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《Saudi Dental Journal》2022,34(3):194-201
Dental sleep medicine is the field of dental practice that deals with the management of sleep-related breathing disorders, which includes obstructive sleep apnea (OSA) in adults and children. Depending on the developmental age of the patient and the cause of the apnea dental treatment options may vary. For adult patients, treatment modalities may include oral appliance therapy (OAT), orthognathic surgery and surgical or miniscrew supported palatal expansion. While for children, treatment may include non-surgical maxillary expansion and orthodontic functional appliances. Many physicians and dentists are unaware of the role dentistry, particularly orthodontics, may play in the interdisciplinary management of these disorders. This review article is an attempt to compile evidence-based relevant information on the role of orthodontists/sleep dentists in the screening, diagnosis, and management of sleep apnea. Oral sleep appliance mechanisms of action, selective efficacy, and the medical physiological outcomes are discussed. The purpose of this review is to provide a comprehensive understanding of how orthodontists and sleep physicians can work in tandem to maximize the benefits and minimize the side effects while treating patients with OSA.  相似文献   
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目的 基于四维计算机X线断层扫描(Computed tomography,CT)血管成像(Dynamic four-dimensional CTA,4D-CTA)测量,计算颅内动脉瘤心动周期内膨胀率,探讨颅内动脉瘤破裂与膨胀率的相关性。方法 回顾性分析2018年5月-2020年5月就诊于哈尔滨医科大学附属第四医院微创神经外科一病区64例(其中未破裂动脉瘤24个,破裂动脉瘤40个)患者的完整资料; 所有患者均行4D-CTA扫描并重建图像; 依据动脉瘤破裂与否,患者分为未破裂组、破裂组; 将1个心动周期的图像数据分成20个阶段,判断动脉瘤是否存在异常搏动点; 同时记录和量化每个阶段动脉瘤的形态特征,计算其体积变化率(膨胀率); 分析动脉瘤破裂相关的危险因素。结果 未破裂组中男女患者比例差异不大; 破裂组女性患者则占70%,女性患者比例显著高于男性; 破裂组吸烟史的比例明显高于未破裂组; 破裂组瘤高(4.63±1.56)mm,瘤宽(4.72±3.68)mm,瘤颈宽(3.86±1.69)mm均大于未破裂组; 破裂组异常搏动点有29个(占72.5%)、膨胀率(14.56±6.25)%; 未破裂组异常搏动点13个(占54.2%)、膨胀率(10.21±3.26)%; 2组有明显差异(P<0.05)。此外,多因素Logistic回归分析显示动脉瘤破裂与吸烟史、纵横比、异常搏动点、膨胀率有关(P<0.05)。ROC分析中纵横比临界值为1.145(P=0.002),灵敏度为77.5%,特异性为58.3%; 存在异常搏动点与否的阈值为0.5(P=0.032),灵敏度为72.5%、特异性为45.8%; 膨胀率的临界值为9.775%(P=0.001),灵敏度为85.0%、特异性为54.2%。结论 借助4D-CTA能观察心动周期内颅内动脉瘤动态变化; 本研究成功量化了动脉瘤膨胀率,颅内动脉瘤破裂与膨胀率有关; 当膨胀率>9.775%,或纵横比>1.145,或存在异常搏动点时动脉瘤破裂风险将进一步增加。  相似文献   
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ObjectivesThis study correlates objective and subjective measurements associated with obstructive sleep apnea (OSA) to define the efficacy of Distraction Osteogenesis Maxillary Expansion (DOME) to treat adult OSA patients with narrow maxilla and nasal floor.MethodsThis is a retrospective study reviewing cases from September 2014 through April 2018 with 75 eligible subjects. Inclusion criteria required OSA confirmed by attended polysomnography (PSG). Pre- and Post-operative clinical data were measured at the Stanford Sleep Medicine and Stanford Sleep Surgery Clinics. DOME is a two-step process starting with insertion of custom-fabricated maxillary expanders anchored to the hard palate by mini-implants followed by minimally invasive osteotomies. After maxillary expansion was complete, orthodontic treatment to restore normal occlusion was initiated. Perioperative Apnea-Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), Nasal Obstruction Symptom Evaluation (NOSE), and Oxygen Desaturation Index (ODI) were measured for 43, 72, 72, and 34 subjects respectively. Statistical analysis was performed using paired T-test with significance set at p-value < 0.05.ResultsThe mean age of test subjects was 30.5 ± 8.5 years with a gender distribution of 57 males and 18 females. There was a significant reduction in pre and post-operative NOSE score (10.94 ± 5.51 to 3.28 ± 2.89, p < 0.0001), mean ESS score (10.48 ± 5.4 to 6.69 ± 4.75, p < 0.0001), and AHI (17.65 ± 19.30 to 8.17 ± 8.47, p < 0.0001) with an increased percentage of REM sleep (14.4 ± 8.3% to 22.7 ± 6.6%, p = 0.0014). No significant adverse effects were identified.ConclusionsDOME treatment reduced the severity of OSA, refractory nasal obstruction, daytime somnolence, and increased the percentage of REM sleep in this selected cohort of adults OSA patients with narrow maxilla and nasal floor.  相似文献   
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乳腺癌是女性最常见的恶性肿瘤之一,其转移显著提高了患者的死亡率。肿瘤微环境中多种因素发挥了免疫抑制作用并促进乳腺癌的转移,其中,髓源性抑制细胞(myeloid-derived suppressor cells,MDSCs)是骨髓祖细胞和活化的髓样细胞的异质群体,被认为是肿瘤微环境中发挥免疫抑制作用的重要成分。乳腺癌可以通过多种途径对MDSCs的扩增或募集产生积极影响。作者综述了近年来发现的乳腺癌影响MDSCs扩增或募集的机制,以及这些过程中潜在的治疗靶点。  相似文献   
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Background:

Spinocerebellar ataxias (SCAs) are a group of neurodegenerative disorders that primarily cause the degeneration in the cerebellum, spinal cord, and brainstem. We study the clinical characteristics, radiological features and gene mutation in Chinese families with SCAs.

Methods:

In this study, we investigated 10 SCAs Chinese families with SCA1, SCA3/Machado–Joseph disease (MJD), SCA7, SCA8. There were 27 people who were genetically diagnosed as SCA, of which 21 people showed clinical symptoms, and 6 people had no clinical phenotype that we called them presymptomatic patients. In addition, 3 people with cerebellar ataxia and cataracts were diagnosed according to the Harding diagnostic criteria but failed to be recognized as SCAs on genetic testing. Clinical characteristic analyses of each type of SCAs and radiological examinations were performed.

Results:

We found that SCA3/MJD was the most common subtype in Han population in China, and the ratio of the pontine tegmentum and the posterior fossa area was negatively correlated with the number of cytosine-adenine-guanine (CAG) repeats; the disease duration was positively correlated with the International Cooperative Ataxia Rating Scale score; and the CAG repeats number of abnormal alleles was negatively correlated with the age of onset.

Conclusions:

Collectively our study is a systematic research on SCAs in China, which may help for the clinical diagnosis and prenatal screening of this disease, and it may also aid toward better understanding of this disease.  相似文献   
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A shortage of blood during the pandemic outbreak of COVID-19 is a typical example in which the maintenance of a safe and adequate blood supply becomes difficult and highly demanding. So far, human RBCs have been produced in vitro using diverse sources: hematopoietic stem cells (SCs), embryonic SCs and induced pluripotent SCs. The existing, even safest core of conventional cellular bioproducts destined for transfusion have some shortcoming in respects to: donor –dependency variability in terms of hematological /immunological and process/ storage period issues. SCs–derived transfusable RBC bioproducts, as one blood group type for all, were highly complex to work out. Moreover, the strategies for their successful production are often dependent upon the right selection of starting source materials and the composition and the stability of the right expansion media and the strict compliance to GMP regulatory processes. In this mini-review we highlight some model studies, which showed that the efficiency and the functionality of RBCs that could be produced by the various types of SCs, in relation to the in-vitro culture procedures are such that they may, potentially, be used at an industrial level. However, all cultured products do not have an unlimited life due to the critical metabolic pathways or the metabolites produced. New bioreactors are needed to remove these shortcomings and the development of a new mouse model is required. Modern clinical trials based on the employment of regenerative medicine approaches in combination with novel large-scale bioengineering tools, could overcome the current obstacles in artificial RBC substitution, possibly allowing an efficient RBC industrial production.  相似文献   
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