PONE-D-20-06167

Variation of Percent of Body fat, Waist, and Cross Sectional Areas of Abdominal Adipose Tissue after Single Unilateral Cryolipolysis-Using the sequential split-body trials-

PLOS ONE

Dear Dr. lee,

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.

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We look forward to receiving your revised manuscript.

Kind regards,

Stephen L Atkin, MD

Academic Editor

PLOS ONE

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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

Reviewer #2: Partly

Reviewer #3: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

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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

Reviewer #2: Yes

Reviewer #3: Yes

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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

Reviewer #2: Yes

Reviewer #3: Yes

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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: 1. There are grammatical errors throughout. Please have native English speaker review and edit, and correct syntax, diction, tense, and punctuation. For example, in intro you say that VATS and SATS are "various." This is not correct english. There are more errors throughout the paper. Not a "weakness" but a risk, or disadvantage, etc.

2. The title needs to be improved. It's not the variation you are presenting, but the effect of cryolipolysis on adipose tissue. There's a difference in the meaning of the word "variation."

3. BMI should be spelled out in its first appearance in the manuscript.

4. Your paper has many strengths, but in its current form with sentence structure and english writing errors it makes it difficult to read.

5. Why would visceral fat change if the cryolipolysis is only on the subcutaneous fat?

6. How do you determine metabolism of the fat?

7. Does the patients medical condition, such as Diabetes or heart condition improve as a result of decreased VATS?

8. How do you control for anatomic variability with visceral fat, since the internal anatomy of a patient may change between CT scan sessions?

Overall, the paper has merit and several strengths, but needs more work to present the information in a more coherent fashion.

Reviewer #2: The manuscript entitled ‘Variation of Percent of Body fat, Waist, and Cross Sectional Areas of Abdominal Adipose Tissue after Single Unilateral Cryolipolysis-Using the sequential split-body trials’ with the aim to explore if single session unilateral cryolipolysis on left abdomen could change visceral and subcutaneous adipose tissue (VAT/SAT) in 12 weeks.

The manuscript can be further improved based on the comments below.

Abstract

Mean, sd to be stated for the figures. Figures for men to be included. P value for 1.2 cm2 (3.6%) to be stated. cm2 to be written as cm^2 (2 in superscript form).

Materials and Methods

Page 4, title 'Material and Method' to be stated as Materials and Methods.

Page 4, the statement ‘All participants were provided with written informed consents.’ requires revision.

Page 4, sample size calculation write up requires revision. More input parameters to be provided i.e 1 or 2 tailed, alpha (0.05), power of study etc. Non-centrality parameter δ 4, critical t 2.314495, degree of freedom 15, total sample size 16 are output parameters.

Page 5, statistical analysis section to be placed at the end of the materials and methods section. Paired t test for what comparison to be clearly stated e.g. Initial week and 12-week.

Results

Page 6, the word mean, sd to be stated where applicable.

Page 7, p value to be stated for all results/findings.

Table 1, the name of the statistical test to be denoted in the table footnote as well as in the statistical analysis section. For the Waist to Hip Ratio, was the value for the SD (initial visit and 8 weeks) zero or there was a value at 2nd decimal point onward? .9 to be stated as 0.9 Decimal point for the p values to be standardized. The dark background to be discarded and replaced with words.

Presentation format of .0 or 0. for figures to be standardized throughout the manuscript [text, table, figure(s)].

Active sentences to be written in passive form.

List of references and citation of references in the text did not meet the journal format.

Reviewer #3: The study presents an orderly and very clear methodology, with interesting results. But unfortunately, the discussion does not clearly present the effect of cryolipolysis on visceral fat, nor does it justify this effect, making the necessary correlation with the literature.

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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: No

Reviewer #2: No

Reviewer #3: No

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Cryolipolysis induced abdominal fat change -split-body trials-

PONE-D-20-06167R1

Dear Dr. Lee,

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.

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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,

Stephen L Atkin, MD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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 #2: All comments have been addressed

Reviewer #3: All comments have been addressed

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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 #2: Partly

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

Reviewer #3: N/A

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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 #2: Yes

Reviewer #3: Yes

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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 #2: Yes

Reviewer #3: Yes

**********

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 #2: Table 1 & Table 1 Rev

Visceral-to-Subcutaneous Fat Ratio - add 0 in front of dot

Visceral-to-Total Fat Ratio - add 0 in front of dot

Reviewer #3: All the doubts from the reviwers were response by the authors. I believe that the article is prepared for publication.

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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 #2: No

Reviewer #3: No