Low thoracic skeletal mass index, a novel marker to predict recurrence of aspiration pneumonia in the elderly stroke patients

Bo Mi Gil; Sun Im; Yu Jin Hong; Hye Seon Kang

doi:10.1371/journal.pone.0315427

Peer Review History

Original SubmissionOctober 25, 2023
20 Aug 2024 Decision Letter - Dong Keon Yon, Editor PONE-D-23-29731Low thoracic skeletal mass index, A novel marker to predict recurrence of aspiration pneumonia in the elderly stroke patientsPLOS ONE Dear Dr. Kang, 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 Oct 04 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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Thank you for stating the following financial disclosure: “This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Korean government (no. 2020R1F1A1065814). Sun Im received this fund.” Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. 5. We note that you have indicated that there are restrictions to data sharing for this study. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. 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You should list all authors and all affiliations as per our author instructions and clearly indicate the corresponding author. Additional Editor Comments: Please address the reviewers' comments appropriately. If not, I cannot guarantee acceptance. [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: This is a retrospective analysis of patients diagnosed with stroke who developed aspiration pneumonia and whether thoracic skeletal muscle index was a predictor for aspiration pneumonia recurrence. The authors analyzed data from 2014-2020 in a single center. Aspiration pneumonia was defined as clinical signs/symptoms of pneumonia in the dependent portions of the lung. Measured thoracic muscle volume used the CSA of the erector spine muscle at the 12th vertebral region. Those with a lower T12MI were more likely to have a recurrence based on multivariate logistic regression analysis. Overall the paper appears to demonstrate a novel association in a large cohort of patients. I had some questions related to their methodology. There were also a few instances in the paper where the authors made statements which may be debatable (such as "80% of pneumonias that require hospitalization are aspiration pneumonias). Would highly recommend that the authors double check that they are using citations appropriately and with the correct context. Major criteria: • The authors divided ESM by height to develop the thoracic skeletal muscle index. Did the authors consider dividing by BMI? Several authors have divided by body size (i.e. BMI) instead of height. Please provide the rationale for dividing by height and not BMI. • In the introduction, the authors state that aspiration pneumonia is responsible for 80% of pneumonia cases that require hospitalization, however the paper that they cite demonstrated 80% for those 70 years and older. The overall prevalence of AP was 60% of hospitalized patients with CAP. Would ensure that the authors are clear what population they are referring to when using citations. Would also include other papers and include a range of incidence for aspiration pneumonia as the cause of CAP in hospitalized patients. Most citations state that 5-15% of cases of CAP are due to aspiration pneumonia, although these may include non-hospitalized patients. • In your methods, please include the rationale and evidence for the the muscle density you use (40 to 100 HU). Many studies use a different range (-50 to +90 for instance). (PMID: 24558953) • The authors quantified the time to recurrence of aspiration pneumonia, but I was surprised they did not do a survival analysis. • In the results section, the authors describe Hazard ratios but it would be helpful to provide an interpretation for the reader. Such as “each drop in T12MI by XX was associated with an increase in AP recurrence by XX” • The authors state that “For this study, we conducted a retrospective review of data for patients diagnosed with dysphagia disorder due to stroke.” -> Do we know when the stroke was diagnosed? Are these recent strokes or happened years prior? Minor criteria: • Methods lines 113-114, “In stroke patients with severe facial palsy and unable to perfect lip seal, the therapist aided by holding the lips around the mouthpiece minimize air leak." -> I believe the authors meant "around the mouthpiece TO minimize air leak" • Please double check your citations. The authors state: “In a previous study, ESMCSA assessed by chest CT was a valuable clinical parameter to correlate symptoms and disease prognosis in patients with chronic obstructive lung disease.[37] “ but the citation for 37 is a basic science paper unrelated to ESM. • In the discussion the authors state: “Most stroke-related pneumonia is dysphagia related AP” - please provide a citation here. Reviewer #2: 1. This manuscript presents the potential of low thoracic muscle index as an effective predictive factor for the recurrence of aspiration pneumonia in patients with stroke. While the paper is well-written, I have some minor concerns. 2. Person-first language (e.g., patient with stroke not stroke patient; or person with diabetes not a diabetic) is highly recommended in academic writing. https://www.nih.gov/nih-style-guide/person-first-destigmatizing-language 3. Discussion line 249-250 “Our results showed that those at the time of AP diagnosis all patients already” The sentence appears to be incomplete. 4. Please check the abbreviation (e.g., confidence interval [CI] and aspiration pneumonia [AP]). To ensure clarity and readability, please use abbreviations consistently once they have been introduced. 5. It would be beneficial to include some other potential confounding factors, such as the severity of stroke or the degree of dysphagia, in multivariate analysis if feasible. ****** 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: No 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.0315427.r001
Revision 1
4 Oct 2024 Author Response Dear Editor-in-Chief, We would like to thank you and the reviewers of the PLOS ONE for taking the time to review our article. It is truly honorable to receive the letter of revision to enrich the work of research we’ve performed. We’d like to appreciate for the time and efforts by the editors to this paper. We have made some corrections and clarifications in the manuscript after going over the reviewers’ comments. The changes are summarized below: Journal requirements: When submitting your revision, we need you to address these additional requirements. 1. 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 A clean copy of the edited manuscript (uploaded as the new manuscript file) 3. Note from Emily Chenette, Editor in Chief of PLOS ONE, and Iain Hrynaszkiewicz, Director of Open Research Solutions at PLOS: Did you know that depositing data in a repository is associated with up to a 25% citation advantage (https://doi.org/10.1371/journal.pone.0230416)? If you’ve not already done so, consider depositing your raw data in a repository to ensure your work is read, appreciated and cited by the largest possible audience. You’ll also earn an Accessible Data icon on your published paper if you deposit your data in any participating repository (https://plos.org/open-science/open-data/#accessible-data). 4. Thank you for stating the following financial disclosure: “This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Korean government (no. 2020R1F1A1065814) and Technology Innovation Program (No. 20018182) funded by the Ministry of Trade, Industry & Energy (MOTIE, Korea), Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. : As the editor suggested, we added the sentences about the role of funders, and we also additional financial disclosure additionally. 5. We note that you have indicated that there are restrictions to data sharing for this study. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For more 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: : We allow data to be available upon request. 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. 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. We will update your Data Availability statement on your behalf to reflect the information you provide. : We will upload our data as supporting information files. 6. In this instance it seems there may be acceptable restrictions in place that prevent the public sharing of your minimal data. However, in line with our goal of ensuring long-term data availability to all interested researchers, PLOS’ Data Policy states that authors cannot be the sole named individuals responsible for ensuring data access (http://journals.plos.org/plosone/s/data-availability#loc-acceptable-data-sharing-methods). Data requests to a non-author institutional point of contact, such as a data access or ethics committee, helps guarantee long term stability and availability of data. Providing interested researchers with a durable point of contact ensures data will be accessible even if an author changes email addresses, institutions, or becomes unavailable to answer requests. Before we proceed with your manuscript, please also provide non-author contact information (phone/email/hyperlink) for a data access committee, ethics committee, or other institutional body to which data requests may be sent. If no institutional body is available to respond to requests for your minimal data, please consider if there any institutional representatives who did not collaborate in the study, and are not listed as authors on the manuscript, who would be able to hold the data and respond to external requests for data access? If so, please provide their contact information (i.e., email address). Please also provide details on how you will ensure persistent or long-term data storage and availability. 7. Please ensure that you include a title page within your main document. You should list all authors and all affiliations as per our author instructions and clearly indicate the corresponding author. : As the editor requested, we included a title page within our main document. Additional Editor Comments: Please address the reviewers' comments appropriately. If not, I cannot guarantee acceptance. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 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 is a retrospective analysis of patients diagnosed with stroke who developed aspiration pneumonia and whether thoracic skeletal muscle index was a predictor for aspiration pneumonia recurrence. The authors analyzed data from 2014-2020 in a single center. Aspiration pneumonia was defined as clinical signs/symptoms of pneumonia in the dependent portions of the lung. Measured thoracic muscle volume used the CSA of the erector spine muscle at the 12th vertebral region. Those with a lower T12MI were more likely to have a recurrence based on multivariate logistic regression analysis. Overall the paper appears to demonstrate a novel association in a large cohort of patients. I had some questions related to their methodology. There were also a few instances in the paper where the authors made statements which may be debatable (such as "80% of pneumonias that require hospitalization are aspiration pneumonias). Would highly recommend that the authors double check that they are using citations appropriately and with the correct context. : Thank you for your valuable pointing that out. We corrected sentences and detailed specific population. (Line 51-54) Major criteria: • The authors divided ESM by height to develop the thoracic skeletal muscle index. Did the authors consider dividing by BMI? Several authors have divided by body size (i.e. BMI) instead of height. Please provide the rationale for dividing by height and not BMI. : Thank you for your valuable comments. Sarcopenia index is different from studies. In some prediction models for sarcopenia, skeletal muscle, sex, age and body weight is included (Eur Arch Otorhinolaryngol. 2023; 280(12): 5583–5594.). We are based on previous studies using ESM and patients’ height squared, and we cited references in line 176. • In the introduction, the authors state that aspiration pneumonia is responsible for 80% of pneumonia cases that require hospitalization, however the paper that they cite demonstrated 80% for those 70 years and older. The overall prevalence of AP was 60% of hospitalized patients with CAP. Would ensure that the authors are clear what population they are referring to when using citations. Would also include other papers and include a range of incidence for aspiration pneumonia as the cause of CAP in hospitalized patients. Most citations state that 5-15% of cases of CAP are due to aspiration pneumonia, although these may include non-hospitalized patients. : As the reviewer suggested, we corrected sentences and detailed specific population. (Line 54). And also added incidence of AP as the cause of CAP in hospitalized patients (Line 51-54) • In your methods, please include the rationale and evidence for the the muscle density you use (40 to 100 HU). Many studies use a different range (-50 to +90 for instance). (PMID: 24558953) : In previous study assess body composition, normal-density muscle is defined as having attenuation values in the 40–100 HU range. We cited related references in line 176. • The authors quantified the time to recurrence of aspiration pneumonia, but I was surprised they did not do a survival analysis. : Thank you for your valuable comments. As the reviewer suggested, we did survival analysis. T2MI is continuous variables, we grouped patients into 4 groups according to T2MI quartile, but there were no differences among 4 groups in Kaplan Meier survival analysis (Log rank 0.916). We will upload as supplementary files. • In the results section, the authors describe Hazard ratios but it would be helpful to provide an interpretation for the reader. Such as “each drop in T12MI by XX was associated with an increase in AP recurrence by XX” : As the reviewer suggested, we changed the expressions to clarify interpretation for the reader (Line 242-251) • The authors state that “For this study, we conducted a retrospective review of data for patients diagnosed with dysphagia disorder due to stroke.” -> Do we know when the stroke was diagnosed? Are these recent strokes or happened years prior? : As the reviewer pointed out, we specified stroke period including acute and subacute stroke. In line 96-97 and 100-101) Minor criteria: • Methods lines 113-114, “In stroke patients with severe facial palsy and unable to perfect lip seal, the therapist aided by holding the lips around the mouthpiece minimize air leak." -> I believe the authors meant "around the mouthpiece TO minimize air leak" : As the reviewer suggested, we added ‘to’ to clarify meaning in lines 138. • Please double check your citations. The authors state: “In a previous study, ESMCSA assessed by chest CT was a valuable clinical parameter to correlate symptoms and disease prognosis in patients with chronic obstructive lung disease.[37] “ but the citation for 37 is a basic science paper unrelated to ESM. : As the reviewer pointed out, we reviewed and cited other reference. • In the discussion the authors state: “Most stroke-related pneumonia is dysphagia related AP” - please provide a citation here. : As the reviewer suggested, we cited references additionally. Reviewer #2: 1. This manuscript presents the potential of low thoracic muscle index as an effective predictive factor for the recurrence of aspiration pneumonia in patients with stroke. While the paper is well-written, I have some minor concerns. 2. Person-first language (e.g., patient with stroke not stroke patient; or person with diabetes not a diabetic) is highly recommended in academic writing. https://www.nih.gov/nih-style-guide/person-first-destigmatizing-language : Thank you for reviewer’s valuable comments. As the reviewer suggested, we corrected several phrases to person-first language. 3. Discussion line 249-250 “Our results showed that those at the time of AP diagnosis all patients already” The sentence appears to be incomplete. : As the reviewer pointed out, we reviewed and deleted incomplete sentences. 4. Please check the abbreviation (e.g., confidence interval [CI] and aspiration pneumonia [AP]). To ensure clarity and readability, please use abbreviations consistently once they have been introduced. : As the reviewer suggested, we rechecked the use of abbreviations and used consistently. 5. It would be beneficial to include some other potential confounding factors, such as the severity of stroke or the degree of dysphagia, in multivariate analysis if feasible. : We agreed the reviewer’s opinion. However, other dysphagic parameters and markers for functional disability except PCF were not significantly different between recurrence and non-recurrence groups. So, we included only min PCF for univariate and multivariate analysis. Attachments Attachment Submitted filename: response to reviewers.docx https://doi.org/10.1371/journal.pone.0315427.r002
28 Oct 2024 Decision Letter - Dong Keon Yon, Editor PONE-D-23-29731R1Low thoracic skeletal mass index, A novel marker to predict recurrence of aspiration pneumonia in the elderly stroke patientsPLOS ONE Dear Dr. Kang, 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 Dec 12 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. 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. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Dong Keon Yon, MD, FACAAI, FAAAAI Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: This is an excellent paper. Please see my minor comments. #1. Considering that this study is retrospective, compliance with the Declaration of Helsinki is not required. #2. In line 130, PCF, Maximal expiratory pressures (MEP) -> PCF, maximal expiratory pressures (MEP) #3. Considering that SPSS is now available up to version 29, did you indeed conduct the statistical analysis using version 20? #4. In a chart review study, it is essential to describe any missing variables that may naturally arise. This aspect appears to be missing from the manuscript. #5. In Table 1, please describe SMD value instead of P value. #6. What covariates were selected for adjustment in the multivariate analysis? I find it difficult to locate this information in the manuscript. Please add it to the table footnote. [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 #2: All comments have been addressed ******** 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 ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes ****** 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: No ****** 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 ****** 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: Thank you for the opportunity to evaluate the revised manuscript. The authors did a good job addressing my comments. ****** 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 ******** [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.0315427.r003
Revision 2
23 Nov 2024 Author Response Dear Editor-in-Chief, We would like to thank you and the reviewers of the PLOS ONE for taking the time to review our article. It is truly honorable to receive the letter of revision to enrich the work of research we’ve performed. We’d like to appreciate for the time and efforts by the editors to this paper. We have made some corrections and clarifications in the manuscript after going over the reviewers’ comments. The changes are summarized below: Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. : As the editor requested, we did review our reference list, and there is no changes to the reference list. Additional Editor Comments: This is an excellent paper. Please see my minor comments. #1. Considering that this study is retrospective, compliance with the Declaration of Helsinki is not required. : As the editor requested, we deleted the sentence about the Declaration of Helsinki. #2. In line 130, PCF, Maximal expiratory pressures (MEP) -> PCF, maximal expiratory pressures (MEP) : Thank you for careful review. We corrected Maximal as maximal. #3. Considering that SPSS is now available up to version 29, did you indeed conduct the statistical analysis using version 20? : We checked again, and our institution is still use SPSS version 20. #4. In a chart review study, it is essential to describe any missing variables that may naturally arise. This aspect appears to be missing from the manuscript. : As the editor suggested, we added sentences about the issue of missing variables in limitation (line 347-350) #5. In Table 1, please describe SMD value instead of P value. : We calculated standardized mean differences for continuous variables and added values at table 1. #6. What covariates were selected for adjustment in the multivariate analysis? I find it difficult to locate this information in the manuscript. Please add it to the table footnote. : We added variables selected for adjustment in the multivariate analysis at the table 4 footnote. Attachments Attachment Submitted filename: response to reviewers_20241114.docx https://doi.org/10.1371/journal.pone.0315427.r004
26 Nov 2024 Decision Letter - Dong Keon Yon, Editor Low thoracic skeletal mass index, A novel marker to predict recurrence of aspiration pneumonia in the elderly stroke patients PONE-D-23-29731R2 Dear Dr. Kang, 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, Dong Keon Yon, MD, FACAAI, FAAAAI Academic Editor PLOS ONE Additional Editor Comments (optional): This is an excellent paper. Reviewers' comments: https://doi.org/10.1371/journal.pone.0315427.r005
Formally Accepted
1 Dec 2024 Acceptance Letter - Dong Keon Yon, Editor PONE-D-23-29731R2 PLOS ONE Dear Dr. Kang, 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. Dong Keon Yon Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0315427.r006

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