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Congratulations on the Acceptance!
Yours,
Yoshi
Prof. Yoshinori Marunaka, M.D., Ph.D.
Please revise your manuscript based on the reviewers' comments, then resubmit the manuscript.
Yours,
Yoshi
Prof. Yoshinori Marunaka, M.D., Ph.D.
[# PeerJ Staff Note: The review process has identified that the English language must be improved. PeerJ can provide language editing services if you wish - please contact us at [email protected] for pricing (be sure to provide your manuscript number and title). Your revision deadline is always extended while you undergo language editing. #]
The authors sufficiently addressed all my comments
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The interesting met analysis has been improved, implemented and corrected.
Now it is more complete and gives a balanced output to readers.
Indedd, graphical abstract and Figures quality has to be improved. In detail, can we replace graphical abstract with a more physiopatologic cartoon ?
Appropriate.
Now they can be considered consistent.
Please, see on Figuires.
Fair English revision is recommended.
Please submit your manuscript revised according to the reviewers' comments.
Yours,
Yoshi
Prof. Yoshinori Marunaka, M.D., Ph.D.
Wu and colleagues performed a meta-analysis to assess the benefit of probiotics and synbiotics (not prebiotics alone!) to prevent postoperative infections after major liver surgery. The authors conducted the meta-analysis according to current standards. The topic is of interest since infections are an important problem after major surgery and probiotics are a safe and potentially cost-effective method to reduce the risk of infections. The paper fulfills all quality criteria: Clear standard English, sufficient background and literature references, standard structure, clear hypothesis, the results sufficiently support the hypothesis.
The design is in principle correct. The authors always write probiotics and/or prebiotics, however, actually, they analysed studies on synbiotics (8 studies) and probiotics (2 studies). The authors should consider changing the wording and explaining in the methods section, why they could not include studies on prebiotics alone. Although it was not prespecified, it would be interesting to perform subgroup/sensitivity analysis by excluding the "probiotics only" studies to see what effect the addition of a prebiotic has.
Since all studies used combinations of different probiotic species, it is not possible to perform any subgroup analysis in relation to the probiotic strains. But the authors could try to design a heatmap-like table that lists the different strains in the different studies to show the overlaps in strains used.
The results are important and clinically meaningful. The underlying data are provided, the analysis is statistically sound. Conclusions are well stated.
If the authors have an idea for a graphical abstract, this would improve the visibility of the article since it would be then commonly used in presentations.
The manuscript is clearly written.
A fair English revision is indeed deserved.
The Figures' resolution is poor and must be upgraded.
The design is correct.
The research tries to give data in favor of pre- and probiotics pre surgery use in liver operations.
One issue we invite the authors to write about is the short-term follow-up period of the studies selected. Could it affect results ? Is it a limitation or issue ?
The findings are supported by results and are a stimuli for larger multi center RCT on per pre- and/ probiotics use in the preoperative period in hepatectomy.
Conclusions seem too strong. This is just " a " metanalysis, we need more and more data and, perhaps we need to distinguish the pre-/probiotics used or to be.
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