Basic Analysis of the Cerebrospinal Fluid: An Important Framework for Laboratory Diagnostics of the Impairment of the Central Nervous System

Round 1

Reviewer 1 Report

Brief summary

Under a general and rather misleading title, the authors provide as an introduction an extended description of CSF physiology and some old and well-established parameters of routine CSF analysis (white blood cells, total protein) and also they make a brief presentation of  “cytological-energy analysis” of CSF. This test is based mainly on self-citations in their studies between 1998 and 2022.  

No particular aim of this study is described.

Introduction is followed by a presentation of data on the above-mentioned parameters from over 1000 neurological patients and controls in order to finally categorize them according to their “energy status” in the conclusions’ section.

An explanation of how those results could have a significant impact either on patient’s diagnosis or treatment is not given by the authors neither seems obvious.

Author Response

Dear Reviewer,

Thank you for the proofreading.

I have been involved in CSF analysis for approximately 26 years - from its basic level to very specialized analyses. I work with a number of medical disciplines. So I know the situation in this field quite well. I consider basic CSF analysis to be an essential source of input. Unfortunately, many laboratory and clinical colleagues look for "super lab markers" and are blind to the valuable information provided by basic CSF analysis. A number of years ago, we developed a CSF baseline examination scheme that provides key information about a patient's current CNS status very quickly, reliably, and inexpensively. We would like to introduce it to the professional community and support deeper interest in this area.

I agree that some parts of our manuscript were difficult to understand. Therefore, I have tried to make them more precise and clear. I have also added five references from different authors who have published our important topic, i.e. energy ratios in CSF.

Thank you for your understanding.

Best regards,

Petr Kelbich et al.

P.S.

The revised manuscript is in attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

I think it could be accepted in the current form. I ask if authors have data regarding neurodegenerative biomarkers. This is interesting especially in relationship with AST and KEB index. If you don't have any data at this regards i suggest to write it down in limits section for future investigations. 

Author Response

Dear Reviewer,

Thank you for your proofreading with a very positive conclusion. Although AST is a non-specific parameter of CNS destruction, our experience with its investigation in patients with neurodegenerative disorders is very good. At least twice we have successfully detected CJD using basic CSF analysis. Unfortunately, our group of patients with neurodegenerative disabilities is not yet ready for publication.

I have added the mention in accordance with your recommendation (see red script in chapter 4.6.).

Sincerely yours,

Petr Kelbich et al.

P.S.

The revised manuscript is in attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

1.        Based on the introduction, it is difficult to understand what the authors want to present through this manuscript. The introduction section should be revised.

2.        Also, it should be presented that the application of the analysis of CSF in biological/medical/biochemical field.

Author Response

Dear Reviewer,

Thank you for your proofreading and for your objections. I agree with you that some parts of our manuscript were difficult to understand. Therefore, I have tried to correct the text in light of your recommendations (see red font). I am convinced that the text is now much better and easier to understand.

Sincerely yours,

Petr Kelbich et al.

P.S.

The revised manuscript is in attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

There is no doubt that the study reflects long experience on CSF basic analysis and deep knowledge of CSF physiology. However, it lacks originality, presentation needs improvement and some interesting data on coefficient of energy balance are lost among the large amount of well-established knowledge presented here. Overall, interest to the readers and scientific soundness of the study and  are not enough for being published in the journal.

Author Response

Dear Reviewer,

Thank you for proofreading our manuscript and for your comment.

In our study, we have described in detail our method of basic CSF analysis. We deliberately presented it on common CNS involvements. Unfortunately, we are not able to cover the whole issue in only one paper. For more detailed information, I can refer readers to some of our earlier study publications.

Best regards,

Petr Kelbich et al.