Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP): A Systematic Review of the Literature in the Last 20 Years

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

            The MS by Dr. Bucuri and colleagues, titled ‘Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP): a systematic review of the literature in the last 20 years’ tackled an interesting and little elaborated topic in gynecologic oncology. This was why I took to reading it with attention and curiosity for possible new findngs. Unfortunately, the MS is lengthy, frequently repetitive, and ambiguous in reporting information. Both the Abstract and Conclusions are vague. The number of stylistic and formal imperfections in the text indicates that the 10 authors did not read the final version of their oeuvre. Consequently, I can only recommend a reconsideration of this paper after a thorough revision and linguistic corrections by a native English speaker. 

Major:

- lines 371-372, is: ‘STUMP tumors sizes range from 0.7cm to 18cm depending on the level of advancement of the cancer, … ‘; NO – STUMPs are not cancers ! ! THIS IS A MAJOR ERROR.  

Minor:

- pls do not capitalize the title, or at least do not capitalize ‘Muscle’ because the first M is not included into the abbreviation STUMP; 

- why not arrange Keywords alphabetically?

- Line 28, is: ‘myomectomy’; since a mass, or STUMP, is being removed, it would be safer to call it ‘tumorectomy’ in this context;  

- line 39: In the main text, the abbreviation STUMP should be explained with its first use;

- line 40: replace ‘averagely’ with ‘on average’;

- line 47, is: ‘exhibit other tumor-related mortality’ sounds odd;

- lines 93-94: remove the repetitive final words: ‘ … in the articles.’;

- line 106, is: ‘ [5,2]; why not cite orderly? ;

- lines 119-120, is: ‘L are have a benign clinical course but LMS show aggressive malignancy, often fatal.; apart from erroneous synthax, the LMS has not been explained;

- the Results and Discussion are combined into one chapter, a rather rare event;

- References 14, 15 and 24 miss page numbers; 

- Reference 28 unnecessarily provides forenames of the authors;

- some journal names are given in full and some are abbreviated; please unify; journal names should be capitalized.

etc., etc.

Comments on the Quality of English Language

This MS requires a thorough stylistic revision together with linguistic corrections by a native English speaker. 

Author Response

The MS by Dr. Bucuri and colleagues, titled ‘Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP): a systematic review of the literature in the last 20 years’ tackled an interesting and little elaborated topic in gynecologic oncology. This was why I took to reading it with attention and curiosity for possible new findngs.

Response: Thank you for your thoughtful review and kind words. I appreciate your attention to this important and underexplored topic in gynecologic oncology. Your feedback is invaluable as we work to refine and enhance the manuscript.

 

 

Major:

1. - lines 371-372, is: ‘STUMP tumors sizes range from 0.7cm to 18cm depending on the level of advancement of the cancer, … ‘; NO – STUMPs are not cancers ! ! THIS IS A MAJOR ERROR.  

Response: Thank you for pointing that out. I have corrected the error in lines 371-372 to reflect that STUMPs are not classified as cancers.

 

Minor:

1. - pls do not capitalize the title, or at least do not capitalize ‘Muscle’ because the first M is not included into the abbreviation STUMP; 

Response: Thank you for your input. I have adjusted the title to correctly reflect the abbreviation.

2.     why not arrange Keywords alphabetically?

              Response: I have made the changes and arranged the keywords alphabetically- line 36

3. Line 28, is: ‘myomectomy’; since a mass, or STUMP, is being removed, it would be safer to call it ‘tumorectomy’ in this context;  

Response: I have updated the term "myomectomy" to "tumorectomy" in line 28 to better reflect the removal of a mass or STUMP

4. line 39: In the main text, the abbreviation STUMP should be explained with its first use;

Response: I have added the full explanation of the abbreviation "STUMP" at its first use in line 39.

5. line 40: replace ‘averagely’ with ‘on average’; - I eliminated the word
6. line 47, is: ‘exhibit other tumor-related mortality’ sounds odd;

Response: I have updated the text to use "increase the tumor-related mortality" as suggested- line 47

7. lines 93-94: remove the repetitive final words: ‘ … in the articles.’; - I removed the final words
8.   line 106, is: ‘ [5,2]; why not cite orderly? ;

Response: I have revised the citations to ensure they are orderly and follow the appropriate format

9.   lines 119-120, is: ‘L are have a benign clinical course but LMS show aggressive malignancy, often fatal.; apart from erroneous synthax, the LMS has not been explained;

Response: I have revised the sentence to correct the syntax and included an explanation for LMS- lines 45-47, line 52

10. the Results and Discussion are combined into one chapter, a rather rare event;

Response: I have distinct sections included in the main one, which provides greater clarity

11.   References 14, 15 and 24 miss page numbers; 

Response: I apologize for the oversight regarding the missing page numbers in references 14, 15, and 24. Thank you for pointing this out.

12. Reference 28 unnecessarily provides forenames of the authors;

Response: I have adjusted reference 28 to include only the initials of the authors, as recommended. Thank you for highlighting this.

13. some journal names are given in full and some are abbreviated; please unify; journal names should be capitalized.

Response: I have revised the references to ensure that all journal names are either given in full or abbreviated consistently and are capitalized as required. Thank you for pointing this out.

 

 

Comments on the Quality of English Language

This MS requires a thorough stylistic revision together with linguistic corrections by a native English speaker. 

Response: I have ensured that the manuscript has undergone thorough stylistic revision and linguistic corrections by a native English speaker. Thank you for highlighting this important aspect.

Thank you very much for your thorough review and valuable comments. I appreciate your suggestions and have made the necessary adjustments to improve the manuscript. Your feedback has been instrumental in refining our work.

Reviewer 2 Report

Comments and Suggestions for Authors

The clinical problem of STUMP diagnosis and treatment is challenging. The only evidence that we can rely on are based on series of cases. Such reviews, thus, are needed and beneficial to our understanding of STUMPs.

However, such reviews should be clear and logical. The authors failed to present the data on STUMP clearly. The information given by the authors is repeated in different sections of the text, as if it was written by several authors and not checked ny the main authors in the end. For example:

Section “diagnosis and presentation” includes data on p16 and p53, and it is repeated once again in the next section.

Please read the whole text and make sure that you do not repeat the data, as it chaotic and hard to follow.

The treatment section does not provide precise data. The part of the text about recurrence in the humerus is irrelevant to the primary surgical treatment. Maybe it should be mentioned in the Recurrence section. What about myomectomy  in fertility sparing ? What about salpingo-oophorectomy in pre – and postmenopausal treatment ?

Is there room for hormonal therapy as STUMPs usually show progesterone receptor  positivity ?

The diagnosis section should be rewritten in order to show clearly what are the criteria for diagnosing STUMPs. Authors wrote about the classification introduced in the manuscript by Ip et al. What about classical Stanford criteria by Bell et al (1994) or criteria introduced in the Dall’Asta paper. Please write about IHC staining: progesterone Receptor, SMA Caldesmon, desmin, CK AE 1/3, CD 10.

There should be a whole section about medical imaging tools – ultrasound, RM, CT. Is any of these useful? According to data from several publications, there are no distinctive features of STUMP on imaging and STUMP diagnosis is usually made after myoma surgery. But it should be clearly stated in the manuscript.

A table with clinical data from 32 papers included in the analysis would be useful .

Minor:

Saying that STUMP are diagnosed in 53 years of age sounds odd, maybe write a range of age ?

Line 40 – the sentence is not clear, please rewrite, besides the symptoms are not complex at all – the mimic myomas

“They are complex in their presentation and symptoms, which makes them difficult to diagnose with certainty because they cannot be definitively classified as benign or malignant based on morphology alone.”

Line 119 “L are have” please rewrite  

Line 125 “gives more detailed” language correction required

Line 141 “p16 is a protein for suppresses” language correction

Line 210 - in which one of the measured tumors was 8cm in diameter  

What is the reason of mentioning just the size of one tumor ?

Line 223 “For Dall’Asta et al. (2014), tumors are about 10cm and 12cm in diameter ad evidenced 223 from the case studies of the featured patients [6].” Language correction required

Line 234 “Nonetheless, the growth patters of the STUMP tumors is generally unusually in patterns for each patient and cannot be predicted precisely”

Language correction required , and the sentence is not clear

 

Line 244 For the case presented, the woman underwent subtotal hysterectomy initially to address her symptoms of increasing menorrhagia and anemia related to the uterine STUMP [26]. This represented the standard surgical management at the time for her predominantly intrauterine located STUMP measuring around 3.5-4cm [27]. The surgery was described as uneventful, with no worrisome features seen on gross or initial microscopic examination of the specimen.

Which case ?? these sentences are not clear

This section is not clear and chaotic :

“The bivariate analysis of the total cases reviewed in the featured articles revealed the following findings. For cases with High mitotic count (>10/10HPF) vs Low/Normal mitotic count, High count: 3 cases, 1 recurrence (33.3%) and Low/Normal count: 96 cases, 7 recurrences (7.3%). The Fisher's Exact Test p-value=0.116 (not significant). For cases of Severe cytologic atypia vs Mild/Moderate atypia, Severe cases were 12 and had 1 recurrence (8.3%) and mild cases were 87 and had 7 recurrences (8%) a p-value of 1.000 which was statistically insignificant. For the consideration of the presence of coagulative necrosis versus its absence, 8 cases had a coagulative necrosis and there was 1 recurrence (12.5%) while 91 cases without coagulative necrosis had 7 recurrences, translating to 7.7%. the Fisher's Exact Test p-value was 0.691 which is not statistically significant because the considered statistical significance is a p-value of less than 0.05.”

 

I do not feel comfortable judging the language's correctness, but please make sure that it is precise and clear and that there are no mistakes.

Do not use term cancer for stump.

Author Response

1. Section “diagnosis and presentation” includes data on p16 and p53, and it is repeated once again in the next section.

Response: I have included the information regarding p16 and p53 in another section of the document, specifically from lines 182 to 201.

2. Please read the whole text and make sure that you do not repeat the data, as it chaotic and hard to follow.

Response: Thank you for your observation. I have reviewed the entire text to ensure that there are no other repetitions, making the document more coherent and easier to follow. Your feedback has been instrumental in refining the clarity and organization of the article.

3. The treatment section does not provide precise data. The part of the text about recurrence in the humerus is irrelevant to the primary surgical treatment. Maybe it should be mentioned in the Recurrence section. What about myomectomy in fertility sparing? What about salpingo-oophorectomy in pre – and postmenopausal treatment?

Response: Thank you for your observations. I have moved the information about recurrence in the humerus to the Recurrence section, as it is more relevant there. Additionally, I have provided precise data in the Treatment section, including details on myomectomy in fertility-sparing procedures (lines 276-284) and about salpingo-oophorectomy in pre- and postmenopausal treatment (lines 281-284). This reorganization aims to enhance the clarity and relevance of the treatment details provided.

4. Is there room for hormonal therapy as STUMPs usually show progesterone receptor positivity?

Response: Thank you for your observation. The lines between 303-306 discuss the potential role of hormonal therapy for STUMPs, given their usual progesterone receptor positivity. This addition provides important context for considering hormonal therapy as a possible treatment option in managing STUMP cases.

5. The diagnosis section should be rewritten in order to show clearly what are the criteria for diagnosing STUMPs. Authors wrote about the classification introduced in the manuscript by Ip et al. What about classical Stanford criteria by Bell et al (1994) or criteria introduced in the Dall’Asta paper. Please write about IHC staining: progesterone Receptor, SMA Caldesmon, desmin, CK AE 1/3, CD 10.

Response: Thank you for your feedback. I have added the information about the criteria for diagnosing STUMPs, including the classical Stanford criteria by Bell et al. (1994) and the criteria introduced by Dall’Asta et al. (2014). I have also included details on immunohistochemical staining for progesterone receptor, SMA, Caldesmon, desmin, CK AE 1/3, and CD 10.-line 102-127

6. There should be a whole section about medical imaging tools – ultrasound, RM, CT. Is any of these useful? According to data from several publications, there are no distinctive features of STUMP on imaging and STUMP diagnosis is usually made after myoma surgery. But it should be clearly stated in the manuscript.

Response: Thank you for your suggestion. I have added a section on medical imaging tools, including ultrasound, MRI, and CT scans. This section clearly states that these imaging modalities do not typically provide distinctive features for diagnosing STUMPs, and that the diagnosis is usually confirmed postoperatively following myoma surgery- line 102-127

7. A table with clinical data from 32 papers included in the analysis would be useful

Response : I have created a comprehensive table that summarizes the number of patients, age of the patients, recurrence status, MRI suggesting the STUMP diagnosis, histology, type of treatment, adjuvant therapy, and follow-up details from the provided references. Your feedback has been invaluable in enhancing the thoroughness and clarity of the data presented.

Minor:

1. Saying that STUMP are diagnosed in 53 years of age sounds odd, maybe write a range of age?

Response: Thank you for pointing that out. I have revised the text to provide an age range for STUMP diagnosis, rather than specifying a single age-line 41

2. Line 40 – the sentence is not clear, please rewrite, besides the symptoms are not complex at all – the mimic myomas

Response: in lines 41-43 there is a revised version of the sentence for clarity

3. Line 119 “L are have” please rewrite - revised version - line 144
4. Line 125 “gives more detailed” language correction required- revised version – lines 150-151
5. Line 141 “p16 is a protein for suppresses” language correction- revised version – line 153
6. Line 210 - in which one of the measured tumors was 8cm in diameter -revised version- lines 236-238
7. What is the reason of mentioning just the size of one tumor? – revised version- line 236-237
8. Line 223 “For Dall’Asta et al. (2014), tumors are about 10cm and 12cm in diameter ad evidenced 223 from the case studies of the featured patients [6].” Language correction required – revised version- lines 237-239
9. Line 234 “Nonetheless, the growth patterns of the STUMP tumors is generally unusually in patterns for each patient and cannot be predicted precisely”- revised version lines 261-263
10. Line 244 For the case presented, the woman underwent subtotal hysterectomy initially to address her symptoms of increasing menorrhagia and anemia related to the uterine STUMP [26]. This represented the standard surgical management at the time for her predominantly intrauterine located STUMP measuring around 3.5-4cm [27]. The surgery was described as uneventful, with no worrisome features seen on gross or initial microscopic examination of the specimen.Which case ?? these sentences are not clear- I eliminated that information considered unnecessary.
11. This section is not clear and chaotic:

“The bivariate analysis of the total cases reviewed in the featured articles revealed the following findings. For cases with High mitotic count (>10/10HPF) vs Low/Normal mitotic count, High count: 3 cases, 1 recurrence (33.3%) and Low/Normal count: 96 cases, 7 recurrences (7.3%). The Fisher's Exact Test p-value=0.116 (not significant). For cases of Severe cytologic atypia vs Mild/Moderate atypia, Severe cases were 12 and had 1 recurrence (8.3%) and mild cases were 87 and had 7 recurrences (8%) a p-value of 1.000 which was statistically insignificant. For the consideration of the presence of coagulative necrosis versus its absence, 8 cases had a coagulative necrosis and there was 1 recurrence (12.5%) while 91 cases without coagulative necrosis had 7 recurrences, translating to 7.7%. the Fisher's Exact Test p-value was 0.691 which is not statistically significant because the considered statistical significance is a p-value of less than 0.05.”

Response: revised version lines 327-348

12. I do not feel comfortable judging the language's correctness, but please make sure that it is precise and clear and that there are no mistakes.

Response: Thank you for your feedback. I have thoroughly reviewed the manuscript to ensure that the language is precise, clear, and free of mistakes.

13. Do not use term cancer for stump.

Response: Thank you for pointing that out. I have revised the manuscript to ensure that the term "cancer" is not used in reference to STUMP. The terminology has been adjusted to accurately describe STUMP as a "tumor of uncertain malignant potential" throughout the text.

Thank you for all your valuable suggestions. Your insights have greatly contributed to improving the clarity and accuracy of the manuscript.

Reviewer 3 Report

Comments and Suggestions for Authors

Article Review: "Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP): a systematic review of the literature in the last 20 years "

Summary: This is a systematic review on the clinical presentation, histologic diagnosis, management and clinical course of STUMP tumors.

 

Comments/Revisions:

1.                   This is an interesting summary of the existing literature on a rare tumor and is worthy of publication.

2.                   The diagnosis of a STUMP tumor is typically postoperative after a hysterectomy or myomectomy for presumed fibroids.  The authors need to emphasize this in the ‘Diagnosis and Presentation’ section.

3.                   In the ‘Treatment’ section the authors need to discuss possible salpingoophorectomy for patients that had their ovaries retained at the time of initial surgery. Is there any evidence in favor or against it?

4.                   The authors need to discuss the topic of surveillance more specifically. Are there any recommendations with regard to frequency of office visits and modalities that should be used (clinical or radiologic)?

5.                   There are many grammar and vocabulary errors and professional editing is recommended prior to publication

 

 

Recommendation: Minor revision

Comments on the Quality of English Language

Article Review: "Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP): a systematic review of the literature in the last 20 years "

Summary: This is a systematic review on the clinical presentation, histologic diagnosis, management and clinical course of STUMP tumors.

 

Comments/Revisions:

1.                   This is an interesting summary of the existing literature on a rare tumor and is worthy of publication.

2.                   The diagnosis of a STUMP tumor is typically postoperative after a hysterectomy or myomectomy for presumed fibroids.  The authors need to emphasize this in the ‘Diagnosis and Presentation’ section.

3.                   In the ‘Treatment’ section the authors need to discuss possible salpingoophorectomy for patients that had their ovaries retained at the time of initial surgery. Is there any evidence in favor or against it?

4.                   The authors need to discuss the topic of surveillance more specifically. Are there any recommendations with regard to the frequency of office visits and modalities that should be used (clinical or radiologic)?

5.                   There are many grammar and vocabulary errors and professional editing is recommended prior to publication

 

 

Recommendation: Minor revision

Author Response

1. This is an interesting summary of the existing literature on a rare tumor and is worthy of publication.

Response: Thank you very much for your positive feedback. I’m pleased to hear that you find the summary of the existing literature on this rare tumor valuable and worthy of publication. Your support and encouragement are greatly appreciated.

2. The diagnosis of a STUMP tumor is typically postoperative after a hysterectomy or myomectomy for presumed fibroids.  The authors need to emphasize this in the ‘Diagnosis and Presentation’ section.

Response: Thank you for your feedback. I have incorporated the emphasis on the fact that STUMP tumors are typically diagnosed postoperatively after a hysterectomy or tumorectomy for presumed fibroids. This information is now highlighted in lines 102-107 of the manuscript.

3. In the ‘Treatment’ section the authors need to discuss possible salpingoophorectomy for patients that had their ovaries retained at the time of initial surgery. Is there any evidence in favor or against it?

Response: Thank you for your suggestion. I have added the discussion about the potential need for salpingo-oophorectomy for patients who had their ovaries retained during the initial surgery. This information can be found in lines 281-283 of the manuscript.

4. The authors need to discuss the topic of surveillance more specifically. Are there any recommendations with regard to frequency of office visits and modalities that should be used (clinical or radiologic)?

Response: Thank you for your feedback. I have incorporated the discussion on surveillance in lines 400-405. The revised section now notes that no standardized surveillance protocol exists, but regular follow-ups combining clinical and imaging assessments are advised. We emphasize the importance of individualized surveillance plans based on patient-specific risk factors and clinical findings, highlighting the significance of early detection through regular monitoring

5. There are many grammar and vocabulary errors and professional editing is recommended prior to publication

Response: Thank you for highlighting this. I have ensured that the manuscript has been thoroughly edited for grammar and vocabulary.

Thank you for all your valuable suggestions. Your feedback has been instrumental in improving the manuscript.

Reviewer 4 Report

Comments and Suggestions for Authors

1.      What is the definition of “rapid growth” of uterine mass?

2.      Could Pre-operative image study (including ultrasonography, CT scan, or MRI) make any contribution for the differentiation of uterine myoma, STUMP and leiomyosarcoma?

3.      About the treatment option, myomectomy and hysterectomy may need to be separate for discussion.

4.      In case of myomectomy for STUMP, If the resection margin is not clear, should immediate hysterectomy be followed for prevention of recurrence?

5.      Is there any reasonable prophylactic method for prevention of recurrence or metastasis of STUMP in the high risk group?

6.      What is the appropriate treatment method for the recurrence or metastasis of STUMP?

Author Response

1. What is the definition of “rapid growth” of uterine mass?

Response: in lines 173-174 I added that the rapid growth was considered an increase of more than 2 cm in diameter within a 6-month period.

2. Could Pre-operative image study (including ultrasonography, CT scan, or MRI) make any contribution for the differentiation of uterine myoma, STUMP and leiomyosarcoma?

Response: Thank you for your suggestion. I have added a section on medical imaging tools, including ultrasound, MRI, and CT scans. This section clearly states that these imaging modalities do not typically provide distinctive features for diagnosing STUMPs, and that the diagnosis is usually confirmed postoperatively following myoma surgery- line 102-127

3. About the treatment option, myomectomy and hysterectomy may need to be separate for discussion.

Response: I have included a note in lines 282-283 emphasizing the variability in clinical outcomes and the importance of individualized treatment plans.

4. In case of myomectomy for STUMP, If the resection margin is not clear, should immediate hysterectomy be followed for prevention of recurrence?

Response: In lines 277-282 : while hysterectomy is often the preferred surgical treatment for STUMPs due to their uncertain malignant potential, myomectomy may be considered for selected young patients who wish to preserve fertility. For early-stage STUMP lesions in women who have not completed childbearing, complete surgical excision via myomectomy could be sufficient therapy given the generally favorable prognosis, even for higher-risk STUMP subtypes.

5. Is there any reasonable prophylactic method for prevention of recurrence or metastasis of STUMP in the high risk group?

Response: There is no standardized prophylactic method specifically for the prevention of recurrence or metastasis of STUMP tumors, primarily due to the limited evidence and variability in clinical outcomes -lines 305-307

6. What is the appropriate treatment method for the recurrence or metastasis of STUMP?

Response: Thank you for your suggestion. We have updated the conclusions to address the treatment of recurrence or metastasis of STUMP:The treatment of recurrence or metastasis of STUMP (Smooth Muscle Tumor of Uncertain Malignant Potential) can be challenging and must be individualized based on the specifics of each case. Each case of STUMP recurrence or metastasis should be discussed with a multidisciplinary team to determine the best course of action tailored to the patient's specific condition and overall health.

Thank you very much for your positive feedback on our manuscript. We greatly appreciate your thoughtful and constructive comments, which have significantly contributed to improving the quality and clarity of our work.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

            Ref.: Revision of the MS wih ID: curroncol-3107998  

            With my first review of this work, I tried to be polite and gentle as a rule, and thus stated that the MS in lengthy, repetitive in many places and requires linguistic correction by a native English speaker. The principal Author sent a list of her answers to my querries, yet if I did not point out a particular omission or imperfection, this was left undone. The reason for that is that the MS was not reviewed by a native speaker who would obviously respond to its needs for improvement. Please judge for yourself based on just a few examples of what I meant:

- Line 24, is: ‘ masses ‘; should be singular;

- Line 41: should read  … (STUMPs) … ;

- Line 46: choose ‘solely’ OR ‘only’ only;  

- Line 67: insert the missing article ‘the’ before ‘literature’; 

- Line 115: the ‘minimal’ should be changed to an adverb;  

- Lines 117-118 read: ‘Also we cannot deny the important role of medical imaging tools, including ultrasound, MRI, and CT scans, that plays an important, but limited role … ‘ - apart from the erroneous use of ‘deny’, apart from the word ‘role’ used twice (tautology), the verb ‘plays’ should be in singular; 

- Line 161 reads: ‘In the 16 cases featured in the Ip et al (2009) ‘s article, 6 cases were … ‘ - a novelty: a Saxon Genetive applied to 2009 ?

- Figure 1 misses many arrows of exclusion and does not sufficiently specify reasons for exclusion;

- Table 1 is poorly constructed:

            * the studies cited are not given alphabetically, nor chronologically - so what is a chosen ‘order’ of them?  

            * I counted the number of patients given in the column ‘Number of Patients’, it is 581 ! whereas Line 96 states that ‘In the 32 reviewed articles, a total of 163 cases were mentioned cumulatively’ …  ? ? ?

            * Why include the column ‘MRI Suggesting STUMP Diagnosis (Yes/No)’ if the only description given throughout the column is ‘No’?  

            * Why include the column ‘Adjuvant Therapy’ if the only description given throughout the column is ‘None’?

- ‘The classical Stanford criteria by Bell et al. (1994)‘ are mentioned a number of times in the text, yet are not included in the Reference list.

Comments on the Quality of English Language

As above.

Author Response

please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

All my suggestions were answered adequately. 

Author Response

Thank you for your prompt and thorough review of our manuscript. We appreciate your feedback and are pleased to hear that our responses to your suggestions were satisfactory. 

Thank you for your continued support and consideration.

Best regards,