Review for 10.1186/1471-230X-14-77 (2014)

Reviewer's report
Title:Correlation between depression, anxiety, and polymorphonuclear cells'
resilience in ulcerative colitis. The mediating role of heat shock protein 70.
Version: 1Date:12 February 2013
Reviewer: Joel E Mawdsley
Reviewer's report:
This is in essence a straightforward paper in which the authors demonstrate that,
in patients with active UC, the positive staining of PMNs for inducible Heat shock
Protien 70 (HSP70i) correlates with scores of depression and anxiety on several
well validated assessment tools. The paper has a clear message which is of
interest. HSP70i has been implicated as an important molecule mediating the
effects of stress. The methodology used is essentially sound. However, I think
there are some simple points which need to be clarified to make the paper easier
to understand for the reader.
Minor essentail revisions
1. Patients were selected from those undergoing assessment for possible
reactivation of their UC. For this reason all patients had active disease of some
degree and there are therefore no patients with quiescent disease included. This
would have been a valuable control group and I think this should be included as
a point for discussion.
2. No reference is made to the distribution of disease or the use of
immunomodulators or immunosuppressants in the descriptive statistics. This
should be included as it might affect results.
3. 27 patients were included. The abstract states "Inflammation severity" was
moderate in 15 patients, severe in 8 and mild in 6. It needs to be clarified as to
whether this is histological (which is what I assume to be the case) rather than
clinical or endoscopic (please see point below).
4. Biopsies were taken from “each anatomical site of the colon” so I would
anticipate there would be multiple biopsies from each patient. But In table 1. the
total N number is 57. This needs to be clarified as I think this is the total number
of biopsies. However as there are only 57 biopsies in total this would make the
mean number of biopsies per patient two which is very low. And in table 1 there
are only 6 biopsies classified as severe, despite there being 8 patients with
severe “inflammation severity” as described in the abstract.
5. In the results section “Immunohistochemistry UC”, the authors state that “the
staining of PMN cells was increased in the biopsies from 22 patients regardless
of the severity of biopsy findings. In the biopsies of the rest 7 patients, negative
PMNs were observed.” However in the abstract it states that “in 22/29 cases with
cases of active cryptitis, PMN cells strongly expressed HSP70i with weak focal
positivity in 7 other cases”. Is this a contradiction?
6. From what I can see in Table 1 no PMNs were ++intense for HSP70i, the
maximum being +medium. But in the abstract it is stated that PMN cells strongly
expressed HSP70i.
7. Would it be possible to see a figure demonstrating the correlation of PMN
staining with the scores in the psychometric questionnaires? as I think this would
show the relationship more clearly.
8. A key question which needs expanding is whether both psychometric
questionnaires and the immunohistochemistry positivity are just related to
disease activity. The authors state that “the severity of the inflammation” was not
related to the presence of immunoreactivity in the PMN cells of the inducible
HSP70. However, the table in the results section would suggest that the clinical
activity index did relate to HSP70i staining (CAI score 7.1 in positive PMN group
and 4.1 in negative PMN group - is this significant?) Was there no relationship
between immunoreactivity and inflammation in each biopsy or no relationship to
the inflammation severity score for each patient as a whole?
9. Was HSP70i immunoreactivity in PMNs increased in all biopsies from the
same patient or just those biopsies in each patient where there was active
inflammation?
Providing these points can be dealt with I think the paper is suitable for
publication.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests