JerMa88/BMC_Womens_Health_Peer_Reviews huggingface dataset:
Title: Global, regional and national uterine fibroid burdens from 1990 to 2021 and projections
until 2050: Results from the GBD study
Version: 2 Date: 21 May 2025
Reviewer's report:
The manuscript explores the global, regional, and national burdens of uterine fibroids, focusing
on data from the Global Burden of Disease (GBD) Study spanning from 1990 to 2021, with
projections extending to 2050. The authors highlight the increasing prevalence and incidence
of uterine fibroids, revealing disparities that correlate with socioeconomic factors and regional
development levels. Utilizing age-standardized rates for incidence, prevalence, and years lived
with disability (YLDs), the study employs average annual percentage change (AAPC) and
autoregressive integrated moving average (ARIMA) models for trend evaluation and future
projections. The findings indicate that while the global age-standardized prevalence rate (ASPR)
of uterine fibroids increased over the study period, there were regional variations, with some
high-middle SDI regions showing declining trends and others, particularly in low-middle
SDI regions, experiencing increases. Notably, the research underscores the need for enhanced
epidemiological surveillance and public health interventions to address the growing burden of
this condition.
Title: Global, regional and national uterine fibroid burdens from 1990 to 2021 and projections
until 2050: Results from the GBD study
Version: 2 Date: 29 May 2025
Reviewer:  Kuan-Ju Huang
Reviewer's report:
Generally, the authors presented an estimation of uterine fibroids burden until 2050. Most of the
results were in line with current clinical observations, and the limitations for interpretation of
the results had been properly addressed.
Title: Global, regional and national uterine fibroid burdens from 1990 to 2021 and projections
until 2050: Results from the GBD study
Version: 2 Date: 30 May 2025
Reviewer:  Hossein Salehi Omran
Reviewer's report:
Dear Authors Team of the Manuscript,
The manuscript " Global, regional and national uterine fibroid burdens from 1990 to 2021 and
projections until 2050: Results from the GBD study" is a well-organized manuscript providing
precious findings about the global burden of uterine fibroid and its future trend until 2050.
However, some kinds of revisions should be discussed before publication.
1. Currently, GBD 2023 data are available, and they will replace the GBD 2021 estimates shortly.
It would be recommended to acknowledge one of the limitations of the study in the discussion.
2. I would recommend adding some more important keywords such as "Forecasting" and "Global
Burden of Diseases studies"  to the list of keywords.
3. Some of the abbreviations such as GBD and SDI have been repeatedly defined. Additionally,
I recommend defining "UF" as the abbreviation of Uterine fibroids first and then using it in the
following of the manuscript.
4. I would recommend to enhance the quality of Figure 1 regarding visual aspects. Some of the
texts are not readable.
5. As well as the limitations of the study which have been discussed, I would recommend
highlighting and discussing the strengths of the manuscript compared to the previously published
studies to demonstrate and illustrate the need for conducting this study.
Overall,  the manuscript is well-designed and provides valuable findings about the epidemiology
of uterine fibroid, its global burden on society, and its future trends. However, there are still
some points that need to be addressed before publication.
Title: Global, regional and national uterine fibroid burdens from 1990 to 2021 and projections
until 2050: Results from the GBD study
Version: 2 Date: 30 May 2025
Reviewer's report:
The manuscript “Global, regional and national uterine fibroid burdens from 1990 to 2021 and
projections until 2050: Results from the GBD study” offers a thorough and comprehensive
analysis of the incidence, prevalence, and years lived with disability (YLDs) associated with
uterine fibroids at global, regional, and national levels. The authors leverage GBD 2021 data
and employ an ARIMA model for projections, adding valuable foresight. The writing is clear,
the methodology sound, and the presentation of results is easy to follow.
The manuscript is well written, logically structured, and addresses an important and growing
women’s health issue.
All sections (Introduction, Methods, Results, Discussion) are appropriately developed, and the
conclusions are directly supported by the data presented.
No major concerns regarding overall structure or statistical analyses.
While the authors do describe potential drivers of the observed declines (e.g., in Poland, the
UK, New Zealand) and increases (e.g., in Brazil, India, the USA) in later paragraphs, it would
be far more effective to integrate these explanations immediately when first presenting the
ASIR trends. That way, readers can grasp the potential demographic shifts, diagnostic changes,
screening practices, socioeconomic factors, and genetic considerations in direct context with
the data, rather than having to wait for a separate section to understand why certain countries
deviate from the global pattern.
Title: Global, regional and national uterine fibroid burdens from 1990 to 2021 and projections
until 2050: Results from the GBD study
Version: 2 Date: 01 Jun 2025
Reviewer:  Helen Trihia
Reviewer's report:
- An extended well-conducted epidemiological study for a common gynecological problem with
heavy financial dimensions.
- As obesity and hormone imbalance , are common causative factors for endometrial cancer as
well, I don't know if it is possible to extend your research on the possible association of increased
prevalence  between the two.
- In 3. Discussion, bottom of the page, correct (suchas higher frequencies of MED12 mutations)
to (such as....)
Title: Global, regional and national uterine fibroid burdens from 1990 to 2021 and projections
until 2050: Results from the GBD study
Version: 2 Date: 02 Jun 2025
Reviewer's report:
This study is a timely and significant contribution to women's global health literature. It
highlights the persistent and, in some cases, growing burden of uterine fibroids worldwide.
Areas for Improvement
1. Uncertainty Intervals & Model Assumptions: It’s important to clearly report uncertainty
intervals for projections and acknowledge potential limitations in forecasting methods,
especially given changing diagnostic criteria and healthcare access.
2. Data Gaps and Underreporting:
Uterine fibroids are often underdiagnosed in low resource settings due to limited access to
imaging. The study should discuss how this may affect estimates, especially in sub Saharan
Africa and South Asia.
3. Risk Factor Analysis:
While burden estimation is central, including or referencing associated risk factors (e.g., age,
BMI, parity, ethnicity, hormonal factors) would enhance interpretability and relevance for
prevention.
4. Disaggregation by Age and Reproductive Status:
Stratifying the burden by age groups particularly reproductive vs. postmenopausal could yield
important insights for clinical and public health interventions.
5. Health System Impact:
Consider discussing the healthcare and economic implications of uterine fibroids (e.g., surgical
demand, fertility impacts, productivity loss), especially as the burden grows.
Title: Global, regional and national uterine fibroid burdens from 1990 to 2021 and projections
until 2050: Results from the GBD study
Version: 4 Date: 12 Jul 2025
Reviewer's report:
This study utilizes GBD 2021 estimates to quantify global and regional trends in age-
standardized incidence, prevalence, and years lived with disability (YLDs) attributable to uterine
fibroids among women from 1990 to 2021. The authors employ average annual percentage
changes (AAPC) to characterize temporal trends and autoregressive integrated moving average
(ARIMA) models to project future trajectories up to 2050. Key findings include modest
global increases in uterine fibroid prevalence, incidence, and related disability, with marked
geographical heterogeneity. Notably, increases were observed in countries like Brazil, India,
and Georgia, while some regions such as Poland, China, and Australia exhibited declines. The
study rightly emphasizes the interplay of socioeconomic development, diagnostic advances, and
lifestyle factors as drivers influencing these trends.
Comments:
The methodology relies heavily on International Classification of Diseases (ICD) codes to define
uterine fibroid cases. However, ICD coding standards and practices have evolved over the
extended study period. The authors should discuss how potential changes or inconsistencies in
ICD code definitions across years may affect case ascertainment and trend reliability.
The discussion section currently offers limited consideration of inherent limitations tied to GBD
data. Specifically, some regions may have incomplete or biased data collection, which could
skew prevalence and incidence estimates. The authors should expand the limitations discussion
to include these factors and their possible impact on the validity of trend interpretations.
Given that the study period extends through 2021, the COVID-19 pandemic may have influenced
healthcare access, diagnostic rates, and reporting of uterine fibroids. The authors should
discuss, even if briefly, how pandemic-related disruptions might have affected the observed
epidemiological patterns or data completeness.
There is occasional inconsistency in presenting results where the manuscript alternates
between absolute case numbers and age-standardized rates without consistently signaling these
transitions explicitly. Clarifying these transitions and ensuring uniform labeling throughout will
improve reader comprehension.
While the manuscript highlights geographic variations in uterine fibroid burden, it would
benefit from deeper exploration of the underlying socioeconomic factors and healthcare resource
distribution that contribute to these disparities. A more detailed discussion on how economic
status, health system capacity, and diagnostic availability intersect with reported regional trends
would provide richer context.
Title: Global, regional and national uterine fibroid burdens from 1990 to 2021 and projections
until 2050: Results from the GBD study
Version: 4 Date: 20 Jul 2025
Reviewer's report:
Based on the overall quality and relevance of the work, the study appears to be suitable for
publication in its current form. The core findings are well-supported and contribute meaningfully
to the existing literature.
Title: The effectiveness of vitamin B6 in reducing mastalgia: a systematic review and meta-
analysis
Version: 1 Date: 20 Jun 2025
Reviewer:  Mohamed Abdel-Maboud
Reviewer's report:
This systematic review and meta-analysis address an important clinical question—the efficacy
of vitamin B# for mastalgia—using conventional meta-analytic techniques across five
interventional trials. The authors report a statistically significant reduction in pain severity
compared to the placebo. However, several methodological and analytical concerns limit
confidence in these conclusions:
1. Clinical Heterogeneity: The five trials differ markedly in B# dose (40–200 mg/day), pain
scales (VAS 0–10, VAS 0–3, Cardiff scale), and treatment duration (2–3 cycles). Although
the use of standardized mean differences (SMDs) accommodates varying scales, it cannot
resolve these fundamental clinical inconsistencies. Given only three studies (in quantitative
synthesis), conducting further subgroup or meta#regression analyses to explore dose, scale, and
demographic effects would have been preferable to pooling these disparate trials.
2. Extreme Statistical Heterogeneity: The primary meta-analysis yields an I² value of 99.6%,
indicating that nearly all variability arises from actual inter-study differences rather than chance.
While pooling under such heterogeneity is not per se forbidden, a summary SMD of –3.57 is not
clinically interpretable when effects diverge so dramatically. A narrative synthesis would better
reflect the uncertainty and prevent misleading effect estimates.
3. Misinterpretation of Sensitivity Analysis: The leave-one-out examination reveals that
excluding Ghazanfarpour et al. shifts the SMD from –3.57 to –0.71 and reduces I² to 79%. Rather
than treating the latter as the "true" effect, this instability should be recognized as evidence of a
weak and inconsistent evidence base. Selecting a post#hoc pooled estimate after excluding the
largest trial constitutes a form of selection bias.
4. Invalid Publication Bias Testing: Conducting Egger's and Begg's tests with only three studies
is statistically unsound, as funnel plot asymmetry tests have negligible power below ten studies.
It would have been more appropriate to acknowledge that publication bias could not be reliably
assessed with such a small number of trials.
5. Inconsistent GRADE Application: The GRADE assessment appears to be based on the post-
hoc SMD (–0.71) rather than the primary analysis. GRADE should appraise the full evidence
set, including its extreme heterogeneity and imprecision, which would likely warrant a "very
low" certainty rating rather than "low.”
In summary, although vitamin B# may hold promise for mastalgia, the marked clinical
and statistical heterogeneity, unstable sensitivity findings, and inadequate bias assessments
undermine the validity of the pooled effect. The authors should reconsider whether a quantitative
synthesis is justified and, if not, present a structured narrative review that more faithfully reflects
the currently available evidence.
Title: The effectiveness of vitamin B6 in reducing mastalgia: a systematic review and meta-
analysis
Version: 1 Date: 24 Jun 2025
Reviewer's report:
First of all, congratulations to the authors for this very interesting paper. I would like to offer
a few suggestions for improvement:
Manuscript:
In the abstract, I would include the number of patients that make up the sample of the review.
Additionally, the conclusions in the abstract do not match those in the main manuscript. While
the abstract assumes that vitamin B6 may have a beneficial effect in reducing the severity
of mastalgia, the manuscript advises interpreting the confidence intervals with caution due to
the high heterogeneity observed and the limited existing scientific evidence. Therefore, the
conclusion in the abstract should be revised accordingly.
In the results section: Why were 268 articles excluded? Even if they did not meet the objectives,
it would be helpful for transparency to specify the reasons for exclusion.
In the discussion section, it would be beneficial to add a subsection on clinical practice.
SUPPLEMENTARY FILE:
The search strategies of the supplementary material will be presented in a table to facilitate
visualization.
Title: A Case Report of Breast Abscess Caused by Peptoniphilus harei after Endoscopic Breast-
Conserving Surgery and Radiotherapy for Breast Cancer and Literature Review
Version: 1 Date: 06 Sep 2024
Reviewer:  Marco Materazzo
Reviewer's report:
Dear Authors,
I congratulate on the interesting article named: "A Case Report of Breast Abscess Caused
by Peptoniphilus harei after Endoscopic Breast-Conserving Surgery for Breast Cancer and
Literature Review" and I congratulate on the compelling case.  Postoperative infection may lead
as reported in locoregional relapse and
-I would like to know if negative wound pressure was applied to the patient in the first recovery
period and why was not applied (risk of locoregional recurrence). Please expand this section.
-I would like to discuss the aesthetic result at the end of the last procedure.  I think the authors
should focus on the infectious risk of endoscopic breast surgery. I am not currently an adopter
of endoscopic breast surgery, but I am asking about the postoperative risk of Endoscopic
breast surgery and I think that a brief report on specific risks regarding this surgery may aid
the discussion of the clinical case. (do you think that potentially the infection was led by
postoperative fluid chronic collection of the tumor bed?)
-To clarify the clinical decision-making process after surgery I would like to ask to disclose the
antibiogram
best regards
Title: A Case Report of Breast Abscess Caused by Peptoniphilus harei after Endoscopic Breast-
Conserving Surgery and Radiotherapy for Breast Cancer and Literature Review
Version: 1 Date: 02 Mar 2025
Reviewer:  Kemal Rasa
Reviewer's report:
I congratulate the authors for this report, a rare case of a patient who developed a breast
abscess caused solely by Peptoniphilus harei after undergoing endoscopic breast cancer surgery.
Diagnosis and treatment stages are shared in the necessary details and enriched with photographs
Title: A Case Report of Breast Abscess Caused by Peptoniphilus harei after Endoscopic Breast-
Conserving Surgery and Radiotherapy for Breast Cancer and Literature Review
Version: 1 Date: 07 Mar 2025
Reviewer:  Omar Hamdy
Reviewer's report:
Dear authors,
Thanks for your work
A few comments to be noted
1- The title does not reflect the condition accurately. The infection is not after endoscopic breast
surgery. Actually, it is after radiotherapy
2- Please add the following details (the tumor clinical staging after neoadjuvant therapy, the
type of axillary surgery done)
3- Please describe the imaging used after the infection occurred
4- Why was the first debridement done under local anesthesia?
5- "couldn't be cleared in a single procedure. ". That is simply because local anesthesia was
only used
6- Is there a plan for reconstruction of the resultant breast defect?
7- The paragraph about "endoscopic breast surgery in the discussion can be omitted
Title: A Case Report of Breast Abscess Caused by Peptoniphilus harei after Endoscopic Breast-
Conserving Surgery and Radiotherapy for Breast Cancer and Literature Review
Version: 1 Date: 11 Mar 2025
Reviewer:  Kulsoom Junejo
Reviewer's report:
Interesting case report, worth publishing
But there are lots of areas of non English language writing which are not understandable, would
have been better to have those translated before sending for review.
Title: A Case Report of Breast Abscess Caused by Peptoniphilus harei after Endoscopic Breast-
Conserving Surgery and Radiotherapy for Breast Cancer and Literature Review
Version: 1 Date: 12 Mar 2025
Reviewer:  Kanchana Wijesinghe
Reviewer's report:
This is an interesting case report.
The Introduction and discussion are good.
I would like to recommend to add a comparison of the three case reports published along with
your patient...was there a difference in the surgical approach?  Have all these patients undergone
radiotherapy? etc
I am concerned about the title. It suggests that the patient has developed the infection
immediately following surgery..where as the patient has actually developed the infection after
radiotherapy. This may warrant an amendment.
Title: A Case Report of Breast Abscess Caused by Peptoniphilus harei after Endoscopic Breast-
Conserving Surgery and Radiotherapy for Breast Cancer and Literature Review
Version: 1 Date: 15 Mar 2025
Reviewer's report:
The most important point is about advantages and disadvantages of Endoscopic breast cancer
surgery: The authors comments includes:
*Endoscopic breast surgery,  has become widely used in breast cancer surgery.
*Its major advantages include discreet incisions and minimal scarring, resulting in better
aesthetic outcomes and increased patient satisfaction
*Endoscopic surgery provides a broader surgical field, enabling better differentiation of
anatomical structures
*Endoscopic surgery shows comparable tumor safety to open surgery
*Endoscopic breast surgery has a lower incidence of complications, including infection, skin
burns, subcutaneous emphysema, intraoperative and postoperative bleeding, wound and flap
necrosis
We know that this procedure is uncommon for breast cancer surgery  and discussing about
similar results in comparison to open surgery is unacceptable especially with new techniques
of Breast Oncoplastic surgery. That was better to report this complication as a disadvantage
of Endoscopic surgery , based on the final photographs of the patient and frequency of tissue
necrosis in this technique.
Title: A Case Report of Breast Abscess Caused by Peptoniphilus harei after Endoscopic Breast-
Conserving Surgery and Radiotherapy for Breast Cancer and Literature Review
Version: 2 Date: 17 Apr 2025
Reviewer:  Omar Hamdy
Reviewer's report:
Dear authors,
Thanks very much for your reply and the modifications performed accordingly
Only two points remaining:
1- Please explain why the patient who was proven to have a complete pathological response
underwent axillary lymph node dissection, not sentinel lymph node biopsy or targeted axillary
dissection
2- Still, the paragraph about endoscopic breast surgery in the discussion does not add to the
context. I agree it is a novel challenging technique but it has nothing to do with the abscess
formation
Title: A Case Report of Breast Abscess Caused by Peptoniphilus harei after Endoscopic Breast-
Conserving Surgery and Radiotherapy for Breast Cancer and Literature Review
Version: 3 Date: 10 Jul 2025
Reviewer's report:
The article spot on a  Breast abscess caused by a rare  organism,  Peptoniphilus harei
the manuscript is well done, organized  and supported by photos and meet best practice
the author should start broad spectrum antibiotics and anti inflammatory when he noticed pain,
redness and swelling before the  abscess developed
Title: A survey assessing the impact of symptoms related to the menstrual cycle and perceptions
of workplace productivity: considerations for employer-sponsored menstrual health programs
Version: 3 Date: 26 Apr 2025
Reviewer's report:
I think the revised version is an improvement.
There is a notable concern regarding sampling bias, and potential commercial influence
 remains, but it would be good if the statistical analysis were corrected and listed as a limitation.
Title: Breast cancer and microbiome: A systematic review highlighting challenges for clinical
translation
Version: 2 Date: 05 Dec 2024
Reviewer's report:
This systematic review of 43 studies examines microbial diversity, specific genera, and
their associations with breast cancer development, subtypes, and treatment outcomes. The
manuscript is well-written, with clearly defined objectives and methodologies, and highlights
the heterogeneity and limitations inherent in the reviewed literature.
Major comments
1. Consider incorporating studies published after August 2022 into the results or discussion
sections, rather than categorizing them as a limitation of the study. This could enhance the
timeliness and relevance of the review.
2. In the results section, consider including figure illustrations to more clearly and effectively
present the findings related to the associations of alpha/beta diversity, similar to the figures
provided in the study by Quinn-Bohmann et al. (10.1186/s12915-024-01887-0).
Minor comments
1. The last two paragraphs in the results section seem to be duplicated.
2. Consider changing the expression of "HER2plus" to "HER2+" or "HER2-positive" in Figure
4A, same case with “HER2minus/ERplus/ERminus”.
Title: Breast cancer and microbiome: A systematic review highlighting challenges for clinical
translation
Version: 2 Date: 06 Dec 2024
Reviewer's report:
Results:
Several cause and effects are discussed but lacking expiation of biological rationale - I suggest
adjustment.
Discussion:
There is a general lack of overall gain for literature with this study - please review and add.
Paragraph 4 and 5 - Studies are poorly described and the final statement seems strong for the
lack of rationale discussed - requires improvement.
I would strongly encourage a table with the main studies the author want to discuss with columns
such as population, sample size, methodology and relevant findings.
Conclusion:
Needs further improvement - why do you need a review to state what is already know in the
topic?