Peer Review History
Original SubmissionDecember 6, 2019 |
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PONE-D-19-33449 Brain MRI findings in relation to clinical characteristics and outcome of tuberculous meningitis PLOS ONE Dear dr Dian, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. I would also like to apologize for the time that it has taken to render a decision on your manuscript. I have had a very difficult time securing a second reviewer. However, I believe that the comments that have been received will be valuable in improving the quality of the manuscript. Please carefully address all of the comments that have been raised, or explicitly state why this has not been done. In addition, I have the following points that should be addressed: 1. Line 135: Please change "Swiss" to "Switzerland" 2. Line 143: You state that the basal ganglia was considered as "caudate nucleus, internal capsule, lentiform nucleus and thalamus." This is incorrect. The thalamus is not part of the basal ganglia, and there other brain structures that are part of the basal ganglia, but not listed here (e.g. nucleus accumbens, olfactory tubercle, substantia nigra, and subthalamic nucleus.). There appears to be some confusion here based on the cited reference (Tai, et al. Scientific Reports volume 6, Article number: 38802 (2016)) . Please clarify. 3. Line 251: It is a bit misleading to refer to a "thin gap" in the 3D MP-RAGE sequence. As it is a 3D sequence, there is no gap at all. We would appreciate receiving your revised manuscript by May 08 2020 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. To enhance the reproducibility of your results, we recommend that if applicable you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols Please include the following items when submitting your revised manuscript:
Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out. We look forward to receiving your revised manuscript. Kind regards, Niels Bergsland Academic Editor PLOS ONE Journal Requirements: 1. When submitting your revision, we need you to address these additional requirements.
Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at http://www.journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and http://www.journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please include the registration number for the clinical trial referenced in the manuscript. 3. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ********** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know ********** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ********** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ********** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: I read carefully the manuscript PONE-D-19-33449 First i will like thanks authors for the quality of the manuscript which is easy to read and well organized This topic in Tuberculosis disease is rare and recent datas are needed to improve the management of such patient world wide. The authors through their MRI focus reinforce previously published message on MRI major place as neurological diagnostic tool for TB. Major concern - Could the authors give information on time between first symptoms and and first MRI ? It might be more relevant than delay between treatment begining and MRI. Line 196 "Only in 39% (13/30) of cases..." I do not understand how you find 30 because just before you speak about 33 cases, please fix it. - Lines 196-1977 the sentence " this was accompanied by worsening clinical symptoms, the most common finding being …" is incomplete, so please complete it ? - What was the dexamethasone posology and what tappering paln do you use ? - What have you done with dexamethasone dosis when worsening was proved clinically and/or radiologically ? - What were the pulmonary findings for these patients (Chest X-Ray and sputum samples) and have you seen association between type of lung involvement and neurological loacalization of TB ? - You stopped follow up at M6 but neurological tuberculosis need up to 9 months of treatment. Could you argue why a such outcome? Have you datas on M6-M12 periods? Minor There is some publication in western country on this topic you could cite : - A. Bleibtreu et al. / Médecine et maladies infectieuses 48 (2018) 533–539 -Venkatraman N, King T, Bell D, Woltmann G, Wiselka M, AbubakarI, et al. High levels of neurological involvement but low mortalityin miliary tuberculosis: a 6-year case-series from the UK. Eur RespirJ 2016;47(5):1578–81 ********** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Dr Bleibtreu Alexandre MD, PhD. Infectious diseases Specialist [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step. |
Revision 1 |
PONE-D-19-33449R1 Brain MRI findings in relation to clinical characteristics and outcome of tuberculous meningitis PLOS ONE Dear Dr. Dian, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we have decided that your manuscript does not meet our criteria for publication and must therefore be rejected. I recognize that you have waited for a long time to have a decision on the manuscript. The manuscript was sent to an additional reviewer who specifically assessed the statistical analysis. The reviewer had major concerns about the statistical approach, resulting in severe doubts about the validity of the results. I am sorry that we cannot be more positive on this occasion, but hope that you appreciate the reasons for this decision. Yours sincerely, Niels Bergsland Academic Editor PLOS ONE [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: (No Response) ********** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: No ********** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: No ********** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ********** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: No ********** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: All concerns were adressed by the authors. The response to reviewers concerns is point by point argue and clear. I am agree with their decision to not improved the references. For me the manuscript is suitable for publication Reviewer #2: In this study, the authors used MRI data collected at baseline in 48 patients with tuberculous meningitis (TBM). They then attempted to test the association between MRI findings (which included meningeal enhancement, tuberculomas, brain infarctions, and hydrocephalus).and clinical characteristics (motor deficits, cranial nerve palsy, microbiological confirmation, and CSF abnormalities). This analysis, however is flawed because none of these comparisons are “clean.” This is due to the fact that so many of the patients had multiple MRI abnormalities. It doesn’t make sense to test each abnormality separately against the others and make conclusions about an individual abnormality given that there are a large number of possible permutations of abnormalities that could occur in any given patient. There is no way to be certain that any one abnormality is associated with any clinical characteristic, since the abnormalities so frequently occur in combination. The way to do this correctly would be to create a model in which the presence or absence of the clinical characteristic is the outcome, and a binary variable is created for each of the potential MRI abnormalities (allowing for one subject to have multiple abnormalities). It is doubtful that there are enough data to give sufficient power to such an analysis. Furthermore, it would also be advisable to consider interactions between the MRI findings (e.g., do patients with both meningeal enhancement AND tuberculomas have a different relationship with a clinical finding than patients who have meningeal enhancement WITHOUT tuberculomas). The small sample would clearly lack sufficient power to see any sort of interactions. I don’t think there is any way this can be fixed. The same problem is inherent in the analysis of the effect of brain abnormalities on six month mortality and functional outcome. It isn’t correct to examine each one separately, for the above reasons. A model would need to contain a variable (yes/no) for EACH abnormality. One possible option would be to count the number of brain abnormalities any patient had, and check whether the number of abnormalities was associated with the different clinical outcomes. I’m not sure this would yield useful information, however. It is not surprising that the authors found none of the MRI abnormalities (again, examined separately) were associated with mortality, disability, or worsening. There is too much overlap between any “one” abnormality and “all others,” since very few subjects HAD just one abnormality. Again, it requires a much more complex analysis than is possible given the small size of the data. I feel that the only way these data could be presented would be descriptively, without an attempt to derive conclusions from very oversimplified (and incorrect) analyses. Minor points: The authors state that 60 patients were enrolled in the “parent” study (a Phase 2b dose-finding study). That is true, but if 12 of these did not have a baseline MRI, then they would never have been considered for the current study. A better way to present this would be to say that of 60 patients enrolled in a Phase 2b dose-finding clinical trial, 48 had baseline MRIs and were therefore eligible for the current study. l.162 Multivariable, not multivariate Survival analysis, not logistic regression, should be used to look at six-month mortality, but again, the fact that subjects could have multiple MRI abnormalities would have to be accounted for. ********** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Bleibtreu Alexandre Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] - - - - - For journal use only: PONEDEC3 |
Revision 2 |
Brain MRI findings in relation to clinical characteristics and outcome of tuberculous meningitis PONE-D-19-33449R2 Dear Dr. Dian, First, I would like to thank you for your enormous patience during this entire process! We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Niels Bergsland Academic Editor PLOS ONE Journal Requirements: 1. When submitting your revision, we need you to address these additional requirements. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and 2. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. |
Formally Accepted |
PONE-D-19-33449R2 Brain MRI findings in relation to clinical characteristics and outcome of tuberculous meningitis Dear Dr. Dian: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Niels Bergsland Academic Editor PLOS ONE |
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