JerMa88/BMC_Gastroenterology_Peer_Reviews huggingface dataset:
Review for 10.1186/s12876-024-03462-x (2024)

Title: Lymph node ratio is a prognostic indicator for locally advanced gastric cancer after
neoadjuvant immunochemotherapy
Version: 2 Date: 01 Aug 2024
Reviewer's report:
This study elucidates the clinical utility of the lymph node ratio (LNR) in gastric cancer patients
who underwent neoadjuvant immunochemotherapy (NICT) and surgery. The novelty of this
study lies in highlighting the utility of LNR in patients who received NICT for gastric cancer.
The overall study design and conclusions are appropriately described. However, there are several
minor issues that need to be addressed:
1. PCR is known to have predictive value. However, in this study, the impact of pCR on PFS
and OS was not significant. What is the reason for this? Since PCR did not show statistical
significance, how about adding MPR to the univariate analysis for further investigation?
2. In the results section of the abstract, the LNR cut-off is described as 30%. This needs to be
corrected.
3. Page 2, line 8: CHECKMATE-649 is a study on unresectable or metastatic gastric cancer,
and RESOLVE did not involve immunotherapy. These references are incorrect and should be
revised.
4. Page 2, lines 9-16: References 7-10 do not seem to be appropriate studies to support the stated
content. It is recommended to revise or add references related to gastric cancer.
5. Page 2, lines 39-41: "Therefore, non-PCR patients may have a worse prognosis than those
who undergo surgery alone, whereas patients who achieve PCR may benefit from neoadjuvant
therapy to the greatest extent possible [29-30]." There is no evidence in the referenced studies to
support that non-PCR patients have a worse prognosis compared to those who undergo ‘surgery
alone’, and this is not a common opinion. The content needs to be revised to match the references.
6. Page 9, lines 41-43: "In this study, we used X-tile software to determine the optimal cut-off
value of 0.33 for LNR, with PCR as the dependent variable." The meaning of this sentence is
unclear. A more detailed explanation is needed.
7. Figure 3: Including the 2-year survival in the figure legend or within the figure itself would
help in understanding the content.
8. Page 9 line 6 ; polymerase chain reaction (PCR) --> PCR
9. To demonstrate that pLNR is a better prognostic factor than the pN stage, the LNR groups
need to include patients with various N stages. However, in this study, the LNR high group
consists entirely of pN3 patients, while the LNR low group includes only two pN3 patients.
Therefore, the pN3 group and the LNR high group are likely to show similar prognoses. To
convincingly show that pLNR is a better predictive marker than the pN stage, the LNR groups
should include patients with a diverse range of N stages. It is recommended to add this as a
limitation of the study.
Review for 10.1186/s12876-024-03462-x (2024)

Title: Lymph node ratio is a prognostic indicator for locally advanced gastric cancer after
neoadjuvant immunochemotherapy
Version: 3 Date: 26 Aug 2024
Reviewer:  Chikara Kunisaki
Reviewer's report:
Major comments
The topic of this study is interesting and informative.
However, the number of patients is unfortunately small to conclude something.
Based on the results of this study, the prognostic value of LNR was as equal to Nstage.
What can we clinically do based on the results of this study?
Minor comments
1. In Results of Abstract section, non-PCR should be fully spelled out at the first appearance.
2. This study is approved by the Ethics Committee of the institution. Please clearly show us the
approved number for this study.
3. It is better to obtain the informed consent from each patient by the opt-out recruitment in the
home page of the institution.
4. How did authors select the regimen of the NICT?
5. Please show us the information of adjuvant chemotherapy.
6. Did all patients undergo R0 gastrectomy? Please clarify this issue.
7. Continuous variables should be expressed if the normal distribution is not observed.
8. It is mandatory to precisely describe the method of multivariate analysis. For example, how
did authors select the factors inserted into multivariate analysis?
9. The duration of follow-up is short to lead appropriate outcomes.
10. In Table 1, please add the explanations for abbreviations.
11. Please unify pCR and PCR. Moreover, was this pathological estimation performed for lymph
node alone or whole resected specimen?
12. In Figure 2, LNR may serve as an alternative to ypN stage for prognostication in LAGC
following NICT.
This is correct. However, the value of AUC between 0.6 to 0.7 is regarded as poor. Therefore,
impact of LNR as prognostic factor is not strong.
13. It is possible to combine Table 2 and Table 3 into new Table 2.
14. Conclusion of Discussion section is too long. I wonder that the following sentence can be
conclusion. Consequently, the LNR may be employed as an ------ diagnosed with LAGC and
treated with NICT.
15. There are many grammatical errors. Please check these.
Review for 10.1186/s12876-024-03462-x (2024)

Title: Lymph node ratio is a prognostic indicator for locally advanced gastric cancer after
neoadjuvant immunochemotherapy
Version: 3 Date: 02 Sep 2024
Reviewer's report:
1)
Page 9, line 29
[12] [13] – These references are not about surgery after NICT.
2)
Page 9, line 32 ~ Page 10, line 11
This paragraph discusses two distinct topics: the optimal cut-off value for LNR and the outcomes
related to (NCIT, but it lacks clarity and organization. It would be better to either reorganize the
content to make the ideas clearer or split it into two separate paragraphs, each with a unified
focus. Additionally, since the content is primarily focused on LNR in esophageal cancer, it
would be better to modify or add information related to gastric cancer to make the discussion
more relevant to that context (e.g., previous studies on determining the optimal cut-off for LNR
in gastric cancer).
Review for 10.1186/s12876-024-03462-x (2024)

Title: Lymph node ratio is a prognostic indicator for locally advanced gastric cancer after
neoadjuvant immunochemotherapy
Version: 4 Date: 16 Sep 2024
Reviewer:  Chikara Kunisaki
Reviewer's report:
Thank you very much for your prompt and sincere responses.
I have some comments for your revise.
1.  First, I am very sorry that my comment had some lacking as concerns statistical analysis.
Continuous varialbes should be expressed as median (range, or IQR) if normal distribution is
not observed.
Please reconsider this issue. Thank you very much for your response.
2.  In general,  Some facors commonly regarded as prognostic factors and factors significantly
selected as prognostic factor in univariate analysis in this situdy are together inserted into
multivariate analysis.
The possible number of inserted factors is the number of events/10.
Please consult a statistician again.
I hope you will response adequately again. Thank you very much.
Review for 10.1186/s12876-024-03462-x (2024)

Title: Lymph node ratio is a prognostic indicator for locally advanced gastric cancer after
neoadjuvant immunochemotherapy
Version: 4 Date: 18 Sep 2024
Reviewer:  Shunji Endo
Reviewer's report:
Thank you for the opportunity to review your article "Lymph node ratio is a prognostic indicator
for locally advanced gastric cancer after neoadjuvant immunochemotherapy".
Neoadjuvant immunochemotherapy is a hot topic at present, so I read your paper with great
interest.
I think it is a great paper, but I have a few comments.
1. Because ypN and LNR are strongly correlated, I think it is inappropriate to include both in
the multivariate analysis. Therefore, we cannot say that LNR is a better prognostic factor than
ypN in this study.
2. I don't quite understand the meaning of "The results show that LNR is an effective means
of identifying patients who do not achieve pCR with higher accuracy than other approaches" in
the Discussion section. If LNR is higher than 0.33, it of course means non-pCR, because pCR
means LNR = 0.
3. The texts in the figures are too small to read.
Review for 10.1186/s12876-024-03462-x (2024)

Title: Lymph node ratio is a prognostic indicator for locally advanced gastric cancer after
neoadjuvant immunochemotherapy
Version: 4 Date: 26 Sep 2024
Reviewer's report:
Table 3
The HR of OS and PFS for the ypT stage (T3-4 vs. T0-2) is less than 1. Please check if the
reference is incorrect. (The results are too different from the univariate analysis in Table 2. It
seems that there might be a statistical error in Table 3.)
Figure 2-B
LNR (AUC = 0.715, p = 0.100) # change to ypTN
Review for 10.1186/s12876-024-03462-x (2024)

Title: Lymph node ratio is a prognostic indicator for locally advanced gastric cancer after
neoadjuvant immunochemotherapy
Version: 7 Date: 01 Oct 2024
Reviewer:  Shunji Endo
Reviewer's report:
I sincerely appreciate that you followed my suggestions and redid the statistical analysis.
However, the text in the figure is still too small.
Review for 10.1186/s12876-024-03384-8 (2024)

Title: The associations between modifiable risk factors and constipation: A comprehensive
Mendelian randomization study
Version: 0 Date: 13 Dec 2023
Reviewer:  Danilo Consalvo
Reviewer's report:
The study is very interesting because it focuses on Mendelian randomization.
In Mendelian randomization is very important to respect the three core instrumental variable
assumptions: relevance, independence and exclusion restriction assumptions.
Recent scientific literature highlights its effectiveness in researching the effectiveness of drugs
on some pathologies and of some risk factors on some other pathologies.
In this study the instrumental variables considered (37) are not so interesting in understanding
risk factors of constipation.
The results was a significant association between genetically predicted gastroesophageal reflux
disease and an increased risk of constipation and a potential association between severe
depression and the use of aspirin with an increased risk of constipation.
It is not clear methodologically what the hypothesis is: is constipation the cause of
gastroesophageal reflux or vice versa? Or is it only a correlation?
I suggest the search for further instrumental variables such as taking opioid drugs, therapy for
Parkinson's, hypothyroidism, genetically based amyloidosis.
The discussion could be modified by starting from the evidence from RCTs and then comparing
this with the evidence from Mendelian randomization.
Review for 10.1186/s12876-024-03384-8 (2024)

Title: The associations between modifiable risk factors and constipation: A comprehensive
Mendelian randomization study
Version: 1 Date: 17 Jul 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?
No - there are minor issues
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?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: This is the review of the manuscript titled " The associations between
modifiable risk factors and constipation: A comprehensive Mendelian randomization study",
which was previously titled "The associations between modifiable risk factors and constipation:
A comprehensive Mendelian randomization study". In this study, authors have used MR analytic
framework to dissect causality of the effects of the genetic predisposition to various modifiable
factors on constipation.
This study is essentially a NEW paper after revision, as the results have changed dramatically.
In fact, there are many news findings, and the Discussion section has improved substantially.
REQUESTED REVISIONS:
In order to make this MS perfect, please do the following. 1) in Abstract, please phrase results
part in such a way that significant results and suggestive associations would be listed in separate
phrases. 2) every time, especially in the beginning of the results and discussion sections, authors
should stress that they are evaluating effects of the genetic components predisposing individual
to being positive for certain exposure instead of effects of the factor as such. For example,
genetic predisposition to elective or prescribed use of aspirin, or genetic predisposition to use of
atorvastatin. 3) there are many small errors, necessitating a proof read throughout. i.e in abstract
say "our objective was..." instead of "our objective is". Also please delete "in domestic and
foreign countries " in Introduction.
ADDITIONAL REQUESTS/SUGGESTIONS:
Great job on revision.
Review for 10.1186/s12876-024-03384-8 (2024)

Title: The associations between modifiable risk factors and constipation: A comprehensive
Mendelian randomization study
Version: 1 Date: 31 Jul 2024
Reviewer:  Danilo Consalvo
Reviewer's report:
At first glance: I found the revised article full of new information. A large amount of data could
be listed and perhaps included in a book.
With a more careful eye, I advise against analyzing the correlation between GERD and
constipation on the basis of visceral hypersensitivity because the ROMA IV Criteria for
constipation do not include pain and visceral hypersensitivity. Perhaps this important point of the
article could be reanalyzed based on the motility disorder and the relationship between transient
lower esophageal sphincter relaxation (TLESR) and colonic slow bowel movement (SCBM) in
constipation.
Review for 10.1186/s12876-024-03384-8 (2024)

Title: The associations between modifiable risk factors and constipation: A comprehensive
Mendelian randomization study
Version: 2 Date: 16 Aug 2024
Reviewer:  Danilo Consalvo
Reviewer's report:
The content of article and the formal method are in line with scientific language of clinical
research.
Review for 10.1186/s12876-024-03384-8 (2024)

Title: The associations between modifiable risk factors and constipation: A comprehensive
Mendelian randomization study
Version: 2 Date: 20 Aug 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: This is the repeat review of the manuscript titled "The associations
between modifiable risk factors and constipation: A comprehensive Mendelian randomization
study". Authors performed an MR study, in which effects of the genetic predisposition to the
presence or magnitude of many clinical risk factors on the trait of constipation were analyzed.
After two revisions, this MS got a complete makeover, and now is ready for publishing.
ADDITIONAL REQUESTS/SUGGESTIONS:
All good now. Authors: congratulation on a great job!
Review for 10.1186/s12876-024-03436-z (2024)

Title: Knowledge, attitudes, and practices of endoscopy among gastroenterologists in diagnosis
and management of inflammatory bowel disease in China: A multicenter cross-sectional study
Version: 2 Date: 13 Jul 2024
Reviewer's report:
I appreciate the opportunity to review this manuscript. The authors are dealing with the important
matter of the “Knowledge, attitudes, and practices of endoscopy among gastroenterologists in
diagnosis and management of IBD”. Base on the findings, the clinical applications of this study
were equivocal.
The study has two limitations. First, the sample size was too small. Second, the findings are
complex and difficult to interpret. Additionally, while the clinical presentations of Crohn's
disease (CD) and ulcerative colitis (UC) differ, the authors aimed to assess physicians'
knowledge, attitudes, and practices regarding both conditions.
In addition, the IBD endoscopy training program included only two postoperative CD patients.
With such a small sample size, it is difficult to evaluate the Rutgeerts score
Review for 10.1186/s12876-024-03436-z (2024)

Title: Knowledge, attitudes, and practices of endoscopy among gastroenterologists in diagnosis
and management of inflammatory bowel disease in China: A multicenter cross-sectional study
Version: 2 Date: 25 Jul 2024
Reviewer's report:
This is primarily a survey study that assessed the knowledge, attitude, and practices of
gastroenterologists in China regarding IBD endoscopic indices.  The strengths of this study are
1) inclusion of participants from different provinces in China, ie. geographic diversity and 2)
inclusion of not only survey data but also pre/post training assessment, ie. multi-faceted.
However, there are major weaknesses that should be be futher clarified and/or rectified:
1) The abstract section is vague.  There was no description of who the participants were nor any
mention of their background characteristics..
2) Several words were mentioned repeatedly throughout the manuscript that was either incorrect
or vague.  For example, "SES-CD is most consistent with clinical practice ...".  What does
this means?  Does it means that the SES-CD is the most frequently used endoscopic index in
clinical practice or is it the most user-friendly index?  Another example is the use of the word
"compliance" throughout the manuscript and in Table 3.  Do the authors mean "concordance"
instead of compliance?
3) In the Methods section, the authors need to clearly explain what the training process entails.
How are those gastroenterologists trained?
4) In the Statistical analysis, the authors mentioend using chi-square analysis.  I did not see any
chi-square analysis in the results; only descriptive statistics.
5) Some contradictory statements: Ex: In the Discussion section, the authors mentioned that most
gastroenterologist had mastered endoscopy scoring while in the later paragraph said that most
gastroenterologists had modest knowledge of endoscopic indices.  I would argue that the authors
do not have the data to claim that most gastroenterolgists had mastered endoscopic scoring.
6) Some survey questions introduced bias.  For example, one of the questions asked "the reason
you find UCEIS difficult to master  are"  This does not give an option for the participant to select
that UCEIS is not difficult to master.
7) Multiple syntax errors, missing words, and incorrect referencing needing edits:  a) reference
67, need editing to mean 6-7 or 6,7.  b) reference 20 refers to an irrelevant reference.
Review for 10.1186/s12876-024-03436-z (2024)

Title: Knowledge, attitudes, and practices of endoscopy among gastroenterologists in diagnosis
and management of inflammatory bowel disease in China: A multicenter cross-sectional study
Version: 3 Date: 23 Sep 2024
Reviewer's report:
I appreciate the opportunity to review this manuscript again. The authors are dealing with
the important matter of the “Knowledge, attitudes, and practices of endoscopy among
gastroenterologists in diagnosis and management of IBD”. The authors had revised the
menuscript properly.
Review for 10.1186/s12876-024-03452-z (2024)

Title: Analysis of the Correlation between Defunctioning Stoma and Postoperative Low
Anterior Resection Syndrome in Rectal Cancer#A prospective cohort study
Version: 2 Date: 07 Jul 2024
Reviewer's report:
This is an interesting paper, reporting risk factors for low anterior resection syndrome (LARS),
especially focusing on defunctioning stoma.
I should be grateful if could answer my comments shown below.
Major comments:
1.  Although it is claimed that defunctioning stoma was not an independent risk factor for LARS
as one of main results of this study, it is not demonstrated by binary logistic regression analysis.
It is certainly a risk factor for LARS, as is demonstrated by the univariate analysis in Table 3.
However, it might not be an independent risk factor due to other confounding factors. I agree
at your discussion that “Univariate analyses yielded that defunctioning stoma may be a risk
factor for LARS mainly due to other confounding factors. In a study by Croese AD, et al., it
was stated that the increased risk of LARS in patients with defunctioning stoma was not due to
the stoma per se, but to the underlying cause of the stoma.” However, to claim this, it must be
demonstrated by binary logistic regression analysis or multivariate analysis. No such data are
presented in this study.
2. It is also claimed that high BMI, tumor closer to dentate line, and ultra-low anterior resection
were independent risk factors for LARS. However, they are only demonstrated in the data at
3 months after surgery in Table 4 (their p values are less than 0.05), and not demonstrated in
the data at 6 months after surgery in Table 5, in which p value for BMI, distance from tumor
to dentate line and ULAR is 0.693, 0.136, and 0.110, respectively. At 12 months after surgery,
only tumor closer to dentate line is an independent risk factors for LARS according to Table 6.
These discrepancies should be stated in Results and summarized in Abstract.
Minor comment
1. The words of “urination urgency” in Abstract and in page 4 should be changed to “fecal
urgency”.
2. It is stated in page 5 as Methods that “In this study, a total of 190 patients received
neoadjuvant therapy, of which 4 (2.1%) patients opted for intermediate/long course neoadjuvant
chemotherapy combined with neoadjuvant radiotherapy, 46 (24.2%) patients opted for short
course neoadjuvant chemotherapy (1-2 cycles), 100 (52.6%) patients opted for intermediate
course neoadjuvant chemotherapy (3-4 cycles), 43 (22.6%) patients opted for long course
neoadjuvant chemotherapy (#5 cycles), and only 1 (0.5%) patient opted for short course
neoadjuvant radiotherapy (1 cycle).” However, these are not methods but one of results of this
study, and should be stated in Results.
3. The word of “mild LARS (21-29 points), and severe LARS (30-42 points)” stated in page 6
should be changed to “minor LARS (21-29 points), and major LARS (30-42 points)” as is used
in the original LARS paper.
Review for 10.1186/s12876-024-03452-z (2024)

Title: Analysis of the Correlation between Defunctioning Stoma and Postoperative Low
Anterior Resection Syndrome in Rectal Cancer#A prospective cohort study
Version: 2 Date: 14 Jul 2024
Reviewer:  Marie-Louise Lydrup
Reviewer's report:
This is an interesting paper on an important issue on functional outcome after anterior resection.
I have some questions.
The aims could be more clearly defined at the end of introduction. As it is now stated the
study attempted to explore correlation between stoma related factors and LARS. Actually other
variables were also studied.
Why did the authors chose to include both minor and major LARS as outcome instead of only
major LARS? Major LARS is more important since the impact on QoL is higher. In the study
by e.g. Sandberg et al only major LARS was evaluated. There is a possibility that the outcome
could be different studying only major LARS.
The two groups defunctioned and non-defunctioned are very different concerning type of
anastomosis. Very few patients with ISR were not defunctioned. The variables chosen for
adjustment in the analysis i.e. tumour distance, type of surgery, neoadjuvant therapy and
defunctioning are interrelated. Adjusting for all variables could not be statistically correct. Are
the authors convinced that power is enough?
Concerning exclusion of patients that experienced complications requiring reoperations: how
many patients were in this group? They should be included in the flowchart.
Concerning cutoff of early stoma reversal (6 months). This could not be considered early reversal
which is normally defined as around 2-3 months.
How do the authors explain lack of influence of tumour level on LARS at 6 months? It is very
odd since tumour level influnced LARS at both 3 and 12 months.
Page 13 line 268: The conclusion made that reversal time had no influence on LARS should be
in my opinion not so firmly stated based on the above questions.
Minor comments:
Page 4 line 84: Urination urgency is not included in LARS.
Page 5 line 108: Concerning type of treatment. The types of neoadjuvant chemo are described
later. It could be better placed in this section.
Page 6 line 123: Were really LARS scores collected via telephone calls? Normally inquiries are
collected via ordinary mail.
Review for 10.1186/s12876-024-03452-z (2024)

Title: Analysis of the Correlation between Defunctioning Stoma and Postoperative Low
Anterior Resection Syndrome in Rectal Cancer#A prospective cohort study
Version: 4 Date: 01 Aug 2024
Reviewer's report:
The current revised version of paper  are acceptable, and ofcourse may be considering for
publication after the other reviewers comments and final decision of editor.
Review for 10.1186/s12876-024-03452-z (2024)

Title: Analysis of the Correlation between Defunctioning Stoma and Postoperative Low
Anterior Resection Syndrome in Rectal Cancer#A prospective cohort study
Version: 4 Date: 07 Aug 2024
Reviewer's report:
Author Yuhan et al. have generally addressed the reviewers' comments, but I would like to make
two following comments, including one minor revision. Even taking that into account, this paper
is valuable in that it is a prospective cohort with large number of cases, and although the results
are not remarkable for their novelty, they are informative for the reader.
Comment1:
The authors have removed 'previous surgery' from the exclusion criteria, but it is inappropriate
for a study to change the indication/exclusion criteria later in a prospective cohort. Please
consider the study design in detail in advance and make sure that indications and exclusions are
well judged before statistical analysis for future studies.
Comment2(minor revision):
Table 1 has not been properly corrected. The reviewer repeatedly stated that the English version
of Emmertsen's LARS score should be included in Table 1. The content of Table 1 in this paper
is the authors' original English wording, which differs from Emmertsen's English version of the
LARS score, which was the original Chinese version of the LARS score. The following is the
English version of Emmertsen's LARS score, so please use this for Table 1 in the text.
Do you ever have occasions when you cannot control your flatus (wind)?
#No, never
#Yes, less than once per week
#Yes, at least once per week
Do you ever have any accidental leakage of liquid stool?
#No, never
#Yes, less than once per week
#Yes, at least once per week
How often do you open your bowels?
#More than 7 times per day (24 hours)
#4–7 times per day (24 hours)
#1–3 times per day (24 hours)
#Less than once per day (24 hours)
Do you ever have to open your bowels again within one hour of the last bowel opening?
#No, never
#Yes, less than once per week
#Yes, at least once per week
Do you ever have such a strong urge to open your bowels that you have to rush to the toilet?
#No, never
#Yes, less than once per week
#Yes, at least once per week
Review for 10.1186/s12876-024-03452-z (2024)

Title: Analysis of the Correlation between Defunctioning Stoma and Postoperative Low
Anterior Resection Syndrome in Rectal Cancer#A prospective cohort study
Version: 4 Date: 14 Aug 2024
Reviewer's report:
Dear Authors
I’ve read your retrospective audit aimed at evaluation of relation between defunctioning  stoma
and LARS among rectal cancer  patients. In general, the study confirm that stoma per se is less
important in terms of LARS than the level of colorectal/anal anastomosis and other confounding
factor. Nevertheless, in my opinion some issues in presented analysis have to be specified.
1. In accordance to obtained results ‘high BMI ‘ was a risk factor of LARS in binary regression
and than in multivariate analysis. What is a definition of ‘high’? Is it a median or mean of  BMI
of the study population? May be another cut-off  point was chosen? Why? Please address in
discussion Is there any explanation why obesity lead to LARS?
2. The same concern about age. In binary regression less/more than age should be provided.
3. More details about anastomosis are needed? E.g. all anastomoses were end-to-end or.. any
pouches, side-to-end etc. “all ISR cases were resected using transanal TME and coloanal
anastomosis (CAA ) or colon-anal (CAAN) was performed for anastomosis” What is a difference
between  coloanal anastomosis (CAA ) or colon-anal (CAAN)?  Also no information about
anastomotic technique is provided, e.g. hand-sewn, stapler etc.
4. An excellent result was demonstrated concerning anastomotic complication, i.e. 0,4%(!) of
leak. (In this context details of anastomotic technique are even more important!). It is far better
than in overwhelming majority of published reports. How can you explain that? May be it is
a result of patient selection before stoma closure? In this context, please provide information
about work up which precede stoma closure? How anastomotic leak was ruled out?
5. Again my concern is about surgical technique. Did you mobilize splenic flexure of colon
routinely? If not, what was the rate of splenic mobilization? There is a sound data that this
surgical maneuver increases LARS.
6. Though information about neo-adjuvant treatment is provided there is no mention about post-
op chemo. About one-third of patients had Stage III-IV and should be administered to systemic
chemotherapy, which also has negative impact to bowel function dew to gastrointestinal toxicity.
Review for 10.1186/s12876-024-03452-z (2024)

Title: Analysis of the Correlation between Defunctioning Stoma and Postoperative Low
Anterior Resection Syndrome in Rectal Cancer#A prospective cohort study
Version: 5 Date: 30 Aug 2024
Reviewer's report:
The revised version of the article is acceptable. Consider using following recently published
studies  as a references, which describing the long-term functional outcomes after the rectal
cancer surgery:
Aliyev V, Goksoy B, Goksel S, Guven K, Bak#r B, Saglam S, Asoglu O. Intersphincteric
Resection for Low Rectal Cancer: Parameters Affecting Functional Outcomes and Survival
Rates. Surg Technol Int. 2021 Oct 26;39:166-172. doi: 10.52198/21.STI.39.CR1460. PMID:
34699602.
Aliyev V, Piozzi GN, Bulut A, Guven K, Bakir B, Saglam S, Goksel S, Asoglu O. Robotic
vs. laparoscopic intersphincteric resection for low rectal cancer: a case matched study reporting
a median of 7-year long-term oncological and functional outcomes. Updates Surg. 2022
Dec;74(6):1851-1860. doi: 10.1007/s13304-022-01396-1. Epub 2022 Oct 5. PMID: 36198884.
Aliyev V, Piozzi GN, Shadmanov N, Guven K, Bak#r B, Goksel S, Asoglu O. Robotic and
laparoscopic sphincter-saving resections have similar peri-operative, oncological and functional
outcomes in female patients with rectal cancer. Updates Surg. 2023 Dec;75(8):2201-2209. doi:
10.1007/s13304-023-01686-2. Epub 2023 Nov 13. PMID: 37955804.
Review for 10.1186/s12876-024-03452-z (2024)

Title: Analysis of the Correlation between Defunctioning Stoma and Postoperative Low
Anterior Resection Syndrome in Rectal Cancer#A prospective cohort study
Version: 7 Date: 02 Oct 2024
Reviewer's report:
Yuhan et al. have adequately addressed the reviewers' comments.
The paper is commendable for being a prospective cohort with a large number of cases, and
although the results are not strikingly novel, they are informative for the reader.
Review for 10.1186/s12876-024-03435-0 (2024)

Title: Effect of incision location and type of fistula on postoperative urinary retention after
radical surgery for anal fistula: A retrospective analysis
Version: 2 Date: 29 Apr 2024
Reviewer:  Tanan Bejrananda
Reviewer's report:
This study on the effect of incision location and type of fistula on postoperative urinary
retention after radical surgery for anal fistula provides valuable insights into the risk factors and
mechanisms associated with this common complication. Here are some review and improvement
points for each section:
1. **Introduction:**
- Review: The introduction effectively sets the context by defining postoperative urinary
retention (POUR) and anal fistula while highlighting the importance of understanding the risk
factors for POUR.
- Improvement: To enhance clarity, consider providing a brief overview of the current standard
practices in radical surgery for anal fistula and existing knowledge on POUR in proctology
surgery.
2. **Materials and Methods:**
- Review: The study design and patient selection criteria are clearly described, and the surgical
procedures are well-explained.
- Improvement: It would be helpful to provide more details on the specific methods used for
data analysis and statistical tests applied to identify risk factors for POUR.
3. **Results:**
- Review: The results section presents comprehensive data on patient characteristics, differences
between POUR and non-POUR groups, and the outcomes of univariate and multivariate
analyses.
- Improvement: Consider organizing the results in a more structured manner, perhaps by
separating findings related to patient characteristics, surgical approaches, and outcomes to
enhance readability.
4. **Discussion:**
- Review: The discussion effectively interprets the study findings in the context of existing
literature, identifies possible mechanisms underlying POUR, and proposes management
strategies based on the identified risk factors.
- Improvement: While the discussion covers a wide range of factors, consider providing more
emphasis on the clinical implications of the findings and practical recommendations for surgeons
to minimize the risk of POUR.
5. **Strengths and Limitations:**
- Review: The strengths and limitations of the study are well-addressed, acknowledging factors
such as study design, data collection methods, and potential biases.
- Improvement: To provide a more balanced assessment, consider discussing potential sources
of bias in more detail and suggesting avenues for future research to address these limitations.
6. **Conclusion:**
- Review: The conclusion succinctly summarizes the key findings and implications for clinical
practice.
- Improvement: Consider reinforcing the significance of the study findings and outlining specific
action points for clinicians to integrate into their practice to reduce the incidence of POUR.
Overall, the study provides valuable insights into the risk factors for POUR after radical
surgery for anal fistula. Enhancing the clarity of presentation and providing more focused
recommendations for clinical practice could further strengthen the impact of the study.
Review for 10.1186/s12876-024-03435-0 (2024)

Title: Effect of incision location and type of fistula on postoperative urinary retention after
radical surgery for anal fistula: A retrospective analysis
Version: 3 Date: 08 Jul 2024
Reviewer's report:
Dear Authors,
Thank you for providing your revised manuscript.
I find the reviews to be more than adequate, except for an area needing further clarification to
support your findings.
In table 1, you listed under history  of urological diseases:
- Urinary tract infection (11): this lacks clarity, virtually every human being experiences on UTI
during their lifetime, please refine this definition.
-Urinary stones, please clarify location (kidney vs bladder vs ureter)
- Urological cancers, treated or untreated at the time of fistula surgery?
Kind Regards
Review for 10.1186/s12876-024-03449-8 (2024)

Title: Evaluating the Efficacy of 8 Non-invasive Models in Predicting MASLD and Its
Progression: A Prospective Study
Version: 3 Date: 27 Jul 2024
Reviewer's report:
This paper analyzes and compares eight noninvasive models to predict intrahepatic steatosis and
progression well.
Hepatic fibrosis is an important predictor of prognosis in MASLD, and this study is less novel in
its approach to the disease because it focuses on steatosis. However, the content of this paper is
useful in the practical diagnosis and management of patients presenting to the clinic, as steatosis
is important in addition to hepatic fibrosis of MASLD.
Review for 10.1186/s12876-024-03449-8 (2024)

Title: Evaluating the Efficacy of 8 Non-invasive Models in Predicting MASLD and Its
Progression: A Prospective Study
Version: 3 Date: 12 Aug 2024
Reviewer:  Islam H. Shawali
Reviewer's report:
Thanks to the authors for the nice work
the topic is interesting yet it needs further studies in the future
The work deserves to be published
Review for 10.1186/s12876-024-03449-8 (2024)

Title: Evaluating the Efficacy of 8 Non-invasive Models in Predicting MASLD and Its
Progression: A Prospective Study
Version: 3 Date: 15 Aug 2024
Reviewer's report:
I THINK IT IS VERY GOOD IDEA TO CORRELATE THE NONINVASIVE TESTING
OF MASLD severirty or its progression to the MRI-PDFF which is standard for fatty liver
evaluations , but I have aquestions about is these subject have therapy during  this year or just
instruction on wt loss , second issue better to add paragraph on inclusion and exclusion criteria
Review for 10.1186/s12876-024-03449-8 (2024)

Title: Evaluating the Efficacy of 8 Non-invasive Models in Predicting MASLD and Its
Progression: A Prospective Study
Version: 3 Date: 17 Aug 2024
Reviewer's report:
The disease spectrum of MASLD includes simple steatosis, steatohepatitis, liver fibrosis, and
cirrhosis. Among these, what is related to the prognosis of the disease is the presence or absence
of MASH or liver fibrosis in particular. It is difficult to say that the increase in steatosis represents
the degree of progression of liver disease.
Besides measuring the degree of steatosis using MRI-PDFF, have you tried measuring changes
in liver stiffness measurement using Fibroscan or MR elastography?
Please add an evaluation of the usefulness of non-invasive markers related to changes of
liver stiffness measurement using Fibroscan or MR elastography or changes of NAS score on
pathologic confirmation.
If you can't provide data like this, it is difficult to consider the results of this study as a
comparative study of markers useful for assessing the progression of liver disease.
Review for 10.1186/s12876-024-03449-8 (2024)

Title: Evaluating the Efficacy of 8 Non-invasive Models in Predicting MASLD and Its
Progression: A Prospective Study
Version: 3 Date: 19 Aug 2024
Reviewer:  Mohamed El-Ghobary
Reviewer's report:
Thank you very much for the effort you put in that study,I appreciate a lot of effort was done,
although I have some small remarks
Last line in page 6 , how can you judge those cases if they are normal now?? And how many
cases?
“MRI-PDFF assessments indicated that some participants no longer had evidence of fatty liver
at the time of entry into the study”
Page 7 third line   sum of cases is not 100%
“(Control: N=146, 17.3%; Mild MASLD: N=400, 47.3%; Moderate MASLD: N=257, 30.4%;
Severe MASLD: N=43, 5%).”
Page 7 last paragraph, how the more severe masld is associated with less fat in liver
“The lower liver fat equation was found in severe MASLD, which was presumably due to the
relatively low rate of diabetes and MetS in this group (as the presence of MetS and diabetes was
a significant factor for the model).”
Page 9 third line :  the third goup is progression group not improve
“categorized (Improve group: N=76, 32.2%; Keep group: N=83, 35.2%; Improve group: N=77,
32.6%; Supplementary Table 2)”
Page 9
“changes in bmi and wc”   here we add – minus  ?
(-0.6 kg/m2, 0.2 kg/m2 and 0.6 kg/m2; 0.001 cm, 0.8 cm and 3.3 cm, respectively; P<0.001).
To become (-0.6 kg/m2, -0.2 kg/m2 and- 0.6 kg/m2; -0.001 cm, -0.8 cm and -3.3 cm,
respectively; P<0.001).
page 9   alt changes and ast changes were switched,  progression cases had marked decrease?
so you have to reorganize from less to more
“For biomarkers related to liver injury (change in ALT: -18.3 U/L, -4.8 U/L and 4 U/L; change
in AST: -7.8 U/L, -4.7 U/L and 1.9 U/L; change in GGT: -8.7 U/L, 0.7 U/L and 6.7 U/L,
respectively; all P<0.001)”
Review for 10.1186/s12876-024-03449-8 (2024)

Title: Evaluating the Efficacy of 8 Non-invasive Models in Predicting MASLD and Its
Progression: A Prospective Study
Version: 5 Date: 03 Sep 2024
Reviewer's report:
I am pleased to inform you that the revised paper is an improvement on the original. It is more
comprehensive and the corrections are well executed. However, it is regrettable that some of the
points previously raised were not addressed, and that a few minor errors remained.
Review for 10.1186/s12876-024-03449-8 (2024)

Title: Evaluating the Efficacy of 8 Non-invasive Models in Predicting MASLD and Its
Progression: A Prospective Study
Version: 6 Date: 10 Sep 2024
Reviewer's report:
Dear Author
A review of the modified files revealed that the authors had made straightforward yet discernible
amendments to the paper.
Review for 10.1186/s12876-024-03449-8 (2024)

Title: Evaluating the Efficacy of 8 Non-invasive Models in Predicting MASLD and Its
Progression: A Prospective Study
Version: 6 Date: 28 Sep 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
changes are done, accepted for publication.
Review for 10.1186/s12876-024-03451-0 (2024)

Title: 5-Hydroxyindoleacetic Acid as a biomarker for revealing perforation in acute appendicitis
Version: 0 Date: 13 Jul 2024
Reviewer:  Sadettin Er
Reviewer's report:
The diagnosis of complicated acute appendicitis can be distinguished by imaging. However,
laboratory studies are still controversial in making this distinction. This study may contribute
to future studies in different laboratories. The material method can also be accepted after
contributing to the literature on the distinction between complicated and non-complicated
appendicitis.
Review for 10.1186/s12876-024-03451-0 (2024)

Title: 5-Hydroxyindoleacetic Acid as a biomarker for revealing perforation in acute appendicitis
Version: 0 Date: 22 Jul 2024
Reviewer's report:
The main purpose of the study should be clearly added and stated in the abstract and introduction
and the study title should be changed accordingly.
Is the aim of the study the diagnostic value of 5-HIAA in diagnosing appendicitis or to
differentiate between complicated and uncomplicated appendicitis? This is not clear.
The sample size should be calculated and determined in accordance with the Power analysis
methodology for both study purposes. This is a must if the study is prospective.
Why should we use 5-HIAA to diagnose appendicitis or to differentiate between complicated
and uncomplicated appendicitis? This should also be clearly stated. Surgery is still the gold
standard after making the diagnosis. CT is also the gold standard imaging method in diagnosis
and in revealing complicated appendicitis, is there a need for 5-HIAA that increases the cost in
addition to this? You need to emphasize the need for this.
Review for 10.1186/s12876-024-03451-0 (2024)

Title: 5-Hydroxyindoleacetic Acid as a biomarker for revealing perforation in acute appendicitis
Version: 0 Date: 02 Aug 2024
Reviewer:  Balvinder Bharath
Reviewer's report:
1. The study does offer a good insight regarding use of 5HIAA in diagnosis of complicated
appendicitis.
2. A thorough grammatical correction has to be done for the paper.
3. The data collected is insufficient to come to the conclusion, the discussion part has to be re
written.
4. Reference used in the article are quite old.
Review for 10.1186/s12876-024-03451-0 (2024)

Title: 5-Hydroxyindoleacetic Acid as a biomarker for revealing perforation in acute appendicitis
Version: 0 Date: 04 Aug 2024
Reviewer:  Semra Demirli Atici
Reviewer's report:
Today, the most common cause of emergency surgery is still acute appendicitis. Therefore,
prospective studies such as these are important.
How did the authors diagnose acute appendicitis? Physical examination? Was the diagnosis
made with imaging support? Not specified in this article.
Were the patients diagnosed with acute appendicitis only with physical examination and 5HIAA
test without any imaging? If imaging was performed, is there a superiority or correlation between
the perforated appendicitis rate here and the 5HIAA test?
Any pregnant patients included in the study?
Review for 10.1186/s12876-024-03451-0 (2024)

Title: 5-Hydroxyindoleacetic Acid as a biomarker for revealing perforation in acute appendicitis
Version: 1 Date: 31 Aug 2024
Reviewer's report:
The revisions I demanded from the authors as a referee have been made. In this version, the
article is suitable for publication.
Review for 10.1186/s12876-024-03451-0 (2024)

Title: 5-Hydroxyindoleacetic Acid as a biomarker for revealing perforation in acute appendicitis
Version: 1 Date: 01 Sep 2024
Reviewer's report:
Thanks for this article.
I think you have emphasisized that the objective was to distinguish between non perforated and
perforated appendicitis in the preoperative setting.
1.  It would be good if you can also mention the surgical access used in both these groups
of patients.  Was it possible to operate onthe perforated cases through a Right lower quadrant
incision or did they all need a midline laparotomy?
2. Did the preoperative  imaging studies corelate with the operative findings ?
Review for 10.1186/s12876-024-03451-0 (2024)

Title: 5-Hydroxyindoleacetic Acid as a biomarker for revealing perforation in acute appendicitis
Version: 1 Date: 04 Sep 2024
Reviewer's report:
First of all, I would like to thank the authors for this beautiful work. I think that the article will
contribute to the literature if the following points are corrected.