JerMa88/BMC_Gastroenterology_Peer_Reviews huggingface dataset:
Review for 10.1186/s12876-025-03662-z (2025)

Title: Relationship Between Gastric Mucosal Atrophy, Cystic Dilatation, and Histopathological
Characteristics
Version: 2 Date: 19 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-Consider adding a short explanation of the key histological terms and their significance in the
context of gastric cancer progression (e.g., what non-intestinal metaplasia refers to and how it
differs from intestinal metaplasia).
-The connection between cystic dilatation and gastric cancer progression is an important aspect
of the study, but the introduction could do more to explain how cystic dilatation is a precursor
or intermediate stage in this progression. For instance, what specific histopathological features
distinguish cystic dilatation from other forms of mucosal atrophy, and how do these features
correlate with malignant potential?
-Cite additional studies focusing on the morphologic and histological features of cystic
dilatation, to reinforce the novelty and relevance of the current study's objectives.
-The discussion outlines several contributing factors (infection, immune response, genetic
influences) but does not go into detail about the precise molecular mechanisms responsible for
the development of cystic dilatation. For example, how do these factors lead to the specific
histopathological changes observed in the gastric mucosa? Are there specific genetic mutations
or signaling pathways that drive the transformation from atrophy to cystic dilatation?
-Provide a more in-depth explanation of how the histopathological features of cystic dilatation
correlate with specific types of early gastric cancer. What key changes (e.g., cellular atypia,
invasion) are observed in cystic dilatation lesions that could predict progression to papillary
cystadenocarcinoma or other types of gastric cancer?
-Offer more concrete suggestions for clinicians on how to manage patients with gastric mucosal
cystic dilatation. For instance, should patients with compound cystic dilatation undergo more
frequent surveillance, or should early intervention strategies be considered?
Review for 10.1186/s12876-025-03662-z (2025)

Title: Relationship Between Gastric Mucosal Atrophy, Cystic Dilatation, and Histopathological
Characteristics
Version: 2 Date: 23 Dec 2024
Reviewer:  Mohamed H. Zidan
Reviewer's report:
Dear Authors,
Re: "Relationship Between Gastric Mucosal Atrophy, Cystic Dilatation, and Histopathological
Characteristics"
Thank you for the opportunity to review your manuscript.
The revised manuscript demonstrates significant improvements, particularly with the inclusion
of numerical details in the abstract, reorganization of patient descriptions, and clearer figure
legends. The addition of p-values where applicable strengthens the statistical rigor. However,
several aspects could still benefit from clarification and refinement.
The histological classifications and progression stages are well-described. Still, the presentation
of statistical data (e.g., comparisons of age and sex distributions across stages of cystic dilatation)
could be more thoroughly discussed in the text rather than relying solely on tables. While the
figures provide critical visual support, certain sections, such as Figure 2, remain somewhat
unclear despite the revisions. Adding more detailed commentary on the figure in the discussion
might improve accessibility.
The immunohistochemical findings, particularly the roles of markers such as MUC5AC and
Ki-67, are intriguing, but their implications for clinical practice or molecular mechanisms
of transformation are underexplored. Future studies focusing on these markers' diagnostic or
prognostic value would greatly enhance the impact of this work.
you can expand your discussion with adding : "The observed transformation of gastric mucosal
atrophy into cystic dilatation and subsequent neoplasia is likely influenced by inflammatory
and molecular disruptions, as suggested by Kuester et al. (2013). Their findings demonstrate
that Helicobacter pylori infection, combined with deficiencies in protease pathways such as
cathepsin x/z, induces premalignant host responses. These insights highlight potential molecular
mechanisms underlying the progression of atrophic lesions to cystic dilations and gastric
adenocarcinoma, reinforcing the need for further exploration into host-pathogen interactions in
gastric cancer pathogenesis."
This addition would enrich your discussion with a molecular perspective while maintaining the
focus on histopathological findings.
Ref: Kuester D, et al. (2013). Induction of premalignant host responses by cathepsin x/
z-deficiency in Helicobacter pylori-infected mice. PLoS One, 8(7):e70242. DOI:10.1371/
journal.pone.0070242
Overall, the manuscript provides valuable data on the pathogenesis of gastric mucosal atrophy
and cystic dilatation. The outlined stages and classifications could serve as a critical foundation
for future research into gastric cancer prevention and early detection. With minor adjustments,
the manuscript would be suitable for publication.
Kind regards,
Review for 10.1186/s12876-025-03662-z (2025)

Title: Relationship Between Gastric Mucosal Atrophy, Cystic Dilatation, and Histopathological
Characteristics
Version: 3 Date: 21 Jan 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
the responses are satisfactory.
Review for 10.1186/s12876-025-03607-6 (2025)

Title: Clinical and Demographic Analysis of Patients with Colorectal Cancer Screened at a
Reference Hospital in Southern Brazil: Comparative Study Based on age (Retrospective Cohort
Study)
Version: 4 Date: 18 Oct 2024
Reviewer's report:
Dear Sir,
I read with much interest this manuscript on a hot topic regarding colorectal incidence among
younger age groups of patients.
I praise the significant collection of cases for this retrospective analysis.
That said, I would like to point out some significant topics that need revision/improvement:
Line 20: “with younger patients presenting more aggressive disease characteristics”
I recommend re-writing this statement as the concept of “aggressive” disease may be vague and
misguided. The authors base this assumption on a higher prevalence 2.3% vs 14.7% of occlusive
disease between the two age groups.
However, this may in fact not reflect a true “aggressiveness” of the disease. CRC screening is,
per international and national guidelines, offered to patients >50ys. Therefore, one should expect
a higher proportion of cases be diagnosed in earlier T stages resulting in a lower risk of occlusive/
subocclusive disease.  On the other hand, younger patients are more prone to present with
prolonged symptomatic disease before undertaking endoscopic examination (as the perceived
risk is lower).
Moreover the authors do not present data regarding biological aggressiveness / differentiation
of the disease. Is there any difference in WHO Tumor Grade (G); linfovascular or perineural
infiltration; adjuvant treatment disease free-survival or overall mortality (within the same TNM
sage group) ? All these (and other) variables are key to access whether younger patients really
have more aggressive tumors.
Line 62: “alcohol consumption, smoking”
Whether alcohol consumption does represent a serious risk factor for accelerated carcinogenesis
in CRC is at least debatable. Nonetheless, as smoking, the variable should be quantified (i.e.
in grams of alcohol per day or units pack years). The burden of these risk factors is strongly
related with this.
Line 105-106: . Among those under 50 years old, 19.3% had right-sided colon cancer and 80.7%
had left-sided colon cancer.
The higher incidence of right-sided CRC in older vs younger patients should be addressed as it
does not support current literature
I feel that addressing these points could greatly improve this manuscript.
Best regards
Review for 10.1186/s12876-025-03607-6 (2025)

Title: Clinical and Demographic Analysis of Patients with Colorectal Cancer Screened at a
Reference Hospital in Southern Brazil: Comparative Study Based on age (Retrospective Cohort
Study)
Version: 4 Date: 07 Dec 2024
Reviewer's report:
Review of Manuscript 11-30-24
Clinical and Demographic Analysis of Patients with Colorectal Cancer Screened at a Reference
Hospital in Southern Brazil: Comparative Study Based on age (Retrospective Cohort Study)
This is a retrospective study of 1,121 pts with CRC who were evaluated for differences in clinical
and demographic factors comparing the age of the pts being <50 years of age vs >50 years of age.
The findings with significant differences included the number of pts <50 who were active
smokers 40% vs 15% > 50 years, the number presenting with obstruction/subocclusion, and the
number <50 who presented with bleeding, 14% vs 2.4%. Gender, stage of disease, laterality,
FH, ethnicity, CEA, adjuvant rx, white cell ratios, alcoholism, etc. showed NSD, whereas
similar studies in North America have often shown statistical differences for stage of disease,
distal disease, more women, and more non-Caucasians. Their findings may represent important
differences for their population.
The authors have identified a particularly damaging association of smoking with CRC which
provides a target for preventative measures as well as demonstrating a prototype for their region.
The findings show appreciable variables from other large studies of early- and late-onset CRC
outside of Brazil and may set a somewhat different guideline for this area of southern Brazil.
In order to compare their results to other publications, it might be helpful to indicate precisely
where the demarcation for proximal vs distal colon was made.
Since CEA was tested extensively, could the CEA levels be compared to subsets of pts, e.g.,
who smoked, had differing stages of disease, clinical presentations, etc.?
Are the authors aware of any similar studies from their population area for comparison to their
data? If so, how do they compare?
Review for 10.1186/s12876-024-03583-3 (2025)

Title: Immune-nutritional indicators predict short-term mortality in olderly patients after
emergency gastrointestinal surgery: a retrospective study
Version: 1 Date: 24 Nov 2024
Reviewer's report:
The manuscript titled "Immune-nutritional indicators predict short-term mortality in elderly
patients after emergency gastrointestinal surgery: a retrospective study" investigates the
prognostic value of immune-nutritional indicators in predicting 90-day mortality among elderly
patients undergoing emergency gastrointestinal surgery. Using a retrospective cohort of 4,120
patients, the study evaluates eight immune-nutritional indicators, including mGPS, HS-mGPS,
PNI, and COUNT, through statistical and machine learning methods like LASSO-Cox and
CoxBoost regression models. The findings suggest that immune-nutritional factors such as
mGPS, HS-mGPS, and PNI can serve as robust predictors for short-term mortality, with the
CoxBoost model showing superior performance (AUC = 0.78). A nomogram model was also
developed, demonstrating good predictive accuracy and calibration.
The manuscript provides valuable insights into the predictive potential of immune-nutritional
indicators for short-term mortality in elderly surgical patients. However, significant revisions are
needed to strengthen its scientific rigor, contextual relevance, and practical implications. Major
improvements in the literature review, external validation, and discussion of clinical applications
are essential before the manuscript can be considered for publication.
-  The manuscript requires an updated and broader review of recent literature. For
example: Integrate findings from DOI: 10.1016/j.sto.2024.102272 and DOI: 10.1097/
JS9.0000000000000783, which offer new insights into predictive indicators and their
applications in similar clinical contexts.
- The study lacks external validation, limiting its applicability to other populations and
settings.The single-center nature of the study introduces selection bias.
- The rationale for including specific indicators like NPS, given its poor predictive performance,
should be clarified.
- Please change the term"elderly" with "older patients", since elderly, as stated by WHO, would
be spregiative term.
- The study focuses solely on mortality without addressing postoperative complications, which
could provide a more holistic view of patient outcomes.
- The discussion section could benefit from a more critical appraisal of the clinical implications,
especially regarding how these predictive models could influence surgical decision-making and
postoperative care.
Review for 10.1186/s12876-024-03583-3 (2025)

Title: Immune-nutritional indicators predict short-term mortality in olderly patients after
emergency gastrointestinal surgery: a retrospective study
Version: 1 Date: 02 Dec 2024
Reviewer's report:
In this manuscript, the authors reported that immune-nutritional indicators predict short-term
mortality in elderly patients after emergency gastrointestinal surgery: a retrospective study
Although this is an important and interesting issue, the author should answer below comments.
Major revision
1
The authors do not list the percentage of content of acute abdominal conditions such as
obstruction, perforation, bleeding, etc. The authors should add more detail on this point.
2.
The study states that the mortality rate is about 10%. However, the cause of death is also not
describe. The authors should add about this point.
3.
Why did the author use the LASSO Cox model in creating the nomogram?
4.
Is it possible to create a nomogram based on the CoxBoost model?
Review for 10.1186/s12876-025-03683-8 (2025)

Title: PALLIATIVE BILIODIGESTIVE BYPASS FOR UNRESECTABLE PANCREATIC
MALIGNANCY AT KILIMANJARO CHRISTIAN MEDICAL CENTRE: A
RETROSPECTIVE CROSS-SECTIONAL STUDY
Version: 3 Date: 26 May 2024
Reviewer's report:
Thank you for this informative study, I have a few cooments below
1. in the 4 years (January 2019 to December 2022), were there any resectable cases of pancreatic
cancer, or all cases were unresectable and thus underwent palliative by pass surgery only.
2.  was pancreatic cancer unresectability determined pre-operatively by imaging studies, intra-
operatively by the surgeons's findings or both?
3. MD Anderson, AHPBA/SSAT/SSO, NCCN etc have well defined criteria of pancreatic cancer
resectability based on major vascular involvement (celiac axis, CHA, SMA, SMV/PV). Which
criteria was used and were pre-operative findings correlating with intra-operative findings.
4. I note that your data collection tool had  ( resident, surgeon, hepatobiliary surgeon).  Was
a hepatobiliary surgeon or surgical oncologist involved in any of this surgeries? is it possible
that some cases that might have been classified as unresectable by resident could have been
resectable under hepatobilairy surgeon with skills to do vascular reconstruction especially portal
vein reconstruction?
5. you have clearly quoted previous studies from Tanzania (Kivuyo et al) and Nigeria, how
does your data compare with other Hepatopancreatobiliary surgery studies within East Africa
(Kenya, Uganda, Rwanda etc)?
6. it's striking that 6 patients were re-admitted and all the 6 re-admitted patients all died? any
explanation? and contributed to the high total 30-day mortality.
8. For purposes of clarity can surgeon classification be clear like it is in the data collection
tool, does surgeon in this case mean general surgeon, ( use clear qualifications; resident, general
surgeon, hepatobiliary surgeon, surgical oncologist etc)
9. Any availability of interventional radiologist with capacity to do percutaneous transhepatic
biliary drainage or availability of interventional endoscopy services like ERCP, EUS in this
center or nearby centres?
10. 34 patients did not meet the inclusion criteria, this number appears big, kindly elucidate
which parts of the inclusion criteria they did not meet.
Review for 10.1186/s12876-025-03683-8 (2025)

Title: PALLIATIVE BILIODIGESTIVE BYPASS FOR UNRESECTABLE PANCREATIC
MALIGNANCY AT KILIMANJARO CHRISTIAN MEDICAL CENTRE: A
RETROSPECTIVE CROSS-SECTIONAL STUDY
Version: 3 Date: 28 May 2024
Reviewer's report:
Thanks for your submission. Please find the attached for my comments and suggestions.
Review for 10.1186/s12876-025-03683-8 (2025)

Title: PALLIATIVE BILIODIGESTIVE BYPASS FOR UNRESECTABLE PANCREATIC
MALIGNANCY AT KILIMANJARO CHRISTIAN MEDICAL CENTRE: A
RETROSPECTIVE CROSS-SECTIONAL STUDY
Version: 3 Date: 01 Jun 2024
Reviewer:  Samiran Nundy
Reviewer's report:
I am afraid this experience is not original and does not deserve publication.
Review for 10.1186/s12876-025-03683-8 (2025)

Title: PALLIATIVE BILIODIGESTIVE BYPASS FOR UNRESECTABLE PANCREATIC
MALIGNANCY AT KILIMANJARO CHRISTIAN MEDICAL CENTRE: A
RETROSPECTIVE CROSS-SECTIONAL STUDY
Version: 3 Date: 02 Jun 2024
Reviewer:  Gaurav Das
Reviewer's report:
1. Abstract, results section 5th line. “The mean overall 30-day survival for all patients was
27.6 days”. This sentence does not make sense to me. The same has been described in the
postoperative course sub-section of results section of the main manuscript. This is followed by a
statement that palliation failure was associated with a mean survival of 11.3 days. These results
are certainly not properly conveyed or else there is a problem with the sample population.
2. Introduction section, paragraph 4. I do not agree to the statement that the survival of
unresectable pancreatic cancer is 3 to 6 months (I do understand that published literature says
that 5-year survival is less than 5%). The disease may be “unresectable” but non-metastatic
and belong to the locally advanced group of cancers which are treated with definite strategies
(systemic treatment, chemoradiation, SBRT etc.)
3. Patients and methods section; sample size and sampling sub-section. “34 patients did not meet
the inclusion criteria”. Can you kindly elaborate on the exclusion criteria? The first paragraph is
unclear regarding what was taken as “unresectability” in the inclusion criteria. In the discussion
section, I do note that all the patients had T4 stage according to the TNM 8th ed.
4. Discussion section 7. The most common imaging modality described is an ultrasound (66%).
Can the authors describe whether an ultrasound will be a sufficient investigation to rule in or
out a locally advanced head of pancreas cancer? The use of a triple-phase contrast computed
tomography (pancreatic protocol) is the standard for assessment of resectability of pancreatic
cancers.
5. A 30-day mortality figure of 13.2% and a palliation failure rate of 22.6% does not show an
encouraging outcome with this palliative procedure for the patient population described in the
study. What are the steps that could be taken to improve upon these figures?
6. Did the patients receive any cancer-directed therapy apart from the palliative diversion
procedures?
Review for 10.1186/s12876-025-03683-8 (2025)

Title: PALLIATIVE BILIODIGESTIVE BYPASS FOR UNRESECTABLE PANCREATIC
MALIGNANCY AT KILIMANJARO CHRISTIAN MEDICAL CENTRE: A
RETROSPECTIVE CROSS-SECTIONAL STUDY
Version: 7 Date: 30 Dec 2024
Reviewer's report:
the  author has addressed all the concerns raised in the previous review, manuscript now looks
well written, coherent and highlights challenges of late presentation and limited interventional
options in management of unresectable pancreatic cancer in a resource limited setting.
Review for 10.1186/s12876-025-03683-8 (2025)

Title: PALLIATIVE BILIODIGESTIVE BYPASS FOR UNRESECTABLE PANCREATIC
MALIGNANCY AT KILIMANJARO CHRISTIAN MEDICAL CENTRE: A
RETROSPECTIVE CROSS-SECTIONAL STUDY
Version: 7 Date: 30 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-Although Eastern Africa’s incidence is mentioned, the study could further highlight the
healthcare infrastructure challenges specific to Tanzania or similar low-income regions. For
example, addressing issues like access to surgical interventions, stent placement, or diagnostic
imaging would provide more context on the barriers to care.
-While the study defines palliation failure well, it would be helpful to further clarify how this
impacts post-surgical management. For instance, are patients with palliation failure considered
for other interventions or supportive care only? Also, how is this failure managed in the context
of limited resources?
-While the mean surgery duration (178.5 minutes) and blood loss (77.2 ml median) provide
useful insight into the complexity and safety of the procedures, it would be valuable to compare
these metrics with other studies to contextualize the results. Was the surgery duration typical
for such procedures in a low-resource setting?
-The discussion mentions the discrepancy in the proportion of patients with locally advanced
versus metastatic disease when comparing this study to Pencovich’s research. However, it
would be helpful to provide more insight into why this difference exists. For example, is it due
to differences in diagnostic capabilities, referral patterns, or patient demographics? Exploring
this in more depth could enhance the understanding of how healthcare systems and patient
characteristics influence disease progression and management.
-While palliation failure was observed in 22.6% of patients, the discussion could provide more
specific insights into the underlying causes of palliation failure. Was it primarily due to persistent
gastric outlet obstruction (GOO), biliary issues, or both? Were any complications directly
contributing to palliation failure (e.g., anastomotic leaks, infections)? More detailed information
could help guide future interventions to improve palliation success rates.
-Furthermore, it would be useful to compare these results with those from other settings (e.g.,
high-income countries) where the management of advanced pancreatic cancer might differ,
particularly in terms of postoperative care and follow-up protocols.
-The study highlights that 81.1% of patients were uninsured, indicating a significant
socioeconomic barrier to accessing timely care. While this point is important, the discussion
could delve deeper into how the lack of insurance and low socioeconomic status impacted both
diagnosis and treatment. For example, did patients wait longer to seek care due to financial
constraints, or were there delays in referrals for advanced imaging or surgical interventions?
Review for 10.1186/s12876-025-03683-8 (2025)

Title: PALLIATIVE BILIODIGESTIVE BYPASS FOR UNRESECTABLE PANCREATIC
MALIGNANCY AT KILIMANJARO CHRISTIAN MEDICAL CENTRE: A
RETROSPECTIVE CROSS-SECTIONAL STUDY
Version: 8 Date: 16 Jan 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory.
Review for 10.1186/s12876-025-03667-8 (2025)

Title: Short- and long-term outcomes of neoadjuvant chemotherapy compared with neoadjuvant
chemoradiotherapy for locally advanced rectal cancer: An updated meta-analysis
Version: 0 Date: 03 May 2024
Reviewer's report:
Dear authors,
I’ve reviewed with pleasure the article submitted to BMC Gastroenterology.
The article is a meta-analysis whose purpose is to evaluate short- and long-term outcomes of
neoadjuvant chemotherapy compared with neoadjuvant chemoradiotherapy for locally advanced
rectal cancer.
Below are my comments:
-INTRODUCTION:
-In this chapter you cite the randomized clinical trial of Schrag et al. (bibliographic item n°6)
like PROGISE trial but I think that the correct name of the trial is PROSPECT trial. So can you
please check and possibly correct it.
- MATERIALS AND METHODS:
-In this chapter when you speak about information extracted from the included studies, you state
that you have also evaluated grade 3/4 adverse event. Could you please specify which of the
classifications you are referring to? (Clavien-Dindo?)
-As you rightly said in the discussion, the neoadjuvant chemotherapy treatment regimens used
in each study were not identical and not always optimal. It would be interesting to include a
table showing what chemotherapy regimens were used in the different meta-analysis studies.
DISCUSSION:
-Although it was not the goal of this meta-analysis it would be important to develop in
the discussion a brief reference to how the type of surgery performed affects the previously
mentioned outcomes. Let me explain further: if we are talking about a tumor localized to the low
rectum, surgery is more likely to have worse functional outcomes and oncological outcomes in
terms of local recurrence than a high rectum regardless of the type of neoadjuvant therapy.
CONCLUSION:
-When you asses that NAC is a reasonable alternative to NACRT for patients with stage T2/
T3 disease, it is important to specify what you are referring to. Perhaps you are referring to
stage II/III (aka T3N0 or any T-N+) according to AJCC TNM Staging System for Rectal Cancer
8th edition. Indeed, in patients staged T2N0, and sometimes in selected patients staged T3N0
(adequately staged, low-risk, high rectal tumors) NCCN guidelines still recommend upfront
surgery. So, I think it would be more correct, when you talk about neoadjuvant therapy, to talk
about stage II and stage III instead of T2/T3 that can lead to confusion.
Review for 10.1186/s12876-025-03667-8 (2025)

Title: Short- and long-term outcomes of neoadjuvant chemotherapy compared with neoadjuvant
chemoradiotherapy for locally advanced rectal cancer: An updated meta-analysis
Version: 0 Date: 17 Jul 2024
Reviewer:  Marcello Filotico
Reviewer's report:
Dear colleague. I have carefully read the paper sent.
The work is very interesting and the previous studies cited for meta-analysis are of scientific
impact and influential on the subject covered. Congratulations on this publication that will offer
important Insights  for thought.
Review for 10.1186/s12876-025-03667-8 (2025)

Title: Short- and long-term outcomes of neoadjuvant chemotherapy compared with neoadjuvant
chemoradiotherapy for locally advanced rectal cancer: An updated meta-analysis
Version: 1 Date: 22 Aug 2024
Reviewer:  Philippe Rouanet
Reviewer's report:
The topic is interesting and ask a real and practical question
The main drawback of this study is the lack of evaluation of th etumoral response after NAC
and before a possible RCT
to my concern, the retrosective graccr 4 study and th eprospective Greccar 14 and NORAD trial
should insert in the discussion and the prospective
Review for 10.1186/s12876-025-03667-8 (2025)

Title: Short- and long-term outcomes of neoadjuvant chemotherapy compared with neoadjuvant
chemoradiotherapy for locally advanced rectal cancer: An updated meta-analysis
Version: 1 Date: 18 Nov 2024
Reviewer's report:
1) The new-castle Ottawa scale is used for observational studies. Please use another tool for
assessing risk of bias in RCTs
2) Risk of bias assessment is done for individual outcomes and cannot be generalized to every
outcome. Either define the main outcome measure and assess risk of bias for that and report that
particular only, or perform risk of bias assessment for every outcome.
3) Local recurrence and distant metastasis are time dependenet variables, using Odds ratio as
the outcomes cannot be justified. Please use meta-analysis with Hazard ratio as the outcome
measure.
4) Quality of strength of evidence should be reported
5) Sensitivity analysis should be reported with only prospective studies
Review for 10.1186/s12876-025-03667-8 (2025)

Title: Short- and long-term outcomes of neoadjuvant chemotherapy compared with neoadjuvant
chemoradiotherapy for locally advanced rectal cancer: An updated meta-analysis
Version: 1 Date: 01 Dec 2024
Reviewer:  Junyang Lu
Reviewer's report:
The optimization of neoadjuvant therapy for rectal cancer has been a hot research topic in recent
years. This meta-analysis compared NAC with standard NACRT in the neoadjuvant treatment
of rectal cancer, providing evidence for the application of NAC in rectal cancer neoadjuvant
therapy. I have the following comments on this article:
1.The inclusion criteria should clearly specify the stage of rectal cancer. TNM staging is the
most important factor influencing long-term efficacy, followed by the neoadjuvant treatment
regimen. In the conclusion, the authors recommend NAC for stage II/III patients and NACRT for
stage IV patients. The research conclusions need to be supported by the study's results, meaning
that the conclusions should apply only to the patients included in the study.
2.The majority of the studies included in the meta-analysis are non-randomized controlled
studies, which have a higher risk of bias. Low-risk patients may be more likely to choose NAC,
while high-risk patients may opt for NACRT. This potential bias should be discussed in the
discussion section of the article.
3.Tumor response in the NACRT group was better than in the NAC group, including a higher
pCR rate and better TRG grading. Theoretically, better tumor shrinkage is more favorable
for sphincter-preserving surgery. However, the higher rate of sphincter-preserving surgery in
the NAC group may be due to differences in tumor location between the two groups before
treatment. As mentioned, tumors located higher in the rectum generally have a lower risk,
and these patients may be more likely to choose NAC. Given these potential biases, the
corresponding statements in the conclusion should be removed.
Review for 10.1186/s12876-025-03667-8 (2025)

Title: Short- and long-term outcomes of neoadjuvant chemotherapy compared with neoadjuvant
chemoradiotherapy for locally advanced rectal cancer: An updated meta-analysis
Version: 2 Date: 17 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
changes are satisfactory, can be accepted for publication.
Review for 10.1186/s12876-025-03667-8 (2025)

Title: Short- and long-term outcomes of neoadjuvant chemotherapy compared with neoadjuvant
chemoradiotherapy for locally advanced rectal cancer: An updated meta-analysis
Version: 2 Date: 11 Jan 2025
Reviewer's report:
Dear authors,
Thank you for your efforts to answer the reviewer's question. A few minor comments and one
major:
Minor:
Page 13: TGR correct would be TRG
"In particular, recently published prospective studies have shown that NAC is not inferior to
NACRT in terms of pCR or TRG." -> Reference
"In patients with stage IV disease, NACRT remains the preferred treatment option."
-> Do you mean AJCC stage IV -> In metastatic disease NACRT is not the right treatment
choice!
Major:
"NAC is a reasonable alternative to NACRT for patients with stage II/III disease. For patients
with stage IV disease, NACRT remains the preferred treatment option".
-> I disagree with your conclusion.
-> Comment on the Prospect study: "First, we would like to emphasise that this study does not
represent a patient population with truly locally advanced disease by international standards. In
particular, the study excluded all patients with cT4 or cN2 disease or disease within 3 mm of
the mesorectal fascia. The cT3 and nodal subgroups were not reported in line with international
consensus, and it is concerning that just over 15% of patients were not staged by MRI. "10.1016/
j.ctro.2023.100672
-> The Prospect trial is a good example of the fact that patients treated in trials comparing NAC
and NCRT are highly selected, excluding patients with risk features (e.g. CRM infiltration, cT3c/
d, ...). So your statement without mentioning that patients with high risk features were excluded
(this needs to be checked in the individual trials) is not correct, at least from my point of view.
Stage II or III disease is too wide a definition. And please clarify what you mean with stage IV.
Review for 10.1186/s12876-025-03667-8 (2025)

Title: Short- and long-term outcomes of neoadjuvant chemotherapy compared with neoadjuvant
chemoradiotherapy for locally advanced rectal cancer: An updated meta-analysis
Version: 3 Date: 01 Feb 2025
Reviewer's report:
Dear authors,
Thank you for taking the effort to respond to our comments. I agree with your statements.
Review for 10.1186/s12876-025-03666-9 (2025)

Title: Serum Uric Acid as a Biomarker for Metabolic Dysfunction-Associated Steatotic Liver
Disease: Insights from Ultrasound Elastography in a Chinese Cohort
Version: 1 Date: 09 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The abstract and methods sections mention serum uric acid (SUA) levels, but it is unclear
whether these levels were measured at a single time point or longitudinally. If the SUA
measurements were taken only at one time point, the potential for fluctuations over time—due
to factors such as diet, medications, or other influences—may limit the interpretation of the
relationship between SUA and MASLD. It would be helpful to clarify this to better assess the
reliability of SUA as a biomarker for MASLD.
-Although the statistical models account for various potential confounders, including metabolic
factors and medications, it is possible that residual confounding remains, particularly due to
unmeasured factors such as dietary habits or genetic predispositions. A brief acknowledgment
of this limitation in the abstract and methods sections would enhance clarity.
-The analysis mentions the use of restricted cubic splines (RCS) to assess non-linearity.
However, the results of these analyses should be clarified further in the manuscript or abstract,
especially regarding the lack of a non-linear relationship found (P for nonlinearity = 0.8451).
A concise explanation of why a linear model was considered appropriate would help readers
understand the statistical reasoning behind the chosen models.
-Additionally, it would be beneficial to include a brief explanation of the rationale for using a
CAP > 248 dB/m as the cutoff for defining hepatic steatosis.
-While the discussion suggests that interventions aimed at lowering SUA levels could reduce
the risk of MASLD, it would be useful to elaborate on potential treatment strategies. For
example, lifestyle interventions such as dietary modifications or exercise programs targeting
SUA could be discussed in more detail. Furthermore, mentioning pharmacological options like
urate-lowering therapies (e.g., allopurinol) would be valuable, as their impact on MASLD risk
remains an area of interest for future research.
Review for 10.1186/s12876-025-03666-9 (2025)

Title: Serum Uric Acid as a Biomarker for Metabolic Dysfunction-Associated Steatotic Liver
Disease: Insights from Ultrasound Elastography in a Chinese Cohort
Version: 4 Date: 04 Jan 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory
Review for 10.1186/s12876-025-03666-9 (2025)

Title: Serum Uric Acid as a Biomarker for Metabolic Dysfunction-Associated Steatotic Liver
Disease: Insights from Ultrasound Elastography in a Chinese Cohort
Version: 4 Date: 07 Jan 2025
Reviewer:  Amira A A Othman
Reviewer's report:
I want to extend my congratulations to all those involved in this work. All the required
amendments have already been made carefully and satisfactorily. I hope that the research will
be presented to science.
Review for 10.1186/s12876-025-03692-7 (2025)

Title: Analysis of the status and risk factors for Helicobacter pylori infection and drug resistance
in the Lianyungang area, China
Version: 0 Date: 31 Dec 2024
Reviewer's report:
This manuscript by Yang et al. investigated the prevalence and mechanisms of antibiotic
resistance in H. pylori from the Lianyungang area. However, the study primarily employed
molecular methods for analysis and did not include H. pylori cultivation to verify phenotypic
characteristics. Therefore, I have the following comments:
Major comments:
1. The study limitations should address the potential inconsistency between phenotype and
genotype. The absence of H. pylori cultivation and subsequent antibiotic susceptibility testing
should be noted as a limitation of the study.
2. In Table S2, it is recommended to categorize the data into CagA+, VacA+, CagA+/VacA
+, and CagA-/VacA- groups. Additionally, previous studies have reported correlations between
CagA/VacA genotypes and disease outcomes, which should be further explored in this study.
Minor comments:
Please revise the formatting of gene names and bacterial species names throughout the
manuscript. For example, H. pylori should be italicized, and "23SrRNA" should be written as
"23S rRNA."
Review for 10.1186/s12876-025-03692-7 (2025)

Title: Analysis of the status and risk factors for Helicobacter pylori infection and drug resistance
in the Lianyungang area, China
Version: 0 Date: 06 Jan 2025
Reviewer:  Fernando P. Monroy
Reviewer's report:
This study used stool samples from residents in Lianyungang to identify the prevalence of H.
pylori infection and resistance to commonly used antibacterial agents and identified potential
risk factors. The manuscript is easy to read and contains all the necessary information, but there
are several concerns that need to be addressed:
1) It would have been easier for the reviewer to have the used line numbers in the text.
2) Throughout the manuscript, please use italics for H. pylori and other genes described.
3) In the abstract, what do you mean by cytotoxin-associated gene A (CagA) and vacuolating
cytotoxin A (VacA) were mutated? Did they express different genotypes (vacA s1,i1,m1; cagA
ABC), or did you base this statement on a comparison to a reference strain?
4) Please provide the reference(s) for the fluorescence PCR melting curve method or list the
primer sequences used in this study.
5) Likewise, provide citations for the nucleic acid mass spectrometry approach.
6) Table 1, under mutation site. Are those commas used? Use italics for genes.
7) Table 2 should be a figure. Also, describe the meaning of attenuated strains. If these strains
lacked both cagA and vacA or only one of these.
8) Similarly, Table 3 should be a figure.
9) In the discussion section, use 13C/14C for isotopes.
10) In the discussion, “Many studies(10-13) have shown ………… Move the (10-13) to the end
of the paragraph.
11) A good read-through for grammatical and style errors throughout the manuscript.
Review for 10.1186/s12876-025-03692-7 (2025)

Title: Analysis of the status and risk factors for Helicobacter pylori infection and drug resistance
in the Lianyungang area, China
Version: 2 Date: 20 Jan 2025
Reviewer's report:
This manuscript has been revised according to the reviewers' suggestions, but I have the
following additional recommendations:
1. Based on the previous suggestions, analyzing the mere presence of cagA and vacA genes
offers limited interpretative value for the data. I recommend performing genotype analyses
of cagA and vacA to further elucidate the associations between these genotypes and disease
outcomes.  If conducting this sequencing analysis is not feasible, it should be addressed in the
study's limitations.
2. While the authors have revised Table 2 as suggested, please ensure consistent formatting of
cagA and vacA as gene names throughout the manuscript. Additionally, H. pylori should be
italicized.
Review for 10.1186/s12876-025-03692-7 (2025)

Title: Analysis of the status and risk factors for Helicobacter pylori infection and drug resistance
in the Lianyungang area, China
Version: 2 Date: 22 Jan 2025
Reviewer:  Fernando P. Monroy
Reviewer's report:
All previous concerns were addressed, and the editorial office can address minor typos-related
issues. The manuscript reads better, and it is ready for publication
Review for 10.1186/s12876-025-03692-7 (2025)

Title: Analysis of the status and risk factors for Helicobacter pylori infection and drug resistance
in the Lianyungang area, China
Version: 3 Date: 09 Feb 2025
Reviewer:  Fernando P. Monroy
Reviewer's report:
The manuscript has addressed my previous concerns. A thorough proofreading has improved
the manuscript.
Review for 10.1186/s12876-025-03684-7 (2025)

Title: The Efficacy and Comparison of Upper Gastrointestinal Bleeding Risk Scoring Systems
on Predicting Clinical Outcomes Among Emergency Unit Patients
Version: 1 Date: 06 Jan 2025
Reviewer:  Jayanton Patumanond
Reviewer's report:
This study involves prognostic prediction research (temporal and geographical external
validation phase) using a retrospective cohort design.
Four scores were selected, and five prediction endpoints were defined a priori. Since these five
prediction endpoints may or may not be highly correlated, this should be considered or accounted
for in the analysis.
Missing data (if any) should be reported, and the methods used to address missing data should
be clearly stated.
Pearson’s r is conceptually appropriate for continuous x and y variables, both with presumed
normal distributions. However, in this case, the y variables (the five predicted endpoints) are
binary. Therefore, Pearson’s r may be inappropriate. Moreover, testing whether these Pearson
r values are significantly different from zero is not meaningful in a clinical context and is
unnecessary.
If the authors wish to express the magnitude of explanation of the four scores over the five
predicted endpoints, it may be more appropriate to use the adjusted R-square value obtained
from simple logistic regression instead.
Measures of discrimination or classification of the scores, as presented with the area under the
receiver operating characteristic curve (AuROC), are descriptive by nature. Testing whether
the AuROC is significantly different from 0.5 (no discriminative power) is not meaningful
in a clinical context. Instead, the 95% confidence intervals of the AuROC values are already
sufficiently informative. Thus, it is unnecessary to present p-values for each AuROC.
Comparing the AuROC values among the four scores is more essential in this context.
For this purpose, the authors could use an online application (https://www.medcalc.org/
manual/comparison-of-roc-curves.php) or the “roccomp” command in Stata software (https://
www.stata.com/manuals/rroccomp.pdf). These tools perform a global test of differences in
AuROC among the four scores. If a significant difference is detected, multiple pairwise
comparisons may be conducted as appropriate.
When the AuROC, sensitivity, and/or specificity values are as low as 60%, even if they are the
highest values among the scores, interpreting them as “most useful” could be misleading and
should be avoided.
Review for 10.1186/s12876-025-03684-7 (2025)

Title: The Efficacy and Comparison of Upper Gastrointestinal Bleeding Risk Scoring Systems
on Predicting Clinical Outcomes Among Emergency Unit Patients
Version: 2 Date: 29 Jan 2025
Reviewer:  Jayanton Patumanond
Reviewer's report:
The authors have clarified and included nearly all the essential elements of the manuscript. The
work is now scientifically sound and suitable for publication.
Review for 10.1186/s12876-025-03684-7 (2025)

Title: The Efficacy and Comparison of Upper Gastrointestinal Bleeding Risk Scoring Systems
on Predicting Clinical Outcomes Among Emergency Unit Patients
Version: 2 Date: 02 Feb 2025
Reviewer:  Chikamasa Ichita
Reviewer's report:
Overall, the revisions appear to address the previous comments. However, there is one correction
needed. The TRIPOD checklist you have attached is the Model Development version; you
should use the Validation version instead. Please refer to the following URL to ensure
appropriate revisions.
https://www.tripod-statement.org/wp-content/uploads/2020/01/Tripod-Checklist-Prediction-
Model-Validation.pdf
Review for 10.1186/s12876-025-03670-z (2025)

Title: Endoscopic and Pathological Characteristics of Gastrointestinal Amyloidosis: A
Retrospective Analysis
Version: 1 Date: 19 Nov 2024
Reviewer's report:
Niu et al wrote the manuscript with the title of “Endoscopic and Pathological Characteristics of
Gastrointestinal Amyloidosis: A Retrospective Analysis” and concluded that small intestine is
the location with the high detection rate of GIA that may be attributed to its anatomical structure,
biopsy technique, lesion distribution characteristics, clinical awareness, and pathological
sensitivity. There are some concerns need to be addressed.
1. How does lesion morphology correlate with clinical symptoms, such as gastrointestinal
bleeding or malabsorption? And what is the endoscopic diagnosis of these lesions before the
pathology result of gastrointestinal amyloidosis come out? Usually, clinical symptoms lead to
relevant exams and endoscopic suspicion of diseases lead to biopsy of relevant lesion. The
readers might be interested in this information. I would suggest a table for this.
2. What are the clinical implications of the involvement of difference layers of gastrointestinal
layer? May add this to the discussion portion.
“Furthermore, there was a significant difference in submucosa involvement across different
lesion morphologies (Fisher’s exact test, p = 0.001), with elevated and flat lesions more likely
to involve the submucosa. Conversely, depressed lesions and normal mucosa were primarily
involved within the mucosal layer, with depressed lesions mainly involving the lamina propria,
while normal mucosa primarily involved the mucosal epithelial layer and lamina propria.”
3. There should be intercomparison of the result in this research with other published data in term
of endoscopic finding and histopathological finding. For examples the result from the following
researches:
Dias E, Santos-Antunes Jo, Marques M, et al.: Clinical and endoscopic findings in
gastrointestinal amyloidosis: a single-center experience. Revista Española de Enfermedades
Digestivas 2022;
Lea U. KrauB, Stephan Schmid, Patricia Mester et al: Clinical, Endoscopic, and Histopathologic
Observations in Gastrointestinal Amyloidosis
4. The conclusion made should be based on solid evidence from the result. Therefore, it would
be inappropriate to conclude that “The high detection rate of GIA in the small intestine may
be attributed to its anatomical structure, biopsy technique, lesion distribution characteristics,
clinical awareness, and pathological sensitivity.”
Review for 10.1186/s12876-025-03670-z (2025)

Title: Endoscopic and Pathological Characteristics of Gastrointestinal Amyloidosis: A
Retrospective Analysis
Version: 1 Date: 08 Jan 2025
Reviewer's report:
In this article, the authors reported a retrospective analysis of gastrointestinal amyloidosis. While
this article may have some insights into GIA. I have some concerns and suggests below:
1. The introduction was too short, there was insufficient background for the readers.
2. Why did the patients underwent endoscopic evaluation? Did they have documented systematic
amyloidosis, or were with some gastrointestinal symptoms? This issue is highly important in
clinical practice and should be clearly mentioned.
3.How could 14 patients with small intestine samples (rather than duodenum) when only one
patient underwent enteroscopy?
4. Is there any clinical implication for focal amyloidosis with normal appearing gastrointestinal
mucosa?
5. In discission, the authors stated mucosal biopsy should be performed even with normal
appearing mucosa. I'd say it depends on the indication for endoscopic exam, and it's not practical
since GIA were so rare.
6. I suggest the authors  should provide the total exam amount during the period in order to
estimate the prevalence of GIA in this hospital cohort and compare to other reports.
Review for 10.1186/s12876-025-03690-9 (2025)

Title: Systematic Review and Meta-Analysis: No Evidence That Low-dose Non-Steroidal Anti-
Inflammatory Drugs (NSAIDs) Reduce the Risk of Pancreatitis After Endoscopic Retrograde
Cholangiopancreatography (ERCP)
Version: 2 Date: 08 Nov 2024
Reviewer's report:
It should be discussed that this study mostly evaluates diclofenac
in contrast to the fact that most of the data regarding rectal NSAIDS has investigated
indomethacin
Review for 10.1186/s12876-025-03690-9 (2025)

Title: Systematic Review and Meta-Analysis: No Evidence That Low-dose Non-Steroidal Anti-
Inflammatory Drugs (NSAIDs) Reduce the Risk of Pancreatitis After Endoscopic Retrograde
Cholangiopancreatography (ERCP)
Version: 2 Date: 18 Nov 2024
Reviewer's report:
I cannot access the figures and tables and so cannot do the review.
Kindest regards,
Andrew Thomson
PS There is an unwritten convention that all material for review is put on one file which is easily
accessible to the reviewer.