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应助: 5 (幼儿园)
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虫号: 2273151
注册: 2013-02-04
专业: 肝纤维化、肝硬化与门脉高

[求助] accept with major revision 但意见不多

Dear Dr Peng,

I regret to inform you that your work can be reconsidered for publication only with extensive revisions to your manuscript. The reviewers' advice on the necessary revisions and their comments are appended below.

If you are willing to undertake the required amendments, please submit a point by point response listing your changes or justifications to the reviewers' comments when you submit the revised manuscript.

With warm regards,

Toshio Kitamura

Reviewers' comments:

A Editorial Board

This study, which is carefully performed, is an interesting one. Both reviewers recognized some merit in this paper. Please carefully respond all concerns raised by the reviewers.

I have one minor concern
Regarding statistic p values, the authors should described them as more accurate number (for example <0.001) instead of 0.00.

Reviewer #1: This paper describes the long-term effects of laparoscopic splenectomy (LS) for patients with chronic immune thrombocytopenia (ITP). They also tried to determine the predictive factors for promising hematological outcomes.
Along with the advancement in some new drugs including rituximab and thrombopoietin receptor agonists, it is important to re-examine and analyze the long-term effects of LS and the predictive factors for good outcomes.

Major issues
1. They retrospectively analyzed the data in 92 patients who underwent LS for chronic ITP. Their remission rate (76.1%) is relatively favorable and indicated that LS is still one of the treatment options for chronic ITP even in an era of new drugs.

2. Using multivariate logistic regression analysis, they showed that only the platelet counts on postoperative months 3 (POM3) was a significant independent prognostic factor for long-time response to LS. This information is also useful to estimate the long-time response for each patient.

3. The authors previously reported about LS for ITP patients (ref 11, Int J Hematol 94:533-538) . In this paper, they analysed 10 ITP patients who underwent LS because of severe thrombocytopenia, from April 2006 to Jan 2011. They have to make clear whether these 10 patients were overlapped with 92 (from Nov 2006 to Aug 2012) patients in the current report or not.

4. They mentioned that one patient has died of severe pulmonary infection after LS on POD 5. I want to know whether this patient was suffered by overwhelming postsplenectomy infection (OPSI). It is also interesting to know whether these patients were given pneumococcal vaccine around LS in their institute.

Minor issues
1. In Table 2, they use abbreviated words "RG" and "NG". They should indicate what these abbreviations stand for.

Reviewer #2: The authors described the clinical research entitled predictive factors associated with long-term effects of laparoscopic splenectomy for chronic immune thrombocytopenia. In this paper, they clearly demonstrated that platelet count on POM3 was significant independent predictor of long-term favorable outcome. Their conclusions are almost acceptable, however, several questions are raised up as below.

1) Several investigators already reported that young patients showed higher CR responses of splenectomy than those in elderly patients. However, CR rate in this paper was thought to be lower (53.3 %) than expected.

2) It was reported that the good response to IVIG might be available for predictor of successful splenectomy. Did you check this phenomenon in your study?

3) The importance of platelet raise after splenectomy was already well known in hematologists. Some papers reported POM 1 was available as predictable indicator.However, you mentioned the POM3 was significant, not POM 1. You should explain the reason on

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