PONE-D-22-351343D Modeling of  Vector/Edge Finite Element Method for Multi-ablation  Technique for Large Tumor- Computational ApproachPLOS 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: Yes

Reviewer #3: Yes

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

Reviewer #1: N/A

Reviewer #2: N/A

Reviewer #3: N/A

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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: No

Reviewer #2: No

Reviewer #3: Yes

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Reviewer #1: No

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: This manuscript entitled "3D Modeling of Vector/Edge Finite Element Method for Multi-ablation Technique for Large Tumor- Computational Approach" implemented the 3D-vector/edge finite element method to simulate the specific absorption rate of microwave ablation (MWA). There are some major points to resolve prior to publication. Therefore, a major revision is recommended. The following points may help during the revision process.

1)The novelty of the paper should be clarified in the abstract and conclusion.

2)Authors should include some other qualitative and quantitative results in the abstract.

3)The overview in the introduction is not complete. It is necessary to review the literature and supplement some relevant literature appropriately. An updated literature review should be conducted based on recent novel studies. It can be helpful to present the state-of-the-art and knowledge gaps in the research.

4)Some of your equations don’t have a prestigious reference.

5)Validation should be performed in a specific new section.

6)Conclusions should be stronger and arranged into a few substantive and interconnected paragraphs instead of a short lump of text. The language is deficient in places.

7)There are some grammatical errors in the manuscript. Be sure to address them.

Reviewer #2: Reviewer report of the manuscript “3D Modeling of Vector/Edge Finite Element Method for Multi-ablation Technique for Large Tumor- Computational Approach” by G. Boregowda and P. Mariappan

In this contribution, the authors present some numerical simulations about microwave ablation applied on liver tissue by using Pennes' equation coupled with the wave propagation equation to predict the electromagnetic field. The main novelty here is that the authors use a four-antennas procedure to improve the extension of the ablated zone; furthermore, the authors also implement the 3D-vector/edge finite element to compute the SAR here. Results have been validated with comparisons with experimental data from the literature. From the simulations, results are shown in terms of temperature distribution and tissue contraction, showing the potential of the procedure here shown in terms of induced thermal damage for the tumor tissue to be treated.

The reviewer thinks that this is a well-presented paper that focuses about a very recent topic, that is MW ablation. It is widely known that optimizing MW ablation predictions to optimize medical procedures still remains a challenging task, and the results here shown are something that might be helpful for future improvements of this technique. Therefore, it is suggested to consider this contribution for publication if the following answers are properly addressed.

-Within the abstract, it is suggested to include more outcomes about results here achieved in terms of ablated zones, as done by the authors within the conclusions

-Please define the aspect ratio when introducing Table 1

-Please report references for the antenna geometry when introducing governing equations. Many geometries have been proposed through the years [1-3], so why did the authors decided to use exactly this antenna? Please note that ablation zones might depend on the antenna employed [4]

-When describing heat transfer, why did the authors decided to use Pennes bio-heat model among the ones proposed in literature through the years [5, 6]? Please report some discussion about this point here

-Did the authors here neglect perfusion dependence from the temperature [7]? If so, please report this as an assumption for the present computations

-In the reviewer's opinion, novelty from the present paper could be better described by improving the state of art in the introduction. Indeed, there are many contributions from the literature referred to the last years that haven't been considered in the literature review, with references to both modeling approach and novel solutions for MW ablation. Since in this contribution the authors focused on both aspects, some improvements in the manuscript are suggested. Microwave ablation have been extensively analyzed by including different aspects within the predictive models such as variable local properties [8], tissue dilation [9], as well as tissue shinkrage [10]; on the other hand, with references to the ablation procedures, pulsating heat sources [11], or number of slots employed [12], have been proposed through the years. Therefore, in order to underline what has been done up to now in the open literature, what should be done, and what is done here, the authors should improve their state of art based on these observations.

-A cell death model is presented here in a separate subsection. Why did the authors decided to use this approach instead of other ones, say CEM43, Arrenhius damage model, or temperature threshold criterion [5]? Please report here pro and cons of the present approach selected for cell death model

-It is not really clear how did the authors decided to locate the antenna within the liver. Which criterion did they use? As future plans, they could also report that some optimization of this procedure might be used by employing different location, timing, and positions, for the antenna. Optimizing ablation shape is still a challenging task to obtain the best ablated zone [13], and using this procedure might be really helpful

-Model validation is here shown with two different values of the r-coordinate. Are the experimental results [14] from ex-vivo or in-vivo experiments? Furthermore, even if the agreement looks fairly well, could the authors report some discussion about why for r = 4.5 mm the model underpredicts temperatures, while for r = 7 mm there is some overprediction?

-Within the paper, it is suggested to present some discussion about pro/cons between the present solution and a conventionally-used single-antenna solution

-Please improve figures. For instance, in Fig. 4, there are no axis and colorbar names here. Is this the heat generation in W/m3?

-In Fig. 8 the authors report temperature evolution through time. First of all please report the spatial location of the point investigated. Secondly, if the authors consider water phase change within their model, why the temperature after 100 °C still continues its growth? Some phase change might arise

-For Fig. 10, please report units (these should me millimeters)

[1] Ortega-Palacios, R., Trujillo-Romero, C. J., Cepeda Rubio, M. F. J., Vera, A., Leija, L., Reyes, J. L., ... & Vega-López, M. A. (2018). Feasibility of using a novel 2.45 GHz double short distance slot coaxial antenna for minimally invasive cancer breast microwave ablation therapy: Computational model, phantom, and in vivo swine experimentation. Journal of Healthcare Engineering, 2018.

[2] Guerrero Lopez, G. D., Cepeda Rubio, M. F. J., Hernandez Jacquez, J. I., Vera Hernandez, A., Leija Salas, L., Valdés Perezgasga, F., & Flores García, F. (2017). Computational FEM model, phantom and ex vivo swine breast validation of an optimized double-slot microcoaxial antenna designed for minimally invasive breast tumor ablation: theoretical and experimental comparison of temperature, size of lesion, and SWR, preliminary data. Computational and mathematical methods in medicine, 2017.

[3] Selmi, M., Bin Dukhyil, A. A., & Belmabrouk, H. (2019). Numerical analysis of human cancer therapy using microwave ablation. Applied Sciences, 10(1), 211.

[4] Hendriks, P., Berkhout, W. E. M., Kaanen, C. I., Sluijter, J. H., Visser, I. J., van den Dobbelsteen, J. J., ... & Burgmans, M. C. (2021). Performance of the Emprint and Amica Microwave Ablation Systems in ex vivo Porcine Livers: Sphericity and Reproducibility Versus Size. CardioVascular and Interventional Radiology, 44, 952-958.

[5] Andreozzi, A., Iasiello, M., & Tucci, C. (2020). An overview of mathematical models and modulated-heating protocols for thermal ablation. Advances in Heat Transfer, 52, 489-541.

[6] Nakayama, A., & Kuwahara, F. (2008). A general bioheat transfer model based on the theory of porous media. International Journal of Heat and Mass Transfer, 51(11-12), 3190-3199.

[7] Shi, J., Chen, Z., & Shi, M. (2009). Simulation of heat transfer of biological tissue during cryosurgery based on vascular trees. Applied Thermal Engineering, 29(8-9), 1792-1798.

[8] Tucci, C., Trujillo, M., Berjano, E., Iasiello, M., Andreozzi, A., & Vanoli, G. P. (2022). Mathematical modeling of microwave liver ablation with a variable-porosity medium approach. Computer Methods and Programs in Biomedicine, 214, 106569.

[9] Keangin, P., Wessapan, T., & Rattanadecho, P. (2011). Analysis of heat transfer in deformed liver cancer modeling treated using a microwave coaxial antenna. Applied Thermal Engineering, 31(16), 3243-3254.

[10] Farina, L., Weiss, N., Nissenbaum, Y., Cavagnaro, M., Lopresto, V., Pinto, R., ... & Goldberg, S. N. (2014). Characterisation of tissue shrinkage during microwave thermal ablation. International Journal of Hyperthermia, 30(7), 419-428.

[11] Andreozzi, A., Brunese, L., Iasiello, M., Tucci, C., & Vanoli, G. P. (2021). Numerical analysis of the pulsating heat source effects in a tumor tissue. Computer Methods and Programs in Biomedicine, 200, 105887.

[12] Keangin, P., Rattanadecho, P., & Wessapan, T. (2011). An analysis of heat transfer in liver tissue during microwave ablation using single and double slot antenna. International Communications in Heat and Mass Transfer, 38(6), 757-766.

[13] Trujillo, M., Prakash, P., Faridi, P., Radosevic, A., Curto, S., Burdio, F., & Berjano, E. (2020). How large is the periablational zone after radiofrequency and microwave ablation? Computer-based comparative study of two currently used clinical devices. International Journal of Hyperthermia, 37(1), 1131-1138.

[14] Yang, D., Converse, M. C., Mahvi, D. M., & Webster, J. G. (2007). Expanding the bioheat equation to include tissue internal water evaporation during heating. IEEE Transactions on Biomedical Engineering, 54(8), 1382-1388.

Reviewer #3: Authors report VFEM assisted computation of temperatures and FDM assisted computation of thermal damage zones for microwave assisted thermal ablation of liver tumor.

Authors mentioned that MWA of tumors larger than 3 cm to achieve spherical ablation region needs to be addressed. Though it is reported that MWA of tumor sizes 3-5 cm could be attained through repeated overlapping ablation with single antenna leading to elliptical ablation zone.

In this paper a spherical tumor of 4 cm diameter is considered for computations.

In my opinion, following comments need to be addressed before publication of this article.

1. Liver tumors are highly perfused, so dynamics of blood perfusion (temperture dependent) as well as heterogeneity of blood flow within the tumor should be considered to get realistic ablation zones. This becomes more important considering large size of the domain considered by the authors (8cm x 8cm).

2. Currently used Eq 11 accounts for just ON/OFF of blood perfusion instead of the complete spatiotemporal perfusion dynamics and this will not provide correct ablation zones. Authors may refer to literature Soni et al 2015 Int J Hyperthermia etc.

3. Numerical value of blood perfusion, considered for the simulation, could not be located in manuscript. Kindly mention this in Table 3 alongwith other parameters.

4. It is not clear, whether the electro-thermal properties corresponding to the ablated region (in total computational domain) are considered for computing the next ablated region, for sequential insertion of the electrode.

5. Please discuss whether the perfusion is cutoff for the first ablated region for computation of the second ablation zone (overlapping of ablation zones) for the next lectrode insertion point/time step and so on.

6. Instead of mentioning sequential insertion points/locations in the tumor, a normalized parameter (probe sepearation, time points) w.r.t. tumor volume may be provided to generalize the multiple elctrode insertion locations & exposure time steps based on a tumor volume.

7. Page 10, line 242 - Please justify the chosen locations for temperature measurements.

8. Page 10, line 253 - Authors mention good agreement with the published literature. But earlier it is mentioned that this literature reports for oval shaped ablation zones. So, how the claim of spherical zones is arrived. Fig. 6b also supports oval shaped ablation zone.

9. Table 4 - There are still remanant tumor cells for 4 minutes exposure as mentioned. Please discuss the strategy to avoid these.

10. Please label the axes in figures 4 and 6 as well as other such figures.

11. Fig. 5 - Please mention the dielectric and thermal parameters, in tablular form, for both the studies (experimental, numerical).

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: Sanjeev Soni

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PONE-D-22-35134R13D Modeling of  Vector/Edge Finite Element Method for Multi-ablation  Technique for Large Tumor- Computational ApproachPLOS ONE

Dear Dr. boregwoda,

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.

Please submit your revised manuscript by Jun 16 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're 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.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

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We look forward to receiving your revised manuscript.

Kind regards,

Cihun-Siyong Alex Gong, Ph.D.

Academic Editor

PLOS ONE

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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: (No Response)

Reviewer #4: (No Response)

Reviewer #5: (No Response)

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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: Yes

Reviewer #4: Partly

Reviewer #5: Yes

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

Reviewer #2: N/A

Reviewer #4: N/A

Reviewer #5: Yes

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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 #4: Yes

Reviewer #5: 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 #4: Yes

Reviewer #5: Yes

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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: The revised version of the present manuscript looks far better than the first version; most of the questions from the reviewer have been properly answered. The manuscript in the present form presents interesting results for whom investigates thermal ablation, described via an innovative procedure based on the 3D vector finite element method. However, some minor improvements should be done by the authors, especially to underline why investigating this subject is still important and which is the novelty here, and which are the assumptions behind the present model. Please find in the following more details about these points.

-The authors report that they use a single-slot commercial coaxial antenna; in the rebuttal, the authors make references to studies from (doi.org/10.48550/arXiv.2008.02032, doi.org/10.1016/j.ijheatmasstransfer.2012.10.043) about this point. What did they mean when they wrote "this was used in one of the Author's previous projects for treating live patients [...]"? It is possible for the authors to report more details about it? For instance, are they talking about some clinical practice done via single-slot antenna? Furthermore - and far more important - please be sure that in Fig. 3 all the quotations have been included. For instance, which is the axial distance between the slot and the antenna's tip? Giving appropriate quotations for the geometry is fundamental for whom wants to reproduce the same model in the future

-In (doi.org/10.1016/j.ijheatmasstransfer.2012.10.043), it is true that the authors concluded that single-slot antennas might improve maximum SAR; on the other hand, it is also reported that the volumetric SAR is higher for the double slot MCA. Therefore, the authors should include all this when describing the geometrical model here, in order to underline that, even if some aspects might be better for double-slot antennas, the authors decided to use a single-slot antenna here

-The authors report in their rebuttal that they decide to use Pennes' bioheat model because liver parameters are homogeneous and isotropic, while blood vessels and flow might not be considered within the computational domain. That's seems unaccurate since, if one considers tissue plus blood as a heat exchanger, their heat capacities are not so different so one would expect an increase of arterial temperature within the perfusion term. The real reason of why Pennes bioheat equation might be still used nowadays, instead of other model like Klinger (doi.org/10.1007/BF02464617) or Chen and Holmes (doi.org/10.1111/j.1749-6632.1980.tb50742.x), is about its simplicity (doi.org/10.1016/bs.aiht.2020.07.003, doi.org/10.1016/j.ijheatmasstransfer.2007.05.030) - and this can be applied to the present study, but the author should report this as a limitation of the present model here.

-The authors done some improvements in the introduction to describe what has been done up to now, especially with references to cells death during thermal ablation (doi.org/10.1007/s10439-010-0177-1). However, it is still not clear for readers why researchers might be still interested in improving tumor thermal ablation modeling and standards; there is no mention in the introduction about modeling for local properties to be variable (doi.org/10.1016/j.cmpb.2021.106569), tissue dilation (doi.org/10.1016/j.applthermaleng.2011.06.005) or shinkrage (doi.org/10.3109/02656736.2014.957250), as well as standards improvements by using time-variable sources (doi.org/10.1016/j.cmpb.2020.105887) or different slots (doi.org/10.1016/j.ijheatmasstransfer.2012.10.043). Therefore, the paper introduction might be improved to underline that it is still important to investigate tumor thermal ablation from a research point of view

-The authors report that they neglect perfusion dependence vs temperature up to 60 °C. However, if one considers the perfusion rate vs temperature linear function reported in (doi.org/10.1016/j.applthermaleng.2008.08.014, doi.org/10.1016/j.applthermaleng.2011.06.005), by considering as an example 40 °C and 60 °C, perfusion rate might vary of about 25-30%. Therefore, the authors should include neglecting temperature dependence of perfusion as an assumption of their model here

Reviewer #4: 1.In Introduction, the frequency of 2.45 GHz is a common frequency in MWA but it is not the only one. A range of frequencies are addressed in previous studies.

2.Please describe the novelties and specific contribution of this work in the field in more detail at the last paragraph of Introduction.

3.Thermal properties of ablated zone change after MWA. Moreover, there is a time interval between changing the location of antenna in which the temperature of previously ablated reduce. Do the authors consider these two points? If not, how you can inform that the effect of these two parameters is negligible?

4.It suggested that the authors try the other treatment durations. For example, 5 min in two sections or 4 min in 3 parts. And find the optimum value for the relation between the MWA duration and the number of positions.

5.It suggested that the authors compare the treatment efficacy if their presented treatment strategy with the conventional MWA treatment which applied one time.

6.Can you find a more efficient treatment by changing and optimizing the positions of the antenna at each step?

7.It is suggested that the authors discuss tumor contraction in more detail, i.e., the effect, the importance, its impact on treatment outcomes, and its contribution to previous studies.

Reviewer #5: The manuscript contains many interesting results concerning microwave ablation. However, some issues should be addressed.

1)The following references should be cited

─Effects of target temperature on thermal damage during temperature-controlled MWA of liver tumor, 2022

─Modeling of heat transfer distribution in tumor breast cancer during microwave ablation therapy, 2022

─Numerical analysis of human cancer therapy using microwave ablation, 2021

2)How does the water contained in the body behave when the temperature exceeds 100°C?

3)Figure 8: Is the model still valid for all the temperatures?

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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.

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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 #2: No

Reviewer #4: No

Reviewer #5: No

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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 PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

3D Modeling of  Vector/Edge Finite Element Method for Multi-ablation  Technique for Large Tumor- Computational Approach

PONE-D-22-35134R2

Dear Dr. boregwoda,

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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Kind regards,

Suhaib Ahmed, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

All the suggested changes have been incorporated in the revised manuscript and acknowledged by the reviewers.

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 #5: 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 #1: Yes

Reviewer #5: Yes

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

Reviewer #1: I Don't Know

Reviewer #5: Yes

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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 #1: Yes

Reviewer #5: 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 #1: Yes

Reviewer #5: Yes

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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: 'Dear Editorial Board and Authors,

I am writing to express my appreciation for the efforts made in addressing my concerns regarding the manuscript submitted for publication. I am pleased to inform you that the authors have made significant improvements to their work.

Reviewer #5: All the comments have been accurately answered.

The English has been improved.

The references were completed.

Accept

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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.

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Reviewer #1: No

Reviewer #5: No

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