Title: Correlation analyses of ultrasonographic and histopathological characteristics of porta
hepatis lymph nodes in biliary atresia
Version: 0 Date: 30 Jan 2025
Reviewer's report:
This manuscript clarifies that the ultrasonographic evaluation of PHLNs reflects their
pathological features and the liver as well as serum level of direct bilirubin in BA (echogenicity
vs. the number of bile granules, ultrasound and pathological size vs. the number of germinal
centers). The authors also showed that the pathological size of PHLNs correlated with the
number of CD8+ T cells especially in the hepatic lobules and the portal area in BA. However,
there was no significant correlation between the number of bile granules in PHLNs and the
proportion of lymphocytes in the liver. They also showed that they are negatively correlated
with the reduction of jaundice three months after KPE and concluded the severity of liver bile
duct injury could be reflected by the size of LNs.
There are some questions about undefined terms. This paper deserves publication in this journal
if these questions below are addressed.
1. Line 148-151
Please define the bile granules and bile particles.
2. Line 214
The authors stated that bile-stained macrophages are also one of the main factors contributing
to the enlargement of PHLNs.
First of all, how did the authors define these cells as macrophage? As the authors themselves
stated that there was no significant correlation between the number of bile granules in PHLNs
and the proportion of lymphocytes in the liver, it is hard to think that bile-stained macrophages
are antigen-presenting, eliciting immune response. They might be just the cells, phagocytosing
bile pigment. As the authors observed that germinal centers of PHLNs are correlated with the
degree of infiltration of CD8+ cells in the hepatic lobule and portal area, swollen PHLNs are
most likely to be the result of proliferation of CD4+, CD8+ T cells in the paracortical area and
activated B cells in the germinal centers.
3. Line 221
There is such a statement as “we showed that the enlargement of the pathological area of PHLNs
in BA reflected the presence of fibrosis in the liver”.  However, I could not find any findings in
result of this paper leading such a conclusion. Please show any evidence for this description.
4. TableS2
The unit of gender is described as (days), while the unit of age is blank. Please Correct it.
5. Table 3
In contrast to the medical term that the author used for “the portal areas” in the text, the term of
“manifold areas” is used instead in the table. Are these terms hold the same meaning? What is
the intention for the author to use these terms differently?
Title: Correlation analyses of ultrasonographic and histopathological characteristics of porta
hepatis lymph nodes in biliary atresia
Version: 0 Date: 30 Jan 2025
Reviewer's report:
This manuscript clarifies that the ultrasonographic evaluation of PHLNs reflects their
pathological features and the liver as well as serum level of direct bilirubin in BA (echogenicity
vs. the number of bile granules, ultrasound and pathological size vs. the number of germinal
centers). The authors also showed that the pathological size of PHLNs correlated with the
number of CD8+ T cells especially in the hepatic lobules and the portal area in BA. However,
there was no significant correlation between the number of bile granules in PHLNs and the
proportion of lymphocytes in the liver. They also showed that they are negatively correlated
with the reduction of jaundice three months after KPE and concluded the severity of liver bile
duct injury could be reflected by the size of LNs.
There are some questions about undefined terms. This paper deserves publication in this journal
if these questions below are addressed.
1. Line 148-151
Please define the bile granules and bile particles.
2. Line 214
The authors stated that bile-stained macrophages are also one of the main factors contributing
to the enlargement of PHLNs.
First of all, how did the authors define these cells as macrophage? As the authors themselves
stated that there was no significant correlation between the number of bile granules in PHLNs
and the proportion of lymphocytes in the liver, it is hard to think that bile-stained macrophages
are antigen-presenting, eliciting immune response. They might be just the cells, phagocytosing
bile pigment. As the authors observed that germinal centers of PHLNs are correlated with the
degree of infiltration of CD8+ cells in the hepatic lobule and portal area, swollen PHLNs are
most likely to be the result of proliferation of CD4+, CD8+ T cells in the paracortical area and
activated B cells in the germinal centers.
3. Line 221
There is such a statement as “we showed that the enlargement of the pathological area of PHLNs
in BA reflected the presence of fibrosis in the liver”.  However, I could not find any findings in
result of this paper leading such a conclusion. Please show any evidence for this description.
4. TableS2
The unit of gender is described as (days), while the unit of age is blank. Please Correct it.
5. Table 3
In contrast to the medical term that the author used for “the portal areas” in the text, the term of
“manifold areas” is used instead in the table. Are these terms hold the same meaning? What is
the intention for the author to use these terms differently?
Please review this paper.
user
Title: Correlation analyses of ultrasonographic and histopathological characteristics of porta
hepatis lymph nodes in biliary atresia
Version: 0 Date: 30 Jan 2025
Reviewer's report:
This manuscript clarifies that the ultrasonographic evaluation of PHLNs reflects their
pathological features and the liver as well as serum level of direct bilirubin in BA (echogenicity
vs. the number of bile granules, ultrasound and pathological size vs. the number of germinal
centers). The authors also showed that the pathological size of PHLNs correlated with the
number of CD8+ T cells especially in the hepatic lobules and the portal area in BA. However,
there was no significant correlation between the number of bile granules in PHLNs and the
proportion of lymphocytes in the liver. They also showed that they are negatively correlated
with the reduction of jaundice three months after KPE and concluded the severity of liver bile
duct injury could be reflected by the size of LNs.
There are some questions about undefined terms. This paper deserves publication in this journal
if these questions below are addressed.
1. Line 148-151
Please define the bile granules and bile particles.
2. Line 214
The authors stated that bile-stained macrophages are also one of the main factors contributing
to the enlargement of PHLNs.
First of all, how did the authors define these cells as macrophage? As the authors themselves
stated that there was no significant correlation between the number of bile granules in PHLNs
and the proportion of lymphocytes in the liver, it is hard to think that bile-stained macrophages
are antigen-presenting, eliciting immune response. They might be just the cells, phagocytosing
bile pigment. As the authors observed that germinal centers of PHLNs are correlated with the
degree of infiltration of CD8+ cells in the hepatic lobule and portal area, swollen PHLNs are
most likely to be the result of proliferation of CD4+, CD8+ T cells in the paracortical area and
activated B cells in the germinal centers.
3. Line 221
There is such a statement as “we showed that the enlargement of the pathological area of PHLNs
in BA reflected the presence of fibrosis in the liver”.  However, I could not find any findings in
result of this paper leading such a conclusion. Please show any evidence for this description.
4. TableS2
The unit of gender is described as (days), while the unit of age is blank. Please Correct it.
5. Table 3
In contrast to the medical term that the author used for “the portal areas” in the text, the term of
“manifold areas” is used instead in the table. Are these terms hold the same meaning? What is
the intention for the author to use these terms differently?
assistant