Reviewer’s report
Title: Midbrain/pons area ratio and clinical features predict the prognosis of Progressive Supranuclear
Palsy
Version: 1 Date: 09 Mar 2020
Reviewer: Ilza Maria Urbano Monteiro
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Reviewer #1:
The paper entitled "treatment of C-section diverticula with hysteroscopic resection in
women without childbearing intention: a retrospective cohort study" is very interesting.
It is a important topic to be studied considering the rising number of C-section delivery
mode, mainly in Latin America and its consequences.
In spite of being a retrospective cohort study, it was well designed to avoid missing
data.
Answer. We thank the reviewer for this positive comment. We agree that treatment of
C-section diverticula with hysteroscopic resection in women without childbearing
intention is an important topic, given the large number of women without childbearing
intention in China and the fact that this group of patients have largely been ignored. We
believe our findings will promote the appropriate way of repair of CSD and will improve
the life quality of patients.
Reviewer #2:
Q1. Regarding the methods, it's unclear how e by whom the diagnosis of CSD was
performed. Taking into consideration that ultrasound is operant dependent, it would be
considered as a bias if this exam was not performed by the same professional/group of
professionals.
Answer. Thank you for your comments. First, the diagnosis of CSD was established via
transvaginal ultrasonography and hysteroscopy. All TVS were performed by a team of
three ultrasound operators, and sonograms display a triangular anechoic filling defect.
The experienced gynecologists performed hysteroscopy which shows the uterine
anterior wall defect at the isthmus, to identify the presence of CSD in the isthmic or
cervical site. Second, all ultrasound operators and gynecologists received standardized
training; therefore the inter-operator bias should be limited added the corresponding
information in the revised manuscript (Methods section, line 19-24, page 4).
Q2. Regarding the factors of poor prognosis, perhaps a more board study such be
taken considering the aspects of the CSD itself, aiming to find a cut-off point to indicate
such a surgery.
Answer. Literature shows more about the relationship between the aspects of the CSD
itself and the outcomes after repair of CSD, such as the morphology of diverticulum,
the parameters of peripheral muscle blood flow, uterine location and other factors.
However, we only consider the size of the CSD itself (length, width, depth and RTM)
because of the retrospective nature of the study, which is a limitation of ours. We agree
that if more factors of the CSD itself are included in the study, the results will be more
objective. In the revision, we added this views in our limitation section (Discussion
section, line 10-12, page 10).
Q4. Other concerns are about the short period of follow up and the small number size
of the present study that does not allow to extrapolate the findings to other population,
not showing new data from what is already known from literature
Answer. This is a limitation and we have already mentioned in our limitation section for
the discussion. The symptom improvement rate of CSD may be different at different
postoperative follow-up times, and the small number size of the present study does not
allow to extrapolate our findings to other population.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?
If an additional statistical review is recommended, please specify what aspects require further
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
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