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1.
The diagnosis of cirrhosis requires screening for oesophageal varices by upper gastrointestinal endoscopy. In many countries, serological tests and elastography are replacing liver biopsy for diagnosing cirrhosis. The aims of this study were to see whether there was an optimal cut-off of liver stiffness that could predict the presence of large (>F2) oesophageal varices and whether this was disease specific. A total of two hundred and twenty-two patients with all cause cirrhosis (Child class A) were screened, and 211 had successful elastography and are included in the analysis. Of the patients studied, one hundred and thirty-two patients had no or small F1 varices and 79 had large varices. Liver stiffness of 19.8 kPa had a negative predictive value of 91% and a positive predictive value of 55% with an area under the curve (AUC) on receiver operating characteristics (ROC) of 0.73 in differentiating between small and large varices. Seven patients with large varices would have been incorrectly classified. In the 157 patients with hepatitis C as the aetiology of cirrhosis, the negative predictive value was 98% and only one patient was misclassified. Liver stiffness was superior in diagnostic accuracy to platelet count in all patients. A liver stiffness of >19.8 kPa could be utilized as a cut-off for endoscopy and beta blocker utilization, particularly in patients with hepatitis C.  相似文献   
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AIM: TO investigate the liver stiffness measurement (LSM) applicability and variability with reference to three probe positions according to the region of liver biopsy.
METHODS: The applicability for LSM was defined as at least 10 valid measurements with a success rate greater than 60% and an interquartile range/median LSM 〈 30%. The LSM variability compared the inter-position concordance and the concordance with FibroTest.
RESULTS: Four hundred and forty two consecutive patients were included. The applicability of the anterior position (81%) was significantly higher than that of the reference (69%) and lower positions (68%), (both P = 0.0001). There was a significant difference (0.5 kPa, 95% CI 0.13-0.89; P 〈 0.0001) between mean LSM estimated at the reference position (9.3 kPa) vs the anterior position (8.8 kPa). Discordance between positions was associated with thoracic fold (P = 0.008). The discordance rate between the reference position result and FibroTest was higher when the 7.1 kPa cutoff was used to define advanced fibrosis instead of 8.8 kPa (33.6% vs 23.5%, P = 0.03).
CONCLUSION: The anterior position of the probe should be the first choice for LSM using Fibroscan, as it has a higher applicability without higher variability compared to the usual liver biopsy position.  相似文献   
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Background and Aims:  The proposed cut-off values for the degree of fibrosis as assessed by liver stiffness measurement (LSM) might not be applicable in severe acute exacerbation of chronic hepatitis B (CHB). We aimed to assess the effect of necroinflammatory activity on LSM in this condition.
Methods:  We prospectively recruited consecutive patients with severe acute exacerbation of CHB (alanine aminotransferase or ALT > 10× upper limit of normal). The relationship of ALT levels and LSM were serially assessed and liver biopsy was carried out after ALT normalization.
Results:  Eleven patients (10 male, median age 43 years) were followed up for 25 weeks; nine patients received antiviral therapy. Overall, LSM was positively correlated with ALT levels ( r  = 0.67, P  < 0.001). At initial presentation, the median serum ALT and LSM was 1136 (581–2210) IU/L and 26.3 (11.1–33.3) kPa. A progressive reduction in LSM was observed during subsequent visits in parallel with the reduction of ALT levels. At the last visit, the median ALT was 27 (11–52) IU/L and LSM was 7.7 (4.7–10.8) kPa. Among the five patients who had liver biopsy carried out at week 25, four patients had F2 fibrosis (LSM 5.7–8.1 kPa) and one patient had F3 fibrosis (LSM 8.6 kPa).
Conclusions:  LSM using transient elastography with the current proposed cut-off values might misdiagnose liver cirrhosis in patients suffering from severe acute exacerbation of CHB. LSM should be assessed after normalization of ALT levels in order to accurately assess the degree of fibrosis.  相似文献   
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As graft survival in pediatric LT is often affected by progressive fibrosis, numerous centers carry out protocol liver biopsies. Follow‐up biopsy protocols differ from center to center, but all biopsies are progressively spaced out, as time from transplant increases. Therefore, there is a need for non‐invasive techniques to evaluate graft fibrosis progression in those children who have no clinical or serological signs of liver damage. Indirect markers, such as the APRI, should be relied on with caution because their sensitivity in predicting fibrosis can be strongly influenced by the etiology of liver disease, severity of fibrosis, and patient age. A valid alternative could be TE, a non‐invasive technique already validated in adults, which estimates the stiffness of the cylindrical volume of liver tissue, 100‐fold the size of a standard needle biopsy sample. The aims of this study were to evaluate the reliability of TE in children after LT and to compare both the TE and the APRI index results with the histological scores of fibrosis on liver biopsies. A total of 36 pediatric LT recipients were studied. All patients underwent both TE and biopsy within a year (median interval ‐0.012 months) at an interval from LT of 0.36 to 19.47 years (median 3.02 years). Fibrosis was assessed on the biopsy specimens at histology and staged according to METAVIR. There was a statistically significant correlation between TE stiffness values and METAVIR scores (P = .005). The diagnostic accuracy of TE for the diagnosis of significant fibrosis (F ≥ 2) was measured as the area under the curve (AUROC = 0.865), and it demonstrated that the method had a good diagnostic performance. APRI was not so accurate in assessing graft fibrosis when compared to METAVIR (AUROC = 0.592). A liver stiffness cutoff value of 5.6 kPa at TE was identified as the best predictor for a significant graft fibrosis (METAVIR F ≥ 2) on liver biopsy, with a 75% sensitivity, a 95.8% specificity, a 90% positive predictive value, and an 88.5% negative predictive value. These data suggest that TE may represent a non‐invasive, reliable tool for the assessment of graft fibrosis in the follow‐up of LT children, alerting the clinicians to the indication for a liver biopsy, with the aim of reducing the number of protocol liver biopsies.  相似文献   
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Purpose

To cross‐validate the magnetic resonance elastography (MRE) technique with a clinical device, based on an ultrasound elastometry system called Fibroscan.

Materials and Methods

Ten healthy subjects underwent an MRE and a Fibroscan test. The MRE technique used a round pneumatic driver at 60 Hz to generate shear waves inside the liver. An elastogram representing a map of the liver stiffness was generated allowing for the measurement of the average liver stiffness inside a region of interest. The Fibroscan technique used an ultrasound probe (3.5 MHz) composed of a vibrator that sent low‐frequency (50 Hz) shear waves inside the right liver lobe. The probe acts as an emitter‐receptor that measures the velocity of the waves propagated inside the liver tissue.

Results

The mean shear stiffness measured with the MRE and Fibroscan techniques were 1.95 ± 0.06 kPa and 1.79 ± 0.30 kPa, respectively. A higher standard deviation was found for the same subject with Fibroscan.

Conclusion

This study shows why MRE should be investigated beyond the Fibroscan. The MRE technique provided elasticity of the entire liver, meanwhile the Fibroscan provided values of elasticity locally. J. Magn. Reson. Imaging 2008;28:1287–1292. © 2008 Wiley‐Liss, Inc.  相似文献   
8.
《Digestive and liver disease》2018,50(10):1062-1067
BackgroundLiver fibroscan has recently been suggested as an alternative method to measure liver steatosis noninvasively. In this study, we evaluated usefulness of controlled attenuation parameter (CAP) for detecting increased arterial stiffness in general population.MethodsA total of 515 asymptomatic patients without potential cause of liver disease who had liver fibroscan and cardio-ankle vascular index (CAVI) during their health check-up exams were included. A cut off of CAP ≥222 dB/m was used to define fatty liver and CAVI ≥ 8 for increased arterial stiffness.ResultsBoth unadjusted and adjusted regression analyses showed significant association between fatty liver and increased arterial stiffness [unadjusted Odds ratio (OR) 1.896, 95% CI 1.305–2.754, p = .001 for CAP ≥ 222 dB/m alone]. With all traditional cardiovascular risk factors such as age, gender, body mass index, hypertension, diabetes mellitus, hypercholesterolemia and smoking adjusted, CAP ≥ 222 dB/m still showed significant association with increased arterial stiffness (OR 2.309, 95% CI 1.419–3.756, p = .001). The correlation between CAP-defined fatty liver and arterial stiffness was especially strong in subjects without diabetes (OR 2.959, 95% CI 1.709–5.122, p < 0.001).ConclusionCAP ≥ 222 dB/m is independently associated with increased arterial stiffness. As increased arterial stiffness is a surrogate and prognosticator for cardiovascular disease, surveillance using liver fibroscan may help screen and further stratify risk of patients.  相似文献   
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