Reviewer ’s report  
 
Title: Is there a correlation between inflammatory markers and coagulation parameters in 
women with advanced ovarian endometriosis?  
 
Version: 1 Date: 25 Oct 2018  
 
Reviewer: C. Matthew Peterson  
 
Reviewer's report:  
 
This manuscript still needs significant work.  
I have outlined recommended changes in the following attachment and also inserted here.  
Once again, a primary en glish speaker and writer should review any subsequent revision 
submitted.  
 
BMCWH -18-00149  Reviewer 1 second review  
Recommend reject with major rewrite  
Repeat review required  
P6L25  ….diseases.  
P6L36  …with or without endometriosis.  
P7L36  …were significant ly higher than those of CA125 (INCLUDE DATA).  
 
P9 Conclusion  You used a CA 125 x fibrinogen as a marker. The conclusion should 
state," The CA 125 x fibrinogen marker provided a statistically significant augmentation to 
the AUC compared to CA 125 alone in d iagnosing endometriotic cysts versus other benign 
ovarian cysts. "  
P10L7 -11 ..inflammatory process in endometriosis is caused by increased activated 
macrophages, cytokines secreted in the endometriotic lesions and peritoneal fluid resulting in 
a local micr oenvironment for the growth and maintenance of endometriosis.  
 
P10L27  …lesions, endometriotic cyst fluid,  
P10L29  …[2-5] as well as elevated…  
P10L33  …Studies document that ovarian endometriomas  
P10L39  … [11], and components of the plasminogen activation system [12]  
P10L41 -48 …benign ovarian cysts. The activities of these various inflammatory and 
coagulation mediators may play a role in the development and progression of endometriosis 
[13].  REMOVE NEXT  SENTENCE  
P11L35   …endometriosis [16,19]. In response to increases noted in coagulation 
factors, the fibrinolytic also demonstrates an upsurge in urokinase plasminogen activator (u -
PA)…(PAI) [20,21].  
P12L15  …studied.  Inflammatory processes can lead…  
P12L 23 …[22]. Additionally, in the…  
P12L27  …and thrombin induce inflammation  
P12L2 -34 Finally, activated fibrinogen generates thrombin which further activates 
chemokine production and macrophage adhesion [25].  
P12L42 -53 For this study, we analyzed the correlat ion between blood coagulation 
parameters (TT, PT, APTT, platelet count (PLT)), fibrinogen , inflammatory biomarkers 
(CRP) as well as NLR and PLR in women with endometriomas compared to both those with 
other benign ovarian cysts and a third group with other  benign gynecologic conditions. We 
also explored how these parameters might be used as auxiliary biomarkers.  
P14L31  …were recorded.  
P16L23  …Serum Cancer Antigen …  
P18L34  …Women with endometriomas showed..  
Editor  Statistical expert should insure appropria te correction for repeated measures.  
Table 1  Change endometriosis to endometrioma in all locations  
I would still list groups as Endometrioma, Other Benign Cysts, Benign Gynecoloogic 
Conditions either as headers in table or in the table legend.  
P20L41 -52 Change all endometriosis to endometriomas, ie …from the endometrioma 
group  
P21L7 -10 ..women form the endometrioma group..  
P 24L22 -23 …with endometriomas showed ….  
P24L28 -29 …women with severe pelvic adhesions… NAD INSERT ADHESIONS 
FOR ADHESION IN ALL SUBSE QUENT LOCATIONS IN PARAGRAPH  
P24L32 -33 Table 2). Additionally, women with server pelvic adhesions 
demonstrated…fibrinogen levels, but..  
P26L1013  Women with endometriomas  
P 28 L20 -22 Women with endometriomas (rASRM level III and IV) demonstrate a 
hypercoagu lable and inflammatory state.  
P28 L26 -27 …adhesions, a significant…  
P28L33 -34 …due to TF -mediated thrombin generation.  LEAVE LAST PART OF 
THIS SENTENCE OFF_ NOT QUITE ACCUARATE  
P29L25 -28 TF binds to circulating….  
P29L29 -30 The TF -VIIa complex  
P30L7 -8 Studies have reported that inflammatory environments influence fibrinolysis 
activation in women…  
P30L18 -19 …endometriosis has been shown to express a higher..  
P30L22 -29 Ovarian endometriomas also demonstrate higher levels of ….than normal 
endometrium [33,3 4].  
P30 L31 -34 Activated plasmin may induce…  
P30:37 -41 In addition to the noted studies we add further evidence that inflammatory 
changes and activated fibrinolytic systems correlate with endometriomas and likely play 
important roles in its development an d progression.  
P31L33  …with endometriomas compared…  
P31L35 -52 …which is…reports [16,19].  Our study  
THIS SECTION NEEDS MAJOR REWRITE FOR CLARITY AND ACCURACY.  
P32L47 -48 …used in the diagnosis of…  
P32L52 -53 ...other disagree  
P33L7 -8 …or its limitation to l evel III and IV as an accurate diagnostic tool…  
P35L33 -37 …fibrinogen levels…  
 THIS MANUSCRIPT REQUIRES A FULL REVIEW AND VETTING BY A 
PRIMARY ENGLISH SPEAKER AND A REPEAT EDITORIAL REVIEW  TO INSURE 
READABILTY AND ACCURACY. ADDITIONALLY STAISTICAL REVIEW IS 
RECOMMENDED REGARDING MULTIPLE ANALYSES.  
 
 
 
 
 
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 comment s to the authors.  
 
Yes 
 
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 manus cript or would you recommend an 
additional statistical rev iew?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
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an organisation that may in any way gain or lose financial ly from the publication of 
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3. Do you hold or are you currently applying for any patents  relating to the content of 
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