JerMa88/BMC_Gastroenterology_Peer_Reviews huggingface dataset:
Review for 10.1186/s12876-025-04017-4 (2025)

Title: The Diagnostic Value of MRI-PDFF in Hepatic Steatosis of Patients with metabolic
dysfunction-associated steatotic liver disease: A Systematic Review and Meta-Analysis
Version: 1 Date: 22 Mar 2025
Reviewer's report:
The paper "The Diagnostic Value of MRI-PDFF in Hepatic Steatosis of Patients with
Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis" aims to evaluate
the diagnostic efficacy of MRI-PDFF in assessing hepatic steatosis through systematic review
and meta-analysis approaches.
The main limitation of the paper is the term NAFLD is not current. The term MASLD and related
ones should be used.
A recent study "Azizi N, Naghibi H, Shakiba M, Morsali M, Zarei D, Abbastabar H, Ghanaati
H. Evaluation of MRI proton density fat fraction in hepatic steatosis: a systematic review and
meta-analysis. Eur Radiol. 2025"  is a more comprehensive study than the author's study that
reduces the impact of the present study.
Many more studies are available in the literature that can be suitable for this analysis (see the
reference above). There should be a more comprehensive explanation of why they did not meet
the criteria.
Review for 10.1186/s12876-025-04017-4 (2025)

Title: The Diagnostic Value of MRI-PDFF in Hepatic Steatosis of Patients with metabolic
dysfunction-associated steatotic liver disease: A Systematic Review and Meta-Analysis
Version: 1 Date: 26 Mar 2025
Reviewer's report:
It's a good paper. I have 2 minor suggestions:
1) I recommend that you use the new nomenclature (i.e. MASLD) instead of NAFLD;
2) Please consider performing subgroup and meta-regression analyses to explore sources of
heterogeneity, including study and population characteristics.
Review for 10.1186/s12876-025-04017-4 (2025)

Title: The Diagnostic Value of MRI-PDFF in Hepatic Steatosis of Patients with metabolic
dysfunction-associated steatotic liver disease: A Systematic Review and Meta-Analysis
Version: 1 Date: 10 Apr 2025
Reviewer's report:
well written article on an important topic in hepatology at the moment
Review for 10.1186/s12876-025-04070-z (2025)

Title: Development and Validation of a Nomogram for Predicting Endoscopic Healing in
Crohn's Disease Patients Receiving Infliximab Treatment
Version: 4 Date: 27 Mar 2025
Reviewer's report:
The manuscript presents significant advancements in predicting infliximab efficacy in CD
patients through a novel nomogram integrating PLR and TDM parameters. With minor revisions
to improve clarity, address limitations, and contextualize findings within existing literature,
this study has strong potential to contribute meaningfully to personalized medicine in IBD
management.
Review for 10.1186/s12876-025-04070-z (2025)

Title: Development and Validation of a Nomogram for Predicting Endoscopic Healing in
Crohn's Disease Patients Receiving Infliximab Treatment
Version: 4 Date: 29 Apr 2025
Reviewer's report:
This was a retrospective study to develop a new nomogram for predicting outcomes in CD
patients.
- The tables are not included in the manuscript, so I am unable to complete my review.
-Please specify the assay type used for measuring IFX levels (HMSA/ELISA/RIA/POC) and
antibodies and please indicate the detectable serum IFX/ATI levels for the specific kits used.
- I do not have access to the tables, but did you assess the effect of immunomodulator use and
the duration of IFX treatment on mucosal healing (MH)?
-The discussion section is too long and would benefit from being more concise.
Review for 10.1186/s12876-025-04070-z (2025)

Title: Development and Validation of a Nomogram for Predicting Endoscopic Healing in
Crohn's Disease Patients Receiving Infliximab Treatment
Version: 5 Date: 14 May 2025
Reviewer's report:
There are few small remaining issues to revise.
1. Replace all instances of abbrevation "MH" with "EH" in the figure 1 and 5 and their captions.
2. Replace „MH“ with „EH“ in the first sentence of the conclusion.
3. In Outcomes and Definitions please revise following sentence: Although historically termed
'endoscopic healing', we adopted the term 'endoscopic healing' to more accurately reflect the
assessment method used. I suppose that you have meant to say: Although historically termed
'mucosal healing', we adopted the term 'endoscopic healing' to more accurately reflect the
assessment method used.
Review for 10.1186/s12876-025-04070-z (2025)

Title: Development and Validation of a Nomogram for Predicting Endoscopic Healing in
Crohn's Disease Patients Receiving Infliximab Treatment
Version: 5 Date: 20 May 2025
Reviewer's report:
Thanks for addressing some of the concerns.  Please find the following comments:
- All the continuous variables should be reported as median (IQR), such as ESR and CRP.
- Regarding IM use, although it was noted as a limitation, I believe it should be reported in
table one and if there is any significant difference between groups, it should be included in
multivariate analysis
- There are multiple recent data confirming the role of clearance in IFX TDM, clinical outcomes,
and inflammatory burden. Please include this data if you have. If you do not have access, please
describe it as a limitation.
Review for 10.1186/s12876-025-04082-9 (2025)

Title: U-shaped association of the stress hyperglycemia ratio for all-cause and cardiovascular
mortality in patients with NAFLD: results from the NHANES database prospective cohort study
Version: 0 Date: 22 May 2025
Reviewer:  Alireza Ramandi
Reviewer's report:
Line 62: please use recent GBD studies / epidemiologic original studies, instead of meta-analyses
(references 1 and 2) in reporting prevalence of fatty liver disease. Your reference number 3 is
a very appreciated paper in the field, but it would be more robust if you could provide a newer
publication along with it.
Line 69: “in-depth understanding of the pathogenesis of NAFLD” the word pathogenesis implies
understanding the underlying molecular pathway that leads to NAFLD, whereas studying cohort
fails to provide sufficient causality for that matter. Please revise the word pathogenesis into
predictive factors, or associations, or similar words.
Line 73: please change the word “admission” due to inaccuracy.
Line 79: the reference number 12 discusses if SHR is a better mortality biomarker in acute
COVID-19 patients. While the major focus of the article is on random blood glucose in
comparison to SHR, it mentions briefly that HBA1C did not show any significant association
with mortality, but SHR did. Nevertheless, this is only in COVID-19 patients, the power of the
study seems to be insufficient, and the setting of the disease is acute. There are no justifications
for your sentence. Please revise your sentence, replace your cited reference, and provide a
justification how an acute marker could help in prediciting mortality in a chronic disease.
Methods/Discussion-limitations: please either justify why you have not included PNPLA3 gene
polymorphism within your covariates in the method section, or in discussion section mention
your limitation of not having PNPLA3 data available. PNPLA3 is the most important gene
variation that has been associated with NAFLD and hepatosteatosis. The importance of this gene
is that it has approximately same prevalence as the NAFLD itself (~30% worldwide) and it is
within a complex pathogenesis pathway that leads to NAFLD. A suitable article to be added
for your references in either method section (justifying lack of PNPLA3 data) and/or discssion
limitation section (Mentioning this phenomenon as a major limitation to your study) would
be: DOI: 10.1111/liv.70091 which has extensively described the role of PNPLA3 and modeled
it, along with a suitable history of PNPLA3 discovery. Please revise your limitation section
by adding this important covariate that has not been included in your study, and cite suitable
references.
Methods: please justify and provide your ad-hoc statistical analysis that has lead you find the
“non-linear” association. A cox survival analysis or a regression cannot provide that data, unless
provided with sufficient ad-hoc tests.
Methods: please provide your Kaplan Meier curve.
Review for 10.1186/s12876-025-04082-9 (2025)

Title: U-shaped association of the stress hyperglycemia ratio for all-cause and cardiovascular
mortality in patients with NAFLD: results from the NHANES database prospective cohort study
Version: 0 Date: 22 May 2025
Reviewer's report:
This manuscript investigates the association between the stress hyperglycemia ratio (SHR)
and all-cause as well as cardiovascular mortality in NAFLD patients using NHANES data.
While the topic is of clinical relevance and the dataset is robust, several major issues—ranging
from methodological weaknesses and unclear statistical presentation to extensive language and
formatting problems—limit the clarity, rigor, and interpretability of the study.
If you believe any comment is based on a misunderstanding or you choose not to implement a
suggested change, please state your reasoning clearly rather than simply agreeing. A thoughtful,
critical response is always appreciated.
Comments
1. The use of causal terms such as "effect," "leads to," and “impact” is inappropriate for an
observational study and needs to be revised throughout the manuscript. Use association-based
phrasing like “linked to” or “associated with.”
2. Proportional Hazards Assumption: There is no assessment or reporting of the proportional
hazards (PH) assumption in the Cox regression models. Please check this assumption (e.g., using
PH test or Schoenfeld residuals) and report the results.
3. Add a dashed or solid horizontal line at HR = 1.0 to clearly demarcate the reference risk level
across the SHR spectrum.
4. You have chosen restricted cubic splines (RCS) to model the non-linear association between
SHR and mortality, which is appropriate for exploratory dose–response analysis. However, you
did not mention whether other non-linear modeling strategies were considered, such as piecewise
linear regression. Please clarify whether alternative models were tested (e.g., piecewise or
segmented regression), and if so, how the RCS was selected as the final approach.
5. Use the term p-value for linear trend. Additionally, compare and discuss the results of the p-
value for linear trend and the non-linearity value.
6. The U-shaped association is mentioned repeatedly, but its clinical implication is unclear. For
example, the discussion implies that SHR < 0.88 is protective but also associates it with increased
mortality. This contradiction needs clearer interpretation and discussion.
7. Although many covariates are included, some relevant confounders such as socioeconomic
status, diet, and medication history are missing. Acknowledge this more explicitly in the
limitations.
8. The manuscript contains numerous grammatical errors, typos, and awkward phrases.
Professional English editing is essential before resubmission.
9. Inconsistent formatting and citation style; please adhere to journal-specific reference
guidelines.
10. Please revise all figures for clarity, consistency, and standalone interpretability. Use
uniform color schemes, standard hazard ratio axes, and ensure all annotations are readable and
informative.
Review for 10.1186/s12876-025-04082-9 (2025)

Title: U-shaped association of the stress hyperglycemia ratio for all-cause and cardiovascular
mortality in patients with NAFLD: results from the NHANES database prospective cohort study
Version: 1 Date: 07 Jun 2025
Reviewer's report:
Thank you for your detailed and thoughtful responses to the previous reviewer and editor
comments. I carefully reviewed your point-by-point rebuttal alongside the revised manuscript,
and I am pleased to see that the manuscript has significantly improved in both scientific clarity
and methodological transparency.
Most of the previously raised issues—including clarification of the NAFLD definition,
adjustment for important confounders, handling of missing data, use of competing risk models,
and improved presentation of the figures and tables—have been satisfactorily addressed.
The inclusion of additional statistical explanation, expanded limitations, and clearer narrative
structure has enhanced the manuscript’s overall quality.
I appreciate the substantial revisions made and your commitment to improving the scientific
rigor and clarity of your work. I believe the article is now in a much stronger position for
publication and will be of value to the field.
I wish you continued success with this and future research endeavors.
Review for 10.1186/s12876-025-04062-z (2025)

Title: Efficacy of extracorporeal immunoadsorption therapy for removal of HBsAg
Version: 1 Date: 19 Feb 2025
Reviewer:  Yoshihiko Yano
Reviewer's report:
The manuscript shows the efficacy and safety of immunoadsorption therapy. It is potentially
interesting, but some modifications and additions are needed.
Major revision:
1. In the study using in vivo rabbit, blood samples were collected before and after the treatment.
This part is clinically important, but in the after treatment, how long does that effect last in the
long term effect? If it is a transient effect and there is no long term drug effect, it would not
be realistic. At least for HBs antigen and HBVDNA, the test results should be repeated and
presented several days and even months after the treatment.
2. For each experiment, the purpose of the experiment should be clearly described. Each
paragraph in the method section should describe why the study is being conducted.
Minor revision:
1. Figure 7 shows the laboratory values before and after the treatment. What would be the
changes in bilirubin level, which is an indicator of hemolysis, and globulin?
2. Why did author use V79 cells? It should be explained why this cell was used and whether the
results can be generalized to experiments with this cell.
3. Author should also describe in more detail how you measured HBS antigen, HBVDNA, etc.
Review for 10.1186/s12876-025-04062-z (2025)

Title: Efficacy of extracorporeal immunoadsorption therapy for removal of HBsAg
Version: 1 Date: 20 Feb 2025
Reviewer's report:
Dear Sirs/Madams,
I really enjoyed your article.
I understand you want to commercialize your research and in this case many details in the article
were missing.  If this article is about affinity resin preparation, where there is no discussion about
ligand and matrix itself, why exactly did these were used. Ligand interaction with vivo objects
was not investigated. Even if your experiments (cytotoxicity and rabbits) show what resin looks
safe, you have not investigated the worst case, when your ligand will start to leak in some case,
which is pretty common for such affinity resins.
If you are working on the platform for this method to obtain immunoadsorption medical devices
it is a good step, but HBsAG probably not hottest target for it.
I think you did great work and wish you luck in your further research and real product
development.
Kind regards
Review for 10.1186/s12876-025-04062-z (2025)

Title: Efficacy of extracorporeal immunoadsorption therapy for removal of HBsAg
Version: 1 Date: 20 Feb 2025
Reviewer:  Heba Shawky
Reviewer's report:
I hereby state my comments regarding the manuscript entitled "Efficacy and safety of
extracorporeal immunoadsorption therapy for removal of HBsAg". In this study, Wang et al.
sought to investigates the efficacy and safety of removal of HBsAg using immunoadsorption.
I found the manuscript addressing a significant clinical question concerning a common disease
affecting a considerable number of people worldwide, not only in China. This study addresses
a critical topic and warrants publication, provided that the following issues are resolved:
1. Considering that the authors approach the biosafety of anti-HBsAg functionalized sepharose
beads; given that it is mentioned in the main title, I have some concerns about the assessment
methodology of biosafety:
# Regardless of the in vitro assessment of cytotoxicity in V79 lung fibroblasts, in page 6, lines
155-157 the authors mention that: To investigate the efficiency and biocompatibility, healthy
rabbits (n=3) were connected to the immunosorbent column and the blood of animals was
circulated through the extracorporeal circuit for 2 h. Rabbits were then monitored for 48 h".
Please clarify whether you investigated the anti-HBsAg functionalized sepharose beads or the
control beads.
# In case that the authors investigated the curative system, i.e., anti-HBsAg functionalized
sepharose beads, two days are far from enough investigating acute toxicity, it should be extended
to 14 days minimum.
# Animal mortality is not the only criterion for biosafety, particularly that the developed system
is investigated in this preclinical study as a step for human use. There are no biochemical,
immunological, or histopathological assessments of biosafety.
2. Regarding the characterization of the developed extracorporeal circulation system, SEM is
merely a method of morphological assessment, more investigations should have been carried
out to determine the molecular interactions between the adsorbed antibody and sepharose beads,
which indicates the system stability.
Review for 10.1186/s12876-025-04062-z (2025)

Title: Efficacy of extracorporeal immunoadsorption therapy for removal of HBsAg
Version: 2 Date: 11 Mar 2025
Reviewer:  Heba Shawky
Reviewer's report:
As authors did not actually performed safety studies, they did a good job removing the word
"safety" in the main title.
Review for 10.1186/s12876-025-04062-z (2025)

Title: Efficacy of extracorporeal immunoadsorption therapy for removal of HBsAg
Version: 2 Date: 18 Mar 2025
Reviewer's report:
Hi!
Interesting article in terms of preparation medical device but some information still unclear:
1.  Antibody structure used for affinity media preparation was not discussed.
2.  Effectiveness of  ligand immobilization on the matrix was studied only trough microscope
analysis.  Passivation of activated  -CHO groups was not discussed.
3. "Adsorption",  "Adsorption efficiency",  "Adsorption ratio", "Adsorption rate" used for same
parameter but there no definition of it in the article.
4. some  topic titles have to be reconsidered.
5.  Need to clarify  when something is "adsorbed" by  media.
6. Dynamic and static adsorption section can be reviewed to provide better understanding of
these experiments.
7. "Immunosorbent adsorption percentage " shall be better defined and difference between it
and "efficacy" should be shown.
8. Difference in numbers between in vivo and in vitro experiments can be discussed.
9. ability to reduce DNA concentration shall be discussed.
I include manuscript with some comments.  I ask  editor to decide are my comments valuable or
not and to decide  can this article  to be published or not. As a specialist i enjoyed reading and
want to see the results of  this work to be published but some items can be more clarified.
Best wishes and good luck with your work!
Review for 10.1186/s12876-025-04062-z (2025)

Title: Efficacy of extracorporeal immunoadsorption therapy for removal of HBsAg
Version: 2 Date: 22 Mar 2025
Reviewer's report:
The article entitled “Efficacy of extracorporeal immunoadsorption therapy for removal of
HBsAg” is self-explanatory." This is an observational study in which HBsAg clearance was the
target of the study. In short, the authors prepared agarose beads containing antibodies to hepatitis
B surface antigen (HBsAg) [anti-HBs]. The characterization of these beads moved on. These
anti-HBs-containing beads had potent capacity to neutralize HBsAg in vitro. Finally, the study
enrolled to show its capacity in an animal model. Use of anti-HBs coated beads was able to
reduce HBsAg and HBV DNA in rabbits.  Based on these observations, the authors commented
that this approach may act as a therapeutic option for the functional cure of chronic hepatitis
B virus (HBV)-infected patients. The article has been reviewed before appearing to me. I am
going to omit repeated comments and focus on the fundamental defects of the article.
Comments
1. The entire study is a defaulted one concerning the fundamental problem of management of
chronic hepatitis B (CHB) patients. It is true that HBsAg reduction by commercially available
drugs is not up to the mark, and this represents a major problem in this regard. Any effort to clear
or reduce HBsAg in CHB patients would be a notable contribution in this context. However,
HBsAg reduction must be associated with containment of the replicative process of HBV in the
CHB patients. In any kind of study where HBsAg is neutralized by this type of approach, it is
either a problem to realize the pathogenesis of CHB progression or just a non-scientific view
over the matter in a holistic manner. After treating CHB patients with antiviral drugs, HBsAg
reduction is expected as a part of the antiviral and immune modulatory action of this drug.
Reduction of HBsAg by anti-HBs beads in a transient manner is not something that is warranted
in CHB patients. Accordingly, it is natural to ask how long HBsAg reduction prevailed in this
animal model.
2. The next issue is regarding the animal model of HBV. The authors injected HBsAg to produce
an animal model of CHB or HBV carrier state. This is a childish approach, and it is never
an accepted mode. Several models of HBV carrier states of CHB have been produced in the
world since 1985. But this type of approach is a confusing one. I would request the authors to
authenticate their model in Rabbit.
3. When an animal model of HBV carrier state is implemented by injecting HBsAg, how may
the rabbit express HBV DNA?  I am really confused regarding the total motive of the authors
and how they proceeded on with this study.
4. HBV DNA was depleted about 66% from rabbit blood. How did the rabbit get HBV DNA?
This requires a clear explanation.
5. As the fundamental basis of the study is in question, the model is not accepted and seems to
be elusive; the result and discussion seem irreverent.
Review for 10.1186/s12876-025-04062-z (2025)

Title: Efficacy of extracorporeal immunoadsorption therapy for removal of HBsAg
Version: 2 Date: 22 Mar 2025
Reviewer:  Yoshihiko Yano
Reviewer's report:
The revised manuscript was mostly well modified. Some points should be checked up.
1. Especially, there are many errors in the wording of the revised section and should be checked
up again; “ARCHITECT i2000SR mechine”, “TP”, “in vitro” et al.
2. Abbreviations for example, “cccDNA, pgRNA” that appear for the first time should be listed
without abbreviation.
3. Figure 4, (%) should be written exactly.
Review for 10.1186/s12876-025-04062-z (2025)

Title: Efficacy of extracorporeal immunoadsorption therapy for removal of HBsAg
Version: 3 Date: 02 Apr 2025
Reviewer's report:
As I discussed in the previous and original review, the authors could not provide a suitable
response to the queries related to the fundamental aspect of the article. Please follow the
comments regarding this.
1. The methodology of production of HBV-infected rabbit is not a rational one. Injecting HBsAg-
positive sera is not supposed to be an animal model of chronic HBV infection.
2. It has been mentioned that a rabbit model of viremia was produced by injecting HBsAg-
positive rabbit serum. I have considerable doubt about this. Additionally, this is not a rational
approach. In other words, a rabbit immunized by HBsAg is not supposed to show HBV DNA.
3. How did the rabbits exhibit HBV DNA? This is not possible in this type of model.
4. I am confused about the production of the model and the fundamental aspect of the article.
Review for 10.1186/s12876-025-04062-z (2025)

Title: Efficacy of extracorporeal immunoadsorption therapy for removal of HBsAg
Version: 4 Date: 22 Apr 2025
Reviewer's report:
The reviewer’s primary concern centered on the validity of the rabbit model. The authors
responded as follows:
1. Clarified that the model was designed to test **physical clearance** of circulating HBsAg/
HBV DNA, not to mimic chronic HBV infection or intrahepatic cccDNA dynamics. This
distinction is now emphasized in the Discussion.
2.  Explained that the injected serum (derived from human plasma) contained HBV virions,
allowing detection via qPCR. The authors acknowledged that this does not reflect true infection
or replication, which aligns with the study’s proof-of-concept scope.
3. Repeatedly emphasized the model’s artificial nature and the need for future studies in
clinically relevant systems (e.g., humanized mice).
While Reviewer 1’s concerns about the model’s biological relevance remain valid, the authors
have adequately justified its use within the study’s scope and openly discussed limitations. No
further experimental changes are feasible at this stage.
Review for 10.1186/s12876-025-04062-z (2025)

Title: Efficacy of extracorporeal immunoadsorption therapy for removal of HBsAg
Version: 4 Date: 03 May 2025
Reviewer's report:
Comment
The authors have explored the immunoadsorption therapy for removal of HBsAg. The approach
and the concept (immunoadsorption the widely known) is interesting. However, this manuscript
is not up to the mark. Below are the comments :
1. In Materials and method section, no references were provided for antibody immobilization
protocol. For e.g.: How did you arrive at the agarose treatment with sodium periodiate for 2 h
in room temperature?
As you know, the protocols are followed by some research articles. So you should provide the
references.
2. Details of chemicals, analytical instruments was not listed in materials and methods section.
3. What is the reason to choose 6 different agarose beads? They all fall within the same particle
size.
4. A follow-up questions to above point. In R& D section you have shown the adsorption of
those 6 different agarose beads (Fig. 3). Can you explain why different beads showed different
adsorption capacities? Please provide an explanation in the manuscript. Can this be generalized
to other immunosorbents? Any previous studies with other immunosorbents?
5. How did you quantify the amount of immobilized antibody on the adsorbents? No details
provided.
6. This is related to Fig. 4. You have provided a statement “According to the result, an adsorbent
with an antibody concentration of around 4 mg/g is sufficient”. However, when we look at Fig.
4, 10 mg of antibody has resulted in another 5 % increase of analyte adsorption. This was not
discussed. My conclusion is: no clear discussion on your results.
7. “The non-specific adsorption efficiency of the immunosorbent was about 10%.” No discussion
on why this high non-specific adsorption and how to overcome this limitation if we want to
implement your immunosorbent column.
8. SEM images and the data look interesting. However, no scale or other details provided within
the image, which is required. Please follow the standard way when reporting them. Refer to
articles that display SEM images.
9.  A follow-up of above comment. Please do BET analysis of the samples, it will provide more
insights and provides solid proof for your discussion and the images you showed.
10. The manuscript should undergo thorough verification in terms of formatting, providing
details etc.
Review for 10.1186/s12876-025-04062-z (2025)

Title: Efficacy of extracorporeal immunoadsorption therapy for removal of HBsAg
Version: 4 Date: 03 May 2025
Reviewer's report:
Dear Sirs,
Good work on changes from the past versions.  But still some points which confuse me:
1. p. 2.3 is more about agarose matrix choice. not about Adsorption efficacy. In materials better
to show HOW you do experiments.
2. 2.4. i s about ligand concentration determination.
3. Dynamic and static adsorption in vitro more show to resulted immunosorbent capacity.  This
parameter best describes your immunosorbent properties.
4. If you are claiming what your sorbent can remove HBV DNA you shall discuss it.
Theoretically it is impossible. It may be a result of the action of rabbit’s immune system.
5. I miss the explanation between in vitro and in vivo efficacy differences.
Probably it is my subjective impression, but some information presented in “Materials and
Methods” shall be moved to “Discussion” and results, and some information from “Discussion”
shall be described in “Materials and Methods”.  I also placed some comments in the file attached.
Kind regards,
Review for 10.1186/s12876-025-04062-z (2025)

Title: Efficacy of extracorporeal immunoadsorption therapy for removal of HBsAg
Version: 5 Date: 19 May 2025
Reviewer's report:
Dear Authors,
It was a long road and I h happy to say now I’m satisfied by the changes you made to the texts. I
have no future comments. I wish you good luck in your future work.  I think some results should
be better highlighted but it is stylish so I will recommend this article be published. Now there
is a much clearer explanation of your impressive results.
Kind regards,
Review for 10.1186/s12876-025-03857-4 (2025)

Title: Diagnostic performance of a new algorithm combining simple, non-invasive and
inexpensive tests for predicting the presence of advanced liver fibrosis in patients with chronic
hepatitis B.
Version: 4 Date: 30 Aug 2024
Reviewer's report:
1. The inclusion criteria for this paper are not specific, such as whether patients with previous
decompensated events have been excluded? It is very important.
2. F2 is significant fibrosis, F3 is advanced fibrosis, and there is no concept of severe fibrosis.
3. Figure 1 shows the prediction algorithm for the study population. The proportion of patients
who met the algorithm of PLT > 192 and ALT < 116 to exclude F2 was 53%, but 15% (33/217)
of patients were misclassified. Therefore, the efficiency of ruling out F2 is too low.
4. The AUC of the new algorithm predicting significant fibrosis (#F2) in the training and
validation groups were 0.83 and 0.67, respectively, with a significant decrease in AUC in the
validation cohort, indicating poor extrapolation of the new algorithm.
5. The new algorithm has not been compared with the most commonly used FIB-4 and APRI
models; There is also no comparison with LSM.
6. Except for PLT > 192 and ALT < 116, the GGT and cut-off values of these parameters in
Figure 1 are not detailed in the results section of this paper.
7. The methods section of the abstract mentions that the purpose of the new algorithm is to
predict F0-1, F2, or F3-4. In Table 1, the proportion of patients with F2 was not included in the
pathological METAVIR scoring system.
Review for 10.1186/s12876-025-03857-4 (2025)

Title: Diagnostic performance of a new algorithm combining simple, non-invasive and
inexpensive tests for predicting the presence of advanced liver fibrosis in patients with chronic
hepatitis B.
Version: 8 Date: 13 Feb 2025
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: The authors have satisfactorily revised the manuscript according
to my questions/concerns and have made appropriate changes in the revised manuscript. The
manuscript has now improved substantially and may be accepted.
ADDITIONAL REQUESTS/SUGGESTIONS:
Fine linguistic editing is needed during copyediting stage.
Review for 10.1186/s12876-025-04088-3 (2025)

Title: Timing of endoscopy in patients with acute variceal bleeding in cirrhosis: An updated
systematic review and meta-analysis
Version: 0 Date: 22 Apr 2025
Reviewer's report:
The authors should be commended as they gathered a big amount of data and they submitted a
nicely written SRMA on this important topic.
Main limitations are the high heterogeneity observed in most of the analyzed outcomes and the
high imprecision (i.e. broad CIs of the point estimates) that undermine their efforts.
There is also a conceptual heterogeneity in the treatments used for the hemostasis.
The authors should comment on the potential role of hemostatic powders in this field (cite the
SRMA: PMID: 31401022)
Review for 10.1186/s12876-025-04088-3 (2025)

Title: Timing of endoscopy in patients with acute variceal bleeding in cirrhosis: An updated
systematic review and meta-analysis
Version: 0 Date: 30 Apr 2025
Reviewer's report:
This study investigates the impact of endoscopy timing on outcomes in cirrhotic patients with
acute variceal bleeding (AVB) through a systematic review and meta-analysis. The topic holds
significant clinical relevance. The authors included recent studies and expanded the sample size,
with a rigorous methodological design. The conclusions provide valuable insights for clinical
practice. Specific comments are as follows:
1.The meta-analysis should adhere to the latest PRISMA guidelines and include a completed
checklist.
2.The search dates should be mentioned in the abstract.
The original conclusion states:" Endoscopy within 6 may be associated with higher mortality,
while endoscopy within 6-24 h had no significant impact on clinical outcomes in AVB patients.
Therefore, the timing for endoscopy would be more appropriate based on each patient's condition
within 24 h than an urgent endoscopy." This conclusion is problematic. The results indicate that
the subgroup analysis (6–24 hours) showed significantly lower mortality compared to the <6-
hour group, but this was based on only 2 studies (n=3,631). Overall, no significant differences
were observed between urgent endoscopy and early endoscopy groups in primary outcomes
(mortality, rebleeding) or secondary outcomes (hospital stay, rescue therapy, transfusion units).
The study does not demonstrate the superiority of "individualized timing within 24 hours" over
"urgent endoscopy," but rather shows no significant difference between the two. This conclusion
may mislead clinical practice.
3.Significant heterogeneity was observed in the analysis of primary outcomes, particularly for
mortality (I² = 69%). Potential sources of heterogeneity include variations in definitions of
endoscopy timing, inconsistencies in baseline patient characteristics (e.g., liver function scores,
bleeding severity), and differences in treatment protocols. Although subgroup analyses were
performed, the study failed to thoroughly explore the root causes of heterogeneity or conduct
sensitivity analyses to assess its impact on result stability.
4.Result Interpretation and Discussion:The <6-hour group showed significantly higher mortality
(OR = 2.05, 95% CI: 1.29–3.26, P = 0.002), but this was derived from only 2 studies (n=3,631).
When endoscopy timing was defined as a 12-hour interval, no significant mortality difference
was observed. The robustness of these findings and potential mechanisms (e.g., critically ill
patients being prioritized for urgent endoscopy, procedural risks) should be discussed. The
discussion should explicitly address the lack of significant differences in primary outcomes
across endoscopy timing groups and compare these findings with similar studies in the field.
Review for 10.1186/s12876-025-04088-3 (2025)

Title: Timing of endoscopy in patients with acute variceal bleeding in cirrhosis: An updated
systematic review and meta-analysis
Version: 0 Date: 11 May 2025
Reviewer's report:
While the authors provide a comprehensive and well-conducted meta-analysis on the timing of
endoscopy in acute variceal bleeding (AVB), the interpretation of their findings—particularly
the increased mortality associated with endoscopy within 6 hours—warrants critical caution due
to potential confounding by indication.
Review for 10.1186/s12876-025-04088-3 (2025)

Title: Timing of endoscopy in patients with acute variceal bleeding in cirrhosis: An updated
systematic review and meta-analysis
Version: 1 Date: 06 Jun 2025
Reviewer's report:
The authors have responded substantively to the reviewers' comments: supplementing the
PRISMA checklist, search dates, sensitivity analyses, meta-regressions, and amending the
formulation of conclusions to acknowledge the risk of confounding bias. This is the largest meta-
analysis of AVB endoscopic timing to date, and the paper will have a positive impact on the
field. In response, the author has made detailed revisions to the reviewers' comments, and I have
no comment.
Review for 10.1186/s12876-025-03992-y (2025)

Title: Prevalence of advanced liver fibrosis in the general population of the Paris region
according to FIB-4 score and Liver Risk Score
Version: 1 Date: 23 Mar 2025
Reviewer's report:
Prevalence of advanced liver fibrosis in the general population of the Paris region according to
FIB-4 score and Liver Risk Score
Thank you for an interesting paper.
LRS and FIB-4 were applied to a general population, rather than a targeted at risk group. I realise
this was the point of the paper but I would ask that the authors’ discuss the limitations of doing
this please.
The authors’ have applied FIB-4 and LRS to their cohort and compared the results and
differences. This is useful in terms of how each test performs, but both tests have their limitations
which are different.  Arguably, comparing the performance of these two tests is not appropriate
because of their limitations. Why wasn’t a third independent test, such as FibroScan, used to
provide a gold standard proxy?
I would recommend that the cost comparison has statistical/health economic review.
Please note, there is a typo on page 11. "directely should be directly"
Review for 10.1186/s12876-025-04063-y (2025)

Title: Comparative Clinical Outcomes of Transcystic vs. Transductal Laparoscopic Common
Bile Duct Exploration: A Retrospective Study
Version: 0 Date: 27 Feb 2025
Reviewer:  Thomas Arkle
Reviewer's report:
Dear Authors,
Many thanks for submitting your manuscript which I read with great interest. I particularly
commend you for the inclusion of excellent intra-operative images.
I hope that the attached review is useful in progressing the manuscript,
Best wishes,
Review for 10.1186/s12876-025-04063-y (2025)

Title: Comparative Clinical Outcomes of Transcystic vs. Transductal Laparoscopic Common
Bile Duct Exploration: A Retrospective Study
Version: 1 Date: 21 Apr 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
-Although  the retrospective design and acknowledge its limitations is justified, no additional
data or analysis (e.g., grading of complications, subgroup analysis by comorbidities) was added
—only acknowledged.
-The cost-effectiveness point was discussed, but still not expanded quantitatively due to data
limitations.
Review for 10.1186/s12876-025-04063-y (2025)

Title: Comparative Clinical Outcomes of Transcystic vs. Transductal Laparoscopic Common
Bile Duct Exploration: A Retrospective Study
Version: 1 Date: 30 Apr 2025
Reviewer:  Thomas Arkle
Reviewer's report:
To the Authors,
Many thanks for the kind responses to my review of your original submission. I have reviewed
these and have a few key points I wished to raise for further clarification. I hope that these are
helpful and I wish you well with the resubmission.
Kind regards,
Review for 10.1186/s12876-025-04063-y (2025)

Title: Comparative Clinical Outcomes of Transcystic vs. Transductal Laparoscopic Common
Bile Duct Exploration: A Retrospective Study
Version: 3 Date: 23 May 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory
Review for 10.1186/s12876-025-04060-1 (2025)

Title: Association between dietary flavonoids intake and metabolic dysfunction-associated
steatotic liver disease especially in non-smokers: A cross-sectional study in US adults
Version: 0 Date: 21 Apr 2025
Reviewer's report:
This study reveals a U-shaped association between dietary flavonoid intake and MAFLD/
MASLD, mediated by low-grade inflammation. Anthocyanidins and flavanones offer the most
protection. Non-smokers exhibited stronger benefits, with smoking status influencing effects.
Using NHANES data, Gao et al., emphasize the importance of flavonoid-rich diets and smoking
cessation for managing MAFLD/MASLD.
I have a few comments:
1. It should be noted that reliance on FLI/USFLI indices without imaging or biopsy may
misclassify cases and introduce outcome bias, which will affect the diagnostic validity of
MAFLD/MASLD.
2. A single 24-hour recall may not accurately reflect habitual intake, which risks
misclassification of exposure.
3. U-shaped inflection thresholds lack validation; the mechanistic rationale for nonlinearity is
underexplored.
4. Biological pathways linking smoking to reduced flavonoid efficacy remain speculative and
require experimental validation. Additionally, authors should clarify their choice of smoke as a
subgroup analysis instead of other lifestyle factors.
5. Additive effects of flavonoid subclasses may oversimplify interactions that are synergistic
or antagonistic.
6. The differential bioavailability of flavonoid subclasses (e.g., isoflavones vs. anthocyanidins)
is overlooked.
7. The recommendation for a "flavonoid-rich diet" lacks practical guidance, such as food sources
and dosages.
8. Abstract highlights smoking interactions, but results emphasize non-smokers; reframe for
consistency.
9. Some citations (e.g., global prevalence of MAFLD/MASLD) are outdated; please include
more updated literature.
10. Considering the difference in flavonoid association between MASLD and MAFLD, a further
subgroup analysis of MASLD-only and MAFLD-only is suggested. And the difference should
be discussed.
Review for 10.1186/s12876-025-04060-1 (2025)

Title: Association between dietary flavonoids intake and metabolic dysfunction-associated
steatotic liver disease especially in non-smokers: A cross-sectional study in US adults
Version: 1 Date: 26 May 2025
Reviewer's report:
I appreciated that the authors have addressed all my comments, and I don’t have any further
comments.
Review for 10.1186/s12876-025-04060-1 (2025)

Title: Association between dietary flavonoids intake and metabolic dysfunction-associated
steatotic liver disease especially in non-smokers: A cross-sectional study in US adults
Version: 1 Date: 31 May 2025
Reviewer:  Bryan Adrian Priego-Parra
Reviewer's report:
The authors have correctly addressed the corrections made.
Review for 10.1186/s12876-025-04039-y (2025)

Title: Feasibility, Efficacy, and Safety of Ventral Caudal Artery Access for Transarterial
Chemoembolization in a Rat Hepatocellular Carcinoma Model
Version: 1 Date: 05 Mar 2025
Reviewer's report:
P5 L108
For reproducibility, I feel it is better to describe details of the MR parameters (model, Tesla
strength, sequence, etc). Was the MRI performed only once? If the tumor was smaller than 5
mm, was a re-scanning conducted?
P6 L113
Body weight at the procedure is important. I feel the body weight of the animals at the time of
angiography need to be described.
P10 L200
Did all animals show tumor enhancement which is consistent with MRI findings (without
spontaneous regression)?
P7 L143
It is reasonable that the DEB-TACE group received the procedure only one time. But, why did
the NS group undergo procedures two times? Just to assess repeatability? If there is reasonable
explanation about why authors chose the study design of 1 time DEB-TACE vs 2 times NS, it
would be better to describe it in more detail.
P8 L169 (and pathology Section)
Does this mean 12 specimens per tumor were evaluated? If there were any specific rules for
section preparation, such as using the largest cross-section, it would be better to describe.
Additionally, in the results section, creating a simple table might be helpful. If there is a
correlation between DOX distribution and necrosis rate, mentioning it could also be beneficial.
Review for 10.1186/s12876-025-04039-y (2025)

Title: Feasibility, Efficacy, and Safety of Ventral Caudal Artery Access for Transarterial
Chemoembolization in a Rat Hepatocellular Carcinoma Model
Version: 1 Date: 14 Mar 2025
Reviewer's report:
Dear authors, the paper is clear, nicely written and complete both in the materials and methods
and results.
Just some information I would suggest to add:
1) Authors mention operator's experience; were all the procedures performed by the same
operator? Was the same operator in charge of both artery exposure and hepatic artery
catheterization?
2) In the discussion, would it be possible to add mean reporting time required for catheterization
using different approaches?
Review for 10.1186/s12876-025-04039-y (2025)

Title: Feasibility, Efficacy, and Safety of Ventral Caudal Artery Access for Transarterial
Chemoembolization in a Rat Hepatocellular Carcinoma Model
Version: 2 Date: 02 May 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
While the study is clearly a preliminary investigation, some points still require small
improvements for enhanced clarity and scientific rigor:
-Generalizability to Larger Models: Although the study is limited to a rat model, a brief
acknowledgment of how anatomical differences may affect the translation to larger animal
models (e.g., rabbits or swine) would enhance the contextual value of the findings.
-Additional Efficacy Metrics: The use of tumor necrosis as the sole efficacy endpoint is
understandable in a preliminary study. Nonetheless, a short justification for the exclusion of
other measures such as tumor size or survival rates should be included in the discussion to
address potential concerns regarding the comprehensiveness of the evaluation.
-Comparison to Clinical Standards: While the authors clarify that hepatic artery access is outside
the study scope, a brief mention or reference to clinical TACE access routes (e.g., femoral or
radial) would strengthen the translational relevance of the study.
Procedural Challenges: The authors report a 100% success rate, which is commendable.
However, explicitly stating whether any technical difficulties were observed during VCA access
would add transparency and practical value for future preclinical applications.
Review for 10.1186/s12876-025-04039-y (2025)

Title: Feasibility, Efficacy, and Safety of Ventral Caudal Artery Access for Transarterial
Chemoembolization in a Rat Hepatocellular Carcinoma Model
Version: 3 Date: 27 May 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory