PONE-D-25-27273Analysis and comparison of the trends in burden of motor neuron disease in China and worldwide from 1990 to 2021PLOS ONE

Dear Dr. Sun,

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Masoud Rahmati

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

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

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

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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: To the Authors of the Manuscript PONE-D-25-27273

Title: Analysis and comparison of the trends in burden of motor neuron disease in China and worldwide from 1990 to 2021

Dear Authors,

I hope this letter finds you well. I have had the opportunity to review your manuscript titled "Analysis and comparison of the trends in burden of motor neuron disease in China and worldwide from 1990 to 2021." I commend you for your efforts in addressing such an important public health issue and for your thorough analysis of the data from the Global Burden of Disease (GBD) database.

General Observations

Your study presents significant findings regarding the trends in motor neuron disease (MND) burden, which are both timely and relevant. The methodology employed, particularly the use of Joinpoint regression analysis, is appropriate for the objectives of your research. The clarity of your objectives and the comprehensive nature of your data analysis are commendable.

Suggested Improvements

While the manuscript is strong in several areas, I would like to offer some suggestions that may enhance its overall quality:

Discussion of Mechanisms: Consider expanding your discussion on the potential biological, environmental, or healthcare-related factors that may influence the observed trends in MND burden. This could provide deeper insights into the implications of your findings.

Contextualization: A more detailed comparison with specific countries or regions, especially those with higher MND burdens, would enrich the context of your findings and enhance their applicability.

Literature Review: Expanding your literature review to include more recent studies related to MND could better situate your work within the existing body of knowledge and highlight its relevance.

Integration of Figures and Tables: Improving the integration of figures and tables into the narrative can facilitate reader understanding. Providing more detailed descriptions of each figure/table in the main text would be beneficial.

Ethics Statement: Clarifying how data privacy and ethical standards were maintained, given the sensitive nature of health data, would strengthen your ethics statement.

Conclusions and Recommendations: Strengthening your conclusions with specific recommendations for future research or public health interventions based on your findings could provide practical applications for your study.

Language and Clarity: A thorough proofreading of the manuscript is recommended to address any awkward phrasing or grammatical errors, thereby enhancing the clarity and readability of your work.

Conclusion

Overall, your manuscript makes a valuable contribution to the understanding of motor neuron disease trends in China and globally. Addressing the identified areas for improvement will significantly enhance the quality and impact of your research. I look forward to seeing the revised version of your manuscript.

Thank you for your hard work and dedication to this important field of study.

Best regards,

Reviewer #2: 1. Numerous grammatical errors, awkward phrasing, and poor flow. The manuscript needs major language editing for clarity and professionalism.

2. Some results are inconsistently described (e.g., prevalence trends in China are reported as both increasing and decreasing at different points).

3. The discussion mainly repeats results instead of providing deeper insights or justification of the results from secondary data source (e.g., why Chinese mortality trends differ from global ones).

4. Heavy reliance on GBD estimates, but the limitations of such secondary data (underdiagnosis, reporting bias, quality of Chinese epidemiological records) are acknowledged only briefly!!.

5. Figures are acceptable but overloaded with information; some redundancy exists between text and visuals.

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Reviewer #1: No

Reviewer #2: No

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PONE-D-25-27273R1Analysis and comparison of the trends in the burden of motor neuron disease in China and worldwide from 1990 to 2021PLOS One

Dear Dr. Sun,

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 Jan 22 2026 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,

Masoud Rahmati

Academic Editor

PLOS One

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (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 #1: Partly

**********

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

Reviewer #1: 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 #1: 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

**********

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: Reviewer Comments to Authors

Thank you for your efforts in revising the manuscript and for addressing the previous reviewer comments. While several positive changes are noted, a number of critical issues remain unresolved. Please consider the following points for further revision:

Discussion Quality

Although expanded, the Discussion section continues to be largely descriptive and lacks sufficient analytical depth. Stronger interpretation of the trends, integration of recent findings, and clearer links to the presented data are needed.

Limitations

The Limitations section has been expanded, but the content remains too general. Please provide a more detailed, data‑specific discussion of how underdiagnosis, reporting bias, and GBD modeling choices may affect ASIR, ASPR, ASDR, and mortality trends.

Literature Update

Only a minimal amount of new literature has been incorporated. Recent region‑specific and China‑specific studies should be critically reviewed and integrated into both the Introduction and Discussion.

Methods Clarity

The Methods section still lacks essential detail. Please clarify GBD data sources, modeling framework, uncertainty intervals, age‑group structures, and Joinpoint analytical specifications.

Figures and Narrative Integration

The manuscript continues to provide limited interpretation of figures. The text should explicitly reference figures and highlight the implications of visual data rather than repeating numerical patterns.

Conclusions and Recommendations

The conclusion remains general. Please provide clearer and more actionable research and policy recommendations tied directly to your findings.

Language and Style

Despite claims of professional editing, numerous issues with clarity, structure, and phrasing persist. A more rigorous language revision is required to ensure precision and readability.

Overall, the manuscript shows progress, but substantial revisions are still required to meet the journal’s scientific and editorial standards.

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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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Reviewer #1: No

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Analysis and comparison of the trends in the burden of motor neuron disease in China and worldwide from 1990 to 2021

PONE-D-25-27273R2

Dear Dr. Sun,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Masoud Rahmati

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: 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

**********

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

Reviewer #1: 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 #1: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

**********

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 Authors,

Thank you for submitting your revised manuscript and for your detailed, point-by-point responses to my review comments.

I have carefully examined your revisions and the accompanying explanations. I am pleased to inform you that you have successfully addressed all the concerns and suggestions I raised in the initial review. The modifications you have implemented are comprehensive and have substantially improved the manuscript.

Specifically, the restructuring of the Discussion section now provides the necessary analytical depth, the expanded Limitations are appropriately data-specific, and the integration of recent literature strengthens the context of your work. The clarifications in the Methods, the improved narrative integration of figures, and the more actionable Conclusion all contribute to a much stronger and more polished manuscript.

The care and effort you have put into this revision are evident. Your work now presents a clear, robust, and compelling analysis suitable for publication.

I congratulate you on your excellent work and have recommended to the Editor that the manuscript be accepted for publication.

I wish you the best with your future research.

Sincerely,

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

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