Epidemiological study of the relationship between meteorological factors and onset of acute aortic dissection in Japan

Ayami Ishikawa; Yasuto Sato; Yasuhiko Terai; Takeshi Usui

doi:10.1371/journal.pone.0311489

Peer Review History

Original SubmissionJune 25, 2024
6 Aug 2024 Decision Letter - Chiara Lazzeri, Editor PONE-D-24-23649Epidemiological study of the relationship between meteorological factors and onset of acute aortic dissection in JapanPLOS ONE Dear Dr. Sato, 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 Sep 20 2024 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. 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However, when data cannot be publicly shared for ethical reasons, we allow authors to make their data sets available upon request. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Before we proceed with your manuscript, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., a Research Ethics Committee or Institutional Review Board, etc.). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of recommended repositories, please see https://journals.plos.org/plosone/s/recommended-repositories. You also have the option of uploading the data as Supporting Information files, but we would recommend depositing data directly to a data repository if possible. Please update your Data Availability statement in the submission form accordingly. [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 Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 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: 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 Reviewer #2: 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: “Epidemiological study of the relationship between meteorological factors and onset of acute aortic dissection in Japan” This article is aimed to deepen the knowledge of meteorological data and its changes and their correlation with aortic dissection incidence. As weather differentiates worldwide the authors correctly focused their analysis on a specific region’s weather data (Shizuoka Prefecture, Japan), providing an overview of possible external factors leading to AAD in their climate zone. No significant similarities with other articles published can be found, with a similarity index close to 3%. The article is well written. No major grammatical errors have been identified. The referral population is correctly identified. Subdivision on several groups based on preoperative, anamnestic and clinical factors has been correctly made. Uncertainties remains upon data collection on patient’s medical history. More information on family history for aortic disease and patient’s smoking history could be obtained to emphasize some of the results that authors identified, such as correlation between meteorological changes and incidence of AAD in smoker patients. Statistical analysis is correctly achieved. Logistic regression has been used to analyze the correlation between meteorological changes and AAD incidence in the various groups, permitting to identify variables correlated with an increased incidence of aortic dissection with statistical significance. As suggestion, multivariate analysis should be implemented to identify correlation between variables identified to be the major responsible for aortic dissection onset. I may also suggest highlighting p-value significance values at the bottom of tables 2 and 3 (p-value < 0.05 for CI of 95%). Authors’ conclusions are sustained by what has been evaluated in the statistical analysis, but further analysis should be obtained as suggested before. The article permits an overview and significant statistical data upon a well-known topic that many authors already discussed before, leading to a deeper perception of a high-risk pathology and its triggers. For this it should be accepted after a minor/major review with implementation of what has been suggested. Reviewer #2: In this manuscript, the authors aimed to identify meteorological factors associated with the onset of acute aortic dissection (AAD). In their single-center, retrospective analysis of 538 patients, they note that AAD onset was associated with a lower daily mean temperature in the preceding 7 days. This effect was compounded by traditional risk factors (i.e., hypertension, smoking, male sex). Major Comments 1. How the time of onset of AAD was defined requires clarification. Was time of AAD onset defined as the time of onset of chest pain as reported by the patient upon hospital admission? Or was time of AAD onset defined as the time of hospital admission? If the latter is the case, then a clear gap is present. I would then suggest revising the definition to the former as this would more accurately represent time of AAD onset. 2. Although it is mentioned by the authors in the limitations section of the manuscript, I do think it is prudent to highlight the lack of information available for select baseline characteristics (medications, complications, family history, smoking, etc.). I understand that this is an inherent limitation of the retrospective study design and criticality of the condition; however, when information is available for ~50% or less of the patients then one must question the validity of select sub-analyses that were performed. Minor Comments 1. I would suggest revising the final statement in the abstract to remained focused on AAD rather than various cardiovascular disease states. 2. The last statement in the introduction should simply state the objective of the manuscript. The authors should avoid stating any results/conclusions of the study at this point. 3. Why were patients with AAD onset in the hospital omitted? Does this refer to patients with iatrogenic aortic dissections? If not, then it is unclear why these patients would be omitted. I presume it is secondary to a lack of outdoor exposure in hospitalized patients; however, the assumption is then made that all patients who suffer AAD outside of hospital are having similar exposure. 4. The authors should define “complications” in the data extraction section of the manuscript. Furthermore, they should better define malperfusion – cerebral, coronary, visceral, spinal cord, upper/lower extremity, etc. 5. References should be provided to support the following statement – “Meteorological factors influencing the onset of AAD include seasonal, weekly, and intraday fluctuations in temperature, humidity, atmospheric pressure, and wind speed.” ****** 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: Prof. Pierluigi Stèfano 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.] 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. https://doi.org/10.1371/journal.pone.0311489.r001
Revision 1
17 Sep 2024 Author Response Thank you very much for reviewing our submission. We have revised our manuscript in accordance with the reviewers’ suggestions. Our point-by-point responses are highlighted in yellow below. Journal Requirements: When submitting your revision, we need you to address these additional requirements. 2. Please provide additional details regarding participant consent. In the ethics statement in the Methods and online submission information, please ensure that you have specified what type you obtained (for instance, written or verbal, and if verbal, how it was documented and witnessed). If your study included minors, state whether you obtained consent from parents or guardians. If the need for consent was waived by the ethics committee, please include this information. Thank you very much for reviewing our manuscript. We have added the following to the Ethical considerations section and the online submission information: The ethical committee approved the use of an opt-out consent process for study participation. An opt-out document was posted on the hospital's website, and individuals who did not agree to participate were excluded from the study. 3. We note that you have indicated that there are restrictions to data sharing for this study. For studies involving human research participant data or other sensitive data, we encourage authors to share de-identified or anonymized data. However, when data cannot be publicly shared for ethical reasons, we allow authors to make their data sets available upon request. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Before we proceed with your manuscript, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., a Research Ethics Committee or Institutional Review Board, etc.). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. Please update your Data Availability statement in the submission form accordingly. Thank you for your valuable comments. We have added the following to the online submission information: As the dataset for this study contains patient personal information, there are restrictions on sharing the data. If you wish to obtain the dataset, you will need to submit a reasonable request to the corresponding author. Upon receiving this request, the ethical review committee will conduct an individual review. 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 Thank you for taking the time to review our submission. 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes 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: Yes Thank you for your perceptive comments. As mentioned above, we have outlined the procedure for obtaining the dataset. 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 5. Review Comments to the Author Reviewer #1: “Epidemiological study of the relationship between meteorological factors and onset of acute aortic dissection in Japan” This article is aimed to deepen the knowledge of meteorological data and its changes and their correlation with aortic dissection incidence. As weather differentiates worldwide the authors correctly focused their analysis on a specific region’s weather data (Shizuoka Prefecture, Japan), providing an overview of possible external factors leading to AAD in their climate zone. No significant similarities with other articles published can be found, with a similarity index close to 3%. The article is well written. No major grammatical errors have been identified. The referral population is correctly identified. Subdivision on several groups based on preoperative, anamnestic and clinical factors has been correctly made. Uncertainties remains upon data collection on patient’s medical history. More information on family history for aortic disease and patient’s smoking history could be obtained to emphasize some of the results that authors identified, such as correlation between meteorological changes and incidence of AAD in smoker patients. Thank you for reviewing our manuscript. To gather information not recorded in the medical records, it would have been necessary to collect data directly from patients and their families, which was not feasible because of budget constraints. We have added a note about this in the Discussion section. Statistical analysis is correctly achieved. Logistic regression has been used to analyze the correlation between meteorological changes and AAD incidence in the various groups, permitting to identify variables correlated with an increased incidence of aortic dissection with statistical significance. As suggestion, multivariate analysis should be implemented to identify correlation between variables identified to be the major responsible for aortic dissection onset. Thank you for your insightful comments. This study used a self-controlled design, where the case was the patient at the time of AAD onset, and the control was the same patient at a randomly selected time within a 29-day period centered around the AAD onset. This means that all variables were matched except for the presence or absence of AAD and meteorological factors. Consequently, multivariate analysis could not be performed, and analysis was conducted using repeating stratified univariate analysis. In future research, multivariate analysis will be possible by using appropriate controls (other than self-controls) for AAD cases. This will allow for the simultaneous examination of multiple factors. We have added a note about this in the Discussion section. I may also suggest highlighting p-value significance values at the bottom of tables 2 and 3 (p-value < 0.05 for CI of 95%). Thank you for pointing this out. Significance levels are provided in Tables 2 and 3. Authors’ conclusions are sustained by what has been evaluated in the statistical analysis, but further analysis should be obtained as suggested before. The article permits an overview and significant statistical data upon a well-known topic that many authors already discussed before, leading to a deeper perception of a high-risk pathology and its triggers. For this it should be accepted after a minor/major review with implementation of what has been suggested. Reviewer #2: In this manuscript, the authors aimed to identify meteorological factors associated with the onset of acute aortic dissection (AAD). In their single-center, retrospective analysis of 538 patients, they note that AAD onset was associated with a lower daily mean temperature in the preceding 7 days. This effect was compounded by traditional risk factors (i.e., hypertension, smoking, male sex). Major Comments 1. How the time of onset of AAD was defined requires clarification. Was time of AAD onset defined as the time of onset of chest pain as reported by the patient upon hospital admission? Or was time of AAD onset defined as the time of hospital admission? If the latter is the case, then a clear gap is present. I would then suggest revising the definition to the former as this would more accurately represent time of AAD onset. Thank you for reviewing our manuscript. The time of AAD onset was determined based on the "patient-reported symptom onset time" as documented in the initial medical record. We have added this note to the Data collection section. 2. Although it is mentioned by the authors in the limitations section of the manuscript, I do think it is prudent to highlight the lack of information available for select baseline characteristics (medications, complications, family history, smoking, etc.). I understand that this is an inherent limitation of the retrospective study design and criticality of the condition; however, when information is available for ~50% or less of the patients then one must question the validity of select sub-analyses that were performed. We appreciate your meaningful comments. As shown in Table 1, missing values occurred in 79.6% of cases for family history, 60.4% for complications, and 44.1% for smoking history. Therefore, the results of the subset analysis using these factors may contain bias and should be interpreted with caution. We have added this note to the Discussion section. Minor Comments 1. I would suggest revising the final statement in the abstract to remained focused on AAD rather than various cardiovascular disease states. Thank you for bringing this to our attention. The text has been revised. The results of this study are expected to help raise awareness in clinical practice and among the general public about reducing the onset of AAD, which is influenced by a drop in temperature. 2. The last statement in the introduction should simply state the objective of the manuscript. The authors should avoid stating any results/conclusions of the study at this point. We appreciate your attention to this matter. The text has been revised. This study aimed to identify meteorological factors associated with the onset of AAD in Japan. 3. Why were patients with AAD onset in the hospital omitted? Does this refer to patients with iatrogenic aortic dissections? If not, then it is unclear why these patients would be omitted. I presume it is secondary to a lack of outdoor exposure in hospitalized patients; however, the assumption is then made that all patients who suffer AAD outside of hospital are having similar exposure. Thank you for your important comments. In this study, we excluded patients who developed AAD in the hospital because of the unique circumstances of being under medical care. Of the seven excluded cases, five developed AAD during surgery. We have added this note to the Discussion section. 4. The authors should define “complications” in the data extraction section of the manuscript. Furthermore, they should better define malperfusion – cerebral, coronary, visceral, spinal cord, upper/lower extremity, etc. Your meaningful comment is duly noted. For complications, data were collected on cardiopulmonary arrest, aortic rupture, cardiac tamponade, and malperfusion. Cardiopulmonary arrest was considered present if it was noted at the time of transport to the hospital. Aortic rupture, cardiac tamponade, and malperfusion were considered present if they were noted in the medical record at the time of admission. For malperfusion, only the presence or absence was reported, and the location could not be specified. We have added this note to the Methods section. 5. References should be provided to support the following statement – “Meteorological factors influencing the onset of AAD include seasonal, weekly, and intraday fluctuations in temperature, humidity, atmospheric pressure, and wind speed.” Your insightful comment is appreciated. We have added the references to the text. Attachments Attachment Submitted filename: ResponseToReviewers2.docx https://doi.org/10.1371/journal.pone.0311489.r002
20 Sep 2024 Decision Letter - Chiara Lazzeri, Editor Epidemiological study of the relationship between meteorological factors and onset of acute aortic dissection in Japan PONE-D-24-23649R1 Dear Dr. Sato, 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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, 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, Chiara Lazzeri Academic Editor PLOS ONE Reviewers' comments: https://doi.org/10.1371/journal.pone.0311489.r003
Formally Accepted
30 Sep 2024 Acceptance Letter - Chiara Lazzeri, Editor PONE-D-24-23649R1 PLOS ONE Dear Dr. Sato, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, 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 customercare@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. Chiara Lazzeri Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0311489.r004

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