Disappearance of Plaque Following Treatment with Antioxidants in Peyronie’s Disease Patients—A Report of 3 Cases
Round 1
Reviewer 1 Report
It is unnecessary for the title to contain the part "with 3 photographic evidence". There is also an unnecessary period at the end of the title.
I suggest the following title: "Disappearance of plaque following treatment with antioxidants in Peyronie’s disease patients - report of 3 cases"
I ask that you do not frame the summary as ... case 1, case 2, case 3, but to more fluidly touch on all three cases.
Please, according to the guidelines of the MDPI journals, the abstract should be written within 200 words.
Why didn't you add "Peyronie's disease" to your keywords?
Please remove section 2 "Treatment method" in its entirety, as it must be an integral part of the section "Case presentations".
Please use the term "figure" instead of "photo".
I ask that figures and tables appear in the manuscript in the order in which they appear in the text.
For easier tracking and consistent handwriting, I suggest that you put all ultrasound images in "suppl. materials".
I suggest you put Table 1 at the end of the "Case presentations" section.
I suggest you combine photos 1 and 2 into one photo and mark them with letters that will indicate the findings before and after the treatment. The same applies to photos 3 and 4.
Remove subsection 3.4
In the discussion, you must state exactly how you decided on the combination of drugs (antioxidants) that you included in the treatment and how you decided on the specified doses.
Are there any possible interactions between the mentioned drugs?
Also, it would be useful to touch a little on the pharmacokinetics and pharmacodynamics of the mentioned drugs and describe the mechanisms by which they act on plaque.
Although the mentioned treatment is not part of the guidelines, I suggest that in the "suppl. materials" in a new table, you list all cases and references to manuscripts that treated patients in this way.
I ask that all treatment modalities for this disease, as well as treatment methods in accordance with existing guidelines, be discussed in the discussion.
It would be good to include part of the conclusion at the end of the discussion as "limitations of the study".
Author Response
Reply to the Reviewer # 1
IMPORTANT: Manuscript with corrections also of English by the MDPI linguistic service
- It is unnecessary for the title to contain the part "with 3 photographic evidence". There is also an unnecessary period at the end of the title.
I suggest the following title: "Disappearance of plaque following treatment with antioxidants in Peyronie’s disease patients - report of 3 cases"
ANSWER
Thank you for your suggestion. I corrected the title.
- I ask that you do not frame the summary as ... case 1, case 2, case 3, but to more fluidly touch on all three cases.
ANSWER
Thank you for your suggestion. I corrected the summary.
- Please, according to the guidelines of the MDPI journals, the abstract should be written within 200 words.
ANSWER
Thank you for your suggestion. I have reduced the length of the abstract text.
- Why didn't you add "Peyronie's disease" to your keywords?
ANSWER
I have indicated in the keywords “Penile Induration” as a “MESH keyword” which refers to Peyronie's disease . Anyway, according to your suggestion I replaced it with Peyronie's disease.
- Please remove section 2 "Treatment method" in its entirety, as it must be an integral part of the section "Case presentations".
ANSWER
Thanks for the suggestion. I have included the entire section (treatment method) in the "Case presentations" as the first subsection.
- Please use the term "figure" instead of "photo".
I ask that figures and tables appear in the manuscript in the order in which they appear in the text.
ANSWER
Thank you for your suggestion. I changed "Photo" to "Figures" and placed the figures within the "Case Presentations" section in the order of citation.
- For easier tracking and consistent handwriting, I suggest that you put all ultrasound images in "suppl. materials".
ANSWER
Ok I do.
- I suggest you put Table 1 at the end of the "Case presentations" section.
ANSWER
Thank you for your suggestion. I have included the Table at the end of the Case Presentations section.
- I suggest you combine photos 1 and 2 into one photo and mark them with letters that will indicate the findings before and after the treatment. The same applies to photos 3 and 4.
ANSWER
Thank you for your suggestion. Ok, I combined the photos of each case into a single figure (before and after the treatment).
- Remove subsection 3.4
ANSWER
I have removed the subsection 3.4 dedicated to the Figures.
- In the discussion, you must state exactly how you decided on the combination of drugs (antioxidants) that you included in the treatment and how you decided on the specified doses.
ANSWER
Thanks for the interesting tip.
I have included these explanations in the Discussion section.
- Are there any possible interactions between the mentioned drugs?
ANSWER
The interactions between the various substances are only positive, as we have obtained a synergy of the different components of the combined therapy, evidenced by the excellent therapeutic results.
- Also, it would be useful to touch a little on the pharmacokinetics and pharmacodynamics of the mentioned drugs and describe the mechanisms by which they act on plaque.
ANSWER
Thanks for the interesting tip.
I have included these explanations in the Discussion section.
- Although the mentioned treatment is not part of the guidelines, I suggest that in the "suppl. materials" in a new table, you list all cases and references to manuscripts that treated patients in this way.
ANSWER
There are no other Authors who have treated PD patients with our same therapy. Our studies exist in the literature in which the same multimodal treatment was not used. Not all of the antioxidants used in this case report were used in our previous articles.
- I ask that all treatment modalities for this disease, as well as treatment methods in accordance with existing guidelines, be discussed in the discussion.
ANSWER
Thank you for your suggestion. I added the related text in the Discussion section.
- It would be good to include part of the conclusion at the end of the discussion as "limitations of the study".
ANSWER
Thank you for your suggestion. I added the related text in the Discussion section.
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Author Response File: 
Author Response.docx
Reviewer 2 Report
General comments to the authors:
Three case series of Peyronie’s disease (PD) successfully treated with solely medical management.
Main manuscript is nicely written in general, but English editing service is preferred. The presentation of figures and pictures are nice and clear. With these figures, this report would provide useful information to physicians, especially urologists.
Specific comments and questions to the authors are outlined separately.
Major
# Ultrasound figure and picture of the penis is very clear. This will be of help to physicians and thus making this article attractive. Authors are to be commended.
# How many patients with PD in total did the authors (or their institutions) treated during the same period (2014-2018?)? I understand that this is not a cohort study. Howeveer, this information would be helpful for readers to get an image of proportion of patients in whom excellent outcomes can be expected with medical management only.
# Authors state that clinical course of case#3 is of most impressive, with rapid response and near-complete recovery. However, question remains that whether it is appropriate to diagnose this patient as PD in the first place. This patient lacks penile curvature, one of the classic symptoms of PD. As the diagnosis is rather clinical (dependent on clinician’s impression), I do not deny their diagnosis entirely, but this should be further discussed in the case presentation and discussion.
# Discussion needs language editing. Too many ideas in too many paragraphs. The reviewer also suggests limiting the number of themes to discuss.
Minor
# There’s no need to repeat that “each patient gave their consent to publish. It should be clearly stated once before the case presentation.
Author Response
Reply to the Reviewer #2
IMPORTANT: Manuscript with corrections also of English by the MDPI linguistic service.
# Ultrasound figure and picture of the penis is very clear. This will be of help to physicians and thus making this article attractive. Authors are to be commended.
ANSWER
Thank you for appreciation.
# How many patients with PD in total did the authors (or their institutions) treated during the same period (2014-2018?)? I understand that this is not a cohort study. Howeveer, this information would be helpful for readers to get an image of proportion of patients in whom excellent outcomes can be expected with medical management only.
ANSWER
Thank you for your suggestion. I added the information (new text) you asked for in the discussion section.
# Authors state that clinical course of case#3 is of most impressive, with rapid response and near-complete recovery. However, question remains that whether it is appropriate to diagnose this patient as PD in the first place. This patient lacks penile curvature, one of the classic symptoms of PD. As the diagnosis is rather clinical (dependent on clinician’s impression), I do not deny their diagnosis entirely, but this should be further discussed in the case presentation and discussion.
ANSWER
Thanks for your impression. I added text in the discussion section to comment on case # 3.
# Discussion needs language editing.
Too many ideas in too many paragraphs. The reviewer also suggests limiting the number of themes to discuss.
ANSWER
Ok I do.
I tried to eliminate some unnecessary paragraphs, but I had to add more paragraphs because requested by Reviewer # 1 (as you can see).
# There’s no need to repeat that “each patient gave their consent to publish. It should be clearly stated once before the case presentation.
ANSWER
Ok. I have eliminated the relative sentence in the presentation of the case.
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Round 2
Reviewer 1 Report
Please remove section 2.1. "Treatment method", and combine everything mentioned in it under the sections where you describe the three cases.
For ease of keeping track of the manuscript, I suggest putting all ultrasound images in "supplementary materials". Please comply with the request to make it easier for readers to follow the manuscript. The presentation of the cases is based on figures, but there are too many here.
Do not use the term "for your" in the discussion!
It is unnecessary to repeat the same reference in two consecutive sentences (eg reference 14).
In the discussion, try to avoid emphasizing and starting the sentence "In case #3", etc...
The discussion needs to be double-checked in detail by a native English speaker.
Author Response
Reply to Reviewer #1
IMPORTANT:
Manuscript was double-checked in detail by a native English speaker of MDPI linguistic service
Please remove section 2.1. "Treatment method", and combine everything mentioned in it under the sections where you describe the three cases.
ANSWER
Thank you for your suggestion. I removed section 2.1. I integrated content into case descriptions where the information wasn't already contained.
For ease of keeping track of the manuscript, I suggest putting all ultrasound images in "supplementary materials". Please comply with the request to make it easier for readers to follow the manuscript. The presentation of the cases is based on figures, but there are too many here.
ANSWER
Agreeing with your reasoning, I followed your suggestion and I uploaded the ultrasound images in the supplementary materials, however leaving the captions in the manuscript to facilitate the editing of the manuscript.
Thank you, indeed, after the changes, reading the manuscript is much smoother.
Do not use the term "for your" in the discussion!
ANSWER
I agree with you. I deleted this term in the Discussion section.
It is unnecessary to repeat the same reference in two consecutive sentences (eg reference 14).
ANSWER
I agree with you. I deleted the same reference in the next sentence.
In the discussion, try to avoid emphasizing and starting the sentence "In case #3", etc...
ANSWER
This clarification on case 3 was requested by Reviewer n.2. However, I have eliminated much of the sentence and ultimately provided sufficient clarification.
The discussion needs to be double-checked in detail by a native English speaker.
ANSWER
Alright, I got a NEW double-check in detail (from a native English speaker) of the Discussion section.
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Reviewer 2 Report
In general, authors tried to respond sincerely to the comments provided.
I have a few minor comments to add.
# Although it is stated that the manuscript is now with corrections made by English language professionals, my impression is that the newly added parts in the Discussion is not adequate for a scientific journal. The message itself is flawless. Please refer to editing service team again for reconsideration of the phrasing.
# Authors added the limitation to this study just as the reviewer recommended. However, as this is a case-series study referring to lack of #double-blind randomization” is a little too much.
Author Response
Reply to Reviewer #2
IMPORTANT:
Manuscript was double-checked in detail by a native English speaker of MDPI linguistic service
In general, authors tried to respond sincerely to the comments provided.
I have a few minor comments to add.
ANSWER
Thank you for your appreciation.
# Although it is stated that the manuscript is now with corrections made by English language professionals, my impression is that the newly added parts in the Discussion is not adequate for a scientific journal. The message itself is flawless. Please refer to editing service team again for reconsideration of the phrasing.
ANSWER
Alright, I got a NEW double-check in detail (from a native English speaker/MDPI service) of the Discussion section.
However, I must inform you that I had to reduce the period concerning the clarifications on case 3 (in Discussion section), because this was requested of me by Reviewer #1 (As part of a major revision). However, I have tried to maintain sufficient clarification of the case as you requested above.
# Authors added the limitation to this study just as the reviewer recommended. However, as this is a case-series study referring to lack of #double-blind randomization” is a little too much.
ANSWER
You're right. I eliminated ...the lack of "double-blind randomization"
Note
As you may have noticed, as requested by Reviewer #1 (As part of a major revision), I removed from the manuscript the ultrasound images and I uploaded these in the supplementary materials to make it easier for readers to follow the manuscript.
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