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1.
自体骨髓干细胞移植治疗终末期肝病临床研究   总被引:18,自引:0,他引:18  
目的 探讨自体骨髓干细胞(BMSC)移植对肝衰竭及肝硬化失代偿期患者的治疗作用.方法 24例肝硬化失代偿期及肝衰竭患者无菌抽取骨髓65~95ml,Kai W01 lert方法分离纯化BMSC,然后经肝动脉或脾动脉导管注入肝脏或脾脏.术后定期检测肝功能和凝血功能,并观察同期的症状体征和不良反应情况.结果 术后2周内所有血清学指标均无显著性改变;与术前比较,术后4周,清蛋白(g/L)为30.91±4.00 vs 27.75±5.40(P<0.05),至12周,升至32.00±6.18(P<0.01);前清蛋白(mg/d1)为18.28±3.78 vs 15.63±3.16(P<0.01);总胆红素(μmmol/L)为36.94±21.15 vs 125.01±150.05;总胆汁酸(μmmol/L)为41.63±33.91 vs 78.00±59.80,凝血酶时间(s)及纤维蛋白原(g/L)分别为14.81±1.69 vs 22.40±7.07和2.63±0.62 vs 1.76±0.95,P均<0.05;球蛋白及肝酶指标均无明显变化(P>0.05).术后1周食欲、体力改善分别为91.67%和87.5%;第2周62.5%肝病面容好转,有1例蜘蛛痣明显减少;术后12周的总生存率为62.5%,其中移植2周后死亡及失访者共9例,其原因为慢性肝衰竭合并白发性细菌性腹膜炎或DIC或肝肾综合征.BMSC肝内灌注术中有2例发现小肝癌,即改予脾内灌注BMSC并术后行经皮肝穿刺肝癌瘤内无水酒精注射,其中1例AFP由80 ng/ml降至9 ng/ml,恢复良好,另1例手术后11周死于肝肾综合征.所有患者均未发现细胞移植并发症.结论 自体BMSC移植治疗终末期肝病近期安全有效,患者肝功能、凝血功能改善明显,生存质量提高,但应严格掌握适应证.  相似文献
2.
Background Renal transplantation in sensitized candidates remains a highly significant challenge worldwide. The production of panel reactive antibody (PRA) against human leukocyte antigen (HLA) is a major risk factor in presensitized recipients. The aim of this study was to evaluate the impact of HLA matching and recipients' PRA on two-year outcome in presensitized renal allograft recipients.
Methods We determined the percentage of panel reactivity and specificity of anti-HLA immunoglobulin (Ig) G antibodies in 73 presensitized renal allograft recipients compared with 81 unsensitized recipients (control group). HLA genotyping of both recipients and corresponding donors was performed by PCR with sequence-specific primers (PCR-SSP). We analyzed the factors influencing the early graft outcome (two-year rejection rates and survival rates of the grafts), including HLA mismatching, class and degree of panel reactivity, and target antigen of donors.
Results Presensitized recipients had a worse two-year outcome than unsensitized recipients (P=0.019 for rejection rate, P=0.01 for survival rate). The difference in number of HLA-mismatched alleles with either 6-antigen matching (Ag M) standard or amino acid residue matching (Res M) standard was not significant between the rejection and non-rejection groups of presensitized recipients or between the graft survival group and graft loss group. Compared with the control group, recipients with both PRA-I and PRA-II antibodies had a significantly worse two-year outcome (P=0.001 for rejection rate, P=0.002 for survival rate). The two-year outcomes of the peak PRA 〉50% group and its subgroup, at-transplant PRA 〉50% group, were significantly worse compared with the control group (P=0.025 and P=0.001 for rejection rate, P=0.043 and P=0.024 for survival rate). The rejection rates of the at-transplant target antigen positive group and its subgroup, HLA-I target antigen positive group, were significantly higher than the control group (P=0.001 and P=-0.001), target antigen negative group (P=0.003 and P=0.001), and peak target antigen positive with negative at-transplant target antigen group (P=0.024 and ,0=-0.002). Two-year graft survival rates of the target antigen positive group and HLA-I target antigen positive group were significantly lower than the control group (P=0.012 and ,P=0.001). The two-year outcome of target antigen unknown group was similar to that of the target antigen positive group. Presensitized recipients with pre-transplant plasmapheresis or immunoadsorption (PRA prepared group) had a better but non-significant two-year outcome than the control group. However, the PRA unprepared presensitized recipients were different to the control group (P=-0.004 for rejection rate and P=-0.005 for survival rate). Hyperacute rejection (HR) occurred in three recipients with positive HLA-I target antigen and without mismatch according to Res M and in one case with positive PRA-II (for an unknown target antigen). No HR occurred in eight cases with positive HLA-II target antigens.
Conclusions Pre-transplant PRA preparations might improve the access of presensitized patients to renal donors. Avoiding antigen-positive donors remains a fundamental measure in preventing HR and early rejections.  相似文献
3.
经冠状动脉骨髓单个核细胞移植治疗缺血性心脏病二年随访   总被引:11,自引:1,他引:10  
Gao LR  Wang ZG  Tian HT  Zhu ZM  Fei YX  Xu HT  Chen Y  Zhu JR  He S  Zhang NK  Ding QA  Yang Y 《中华医学杂志》2007,87(10):685-689
目的观察经冠状动脉自体骨髓单个核细胞(BMMC)移植治疗缺血性心脏病的长期效果及安全性。方法76例缺血性心脏病病人。其中BMMC移植者52例,包括急性心肌梗死(AMI)26例,慢性缺血性心力衰竭(CIHF)26例,对照24例(AMI10例,CIHF14例)。对照组:常规治疗(药物及介入治疗);移植组:在常规治疗基础上加经冠状动脉自体BMMC移植。细胞移植方法:于髂后上嵴抽取骨髓,梯度密度法分离获得BMMC,将细胞悬液调为2×10^6/ml浓度,超选择性经梗死相关冠状动脉气囊充盈下高压注入BMMC,重复注入6—8次,或经冠状动脉选择性移植,气囊未充盈下高压注入移植细胞。随访观察临床及实验室指标,二维超声心动图,正电子发射体层心肌显象。结果52例完成2年随访。AMI病人BMMC移植后1年左室射血分数(LVEF)比术前增加了5.8%(53.9%±2.9%vs59.7%±1.5%,P〈0.05),2年增加了3.8%(57.7%±1.7%,P〉0.05),对照组LVEF减低,但差异无统计学意义。左室舒张末容量(LVEDV)、左室收缩末容量(LVESV)无显著改善。移植组2年心肌代谢缺损区与3个月比较无变化;BMMC移植组与术前相比差异有统计学意义(P〈0.05)。CIHF病人BMMC移植后1年、2年LVEF与术前比较分别增加了8.8%、9.2%(P〈0.01),LVESV下降20.4%、27.8%(均P〈0.05),2年心肌代谢缺损区与3个月比较无变化;对照组心功能明显恶化。Holter检测未发现新的心律失常。结论BMMC治疗可明显改善CIHF病人的心功能。而对AMI病人并无左室收缩功能改善的长期效果,仅限制了心室重塑。  相似文献
4.
Background Adipose-derived stem cells (ADSCs) are capable of differentiating into cardiomyogenic and endothelial cells in vitro. We tested the hypothesis that transplantation of ADSCs into myocardial scar may regenerate infracted myocardium and restore cardiac function. Methods ADSCs were isolated from the fatty tissue of New Zealand white rabbits and cultured in Iscove's modified dulbecco's medium. Three weeks after ligation of left anterior descending coronary artery of rabbits, either a graft of untreated ADSCs (UASCs, n=14), 5-azacytidine-pretreated ADSCs (AASCs, n=13), or phosphate buffer saline (n=13) were injected into the infarct region. Transmural scar size, cardiac function, and immunohistochemistry were performed 5 weeks after cell transplantation. Results ADSCs in culture demonstrated a fibroblast-like appearance and expressed CD29, CD44 and CD105. Five weeks after cell transplantation, transmural scar size in AASC-implanted hearts was smaller than that of the other hearts. Many ADSCs were differentiated into cardiomyocytes. The AASCs in the prescar appeared more myotube-like. AASCs in the middle of the scar and UASCs, in contrast, were poorly differentiated. Some ADSCs were differentiated into endothelial cells and participate in vessel-like structures formation. All the ADSC-implanted hearts had a greater capillary density in the infarct region than did the control hearts. Statistical analyses revealed significant improvement in left ventricular ejection fraction, myocardial performance index, end-diastolic pressure, and peak +dP/dt, in two groups of ADSC-implanted hearts relative to the control hearts. AASC-implanted hearts had higher peak -dP/dt values than did control, higher ejection fraction and peak +dP/dt values than did UASC-implanted hearts. Conclusions ADSCs transplanted into the myocardial scar tissue formed cardiac islands and vessel-like structures, induced angiogenesis and improved cardiac function. 5-Azacytidine pretreatment before implantation is desirable for augmenting myogenesis. Transplantation of 5-azacytidine-treated ADSCs into the myocardial scar was more efficient than that of untreated ADSCs in preservation of cardiac function.  相似文献
5.
同种异体肾移植术后长期应用雷公藤多苷的临床观察   总被引:10,自引:4,他引:6  
目的:观察肾移植术后长期应用雷公藤多苷(TⅡ)的临床效果。方法:对223例同期肾移植受者进行对照性临床研究,随机分为TⅡ组(n=121)和对照组(n=102),另根据TⅡ剂量的不同将TⅡ组121例患者分为常规剂量TⅡ组(n=82)和双倍剂量TⅡ组(n=39)。以糖皮质激素、环孢素和硫唑嘌呤作为防治排斥的“三联”免疫抑制基础药物。各组患者均无并发感染、环孢素肾中毒和手术并发症。各组之间的性别、年龄、透析时间、冷缺血和热缺血时间、淋巴细胞毒性试验、群体反应性抗体水平均非常接近。结果:TⅡ组与对照组术后3个月内经病理证实的急性排斥发生率有明显差异,分别为4.1%和26.5%。TⅡ双倍剂量组在术后3个月内无一例发生急性排斥。TⅡ组中发生急性排斥的病理程度也较对照组轻。根据Banff分类,TⅡ组5例患者细胞性排斥为中度急性排斥(ⅡA级);对照组27例急性排斥中,重度急性排斥(Ⅲ级)和中度急性排斥(ⅡB级)各11例。两组之间慢性移植肾肾病(CAN)的发生率分别为7.4%和12.7%。TⅡ组移植肾5年存活率明显高于对照组(90.9%郴77.5%。P〈0.01)。TⅡ组大多数受者5年内肾功能正常,肾功能异常(SCr≥132.6μmol/L)的发生率明显低于对照组,分别为33.6%和61.8%。对血肌酐倒数到达透析需要的时间(1/SCr为0.1)进行预测,即1/SCr值由0.5~0.1,预期到达的时间(月),TⅡ组和对照组之间的预期值分别为0.5:90.14和42.67;0.2:164.71和66.79;0.1:186.91和78.08。结论:肾移植术后长期应用TⅡ能有效地降低肾移植术后急性排斥发生率,减轻排斥反应的病理程度,降低CAN的发生率,保持移植肾功能长期稳定。雷公藤多苷不良反应轻,适合于长期用药。  相似文献
6.
神经干细胞移植治疗脊髓损伤的实验研究   总被引:8,自引:0,他引:8  
目的:观察神经干细胞(NSCs)移植对脊髓损伤(SCI)大鼠功能恢复的作用。方法:30只Wistar大鼠随机分为对照组、损伤组和移植组,每组10只;损伤组和移植组制作成L4平面的脊髓全横断模型,将培养的大鼠NSCs悬液注入移植组损伤脊髓处,损伤组注射等量的生理盐水。术后2mo,采用BBB评分、皮层体感诱发电位(CSEP)和辣根过氧化物酶(HRP)逆行示踪技术观察大鼠脊髓运动和传导功能的恢复程度。结果:术后2mo,BBB评分损伤组、移植组大鼠有所恢复,但都未达到正常水平,其中移植组的大鼠恢复较好,评分较高,与损伤组有统计学差异。SCI后,损伤组、移植组的CSEP波消失,术后2mo移植组的波形有所恢复,但潜伏期延长。对照组脊髓前角可见到许多HRP标记阳性神经元,损伤组未见阳性神经元,移植组可见有阳性神经元,但数目较对照组少。结论:NSCs脊髓内移植能促进损伤脊髓运动和传导功能的部分恢复。  相似文献
7.
Background The main therapeutic treatments for hepatic artery complications after orthotopic liver transplantation (OLT) include thrombolysis, percutaneous transluminal angioplasty, stent placement, and liver retransplantation. The prognosis of hepatic artery complications after OLT is not only related to the type, extent, and timing but also closely associated with the selection and timing of the therapeutic methods. However, there is no consensus of opinion regarding the treatment of these complications. The aim of this study was to determine optimal treatment for hepatic artery complications after OLT.
Methods The clinical data of 25 patients diagnosed with hepatic artery thrombosis (HAT) and hepatic artery stenosis (HAS) between October 2003 and March 2007 were retrospectively reviewed. Treatments included liver retransplantation and interventions which contain thrombolysis, percutaneous transluminal angioplasty and stent placement.
Results Among five patients with HAT, 3 were treated with thrombolysis. One recovered, one died after thrombolysis and another one died of multi-organ failure after retransplantation because of recurrent HAT. The remaining 2 patients underwent successful retransplantation and have survived after that. Among 12 patients presented with HAS within 1 month postoperatively, 2 patients underwent retransplantation due to irreversible liver failure and another 10 patients were treated with interventions. The liver function failed to improve in 3 patients and retransplantations were performed in 4 patients after stent placement because of ischemic cholangitis. Among 6 patients undergoing liver retransplantations, two died of intracranial hemorrhage and infection respectively. Eight patients presented with HAS after 1 month postoperatively, 5 patients were treated with interventional management and recovered after stent placement. Among another 3 patients presented with HAS, 2 patients’ liver function was stable and one patient received late liver retransplantation due to  相似文献
8.
兔角膜内皮细胞移植治疗角膜内皮损伤   总被引:8,自引:0,他引:8  
Liu XW  Zhao JL 《中国医学科学院学报》2007,29(3):407-412,I0010
目的 研究兔角膜内皮细胞(CECs)移植的可行性和移植后细胞的形态和功能。方法 体外培养兔CECs并用Brdu标记后接种在Gelatin膜载体上;采用α-氰基丙烯酸脘基酯作为组织黏合剂,将接种有兔CECs的载体与机械去除了内皮细胞的自体兔角膜植片相黏合,原位缝合对21只新西兰白兔的右眼进行CECs移植;另外17只兔的右眼作为对照仅移植没有接种任何细胞的载体膜。术后1、2、4、8、12周观察兔眼角膜移植片的透明情况、眼压和植片厚度,并利用共焦显微镜进行移植细胞的形态观察和计数。观察12周后处死动物,角膜标本分别进行组织切片、免疫组织化学染色和电镜观察。结果 CECs在Gelatin膜载体上生长良好,体外培养3—5d后细胞汇合,细胞密度可以达到约2700个/mm^2。术后2周,所有植片均发生了水肿,并逐渐浑浊。CECs组植片在术后4周左右逐渐水肿减退,开始恢复透明;而对照组角膜植片则持续水肿,逐渐浑浊。术后移植细胞的密度随时间推移逐渐降低,术后12周时,移植细胞的平均密度为(2023±330)个/mm^2。Brdu单克隆抗体免疫组织化学染色显示,植片上的细胞为移植细胞。结论 Gelatin膜作为内皮细胞培养载体并进行内皮细胞移植是一种可行的方法。  相似文献
9.
大鼠肾移植三种尿路重建术式的比较   总被引:8,自引:1,他引:7  
目的 对大鼠肾移植3种尿路重建术式进行比较,筛选出稳定性好、并发症少的手术方案.方法 以3种术式进行大鼠同系肾移植尿路重建:A组,供/受体输尿管端端吻合术(n=14);B组,供体膀胱瓣-受体膀胱吻合术(n=15);C组,供体输尿管-受体膀胱浆肌层隧道术(n=17).对各组尿路重建时间、尿路并发症以及血肌酐动态指标进行比较.结果 A、B、C 3组手术时间分别为(6±2.0)min、(14±2.5)min、(7±2.0)min, A组与C组差异无统计学意义, B组用时分别与A组、C组差异有统计学意义(P<0.05);术后,A组输尿管梗阻发生率最高(21.4%),B组尿漏发生率最高(13.3%);C组术后尿路并发症总发生率最低,为11.8%,A、B两组术后尿路并发症总发生率分别为28.5%和26.1%,与C组之间差异均有统计学意义(P<0.05);血肌酐监测显示A组术后40d与C组差异有统计学意义(P<0.05),术后60d与B、C两组间差异有统计学意义(P<0.05).结论 供体输尿管-受体膀胱浆肌层隧道吻合术后尿路并发症少,对移植肾恢复影响小,是大鼠肾移植尿路重建的较理想方案.  相似文献
10.
自体富血小板凝胶在糖尿病难治性皮肤溃疡中的初步应用   总被引:8,自引:2,他引:6  
目的 评价自体富血小板凝胶(autologous platelet-rich gel,APG)治疗糖尿病难治性皮肤溃疡的有效性和安全性.方法 共纳入13例患者;取患者自身外周静脉血,经离心、分离、浓缩制得富含血小板血浆(platelet-rich plasma,PRP),将其与凝血酶-钙剂按一定比例(10∶1)(V/V)混合凝固形成APG,然后用双通注射器将APG均匀喷洒至溃疡表面或注射至深部窦道内.结果 13例患者治疗12周后,溃疡愈合率为69.2%(9/13),总有效率为84.6%(11/13);APG治疗后前3周溃疡面积愈合速度最快(P<0.05);APG对窦道治愈率为83.3%(10/12);治疗过程中无不良反应发生.结论 APG用于治疗糖尿病难治性皮肤溃疡是安全有效的.  相似文献
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