese patients with
Crohn's disease
Version: 0 Date: 28 Oct 2023
Reviewer's report:
The article explores the correlation between decreasing hemoglobin levels and the increasing
prevalence of sarcopenia in patients with Crohn's disease. The research provides valuable
insights into the potential role of hemoglobin as an indicator of sarcopenia in CD patients and
provides a comprehensive insight into the association between hemoglobin levels and sarcopenia
in Chinese CD patients. The methodology is thorough and ensures clarity in understanding the
research process.
However, some points need to be addressed:
- The introduction could benefit from a more detailed explanation of the mechanisms causing
sarcopenia in CD patients, not only chronic inflammation but also malnutrition (see PMID:
36933563) and the clinical relevance of sarcopenia in CD patients (see also PMID: 37862577).
- It might be beneficial to provide a brief rationale for the chosen cut-off values in defining
sarcopenia.
- Given the retrospective nature of the study, potential biases or limitations should be addressed.
While the study acknowledges its limitations, a more in-depth exploration of how these
constraints might affect the conclusions would have been beneficial.
- The discussion could benefit from a more in-depth exploration of interventions or treatments
that could address the identified associations.
- The article's language and presentation would benefit from revision and correction by a
native speaker. Some sections could be clearer and more concise to enhance readability and
comprehension.
Review for 10.1186/s12876-024-03182-2 (2024)

Title: The association between hemoglobin level and sarcopenia in Chinese patients with
Crohn's disease
Version: 0 Date: 17 Dec 2023
Reviewer's report:
The topic is clinically relevant; however, it lacks significant insights in a clinical context,
practical implications, and novel contributions to Crohn's disease management. Furthermore,
the retrospective design of the study, conducted at a single tertiary referral center, limits the
generalizability of the results to the total IBD population.
Firstly, the assessment of sarcopenia is incomplete. The authors should familiarize themselves
with the current recommendations within the clinical algorithm used for sarcopenia (https://
www.ncbi.nlm.nih.gov/pmc/articles/PMC6322506/), which indicates that three elements should
be assessed to diagnose sarcopenia: muscle strength, muscle quantity, and physical performance.
Without evaluating all three elements, proper diagnosis of sarcopenia is not possible. The authors
only assessed one of the required elements, so they cannot claim to have diagnosed sarcopenia
based solely on that element.
Indeed, measuring sarcopenia can be challenging, with limitations in accessibility, including
the need for specialized staff, cost, and time. Please include a comment in the discussion
on inexpensive and easily administered point-of-care tests to implement the assessment of
sarcopenia as standards of care for risk stratification in inflammatory bowel disease (Nardone
OM, 10.1016/j.dld.2023.04.014).
The authors mentioned that the exact mechanism of sarcopenia remains unknown. However,
factors such as aging, inflammation, mitochondrial dysfunction, insulin resistance, and gut
microbiota are related to sarcopenia. Please include a comment on this.
Both persistent chronic inflammation and malnutrition collaboratively predispose patients with
inflammatory bowel disease (IBD) to the development of sarcopenia. It may be important to
include data about BMI and the clinical activity of the disease (HBI clinical score).
The authors wrote about endoscopic granuloma detection. Granuloma detection is generally a
histologic feature. How can the authors assess it using endoscopy? Please clarify and explain
this point.
Unfortunately, in its current form, the manuscript is marred by several grammatical slips and
stylistically cumbersome passages.
The references should be updated. Recent data has shown the association between extra-
intestinal manifestations and sarcopenia in CD.
Review for 10.1186/s12876-024-03182-2 (2024)

Title: The association between hemoglobin level and sarcopenia in Chinese patients with
Crohn's disease
Version: 2 Date: 15 Jan 2024
Reviewer's report:
The authors have addressed some of the raised points, but several concerns remain. A plausible
explanation for the relationship between anemia and sarcopenia may be linked to disease
activity. If data on disease activity are lacking, explaining the level of anemia and ensuring the
association with CD becomes challenging.
The authors assert that malnutrition causes anemia and sarcopenia. The connection between
malnutrition and sarcopenia has already been demonstrated [doi: 10.3390/nu14173460].
However, in the current study, the number of patients suffering from malnutrition is unknown.
Please include this data
Also, consider whether other comorbidities or other conditions (such as age, comorbidity, and
sedentary activity) could cause anemia, and provide this information.
Given recent diagnoses, understanding the impact of CD inflammation on sarcopenia
development is questionable. Please provide a comment about this.
As previously argued, granulomas cannot be detected via endoscopy; this is a histological
feature. Please correct and explain how the authors identify the presence of granulomas.
The authors state, "Sarcopenia evaluated by CTE or MRE did not cause additional cost or
ionizing radiation." Remove CTE from this sentence, as it is associated with ionizing radiation.
There's a lack of other Montreal parameters. Please add L2, L3, and B2, B3 percentages.
Change the Montreal classification in Table 1 accordingly.
Regrettably, the manuscript, in its current form, still suffers from logically cumbersome
passages. The discussion section, in particular, contains redundant sentences. For instance, the
statement "if anemia or low hemoglobin level is associated with sarcopenia, the sarcopenia may
be improved by the intervention on anemia. Consequently, clinical outcomes may be improved"
is repeated twice. Please revise and tone down this sentence, as it lacks evidence support.
Review for 10.1186/s12876-024-03182-2 (2024)

Title: The association between hemoglobin level and sarcopenia in Chinese patients with
Crohn's disease
Version: 2 Date: 16 Jan 2024
Reviewer's report:
The manuscript titled "The Association Between Hemoglobin Level and Sarcopenia in Chinese
Patients with Crohn's Disease" presents a comprehensive study aimed at exploring the link
between hemoglobin levels and sarcopenia in patients suffering from Crohn's Disease (CD).
The topic is both relevant and timely, considering the growing interest in understanding the
multifaceted complications associated with CD. The authors have made a significant effort to
provide a detailed analysis of the data collected and have presented a well-structured argument
supporting their findings.
Review for 10.1186/s12876-024-03185-z (2024)

Title: Prediction of survival and analysis of prognostic factors for patients with AFP negative
hepatocellular carcinoma: A population-based study
Version: 1 Date: 06 Nov 2023
Reviewer's report:
In this study, the authors aimed to to establish a nomogram of risk factors affecting the prognosis
of patients with alpha-fetoprotein (AFP) -negative Hepatocellular carcinoma (HCC) and to
evaluate its diagnostic efficiency.
They analyzed data from patients with AFP-negative initial diagnosis of HCC (ANHC),
collected from the Surveillance, Epidemiology, and End Results (SEER) database for model
establishment and validation and constructed nomograms with overall survival (OS) and cancer-
specific survival (CSS) as clinical endpoint events and constructed survival analysis by using
Kaplan-Meier curve.  The study included 1811 patients and they found in the multivariate
analysis, that the independent risk factors affecting prognosis were age, ethnicity, tumor
size, tumor grade, surgery, chemotherapy, and radiotherapy. The nomogram-based model
related C-indexes were 0.762 (95% confidence interval (CI): 0.752-0.772) and 0.752 (95%
CI: 0.740-0.769) for predicting OS, and 0.785 (95% CI: 0.774-0.795) and 0.779 (95% CI:
0.762-0.795) for predicting CSS. The nomogram model showed that the predicted death was
consistent with the actual value. The ROC analysis and DCA showed that the nomogram had
good clinical value compared with TNM staging.
Therefore, they concluded that  age, ethnicity, tumor diameter, tumor grade, surgery,
chemotherapy, and radiotherapy were independent prognostic factors for patients with ANHC.
Although the topic addressed is of clinical interest, the study suffers from important issues
limiting the impact of study results. 1) TNM staging system: this is a staging system not taking
into account the residual live function and underlying liver disease, both of which have a
significant prognostic impact; 2) regarding treatments, it is not clearly described how (which
criteria) surgical treatment, liver transplantation, chemotherapy (which one?) and radiotherapy
were decided; 3) were HCC patients under imaging surveillance for HCC, as recommended by
international guidelines?