Sarcopenia and Pleural Effusions: Exploring a Potential Link

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This is a well example of a narrative review with a well implemented methodological frame. And it could very well be accepted in present form. However I would ask for authors to change the term used to describe the study type from "non-systematic review" to "narrative review", also, I would ask for authors to add some information from the conclusions obtained in the abstract as I believe it would be a very interesting addition to the article.

Author Response

Dear Reviewer, thank you for your comments. Please see the attachment for the point-by-point response.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Please add in the methods section the process for screen and including or excluding each study. I acknowledge it is located in the figure, but a more detailed description is necessary. Did a person do this? Did you use software to eliminate bias or human error.

 

It would be beneficial in the introduction to discuss not only the pathophysiology but just the physiology and mechanism of PE. You note it is an imbalance of fluid production vs reabsorption but there is not discussion on how this imbalance comes about. Is it predominantly in one type of population? Many of the included studies are in patients with liver complications. Does PE present in those with healthy/ normal functioning livers? 

The discussion section does a nice job of summarizing each of the papers included in the review, though it seems more of a regurgitation of each study. It would be more beneficial to use each study as a way to convey a possible mechanism of sarcopenia causes PE. Currently this manuscript serves as a central hub for readers to read a summarized version of each paper instead of reading each paper. To increase the impact of this paper, please dive deeper into each study and make connections and propose studies that can be done to fill the gap and answer questions. 

Author Response

Dear Reviewer, thank you for your comments. Please see the attachment for the point-by-point response.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The review explores potential relationships between sarcopenia and pleural effusions. The idea of a linkage between these two conditions is rather interesting and novel to this reviewer. Given the significant burden of chronic disease, frailty, and metabolic disease it is important to understand how loss of muscle mass as a result of aging impacts infirmity and loss of independence in daily living. 

The review is generally well written and referenced. The major issue is not one of the quality of the content but rather a need for better organization. The text needs subheadings that clearly organize the content of the review in an easily understandable format that gives the reader an easy overview. Large blocks of text without subheadings cause a fatigue in the reader. Moreover, it is difficult to follow the narrative without the guiding signposts that clear organization in the form of subheadings can provide. 

Also, a figure or graphical abstract could aid the reader in appreciating the contribution of the article to our understanding of sarcopenia as a potential causal factor in chronic diseases that burden our societies and health care systems. 

The conclusion statement is excellent in its clarity. The rest of the article should be organized in a way similar to this section. The impact will be enhanced by revising the paper according to the comments above. I encourage the authors to revise the article since it has good potential interest to the readership of the journal.

Author Response

Dear Reviewer, thank you for your comments. Please see the attachment for the point-by-point response.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

No Further comments

Reviewer 3 Report

Comments and Suggestions for Authors

The authors have addressed the major concerns well. Their revisions are appreciated.