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Your Submission JPEDSURG-D-17-00232 (без темы)

Karen Jaeger <eesserver@eesmail.elsevier.com>

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michael.levin@gri.health.gov.il

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Ms. Ref. No.:  JPEDSURG-D-17-00232
Journal of Pediatric Surgery

Dear Misha,

Your manuscript titled "Radiological anatomy of the colon in children: Dosed hydrostatic barium enema",
has been carefully evaluated by three of our editorial consultants.

I regret to inform you that this will not be published in the Journal of Pediatric Surgery. Unfortunately, the manuscript received a low priority score. Many manuscripts are submitted to the Journal.  However, only those that achieve a high content rating and priority scoring can be published.

We appreciate your submitting your work to the Journal.

Sincerely,

George W. Holcomb III, M.D., MBA
Editor-in-Chief
Journal of Pediatric Surgery

Reviewers' comments:


Reviewer #1: The authors performed barium enemas in 65 children and attempted to analyze the images allowing them to make a series of theoretical assumptions and wrong generalizations. 

A few examples:

* Arbitrarily the authors assumed that certain radiological images represent the form and dimension of the "anal canal", the "puborectalis muscle", the "external sphincter", and the "internal sphincter".

* In many portions of the manuscript, the terminology used is impossible to understand: "value of the colon", "hydrostatic dosage barium", "correction of the projection magnification", "the radiopaque restrictor (marker) is strung on the tip of the enema", "the area between the marker (anus) and the rectum, which does not contain a contrast agent is equal to the anal canal length measured by the manometric method. Consequently, this is a zone of the anal canal contraction", "we calculate the constant (c), which is the integral characteristic of the colon value".



Reviewer #2: This retrospective study of 65 barium enemas used a technique of standardising the hydrostatic filling pressure to obtain what the authors hoped would be standardisation of the dimensions of the lower intestine and anal canal. These studies apparently (although it is not made clear) were selected from 589 other barium enema examinations during the same period between 1980 and 1983. It is not clear from the text how these were selected for inclusion or for what reason the studies were undertaken in the first place. Nor does the text describe why the other 524 were excluded. This illustrated how limited retrospective studies can be by introducing variables which can not be controlled for and thus bringing into question the validity of any analysis.
The paper is appropriately constructed but the language is sometimes unclear for the reader. I would have liked a clearer explanation in the Introduction section of how and why the dimensions the authors planned to measure would be important in diagnosis. The hyposthesis is not clearly stated with reference to this. Further, Barium studies illustrate a dynamic view of the anatomy of the lower gut and anal canal. It is not explained how this is controlled for. The method of performing the barium enema is clearly presented but there is no reference as to how the measurements were standardised for age. There is no background to the derivation of the constant C described in the Methods section. Nor could I find any reference to this constant C in the Results section or the Table. Nowhere in the Results section was there any reference to statistical analysis, nor any attempt to control for age. That being the case most of the Discussion section is very limited in value. The
References were appropriate both in number and content although many quoted were more that 10 years old. The Figures were clear although I'm not sure exactly what Figure 3 means particularly without any statistical analysis. The Table was clear as far as the data allows.
I don't think that this study advances our knowledge of ano-rectal and colonic anatomy both in health and disease.



Reviewer #3: The article is better suited for a radiology journal as I do not think it will be of great interest to most pediatric surgeons
The manuscript needs to be significantly revised if it were to be considered for publication for the following reasons:
1) There are no data in the results section of the abstract. The abstract is not clear.
2) There are multiple repetitive statements in the article
3) There are multiple grammatical and typographical errors.
4) It is very difficult to follow the article due to the errors and the structure of the paper.
5) Limited data in the results section to support any conclusions. The only table with data is found in the methods section 

I would be interested to know if there was leaking of contrast when measuring the volume of the colon and how that was accounted for.