JerMa88/BMC_Gastroenterology_Peer_Reviews huggingface dataset:
Review for 10.1186/s12876-025-04169-3 (2025)

Title:  Efficacy of Prophylactic Dexamethasone in Reducing Post-Embolization Syndrome
Following Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: A
Systematic Review and Meta-Analysis
Version: 1 Date: 21 Jul 2024
Reviewer:  Haohuan Tang
Reviewer's report:
Dear Editor and Authors,
I have carefully reviewed the manuscript you submitted (ID: 1eca6334-49e8-4d49-932a-
cacdd914e198) and conducted a thorough re-evaluation based on the initial review. The authors
have responded to each of the reviewers' suggestions and have overall improved the manuscript.
While some issues remain challenging to address at this stage, the authors have indicated their
willingness to follow up with related research. I appreciate the modifications and responses
made by the authors based on the initial review comments, which have enhanced the quality and
readability of the manuscript. Overall, the authors' efforts and responsiveness are commendable,
and I believe the manuscript now meets the standards for publication.
Thank you once again for your trust and collaboration.
Best regards!
Review for 10.1186/s12876-025-04169-3 (2025)

Title:  Efficacy of Prophylactic Dexamethasone in Reducing Post-Embolization Syndrome
Following Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: A
Systematic Review and Meta-Analysis
Version: 1 Date: 21 Jul 2024
Reviewer:  Chenxi Yu
Reviewer's report:
The revised manuscript has done a good job of fulfilling the suggestions made by the previous
reviewers, and there are no other parts that need to be changed. Thanks to the authors for their
hard work.
Review for 10.1186/s12876-025-04169-3 (2025)

Title:  Efficacy of Prophylactic Dexamethasone in Reducing Post-Embolization Syndrome
Following Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: A
Systematic Review and Meta-Analysis
Version: 1 Date: 30 Jul 2024
Reviewer's report:
I think the authors have responded to my previous comments well.
Review for 10.1186/s12876-025-04143-z (2025)

Title: Management and outcomes of patients with obstructive jaundice from pancreatobiliary
diseases in Rwanda
Version: 1 Date: 11 May 2025
Reviewer:  Aderemi Oluyemi
Reviewer's report:
Dear Authors,
The concept behind this work is BRILLIANT. I commend any such group that is making such
strides to bridge the gap of management of hepatobiliary disease treatment in our continent. The
additional endeavor to extensively document such nobel work into scientific literature is worthy
of double honor.
I will endorse this paper being taken down and majorly overhauled. I advice that the manuscript
be re-read by a colleague (whether at home in Rwanda or abroad) who has cognate exoerience
in scientific writing.
My many corrections about the text should be taken into consideration before re-submitting this
piece. We hail your work and endeavor but this manuscript, in the present state that it appears
is unacceptable by any reputable journal just on the basis of the lack of demonstrable expertise
in presentation
Review for 10.1186/s12876-025-04143-z (2025)

Title: Management and outcomes of patients with obstructive jaundice from pancreatobiliary
diseases in Rwanda
Version: 1 Date: 19 May 2025
Reviewer:  Azza Naif
Reviewer's report:
Table 3: I think it would make more sense if the imaging investigations done was the same for
all patients, that way it will not be biased on the results you give. Otherwise we can omit this
part I think.
Table 7:  We should correct the heading to reflect the findings. Something like "Intraprocedural
stent placement and success rate"
Do we have two tables representing the same thing?? table 4 and table 10 on laboratory findings.
I think only one is enough.
In Discussion paragraph two, where you reported on the study done by Odongo in Uganda,
abdominal pain repeated twice with different percentages?
403: "not fully representing"
Review for 10.1186/s12876-025-04143-z (2025)

Title: Management and outcomes of patients with obstructive jaundice from pancreatobiliary
diseases in Rwanda
Version: 1 Date: 21 May 2025
Reviewer's report:
I am appreciated by the author's work. The  result and conclusion is depenadable. I hope the
author can consult the following advice:
1. What's the diagnotic criteria of  the obustructive juandice, and what's the  indication of ERCP,
PTBD, or surgery?
2.Except for ERCP, PTBD, and surgery,  have you performed any adjuvant therapy such as
chemothrapy or radiotherapy to keep the bile duct patent?
3. ERCP or PTBD seems palliative therapy for obstructive juandice, and why radical surgery
are not choosed for it?
Review for 10.1186/s12876-025-04156-8 (2025)

Title: Predictive factors for metabolic syndrome in patients with Metabolic dysfunction-
associated steatotic liver disease (MASLD)
Version: 0 Date: 16 May 2025
Reviewer's report:
The topic of research is commendable. But the study lacks the potential to be published. In
the introduction section itself, the literature is not sufficient to support predictive factors for
metabolic syndrome. The introduction section seems to be inappropriately written.  Basically,
after reviewing the manuscript completely, it does not seem that drafting has been done up to
the mark, leading to its publication.
Review for 10.1186/s12876-025-04156-8 (2025)

Title: Predictive factors for metabolic syndrome in patients with Metabolic dysfunction-
associated steatotic liver disease (MASLD)
Version: 0 Date: 19 May 2025
Reviewer:  Michael Dwinata
Reviewer's report:
Since the design was cross sectional study, we cannot really determine the causality or predictors
for an outcome.
I understand that you use GAM model to resolve this, but I saw that the nonlinearity result was
significant. You said that it was confirmed further with logistic regression analysis. Could you
give more data about this and convice that the final result of analysis can infer causality between
the 4 variables to the outcome?
Please also give the predictive model that you mention to measure the AUC
Review for 10.1186/s12876-025-04156-8 (2025)

Title: Predictive factors for metabolic syndrome in patients with Metabolic dysfunction-
associated steatotic liver disease (MASLD)
Version: 3 Date: 19 Jun 2025
Reviewer's report:
The list of Abbreviations section does not match the article actually. Otherwise, the quality of
article has been worked upon and seems to be improved. With minor formatting, the article can
be considered ready to go.
Review for 10.1186/s12876-025-04156-8 (2025)

Title: Predictive factors for metabolic syndrome in patients with Metabolic dysfunction-
associated steatotic liver disease (MASLD)
Version: 3 Date: 22 Jun 2025
Reviewer's report:
• In Table 1, patients took only glimepiride among sulfonylureas, only sitagliptin among DPP-4
inhibitors, or only dapagliflozin among SGLT-2 inhibitors, and did not take any other drugs
containing active substances from these groups (e.g., gliclazide, liraglutide or empagliflozine)?
• Among the complications of diabetes, was the rate of cardiovascular complications in patients
not examined? If not, why wasn't it investigated?
• How do you explain that HbA1c was not significantly associated with the presence of metabolic
syndrome? Please describe this in a few sentences.
• Please clarify references 3, 16, 21, 25, 31 and 33.
Review for 10.1186/s12876-025-04117-1 (2025)

Title: Prognostic Value of ALBI Score for All-Cause Mortality in Metabolic Associated Fatty
Liver Disease Patients: A Cohort Study from NHANES 2003-2018
Version: 2 Date: 16 Jun 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/s12876-025-04154-w (2025)

Title: Safety of infliximab and adalimumab in pediatric inflammatory bowel diseases: a
disproportionality analysis from the FAERS database
Version: 1 Date: 20 Jun 2025
Reviewer's report:
Thank you for the thorough revisions. I have no additional comments, aside from a few
grammatical errors that still need to be corrected.
Review for 10.1186/s12876-025-04119-z (2025)

Title: The Development of a Multimodal Prediction Model Based on CT and MRI for the
Prognosis of Pancreatic Cancer
Version: 0 Date: 01 May 2025
Reviewer's report:
This study developed and validated a hybrid radiomics model to predict the overall survival in
pancreatic cancer patients and identify risk factors that affect patient prognosis. A major revision
was recommended before re-consideration.
1)The data span from 2013 to 2023, but the manuscript does not address potential temporal
biases, evolution of imaging protocols, or treatment regimens.
2)Many patients did not undergo surgery, and important prognostic factors like microvascular
invasion, perineural invasion, and margin status were missing, which limits model robustness.
3)In the introduction part, the authors should emphasize the dire need of diagnosis
pancreatic cancer at an early stage and following references could be added: doi: 10.4251/
wjgo.v16.i4.1256; doi: 10.2147/IJN.S335588.
4)The decision to retain 80% variance in PCA is common, but the specific selection of 15–18
components lacks detailed rationale, especially when dealing with non-linear RSF models.
5)Although the model predicts survival, it doesn’t classify patients into low-, intermediate-, or
high-risk groups, which is essential for clinical utility.
6)Radiomics-based approaches are widely utilized in tumor staging, early diagnosis,
differentiation, prognosis prediction, and treatment evaluation. I recommend that the authors
emphasize the clinical significance of radiomics in the revised manuscript. The following
references may be considered to support this context: DOI: 10.1007/s11596-022-2535-2; doi:
10.1007/s00261-020-02506-6; doi: 10.3389/fonc.2020.01618.
7)Although two physicians annotated the ROIs, the study does not quantify inter-rater agreement
(e.g., Dice coefficient), which is critical in radiomics.
8)Although PCA and LASSO were applied for feature reduction, the final RSF model is trained
on relatively high-dimensional data (many radiomics + clinical features) with only 190 training
samples, which still poses a risk of overfitting—especially with machine learning methods like
RSF.
9)The study compares multiple models (unimodal, bimodal, hybrid, COX, RSF) without clearly
adjusting for multiple testing, increasing the risk of Type I error.
10)Key performance metrics (e.g., C-index, Brier score) are reported without 95% confidence
intervals, which are essential to assess statistical uncertainty.
11)No power analysis or rationale is provided to justify that the sample size (n=272) is sufficient
given the number of features used.
Review for 10.1186/s12876-025-04119-z (2025)

Title: The Development of a Multimodal Prediction Model Based on CT and MRI for the
Prognosis of Pancreatic Cancer
Version: 0 Date: 30 May 2025
Reviewer's report:
This is a rigorous retrospective study aiming to develop a multimodal radiomics model based
on clinical data, contrast-enhanced CT, and MRI using the RSF algorithm to predict prognosis
in pancreatic cancer patients, providing a potentially valuable tool for individualized treatment
decisions. The methodology is generally sound, the writing is clear, and the visualizations
are comprehensive. However, several clarifications or improvements are needed before the
manuscript can be considered for publication:
1. Image Preprocessing:
Why was resampling to 3×3×3 mm³ chosen instead of the commonly used 1×1×1 mm³?
Why was signal intensity normalization not performed for the images?
2. Clinical Feature Dimensionality Reduction:
Why was Lasso used for clinical feature dimensionality reduction instead of the commonly used
univariate/multivariate logistic regression?
3. Inappropriate Terminology:
In "The Development and Evaluation of Models" section, the terms "imaging histologic features"
and "genomics model" are misused. The study does not involve histology or genomics research.
4. Feature Annotations:
Please annotate the meanings of features such as ct_pc1, ct_pc2, ct_pc15, and mri_pc2 to aid
reader understanding.
5. Discussion Section:
Which machine learning algorithms are commonly used for survival data?
Why were RSF and Cox chosen for comparison, and have there been prior studies comparing
similar algorithms?
Review for 10.1186/s12876-025-04155-9 (2025)

Title: Percutaneous Endoscopy in the Management of Intra-abdominal Complex Disorders
Version: 1 Date: 20 May 2025
Reviewer's report:
This study presents a rare and clinically valuable report evaluating the diagnostic utility and
safety of puncture-guided percutaneous endoscopy in the management of intra-abdominal
complex disorders. Compared to conventional diagnostic modalities such as laparoscopy or
PET-CT, this technique offers a relatively simple and cost-effective alternative, with the added
benefit of being feasible even in smaller healthcare centers due to the use of flexible gastroscopy.
Minor comment:
Some typographical and formatting errors were noted throughout the manuscript.
Review for 10.1186/s12876-025-04155-9 (2025)

Title: Percutaneous Endoscopy in the Management of Intra-abdominal Complex Disorders
Version: 1 Date: 21 May 2025
Reviewer's report:
This manuscript is an article of percutaneous endoscopy for intra-abdominal complex disorder.
Intra-abdominal procedures using a flexible endoscope are interesting. Observing the abdominal
cavity and a biopsy-like procedure seems feasible. However, it does not seem to be superior
to a conventional laparoscope. Author should revise this manuscript according to reviewer’s
comments following below.
1. The authors should provide a theoretical explanation of the advantages of percutaneous
endoscopy compared to laparoscopy. Although the comparison with laparoscopy is mentioned
on page 9, line 23 to page 10, line 3, it is not sufficient. It is believed that laparoscopy is
more maneuverable and has better visibility in the abdominal cavity. Previously, laparoscopy
was performed under local anesthesia. In addition, with needle forceps, the destruction of the
abdominal wall is not much different.
2. The author needs to explain how much more costly and time consuming it would be to perform
this procedure laparoscopically.
3. The author needs to explain why general anesthesia is not used.
Wouldn't the patient suffer if the pneumoperitoneal pressure is 10-13 mmHg?
4. The author needs to describe the diseases for which this technique is not indicated.
Review for 10.1186/s12876-025-04155-9 (2025)

Title: Percutaneous Endoscopy in the Management of Intra-abdominal Complex Disorders
Version: 1 Date: 29 May 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
1. Lack of Comparative Control Group
The study is a retrospective case series without a comparator (e.g., diagnostic laparoscopy,
imaging-only diagnosis).This limits the ability to objectively assess the advantages of
percutaneous endoscopy over other diagnostic modalities.
2. Small Sample Size and Single-Center Design
Only 37 patients were included, and all procedures were performed at a single center by
highly experienced endoscopists.The small sample size reduces the statistical power and
generalizability of the findings.
3. Selection Bias and Lack of Randomization
As a retrospective study, there is an inherent risk of selection bias. The patients included
may represent more diagnostically ambiguous or severe cases, which could overestimate the
effectiveness of percutaneous endoscopy.
4. Inadequate Description of Diagnostic Yield Calculation
The manuscript mentions a diagnostic accuracy rate of 91.9%, but it is unclear how this was
defined or confirmed (e.g., via pathological confirmation, clinical follow-up). Ambiguity in
outcome measurement weakens the validity of the reported success rate. Clarify the definition
of diagnostic success and specify the gold standard used for confirmation.
5. Limited Long-Term Outcome Data
The study does not report long-term follow-up data beyond the initial diagnostic and short-term
postoperative period, making it difficult to assess the technique's long-term utility and safety.
6. Underreporting of Minor Complications
The manuscript reports no postoperative complications at all, which may be an overestimation
of safety. Minor issues like transient pain, subcutaneous emphysema, or mild infections may
have been missed or underreported.
7. Cost Analysis Is Superficial
Although median hospitalization costs are provided, the economic evaluation lacks depth (e.g.,
no cost-effectiveness or cost-comparison analysis with other techniques). The value proposition
of percutaneous endoscopy remains unclear.
8. Typographical and Formatting Issues
Examples:
"Inclusion Criteria: 1) Strong suspicion..." # incomplete numbering.
Several punctuation inconsistencies (e.g., spaces before/after hyphens, commas).
9. Limited Discussion on Learning Curve
The manuscript mentions a reduction in procedure time with experience but does not analyze the
learning curve quantitatively. It is unclear how quickly new operators can become proficient.
Include data or discussion on procedural training, operator variability, or the number of cases
required to achieve competence.
10. Generalizability Is Not Adequately Addressed
All procedures were performed under specific institutional settings and by senior clinicians,
limiting reproducibility in less-equipped or rural centers. May not reflect real-world feasibility.
Review for 10.1186/s12876-025-04155-9 (2025)

Title: Percutaneous Endoscopy in the Management of Intra-abdominal Complex Disorders
Version: 1 Date: 02 Jun 2025
Reviewer's report:
Thank you for the opportunity to review your valuable work. This retrospective study
investigates the utility of percutaneous endoscopy in diagnosing and treating complex intra-
abdominal diseases. Although the number of cases is modest (37 patients), the results appear
highly favorable. I have provided several comments below, which I hope the authors will find
constructive.
Review for 10.1186/s12876-025-04155-9 (2025)

Title: Percutaneous Endoscopy in the Management of Intra-abdominal Complex Disorders
Version: 2 Date: 17 Jun 2025
Reviewer's report:
This is a revised version of percutaneous endoscopy for intra-abdominal complex disorder. Intra-
abdominal procedures using a flexible endoscope are interesting. This revised manuscript has
been addressed for the reviewers’ comments. However, There are still some corrections to be
made. Author should revise this manuscript according to reviewer’s comments following below.
On page 9, lines 14 through 16, it is marked #Third, compared to conventional laparoscopy, this
technique requires only a small incision, potentially causing less damage to the abdominal wall
and making closure at the puncture site easier‘. Since trocars used in laparoscopic procedures
are used, wound damage and ease of wound closure are not superior to those of laparoscopy,
but are comparable. Laparoscopic procedure is also possible under local anesthesia.
Review for 10.1186/s12876-025-04155-9 (2025)

Title: Percutaneous Endoscopy in the Management of Intra-abdominal Complex Disorders
Version: 2 Date: 18 Jun 2025
Reviewer's report:
Thank you for the opportunity to review the revised manuscript.
The points I previously raised have been appropriately addressed, and I have no further
comments.
Thank you again.
Review for 10.1186/s12876-025-04182-6 (2025)

Title: Socioeconomic Burden of Patients Hospitalized for Fecal Impaction: A Nationwide
Retrospective Observational Study
Version: 0 Date: 27 Apr 2025
Reviewer:  Jen-Tzer Gau
Reviewer's report:
This study has provided important findings related to the economic care cost and mortality
data for those patients who were hospitalized with fecal impaction (FI) diagnosis.  This study
also provides important messages to medical society who takes care of aging population that
constipation is highly prevalent, and untreated constipation could lead to fecal impaction and
serious complications.
The abstract -- the first sentence of the background could be better described or re-phrased.
The results are accurately reported and presented.
The discussion section may need some editing to improve the accuracy of the statements and
descriptions.  See my comments in the edited manuscript document.
The conclusion in the abstract and in the main text may need editing.  See my comments in the
manuscript.
The tables and figures are well done and have no further comments.
Review for 10.1186/s12876-025-04182-6 (2025)

Title: Socioeconomic Burden of Patients Hospitalized for Fecal Impaction: A Nationwide
Retrospective Observational Study
Version: 0 Date: 03 May 2025
Reviewer's report:
Please see suggestions for few changes and comments below:
Prior to last sentence in background:
most aged country in the world -> the world's oldest country
In definitions and outcomes I would use "and"instead of "or" between the codes provided, all
these codes were included
In the study participants: Please clarify why FI development after admission was excluded? it
is not clear or easily understandable and how it affects results and outcomes of this study
Study Participants
This study included patients diagnosed with FI at the time of admission between April 2016
and March 2023. The exclusion criteria were age younger than 16 years, pregnancy, and FI
development after admission.
Please add "may have had biased..” below instead of "have biased.."
Previous studies may have biased characteristics owing to their small size and specifically
targeted populations, leading to inaccurate mortality rates.
Statistical analysis
Replace semicolons with commas in below
“using the variables of age; sex; pathway to admission; arrival by emergency ambulance; annual
number of FIs per hospital; Charlson comorbidity index; history of constipation;”
Discussion: the fact that constipation contributed to lower mortality may have more underlying
reason than positive/preventive effect of its management on FI development. Perhaps an
underreported diagnosis of constipation?  Maybe clarify further how constipation was coded in
relation to admission source, and or otherwise.
Limitations:
"Second, although the DPC database is comprehensive for inpatients,"
Change intpatients to inpatient hospitalizations, admission, or something similar with context
to "inpatients"
Interesting study, otherwise, would be more striking if there were other than US comparisons,
if any, additionally available studies.  reference 14 you have used and available US data is
administrative database which is inferior as a database compared to yours in this setting as per
description there are more clinical datavariables.
Review for 10.1186/s12876-025-04182-6 (2025)

Title: Socioeconomic Burden of Patients Hospitalized for Fecal Impaction: A Nationwide
Retrospective Observational Study
Version: 0 Date: 04 May 2025
Reviewer's report:
This is a delicious paper I have no hesitation in recommending it for publication following some
minor tidy-up. Basically, I would like to see this paper published in BMC Gastroenterology, but
still have some problems as indicated below.
#; Why didn't you use those without FI as a comparison first? I don't think we can know how
much FI affects prognosis and cost without comparing it to people without FI.
#; Please give us a breakdown of the causes of the surgeries being performed on FI.
#; How often should suppositories be used?
4; I feel that the original history of the patient is insufficient. Can you describe cerebrovascular
disease in particular?
5; To consider medical expenses, I believe they are calculated based on the cost paid to the
hospital, but there is no mention of what happens to private room charges or anything like that.
Please describe if possible.
6; It should be noted whether or not the patient is being treated at the time of diagnosis of
constipation.
I would like to recommend publication of the paper after the authors have addressed the
concerns which I have stated above.
Review for 10.1186/s12876-025-04182-6 (2025)

Title: Socioeconomic Burden of Patients Hospitalized for Fecal Impaction: A Nationwide
Retrospective Observational Study
Version: 1 Date: 04 Jul 2025
Reviewer's report:
This is a well-written and scientifically sound manuscript. The research is original,
methodologically rigorous, and the results are clearly presented. We recommend acceptance
without changes.
Review for 10.1186/s12876-025-04182-6 (2025)

Title: Socioeconomic Burden of Patients Hospitalized for Fecal Impaction: A Nationwide
Retrospective Observational Study
Version: 1 Date: 04 Jul 2025
Reviewer:  Jen-Tzer Gau
Reviewer's report:
There are a comment and potential errors in the Table 4 that need to be corrected or addressed.
Review for 10.1186/s12876-025-04182-6 (2025)

Title: Socioeconomic Burden of Patients Hospitalized for Fecal Impaction: A Nationwide
Retrospective Observational Study
Version: 2 Date: 19 Jul 2025
Reviewer:  Jen-Tzer Gau
Reviewer's report:
The authors' reply to the additional questions/concerns are reviewed and all are satisfied.  Those
additional statements are all appropriate and well described.  The correction for the Table 4 is
done.  All are satisfied on my review.
Review for 10.1186/s12876-025-04162-w (2025)

Title: Investigating the shared genetic information between serum concentration levels of liver
enzymes and cholelithiasis
Version: 2 Date: 23 May 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-Insufficient detail on phenotyping and diagnosis:
The manuscript lacks a clear definition of how liver enzyme levels and cholelithiasis cases were
measured or diagnosed. For example, were the liver enzymes measured at a single time point
or averaged over multiple visits? How was cholelithiasis defined—ICD codes, imaging reports,
or self-reporting?
-Population characteristics underreported:
Although the use of the UK Biobank is mentioned, there is no detailed information about
population characteristics such as age range, sex distribution, or adjustment for potential
confounders (e.g., BMI, alcohol consumption, metabolic status), which could influence both
liver enzymes and gallstone risk.
-Lack of clarity on statistical thresholds:
The LDSC, MR, and MTAG methods are described at a high level, but the manuscript does
not specify key parameters such as the threshold for declaring significant genetic correlation
(e.g., Bonferroni correction?), or how multiple testing was controlled across different traits and
methods.
-No justification for MR assumptions:
While MR was used to assess causal relationships, the authors do not elaborate on how the three
core MR assumptions (relevance, independence, and exclusion restriction) were evaluated or
justified. For example, were F-statistics reported to demonstrate instrument strength?
-Pleiotropy and heterogeneity checks are mentioned but not elaborated:
MR-Egger intercept and Cochran’s Q test are referenced, but results or thresholds for
interpreting pleiotropy and heterogeneity are not described. Readers may question how the
authors concluded that causal estimates were robust.
-Functional annotation pipeline needs more detail:
While FUMA, MAGMA, and DEPICT are mentioned, the manuscript does not explain how
input data were processed for each tool, what gene sets or tissues were included, or how
enrichment significance was determined. This limits reproducibility.
-Colocalization lacks resolution detail:
The COLOC analysis is briefly mentioned without specifying the resolution of loci (e.g., 1 Mb
windows), choice of prior probabilities, or how posterior probabilities (PP4) were interpreted.
The absence of this information undermines confidence in shared causal variant claims.
-No replication strategy:
The study appears to rely solely on the UK Biobank for both exposure and outcome GWAS.
There is no mention of replication in an independent cohort, which limits the generalizability of
findings and raises concerns about overfitting.
-Ethical considerations not mentioned:
There is no explicit mention of ethical approval, participant consent, or data use agreements,
even though the UK Biobank has strict usage guidelines. This should be clearly stated.
Review for 10.1186/s12876-025-04162-w (2025)

Title: Investigating the shared genetic information between serum concentration levels of liver
enzymes and cholelithiasis
Version: 2 Date: 30 May 2025
Reviewer:  Mohamed H. Zidan
Reviewer's report:
Dear Authors,
Re: “Investigating the Shared Genetic Information Between Serum Concentration Levels of
Liver Enzymes and Cholelithiasis”
Thank you for the opportunity to review this well-executed and ambitious study. Your
manuscript tackles a highly relevant and biologically intriguing topic by leveraging genome-
wide association study (GWAS) data to investigate the genetic correlation, shared loci, and
potential causal links between serum liver enzyme levels and cholelithiasis. The combination of
cross-trait meta-analysis, Mendelian randomization, and functional enrichment adds significant
depth to the analysis.
The strength of your work lies in its integration of multiple statistical and genomic
methodologies, including LD score regression, LOGODetect, MTAG, and both univariable and
multivariable Mendelian randomization approaches. The careful consideration of confounders
such as BMI and cholesterol, along with the use of publicly available and well-curated datasets,
increases the robustness of your findings. The conclusion that elevated ALT may increase
cholelithiasis risk and that certain genes like SPTLC3 may mediate this relationship is both
plausible and clinically relevant.
In summary, this is a high-quality manuscript that uses a sophisticated and well-justified
methodology to address a biologically and clinically important question. please add a clear
conclusion section. yet I recommend on accepting the manuscript.
Sincerely,
Review for 10.1186/s12876-025-04171-9 (2025)

Title: Clinical Relevance of Transperineal Ultrasound Compared with Anorectal Manometry
for the Evaluation of Female Patients with Obstructive Defecation Syndrome
Version: 3 Date: 30 Jun 2025
Reviewer:  Gonzalo Martin-Martin
Reviewer's report:
Thank you for considering the proposed changes and implementing them as much as possible
Review for 10.1186/s12876-025-04158-6 (2025)

Title: CTI as a Biomarker for Diarrhea in U.S. Adults: Insights from NHANES 2005–2010
Version: 3 Date: 09 Jun 2025
Reviewer's report:
I think this article is a honest attempt to compare old and new index of bowel activity.
Indeed, I think the English used must be revised and improved as it is a bit simplistic.
Perhaps, the conclusions are a bit too strong and must be milder as these findings come from
a retrospectives database analysis.
Figures and Tables are sufficiently accurate.
Review for 10.1186/s12876-025-04158-6 (2025)

Title: CTI as a Biomarker for Diarrhea in U.S. Adults: Insights from NHANES 2005–2010
Version: 5 Date: 09 Jul 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory
Review for 10.1186/s12876-025-04158-6 (2025)

Title: CTI as a Biomarker for Diarrhea in U.S. Adults: Insights from NHANES 2005–2010
Version: 5 Date: 09 Jul 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/s12876-025-04176-4 (2025)

Title: CT assessment of total abdominal muscle area index (TAMAI) as a predictive tool for
early post operative complications in laparoscopic sleeve gastrectomy: A prospective case-
control study
Version: 7 Date: 27 Jun 2025
Reviewer:  Dimitrios Kehagias
Reviewer's report:
Thank you for submitting the revised version and addressing most comments. The manuscript
has been significantly refined but I have some more minor comments that you need to address.
Below are my suggestions:
1. In the abstract, results section. "The study enrolled 30 patients who underwent MBS". Here
instead of MBS, replace it with laparoscopic sleeve gastrectomy (LSG).
2. Make sure the abbreviations are mentioned once only at the beginning and then used
throughout the text. For instance, BMI is not provided, or LSG is repeatedly mentioned with
the full name.
3. In the introduction try to expand a bit more, by enriching the background. Mentioning exactly
the preoperative predictive factors for postoperative complications in MBS and citing some
recent systematic reviews or landmark studies could improve this.
4. In the methods, section II, change title to “Demographics, anthropometric data and surgical
technique”
Add in this section a paragraph describing the details of laparoscopic sleeve gastrectomy
(distance from pylorus, bougie size used) and also mention whether all these procedures were
performed by one surgeon and what experience did the surgeon or surgeons have.
Since you investigate complications, these factors are important to be adjusted.
5. Section III "CT acquisition". Clarify that the CT was performed only pre-operatively
(baseline) and not postoperative to evaluate changes in visceral fat. The aim was to show the
prognostic value of preoperative CT for complications. This has to be clear to the reader.
6. Results, section I. "Comparison of age, gender, BMI, weight, and height between the two
arms showed no statistical significance with p values >0.05 ."
These parameters should be added in the table 1 as well, so that you can show the comparisons.
Mentioning just that there were comparable is not enough. Cite also table 1 in the text.
7. Figures and tables are not cited in the text. None of them.
8. In the discussion remove the subtitles. Discussion is one text, not including any subtitles.
Ideally, the findings of your study should mentioned and summarized in the first paragraph.
However, the current form is proper for me.
I believe that after these changes the manuscript will be ready to be published. Carefully revise
the manuscript and address these points that will significantly improve your paper.
Review for 10.1186/s12876-025-04176-4 (2025)

Title: CT assessment of total abdominal muscle area index (TAMAI) as a predictive tool for
early post operative complications in laparoscopic sleeve gastrectomy: A prospective case-
control study
Version: 10 Date: 16 Jul 2025
Reviewer:  Dimitrios Kehagias
Reviewer's report:
Thank you for sending me the revised version. The authors have effectively addressed my
comments and have refined even more the manuscript. I have no further concerns and my
suggestion is acceptance of the manuscript. Thank you for the co-operation.
Review for 10.1186/s12876-025-04151-z (2025)

Title: Doppler ultrasound and 2D Shear wave ultrasound elastography for liver fibrosis
evaluation in Fontan-associated liver disease
Version: 1 Date: 01 Jun 2025
Reviewer's report:
It’s better to classify Fontan if hypertensive or not according to underlying cardiac lesion,
with interruption of pulmonary blood flow or not,  correlate with protein losing enteropathy in
selected patients
Correlation with Oxygen Saturation and  growth parameters ( degree of failure to thrive)
Review for 10.1186/s12876-025-04151-z (2025)

Title: Doppler ultrasound and 2D Shear wave ultrasound elastography for liver fibrosis
evaluation in Fontan-associated liver disease
Version: 1 Date: 04 Jun 2025
Reviewer's report:
This study evaluated the diagnostic performance of Doppler ultrasound and 2D-SWE in
assessing hepatic fibrosis in Fontan patients and compared the findings with biopsy-proven
fibrosis severity
- The authors tackle an important and very interesting subject. The manuscript is well written.
Congratulations to the authors!
- Please write out first APRI, FIB-4, and RI as it is the 1st time these abbreviations are introduced
into the text
- in the introduction please specify what Doppler ultrasound is of? I believe you mean it to be
of the hepatic artery and the portal vein
- The binary classification of fibrosis is useful to augment the findings in a relatively small
sample size
- Can the authors please hypothesize why hepatic arterial Doppler was a target for investigation
for looking at fibrosis or cirrhosis? This can be outlined best in the introduction.
- For the liver elastography data between the significant and non-significant fibrosis groups,
were there any outliers? Were higher tertile for example more likely yo have fibrosis/cirrhosis?
- Do the authors have any longitudinal data on the ARFI? Was there much variation in values
over time in any one individual?
- Please correct the grammar of this sentence in the discussion section:"However, our study
could not show statistic significant. " should be did not show statistical significance...
- In the discussion section:"When hepatic fibrosis progresses and presence of porta hypertension
" should say portal and not "porta"
* We believe that using PVV in classified non-cirrhosis or cirrhosis group are challenges.  Should
read "are challenging
- It is not clear from the results data presented how Doppler aids the clinical parameters or the
liver stiffness in the more accurate identification of  advanced fibrosis/cirrhosis. Please can the
authors give data in the results section to support this observation
Review for 10.1186/s12876-025-04151-z (2025)

Title: Doppler ultrasound and 2D Shear wave ultrasound elastography for liver fibrosis
evaluation in Fontan-associated liver disease
Version: 2 Date: 28 Jun 2025
Reviewer's report:
Good work
Just classify according to pathology, timing of intervention, and  pulmonary artery pressure
And If on long term medications that can contribute to liver affection
Review for 10.1186/s12876-025-04150-0 (2025)

Title: Association Between Albumin-Corrected Anion Gap and Delirium in Acute Pancreatitis:
Insights from the MIMIC-IV Database
Version: 1 Date: 13 Jun 2025
Reviewer's report:
The authors present findings of retrospective analysis of the MIMIC-IV database the goal of
examining the association between albumin-corrected anion gap (ACAG) and delirium at any
point during a hospitalization in patients with acute pancreatitis.  A biomarker for delirium in
this population would indeed be of interest. I think this is what the authors are stating but it
remains very unclear currently.  I have a few broad questions about this manuscript that warrant
addressing.
First, at one time point was the ACAG assessed?  Within 24 hours of ICU admission? At any
point in the hospitalization?  If it is within the first 24 hours of ICU admission, and this value
is associated with development of delirium at any point during an ICU admission for AP, then
this would indeed be an intriguing biomarker.  This needs to be clarified, and I would suggest
mentioning it in the last paragraph of the introduction if this is the case.
Further, the primary outcome needs clarification.  What is meant, specifically, by risk of delirium
within 28 days of hospitalization?  Does this mean occurrence of delirium at any time point up to
28 days after a hospitalization for AP?  If so, one would need at least daily delirium assessments
for this outcome.  Does this this dataset contain this degree of data?  If so, who performed the
CAM’s?  Was it nurses or research team members?
I am also assuming that this dataset does not have post hospitalization delirium assessments.   If
so, please clarify that outcomes assessments were censored at time of hospital discharge.
Within the data collection section, please clarify the CAM-scale used.  Was it the CAM-ICU,
3D-CAM, other?  Was delirium defined as a positive result on these tests at any time during
hospitalization?
One other small point/ query:  Does this database include surgical ICU admissions, medical or
both?
Overall, again, I think the authors are trying to state that ACAG collected within 24 hours
of ICU admission is predictive of delirium occurrence at any point during hospitalization. If
this is correct, I would strongly encourage the authors to clarify their language to reflect this
finding with specific attention to the time frame of both the exposure (ACAG) and the outcome
(delirium).
Review for 10.1186/s12876-025-04150-0 (2025)

Title: Association Between Albumin-Corrected Anion Gap and Delirium in Acute Pancreatitis:
Insights from the MIMIC-IV Database
Version: 1 Date: 20 Jun 2025
Reviewer's report:
The authors Ge et al. present a study that aims to investigate the association between delirium
and albumin-corrected anion gap based on the MIMIC-IV dataset. The manuscript is well written
but misses several aspects that are crucial to follow the content:
Major Comments
- Since you apply machine learning, please give the reader an overview
about related work and cite a few references that show that delirium ML
models were applied for septic patients, also with MIMIC-IV data already or
in a perioperative context https://www.nature.com/articles/s41598-023-38650-4, https://
journals.plos.org/plosone/article?id=10.1371/journal.pone.0319297, https://doi.org/10.1371/
journal.pdig.0000414, https://www.nature.com/articles/s41598-024-61627-w
- In Methods, further describe how you defined Clinical Outcomes and especially delirium
(CAM-ICU, Nu-DESC) etc. The usage of statistical tests like MWU test should be backed up
with references. You should explain how you retrieved 95% CI on the basis of your cox model.
Please also motivate more why you used cubic splines, is there evidence that your data follows
these? “The dataset was randomly split into a training set (75%) and a validation set (25%).”
Were the data spitted by patient ids or stays? Elaborate more what you exactly predict and on
what kind of bases also including the exact time of delirium assessment and your prediction
horizon. Justify why you did not apply multiple testing correction and why you picked SHAP
values for explanations. You fitted a COX model where the coefficients are relatively straight
forward to interpret.
- In your Results, you should always cite an effect size alongside your statistical p-values.
- “Boruta Algorithm” this section is “floating” in the text and the reader cannot follow 1) how
this algorithm works 2) why you have chosen this for feature selection 3) why the algorithm has
picked your presented features
- You should add further explanations and performance metrics for your ML algorithms like
AUPRC curves alongside AUROC and critically discuss the application thereof. How do you
intend to apply these models?
- In the Discussion, you should critically explain the role of missing data like missing ACAG
potentially leading to skewed distributions, at least arguing why no imputation was used
-
Minor Comments
- “Intensive Care Units at Beth Israel Deaconess Medical Center in Boston, Massachusetts.”,
add that the data is from the US to be precise
- “As a valuable resource for clinical research, particularly in intensive care, epidemiology, and
outcomes analysis, the MIMIC-IV database is structured to support large-scale data analysis
and has been widely employed in studies on critical illnesses, predictive modeling, and the
development of decision-support tools.“ shorten the sentence and consecutive ones , these are
not 100% relevant for your study
-
Review for 10.1186/s12876-025-04159-5 (2025)

Title: Relationship between gut microbiota dysbiosis and bile acid in patients with hepatitis B-
induced cirrhosis
Version: 2 Date: 20 Jun 2025
Reviewer:  Giuseppe Guido Maria Scarlata
Reviewer's report:
This study aimed to investigate the relationship between the gut microbiota and BAs in patients
with HBC. The identification of gut microbiota with high specificity was performed in BA-
high patients, which may contribute to the identification of novel biomarkers for assessing and
monitoring HBC progression and provide new insights into therapeutic strategies targeting gut
microbiota-mediated bile acid metabolism in HBC management.
I have some suggestions to improve the manuscript:
1. Background is very poor. I suggest to add some important points about the gut microbiota
composition in health and disease (see: doi:10.3390/nu15163569);
2. Role of bile acids: although BA are mentioned to have “antibacterial” effects, the presented
data suggest higher BA levels associate with worse liver function and more dysbiosis,  a
contradiction that is not addressed;
3. The repeated reporting of phylum/class/order/family/genus level differences in Tables 2 and
4 creates excessive duplication (e.g., reporting "Bacilli," "Lactobacillales," "Streptococcaceae"
and "Streptococcus" together without synthesis);
4. Several indices (Shannon, Simpson) show no difference, yet authors claim differences in “#-
diversity.” This oversimplifies ecological complexity;
5. Clarify statistical test used in #-diversity PCA (e.g., PERMANOVA?) and report its p-value
and R²;
6. Underline the strenghts and the limitations of your study.
Review for 10.1186/s12876-025-04172-8 (2025)

Title: Relationship of Coffee Consumption with Colonic Diverticulosis
Version: 2 Date: 10 Aug 2024
Reviewer:  Shahram Agah
Reviewer's report:
Dear Authors,
Thank you for your manuscript on the relationship between coffee consumption and colonic
diverticulosis. I have a few suggestions that could enhance the clarity and rigor of your study:
1. Please consider including actual numbers and key findings in the abstract. This would provide
readers with a clearer understanding of your results upfront.
2. The validity and reliability of the questionnaire used in your study are not discussed. Providing
details on how it was developed and tested for accuracy would strengthen your methodology.
3. While you analyze coffee subtypes, it is important to control for or explore potential
interactions/combining effects with other dietary factors, such as fiber intake. Additionally, diet
should be considered as a confounding variable, alongside other factors like socioeconomic
status, as these can significantly impact diverticulosis risk.
4. The discussion could benefit from a deeper exploration of the biological mechanisms by which
coffee may influence diverticulosis, rather than merely listing potential effects.
Thank you for considering these suggestions. I believe they will contribute to the overall strength
of your manuscript.
Best regards
Review for 10.1186/s12876-025-04172-8 (2025)

Title: Relationship of Coffee Consumption with Colonic Diverticulosis
Version: 2 Date: 13 Mar 2025
Reviewer:  Francesco di Mario
Reviewer's report:
Diverticulosis and diverticular disease have been hot topics in gastroenterological literature.
The search for individualised risk factors, almost related to lifestyle and consumption of different
substances like coffee, alcohol, fibers, and smoking, is increasing in different countries in the
world. The present study is based on a huge sample of the population in a country with elevated
consumption of coffee,  collecting subjects who underwent colonoscopy to search for a possible
relationship with colonic diverticulosis. As a matter of fact, the evidence is based on several
subjects showing diverticulosis, and the relationship between different kinds of coffee is not so
clear and therefore, the relationship in favor of a causal effect remains to be established. Every
contribution in this field is welcome, but the study seems to be not so relevant to add convincing
data. Finally, the conclusion is not in line with the results and needs to be modified.