JerMa88/BMC_Womens_Health_Peer_Reviews huggingface dataset:
Title: Anogenital high-risk HPV prevalence and screening considerations in female transplant
recipients: A cross-sectional study
Version: 0 Date: 11 Aug 2024
Reviewer's report:
This manuscript assessed the cervical and anal hrHPV prevalence in a large cohort of organ
transplant recipients.  Findings include an overall prevalence of cervical hrHPV of 15.9%, anal
hrHPV of 20.3% and co-prevalence of both cervical and anal hrHPV of 71.8%.  Transplant
specific risk factors were not associated with increased risk of cervical hrHPV.
The authors are to be commended on performing anogenital hrHPV testing on such a large
cohort of transplant patients.  Their findings are a significant addition to the current literature of
anogenital HPV in this very at risk patient population.
Comments:
1) Introduction—anal cancer screening guidelines are outlined in the consensus guidelines for
anal cancer screening [Stier EA, Clarke MA, Deshmukh AA, et al. International Anal Neoplasia
Society's consensus guidelines for anal cancer screening. Int J Cancer. 2024;154(10):1694-1702.
doi:10.1002/ijc.34850].
2) Follow-up is unclear.  In the methods, the only follow-up indicated is for patients testing +
for hrHPV were seen in the dysplasia clinic.  However, in the test, section 3.4, if appears that
patients testing + for cervical hrHPV were offered follow-up between 6 and 18 months.  please
clarify.  Was genotyping only performed on the patients at the follow-up evaluation?
3) Would combine tables 1 and 2 given that the headers are the same.  Also, would specify in
the title of the table as well as the headers that these are cervical hrHPV positive (or negative)
patients
4) Section 3.1. is there a statistically significant difference between prevalence of cervical
and anal hrHPV?  And is the hrHPV prevalence different between <30 and 31-45?  Or is the
difference between >45 and <= age 45?
5) As stated above, section 3.4 was unclear.  Couldn’t you comment on the multiple HPV types
from the original HPV testing? Or is this information only available in the follow-up patients?
6) Figure 2 should be prevalence %-- the % as it is currently shown is misleading.
7) In the Discussion, 4th paragraph has a double negative where it shouldn’t be:
Our findings suggest that neither the time since transplantation nor the type of iatrogenic
immunosuppression were not associated with increased hrHPV prevalence
8) The guidelines again should be referenced in paragraph 5.
9) The authors should mention that high resolution anoscopy (HRA) referral (and not referral to
proctologists) would be the preferred management of + anal hrHPV testing (again referencing
the anal cancer screening guidelines) and may consider mentioning that waiting for 10 years
post transplant (as is recommended in the guidelines) may be waiting too long to assess patients
for possible anal HSIL.
Title: Anogenital high-risk HPV prevalence and screening considerations in female transplant
recipients: A cross-sectional study
Version: 2 Date: 03 Feb 2025
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (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 technical rigor to allow
confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
No - there are issues with the statistics 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 - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: This is an interesting study examining the prevalence of age-
dependent anogenital hrHPV in transplanted patients and risk factors associated with hrHPV in
this high-risk patient group using cross sectional study design approach. The research question
seems to be important and, in general, the employed methodology is sound.
REQUESTED REVISIONS:
Abstract:
Within the abstract, the authors need to communicate the mean/median age (and possibly age
range) of the participants.
Methods:
Please provide the method you used to deal with potential multicollinearity among independent
variables for your regression analysis.
Did the authors test for interactions among the independent variables? Why or why not?
Also, please provide the method used to validate your final model (k-fold cross-validation?
bootstrap? etc)
Was the R software version 4.0.5 that the authors used, a Windows or Mac version?
Discussion:
Can causal inference be drawn in this study since the study design is cross-sectional in nature?
Please, add this to the discussion section.
Also, this reader believes the discussion section in this paper is a bit weak. An expansion on
what the findings mean and the implications for anogenital health in Germany and other similar
settings should be communicated in this section in greater detail.
Title: Anogenital high-risk HPV prevalence and screening considerations in female transplant
recipients: A cross-sectional study
Version: 2 Date: 05 Feb 2025
Reviewer:  Mayura Nathan
Reviewer's report:
The version of the paper showing 'marked changes' (by Rachel Sachs), reads well. It has all the
characteristics clearly laid out.
The following minor alterations are needed:
1. Line 185  Should read (see Table2)
2. Line 192 should read 'for transplantation, nicotine use and age of ...
3. In line 167 / 168 authors  state 'The anal hrHPV prevalence was 20.3% (40/197)
but in Line 249 indicate 71.8% (23/32) whereas......only 10.9% (18/165) had ....
Is this 40 or 41 ?
This paper contributes additional scientific information on Transplant recipients and anogenital
HPV . Information on this topic is lacking, and I congratulate the authors for their efforts with
this paper.
Title: Anogenital high-risk HPV prevalence and screening considerations in female transplant
recipients: A cross-sectional study
Version: 3 Date: 18 May 2025
Reviewer's report:
The authors have done a good job addressing the concerns mentioned in the reviews.
There are a few additional minor points:
Line 157 should specify cervical hrHPV positive…
Line 164 should specify anal hrHPV prevalence…
Line 300—some mention should be made of the lack of high resolution anoscopy referral
available in Germany and how implementation of anal cancer screening for these at-risk patients
should include the expansion of high resolution anoscopy facilities so as to best assess the true
risk of anal HSIL and cancer in the transplant population.
Title: Examining the characteristic features of lipedema and the usefulness of BMI and WHtR
in Clinical Evaluation
Version: 1 Date: 25 Aug 2024
Reviewer:  Gabriele Faerber
Reviewer's report:
This is an excellent paper supporting the findings of other authors concerning the unsuitability
of BMI and the suitability of WHtR for assessing or excluding obesity in lipoedema. It would
be useful to  write a few sentences about why WHtR is better than WHR waist-hip ratio) which
can underestimate obesity in extreme disproportion in the hip and thigh region.
I strongly recommend adding a few references (see comments), especially the recently published
German guidelines on lipoedema which also provide more references to support the conclusion
of your paper.
Table 2 is difficult to read, maybe it can be improved in the final layout
Title: Examining the characteristic features of lipedema and the usefulness of BMI and WHtR
in Clinical Evaluation
Version: 1 Date: 25 Aug 2024
Reviewer:  Manuel Cornely
Reviewer's report:
Thank you for the invitation to review
‘ Investigation of the characteristic features of lipoedema and the usefulness of BMI and WHtR
in clinical assessment’
The paper is very well structured, the argumentation conclusive, the presentation appropriate.
I made only a few comments. The work can be published.
It is a welcome addition to the discussion on the clinical picture of lipoedema.
With most sincere thanks
Prof Manuel Cornely
Title: Examining the characteristic features of lipedema and the usefulness of BMI and WHtR
in Clinical Evaluation
Version: 2 Date: 13 Sep 2024
Reviewer:  Gabriele Faerber
Reviewer's report:
Dear authors,
thank you for diligently incorporating both reviewers` comments and suggestions. I have only
remarked on a few more mainly grammatical mistakes.
Congratulations to you for undertaking his important study which I gladly recommend for
publication!
Title: Examining the characteristic features of lipedema and the usefulness of BMI and WHtR
in Clinical Evaluation
Version: 2 Date: 16 Sep 2024
Reviewer's report:
Thank you for the opportunity to review this work.  I appreciate the  authors efforts of separating
clinical data BMI and WHtR  and comparing them.    This is paper offers a lot of data.   Some
the data and observations will help us better understand lipedema.  There are some changes I
would suggest.
I have some suggestion for revisions.  Introduction Line 78 It is generally believed that there
is no edema in pure lipedema, there is an evidence for lymphatic [ disfunction] dysfunction
in lipedema patients, possibly resulting from microangiopathy (24).      The statement that
there is no edema in lipedema is controversial Edema is clinically appreciated in most women
with lipedema. The paper cited for support of your statement by Allen and Herbst ,  reports on
increased interstitial space in ex vivo specimens. However in Vivo these spaces would be filled
with interstitial fluid.  Your supporting reference actually argues for increased interstitial fluid
in lipedema .  There is also other evidence to support increased interstitial fluid in lipedema.
Please amend your statement. 
 Ln 101 you state BMI  "underestimates the accumulation of adipose tissue around the
extremities' (41).  This is not correct . BMI accounts for all the mass of the body equally.   The
metabolic changes of  Obesity are more closely linked to waist circumference measurements
than normal population BMI and obesity tables. Therefore  BMI  measurements overestimates
the  waist circumference in women with Lipedema compared to the rest of the population .
There is a good deal of data in the paper. Your observation of correlation between reported pain
by VAS and subjective sensitivity to touch confirm what many of us have assumed. 
The difference of Subjective level of accumulation of fatty tissue around hips/thighs
  and Subjective level of intensity of bruising  are reported. I am not sure what the clinical
significance of these differences are.   What does this tell us about lipedema disease?
Title: Examining the characteristic features of lipedema and the usefulness of BMI and WHtR
in Clinical Evaluation
Version: 3 Date: 19 May 2025
Reviewer's report:
Congratulations to the authors for sharing their data and producing this helpful manuscript. This
paper adds insights into clinical observations such as reported pain and tissue sensitivity. The
separation by waste to height ratio adds new information. The authors have fully addressed all
of my comments.
Title: Hemorrhagic Ascites in Endometriosis: A Case Series and Clinical Implications
Version: 1 Date: 19 May 2025
Reviewer's report:
This is a well-structured and informative case series that sheds light on a rare yet important
clinical presentation of endometriosis. The manuscript is scientifically valid and offers
meaningful insights for gynecologists and general clinicians dealing with complex differential
diagnoses.
Here are a few suggestions to improve the clarity and overall quality of the manuscript:
Clarify Case Selection: Please indicate whether these three cases represent all instances
encountered during a defined period, or if they were selected based on specific criteria (e.g.,
severity, surgical management, outcome). This will help the reader understand the scope and
representativeness of the report.
Language and Structure: While the content is clear, several sections would benefit from
improved fluency and grammatical corrections. A professional English language edit is
recommended to improve readability and consistency.
Consistency in Terminology: Standardize the use of terms such as “hemorrhagic ascites” vs.
“bloody ascites” throughout the manuscript for clarity and scientific accuracy.
Discussion of Limitations: Consider briefly acknowledging the limitations of the study (e.g.,
small sample size, limited generalizability, lack of fertility outcomes), as this will strengthen the
academic rigor of your discussion.
Enhancing Presentation:
Ensure that all figures and referenced video clips (e.g., Figure 1, Video Clip 1) are included and
clearly labeled.
A comparative summary table of the three cases (demographics, findings, treatment, outcomes)
would significantly enhance reader comprehension.
Fertility Preservation Section: This section is highly relevant and well-intentioned. However,
it would benefit from clearer linkage with the three cases presented, especially since none of
the patients opted for fertility preservation. Acknowledging this more explicitly would improve
coherence.
Overall, your work makes a valuable contribution to the literature. I encourage you to implement
the above suggestions to further strengthen your manuscript.
Title: Prognostic factors of progesterone resistance in symptomatic adenomyosis: Impact of
lesion localization on treatment outcome of levonorgestrel intrauterine system
Version: 1 Date: 22 Apr 2025
Reviewer:  Takashi Matsushima
Reviewer's report:
This manuscript is a retrospective study comparing uterine adenomyosis that demonstrated
resistance to LNG-IUS with uterine adenomyosis that responded well to LNG-IUS, in order
to clarify the characteristics of uterine adenomyosis that shows resistance to LNG-IUS. The
manuscript is largely acceptable in terms of research methods and interpretation of results, but
there are some points that require clarification or revision. In particular, it is important to consider
whether endometriosis is present in combination with adenomyosis. This point must be taken
into account in this study.
The following points are listed for consideration for revision.
1# Definition of progesterone resistance: Abstract, line 22 states, “progesterone resistance was
interpreted as continued menorrhagia during LNG-IUS treatment,” but the main text, lines
93-84, defines it as “progesterone resistance was interpreted as the state in which dysmenorrhea
continued after starting LNG-IUS treatment.” Please make it consistent.
2# Materials and Methods, lines 73-74: “Patients who were lost to follow-up, those without
dysmenorrhea, and those who experienced expulsion of LNG-IUS within 6 months were
excluded.” Are the exclusion criteria for the study population limited to the cases listed here?
For example, should other conditions associated with dysmenorrhea (e.g., submucosal fibroids,
endometrial polyps, or endometrial cancer) also be excluded?
3# Materials and Methods Lines 82-84: “The subtypes of adenomyosis were classified based on
lesion localization on MRI according to the method of Kishi et al.”: If the Kishi method was
used, there should be four subtypes. It should be stated whether type 3 of the Kishi classification
was excluded from the study or whether type 3 was not found in the 26 cases in this study.
4# Results: If the Mann–Whitney U test was used for the difference test, the results are usually
shown as the median (interquartile range). In this manuscript, the results are shown as Average
± SD (Minimum - Maximum). Is there a reason for this notation?
5# Discussion: The main issue in this study is how the presence or absence of endometriosis,
a confounding factor, was evaluated. The pain that persists even after using LNG-IUS cannot
be distinguished between being caused by adenomyosis or endometriosis. The fact that the
Progesterone-sensitive group has a significantly higher proportion of Intrinsic type suggests
that there are fewer cases of endometriosis in this group. The Extrinsic type is 30% in the
progesterone-resistant group, showing a higher tendency compared to the intrinsic type. This
suggests that cases with concomitant endometriosis are more likely to be progesterone-resistant.
As mentioned earlier, this point should be discussed in the Discussion section.
Title: Prognostic factors of progesterone resistance in symptomatic adenomyosis: Impact of
lesion localization on treatment outcome of levonorgestrel intrauterine system
Version: 1 Date: 03 May 2025
Reviewer's report:
This manuscript presents a retrospective case–control study evaluating prognostic factors for
progesterone resistance in adenomyosis patients treated with LNG-IUS. It identifies intrinsic
adenomyosis as a favorable prognostic subtype and highlights the predictive value of treatment
response as early as 1 month.
Major Concerns:
-The study defines resistance based on the bottom 25% of VAS improvement, but this is an
arbitrary cut-off. Consider validating this threshold with external data or clinical benchmarks.
-Only 13 patients per group in resistance/sensitive arms. Results should be interpreted with
caution due to potential underpowering.
-Prior hormonal treatments (DNG, EP, GnRH-a) were present in a subset of patients. Were
washout periods considered?
-VAS scores are subjective. Did the authors consider other objective markers or patient-reported
outcomes (e.g., SF-36, Menorrhagia Questionnaire)?
- please discuss on relevant papers on this topic in the Discussion section (eg DOI 10.1097/
SPV.0000000000000464;  DOI: 10.1007/s00192-020-04536-6)
Title: Prognostic factors of progesterone resistance in symptomatic adenomyosis: Impact of
lesion localization on treatment outcome of levonorgestrel intrauterine system
Version: 3 Date: 18 May 2025
Reviewer's report:
dear
thank you for your replies.
I would suggest to add insights from recent studies (eg doi 10.23736/S2724-5276.20.05842-9)
highlighting the frequent co-occurence of endometriosis and adenomyosis in young women and
the complex pathophysiological basis of chronic pelvic pain (eg 10.1016/j.jmig.2022.10.007).
Title: Evaluation of the diagnostic value of the Risk of Ovarian Malignancy Algorithm (ROMA)
index in the detection of ovarian cancer in postmenopausal women: a meta-analysis.
Version: 1 Date: 01 Mar 2025
Reviewer's report:
This is a well-written study that comprehensively analyzes the diagnostic value of the ROMA
index in ovarian cancer detection. It is a timely topic, and I recommend accepting it after minor
revisions. However, I still have a few concerns:
1. There are too many figures, and the formatting is inconsistent. I suggest moving some of the
relatively less important figures to the appendix.
2. Given the substantial results on publication bias, why was only one analysis conducted?
3. Please supplement the manuscript with GRADE and AMSTAR 2 assessments. Additionally,
consider discussing the relationship between ROMA and socioeconomic status, as the included
studies lack data from LMICs. This should be addressed in the discussion section. You may
refer to and cite this article: https://doi.org/10.1038/s41467-024-54444-2.
Title: Evaluation of the diagnostic value of the Risk of Ovarian Malignancy Algorithm (ROMA)
index in the detection of ovarian cancer in postmenopausal women: a meta-analysis.
Version: 1 Date: 03 Mar 2025
Reviewer's report:
The results are not well expressed.
The study was not conducted based on PRISMA.
Search time frame not reported.
Search strategy is limited.
Search needs to be updated.
The introduction is very poorly written and the authors have not mentioned the novelty
of the work and the necessity of doing it. Use more up-to-date studies, for example, the
study Rahimpour E, Niroomand B, Kalatehjari M, Shahbakhti F, Bahardoust M, Goodarzy B,
Majdolashrafi F, Ghorbanzade S, Tizmaghz A. Effect of the Number of Negative Lymph Nodes
Removed on the Survival and Recurrence Rate After Primary Surgery in Patients with Ovarian
Cancer: A Multi-Center Retrospective Cohort Study. Indian Journal of Surgical Oncology. 2024
Sep 27:1-7.
Appropriate tools were not used to assess the quality of the studies.
Inclusion and exclusion criteria were not clearly stated.
There are many writing errors. The writing needs improvement.
Limitations of the study and its solutions are discussed.
Title: Evaluation of the diagnostic value of the Risk of Ovarian Malignancy Algorithm (ROMA)
index in the detection of ovarian cancer in postmenopausal women: a meta-analysis.
Version: 1 Date: 08 Mar 2025
Reviewer's report:
First of all, I would like to thank the editor for inviting me to review this manuscript.
This meta-analysis is a typical example of a manuscript that has reached a point of diminishing
returns. When I first started learning how to write scientific manuscripts, I also encountered the
same issue as the authors here—namely, the inclusion of too few, too poor, or too many samples.
At this stage, it is important to cut losses in a timely manner rather than continue writing. After
all, sunk costs are something we need to consider, especially when, during the writing process,
we realise that we have spent a significant amount of time but are unable to proceed further.
This can lead to frustration, distress, and the feeling that all our efforts have been in vain.
Major :
Sample size in meta-analyses involving various "scoring" methods: A larger number of included
samples is required, as a small sample size makes it difficult to identify meaningful findings.
Statistical heterogeneity: The heterogeneity of sensitivity (I² = 93.06) and specificity (I² = 81.67)
is extremely high (p < 0.05), indicating significant differences in the results of the included
studies. This not only reinforces the first point but also lacks further subgroup analyses based
on factors such as lifestyle and age.
Different studies use different cut-off values (e.g., 25.1–40 vs. 10–25), making it difficult to
establish a unified threshold in clinical practice. Although the subgroup analysis suggests that the
25.1–40 range is preferable, the optimal threshold still requires further validation. This highlights
the issue of the clinical applicability of the ROMA index cut-off value.
Minor :
The figures could be more carefully prepared. Many fonts in the images appear stretched or
compressed in Word, so a consistent standard should be applied.