All reviews of published articles are made public. This includes manuscript files, peer review comments, author rebuttals and revised materials. Note: This was optional for articles submitted before 13 February 2023.
Peer reviewers are encouraged (but not required) to provide their names to the authors when submitting their peer review. If they agree to provide their name, then their personal profile page will reflect a public acknowledgment that they performed a review (even if the article is rejected). If the article is accepted, then reviewers who provided their name will be associated with the article itself.
One of the reviewer was happy with the revision but suggested some minor improvements. I guess you can do that. The other reviewer did not reply, and I therefore assume that they are either accepting the revised version or are not interested in commenting on your revision.
I look forward receiving your final version.
Language and grammar were corrected.
The study is clear for readers.
All requirements were written in order, the references provided, except reference 6 written more than once.
Background added
Abstract is written
The concept of the study is clear
Questions were answered and changes were made.
Findings are clear and more organized.
The data provided better.
All my questions were answered and the changes were made
The conclusion now is simple and more informative.
Use one of these; either Pre-operative or preoperative style throughout the manuscript, same for postoperative.
Cancel the writing of reference No. 6 inline 63, as it has been repeated 3 times.
Line 213 Sen V et. al.
Reference 22 inline 215 is 23.
As you can see, your paper was examined by 3 reviewers who expressed divergent opinions. Reviewer #1 submitted a very detailed report while suggesting that only minor revisions was needed. Reviewer #3 submitted a shorter report but also suggested that minor revision was needed. Reviewer #2 suggested rejection, explaining that there was nothing really new in your submission and that your limited number of cases was "unlikely to alter management"...
Based on these reports, I want to give you the opportunity to try answering them. So, please, take all comments in serious consideration and prepare a rebuttal where you defend your work and show where in the revised version the paper has been modified. If you disagree with some of the suggestions or remarks raised by the reviewers, explain why. This rebuttal will be an essential element for me to make a final decision about your submission. Also, keep in mind that your rebuttal and the revised version may be submitted to the same or to different reviewers for comment.
If you are ready to do the necessary work, I'll be happy to read your new version and your rebuttal. However, because of what I explain above, I cannot make any commitment at this stage about the final acceptance of your paper.
[# PeerJ Staff Note: The review process has identified that the English language must be improved. PeerJ can provide language editing services - please contact us at [email protected] for pricing (be sure to provide your manuscript number and title) #]
Grammar and language need correction and some explanations:
1- Tittle; Better to be in this way: A pre-operative nomogram for sepsis in percutaneous nephrolithotomy treating solitary, unilateral, and proximal ureteral stones. Because you are discussing a method in a procedure.
2- Line 24; the correct is; ,and
3- Line 40; the correct is the receiver, ,and
4- Line 60; the correct is the local
5- Line 64; the correct is; a pre-operative model: The phrase there is an absence of a pre-operative, predictive model may be unnecessarily wordy. Consider using an adjective instead of a noun phrase.
6- Line 73; the correct is: of the ethics: It appears that the preposition from may be incorrect in this context. Consider changing it.
7- Line 78; the correct is ; ,and: Your sentence contains a series of three or more words, phrases, or clauses. Consider inserting a comma to separate the elements.
8- Line 85: the correct is;tests , including albumin and globulin,
9- Line 96: the correct is; judgment
10- Line 98: the correct is; Otherwise, we
11- Line 100: the correct is; hypertension, and coronary
12- Line 105: the correct is; t-test
13- Line 105: the correct is; with a normal
14- Line 108: the correct is; converting the regression
15- Line 105: the correct is: The predictive, the model
16- Line 110; the correct are ; ,and. A calibration
17- Line 112: the correct is; the discriminative
18- Line 113: the correct is ;( In addition) The phrase In addition may be wordy. Consider changing the wording. Also or beside the clinical
19- Line 115: the correct is; P-value <0.05 was considered significant.
20- Line 137: the correct is; the calibration
21- Line 138: the correct is; by the Hosmer-Lemeshow test
22- Line 139 and 140; the correct is; the curve, the model
23- Line 141: the correct is; change had the ability to could
24- Line 151-153: Monotonous passage; We reported a sepsis rate of 4.7% (35/745) after PCNL for the treatment of proximal ureteral stones. This result was consistent with that (0.3%-9.3%) of a previous study conducted by Gutierrez et al. 13. Sepsis can further lead to organ dysfunction and even septic shock, endangering patients' lives Is 3 similar sentences in a row. These sentences seem repetitive because they all follow the same pattern. Consider changing the word order
25- Line 162,163; the nutritional and the insufficient
26- Line 173: the correct is; maybe
27- Line 183: the correct is: potential (of a potential) The indefinite article, a, may be redundant when used with the uncountable noun infection in your sentence. Consider removing it.
28- Line 192: the correct is; a comparison ( It appears that an article is missing before the word comparison. Consider adding the article.)
29- Line 204: the correct is; why female sex
30- Line 208; the correct is; Second, the only
31- Line 212 and 215; the correct are; , and . a prospective
32- Line 230; the correct is; Acknowledgments
References:
No. 7: Line 254; Biomed Res Int. 2019 January 20;2019:8078139.
No. 3,4,5: Line 244-250; change as mentioned later on in the next session.
No. 11: Line 262; Wiesenthal JD1, Ghiculete D, D'A Honey RJ, Pace KT. A comparison of treatment modalities for renal calculi between 100 and 300 mm2: are shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy equivalent? J Endourol. 2011;25(3):481-5.
Tables:
Generally are ok, but a suggestion, if possible, to classify the degree of hydronephrosis.
Line 23; Abstract;
The background doesn't explain the scope of the work; it realizes the aim or the objective of the study. It is better to have a background in the first with the author's speech and an objective of the study.
Line 50,51;
Reference 3 is a guideline book, suggest to use this update reference on management of urolithiasis:
Standard percutaneous nephrolithotomy (sPCNL) remains the optimal treatment for stones between 1 and 2.5 cm ( Heinze, Alexander; Gozen, Ali S.; Rassweiler, Jens. Tract sizes in percutaneous nephrolithotomy does miniaturization improve outcomes? Current Opinion in Urology: March 2019 - Volume 29 - Issue 2 - p 118-123.)
Line 51 and 53;
This; Compared with the latter modality, PCNL is associated with less ureter injury, more fluent intrarenal irrigation, better visibility, and a superior stone-free rate 4,5. It has no relation with the main topics; it is about two different endourological procedures. It is better to be removed. Suggest to use this reference:
Overall, PCNL provides significantly higher stone-free rates than RIRS, at the expense of higher complication rates, blood loss, and longer length of stay, with no differences in surgical time and secondary procedures. ( Shuba DeRiccardo AutorinoFernando J. KimHomayoun ZargarHumberto LaydnerRaffaele BalsamoFabio C. TorricelliCarmine Di PalmaWilson R. MolinaManoj MongaMarco De SioCorrigendum re: "Percutaneous Nephrolithotomy VersusRetrograde Intrarenal Surgery: A Systematic Review and meta-analysis" [Eur Urol 2015;67:125–37]
Line 57;
Better not to mention the author's name in the introduction, writ in a passive word as long as it has a reference number.
Line 54-56;
It has no reference number.
Patients and methods;
Line 76;
The inclusion criteria should include the size of the stone; according to EAU guideline 2019, page 303, ureteric stones are classified to <10mm and >10mm. <10mm stones are treated by ESWL or URS.
Line 84;
1-Before surgery: As long as this study is a retrospective type, you cant perform a test or a procedure on patients already treated.
2-Patients with fever and treated by antibiotics either they resolve or have a suppression.
3- Tubes (nephrostomy and JJ ) usually removes in the same session of surgery to avoid two anesthesia or recurrence of the infection.
This part of the study need to be written again in this way:
The study was conducted under the approval of the Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (2019S1035). We retrospectively enrolled 745 patients who underwent PCNL from January 2012 to December 2018. The inclusion criteria were the following: (1) PCNL was performed to treat unilateral, solitary, and proximal ureteral stones; and (2) age ≥18 years. Stones size bigger than 10mm.The exclusion criteria were anatomical renal abnormalities (horseshoe kidney, solitary kidney, transplant kidney, and kidney duplication).
Patients information were collected from our hospital's database, including age, sex, body mass index (BMI), comorbidities (diabetes, hypertension, and coronary heart disease), stone size and laterality, prior indwelling stent, blood tests (cholesterol, creatinine, albumin, and globulin levels and white blood cell count), fever (defined as body temperature >38°C), urine tests (white blood cell and nitrite), urine culture, and ASA score. Patients imaging, including abdominal computed tomography CT, confirmed the presence and size of proximal ureteral stones (above the fourth lumbar spine or in the ureteropelvic junction). Types of anesthesia, preoperative antibiotics, surgeons years experience, PNL operation details were identified and recorded. Postoperative patients' data were revised, collected, and recorded.
Sepsis was defined according to the 2001 International Sepsis Definitions Conference; occurrence of an infection and a minimum of two of the following within 48 hours of surgery: (1) heart rate >90/minute, (2) body temperature >38°C, (3) leukocyte count <4,000 cells/μL or >12,000 cells/μL, and (4) respiratory rate >20/minute (9).
All statistical analyses were performed using SPSS 24.0 and R software 3.6.2. The student t-test was used to detect differences between continuous variables with a normal distribution. The chi-square test or Fisher's exact test was used to compare categorical variables. The multivariable logistic regression method was used to determine independent risk factors for sepsis. Then predictive nomogram was generated based on converting the regression coefficient to a 0- to 100-point scale proportionally. The predictive performance of the model was measured by validation, discrimination, and decision analysis10. A calibration curve was generated with 1000 bootstrap samples to reduce the overfit bias. Hosmer-Lemeshow (HL) test implied good calibration when the test is insignificant. The discriminative performance was assessed by area under the receiver operating characteristic (ROC) curve. Also, the clinical usefulness of the nomogram is evaluated by decision curve analysis (DCA) by evaluating net benefits at different threshold probabilities. P-value <0.05 was considered significant.
Is there any information about the Shape of the stones( extensions), condition of the patients (paraplegia is associated with postoperative sepsis in Campbell- Walsh Urology Edition 10th), and degree of hydronephrosis (Kuldeep Sharma et al. Factors predicting infectious complications following percutaneous nephrolithotomy. Urology Annals; Year : 2016 | Volume : 8 | Issue : 4 | Page : 434-43. Post-PCNL infectious complications were found to be more common in patients with renal failure, diabetes mellitus, preoperative PCN placement, staghorn calculi, severe HDN, multiple punctures, and prolonged duration of surgery. ?
Line 121; No need for Figure 1; is extra-explanation.
Line 125: change hight to size ( more informative).
Conclusion:
Is too long, I suggest this:
A new nomogram is developed to predict sepsis in PNL for an upper ureteric single stone if the patient has these characters: female sex, lower AGR, positive urine culture, and leukocytosis.
Discussion:
Line 152 and 153 ; (Sepsis can further lead to organ dysfunction and even septic shock, endangering patients' lives 6,14.) Has no advisory role in the discussion, consider removal. Especially the reference (6) has been used before.
Line 165, reference 17: has a different opinion about low and high-normale serum albumin levels? See this reference talk about stone size as a predictor for sepsis and the albumin.
It was concluded that patients with larger stone size and preoperative urinary tract infection might have a higher risk of developing SIRS and fever after the operation, while a high-normal level of serum albumin might be the protective factor for postoperative fever. ( Tian Yang et al. , The Evaluation of Risk Factors for Postoperative Infectious Complications after Percutaneous Nephrolithotomy. January 11, 2017)
Line 166: Abbreviation written without preceding details; high-sensitive C-reactive protein/albumin (hs-CRP/Alb) ratio.
Line 172; references 14,8 has been repeated twice. Consider new references!
Line 178: It is not clear where and how the sepsis increased by three times in patients with a preoperative positive culture.
Line 192; Ryan et al. decision may be simple, but it is not effective for urologist decisions. The upper urinary tract urine is highly dependable for postoperative suspecting sepsis. See reference;
The results of this study suggest that positive stone C&S and pelvic urine C&S are better predictors of potential urosepsis than bladder urine. Therefore, a routine collection of these specimens is recommended. ( PARAMANANTHAN MARIAPPAN, GORDON SMITH, SIMON V. BARIOL, SAMI A. MOUSSA, and DAVID A. STONE AND PELVIC URINE CULTURE AND SENSITIVITY ARE BETTER THAN BLADDER URINE AS PREDICTORS OF UROSEPSIS FOLLOWING PERCUTANEOUS NEPHROLITHOTOMY: A PROSPECTIVE CLINICAL STUDY. Journal of UrologyAdult Urology: Urolithiasis/Endourology1 May 2005)
The study reported a pre-operative nomogram for sepsis after percutaneous
nephrolithotomy treating solitary, unilateral, and proximal ureteral stones. There were many studies reported on this topic
1.An internal or external verification is required to confirm the useful of the crearted nomogram.
2.Definition of ”sepsis” according to the 2001 International Sepsis Definitions Conference in the study is the same to systemic inflammatory response syndrome（SIRS）which make difficulty to follow which the author want to study.
The authors present a nomogram to predict sepsis after percutaneous nephrolithotomy treating solitary, unilateral, and proximal ureteral stones. there were many studies reported on this topic，and the stone location specific to proximal ureter is the only difference compared to other studies. However，the stone location in ureter is not a risk factor to sepsis after PCNL, thus this limited case series is not presenting a novel idea and is unlikely to alter management.
none
No Comment
No comment
No comment
Title: A pre-operative nomogram for sepsis after percutaneous nephrolithotomy treating solitary, unilateral, and proximal ureteral stones (#46687)
The paper aimed to determine the preoperative predictors of sepsis after percutaneous nephrolithotomy (PCNL) in patients with unilateral, solitary and proximal ureteral stones, and developed the nomogram to predict sepsis with significant and independent predictors.
Female, positive urine culture and leukocytosis are well known risk factors for sepsis following PCNL and lower albumin globulin ratio (AGR) is new finding in this paper.
There are a few comments to address before publication.
1. The author analyzed sepsis in this paper, how many cases presented septic shock in enrolled cases with sepsis?
2. The cut-off point of AGR was set at 1.5 in this paper. I am wondering how the author determine this cut-off point. Need to make it clear in method section.
3. This paper contained a bit complicated statistical analysis, such as developing nomogram and validation of that. Is there any proper statistician in co-author? If so, please make it clear in affiliation section.
All text and materials provided via this peer-review history page are made available under a Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.