Review for 10.1186/s12876-024-03496-1 (2024)

Title: Efficacy and safety of tanshinone IIA in combination with mesalazine in the treatment of
ulcerative colitis: a Systematic review and meta-analysis
Version: 1 Date: 07 Sep 2024
Reviewer's report:
This study overview on the combination of Tanshinone IIA and mesalazine for treating
ulcerative colitis (UC) presents interesting findings, but there are several critical points to
consider:
- Overall writing needs extensive improvement. The text could benefit from more consistent
tense usage and careful proofreading to avoid confusion.
- There are several grammatical issues and awkward phrases throughout the text (e.g., "minors
compared to that of the M group," "the efficacy rate was wanted to be determined"), which
detract from the overall clarity.
- The abstract starts with an unclear objective: “...remains uncertain. In this context, overall
response rate regarding the tanshinone IIA and mesalazine treatment of UC was wanted to be
determined.” This could be more concise and direct. Notably, abstract starts by background then
objective
- “Thus, The goal of the present research therefore was to identify useful interventions in relation
to the UC.” This is also unclear and not specific
-“ Piagetian based intervention” is irrelevant to some degree.
- The final sentence in the abstract mixes conclusions with recommendations, making it less
clear: "Despite some limitations, these findings underscore... however, thus, there is a need to
engage more research." The transition from findings to future recommendations is awkwardly
phrased.
- The introduction introduces UC symptoms and pathophysiology but could benefit from more
precise language.
- The explanation of mesalazine’s side effects could be expanded to discuss why adding
Tanshinone IIA might alleviate them. The phrase "cannot be cured by medication alone" is also
vague.
Methods
- It’s unclear whether the protocol fully followed PRISMA guidelines.
Results:
- The results are significant, but some critical elements are either underexplained or confusing.
For example, “The present evaluation of the total adverse event accumulation showed that the
Piagetian-based intervention did not differ from the control group.” This statement is misplaced
and irrelevant, as the study doesn't seem to relate to Piagetian theory.
-  “Sensitivity analysis: The review’s sensitivity was also checked by removing each of the
included studies consecutively and calculating the proportion of remaining studies that reported
on at least one positive outcome from each study arm. Thus, the same combined with the fact that
none of the studies shifts the outcome of the meta-analysis to a greater extent and it can be stated
that the result of this meta-analysis is definitive.” This should be provided as supplementary
table or figure
- The reported significant reduction in TNF-# and CRP levels in the T+M group is compelling,
but more discussion is needed about the potential clinical relevance of this reduction.
- Discussion needs extensive re-writing
- Although some limitations are acknowledged (e.g., small sample size, heterogeneity in IL-6
analysis), the discussion doesn’t fully explore how these limitations affect the interpretation of
the results.
- The small number of included studies (six RCTs) is noted but not sufficiently critiqued. What
other potential biases might arise from this limitation.
Conclusion:
- The conclusion is generally in line with the findings, but the final sentence could be more
precise. Instead of "The further research is needed to make the results more significant and
establish them definitely," it would be stronger to specify what kind of further research is needed
(e.g., larger sample sizes, multi-center RCTs, long-term follow-up studies).