Visual analysis of abdominal aortitis treatment using the CiteSpace bibliometric method

Abstract

BACKGROUND

Abdominal aortitis can induce aneurysms, and tumor rupture can lead to organ ischemia or even sudden death. At present, there is a lack of extensive understanding and identification of key problems in the treatment of abdominal aortitis, which needs to be further analyzed using bibliometric analysis.

AIM

To discuss the research hotspot and development trend of abdominal aortitis treatment.

METHODS

We searched the English literature (published from January 1, 2000 to March 12, 2024) on the treatment of abdominal aortitis in the Web of Science database. Then, we identified and screened duplicate literature using CiteSpace 6.1R2 software. We conducted an analysis of the number of papers, a co-occurrence analysis of the authors and institutions, and co-occurrence and cluster analyses of the keywords. Then, we drew the author, institution, and keywords of the studies into graphs for visualization. Finally, we expounded on the author, institutional network interactions, and hot keywords of the studies on the treatment of abdominal aortitis.

RESULTS

We included 210 English literature articles involving 190 authors; the author cooperation team was mainly represented by Caradu Caroline, Berard Xavier, Lu Guanyi, Harada Kenichi, and Sharma Ashish K. In the keyword analysis, high-frequency keywords include abdominal aortic aneurysm (38), abdominal aorta (24), Takayasu arteritis (22), etc. The three most central keywords were disease (0.69), classification (0.68), and abdominal aortic aneurysm (0.55). The first nine clusters of keywords are case report, abdominal aortic aneurysm, Takayasu arteritis, dyspnea hematuria, aortic elastic, IgG4-related disease, report, mid aortic dysplastic syndrome, and statin. In the keyword emergent analysis, 14 emergent words were obtained. Among them, seven keywords with strong abruptness were Takayasu arteritis, abdominal aortic aneurysm, disease, retroperitoneal fibrosis, expression, management, and large vessel vasculitis. In the past 3 years, the incidences of abdominal aortic aneurysm (intensity: 4.62) and inflammation (intensity: 1.99) were higher.

CONCLUSION

The number of published papers is on the increase, but the cooperation among authors is scattered. The research focus is mainly on the pathogenesis and treatment of abdominal aortitis-related diseases.

Key Words: Abdominal aortitis; Treatment; Abdominal aortic aneurysm; CiteSpace; Visualization; Cluster

Core Tip: Aortitis is a chronic inflammatory condition that can cause serious illness and even death if left untreated. A CiteSpace bibliometric analysis of the treatment of abdominal aortitis clarified the key issues in the treatment of abdominal aortitis and the network connections between treatments, authors, institutions, countries, and keywords.

INTRODUCTION

Inflammatory lesions of the great artery endothelium include morphological changes of the artery endothelium and the expression of inflammatory molecules that directly affect the pathological evolution of the disease. Abdominal aortitis is a chronic non-specific inflammatory disease characterized by abdominal pain, abdominal throb pain, abdominal muscle tension, fever, nausea, and vomiting[1]. The etiology of abdominal aortitis is unclear but may be related to the destruction of the middle layer of the aortic wall and structural changes of the vascular wall caused by genetics, hypertension, chronic inflammation, and other factors[2]. If not treated properly or in time, abdominal aortitis can induce aneurysms[3], and the resulting rupture of aneurysms can lead to organ ischemia, which is the third cause of sudden death after myocardial infarction and stroke[4]. Recent studies demonstrated that glucocorticoids (prednisone and methylprednisolone), immunosuppressants (azathioprine and cyclophosphamide), and surgery (such as aortic artificial vascular replacement) have significant effects on the treatment of abdominal aortitis[5].

Bibliometric analyses use statistical methods and visualization to explore the structure and trends of a discipline or field[6]. Compared with traditional reviews, bibliometric analyses, which have been gradually applied to medical-related fields, can quickly identify key issues in a field[7,8]. However, this method has not been applied to the treatment of abdominal aortitis. Thus, a bibliometric analysis was conducted with relevant research literature included in the Web of Science (WOS) database as the research object, and the results were visualized using CiteSpaceV software. This analysis can improve our understanding of the content and hot topics of current research on the treatment of abdominal aortitis and provide a reference for future research.

MATERIALS AND METHODS

Research data

Data for this study came from the WOS database from January 1965 to March 12, 2024. The database search retrieved 317 pieces of English literature, including 210 pieces published from January 1, 2000 to March 12, 2024 (Table 1).

Table 1 Top 10 authors on the treatment of abdominal aortitis from 2000 to 2014.

Serial number	Number of publications	Year	Author
1	3	2023	Caradu Caroline
2	3	2023	Berard Xavier
3	2	2018	Lu Guanyi
4	2	2009	Harada Kenichi
5	2	2018	Sharma Ashish K
6	2	2008	Rodriguez Heron E
7	2	2023	Ducasse Eric
8	2	2018	Spinosa Michael D
9	2	2016	Fu Weiguo
10	2	2018	Su Gang

Research method

CiteSpaceV software was applied to visually analyze the research content and hotspots. CiteSpace is a Java-based application for analyzing and visualizing trends and patterns in the scientific literature for complex, long-term, diverse data. The software can visually present various data in a certain research field, including research results, research institutions, researchers, and keywords[9]. The main research indicators for this analysis included the number of publications, authors, institutions, countries, and keywords.

RESULTS

Distribution of the number of published documents

Between January 1, 2000 and March 12, 2024, 210 English literature publications were identified, with an average annual publication volume of 8.4 ± 5.6. The lowest publication rate was 1 in 2001 and 2010. The largest number of articles was 23 in 2022. The distribution of published papers shows that research in the field of abdominal aortitis is increasing. The number of papers decreased in 2019 compared with 2018, but the number of published documents began to increase in 2020. The data was retrieved up until March 12, 2024; thus, the data for 2024 are incomplete (Figure 1).

Figure 1 Number of publications collected in the World of Science database each year from 2000 to 2014.

Author distribution

The author distribution map has 190 nodes, each representing a different author, and 445 lines (Figure 2). The node size represents the frequency of each author’s appearance, and the color of the node represents a different year. The top authors with the most recent publications were Caradu Caroline, Berard Xavier, Lu Guanyi, Harada Kenichi, and Sharma Ashish K. Caradu Caroline and Berard Xavier mainly published in the past 3 years.

Figure 2 Author distribution.

Analysis of national/regional and institutional cooperation networks

Nodes with high mediation-centrality are displayed in the CiteSpace graph to show the importance of the node. The network maps of institutions and countries were established by the software. The institution where the first author worked was considered the publishing institution. The five institutions with the largest number of publications were Assistance Publique Hopitaux Paris, State University System of Florida, Post Graduate Institute of Medical Education & Research, Institut National de la Sante et de la Recherche Medicale, and CHU Bordeaux. Each institution published three papers. Post Graduate Institute of Medical Education & Research published the most papers in recent years. The top five centrality countries in terms of publication volume were the United States (0.4), Japan (0), China (0.22), Italy (0.08), and France (0.14) (Table 2). Based on the publishing institutions and national cooperation networks, few cooperative relationships developed among different research institutions, but close cooperation developed among different countries (Figure 3).

Figure 3 Cooperation network of issuing agencies and countries. A: Language agency; B: Country.

Table 2 The 10 institutions and countries with the highest number of publications.

Rank	Published papers, n	Year	Institution	Count	Centrality	Year	Country
1	3	2004	Assistance Publique Hopitaux Paris	58	0.4	2000	United States
2	3	2018	State University System of Florida	24	0	2009	Japan
3	3	2019	Post Graduate Institute of Medical Education & Research	19	0.22	2016	People’s Republic of China
4	3	2016	Harvard University	15	0.08	2001	Italy
5	3	2016	Institut National de la Sante et de la Recherche Medicale	14	0.14	2004	France
6	3	2023	CHU Bordeaux	10	0	2000	India
7	2	2009	Kanazawa University	9	0	2000	Turkey
8	2	2017	Chongqing Medical University	8	0.01	2003	England
9	2	2016	Centre National de la Recherche Scientifique	7	0	2008	South Korea
10	2	2012	University of Tokyo	5	0	2000	Austria

Keyword analysis

Keyword analysis revealed 100 nodes and 271 connections (Figure 4). The three keywords with the highest frequency were abdominal aortic aneurysm (38), abdominal aorta (24), and Takayasu arteritis (22). The three most central keywords were disease (0.69), classification (0.68), and abdominal aortic aneurysm (0.55; Table 3). The first nine clusters of keywords were case report, abdominal aortic aneurysm, Takayasu arteritis, dyspnea hematuria, aortic elastic, IgG4-related disease, report, mid aortic dysplastic syndrome, and statin (Figure 5). In the last 20 years, abdominal aortic aneurysm was the main research content. With the continuous discovery of abdominal aortic aneurysm and its pathogenesis, the treatment of abdominal aortitis and related diseases have attracted more attention.

Figure 4 Keyword cluster analysis diagram.

Figure 5 Keyword time diagram.

Table 3 Main keywords in the treatment of abdominal aortitis from 2000 to 2014.

Keywords	Count	Centrality
Disease	11	0.69
Classification	12	0.68
Abdominal aortic aneurysm	38	0.55
Abdominal aorta	24	0.54
Takayasu arteritis	22	0.50
Giant cell arteritis	9	0.29
Aneurysm	7	0.26
Aortic aneurysm	10	0.24
Experience	8	0.21
Management	15	0.20

Keyword citation outburst

The Burstness algorithm in CiteSpaceV software was used to derive the 14 most sudden keywords from January 1, 2000 to March 12, 2024. The keywords with strong outbursts included Takayasu arteritis, abdominal aortic aneurysm, disease, retroperitoneal fibrosis, expression, management, and large vessel vasculitis. In the past 3 years, the sudden occurrences of abdominal aortic aneurysms (intensity: 4.62) and inflammation (intensity: 1.99) were high, especially abdominal aortic aneurysms (Figure 6).

Figure 6 Top 14 keywords with the strongest citation bursts.

DISCUSSION

The purpose of this study was to visually analyze the research content and hot topics in the field of abdominal aortitis treatment by reviewing the current research status. A total of 210 studies related to the treatment of abdominal aortitis were retrieved from the WOS database. Studies from the past 20 years were objectively sorted. The number of articles published about the treatment of abdominal aortitis increased. The number of articles being published peaked around 2022, suggesting that the field of abdominal aortitis treatment has received the attention of researchers. As the data from 2024 were incomplete, the annual trend for 2024 requires further study.

The research cooperation in abdominal aortitis treatment was relatively close in the early stage, and the authors were scattered in the middle stage. Past Assistance Publique Hopitaux Paris, State University System of Florida, Post Graduate Institute of Medical Education & Research, Institut National de la Sante et de la Recherche Medicale, and CHU Bordeaux published the most papers in the field of abdominal aortitis treatment, and Post Graduate Institute of Medical Education & Research published the most papers in recent years. The institutions with the most frequent publications were in the United States (0.4), Japan (0), China (0.22), Italy (0.08), and France (0.14). The research institutions were scattered and their cooperative relationships in the field of abdominal aortitis treatment were low, but the cooperation between different countries was relatively close. The research teams were mainly composed of medical universities and their affiliated hospitals, and the lack of inter-institutional cooperation was not conducive to the output of scientific research results.

The top nine clustering modules were case report, abdominal aortic aneurysm, Takayasu arteritis, dyspnea hematuria, aortic elastic, IgG4-related disease, report, mid aortic dysplastic syndrome, and statin. A further cluster analysis of keywords showed that the 0 cluster was the largest. The main types of studies on abdominal aortitis were medical records reports. The studies exhibited deficiencies, including incomplete data, sample selection bias, and lack of control. Thus, obtaining effective guidance data was difficult. The second cluster was abdominal aortic aneurysms. The mechanism and treatment of abdominal aortic aneurysms have been widely studied, including the influence of abdominal aortitis on the progression of abdominal aortic aneurysms and the treatment of abdominal aortic aneurysms. Takayasu arteritis is a chronic, progressive, non-specific inflammation of the aorta and its major branches and pulmonary arteries, causing narrowing or occlusion of different parts of the aorta. Inflammatory cells in abdominal aortic inflammation contribute to the pathogenesis of arteritis[10]. The IgG4-related disease is diagnosed from urine test results, involves the lungs, and can cause dyspnea; retroperitoneal and mesentery may also be involved and this involvement manifests as a retroperitoneal perimeter, mesentery region, abdominal para-aortic fiber mass, or abdominal and retroperitoneal lymph node enlargement. Involvement of the aorta can lead to aortitis[11].

The sudden detection of keywords can reveal recent research frontiers. Our results showed that the research focus in the past 3 years was on abdominal aortic aneurysms and inflammation. According to the keyword co-occurrence map analysis, abdominal aortitis is closely related to abdominal aortic aneurysm and inflammation[12]. The research direction of this disease mechanism focused on abdominal aortic lesions[13] and inflammation[14]. An abdominal aortic aneurysm is a local dilation of the lower renal segment of the aorta. Inflammation is a central factor in the development of this disease. A large number of inflammatory cells, including macrophages, T cells, B cells, and neutrophils, infiltrate the aortic wall, suggesting that they play a key role in the development of abdominal aortic disease[15]. Aortitis is a chronic inflammation of the aorta, leading to diffuse wall thickening, loss of elasticity, stenosis, occlusion, dissection, calcification, and aneurysm formation. An abdominal aortic aneurysm develops when the periarteritis spectrum is involved[16]. When the intestinal flora is disturbed, extracellular neutrophil traps rapidly form, leading to abdominal aortic aneurysms[17]. Song et al[18] demonstrated that inhibition of vascular inflammation could prevent the formation of abdominal aortic aneurysms.

Chronic vascular inflammation leads to vascular endothelial injury, which is a common pathological feature of many cardiovascular diseases that aggravate the chronic vascular inflammatory response. Abdominal aortitis is a type of inflammatory disease. Thus, anti-inflammatory treatments to reduce the chronic inflammatory response of the abdominal aorta are the core treatment for abdominal aortitis. Long-term use of steroids and non-steroidal anti-inflammatory agents can lead to serious adverse effects, including gastrointestinal tract damage, cardiovascular damage, and abnormal kidney function[19]. Therefore, abdominal aortitis research is focused on effective anti-inflammatory treatment with low adverse reactions. Callemeyn et al[20] reported a case of non-aneurysmal infectious aortitis (surgery was contraindicated) for which conservative treatment was limited to intravenous vancomycin combined with flucloxacillin; the patient remained healthy 1 year later. Ahmad et al[21] retrospectively analyzed patients with non-infectious great arteritis (median erythrocyte sedimentation rate of 70.0 mm/h and median C-reactive protein of 68.0 mg/L) who were treated with prednisolone and methotrexate due to the difficulty in diagnosing the non-specific symptoms; up to abdom48.3% of patients developed vascular complications, including ischemia, aortic dilation, aneurysm, and arterial dissection. Tang et al[22] showed that coronary artery bypass grafting and “open” stent implantation were effective treatments for syphilitic arteritis. Abdominal aortitis is multifaceted and causes a variety of related diseases, including abdominal aortic aneurysms, inflammatory abdominal aortic aneurysms, and high-safety arteritis. Therefore, the treatment for abdominal aortitis, including aortitis and vasculitis, requires a multi-target comprehensive program. The treatment of abdominal aortitis and related diseases is equally important, and comprehensive countermeasures for the prevention and treatment of aortitis are needed.

At present, researchers pay more attention to abdominal aortic aneurysms and inflammation, which may be the trend in the future. The pathogenesis of abdominal aortic aneurysms involves the activity of inflammatory cells. Benson et al[23] demonstrated that trimethylamine n-oxide derived from intestinal microbes contributes to abdominal aortic aneurysms via inflammation and apoptosis mechanisms. Zhang et al[24] revealed that ganglioside GM3 prevents abdominal aortic aneurysms by inhibiting ferroptosis. Therefore, future development trends may change from abdominal aortitis to abdominal aortic aneurysm and inflammation.

CONCLUSION

From 2010 to 2024, the number of publications related to abdominal aorta treatment in China was stable. The research institutions were mainly affiliated hospitals of medical colleges and universities, but the cooperation among the institutions was not close, indicating that cooperation should be strengthened in the future. Highly productive authors rely on their institutions to form a relatively close cooperation relationship between the small group, the authors of cross-regional or unit cooperation do not do much. The increased focus on abdominal aortitis-related diseases suggests that the study of complications and treatment may be the main research focus in the future, especially for abdominal aortic aneurysms. Targeted treatments for the prevention and control of abdominal aortic aneurysms also require attention.