ORIGINAL RESEARCH article

Front. Neurol., 05 November 2024

Sec. Neurocritical and Neurohospitalist Care

Volume 15 - 2024 | https://doi.org/10.3389/fneur.2024.1433025

The 100 most-cited articles in hypothermic brain protection journals: a bibliometric and visualized analysis

  • 1. Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan Province, China

  • 2. Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, The Affiliated Hospital, Southwest Medical University, Sichuan Province, China

  • 3. Department of Anesthesiology, Fushun County People’s Hospital, Zigong, Sichuan Province, China

Abstract

Introduction:

A bibliometric analysis is used to assess the impact of research in a particular field. However, a specialized bibliometric analysis focused on hypothermic brain protection has not yet been conducted. This study aimed to identify the 100 most-cited articles published in the field of hypothermic brain protection and analyze their bibliometric characteristics.

Methods:

After screening articles from the Web of Science citation database, complete bibliographic records were imported into Python for data extraction. The following parameters were analyzed: title, author’s name and affiliation, country, publication year, publication date, first author, corresponding author, study design, language, number of citations, journal impact factors, keywords, Keywords Plus®, and research topic.

Results:

The 100 articles were published between 1990 and 2016. The citation frequency for each publication ranged from 86 to 470. Among the 100 articles, 73 were original articles, 18 were review articles, 8 were clinical articles, and 1 was editorial material. These papers were published in 37 journals, with the Journal of Cerebral Blood Flow and Metabolism being the most prolific with 15 papers. Eighteen countries contributed to the 100 publications, 51 of which were from United States institutions. In addition, the keywords in the Sankey plot indicated that research in the field of hypothermic brain protection is growing deeper and overlapping with other disciplines.

Discussion:

The results provide an overview of research on hypothermic brain protection, which may help researchers better understand classical research, historical developments, and new discoveries, as well as providing ideas for future research.

Highlights

  • The unique advantage of this study is that it is the first bibliometric study to identify and characterize articles in the field of hypothermic brain protection in all journals of the Science Network (SCIE).

  • Most bibliometric studies exclude nonprofessional journals.

  • We generated a more comprehensive list of the 100 most-cited articles in the field of hypothermic brain protection by including all journals in the analysis.

Introduction

Hypothermic brain protection is an important technique used in neurosurgery to mitigate ischemic and hypoxic injuries. Moreover, lowering the temperature of the brain tissue can protect neurological function (1). Recent research has focused on understanding the mechanisms of hypothermic brain protection and its ability to protect brain functions (2). Hypothermia inhibits the generation of free radicals, reduces apoptosis, and stabilizes cell membrane integrity (3). Clinical methods for hypothermic brain protection include surface, nasopharyngeal, and intravenous cooling (4). However, hypothermia can also lead to complications, such as immunosuppression and renal failure, highlighting the need for further investigation to determine the optimal hypothermic brain protection protocol (5).

Several related studies in the field of hypothermic brain protection have been published in various journals. Analysis of these articles is crucial to evaluate their impact on basic research, clinical practice, and the surgical profession. Bibliometric analysis is an excellent method to assess this impact (6).

Bibliometrics is a discipline that uses quantitative and statistical methods to analyze scientific literature (7). It provides valuable information and reveals the laws and trends in the development of a particular scientific discipline (8). In neurological surgery, bibliometric analysis has been widely applied to analyze research hotspots and developmental trajectories of various diseases, including cerebral aneurysms, stroke, and traumatic brain injury (9–11). This analysis provides guidance for future research directions and resource allocation in the field of neurosurgery. However, specialized bibliometric analyses have not yet been performed in the field of hypothermic brain protection.

Therefore, this study aimed to identify the 100 most-cited articles published in the field of hypothermic brain protection using bibliometric methods. We analyzed their bibliometric characteristics to provide insights into the developments in this field.

Materials and methods

Ethical considerations

This study analyzed and described previously published articles; therefore, no ethical approval was required.

Data sources and search strategies

The Clarivate Analytics’ Web of Science (WOS) (1980–present) citation database was used as the data source to identify articles in the field of hypothermic brain protection and track their citations. Considering the broad range of topics covered in the articles on hypothermia-related brain protection, we conducted a pre-search to determine the best search formula. The last search was conducted on August 21, 2023, using the expressions detailed in Supplementary Table S1. All obtained references, including bibliographic and citation data, were exported from the database and subsequently imported into document management software (Zotero, 6.0.30; https://www.zotero.org/) to remove duplications and screen them. The search strategy produced 1,847 records, listed in descending order, based on the number of citations retrieved from the source database.

Study selection and data extraction

Two independent researchers (Geli and Huang) screened the literature in the database in descending order based on WOS citations. Literature in the field of non-hypothermic brain protection was excluded based on the title and abstract. For uncertain articles, the full text was obtained for accurate inclusion or exclusion determination. During the study selection process, discrepancies between investigators were resolved by a third investigator (Hu). The evaluation was terminated at the 100th paper with the highest number of citations. Finally, the 100 most-cited articles in the field of hypothermic brain protection were listed for further analysis. Complete bibliographic records were exported from the WOS in plain text or Excel (Microsoft Corporation, Redmond, WA, United States) format and imported into Python (version 3.11.5; https://www.python.org/downloads/release/python-3115/) for data extraction.

The following information was extracted using Python and stored in Microsoft Excel (Microsoft Corporation): article title, author, abstract, keywords, year of publication, published journal, cited references, PMID, DOI, total citations, and annual average citations. We also determined the impact factor (IF) of the articles based on the currently published journal citation report (JCR® IF 2023).

Data analysis and visualization

Descriptive statistics of the selected articles were analyzed using Microsoft Excel 2023 (Microsoft Corporation), Python (version 3.11.5), and VOSviewer [version 1.6.20; developed by van Eck and Waltman (12)], a literature knowledge visualization software for constructing a bibliometric network. Before data analysis, the obtained data were standardized. All authors were checked through their institutions or email addresses to eliminate potential confusion from authors sharing the same names and initials, ensuring that they were specific individuals. The names of all institutions, such as universities and research centers, were reviewed and included at the same level, whereas the individual departments or research units under them were removed. Articles from Northern Ireland and Britain were considered to be from the United Kingdom. Different keywords with the same meaning were merged into one term (e.g., head injury and brain injury were collectively classified as brain injury). Some authors in the top 20 articles did not provide keywords (n = 7), and three independent researchers discussed and determined the keywords for these articles based on Keywords Plus®. All references were standardized to create a unified list. Excel (Microsoft Corporation) was used to list the basic characteristics of the selected documents in a tabular form. The bibliometric network was graphically generated using the VOSviewer software (12). In a network visualization map, different nodes represent different elements such as countries, institutions, authors, or terms. The links between nodes represent relationships such as coauthors, co-citations, or co-occurrences, and are weighted by the total link strength (13). Python (version 3.11.5) and R (version 4.3.1; R Foundation for Statistical Computing, Vienna, Austria) were used to construct radar charts describing article types and publication years and a Sankey plot was created to describe the relationships among authors, countries, and keywords. The packages used in Python and R are listed in Supplementary Table S2. The research process is shown in Figure 1.

Figure 1

Results

Citations

The 100 most-cited articles from all journals were published between 1990 and 2016, as shown in Table 1, and are listed in descending order based on the total WOS citation count on the search day (1, 14–112). Additionally, the table includes the year of publication, journal name, IF, first author, corresponding author, and average citations per year count based on WOS data.

Table 1

RankingTitleJCR® IFTotal citationsAverage citationJournalFirst authorCorresponding authorPublished year
1Glutamate release and free-radical production following brain injury—effects of posttraumatic hypothermia4.747016.8Journal of NeurochemistryGlobus, MYTGlobus, MYT1995
2Marked protection by moderate hypothermia after experimental traumatic brain injury6.344013.8Journal of Cerebral Blood Flow and MetabolismClifton, GLDr. G. L. Clifton1991
3Delay in cooling negates the beneficial effect of mild resuscitative cerebral hypothermia after cardiac-arrest in dogs— a prospective, randomized study8.841713.9Critical Care MedicineKuboyama, KPeter Safar1993
4Therapeutic modulation of brain temperature—relevance to ischemic brain injury6.941613.4Cerebrovascular and Brain Metabolism ReviewsGinsberg, MDGinsberg, MD1992
5Intraischemic but not postischemic brain hypothermia protects chronically following global forebrain ischemia in rats6.341013.7Journal of Cerebral Blood Flow and MetabolismDietrich, WDDietrich, WD1993
6Delayed postischemic hypothermia—a 6 month survival study using behavioral and histological assessments of neuroprotection5.340914.6Journal of NeuroscienceColbourne, FFrederick Colbourne1995
7Mild intraoperative hypothermia during surgery for intracranial aneurysm158.534519.2New England Journal of MedicineTodd, MMTodd, MM2005
8Effects of hypothermia on energy metabolism in mammalian central nervous system6.332816.4Journal of Cerebral Blood Flow and MetabolismErecinska, MErecinska, M2003
9Protective effects of moderate hypothermia after neonatal hypoxia-ischemia: short-and long-term outcome3.627310.9Pediatric ResearchBona, EThoresen, M1998
10Posttraumatic brain hypothermia reduces histopathological damage following concussive brain injury in the rat12.72719.3Acta NeuropathologicaDietrich, WDDietrich, WD1994
11The effect of hypothermic cardiopulmonary bypass and total circulatory arrest on cerebral metabolism in neonates, infants, and children62588.1Journal of Thoracic and Cardiovascular SurgeryGreeley, WJGreeley, WJ1991
12Brain temperature alters hydroxyl radical production during cerebral ischemia reperfusion in rats6.32489.2Journal of Cerebral Blood Flow and MetabolismKil, HYDr. C. A. Piantadosi1996
13Environment-, drug- and stress-induced alterations in body temperature affect the neurotoxicity of substituted amphetamines in the C57BL/6J mouse3.52378.2Journal of Pharmacology and Experimental TherapeuticsMiller, DBMiller, DB1994
14Induced hypothermia in critical care medicine: a review8.823311.7Critical Care MedicineBernard, SABernard, SA2003
15Antegrade cerebral perfusion with cold blood: a 13-year experience4.62289.5Annals of Thoracic SurgeryBachet, JBachet, J1999
16Treatment advances in neonatal neuroprotection and neurointensive care4821918.3Lancet NeurologyJohnston, Michael VJohnston, MV2011
17The relationship among canine brain temperature, metabolism, and function during hypothermia8.82136.7AnesthesiologyMichenfelder, JDMichenfelder, JD1991
18Xenon and hypothermia combine to provide neuroprotection from neonatal asphyxia11.221311.8Annals of NeurologyMa, DQMaze, M2005
19Low environmental temperatures or pharmacological agents that produce hypothermia decrease methamphetamine neurotoxicity in mice2.91856.4Brain ResearchAli, SFAli, SF1994
20Whole-body hypothermia for neonatal encephalopathy: animal observations as a basis for a randomized, controlled pilot study in term infants81808.6PediatricsShankaran, SShankaran, S2002
21Moderate hypothermia mitigates neuronal damage in the rat-brain when initiated several hours following transient cerebral-ischemia12.71776.1Acta NeuropathologicaCoimbra, CC. Coimbra1994
22Mild hypothermia reduces apoptosis of mouse neurons in vitro early in the cascade6.31768.4Journal of Cerebral Blood Flow and MetabolismXu, LJGiffard, RG2002
23Long-lasting neuroprotective effect of postischemic hypothermia and treatment with an anti-inflammatory/antipyretic drug—evidence for chronic encephalopathic processes following ischemia8.31766.5StrokeCoimbra, CCoimbra, C1996
24Posthypoxic cooling of neonatal rats provides protection against brain injury4.41746.4Archives of Disease in Childhood-fetal and Neonatal EditionThoresen, MDr. Marianne Thoresen1996
25Xenon and hypothermia combine additively, offering long-term functional and histopathologic neuroprotection after neonatal hypoxia/ischemia8.317411.6StrokeHobbs, CatherineThoresen, M2008
26Chronic histopathological consequences of fluid-percussion brain injury in rats: effects of post-traumatic hypothermia12.71696.5Acta NeuropathologicaBramlett, HMBramlett, HM1997
27Effect of hypothermia on cerebral blood flow and metabolism in the pig4.61688.0Annals of Thoracic SurgeryEhrlich, MPGriepp, RB2002
28Indefatigable ca1 sector neuroprotection with mild hypothermia induced 6 h after severe forebrain ischemia in rats6.31636.8Journal of Cerebral Blood Flow and MetabolismColbourne, FColbourne, F1999
29Brain injury following trial of hypothermia for neonatal hypoxic-ischaemic encephalopathy4.916114.6Archives of Disease in Childhood-Fetal and Neonatal EditionShankaran, SeethaShankaran, S2012
30Protective effects of brain hypothermia on behavior and histopathology following global cerebral-ischemia in rats2.91585.1Brain ResearchGreen, EJGreen, EJ1992
31RBM3 mediates structural plasticity and protective effects of cooling in neurodegeneration64.815519.4NaturePeretti, DiegoMallucci, GR2015
32Hypothermia prevents ischemia-induced increases in hippocampal glycine concentrations in rabbits8.31524.8StrokeBaker, AJDr. M. H. Zornow1991
33Influence of mild hypothermia on inducible nitric oxide synthase expression and reactive nitrogen production in experimental stroke and inflammation5.31487.0Journal of NeuroscienceHan, HSYenari, MA2002
34Mild hypothermia inhibits inflammation after experimental stroke and brain inflammation8.31467.3StrokeDeng, HYenari, MA2003
35General versus specific actions of mild-moderate hypothermia in attenuating cerebral ischemic damage6.31459.1Journal of Cerebral Blood Flow and MetabolismZhao, HengZhao, H2007
36The importance of brain temperature in cerebral injury4.21434.6Journal of NeurotraumaDietrich, WDDietrich, WD1992
37Protection against hippocampal ca1 cell loss by postischemic hypothermia is dependent on delay of initiation and duration3.61424.6Metabolic Brain DiseaseCarroll, MCarroll, M1992
38Co-administration of MDMA with drugs that protect against MDMA neurotoxicity produces different effects on body temperature in the rat3.51425.3Journal of Pharmacology and Experimental TherapeuticsMalberg, JEKaren Sabol1996
39Twenty-four hours of mild hypothermia in unsedated newborn pigs starting after a severe global hypoxic-ischemic insult is not neuroprotective3.61386.3Pediatric ResearchThoresen, MThoresen, M2001
40Posttraumatic brain hypothermia provides protection from sensorimotor and cognitive-behavioral deficits4.21354.8Journal of NeurotraumaBramlett, HMEdward J. Green1995
41Hypothermia for acute brain injury-mechanisms and practical aspects38.113412.2Nature Reviews NeurologyChoi, H. AlexMayer, SA2012
42Hypothermia as a potential treatment for cerebral-ischemia1314.4Cerebrovascular and Brain Metabolism ReviewsMaher, J1993
43Systemic inflammatory challenges compromise survival after experimental stroke via augmenting brain inflammation, blood-brain barrier damage and brain oedema independently of infarct size9.313010.8Journal Of NeuroinflammationDenes, AdamDenes, A2011
44Hibernation in ground squirrels induces state and species-specific tolerance to hypoxia and aglycemia: an in vitro study in hippocampal slices6.31285.1Journal of Cerebral Blood Flow and MetabolismFrerichs, KUFrerichs, KU1998
45Hypothermia in the management of traumatic brain injury—a systematic review and meta-analysis38.91276.4Intensive Care MedicineHenderson, WRHenderson, WR2003
46Protection in animal models of brain and spinal cord injury with mild to moderate hypothermia4.21258.9Journal of NeurotraumaDietrich, W. DaltonDietrich, WD2009
47A comfortable hypothesis reevaluated—cerebral metabolic depression and brain protection during ischemia8.81254.0AnesthesiologyTodd, MMTodd, MM1992
48Delayed induction of mild hypothermia to reduce infarct volume after temporary middle cerebral-artery occlusion in rats4.11254.3Journal of NeurosurgeryKaribe, HPhilip R. Weinstein1994
49Neuroprotection after several days of mild, drug-induced hypothermia6.31244.6Journal of Cerebral Blood Flow and MetabolismNurse, SNurse, S1996
50Selective antegrade cerebral perfusion and mild (28°C–30°C) systemic hypothermic circulatory arrest for aortic arch replacement: results from 1002 patients612411.3Journal of Thoracic and Cardiovascular SurgeryZierer, AndreasZierer, A2012
51Effects of isoflurane and hypothermia on glutamate receptor-mediated calcium influx in brain-slices8.81234.2AnesthesiologyBickler, PEBickler, PE1994
52Cirp protects against tumor necrosis factor-alpha-induced apoptosis via activation of extracellular signal-regulated kinase5.11237.2Biochimica et Biophysica Acta-Molecular Cell ResearchSakurai, ToshiharuFujita, J2006
53Neuroprotective adaptations in hibernation: therapeutic implications for ischemia-reperfusion, traumatic brain injury and neurodegenerative diseases7.41225.5Free Radical Biology and MedicineDrew, KLDrew, KL2001
54A comparison of the cerebral protective effects of isoflurane and mild hypothermia in a model of incomplete forebrain ischemia in the rat8.81223.9AnesthesiologySano, TDrummond1992
55Therapeutic hypothermia: neuroprotective mechanisms3.11217.6Frontiers in Bioscience-LandmarkLiu, LipingYenari, MA2007
56Temperature modulation of ischemic neuronal death and inhibition of calcium calmodulin-dependent protein kinase-ii in gerbils8.31203.6StrokeChurn, SBRobert J. DeLorenzo1990
57Resuscitative hypothermia8.81194.4Critical Care MedicineMarion, DWMarion, DW1996
58Mild-to-moderate hypothermia in aortic arch surgery using circulatory arrest: a change of paradigm?3.411810.7European Journal of Cardio-Thoracic SurgeryUrbanski, Paul PUrbanski, PP2012
59Persistent neuroprotection with prolonged postischemic hypothermia in adult rats subjected to transient middle cerebral artery occlusion5.31185.1Experimental NeurologyCorbett, DColbourne, F2000
60Metabolic downregulation—a key to successful neuroprotection?8.31187.9StrokeYenari, MidoriYenari, M2008
61Cooling combined with immediate or delayed xenon inhalation provides equivalent long-term neuroprotection after neonatal hypoxia-ischemia6.31188.4Journal of Cerebral Blood Flow and MetabolismThoresen, MarianneDingley, J2009
62Antegrade selective cerebral perfusion in thoracic aorta surgery: safety of moderate hypothermia3.11177.3European Journal of Cardio-Thoracic SurgeryPacini, DavidePacini, D2007
63Occurrence of potentially detrimental temperature alterations in hospitalized patients at risk for brain injury8.91174.7Mayo Clinic ProceedingsAlbrecht, RFLanier, WL1998
64Influence of hypothermia on post-ischemic inflammation: role of nuclear factor kappa B (NFkappaB)4.21166.8Neurochemistry InternationalYenari, Midori AYenari, MA2006
65Mild posttraumatic hypothermia reduces mortality after severe controlled cortical impact in rats6.31154.3Journal of Cerebral Blood Flow and MetabolismClark, RSBP. M. Kochanek1996
66Topiramate extends the therapeutic window for hypothermia-mediated neuroprotection after stroke in neonatal rats8.31156.1StrokeLiu, YQSilverstein, FS2004
67Low-flow hypothermic cardiopulmonary bypass protects the brain61143.6Journal of Thoracic and Cardiovascular SurgerySwain, JAJulie Swain1991
68Posttraumatic hypothermia in the treatment of axonal damage in an animal model of traumatic axonal injury4.11124.5Journal of NeurosurgeryKoizumi, HPovlishock, JT1998
69Regulation of therapeutic hypothermia on inflammatory cytokines, microglia polarization, migration and functional recovery after ischemic stroke in mice6.111015.7Neurobiology of DiseaseLee, Jin HwanYu, SP2016
70Cooling the injured brain: how does moderate hypothermia influence the pathophysiology of traumatic brain injury3.11096.8Current Pharmaceutical DesignSahuquillo, JuanSahuquillo, J2007
71A study of brain protection during total arch replacement comparing antegrade cerebral perfusion versus hypothermic circulatory arrest, with or without retrograde cerebral perfusion: analysis based on the japan adult cardiovascular surgery database610813.5Journal of Thoracic and Cardiovascular SurgeryOkita, YutakaOkita, Y2015
72Effects of pH on brain energetics after hypothermic circulatory arrest4.61073.6Annals of Thoracic SurgeryAoki, MDr. Jonas1993
73Postischemic hypothermia and il-10 treatment provide long-lasting neuroprotection of ca1 hippocampus following transient global ischemia in rats5.31064.4Experimental NeurologyDietrich, WDDietrich, WD1999
74Moderate posttraumatic hypothermia decreases early calpain-mediated proteolysis and concomitant cytoskeletal compromise in traumatic axonal injury5.31024.3Experimental NeurologyBuki, ABuki, A1999
75Protective effects of moderate hypothermia on behavioral deficits but not necrotic cavitation following cortical impact injury in the rat4.21014.0Journal of NeurotraumaDixon, CEHayes, RL1998
76Mild hypothermia attenuates cytochrome c release but does not alter Bcl-2 expression or caspase activation after experimental stroke6.31004.8Journal of Cerebral Blood Flow and MetabolismYenari, MAYenari, MA2002
77Moderate hypothermia and unilateral selective antegrade cerebral perfusion: a contemporary cerebral protection strategy for aortic arch surgery4.61007.7Annals of Thoracic SurgeryLeshnower, Bradley GChen, EP2010
78Prolonged mild hypothermia therapy protects the brain against permanent focal ischemia8.3984.5STROKEYanamoto, HYanamoto, H2001
79Role of hypothermia in the mechanism of protection against serotonergic toxicity. II. Experiments with methamphetamine, p-chloroamphetamine, fenfluramine, dizocilpine and dextromethorphan3.5983.5Journal of Pharmacology and Experimental TherapeuticsFarfel, GMLewis Seiden1995
80Intracerebral temperature in neurosurgical patients4.8983.1NeurosurgeryMellergard, PMellergard, P1991
81Therapeutic hypothermia for acute stroke48964.8Lancet NeurologyOlsen, TSOlsen, TS2003
82Cerebral oxygen-metabolism during hypothermic circulatory arrest in humans4.1963.2Journal of NeurosurgeryAusman, JIAusman, JI1993
83Prospective randomized trial of normothermic versus hypothermic cardiopulmonary bypass on cognitive function after coronary artery bypass graft surgery8.8954.3AnesthesiologyGrigore, AMNewman, MF2001
84Delayed, spontaneous hypothermia reduces neuronal damage after asphyxial cardiac arrest in rats8.8954.1Critical Care MedicineHickey, RWHickey, RW2000
85Combination of systemic hypothermia and n-acetylcysteine attenuates hypoxic-ischemic brain injury in neonatal rats3.6945.5Pediatric ResearchJatana, MJenkins, D2006
86Mild intraischemic hypothermia suppresses consumption of endogenous antioxidants after temporary focal ischemia in rats2.9943.2Brain ResearchKaribe, HPhilip R. Weinstein1994
87Therapeutic time window of post-ischemic mild hypothermia and the gene expression associated with the neuroprotection in rat focal cerebral ischemia2.9945.9Neuroscience ResearchOhta, HiroyukiShintani, Y2007
88Hypothetical pathophysiology of acute encephalopathy and encephalitis related to influenza virus infection and hypothermia therapy1.4934.0Pediatrics InternationalYokota, SYokota, S2000
89Effect of delayed MK-801 (dizocilpine) treatment with or without immediate postischemic hypothermia on chronic neuronal survival after global forebrain ischemia in rats6.3933.3Journal of Cerebral Blood Flow and MetabolismDietrich, WDDietrich, WD1995
90Mild postischemic hypothermia limits cerebral injury following transient focal ischemia in rat neocortex2.9933.4Brain ResearchYanamoto, HKevin S. Lee1996
91Regional alterations of protein-kinase-c activity following transient cerebral-ischemia—effects of intraischemic brain temperature modulation4.7893.1Journal Of NeurochemistryBusto, RBusto, R1994
92Treatment window for hypothermia in brain injury4.1884.0Journal of NeurosurgeryMarkgraf, CGMarkgraf, CG2001
93Behavioral protection by moderate hypothermia initiated after experimental traumatic brain injury4.2882.9Journal of NeurotraumaLyeth, BGLyeth, BG1993
94Novel thyroxine derivatives, thyronamine and 3-iodothyronamine, induce transient hypothermia and marked neuroprotection against stroke injury8.3885.5StrokeDoyle, Kristian PStenzel-Poore, MP2007
95Mild to moderate hypothermia prevents microvascular basal lamina antigen loss in experimental focal cerebral ischemia8.3884.6StrokeHamann, GFHamann, GF2004
96Diminished neuronal damage in the rat brain by late treatment with the antipyretic drug dipyrone or cooling following cerebral ischemia12.7883.3Acta NeuropathologicaCoimbra, CCoimbra, C1996
97Therapeutic hypothermia alters microrna responses to traumatic brain injury in rats6.3877.3Journal of Cerebral Blood Flow and MetabolismTruettner, Jessie SDietrich, WD2011
98Role of hypothermia in the mechanism of protection against serotonergic toxicity. I. Experiments using 3,4-methylenedioxymethamphetamine, dizocilpine, CGS 19755 and NBQX3.5873.1Journal of Pharmacology and Experimental TherapeuticsFarfel, GMLewis Seiden1995
99The relationship between intelligence and duration of circulatory arrest with deep hypothermia6873.1Journal of Thoracic and Cardiovascular SurgeryOates, RKOates, RK1995
100Delayed onset of prolonged hypothermia improves outcome after intracerebral hemorrhage in rats6.3864.5Journal of Cerebral Blood Flow and MetabolismMacLellan, CLColbourne, F2004

List of the 100 most-cited articles in hypothermic brain protection journals.

JCRIF, Journal Citation Reports Impact Factor; average citations, average number of citations per year since publication.

The citation frequency of these 100 studies ranged from 86 to 470 times (mean = 156), with the average annual citation volume ranging from 2.9 to 19.4 times (mean = 7.3). The median publication year for these articles is 1999. Approximately one-fifth of the articles (n = 18) were cited more than 200 times, and only six articles were cited more than 400 times. The most-cited article, titled “Glutamate release and free radical production following brain injury: effects of posttraumatic hypothermia” was published by Globus et al. (14) in the Journal of Neurochemistry in 1995 and has 470 citations to date.

We also created a network visualization based on the number of citations per article (Figure 2). Globus et al. (14), Clifton et al. (15), Kuboyama et al. (16), Ginsberg et al. (17), Dietrich et al. (18), and Colbourne et al. (19) all received more than 400 citations, making them the largest nodes in the graph. Todd et al. (20) and Erecinska et al. (21) also received a high number of citations.

Figure 2

Years and types of publications

Among the 100 most-cited articles, 1991–1996 had the most publications (n = 42) (Figure 3), with the highest number of publications occurring in 1996 (n = 9) and a smaller peak occurring in 2007 (n = 6). The lowest numbers of publications occurred in 1990, 1997, 2010, and 2016 (n = 1). Among the types of published articles, randomized controlled trials were the most common (n = 73), followed by reviews (n = 18), whereas case reports, clinical studies, and other types of articles were the least common (n = 9) (Table 2).

Figure 3

Table 2

Study typeCount
Randomized Controlled Trial73
Review18
Clinical Trial3
Comparative Study3
Clinical Research1
Case Reports1
Editorial1
Total count100

Statistics on the types of studies in the 100 most-cited articles.

Contributing authors

We established a collaborative network based on the authors who published two or more papers (Figure 4). Dietrich, Ginsberg, and Busto published the most relevant articles; therefore, their nodes were the largest. In addition, we observed close collaboration among multiple authors. For example, Dietrich closely cooperated with Busto, Alonso, and others (Figure 4A). More detailed and specific collaborations between the authors can be found in the author coupling diagram (Figure 4B). There are five main color classifications, with yellow representing authors such as Dietrich, Busto, and Ginsberg, who have the highest collaborations. There are many collaborations among the authors, represented in green, such as Markgraf, Clifton, and Marion. The authors represented in red, such as Yenari, Steinberg, Chan, and Graham, strongly cooperated with each other. The authors represented in blue, such as Colbourne, Wieloch, Corbett, and Yanamoto, strongly cooperated with each other. Purple represents authors such as Thoresen, Loberg, and Chakkarapani, who participated in many collaborations.

Figure 4

Contributing countries and institutions

Visual networks and statistical charts were developed for both countries and their institutions. The 100 most-cited articles included 136 countries/regions and 258 institutions. The maps clearly indicated the presence of clusters. It is evident from the number of publications and international cooperation that the United States has the greatest influence among many countries. In addition, Japan has established strong scientific relationships with countries such as Germany, Canada, and Sweden (Figure 5). Among the countries that published articles, the United States (n = 51), the United Kingdom (n = 8), and Japan (n = 8) had the highest number of published articles, whereas the remaining articles were scattered among other countries (Table 3).

Figure 5

Table 3

JournalCountryYearCount
Journal of Cerebral Blood Flow and MetabolismUnited States198115
StrokeUnited States197010
AnesthesiologyUnited States19405
Journal of NeurotraumaUnited States19845
Journal of Thoracic and Cardiovascular SurgeryUnited States19365
Acta NeuropathologicaGermany19614
Annals of Thoracic SurgeryUnited States19654
Brain ResearchNetherlands19664
Critical Care MedicineUnited States19734
Journal of NeurosurgeryUnited States19444
Journal of Pharmacology and Experimental TherapeuticsUnited States19094
Experimental NeurologyUnited States19593
Pediatric ResearchUnited States19673
Archives of Disease in Childhood-Fetal and Neonatal EditionUnited Kingdom19962
Cerebrovascular and Brain Metabolism ReviewsUnited States19892
European Journal of Cardio-Thoracic SurgeryNetherlands19872
Journal of NeurochemistryUnited States19562
Journal of NeuroscienceUnited States19812
Lancet NeurologyUnited Kingdom20022

Countries of the 100 articles in hypothermic brain protection journals.

Multiple institutions also formed regional cooperative networks. The University of Miami has close cooperation with the University of Texas, the University of Pittsburgh, and others. Stanford University has close cooperation with Duke University, the University of California, San Francisco University, and others. The Memorial University of Newfoundland cooperates closely with Emory University, Yale University, and others (Figure 6).

Figure 6

Journal of publication

Journals with at least two publications and their main characteristics are listed in Table 4. There are 19 journals on the list, and the two journals with the highest publication volumes in the field of hypothermic brain protection are the Journal of Cerebral Blood Flow and Metabolism and Stroke, with 15 and 10 articles published, respectively. Additionally, five articles were published in Anesthesiology, the Journal of Neurotrauma, and the Journal of Thoracic and Cardiovascular Surgery.

Table 4

CountryCount
USA51
Japan8
UK8
Canada6
Sweden5
Germany4
Norway3
Australia2
China2
Wales2
Hungary2
Italy1
Israel1
France1
Austria1
Denmark1
South Korea1
SPAIN1
Total count100

Journal distribution and main characteristics of the 100 most-cited articles on hypothermic brain protection.

The minimum number of articles from any one journal is ≥2. SJR, SCImago Journal Rank 2022; cites/doc: total citations/total documents; Year: journal establishment year.

Research topics

The relationships among the authors, countries, and research keywords of the 20 most-cited articles in hypothermic brain protection journals are shown in Figure 7. Other keywords related to hypothermic brain protection with a high frequency of occurrence included hyperthermia, dopamine, ischemia, metabolism, surgery, and trauma.

Figure 7

Discussion

With continuous advances in science and technology, research in the biomedical field is expanding in terms of breadth and depth, leading to an exponential increase in the number of related studies (113). Effectively screening useful information from this vast body of literature poses a major challenge for researchers. Bibliometric analysis, a key tool in modern medical research, allows researchers to quantitatively analyze scientific literature to reveal development dynamics and trends in the research field. Using bibliometric analysis, researchers can better understand the development of a discipline, identify cutting-edge fields and research hotspots, evaluate the impact and quality of academic achievements, and provide valuable references and guidance for future medical research and strategic planning (10).

Hypothermic brain protection is a key area of medical research aimed at reducing brain injury and improving the tolerance to cerebral ischemia, trauma, and other conditions. Hypothermic brain protection techniques have shown potential neuroprotective effects in patients with neurological ischemia or injury (114–116). Although there are challenges to its clinical application, research on hypothermic brain protection is advancing, providing new ideas and methods for improving the treatment of brain injuries and neurological diseases.

The research that is most cited in a specific field is often considered a milestone and can be referred to as “classic (117, 118).” The frequency of citations in a paper generally reflects its importance, indicating that it has gained recognition from researchers in the relevant field as well as sparking discussions and guiding new research directions (119, 120). Owing to its pioneering contributions, this study provides important reference values for further analysis. This study identified and analyzed the 100 most-cited articles in the field of hypothermic brain protection, providing an historical overview of the development of the research field over time, defining interesting trends, and potentially offering clues for the future development of basic research and clinical practice in hypothermic brain protection.

Since Busto et al. (121, 122) first proposed the use of mild hypothermia (33–35°C) to treat brain injuries in the 1980s, experts have recognized its protective effects on the body, particularly on the brain. The question of whether lowering body temperature to induce hypothermia can effectively shield the brain has sparked interest in clinical and basic research. The 100 most cited articles listed in this study have shown that hypothermia can improve brain function and provide significant protection (1, 14–112). The current mechanisms of hypothermic brain protection include reducing brain energy metabolism, protecting the blood brain barrier, decreasing brain swelling and pressure, preventing lactic acid accumulation, limiting the release of harmful amino acids, blocking the detrimental effects of calcium, inhibiting nitric oxide production, reducing the generation of oxygen radicals, enhancing the elimination of oxygen radicals, suppressing the expression of genes associated with cellular damage, and reducing inflammation and neuronal cell death (2, 123).

Hypothermic brain protection is used to lower a patient’s body or brain temperature to decrease brain oxygen consumption and facilitate recovery (124). Mild hypothermia (33–35°C) and moderate hypothermia (28–32°C) are commonly used, and studies have indicated that 33°C is the optimal temperature for treatment (125). Deep hypothermia (17–27°C) is reserved for specific patients (for example, those with aortic stenosis or aortic dissection) due to more severe complications (126).

However, some recent large-scale clinical studies have refuted this view. In a study conducted in 2005 to determine whether hypothermia during craniotomy can improve the prognosis of patients with acute aneurysmal subarachnoid hemorrhage, there was no significant difference in hospitalization time, total hospitalization time, or follow-up mortality in the intensive care unit between the hypothermia group and the normal temperature group during craniotomy (20). Another randomized controlled trial published in 2010 showed no correlation between intraoperative hypothermia or supplementation of protective drugs and neurological prognosis in patients undergoing temporary clipping during cerebral aneurysm surgery (127). At the same time, some systematic reviews also expound similar viewpoints (128–130).

There is a guideline stating that the duration of brain hypothermia should be sufficient to provide brain protection (131). For patients with craniocerebral injury, it is challenging to achieve favorable clinical outcomes with short-term (24–48 h) mild hypothermia treatment. It is recommended that the duration of mild hypothermia treatment for such patients be maintained for at least 3–5 days. Therefore, additional research is required to determine the appropriateness of utilizing low temperatures in varying circumstances, along with the corresponding low-temperature strategy and duration of maintenance.

The most-cited studies in the field of hypothermic brain protection generally describe the effects of posttraumatic hypothermia on neuronal damage in rats with traumatic brain injury (TBI) (14). Research has shown that TBI leads to a significant increase in the glutamate and hydroxyl radical levels in the brain, with a positive correlation between these two factors. Post-traumatic hypothermia effectively suppresses these elevations, indicating a potential link between glutamate release and hydroxyl radical production in the brain after TBI. This groundbreaking discovery has had a significant guiding influence on clinical treatment, making it the most influential article. Six articles, with a total citation count of over 400 in this field, can be referred to as “classics.” The six authors and their teams—Globus et al. (14), Clifton et al. (15), Kuboyama et al. (16), Ginsberg et al. (17), Dietrich et al. (18), and Colbourne et al. (19)—have all made significant contributions to further research in the field of hypothermic brain protection.

The temporal distribution of these 100 articles revealed that they were published between 1990 and 2016, whereas the years that produced a relatively large number of highly influential articles were 1991–1996 and 2007. Furthermore, it must be emphasized that the total citation count of publications over the past 3 years may have been underestimated, considering that recently-published articles will take time to attract citations. Over time, an increasing number of recently-published studies have become highly cited (132). Among the 100 articles, the proportion of basic research was the highest (n = 73), followed by reviews (n = 18), whereas the proportions of clinical research and case reports were low (n = 8). These findings indicate that although we have observed the protective effect of hypothermia, we still have only a partial understanding of its mechanism, and the study of the specific mechanism of hypothermic brain protection remains a hot topic (123).

Regarding countries and institutions, most of the 100 most-cited articles in the field of hypothermic brain protection were from the United States (n = 51), which also had an overwhelming number of citations, indicating that the United States is the most influential country in this field. The United States has always led the world in the field of hypothermic brain protection research, and its continuously innovative medical technology and cutting-edge research results have inspired tremendous progress. The most-cited authors were from the United States. The University of Miami and Stanford University the institutions with the most cited articles, reflecting their authority in the field of hypothermic brain protection (35, 39). In terms of international cooperation, the United States cooperates closely with multiple countries, whereas Japan cooperates closely with Germany, the United Kingdom, and Sweden. At the institutional level, Stanford University cooperates closely with the University of California, Emory University, and Duke University (42).

The most-cited research in this field is more likely to be published in highly-influential neurosurgical journals such as the Journal of Cerebral Blood Flow and Metabolism and Stroke (15, 36). In addition, several studies published in these journals, apart from those in the field of neurosurgery, involve the intersection of anesthesia and critical care, as well as pediatrics and neurosurgery, such as anesthesiology, critical care medicine, and pediatric research (16, 22, 30). Interestingly, these results suggest that hypothermic brain protection has aroused great interest not only among neurologists but also among anesthesiologists and pediatricians due to its close connection to their clinical work.

The Sankey plot illustrated the relationships among authors, countries, and agreed-upon keywords. The keywords used were further extended to include “hypothermia,” “brain,” “neuroprotection,” “surgery,” “trauma,” “ischemia,” “metabolism,” and others. A relatively novel keyword, “xenon,” was used to explore the treatment of neonatal hypoxic-ischemic brain injury (31, 38, 73). The experimental data from these studies showed that low-concentration xenon combined with mild hypothermia may be a safe and effective treatment for perinatal asphyxia. Most articles mentioned keywords such as “hypothermia” and “neuroprotection” in their titles; however, a few articles do not mention them. We recommend that the terms “hypothermia” and “neuroprotection” are included in the title so readers can easily identify the nature of the article and index it in search databases.

Keywords Plus® was used with the Clarivate Analytics1 algorithm, which is based on repeated words or phrases appearing in the reference lists of indexed articles (133). In the absence of author keywords, Keywords Plus® is considered to have special value. However, compared with keywords, the number of Keywords Plus® was greater, and the concentration of keywords was not strong. The use of Keyword Plus® to construct Sankey plots may have caused data distortion. Therefore, we constructed the Sankey plot using keywords. Seven of the 20 most-cited articles in this field did not provide keywords, and three researchers summarized the keywords after their discussion according to Keywords Plus®.

This study has several limitations. The first limitation is inherent in citation analysis which is based on the absolute number of citations of an article. The number of citations is a substitute for this influence; however many factors can affect the citation rate. Generally the number of citations an article receives reflects its impact and level of recognition by academic and clinical communities. However the number of citations depends on many factors such as factors related to the paper including quality length publication year and literature type; factors related to journals such as journal influence language and publication format; and factors related to the author such as reputation academic ranking and productivity. Second only English versions of the articles were included in the study; however English is the most widely-used language worldwide making it possible for articles published in English to be widely read and cited. Third the search was conducted only on the WOS database which may have resulted in missing several relevant publications from other databases such as Google Scholar Scopus and PubMed. Searching databases from multiple sources can yield more complete citation results because the number of citations varies among databases from different sources (134). However different databases have different reference-counting methods which may be unsuitable for merging data from different databases. Among these databases WOS is one of the most commonly used databases for analyzing highly-cited articles in a particular field (135–137). The fourth limitation was the time factor because the WOS currently covers only articles published after 1980. We may have missed articles published before 1980 with higher citation frequencies than those included in this study. Additionally recently published articles require time to attract citations. Therefore the citation frequency in early studies should be higher than that in recently published studies and some recently-published representative works may not be included. Quotations may not fully represent the true academic value and the impact of a study should be evaluated from all aspects. Future work can start by updating the time periods searching in and merging multiple databases and establishing algorithms for the influence of new and old articles. Nevertheless the results of this study provide valuable insights for researchers.

Conclusion

This bibliometric study offers a comprehensive overview of the advancements, trends, and current trajectories in both basic research and clinical applications within the domain of hypothermic brain protection. By conducting a bibliometric analysis of the WOS database, this study identified and thoroughly analyzed the 100 most impactful articles that have significantly contributed to advancing this field. Rapid growth has been observed in the field of hypothermic brain protection. The United States emerged as a dominant force in terms of the number of highly influential articles, prominent academic institutions, and leading scientists in this area of research. Predominantly, articles in this field focus on basic research and delve into the underlying mechanisms. Keywords, such as “hypothermia” and “neuroprotection” intersect with other fields, enriching the comprehension of mechanisms and broadening their applicability. Continuous and profound research endeavors in this sphere promise a deeper understanding of the molecular pathophysiological mechanisms underlying various diseases, thereby unveiling potential therapeutic targets.

Statements

Data availability statement

The original contributions presented in the study are included in the article/Supplementary material, further inquiries can be directed to the corresponding authors.

Author contributions

LH: Writing – original draft, Visualization, Software, Methodology, Investigation, Data curation, Conceptualization. SG: Writing – original draft, Visualization, Software, Methodology, Data curation. FL: Writing – original draft, Resources, Methodology, Formal analysis, Data curation. LN: Writing – review & editing, Visualization, Resources, Methodology, Funding acquisition, Formal analysis. JW: Writing – review & editing, Validation, Supervision, Resources, Funding acquisition. JZ: Funding acquisition, Writing – review & editing, Supervision. MW: Writing – review & editing, Validation, Supervision, Resources, Project administration, Funding acquisition. YC: Project administration, Methodology, Writing – review & editing, Validation, Funding acquisition.

Funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. The work was supported by the Sichuan Science and Technology Program (2022YFS0632), the Joint Foundation of the Luzhou Government and Southwest Medical University (2021LZXNYD-J28), Southwest Medical University Technology Program (2023QN013), and 2021-year Zigong City Health Commission Project (2021yb077).

Acknowledgments

The authors would like to thank Natalie from Editage (www.editage.cn) for English language editing.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fneur.2024.1433025/full#supplementary-material

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Summary

Keywords

hypothermia, brain protection, surgery, bibliometric analysis, citations highlights

Citation

Hu L, Geli S, Long F, Nie L, Wu J, Zhou J, Wang M and Chen Y (2024) The 100 most-cited articles in hypothermic brain protection journals: a bibliometric and visualized analysis. Front. Neurol. 15:1433025. doi: 10.3389/fneur.2024.1433025

Received

15 May 2024

Accepted

15 October 2024

Published

05 November 2024

Volume

15 - 2024

Edited by

Luis Rafael Moscote-Salazar, Colombian Clinical Research Group in Neurocritical Care, Colombia

Reviewed by

Luis Alberto Camputaro, Specialized Institute “Hospital El Salvador”, El Salvador

Yaoheng Yang, Washington University in St. Louis, United States

Updates

Copyright

*Correspondence: Maohua Wang, Yingxu Chen,

†These authors have contributed equally to this work

Disclaimer

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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