research 1 bvs

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Research 1   (#1700300)

• 2014 - 2015
• 2015 - 2022
• 2022 - And Beyond (current)

Resources related to the standards in this course

Click on the individual standards to find resources, loading...., course standards, general course information and notes, general notes.

The purpose of this course is to enable students to develop fundamental knowledge of the steps in the research process. The content should include, but not be limited to, the following:

• nature and purpose of research
• research questions and hypotheses
• research methods and procedures
• review of literature and other resources
• primary and secondary sources
• directed investigations
• organization of information
• report formats, styles, and content
• critical analysis of research
• submission of a major independent research project

Florida’s Benchmarks for Excellent Student Thinking (B.E.S.T.) Standards This course includes Florida’s B.E.S.T. ELA Expectations (EE) and Mathematical Thinking and Reasoning Standards (MTRs) for students. Florida educators should intentionally embed these standards within the content and their instruction as applicable. For guidance on the implementation of the EEs and MTRs, please visit https://www.cpalms.org/Standards/BEST_Standards.aspx  and select the appropriate B.E.S.T. Standards package.

Qualifications

As well as any certification requirements listed on the course description, the following qualifications may also be acceptable for the course:

Any field when certification reflects a bachelor or higher degree.

General Information

Educator certifications, student resources.

Learn about the Liver, Pancreas, Kidneys, Intestines, and Bladder in this interactive research page.

This is Part 3 in a three-part series on the organs and structures of the Human body.

Type: Original Student Tutorial

Learn how the Space Shuttle program revived the area near Cape Canaveral, Florida, and how the possibility of living in space on the Space Station brought new jobs and excitement with this interactive tutorial.

This is part 2 in a three-part series.

Learn about the early days of NASA, the work at Cape Canaveral during the Moon missions, and how this work affected the people and economy of Florida with this interactive tutorial.

This is part 1 in a three-part series.

Learn more about how to empower and enourage others with your leadership skills in this interactive resiliency tutorial.

Learn to measure and compare the mass of solids as Devin helps Chef Kyle in the bakery with this interactive tutorial.

Learn about the heart, lungs, stomach, brain, and reproductive organs in this interactive research page on the organs and structures of the human body.

This is part 1 in three-part series.

Learn about the water cycle's major stages and the importance of the ocean in the water cycle with this Interactive Science Research Page.

Explore and compare objects in the solar system, including planets, moons, the Sun, comets, and asteroids, with this interactive research page.

Explore how weathering and erosion may have affected Pnyx Hill, the ancient Greek democratic meeting place which influenced our modern government with this interactive tutorial.

Explore excerpts from the extraordinary autobiography  Narrative of the Life of Frederick Douglass , as you examine the author's purpose for writing and his use of the problem and solution text structure. By the end of this interactive tutorial, you should be able to explain how Douglass uses the problem and solution text structure in these excerpts to convey his purpose for writing.

Continue to study George Vest's "Eulogy of the Dog" speech and his use of rhetorical appeals. In Part Two of this two-part series, you'll identify his use of ethos and pathos throughout his speech.

Make sure to complete Part One before beginning Part Two. Click HERE to launch Part One.

Read George Vest's "Eulogy of the Dog" speech in this two-part interactive tutorial. In this series, you'll identify and examine Vest's use of ethos, pathos, and logos in his speech. In Part One, you'll identify Vest's use of logos in the first part of his speech. In Part Two, you'll identify his use of ethos and pathos throughout his speech. 

Make sure to complete both part of this series! Click HERE to launch Part Two.

Continue to study epic similes in excerpts from The Iliad in Part Two of this two-part series. In Part Two, you'll learn about mood and how the language of an epic simile produces a specified mood in excerpts from The Iliad .

Make sure to complete Part One before beginning Part Two. Click HERE to view "That's So Epic: How Epic Similes Contribute to Mood (Part One)."

Learn about how epic similes create mood in a text, specifically in excerpts from The Iliad , in this two-part series.

In Part One, you'll define epic simile, identify epic similes based on defined characteristics, and explain the comparison created in an epic simile.

In Part Two, you'll learn about mood and how the language of an epic simile produces a specified mood in excerpts from The Iliad . Make sure to complete both parts!

Click HERE to view "That's So Epic: How Epic Similes Contribute to Mood (Part Two)." 

Continue to read the famous short story “The Bet” by Anton Chekhov and explore the impact of a fifteen-year bet made between a lawyer and a banker. In Part Two, you’ll cite textual evidence that supports an analysis of what the text states explicitly, or directly. You'll also make inferences, support them with textual evidence, and use them to explain how the bet transformed the lawyer and the banker by the end of the story.

Make sure to complete Part One before  beginning Part Two. Click  HERE  to view Part One.

Make sure to complete Part Three after you finish Part Two. Click HERE to view "Risky Betting: Analyzing a Universal Theme (Part Three)." 

Read the famous short story “The Bet” by Anton Chekhov and explore the impact of a fifteen-year bet made between a lawyer and a banker in this three-part tutorial series.

In Part One, you’ll cite textual evidence that supports an analysis of what the text states explicitly, or directly, and make inferences and support them with textual evidence. By the end of Part One, you should be able to make three inferences about how the bet has transformed the lawyer by the middle of the story and support your inferences with textual evidence.

Make sure to complete all three parts!

Click HERE to launch "Risky Betting: Text Evidence and Inferences (Part Two)."

Click HERE to launch "Risky Betting: Analyzing a Universal Theme (Part Three)." 

Identify rhyme, alliteration, and repetition in Edgar Allan Poe's "The Raven" and analyze how he used these sound devices to affect the poem in this interactive tutorial.

Study excerpts from the classic American novel Little Women by Louisa May Alcott in this interactive English Language Arts tutorial. Using excerpts from chapter eight of  Little Women, you'll identify key characters and their actions. You'll also explain how interactions between characters contributes to the development of the plot. 

Examine how allusions contribute to meaning in excerpts from O. Henry's classic American short story “The Gift of the Magi." In this interactive tutorial, you'll determine how allusions in the text better develop the key story elements of setting, characters, and conflict and explain how the allusion to the Magi contributes to the story’s main message about what it means to give a gift.

Learn to identify imagery in William Shakespeare's "Sonnet 18" and explain how that imagery contributes to the poem's meaning with this interactive tutorial.

Study William Shakespeare's "Sonnet 18" to determine and compare two universal themes and how they are developed throughout the sonnet. 

Explore the form and meaning of William Shakespeare's “Sonnet 18.”  In this interactive tutorial, you’ll examine how specific words and phrases contribute to meaning in the sonnet, select the features of a Shakespearean sonnet in the poem, identify the solution to a problem, and explain how the form of a Shakespearean sonnet contributes to the meaning of "Sonnet 18."

Analyze how O. Henry uses details to address the topics of value, sacrifice, and love in his famous short story, "The Gift of the Magi." In this interactive tutorial, you'll also determine two universal themes of the story.

Explore key story elements in more excerpts from the classic American short story “The Gift of the Magi” by O. Henry.

In Part Two of this two-part series, you'll analyze how important information about two main characters is revealed through the context of the story’s setting and events in the plot. By the end of this tutorial, you should be able to explain how character development, setting, and plot interact in "The Gift of the Magi."

Make sure to complete Part One before beginning Part Two. Click HERE  to launch Part One. 

Explore key story elements in the classic American short story “The Gift of the Magi” by O. Henry. Throughout this two-part tutorial, you'll analyze how important information about two main characters is revealed through the context of the story’s setting and events in the plot. By the end of this tutorial series, you should be able to explain how character development, setting, and plot interact in excerpts from this short story.

Make sure to complete both parts! Click HERE  to view "How Story Elements Interact in 'The Gift of the Magi' -- Part Two."

Learn to distinguish between a gerund phrase that's used as a direct object and a gerund phrase that used as the object of the preposition. In this interactive tutorial, you'll also practice using gerund phrases as a direct object or the object of the preposition in sentences of your own. 

This tutorial is Part Two of a two-part series. Make sure to complete Part One before beginning Part Two. Click HERE  to launch "Spice Up Your Writing Part One: Using Gerund Phrases as Subjects or Subject Complements." 

Read more from the fantasy novel The Princess and the Goblin by George MacDonald in Part Two of this three-part series. By the end of this tutorial, you should be able to compare and contrast the archetypes of two characters in the novel.

Make sure to complete all three parts of this series in order to compare and contrast the use of archetypes in two texts.

Click HERE   to view "Archetypes -- Part One: Examining an Archetype in The Princess and the Goblin ."

Click HERE   to view "Archetypes -- Part Three: Comparing and Contrasting Archetypes in Two Fantasy Stories." 

Learn to determine the important traits of a main character named Princess Irene in excerpts from the fantasy novel  The Princess and the Goblin  by George MacDonald. In this interactive tutorial, you’ll also identify her archetype and explain how textual details about her character support her archetype.  

Click HERE   to view "Archetypes -- Part Two: Examining Archetypes in The Princess and the Goblin. "

Learn to identify aspects of setting and character as you analyze several excerpts from “The Yellow Wallpaper," a chilling short story by Charlotte Perkins Gilman that explores the impact on its narrator of being confined to mostly one room. You'll also determine how the narrator’s descriptions of the story’s setting better reveal her emotional and mental state.

This interactive tutorial is Part One in a two-part series. By the end of Part Two, you should be able to explain how the narrator changes through her interaction with the setting. Click below to launch Part Two.

The Power to Cure or Impair: The Importance of Setting in 'The Yellow Wallpaper' -- Part Two  

Continue to examine several excerpts from the chilling short story “The Yellow Wallpaper” by Charlotte Perkins Gilman, which explores the impact on its narrator of being confined to mostly one room. In Part Two of this tutorial series, you'll determine how the narrator’s descriptions of the story’s setting reveal its impact on her emotional and mental state. By the end of this tutorial, you should be able to explain how the narrator changes through her interaction with the setting.

Make sure to complete Part One before beginning Part Two. Click HERE  to launch "The Power to Cure or Impair: The Importance of Setting in 'The Yellow Wallpaper' -- Part One." 

Explore the mysterious poem “The House on the Hill” by Edwin Arlington Robinson in this interactive tutorial. As you explore the poem's message about the past, you’ll identify the features of a villanelle in the poem. By the end of this tutorial, you should be able to explain how the form of a villanelle contributes to the poem's meaning.

Learn to distinguish between passive and active voice and how to revise sentences by changing them from passive to active voice in this magic-themed tutorial. 

Continue to explore the significance of the famous poem “The New Colossus” by Emma Lazarus, lines from which are engraved on the pedestal of the Statue of Liberty. 

In Part Two of this two-part series, you’ll identify the features of a sonnet in the poem "The New Colossus." By the end of this tutorial, you should be able to explain how the form of a sonnet contributes to the poem's meaning. 

Make sure to complete Part One before beginning Part Two.

Click HERE   to launch "A Giant of Size and Power -- Part One: Exploring the Significance of 'The New Colossus.'"

Continue to examine how setting influences characters in excerpts from The Red Umbrella  by Christina Diaz Gonzalez with this interactive tutorial.

This is part 2 in a two-part series. Make sure to complete Part One first. Click HERE  to launch "Analyzing the Beginning of The Red Umbrella -- Part One: How Setting Influences Events." 

In Part One, explore the significance of the famous poem “The New Colossus” by Emma Lazarus, lines from which are engraved on the pedestal of the Statue of Liberty. 

This famous poem also happens to be in the form of a sonnet. In Part Two of this two-part series, you’ll identify the features of a sonnet in the poem. By the end of this tutorial series, you should be able to explain how the form of a sonnet contributes to the poem's meaning. Make sure to complete both parts!

Click  HERE to launch "A Giant of Size and Power -- Part Two: How the Form of a Sonnet Contributes to Meaning in 'The New Colossus.'"

Explore excerpts from the beginning of the historical fiction novel The Red Umbrella  by Christina Diaz Gonzalez in this two-part series. In Part One, you'll examine how setting influences events. In Part Two, you'll examine how setting influences characters.

Make sure to complete both parts! Click  HERE to launch Part Two.

Learn to distinguish between a gerund phrase that's used as a subject and one that's used as a subject complement. In this interactive tutorial, you'll also practice using gerund phrases as subjects or subject complements in sentences of your own. Using gerund phrases can add detail and variety to your writing.

This is Part One of a two-part series. Click HERE   to launch "Part Two: Using Gerund Phrases as Objects." 

This SaM-1 video provides the students with the optional "twist" for Lesson 17 and the Model Eliciting Activity (MEA) they have been working on in the Grade 3 Physical Science Unit: Water Beach Vacation. 

To see all the lessons in the unit please visit  https://www.cpalms.org/page818.aspx .

This video introduces the students to a Model Eliciting Activity (MEA) and concepts related to conducting experiments so they can apply what they learned about the changes water undergoes when it changes state.  This MEA provides students with an opportunity to develop a procedure based on evidence for selecting the most effective cooler.

This SaM-1 video is to be used with lesson 14 in the Grade 3 Physical Science Unit: Water Beach Vacation. To see all the lessons in the unit please visit  https://www.cpalms.org/page818.aspx .

Learn how to use verbs and verb phrases to convey specific meanings through the use of specific verb tenses: past perfect tense and past perfect progressive tense. 

This interactive tutorial is Part Two in a two-part series. You should complete Part One before beginning Part Two. Click HERE to launch Part One.

Learn how to use verbs and verb phrases to convey specific meanings through the use of specific verb tenses: simple past tense and past progressive tense. 

This interactive tutorial is Part One in a two-part series. In Part Two, you'll explore the use of past perfect tense and past perfect progressive tense. Make sure to complete both parts!

Click HERE to launch Part Two.

Learn how to identify different sources of scientific claims and to evaluate their reliability in this interactive tutorial.

Learn how to use verb phrases in particular tenses to convey specific meanings. In this interactive tutorial, you'll explore the use of four verb tenses: simple future, future progressive, future perfect, and future perfect progressive. 

Learn to enhance your writing with verbs and verb phrases in different tenses to convey specific meanings. In Part Two, you'll work with three perfect tenses: present perfect, past perfect, and future perfect.  

We recommend that you complete Part One before starting Part Two. In Part One, you'll work with three simple tenses: past, present, and future. Click HERE to view Part One.

Learn how verbs and verb phrases can convey specific meanings through the use of three verb tenses--simple present, present progressive, and present perfect--in this interactive tutorial.

Learn to enhance your writing with verbs and verb phrases in different tenses to convey specific meanings. In Part One, you'll work with past tense, present tense, and future tense.

We recommend that you complete Part Two after Part One. In Part Two, you'll work with three tenses: present perfect, past perfect, and future perfect. Click  HERE  to view Part Two.

Learn to enhance your writing by using phrases. In this interactive tutorial, you'll learn about absolute phrases and how they can add interest, depth, and variety to your writing.

Learn to enhance your writing by using phrases. In this interactive tutorial, you'll learn about adverb prepositional phrases. Using adverb prepositional phrases will help add interest, depth, and variety to your writing!

Learn to enhance your writing with two types of phrases that can function like adjectives in a sentence: the participle phrase and the prepositional phrase. In this interactive tutorial, you'll discover how phrases can help add detail and specificity to your writing.

Learn about parallel form in this interactive English Language Arts tutorial. In this tutorial, you'll use parallel form with lists in sentences, identify sentences that contain parallel form and sentences that contain faulty parallelism, and practice editing sentences that contain faulty parallelism. You'll also examine how parallel form can add smoothness, clarity, and gracefulness to your writing. 

Learn to enhance your writing by using prepositional phrases. In this interactive tutorial, you'll learn how prepositional phrases add description and specificity and help make your writing more interesting.

Learn to enhance your writing by using noun phrases in this interactive tutorial. Although noun phrases can be used in many ways, here you'll learn how they can be used as the subject of a sentence or the object of a verb to add interest, detail, and specificity to your writing.

Learn to use commas correctly to set off an introductory clause, phrase, or word at the start of a sentence with this interactive tutorial.

Learn to use commas correctly with this interactive English Language Arts tutorial. You'll review a number of important comma rules, including when not to use a comma, and you'll learn to identify errors in comma usage. 

Learn about two mysterious punctuation marks: quotation marks and the dash. As you complete this interactive tutorial, you'll learn a number of important rules and guidelines to help you use them correctly.

This is Part Two of a two-part series.  Click HERE to launch Part One   to learn about the apostrophe and the ellipsis.

Explore Robert Frost's poem "Mending Wall" and examine words, phrases, and lines with multiple meanings. In this interactive tutorial, you'll analyze how these multiple meanings can affect a reader’s interpretation of the poem.

Learn about four mysterious punctuation marks in this two-part interactive tutorial. In Part One, you'll learn important rules and guidelines to help you correctly use the apostrophe and the ellipsis. 

In Part Two, you'll learn to correctly use quotation marks and the dash. Make sure to complete both parts! Click  HERE to open Part Two.

Examine the topics of transformation and perfection as you read excerpts from the “Myth of Pygmalion” by Ovid and the short story “The Birthmark” by Nathaniel Hawthorne. By the end of this two-part interactive tutorial series, you should be able to explain how the short story draws on and transforms source material from the original myth. 

This tutorial is the second in a two-part series.  Click HERE to launch Part One.

Examine the topics of transformation and perfection as you read excerpts from the “Myth of Pygmalion” by Ovid and the short story “The Birthmark” by Nathaniel Hawthorne. By the end of this two-part interactive tutorial series, you should be able to explain how the short story draws on and transforms source material from the original myth.  

This tutorial is the first in a two-part series. Click HERE to launch Part Two .

Learn three rules for using commas correctly in your writing through use of this interactive English Language Arts tutorial. You'll learn how to join two independent clauses without creating a comma splice, how to identify and offset a nonessential clause in a sentence, and how to use the controversial Oxford comma. 

Learn more about that dreaded word-- plagiarism --in this interactive tutorial that's all about citing your sources, creating a Works Cited page, and avoiding academic dishonesty!

Learn about the ways to correctly use a colon in a sentence by exploring this interactive tutorial! We'll go over contexts where colon use is appropriate, and you'll learn guidelines for colon usage. You'll also learn several important rules for capitalization usage after a colon. By the end, you should be apply to apply these rules to correctly use a colon within a sentence. 

Learn and practice how to use semicolons in this interactive tutorial. You'll learn three important rules for using the semicolon to join clauses together. By the end, you should be able to apply these three rules to correctly use a semicolon within a sentence.

Learn about adverb clauses, a flavorful ingredient that can enhance your sentences. In this interactive tutorial, you'll learn about adverb clauses and how these clauses can add interest, depth, and variety to your writing.

Learn about adjective clauses and how they can add interest, depth, and variety to your writing in this sweet-themed interactive tutorial.

Learn more about that dreaded word-- plagiarism --in this interactive tutorial that's all about citing your sources and avoiding academic dishonesty!

Explore excerpts from Ralph Waldo Emerson's essay "Self-Reliance" in this two-part series. This tutorial is Part Two. In this tutorial, you will continue to examine excerpts from Emerson's essay that focus on the topic of traveling. You'll examine word meanings and determine the connotations of specific words. You will also analyze the impact of specific word choices on the meaning of this portion of the essay.

Make sure to complete Part One first. Click HERE  to launch Part One.

Explore excerpts from Ralph Waldo Emerson's essay "Self-Reliance" in this two-part interactive tutorial series. You will examine word meanings, examine subtle differences between words with similar meanings, and think about the emotions or associations that are connected to specific words. Finally, you will analyze the impact of specific word choices on the meaning of these excerpts.

Make sure to complete both parts! Click HERE to launch Part Two.

Explore excerpts from Ralph Waldo Emerson's essay "Self-Reliance" in this interactive two-part tutorial. This tutorial is Part Two. In this two-part series, you will learn to enhance your experience of Emerson's essay by analyzing his use of the word "genius." You will analyze Emerson's figurative meaning of "genius" and how he develops and refines the meaning of this word over the course of the essay.

Make sure to complete Part One before beginning Part Two. Click HERE  to view Part One.

Learn to enhance your writing by combining clauses. In this interactive tutorial, you'll learn how to combine independent and dependent clauses to add interest, depth, and variety to your writing. 

Explore excerpts from Ralph Waldo Emerson's essay "Self-Reliance" in this interactive two-part tutorial. In Part One, you’ll learn to enhance your experience of a text by analyzing its use of a word’s figurative meaning. Specifically, you'll examine Emerson's figurative meaning of the key term "genius." In Part Two, you’ll learn how to track the development of a word’s figurative meaning over the course of a text. 

Make sure to complete both parts of the tutorial! Click  HERE to launch Part Two.

Practice analyzing word choices in "The Raven" by Edgar Allan Poe, including word meanings, subtle differences between words with similar meanings, and emotions connected to specific words. In this interactive tutorial, you will also analyze the impact of specific word choices on the meaning of the poem.

This is Part Two of a two-part series. Part One should be completed before beginning Part Two. Click  HERE to open Part One.

Practice analyzing word choices in "The Raven" by Edgar Allan Poe in this interactive tutorial. In this tutorial, you will examine word meanings, examine subtle differences between words with similar meanings, and think about emotions connected to specific words. You will also analyze the impact of specific word choices on the meaning of the poem.

This tutorial is Part One of a two-part series on Poe's "The Raven." Click  HERE to open Part Two.

Learn how to create a Poem in 2 Voices in this interactive tutorial. This tutorial is Part Three of a three-part series. In this tutorial, you will learn how to create a Poem in 2 Voices using evidence drawn from a literary text: The Strange Case of Dr. Jekyll and Mr. Hyde by Robert Louis Stevenson.

You should complete Part One and Part Two of this series before beginning Part Three.   

Click HERE to launch Part One. Click HERE to launch Part Two. 

Get ready to travel back in time to London, England during the Victorian era in this interactive tutorial that uses text excerpts from The Strange Case of Dr. Jekyll and Mr. Hyde . This tutorial is Part Two of a three-part series. You should complete Part One before beginning this tutorial. In Part Two, you will read excerpts from the last half of the story and practice citing evidence to support analysis of a literary text. In the third tutorial in this series, you’ll learn how to create a Poem in 2 Voices using evidence from this story. 

Make sure to complete all three parts! Click to  HERE launch Part One. Click  HERE to launch Part Three. 

Learn how authors create mood in a story through this interactive tutorial. You'll read a science fiction short story by author Ray Bradbury and analyze how he uses images, sound, dialogue, setting, and characters' actions to create different moods. This tutorial is Part One in a two-part series. In Part Two, you'll use Bradbury's story to help you create a Found Poem that conveys multiple moods.

When you've completed Part One, click HERE to launch Part Two.

Practice writing different aspects of an expository essay about scientists using drones to research glaciers in Peru. This interactive tutorial is part four of a four-part series. In this final tutorial, you will learn about the elements of a body paragraph. You will also create a body paragraph with supporting evidence. Finally, you will learn about the elements of a conclusion and practice creating a “gift.” 

This tutorial is part four of a four-part series. Click below to open the other tutorials in this series.

• Drones and Glaciers: Eyes in the Sky (Part 1)
• Drones and Glaciers: Eyes in the Sky (Part 2)
• Expository Writing: Eyes in the Sky (Part 3)
• Expository Writing: Eyes in the Sky (Part 4)

Practice citing evidence to support analysis of a literary text as you read excerpts from one of the most famous works of horror fiction of all time,  The Strange Case of Dr. Jekyll and Mr. Hyde. 

This tutorial is Part One of a three-part tutorial. In Part Two, you'll continue your analysis of the text. In Part Three, you'll learn how to create a Poem in 2 Voices using evidence from this story. Make sure to complete all three parts! 

Click  HERE to launch Part Two. Click HERE to launch Part Three. 

Learn how to write an introduction for an expository essay in this interactive tutorial. This tutorial is the third part of a four-part series. In previous tutorials in this series, students analyzed an informational text and video about scientists using drones to explore glaciers in Peru. Students also determined the central idea and important details of the text and wrote an effective summary. In part three, you'll learn how to write an introduction for an expository essay about the scientists' research. 

This tutorial is part three of a four-part series. Click below to open the other tutorials in this series.

• Drones and Glaciers: Eyes in the Sky (Part 2)
• E xpository Writing: Eyes in the Sky (Part 4)

Learn how to identify the central idea and important details of a text, as well as how to write an effective summary in this interactive tutorial. This tutorial is the second tutorial in a four-part series that examines how scientists are using drones to explore glaciers in Peru. 

This tutorial is part two of a four-part series. Click below to open the other tutorials in this series.

Learn about how researchers are using drones, also called unmanned aerial vehicles or UAVs, to study glaciers in Peru. In this interactive tutorial, you will practice citing text evidence when answering questions about a text.

This tutorial is part one of a four-part series. Click below to open the other tutorials in this series.

• Drones and Glaciers: Eyes in the Sky (Part 1)

Learn how to avoid plagiarism in this interactive tutorial. You will also learn how to follow a standard format for citation and how to format your research paper using MLA style. Along the way, you will also learn about master magician Harry Houdini. This tutorial is Part Two of a two-part series on research writing.

Be sure to complete Part One first. Click to view Part One .

Learn about paraphrasing and the use of direct quotes in this interactive tutorial about research writing. Along the way, you'll also learn about master magician Harry Houdini. This tutorial is part one of a two-part series, so be sure to complete both parts.

Check out part two— Avoiding Plaigiarism: It's Not Magic here .

Learn how to create a Found Poem with changing moods in this interactive tutorial. This tutorial is Part Two of a two-part series. In Part One, students read “Zero Hour,” a science fiction short story by author Ray Bradbury and examined how he used various literary devices to create changing moods. In Part Two, students will use words and phrases from “Zero Hour” to create a Found Poem with two of the same moods from Bradbury's story.

Click HERE   to launch Part One.

Cite text evidence and make inferences about the "real" history of Halloween in this spooky interactive tutorial. 

See how data are interpreted to better understand the reproductive strategies taken by sea anemones with this interactive tutorial.

Examine field sampling strategies used to gather data and avoid bias in ecology research. This interactive tutorial features the CPALMS Perspectives video .

Learn how to cite evidence and draw inferences in this interactive tutorial. Using an informational text about cyber attacks, you'll practice identifying text evidence and making inferences based on the text.

Learn how to define and identify claims being made within a text. This tutorial will also show you how evidence can be used effectively to support the claim being made. Lastly, this tutorial will help you write strong, convincing claims of your own.

Learn to identify explicit textual evidence and make inferences based on the text. In this interactive tutorial, you'll sharpen your analysis skills while reading about the famed American explorers, Lewis and Clark, and their trusted companion, Sacagawea. You'll practice analyzing the explicit textual evidence wihtin the text, and you'll also make your own inferences based on the available evidence. 

Explore the mystery of muscle cell metabolism and how cells are able to meet the need for a constant supply of energy. In this interactive tutorial, you'll identify the basic structure of adenosine triphosphate (ATP), explain how ATP’s structure is related it its job in the cell, and connect this role to energy transfers in living things.

Learn to identify and analyze extended metaphors using W.B. Yeats' poem, "The Stolen Child." In this interactive tutorial, we'll examine how Yeats uses figurative language to express the extended metaphor throughout this poem. We'll focus on his use of these seven types of imagery: visual, auditory, gustatory, olfactory, tactile, kinesthetic, and organic. Finally, we'll analyze how the poem's extended metaphor conveys a deeper meaning within the text.

Learn to identify and analyze the central idea of an informational text. In this interactive tutorial, you'll read several informational passages about the history of pirates. First, you'll learn the four-step process for pinpointing the central idea. Then you'll analyze each passage to see how the central idea is developed throughout the text.

Learn how to make inferences based on the information included in the text in this interactive tutorial. Using the short story "The Last Leaf" by O. Henry, you'll practice identifying both the explicit and implicit information in the story. You'll apply your own reasoning to make inferences based on what is stated both explicitly and implicitly in the text. 

Learn some of the basic rules for using semicolons and colons in this baseball-themed tutorial. In this interactive tutorial, you'll practice identifying independent clauses and distinguishing between conjunctive adverbs and coordinating conjunctions. You'll also learn how to organize a list of items using a semicolon. Finally, you'll learn how to introduce a list or quotation using a colon.

Join Baby Bear to answer questions about key details in his favorite stories with this interactive tutorial. Learn about characters, setting, and events as you answer who, where, and what questions.

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• Research article
• Open access
• Published: 28 January 2020

Bioresorbable vascular stents and drug-eluting stents in treatment of coronary heart disease: a meta-analysis

• Hao Chen 1 ,
• Zhurong Luo 1 &
• Yunqiang Yu 1  

Journal of Cardiothoracic Surgery volume  15 , Article number:  26 ( 2020 ) Cite this article

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To compare the efficacy and safety of bioresorbable vascular stents (BVS) and drug-eluting stents (DES) in coronary heart disease.

The full text of clinical studies involving BVS and DES was retrieved in PubMed, Springer, EMBASE, Wiley-Blackwell, and Chinese Journal Full-text Database. Review Manager 5.3 was used for meta-analysis to evaluate the risk of target lesion failure, stent thrombosis and cardiac death in BVS and DES.

Finally, 10 studies with 6383 patients were included in the meta-analysis. Compared with DES group, BVS group had significantly increased risk of target lesion failure (OR = 1.46, 95%CI 1.20–1.79, P  = 0.0002; P Heterogeneity  = 0.68, I 2  = 0%), stent thrombosis (OR = 2.70, 95%CI 1.57–4.66, P  = 0.0003; P Heterogeneity  = 1.00, I 2  = 0%) and cardiac death (OR = 2.19, 95%CI 1.17–4.07, P  = 0.01; P Heterogeneity  = 0.93, I 2  = 0%).

This study shows that DES is a safer treatment than BVS for coronary revascularization.

Peer Review reports

Coronary heart disease (CHD), has been a leading cause of morbidity and mortality in the world [ 1 , 2 ]. The prevalence of CHD is increasing year by year and patients tend to be younger [ 3 , 4 ]. Percutaneous coronary intervention (PCI) with stents is a common treatment strategy for CHD patients with significant stenosis of coronary arteries (> 70%). Nowadays, drug-eluting stents (DES) are widely used in PCI. Compared with previous bare metal stents, the obvious improvement of DES is the carriers of anti-proliferation drugs [ 5 ]. The drug carriers of DES are mainly polymer coatings, which are designed to carry enough drug dosage and can effectively control the decomposition, diffusion and release of paclitaxel or other drugs.

Bioabsorbable vascular stent (BVS) is a type of newly invented stent and theoretically have a number of potential benefits [ 6 , 7 ]. First, the occlusion of coronary artery can be opened by BVS implantation. Second, after being absorbed, BVS can restore normal vasomotion and endothelial function. In past several years, several clinical studies have been conducted to compare the efficacy of BVS with DES in parameters like target lesion failure. However, the outcomes were inconsistent and remain to be identified [ 8 , 9 , 10 , 11 ].

To establish the clinical efficacy of BVS, we conducted this meta-analysis of available randomized controlled trails (RCT) and clinical prospective studies comparing BVS and DES in CHD.

Materials and methods

Search strategy.

The comparison between BVS and DES was comprehensively analyzed. Articles from inception to October 2018 were searched from PubMed, Springer, EMBASE, Wiley-Blackwell, and Chinese Journal Full-text Database. Systematic reviews and meta-analysis were conducted.

Two members of our team searched for articles independently using the following keywords: (1) bioresorbable stents OR BVS; (2) drug-eluting stents OR DES; (3) coronary heart disease OR CHD. All these terms are assembled with the connection symbol “and” to search the database for related articles. In order to obtain more relevant research and higher accuracy, the reference list of each article retrieved were also reviewed.

Citation selection

All articles after the first screening were further selected by two other authors. The titles and abstracts of these articles are independent and carefully screened. Then, if the research may be relevant, full-text research will be obtained.

The following inclusion criteria must be met in the citations included in this study:

A randomized control trial study or a controlled clinical trial study;

Comparison of the treatment between BVS and DES;

Availability of full text.

Exclusion criteria:

Observational studies;

Studies on other treatments other than BVS or DES;

Studies lacking outcome measures or comparable results.

Finally, the two authors jointly identified included articles. They examined whether the study met the above requirements. If there was any difference or no agreement was reached, the third investigator helped to make the decision.

Data extraction

Two reviewers read the full text and extracted the relevant data of each study into the coding table in Microsoft Excel software. The characteristics extracted in this study included the first author’s name, publication year, year of onset, sample size (bioresorbable/drug-eluting), age range of patients and outcome parameters. The parameters were about target lesion failure, stent thrombosis and cardiac death in BVS and DES.

Statistical analysis

Meta-analysis was performed by Revman 5.3 (Cochrane Collaboration, 2014) to assess differences in clinical efficacy between BVS and DES and to assess publication bias. Q statistics reflect the level of heterogeneity. When the heterogeneous I 2 statistic was greater than 50% reflecting moderate or high heterogeneity, a random effect model was used, otherwise a fixed effect model was deployed.

We also performed a bias analysis of each study with the following criteria: (1) random sequence generation, (2) allocation concealment, (3) blinding of participants and personnel, (4) blinding of outcome assessment, (5) incomplete outcome data, (6) selective reporting, and (7) other bias. In our studies, all parameters are two variables and the corresponding risk of 95% confidence interval (CIS) is calculated (RR). Funnel plots together with Egger tests were also applied to assess possible publication bias. P value < 0.05 was considered that statistically significant was observed.

Search results

A total of 362 related articles were found in the preliminary search of electronic database. After a thorough review, 10 papers eventually met all inclusion criteria [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. The other 352 articles were excluded due to duplication, article types, irrelevant studies, no control groups, incomplete data or comparisons. Figure  1 is a flowchart of identification, inclusion and exclusion, reflecting the search process and the reasons for exclusion.

Flow diagram of the study identification, inclusion and exclusion

Characteristics of included studies

Table  1 lists the first author’s name, year of publication, sample size (bioresorbable/drug-eluting), age range of patients, and outcome parameters for each study. All these articles were published from 2010 to 2018. The sample size is between 35 and 2604. At last, 6383 patients with coronary heart disease, including 3573 in BVS group and 2810 in DES group were included in our meta-analysis.

Quality assessment

The deviation table in the Review Manager 5.3 tutorial is used to assess the risk of each study by applying the criteria for evaluating design-related deviations. The risk of bias in this study is listed in Table  2 . Participants and respondents had a high risk of blindness due to significant differences between bioresorbable group and drug-eluting group.

Results of meta-analysis

Meta-analysis about target lesion failure.

Ten studies involved target lesion failure. All 10 studies showed statistically significant differences in target lesion failure between BVS and DES. The meta-analysis suggested that the target lesion failure of the BVS group was significantly higher than that of DES group with no heterogeneity among studies (OR = 1.46, 95% CI 1.20–1.79, P  = 0.0002; P Heterogeneity  = 0.68, I 2  = 0%; Fig.  2 ).

A forest plot for target lesion failure in BVS and DES groups

Meta-analysis about the stent thrombosis

The forest plot for meta-analysis about the stent thrombosis was presented in Fig.  3 . The results demonstrated that the stent thrombosis in BVS group was significantly higher than that of DES group with no heterogeneity among studies (OR = 2.70, 95%CI 1.57–4.66, P  = 0.0003; P Heterogeneity  = 1.00, I 2  = 0%; Fig. 3 ).

A forest plot for stent thrombosis in bioresorbable and drug-eluting groups

Meta-analysis about the cardiac death

All included studies about the cardiac death was shown in Fig.  4 . The overall result indicated that the cardiac death in BVS was significantly higher than that of DES group with no heterogeneity among studies (OR = 2.19, 95%CI 1.17–4.07, P  = 0.01; P Heterogeneity  = 0.93, I 2  = 0%; Fig. 4 ).

A forest plot for cardiac death in bioresorbable and drug-eluting groups

Bias analysis

Funnel plots of target lesion failure in bioresorbable and drug-eluting was performed. All studies are included in the plot. The results showed that the funnel plot had medium symmetry and little publication bias (Fig.  5 ).

Begg’s funnel plot of publication bias

CHD is mainly caused by abnormal lipid metabolism, which leads to accumulation of lipid in intima of arteries, and then causes a series of ischemic symptoms [ 14 , 18 ]. With the transformation of dietary structure and the acceleration of aging, the incidence of CHD showed a significant rising trend and has become a heavy disease burden to the society. For patients with obstructive CHD, stents implantation is an effective therapy to maintain normal coronary circulation.

DES surface coating of high molecular polymer contains anti-smooth muscle proliferation drugs [ 19 , 20 , 21 ]. Contemporary DES has better clinical outcomes than bare-metal stents, but there are still risks of stent stenosis and thrombosis due to persistent inflammation, loss of normal vessel curvature and so on [ 22 , 23 ]. In view of this, BVS was invented to provided mechanical support like DES for 1 year, followed by complete bio-resorption over several years. Several large RCTs showed BVS was noninferior to DES with respect to symptoms control. However, its safety remains to be established.

In our meta-analysis, BVS had a significantly higher risk of target lesion failure, stent thrombosis and cardiac death than DES at 1 year, which indicated that BVS was not as safe as DES. All these results demonstrated that DES was a better therapy than BVS for coronary revascularization. In fact, the AIDA study and ABSORB III study both demonstrated an increased risk of scaffold thrombosis [ 24 , 25 ]. BVS is, by design and performance, more thrombogenic than current DES. The reasons for higher rate of thrombosis with BVS were not fully clear and some concerns have been raised about the optimal preparation of the lesion and insufficient post-dilatation [ 26 ]. In addition, the latest guidelines on coronary revascularization does not support the use of BVS with a class III level of evidence C recommendation [ 27 ]. Therefore, interventionalist should be aware of the possible risks related to the use of BVS.

Some limitations existed in this research. First, the present number of studies on BVS is still limited especially in outcome analysis. Second, most of the studies included were investigating ‘Absorb BVS’ device. New BVS with a smaller footprint, less thrombogenicity (e.g., magnesium), faster reabsorption and advanced mechanical properties is under development. We cannot dismiss the safety and efficacy of new BVS technology.

BVS had a significantly higher risk of target lesion failure, stent thrombosis and cardiac death than DES. DES is a safer treatment strategy than BVS for coronary revascularization.

Availability of data and materials

Not applicable.

Abbreviations

• Bioresorbable vascular stents
• Coronary heart disease
• Drug-eluting stents

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Acknowledgements

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Le Ni and Hao Chen contributed equally to this work and should be considered co-first authors.

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The 900th Hospital of PLA Joint Logistics Support Force, 156 West Second Ring Road, Fuzhou City, Fujian Province, China

Le Ni, Hao Chen, Zhurong Luo & Yunqiang Yu

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YY designed, coordinated, and collected the data for the review. ZL assisted with the data extraction and analysis. LN assisted with the study selection and quality assessment. HC was involved as the third reviewer to solve disagreement when necessary. HC provided general advice and assisted with the writing of the review. All authors read and approved the final manuscript.

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Correspondence to Zhurong Luo or Yunqiang Yu .

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Ni, L., Chen, H., Luo, Z. et al. Bioresorbable vascular stents and drug-eluting stents in treatment of coronary heart disease: a meta-analysis. J Cardiothorac Surg 15 , 26 (2020). https://doi.org/10.1186/s13019-020-1041-5

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DOI : https://doi.org/10.1186/s13019-020-1041-5

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• Review Article
• Published: 29 September 2016

Bioresorbable vascular scaffolds — basic concepts and clinical outcome

• Ciro Indolfi 1 , 2 ,
• Salvatore De Rosa 1 &
• Antonio Colombo 3 , 4  

Nature Reviews Cardiology volume  13 ,  pages 719–729 ( 2016 ) Cite this article

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• Coronary artery disease and stable angina
• Interventional cardiology

Bioresorbable vascular scaffolds (BVS) are the latest innovation in the field of coronary interventions and are emerging as a promising treatment for patients with coronary artery stenoses

Available data from direct comparison in randomized studies showed similar clinical results in patients treated with BVS compared with the current generation of drug-eluting stents

Appropriate selection of target lesions and an appropriate implantation technique are crucial to achieving a good long-term result with the currently available devices

Some concerns remain about scaffold thrombosis and coronary restenosis

The introduction of percutaneous treatment of coronary artery stenosis with balloon angioplasty was the first revolution in interventional cardiology; the advent of metallic coronary stents (bare and drug-eluting) marked the second and third revolutions. However, the latest generation of drug-eluting stents is limited by several factors. Permanent vessel caging impairs arterial physiology, and the incidence of very late stent thrombosis — although lower with the second generation than with the first generation of drug-eluting stents — remains a major concern. This complication is mainly related to the presence of permanent metallic implants, chronic degeneration triggered by an inflammatory response to the coating polymer, and/or adverse effects of antiproliferative drugs on endothelial regeneration. In 2011, self-degrading coronary stents — the bioresorbable vascular scaffolds (BVS) — were introduced into clinical practice, showing good short-term results owing to their adequate strength. The advantage of these devices is the transient nature of vascular scaffolding, which avoids permanent vessel caging. In this Review, we summarize the latest research on BVS, with a particular emphasis on the implantation technique (which is different from that used with metallic stents) to outline the concept that BVS deployment methods have a major effect on procedural success and prognosis of patients with coronary artery stenosis. Furthermore, the clinical outcome of BVS in randomized clinical trials and in phase IV studies are discussed in different pathophysiological settings, such as stable or acute coronary disease. Finally, all the available data on the safety profile of BVS regarding scaffold thrombosis are discussed.

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Ciro Indolfi & Salvatore De Rosa

Department of Medicine, URT-CNR, Consiglio Nazionale delle Ricerche of IFC, Viale Europa S/N, Catanzaro, 88100, Italy

Ciro Indolfi

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Indolfi, C., De Rosa, S. & Colombo, A. Bioresorbable vascular scaffolds — basic concepts and clinical outcome. Nat Rev Cardiol 13 , 719–729 (2016). https://doi.org/10.1038/nrcardio.2016.151

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Bioresorbable Vascular Scaffolds: a Dissolving Dream?

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The first bioresorbable vascular scaffold (BVS), the Absorb BVS™ (Abbott Vascular, Santa Clara, CA, USA) made of poly-l-lactic acid came to the market in 2011 raising great expectations of another “revolution” in interventional cardiology. BVS was designed to mimic the acute results of drug-eluting metallic stents (DES) while avoiding the long-term penalties of stent thrombosis by maintaining the natural architecture of the vessel through temporary mechanical support with subsequent scaffold resorption. It was hypothesized that scaffold resorption would restore vasomotion, allowing luminal expansion and constriction as physiologically appropriate, and lessen subsequent plaque accretion. Empiric studies have not fulfilled these hopes. Rather, the Absorb BVS was associated with a higher risk of myocardial infarction and target lesion failure compared with 2nd generation DES [ 1 ]. An individual-patient-data pooled meta-analysis of the 4 randomized ABSORB trials in which patients were treated with everolimus-eluting Absorb BVS or cobalt-chromium everolimus-DES showed at 3 years a higher rate of target lesion failure (11.7% versus 8.1%; risk ratio [RR], 1.38; 95% confidence interval [CI], 1.10–1.73; P  = 0.006), driven by greater target vessel myocardial infarction (7.8% versus 4.2%; RR, 1.72; P  = 0.0006) and ischemia-driven target lesion revascularization (6.6% versus 4.4%; RR, 1.44; p  = 0.02), with comparable cardiac mortality of 1.1%. Device thrombosis rates were also higher with BVS (2.4% versus 0.6%; RR, 3.71; P  = 0.001) [ 2 ].

A subsequent BVS approach is the magnesium-based metallic Magmaris™ BVS (Biotronik AG, Bülach, Switzerland). In principle, it offers greater radial force and complete resorption in months vs years for Absorb BVS [ 2 ]. In this issue of CDT, Tousek et al. present the 12-month results of the PRAGUE-22 study which investigated late lumen loss in acute coronary syndrome patients receiving Magmaris sirolimus-eluting scaffold or permanent Xience DES [ 3 ]. The study was a small but carefully performed two-center randomized study with 25 patients in each group. Baseline and procedural characteristics were similar between groups except for higher rates of pre- and post-dilatation in the Magmaris group. This procedural difference was necessitated by vessel preparation needed for the Magmaris stent which included predilation using a balloon of diameter ≤ 0.5 mm than that of the vessel and post-dilation using a noncompliant balloon inflated to > 16 atm. Angiographic late lumen loss at 12 months was greater in the Magmaris group than in the Xience group (0.54 ± 0.70 vs. 0.11 ± 0.37 mm; p  = 0.029). Similarly, OCT-measured late lumen diameter loss in the Magmaris group was also significantly higher than that in the Xience group (0.59 ± 0.37 vs 0.22 ± 0.20 mm; p  = 0.01). During follow-up, three clinical events occurred in the Magmaris group requiring re-intervention. All these cases presented as unstable angina, two attributed to early strut collapse and one due to neointimal proliferation. One MI occurred in the Magmaris group due to scaffold thrombosis in the setting of DAPT discontinuation. One target lesion revascularization at 5 months occurred in the Xience group due to edge restenosis. The authors concluded that a greater degree of late lumen loss occurs at 12 months with the use of a magnesium-based bioresorbable stent in patients with acute coronary syndrome compared to a permanent, everolimus eluting metallic stent. The small size of the study precluded conclusion regarding differences in clinical outcomes.

The current study is in line with previous (somewhat disappointing) results of Magmaris BVS in humans. Previous single-arm experience has suggested that Magmaris is relatively safe [ 2 ]. However, in STEMI patients, the randomized MAGSTEMI trial showed that despite improved vasomotion at 1 year in the treated segment in the BVS group, late lumen loss was higher (vs DES) in the Magmaris group (in-segment: 0.39 ± 0.49 mm vs 0.02 ± 0.27 mm, P  < 0.001; in-device: 0.61 ± 0.55 mm vs 0.06 ± 0.21 mm; P  < 0.001) as was angiographic restenosis rate (in-segment 0% vs 21.5%, p  < 0.001) [ 4 ]. At 3 years in the single-arm BIOSOLVE studies, the primary mode for target-lesion failure in 189 patients was target-lesion revascularization (3.4%) and cardiac death (2.3%) but on a positive note, there were no definite or probable scaffold thromboses [ 5 ].

Based on previous studies and the current study by Tousek et al., it is fair to ask whether the concept of BVS is wrong or whether there are technical issues that ultimately can be overcome to improve long-term outcomes. The European Society of Cardiology has acknowledged the current concerns about BVS by providing a Class IIIC recommendation, recommending their use only as part of a well-designed clinical trial. Further, for those patients who already received a BVS while they were commercially available, it is recommended that DAPT should be continued for 3 years or longer. Despite the rather discouraging results to date, there are reasons to believe that BVS has a brighter future based on some insights gleaned from bench testing and empiric results in clinical studies.

Implantation technique for BVS has, by and large, followed the DES approach. There may be better methods for BVS deployment, with each material used having unique implantation requirements. Blachutzik et al. systematically evaluated the mechanical effect of non-compliant balloon post-dilatation on Magmaris BVS as measured with OCT. Post-dilatation reduced malapposition without causing strut fracture and led to a larger scaffold diameter [ 6 ]. Bench testing by Barkholt et al. also demonstrated that the Magmaris stent could be post-dilated to a larger diameter without fracture and also observed that recoil was greater at 120 min after post-dilatation than metallic stents, Absorb BVS and a novolimus-eluting PLLA-based scaffold [ 7 ].

Relative to current DES, BVS strut thickness is much larger (60–80 μm for DES vs 140–150 μm for Magmaris and Absorb). Previous studies in the “ancient days” of bare metal stents demonstrated conclusively that simply decreasing stent strut thickness was associated with a decrease in long-term adverse cardiac events [ 8 ]. As such, decreasing BVS strut thickness while maintaining tensile strength is one potential way to improve outcomes. Second, the BVS degradation profile may need to be optimized. Dissolution times need to follow the “Goldliocks” principle: not too short so as to be an effective temporary scaffold (which may not be the case at present), and not too long, so as to not create its own issues by being present when no longer needed. Further, the method of dissolution may need to be improved so that BVS remnants do not become part of the problem by being the nidus for thrombus formation. Further improvement in biocompatibility (already apparently acceptable) may allow for prompt, complete and predictable neointimal strut encapsulation and dissolution. The impact of the clinical situation, i.e., acute coronary syndrome vs stable disease, in regard to strut resorption is another avenue of research.

We hypothesize that BVS will ultimately improve long-term results when technical issues are overcome. Our optimism is based on major developments in interventional cardiology that seemed fruitless for a long period. For those with a long memory, there were innumerable failures in preventing restenosis before DES. Thus, we hope that developers keep persevering, bearing in mind that, “It’s darkest before the dawn”.

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Chaus, A., Uretsky, B.F. Bioresorbable Vascular Scaffolds: a Dissolving Dream?. Cardiovasc Drugs Ther 37 , 1–3 (2023). https://doi.org/10.1007/s10557-022-07401-4

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DOI : https://doi.org/10.1007/s10557-022-07401-4

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Challenges and chances coexist: A visualized analysis and bibliometric study of research on bioresorbable vascular scaffolds from 2000 to 2022

Xiaohan zhang.

a Department of Cardiovascular Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China

b Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia

c Department of Cerebrovascular Disease, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China

d The Second Clinical College, Shanxi University of Chinese Medicine, Shanxi, China.

Yuchen Jiang

Background:.

Bioresorbable scaffolds (BVS) provide a transient supporting force for blocked vessels and allow them to return to previous physiological characteristics. After verification with twists and turns, it has been acknowledged as an emerging revolution in percutaneous coronary intervention that expresses the current concept of intervention without placement. Through this bibliometric study, we organized the knowledge structure of bioresorbable scaffolds and attempted to predict future research hotspots in this field.

seven thousand sixty-three articles were retrieved from the web of science core collection database from 2000 to 2022. Then, we utilize CiteSpace 6.1.R2, Biblioshiny and VOS viewer 1.6.18 to analyze the data visually.

First, according to the spatial analysis, the number of annual publications has shown an approximately increasing trend over the past 2 decades. The USA, the People’s Republic of China, and GERMANY published the most articles on bioresorbable scaffolds. Second, SERRUYS P ranked first for his most prolific work and highest cited frequency in this domain. Third, the hotspots in this field can be inferred from the keyword distribution; they were the fabrication technique based on tissue engineering; the factors to be optimized for bioresorbable scaffolds, such as mechanical property, degradation, and implantation; and the common adverse effects of bioresorbable scaffolds, such as thrombosis. Most importantly, in terms of burst detection, we could speculate that cutting-edge technology for manufacturing scaffolds represented by 3D printing constitutes the future hotspots in bioresorbable scaffold development.

Conclusion:

In the first visualized bibliometric analysis of BVS, we attempt to provide a panoramic view. By enrolling extensive literature, we review the growing trend of BVSs. Since its first introduction, it has been through periods of early prosperity, questioned safety subsequently and the resultantly advanced techniques in recent years. In future, the research should focus on utilizing novel techniques to consummate the manufacturing quality and assure the safety of BVSs.

1. Introduction

Coronary heart disease has been threatening public health globally as a critical fatal factor. Pathologically, coronary atherosclerosis causes luminal stenosis, contracture, and obstruction, thus blocking myocardial perfusion. Revascularization, including percutaneous coronary intervention (PCI) recommended by guidelines, leads to the remission of angina, the reduction of the use of antianginal drugs, and the improvement of prognosis. [ 1 – 3 ] Put in clinical practice for over 4 decades, PCI has been through 4 stages of reformation, which are balloon angioplasty, bare metal stents (BMS), drug-eluting stents (DES), and bioresorbable vascular scaffold (BVS) respectively. Plain balloon angioplasty might be considered the secondary substitute for stent implantation after demonstrating the superiority of stenting, given the feasibility of repeated revascularization. [ 4 ] BMS brings about an approximately 30% lower restenosis rate than plain balloon angioplasty. [ 5 ] However, the incidences of late stent thrombosis (>30 days) in BMS are not unusual and have been widely reported before with a percentage of 0.4% to 0.8%. [ 6 , 7 ] In the era of DES, the early generation decreased angiographic restenosis by around 50% to 70% yet increased higher risk of very late stent thrombosis (>1 year) in comparison with BMS. [ 8 , 9 ] The second-generation DES established as an IA recommendation for people undergoing PCI in the 2021 ACA/AHA guideline for revascularization, attempted to solve the imperfection of its predecessor by introducing biocompatible or biodegradable polymers rather than optimizing another metallic layer. [ 10 , 11 ] Though the used drugs in DES (e.g., paclitaxel, sirolimus, and its derivatives) are introduced to circumvent neointimal hyperplasia and constrictive remodeling [ 12 ] when eliminating neointimal hyperplasia is no longer the culminating goal, more research on biodegradable stents facilitating beneficial reendothelialization is excepted. [ 13 ]

Completely BVS has been designed to temporarily provide mechanical support for the lesion site before degrading into inert end-products like water and carbon dioxide. Still, the capability to prevent neointimal proliferation could be retained by eluting immune-suppressive drugs. [ 14 ] It is noted that the restored coronary physiological characteristic guarantees further revascularization such as coronary artery bypass grafting (CABG). There are 2 technology forms of BVS verified by clinical trials: bioresorbable polymetric vascular scaffold with degradation of 24 months and bioresorbable metallic alloy scaffold with degradation of 9 to 12 months. [ 15 , 16 ] However, the risk of fatal complications such as stent thrombosis after BVS implantation reported by several randomized controlled trials is not negligible. [ 17 – 19 ] In the 2018 ESC Guidelines on myocardial revascularization , the application of any BVS should be restricted to well-controlled clinical studies, [ 20 ] which indicates the necessity of more validated data from large-scale follow-up trials and improving the manufacturing technology such as the degradation, mechanical strength, and the thickness of stent beam.

In this review, we will panoramically look at BVS’s research status and hotspots based on knowledge mapping. We hope our work will help more cardiologists collect their research thoughts, reduce the risk of major adverse cardiac events (MACE) by BVS implantation and prompt the application of BVS.

2. Materials and methods

2.1. data source and search.

Figure ​ Figure1 1 describes data retrieval and visualized analysis according to PRISMA 2020 flow diagram for systematic review. The literature was retrieved on July 15, 2022, from the Core Collection database of Web of Science core collection, one of the most authoritative databases comprising the most comprehensive publications in many scientific fields. In the scientific literature, “scaffold” and “stent” share the same implications. However, “stent” is prone to refer to as DES for the patent reason. Despite “biodegradable” medical devices often cited as “bioresorbable,” slight differences exist because “biodegradable” reflects the disappearance of the compound into another substance. In contrast, “bioresorbable” does not necessarily imply the elimination of the polymer from the body. [ 21 ] Moreover, “bioresorbable vascular scaffold” is a more accurate rather than common term. The search strategy was as follows: [TS= (“bioresorbable scaffold”) OR (“bioresorbable vascular scaffold”) OR (“bioresorbable vascular stent”) OR (“biodegradable vascular stent”) OR (“biodegradable vascular scaffold”)] AND [Language = (English)]. The time interval of retrieval was from January 2002 to December 2022. As the versatile therapeutic applications of BVS, we restricted the included articles to solely discussing cardiovascular use. Two independent reviewers (XHZ and ZZG) were enrolled in literature screening to control the selection bias.

The flowchart of data retrieval and bibliometrics analysis.

There were 14,129 publications found in total. Then we perform the exclusion in terms of document types and article topics, including 1001 meeting abstracts, 409 editorial materials, 185 letters, 87 early access, 25 corrections, 44 book chapters, 7 news items, and 5308 articles irrelevant to cardiovascular. As a result, 7063 papers (5592 articles and 1471 review articles) with their full records and cited references were refined and exported in “Plain text file” format.

2.2. Scientometric analysis methods

Knowledge mapping, a generic strategy of visualized analysis, is introduced for researchers to investigate a scientific domain by identifying significant areas of research activities, intellectual milestones, and evolutionary stages in developing critical specialties. [ 22 ] CiteSpace 6.1.R2, Biblioshiny, and VOS viewer 1.6.18 are freely available software to perform visual analytic tasks of knowledge mapping. [ 23 – 25 ]

The basic principles applied to this study are itemized as the following aspects. Firstly, a map’s 2 most fundamental elements are nodes and links representing each term (e.g., country, institution, author, etc) and the connection among them. [ 26 ] Coloring each area is based on the published order, and the warmer color tune represents the more recent term. [ 27 ] Secondly, a node’s betweenness centrality (BC) is commonly used to highlight potential pivotal points of paradigm shift over time, [ 28 ] in other words, a transformative discovery. Burst detection, a computational technique to identify sharp increases of interest in a specialty, is served to detect emerging trends and abrupt changes promptly. [ 24 ] Thirdly, terms in the articles are classified into several clusters according to the intergroup similarity, and the prominent member of the cluster inferred by the algorithm as recurring themes in the cited papers, the research front, and the intellectual base will be generated as labels. The multidimensional scaling map is colored in terms of each cluster membership, Cite Space distributes the ID #0 to the largest cluster, and the cluster gradually shrinks when the ID number increases. Fourthly, the time-zone view consisting of an array of vertical strips is complementary to the cluster view. [ 24 ] The generation of annual labels by the Latent Semantic Indexing algorithm is laid on the corresponding chronological line, which enables the intellectual base to point toward the research fronts from left to right.

Before running the software, all operation metrics were set to default.

3. Result and discussion

3.1. the distribution of annual publications.

Aiming to conclude the overall process and research upsurges in the knowledge domain of the bioresorbable scaffold, the distribution of annual literature comes as the first indicator. [ 29 ] 7063 published records in 2000 to 2022 were shown as a column chart (Fig. ​ (Fig.2) 2 ) showing an approximately linear increasing trend year by year. It was in 2000 that the first bioresorbable scaffold Igaki-Tamai (Kyoto Medical Planning Co., Japan) was released. Yet, it still needs to acquire approval due to its defects, illustrating the relatively low number of yearly publications a few years after 2000. Until 2006, the ABSORB Cohort A trial, which supported the first launch of Absorb vascular scaffold (Abbott Vascular, US) in 2010, stirred more attention to BVS research. The development of BVS started to accelerate and reached 2 surges in 2010 and 2014, respectively. After that, the research on BVS entered a period of rapid advancement, which was out of the restrictions of permanent metallic coronary stents, such as the risks of target lesion revascularization, preclusion of late lumen enlargement, and the lack of reactive vasomotion. [ 14 ]

The distribution of annual bibliometric records about bioresorbable vascular scaffold.

3.2. Collaboration analysis of countries and institutions

The collaboration map of countries/institutions (Fig. ​ (Fig.3A 3 A and B) can reflect the integral structure of a specific research field and clarify the cooperative relationship between different countries/institutions. The ranking of the top 5 countries/institutions (Table ​ (Table1) 1 ) was concluded by Cite Space. Other than quantity, we consider BC as a connection-measuring property that quantifies the importance of the nodes’ position in a network. [ 24 ] All the top 5 productive countries scoring high BC value (above 0.1) contributed 8356 articles (77%) in this domain; they were the USA, the People’s Republic of China, Germany, England, and Italy. The USA was the dominating country in the early implementation of BVS for sponsoring a series of groundbreaking clinical trials. Thousands of relevant studies were carried out in the USA, but cooperation with other countries remained comparatively few. European countries represented by Germany communicated most with others with the highest BC of 0.62, and their academic achievement included the BVS system of DESolve (Elixir Medical Co., US), Magmaris (Biotronik, Berlin, Germany) and BIOSOLVE (Biotronik, Berlin, Germany), etc. It is worth noting that 2 of the top 5 prolific institutions were from China: Shanghai Jiao Tong University and the Chinese Academy of Medical Sciences. The formation of several prominent academic communities about BVS in China suggested developing countries technological advancement, and more attention was paid to BVS. In addition, the abundant links between institutions indicated good cooperation among them, and Erasmus MC carried out the most communication with other institutions for the influential work of academic celebrities.

The top 5 countries/institutions with the highest quantity of articles.

BC = betweenness centrality.

The co-occurrence map of countries and institutions. (A) Network of countries with publications about BVS using the R package Bibliometrix. (B) Network of institutions in the BVS domain using VOSviwer. BVS = bioresorbable vascular scaffold.

3.3. Analysis of authors

The continuous efforts of researchers prompt the progress of BVS research, and a co-authorship map of authors (Fig. ​ (Fig.4A) 4 A) and cited authors (Fig. ​ (Fig.4B) 4 B) can provide information about influential figures to help grasp state-of-art research and find potential collaborators. Of the included bibliometric records, 2305 authors contributed 3652 collaborations. We reduced the peripheral nodes to clarify the network structure, as shown in Figure ​ Figure4A. 4 A. The top 10 productive authors & cited authors are counted by VOS viewer and listed in Table ​ Table2. 2 . As shown in Figure ​ Figure4, 4 , the links connecting nodes of authors remained relatively dense, which meant some dominating academic communities represented by Serruy’s academic team in the BVS field had been formed.

The top 10 authors/cited authors with the highest quantity of articles/cited frequency.

TLS = Total link strength.

The co-authorship map of authors. (A) Network of authors in the BVS research field accentuating the relationship between Serruys and other collaborators by VOS viewer. (B) Network of cited authors in the BVS field using the R package Bibliometrix. BVS = bioresorbable vascular scaffold.

Serruys Patrick, a cardiologist from Erasmus MC in the Netherlands, had been devoted to PCI-related refinement for decades and was the researcher who owned the highest quantity of articles and cited frequency. He convened several leading researchers in this domain, such as Onuma Y, Windecker S, and GARCIA-GARCIA HM. He initiated a series of groundbreaking ABSORB clinical trials, which proved the noninferiority of BVS to DES regarding the primary endpoint after revascularization. [ 30 , 31 ] Onuma Yoshinobu, a consultant for Abbott Vascular from Imperial College London, shared excellent cooperation with Serruys. He demonstrated the low MACE rate and resultantly sustained safety of bioresorbable everolimus-eluting scaffold by the 5-year follow-up of the first-in-humans ABSORB Cohort A Trial. [ 32 ] However, these 2 cardiologists jointly reported unsatisfying results, which decelerated the clinical application of BVS and made the necessity for prolonged follow-up clear. In ABSORB II trial at 3-year follow-up, the everolimus-eluting BVS failed to meet the expectation of superior vasomotor reactivity and non-inferior late luminal loss than the everolimus-eluting permanent stent (EES) as well as 2.17 times higher risk of the composite endpoint of BVS to DES in ABSORB II clinical trial in 2016. [ 33 ] Stone GW, a cardiologist from Columbia University who took an active part in ABSORB and FANTOM series trials, was the author with the second cited frequency. He conducted that 1 year was the optimal dual antiplatelet therapy duration after BVS implantation from the integration of 5 ABSORB trials, which helped shorten the anticoagulant-taking course. [ 34 ]

3.4. Analysis of topic distribution

Keywords, the highly condensed version of science literature, can directly embody the central argument of an article. In this science mapping review, the distribution of topics was analyzed as follows: The overview co-occurrence map (Fig. ​ (Fig.5A) 5 A) and the clustering (Fig. ​ (Fig.5B) 5 B) based on the log-likelihood ratio algorithm generally depict the intellectual base of the research status. At the same time, burst detection of the BVS field (Fig. ​ (Fig.6) 6 ) allows researchers to trace the transformative discoveries in the BVS domain from a temporal view. [ 35 ] The top 20 keywords with the highest occurrence frequency are counted by Cite Space and listed in Table ​ Table3, 3 , and Table ​ Table4 4 which is extracted from Cite Space enumerates each cluster. In Figure ​ Figure5B, 5 B, the more nodes a cluster contains, the larger it is. The silhouette is an index to measure the homogeneity of a cluster, values bigger than 0.7 lead to efficient and reliable results. Therefore, the clustering result in Figure ​ Figure5B 5 B can be regarded as satisfactory. [ 36 ] Combining the science map in Figure ​ Figure5, 5 , the topic distribution be classified into 4 aspects.

The top 20 keywords with the highest occurrence frequency.

Summary of the largest 13 clusters.

LLR = log-likelihood ratio algorithm.

Keyword co-occurrence and clustering. (A) The co-occurrence map of the main keyword in articles about BVS using VOSviewer. (B) The top 13 clusters of main keywords generated by Cite Space. BVS = bioresorbable vascular scaffold.

The top 20 main keywords in BVS-related articles with the strongest citation bursts concluded by Cite Space. BVS = bioresorbable vascular scaffold.

3.4.1. The BVS fabrication based on tissue engineering

Tissue engineering is a scientific discipline integrating cellular biology and material science. The interaction between cardiology and tissue engineering could present as replacing the scarred, nonfunctional infarcted area of the heart with functionally regenerated vascular endothelial tissue after BVS implantation. [ 37 ]

Regarding BVS fabrication, the biomaterials selection comes as the first consideration. A candidate material should be durable allowing cell infiltration, adhesion, and proliferation with satisfying biocompatibility, compliance, and strength. [ 38 ] The composite scaffolds combine synthetic and natural polymers to mimic the native cell structure, improve physical properties, and optimize biochemical composition. They are designed to be superior to any individual component. [ 37 , 39 ]

The biodegradable polymers that are currently applied in a wide range of medical use include poly lactic acid (PLA), poly glycolic acid, polycaprolactone (PCL), poly ester amide, and poly citric acid, etc. Among them, PLA, which resolves into lactic acid and is ultimately metabolized into water and carbon dioxide, shows the most promising clinical outcomes and gets approved by FDA for applications directly in contact with biological fluids. [ 40 ] In addition, it is feasible to reinforce PLA-based scaffold using cellulose nanofiber, the synthetic of the most abundant natural polymer, which performs salient mechanical properties with 46.6 GPa elastic modulus and 1170 MPa of tensile strength. [ 41 , 42 ] Incorporating metal biomaterials is the second-generation strategy in BVS fabrication. The inherent merits of metals, such as thermally and chemically stable, electroconductivity, and magnetic properties, enable them to be better manipulated over the scaffold. [ 37 , 39 ]

3.4.2. The drug-delivery system of BVS

The drug release duration is expected to match the timeline of vascular remodeling (generally 12 months) until the complete healing to avert excessive inflammation and restenosis. [ 43 , 44 ] The clinical benefits of the bioresorbable drug delivery system motivate its research and application, that is, controlled drug release to the specific site and resultantly in better patient compliance for less medication taking and fewer side effects.

Physical controlled release is the mainstay of DES, where manufacturing aspects such as polymer formulation, coating thickness, or exposed stent surfaces are linked to predictable release rates. [ 45 ] The pharmacology strategy applied to BVS is similar to DES. However, the temporary drug-elution and scaffolding until the healing of vessels rather than permeant foreign materials can lead to a reduction in late/very late thrombosis, expansive remodeling, and luminal enlargement. Also, as the duration of biosorption is modifiable according to the type of polymer, the multiple drug-elution can be potentially tuned. [ 39 ]

3.4.3. The factors yet to be improved in BVSs

Three aspects were listed in the keywords with the highest frequency: mechanical property, degradation, and implantation.

Early BVS was constructed with PLA, which provided transient but deficient mechanical support by semicrystalline polymers .[ 43 , 44 ] Consequently, increased struts and surface area are needed to maintain mechanical stability, accompanying significant local inflammation related to active erosion and raising the risk of scaffold thrombosis in small vessels. [ 45 ] Bio-corrodible metals such as magnesium (Mg), iron, and zinc are the updated materials for their enhanced mechanical strength. Cobalt-chromium tensile modulus of elasticity is 63 times higher than PLLA and 5 times higher than Mg-alloy. [ 21 ] Among the counterparts verified by clinical trials, Magmaris (Mg-based alloy) BVS owns comparable radial stiffness to BMS, as well as a higher deformation resistance and slighter struct of 150µm than pure magnesium. [ 14 , 46 ]

The crux of determining the optimal degradation rate lies in simulating the vascular healing timelines. Too fast degradation could lead to acute vessel reconcile, and the prolonged degradation brought about persistent inflammation. [ 47 ] In rats, collagen fibers increased in vessels up to 6 months after BVS implantation, followed by the formation of normal vessels at 12 months. [ 43 , 44 ] The degradation of the common BVSs includes the PLLA-based scaffold ABSORB for 24 to 48 months, DESolve for 24 months, and Mg-based alloy Magmaris for 9 to 12 months. The shorter degradation of the alloy-based scaffolds is considered one of the advantages besides its mechanical property. [ 15 , 16 ]

The surgical skill of physicians is also relevant to the prognostic performance after BVS implantation. Three studies cohorts of ABSORB series clinical trial concluded that the oversize scaffold implantation was associated with a higher risk of MACE driven by the higher rate of myocardial infarction (MI). Ellis et al [ 49 ] reported that relative scaffold under-sizing was the most vital determinant of very late scaffold thrombosis, thus evinced the importance of implanting the appropriate scaffold size. [ 48 ]

3.4.4. The outcome of clinical trials of BVS

Clinical outcomes generalizing the efficacy, feasibility, and safety of BVS underlie the evolution of this domain. Among the groundbreaking ABSORB series trials, at the earlier 6-month and 12-month follow-up, everolimus-eluting BVS had been satisfactory for the comparable medium-term performance to DES by utilizing optical coherence tomography to document late lumen loss and resorption. [ 31 , 50 ] To our disappointment, the subsequent 3-year follow-up observed more scaffold thrombosis in the ABSORB group than in the EES group (3% vs 0, P = .0331), the higher rate of device-oriented target vessel MI than EES dispirited this progress (6% vs 1%, P = .0108). [ 33 ] DESolve scaffolds, the newer iteration of ABSORB, modified the limitation of radial strength to withstand vascular modeling and resultant scaffold shrinkage. The DESolve first-in-man trial demonstrated effectiveness with low late lumen loss (0.19 ± 0.19 mm) and thin neointimal coverage (0.12 ± 0.04 mm) performed by optical coherence tomography. [ 51 ] In the DESolve III trial, which first confirmed the safety of this series, Mistent sirolimus-eluting bioabsorbable scaffold constructed with cobalt-chromium alloy had a comparable safety performance to EES at 3 years in terms of similar the primary endpoint (10.5% vs 11.5%, P = .55) and the secondary endpoint (22.7% vs 22.9%, P = .34). [ 52 ] In the newest prospective multicenter BIOSOLVE-II and BIOSOLVE-III trials, which assessed the second-generation absorbable Mg-alloy DREAMS 2G scaffold (commonly known as Magmaris), the follow-up was scheduled annually within 3 years. Promisingly, complications remained very few after 2 years of scaffold resorption, and late lumen loss and diameter stenosis did not increase substantially in the meantime. [ 53 ] The early safety and efficacy of new-generation BVSs have been substantiated, and insightful trials with larger scales and longer follow-ups are expected.

3.5. Burst detection of keywords

In Cite Space, a current research front is identified based on burst terms extracted from titles, abstracts, descriptors, and identifiers of bibliographic records. [ 24 ] According to the top 20 keywords with the strongest citation bursts (Fig. ​ (Fig.6), 6 ), “3D printing” owns the strongest bursts among the keywords remaining positive in burst detection in 2022, which can be deemed as the current overriding research hotspot and promising direction ensued. Taking the research status discussed before as the prerequisite, the future research of BVS mainly focuses on the security to be reinforced, the pending clear CAD indications and the ever-advancing manufacturing technology such as 3D printing.

3.5.1. Coronary artery disease (CAD) as the indication of BVS

Vascular disease, especially CAD, revolutionizes the actual application of BVS implantation. It is prone to show more potential in ST-segment elevation myocardial infarction than DES, which might relate to the desire for better prognostic performance for younger age and less extensive coronary artery disease in patients and the avoidance of inflammatory response between the necrotic core and DES prolonging the arterial healing. [ 54 , 55 ] Patients with angina could also benefit from BVS implantation. Angina was the significant endpoint in the ABSORB IV trial, and the occurrences within 1 year were less with BVS than EES (20.3% vs 20.5%, 1-sided p non-inferiority = 0·0008; 2-sided p superiority = 0·8603). [ 56 ] Beyond that, as a minimally invasive procedure emphasizing repairing and remodeling the coronary artery, BVS implantation has no effects on future revascularization, thereby altering the clinical indications of CABG. Further identifying the adaptive features of BVS among CAD patients is critical to bring it into clinical practice.

3.5.2. The safety of BVS implantation

Since Serruys et al [ 33 ] reported the worrying device-oriented peri-procedural MI and the incidence of very late scaffold thrombosis in 2016, the safety of BVS implantation has become a significant concern. In subsequent ABSORB trials and The Amsterdam Investigator-initiateD Absorb strategy (AIDA) trial at 2-year follow-up, it was also observed higher rates of target vessel MI and occurrence of scaffold thrombosis with BVS than EES. [ 18 , 57 , 58 ] To our relief, the final 5-year result of AIDA indicated that the additive risk of BVS implantation seemed to be continuous for 4 years and reached a plateau afterwards. [ 59 ] The adverse events not happening on DES might be correlated to the scaffold dismantling in the erosion process; the second-generation metallic alloy BVS is trying to mitigate them by conforming to the mechanism of DES. Haude M et al [ 53 ] have proved the noninferiority for the safety of Mg-based BVS than EES. Recently, the 7-year nitrided iron-based absorption in vivo demonstrated the protection of this novel technique with no scaffold thrombosis formation in the coronary artery of pigs and complete absorption in situ, unlike calcium phosphate left after the absorption of magnesium. [ 60 ]

3.5.3. 3D printing in fabricating BVS

A customizable BVS with a specific individual strut and the whole scaffold design can be manufactured by 3D printing, which is different from the traditional laser machining of polymer tubes. [ 61 ] This cutting-edge technology aims to allow the significant properties of BVS, including mechanical strength, geometry, degradation, and drug release, to reach optimality for patients, especially those who suffer from atypical vessel anatomy. Lee et al [ 62 ] designed an innovative 3D PLA scaffold with Heparin coating to compensate for the thick strut, exhibiting excellent function of thromboresistance and hemocompatibility and a few neointimal hyperplasia in an in vivo study. Moreover, 3D printing has been expected to be more suitable for fabricating composite BVS. Guerra et al [ 63 ] found that the PCL/PLA composite scaffold combining the advantages of both presented the excellent expansion behavior of PCL and satisfactory recoil ratio of PLA. Although 3D printing BVS has not been approved for clinical use, the future results of in vivo trials have supported its role as an experimental paradigm in CAD treatment.

3.6. Co-citation analysis of references

In a co-citation network (Fig. ​ (Fig.7A), 7 A), the cited references are performed as nodes, and the links between them represent the frequency the same article cites them. If 2 references are co-cited repeatedly, we can speculate the practical relevance between them and capture the underlying research focuses of BVS. [ 35 ] The top 10 references with the highest cited frequency are counted by Cite Space and listed in Table ​ Table5 5 .

The top 10 references with the highest cited frequency.

BC = betweenness centrality, PCI = percutaneous coronary intervention.

The co-citation map and time-zone view of cited references about BVS. (A) The co-citation network of reference using VOS viewer. (B) A time-zone view of cited references generated by Cite Space. BVS = bioresorbable vascular scaffold.

The article cited most is the report of ABSORB II trial 1-year follow-up published on the LANCET in 2015, the noninferiority in performance and composite device-orientated endpoint with BVS than EES was verified for the first time. [ 30 , 31 ] And Ellis et al [ 64 ] reinforced this conclusion through ABSORB III trial at 1-year follow-up, which takes up the second cited frequency in the BVS domain. Warned by the GHOST-EU trial in 2014, the early and midterm scaffold thrombosis cannot be ignored, and the alarming results of ABSORB III at 3-year follow-up (i.e., higher rate of scaffold thrombosis, target vessel failure) were the pivotal turning point which suspended the commercial process of BVS for its safety concern. [ 17 – 19 ] The AIDA trial at 2-year follow-up and a meta-analysis that enrolled the ABSORB JAPAN trial also emphasized the authenticity of subacute scaffold thrombosis, they were the references with the 5th, the 7th, and the 8th cited frequency, respectively. [ 57 , 58 , 65 ] A cohort study ranking 6th in cited frequency investigated the correlates of BVS scaffold thrombosis as clinical factors, such as decreased left ventricular function, interruption of dual antiplatelet therapy, and heedless implantation. Furthermore, the angiographic analysis indicated that smaller vessels tended to induce scaffold thrombosis. [ 66 ]

In the time-zone view (Fig. ​ (Fig.7B), 7 B), the horizontal movement of an item is restricted chronologically, but its vertical direction is entirely determined by its connections with objects in other time zones. [ 24 ] In the first 5 years of the 21st century, most research on BVS mainly focused on bone tissue engineering, which was designed to cover and regenerate articular cartilage defects. [ 67 ] #11 chondrocytes, #15 bioresorbable polymer, and #0 electrospinning represented the primary material in #14 tissue engineering. Hereafter, researchers had been dedicating to refining BVS properties on mechanical strength and degradation employing introducing #12 nanofiber or looking for the optimal #7 biodegradable polymers. Since 2010, the entrance of Abbott into the BVS domain has stirred a boom in clinical trials and the promotion of commercialization. #6 optical coherence tomography and intravascular ultrasound were the standard imaging methods to evaluate the performance of BVS by measuring the late lumen enlargement and bioresorption of polymeric struts. The reports comparing the #1 bioresorbable scaffold (#9 bioresorbable vascular scaffold) and #2 drug-eluting stent could trace back to 2015. Initially, both the device success rate and device-oriented clinical endpoint of BVS generally matched that of the DES, which indicated a promising path for BVS development. [ 30 , 31 ] However, the more comprehensive data explicitly stated the imprudence of applying bioresorbable polymetric scaffolds to clinical use. They guided the further research directions in 2 ways: prolonging the follow-up observation and updating the BVS fabrication. Metallic alloys (such as magnesium, iron, and #5 zinc) manufacture the second-generation BVS struts, confirming improved mechanical strength and less device-oriented thrombosis after implantation. #18 3D printing (#16 additive manufacturing) is the latest research hotspot of BVS and a viable alternative to standard off-the-shelf scaffolds. The fabrication process is short enough to complete within 20 minutes from parameter assessment to the scaffold delivery; additionally, the design versatility allows BVS to modify various properties and makes it suitable for customization. [ 61 ]

4. Conclusion

Revascularization has occupied a significant role in coronary heart disease treatment, which is applied to patients with persistent symptoms despite standard medical therapy in the 2018 ESC/EACTS Guidelines. [ 20 ] PCI could improve the long-term outcome for patients with stable CAD and is more economically attractive than medical therapy alone. [ 1 – 3 ] On recommendation for the type of revascularization, PCI prioritizes CABG in <3-vessel CAD lesions with proximal LAD stenosis. [ 20 ] Nowadays, DES is regarded as the gold standard treatment in PCI. But a metallic frame distorting and constraining the vessels limits vasomotion, and adaptive vascular remodeling could serve as a nidus for chronic inflammation, neo-atherosclerosis, and scaffold thrombosis. [ 17 – 19 ] BVS, the 4th transformation representing the future direction of PCI, aims to improve the late outcomes of scaffold implantation but also confronts several challenges in its development. In recent years, the long-term risks of bioresorbable polymetric vascular scaffold post implantation have been reported to be stable; the second-generation BMVSs also appear non-inferior to DES on safety and performance. Meanwhile, the ascending 3D printing technology makes it possible to fabricate customized and composite BVS.

This review taps into scientific literature concerning bioresorbable scaffolds published within the past 2 decades on web of science core collection. Cite Space and VOS viewer, the efficient tools of visual analysis, are chosen to illustrate the intellectual base and research frontiers through graphics visually.

In terms of the analysis of spatiotemporal distribution, we noticed that the BVS domain had been paid increasing attention, and several academic groups have formed, especially the frontrunners represented by Serruys Patrick from Erasmus MC and Onuma Yoshinobu from Imperial College London. They shared excellent cooperation and communication in clinical trials funded by Abbott Laboratories.

From the topic distribution, the research status can be generalized as 4 aspects: the tissue engineering on BVS fabrication, the drug delivery system, the factors yet to be improved, such as mechanical property and degradation of BVS as well as the implantation technique, and the main clinical trials including the ABSORB series trials laying the foundation of BVS research and DESolve, BIOSOLVE trials assessing the second-generation metallic alloy BVS. Based on burst detection, the research hotpots can be inferred as 3 points: the efficacy of BVS in CAD treatment, the safety of BVS implantation, and 3D printing in BVS fabrication which is regarded as the current hotspot for its citation bursts continuing today.

There are some inevitable limitations in this review. First, we chose WOSCC as the only database resource for its predominant collection of authoritative articles. However, not using other databases could lead to an information gap and bias. Second, the time lag, which takes the period for the accumulation of high cited frequency, would result in overlooking the detection of research fronts is the main challenge of co-citation analysis.

To our knowledge, this review visually analyzes science literature about BVS for the first time. The knowledge mapping amalgamating Cite Space and VOS viewer could cover different mapping tools’ shortages and enable a more comprehensive analysis of BVS. It makes it easier and more direct for researchers to grasp the existing knowledge structure of BVS from multiple dimensions, seek potential collaborators, and establish further research directions.

Author contributions

Conceptualization: Huan Wang, Bai Du, Yuanhui Hu.

Data curation: Xiaohan Zhang, Huan Wang, Bai Du.

Formal analysis: Yuchen Jiang, Bai Du, Yuanhui Hu.

Funding acquisition: Bai Du, Yuanhui Hu.

Investigation: Zezhen Guo, Bai Du, Yuanhui Hu.

Methodology: Xiaohan Zhang, Huan Wang.

Resources: Bai Du.

Software: Lihong Zhu.

Supervision: Bai Du.

Validation: Xiaohan Zhang.

Visualization: Xiaohan Zhang, Yao Liu.

Writing – original draft: Xiaohan Zhang, Zezhen Guo, Lihong Zhu, Yao Liu.

Writing – review & editing: Xiaohan Zhang, Bai Du.

Abbreviations:

Posted history: This manuscript was previously posted to Research Square: https://doi.org/10.21203/rs.3.rs-2345658/v1

This work was supported by the Scientific and technological innovation project of the China Academy of Chinese Medical Sciences (No. CI2021A03318).

This review did not require ethics committee review board approval or informed consent.

The authors of this work have no conflicts of interest to disclose.

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

How to cite this article: Zhang X, Guo Z, Zhu L, Liu Y, Wang H, Jiang Y, Du B, Hu Y. Challenges and chances coexist: A visualized analysis and bibliometric study of research on bioresorbable vascular scaffolds from 2000 to 2022. Medicine 2023;102:21(e33885).

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Bioresorbable vascular scaffolds - basic concepts and clinical outcome

Affiliations.

• 1 Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro 88100, Italy.
• 2 URT-CNR, Department of Medicine, Consiglio Nazionale delle Ricerche of IFC, Viale Europa S/N, Catanzaro 88100, Italy.
• 3 Department of Interventional Cardiology, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milano and EMO-GVM, Centro Cuore Columbus, Via Buonarroti 48, 20145 Milan, Italy.
• PMID: 27681575
• DOI: 10.1038/nrcardio.2016.151

The introduction of percutaneous treatment of coronary artery stenosis with balloon angioplasty was the first revolution in interventional cardiology; the advent of metallic coronary stents (bare and drug-eluting) marked the second and third revolutions. However, the latest generation of drug-eluting stents is limited by several factors. Permanent vessel caging impairs arterial physiology, and the incidence of very late stent thrombosis - although lower with the second generation than with the first generation of drug-eluting stents - remains a major concern. This complication is mainly related to the presence of permanent metallic implants, chronic degeneration triggered by an inflammatory response to the coating polymer, and/or adverse effects of antiproliferative drugs on endothelial regeneration. In 2011, self-degrading coronary stents - the bioresorbable vascular scaffolds (BVS) - were introduced into clinical practice, showing good short-term results owing to their adequate strength. The advantage of these devices is the transient nature of vascular scaffolding, which avoids permanent vessel caging. In this Review, we summarize the latest research on BVS, with a particular emphasis on the implantation technique (which is different from that used with metallic stents) to outline the concept that BVS deployment methods have a major effect on procedural success and prognosis of patients with coronary artery stenosis. Furthermore, the clinical outcome of BVS in randomized clinical trials and in phase IV studies are discussed in different pathophysiological settings, such as stable or acute coronary disease. Finally, all the available data on the safety profile of BVS regarding scaffold thrombosis are discussed.

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Broward Virtual School: Preparing Students for Success

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INTRODUCTION

Broward Virtual School (BVS) seeks to prepare students for success in college and careers through the provision of excellence in teaching and advanced technology (Broward Virtual School [BVS], 2017a). Its mission statement states that, "The Broward Virtual School learning experience will provide students with an individualized, rigorous and engaging instructional model through a technology driven, interactive format" (BVS, 2017f, para. 1). BVS is committed to providing the necessary resource and tools to ensure students receive the skills need to be successful. It is a virtual school that strives for excellence while establishing a flexible and challenging alternative for students. BVS continues to meet the challenges that virtual schools face and they have reached a level that has made them a viable school of choice for students and parents within the county and beyond.

BVS is a part of the Broward County Public School System (BCPSS) (BVS, 2017a). Students within the county have the ability to take virtual courses through BVS free of charge. BVS was formerly located in Davie, Florida, but has since transitioned to Coconut Creek High School's campus, in Coconut Creek, Florida. BVS partners with Florida Virtual School to offer secondary courses, and K12 Inc. to offer K-5 courses to bring quality distance learning courses to K-12 students throughout the county, state and other areas. In 2016, BVS serviced more than 15,000 students (Royes, 2017a). BVS courses are 100% online with the exception of some exams, labs, and some meetings. Since BVS is a part of BCPS, it is fully accredited through AdvancED (BVS, 2017a). BVS takes pride in helping students prepare for success in colleges and careers.

BVS COURSES

BVS is comparable to traditional schools due to the nature of providing quality educational experiences to students (LishonSavarino, 2013). BVS is a flexible alternative for students that is designed with content that is at or above grade level (BVS, 2017c). The courses at BVS are an alternative for students that is not only flexible but challenging as well. The BVS curriculum encourages problem solving skills and critical thinking skills, as students work on real-life projects. BVS offers opportunities for students to utilize the knowledge and skills they have gained throughout their courses. BVS recommends that students devote approximately one hour...

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