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 March 2013
Reviewer: Eva Szigethy
Reviewer's report:
The manuscript, "Correlation between depression, anxiety, and
polymorphonuclear cells' resilience in ulcerative colitis. The mediating role of
heat shock protein 70" is covers an important and interesting topic with the
association of psychological symptoms with inflammatory processes in ulcerative
colitis. In the current form, there are significant problems with the organization
and flow of the introduction and discussion sections, a lack of hypothesis driven
objectives, and problems with some of the methodological choices made by the
authors. Specific comments are below.
Major Compulsory Revisions:
1) The abstract is missing a rationale for the study as well as clinical significance
of the findings.
2) In the Introduction, there is a lack of flow of the paragraphs leading from
general statements to the specific hypotheses underlying the aims of this study.
In fact, there is an absence of theory driven hypotheses altogether.
3) In the methods section, there is an absence of specific inclusion/exclusion
criteria. Also there is a lack of justification of why CD patients were excluded.
4) The methods sections mixes up components of the Biopsies and
Psychometric Tools and reference to each should be kept in its respective
section.
5) The authors do not justify why they have two different anxiety and two different
depression scales. This complicates findings and analyses unnecessarily.
6) In results section, HSP70i PMN findings are dichotomized to either positive or
negative but the basis for this distinction is not explained in the methods section
where different scales of measuring immunohistochemical intensity are
described. Same for using it as a dichotomous variable in the logistic regression
model.
7) There is an absence of statistical detail in describing the logistic regression
results. For example the statistical significance of the full model containing all
predictors is absent. Also how much variance the model as a whole explained is
absent.
8) The discussion is very disjointed and does not adequately address the clinical
relevance of the findings.
9) There are several major limitations of the study that are not mentioned, Firs
western blot is the standard for quantification and not immunohistochemistry that
can lend itself to batch differences hence false positives/negatives. There is no
mention of what controls were used to mitigate against such spurious findings.
Also it is not mentioned that patients with adenocarcinomas (without mention of
detail of stage or location of cancer) may not be the same as normal healthy
controls.
Minor Essential Revisions:
1) There are several statements in the introduction that are inaccurate and/or not
adequately referenced. For example, for the statement, " Animal research depicts
a causal relationship between experimentally induced depression and increased
secretion of pro-inflammatory cytokines leading to reactivation, wheras tricyclic
antidepressnats seem to attenuate this effect" warrants more than one citation.
Also the statement, " UC patients seem to be influenced more than CD patients
by external factors and to lesser extent by genetic factors" is not correct. Several
studies have shown patients with CD are affected by multiple psychosocial
factors.
2) In the methods section, under Biopsies, the sentence,"The distinction between
UC and CD was established..." does not make sense since this is a study of UC
patients only.
3) In the methods section, under Biopsies, it is the first mention of constitutive
and inducible forms of the HSP70 protein. This distinction should be made early
in the introduction.
4) Under results, Psychometric tools, the sentence, "Most scores for all
psychometric tools were normal." warrants more explanation.
5) Table 3 is listed twice; Table 1 is inadequately labeled and the relevance of
Table 2 findings are not integrated into the text.
6) Several grammatical errors need to be fixed throughout the document.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'