Title: Formation of non-cholesterol gallstones in populations within clonorchiasis endemic
regions is closely related to Clonorchis sinensis infection
Version: 1 Date: 27 Feb 2025
Reviewer's report:
The manuscript explores the relationship between C. sinensis infection and gallbladder stone
disease, particularly focusing on the impact of infection on bile components, gallbladder
motility, and the formation of gallstones. The study investigates epidemiological correlations
and evaluates the morphology of C. sinensis eggs in gallbladder stones, bile sediment, and
bile samples. The authors also analyze the concentrations of various bile components and the
motility of the gallbladder in patients with GBSD, comparing those with and without C. sinensis
infection.
Major Comments:
1. It is mentioned in the manuscript that the percentage of male GSI patients is significantly
higher than that of female patients, and in Figure 2a it is shown that C. sinensis doesn’t seem
to be a risk factor for gallbladder stones in female patients. However, in the discussion section
doesn’t address possible reasons for this, such as the influence of sex hormones. Based on the
current findings, it seems difficult to explain why female patients are not affected by C. sinensis
infection in terms of its mechanism on gallbladder stone formation.
It is hoped that the authors will further explore and propose relevant hypotheses or explanations.
2. The manuscript concludes that C. sinensis infection, particularly the retention and calcification
of eggs, plays a crucial role in the formation of non-cholesterol gallstones in males. While the
study presents compelling data, the causal relationship between infection and stone formation
should be discussed more carefully. Calcification doesn’t necessarily mean that the eggs directly
caused the stone formation. Calcification may be a result of the stone formation process rather
than the sole causal factor.
The authors should clarify whether the morphological changes observed in the eggs (e.g.,
calcification) are a result of the infection itself or a consequence of the pathological environment
within the gallbladder.
3. The manuscript lacks discussion of potential confounding factors and other known risk factors
for GBSD (e.g., obesity, cholesterol levels). As mentioned in Table 2, 24 patients with C. sinensis
positive had cholesterol stones, whether confounding factors contributed to this stone formation.
These should be mentioned to provide a more comprehensive understanding of the study.
Overall Evaluation:
This study adds valuable information regarding the relationship between C. sinensis infection
and GBSD. However, the conclusions are somewhat overstated, and the manuscript would
benefit from more careful consideration of the limitations and a deeper exploration of the
mechanisms underlying the observed results. If the authors revise the manuscript to address
these concerns, it will be suitable for publication.
Title: Formation of non-cholesterol gallstones in populations within clonorchiasis endemic
regions is closely related to Clonorchis sinensis infection
Version: 1 Date: 27 Feb 2025
Reviewer's report:
The manuscript explores the relationship between C. sinensis infection and gallbladder stone
disease, particularly focusing on the impact of infection on bile components, gallbladder
motility, and the formation of gallstones. The study investigates epidemiological correlations
and evaluates the morphology of C. sinensis eggs in gallbladder stones, bile sediment, and
bile samples. The authors also analyze the concentrations of various bile components and the
motility of the gallbladder in patients with GBSD, comparing those with and without C. sinensis
infection.
Major Comments:
1. It is mentioned in the manuscript that the percentage of male GSI patients is significantly
higher than that of female patients, and in Figure 2a it is shown that C. sinensis doesn’t seem
to be a risk factor for gallbladder stones in female patients. However, in the discussion section
doesn’t address possible reasons for this, such as the influence of sex hormones. Based on the
current findings, it seems difficult to explain why female patients are not affected by C. sinensis
infection in terms of its mechanism on gallbladder stone formation.
It is hoped that the authors will further explore and propose relevant hypotheses or explanations.
2. The manuscript concludes that C. sinensis infection, particularly the retention and calcification
of eggs, plays a crucial role in the formation of non-cholesterol gallstones in males. While the
study presents compelling data, the causal relationship between infection and stone formation
should be discussed more carefully. Calcification doesn’t necessarily mean that the eggs directly
caused the stone formation. Calcification may be a result of the stone formation process rather
than the sole causal factor.
The authors should clarify whether the morphological changes observed in the eggs (e.g.,
calcification) are a result of the infection itself or a consequence of the pathological environment
within the gallbladder.
3. The manuscript lacks discussion of potential confounding factors and other known risk factors
for GBSD (e.g., obesity, cholesterol levels). As mentioned in Table 2, 24 patients with C. sinensis
positive had cholesterol stones, whether confounding factors contributed to this stone formation.
These should be mentioned to provide a more comprehensive understanding of the study.
Overall Evaluation:
This study adds valuable information regarding the relationship between C. sinensis infection
and GBSD. However, the conclusions are somewhat overstated, and the manuscript would
benefit from more careful consideration of the limitations and a deeper exploration of the
mechanisms underlying the observed results. If the authors revise the manuscript to address
these concerns, it will be suitable for publication.
Please review this paper.
user
Title: Formation of non-cholesterol gallstones in populations within clonorchiasis endemic
regions is closely related to Clonorchis sinensis infection
Version: 1 Date: 27 Feb 2025
Reviewer's report:
The manuscript explores the relationship between C. sinensis infection and gallbladder stone
disease, particularly focusing on the impact of infection on bile components, gallbladder
motility, and the formation of gallstones. The study investigates epidemiological correlations
and evaluates the morphology of C. sinensis eggs in gallbladder stones, bile sediment, and
bile samples. The authors also analyze the concentrations of various bile components and the
motility of the gallbladder in patients with GBSD, comparing those with and without C. sinensis
infection.
Major Comments:
1. It is mentioned in the manuscript that the percentage of male GSI patients is significantly
higher than that of female patients, and in Figure 2a it is shown that C. sinensis doesn’t seem
to be a risk factor for gallbladder stones in female patients. However, in the discussion section
doesn’t address possible reasons for this, such as the influence of sex hormones. Based on the
current findings, it seems difficult to explain why female patients are not affected by C. sinensis
infection in terms of its mechanism on gallbladder stone formation.
It is hoped that the authors will further explore and propose relevant hypotheses or explanations.
2. The manuscript concludes that C. sinensis infection, particularly the retention and calcification
of eggs, plays a crucial role in the formation of non-cholesterol gallstones in males. While the
study presents compelling data, the causal relationship between infection and stone formation
should be discussed more carefully. Calcification doesn’t necessarily mean that the eggs directly
caused the stone formation. Calcification may be a result of the stone formation process rather
than the sole causal factor.
The authors should clarify whether the morphological changes observed in the eggs (e.g.,
calcification) are a result of the infection itself or a consequence of the pathological environment
within the gallbladder.
3. The manuscript lacks discussion of potential confounding factors and other known risk factors
for GBSD (e.g., obesity, cholesterol levels). As mentioned in Table 2, 24 patients with C. sinensis
positive had cholesterol stones, whether confounding factors contributed to this stone formation.
These should be mentioned to provide a more comprehensive understanding of the study.
Overall Evaluation:
This study adds valuable information regarding the relationship between C. sinensis infection
and GBSD. However, the conclusions are somewhat overstated, and the manuscript would
benefit from more careful consideration of the limitations and a deeper exploration of the
mechanisms underlying the observed results. If the authors revise the manuscript to address
these concerns, it will be suitable for publication.
assistant