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821.
An 8-year-old girl, who had been mechanically ventilated for 2 days, was referred to our clinic with total atelectasis of the right lung. Bronchoscopic examination showed an endobronchial mass lesion which was located on the right side of the carina. Carinal resection was performed and the patient was discharged on postoperative day 7. We presented this case report because of the rarity of tracheal tumors in childhood and to discuss the recommended surgical technique for pediatric carinal resection.  相似文献   
822.
OBJECTIVE: To evaluate the safety and efficacy of heart rate reduction by intravenous esmolol in patients who are assigned for coronary angiography with 64-slice computed tomography (CT). METHODS: Five hundred consecutive patients were prospectively analyzed. Patients with an initial heart rate less than 65 beats per minute (bpm) did not receive esmolol. Patients with a heart rate between 65 and 80 bpm received a bolus dose of 1 mg/kg intravenous esmolol. Patients with an initial heart rate between 80 and 90 bpm received a bolus dose of 2 mg/kg intravenous esmolol. An additional 1 mg/kg intravenous esmolol was given to the patients when the target heart rate was not reached with the first bolus dose. Patients with an initial heart rate more than 90 bpm received 50 mg atenolol PO, and were reevaluated after 1 h. RESULTS: A total of 391 patients with a heart rate > or =65 bpm before multislice computed tomography (MSCT) examination received intravenous esmolol with a mean dose of 158+/-55 mg. Initial and final mean heart rates were 80+/-11 bpm and 63+/-7 bpm, respectively (P<0.0001). Heart rate below 65 bpm was reached in 265 (65%) of these 391 patients. Only four patients (1%) had a final heart rate above 80 bpm before MSCT imaging. Four of the 391 patients (1%) had a final heart rate below 50 bpm. CONCLUSION: Intravenous esmolol is safe and effective to reach the optimum heart rate in patients assigned for MSCT.  相似文献   
823.
Although hypothyroid myopathy is seen frequently and the relationship with autoimmune hypothyroidism and myasthenia gravis is well known, specific forms of hypothyroid myopathy such as Hoffman's syndrome (HS) are rarely described. Here we describe a 40-year-old patient with Hashimoto thyroiditis showing symptoms and signs of two discrete forms of hypothyroid myopathy (HS and myasthenic syndrome) together. To our knowledge this is the first reported case with features of both of these syndromes. We discuss the diagnosis, speculate whether this patient may represent a unique form of hypothyroid myopathy, and report the 6-month follow-up of the patient both clinically and electrophysiologically.  相似文献   
824.

Background

The aspartate aminotransferases (AST) to platelet ratio index (APRI) may serve as a noninvasive marker to assess liver fibrosis.

Objectives

To assess the diagnostic ability of the APRI for prediction of fibrosis in patients with chronic hepatitis B (CHB), chronic hepatitis C (CHC), and non-alcoholic fatty liver disease (NAFLD).

Patients and Methods

This retrospective study included 207 patients with CHB, 108 with CHC, and 140 patients with NAFLD. The APRI was calculated as (AST level/upper normal limit for AST)/platelet counts (109/L) × 100. The stage of liver fibrosis in patients with chronic viral hepatitis was graded using the METAVIR scale. The Kleiner system for grading fibrosis was used in patients with NAFLD.

Results

Bivariate correlation analyses showed that the APRI was significantly associated with fibrosis scores in patients with CHC (p = 0.2634, p = 0.0059) and NAFLD (p = 0.2273, p = 0.0069), but not in those with CHB (p = 0.1005, p = 0.1495). Receiver operating characteristic (ROC) curves were used for assessing the ability of the APRI as a predictor of the absence or presence of liver fibrosis (fibrosis score of 0 vs fibrosis scores of 1-4). In patients with CHC, the APRI showed a sensitivity of 72.7% and a specificity of 62.4% for detection of fibrosis (p<0.01). In the NAFLD group, the APRI showed a sensitivity of 60.0% and specificity of 73.3% for detection of fibrosis (p<0.01). In patients with CHB, the APRI showed a sensitivity of 55.0% and a specificity of 75.4% for fibrosis (p=NS).

Conclusions

The APRI shows an acceptable accuracy for the assessment of liver fibrosis in patients with CHC and NAFLD, but not in those with CHB.  相似文献   
825.
OBJECTIVE: To examine evolving patterns of depression diagnosis and treatment in older U.S. adults in the era of newer‐generation antidepressants. DESIGN: Trend analysis using data from the Medicare Current Beneficiary Survey, a nationally representative survey of Medicare enrollees, from 1992 to 2005. SETTING: Community, usual care. PARTICIPANTS: Older Medicare fee‐for‐service beneficiaries. MEASUREMENTS: Depression diagnoses and psychotherapy use identified from Medicare claims; antidepressant use identified from detailed medication inventories conducted by interviewers. RESULTS: The proportion of older adults who received a depression diagnosis doubled, from 3.2% to 6.3%, with rates increasing substantially across all demographic subgroups. Of those diagnosed, the proportion receiving antidepressants increased from 53.7% to 67.1%, whereas the proportion receiving psychotherapy declined from 26.1% to 14.8%. Adjusting for other characteristics, odds of antidepressant treatment in older adults diagnosed with depression were 86% greater for women, 53% greater for men, 89% greater for whites, 13% greater for African Americans, 84% greater for metropolitan‐area residents, and 55% greater for nonmetropolitan‐area residents. Odds of antidepressant treatment were 54% greater for those diagnosed with major depressive disorder (MDD) and 83% greater for those with other depression diagnoses, whereas the odds of receiving psychotherapy was 29% lower in those with MDD diagnoses and 74% lower in those with other depression diagnoses. CONCLUSION: Overall diagnosis and treatment rates increased over time. Antidepressants are assuming a more‐prominent and psychotherapy a less‐prominent role. These shifts are most pronounced in groups with less‐severe depression, in whom evidence of efficacy of treatment with antidepressants alone is less clear.  相似文献   
826.
827.
The impact of persistent mixed chimerism (MC) after haematopoietic stem cell transplantation (HSCT) remains unclarified. We investigated the incidence of MC in peripheral blood beyond day +50 after HSCT and its impact on rejection, chronic graft‐versus‐host disease (c‐GvHD) and relapse in 161 children receiving allogeneic HSCT for haematological malignancies. The 1‐year incidence of late MC was 26%. Spontaneous conversion to complete donor chimerism (CC) occurred in 43% of patients as compared to 62% after donor lymphocyte infusions. No graft rejection occurred. The 1‐year incidence of c‐GvHD was 20 ± 7% for MC, and 18 ± 4% for CC patients (P = 0·734). The 3‐year cumulative incidence of relapse (CIR) according to chimerism status at days +50 and +100 was 22 ± 4% for CC patients vs. 22 ± 8% for MC patients (day +50; P = 0·935) and 21 ± 4% vs. 20 ± 7% (day +100; P = 0·907). Three‐year CIRs in patients with persistent MC and patients with CC/limited MC were comparable (8 ± 7% vs. 19 ± 4%; P = 0·960). HSCT for acute leukaemia or myelodysplastic syndrome as secondary malignancies (hazard ratio (HR) 4·7; P = 0·008), for AML (HR 3·0; P = 0·02) and from mismatched donors (HR 3·1; P = 0·03) were independent factors associated with relapse. Our data suggest that late MC neither protects from c‐GvHD nor does it reliably predict impending disease relapse.  相似文献   
828.
There exists a complex, dynamic interaction between mechanical ventilation and the splanchnic vasculature that contributes to a myriad of gastrointestinal tract complications that arise during critical illness. Positive pressure-induced splanchnic hypoperfusion appears to play a pivotal role in the pathogenesis of these complications, the most prevalent of which are stress-related mucosal damage, gastrointestinal hypomotility and diarrhea. Furthermore, characteristics of the splanchnic vasculature make the gastrointestinal tract vulnerable to adverse effects related to positive pressure ventilation. While most of these complications seen in mechanically ventilated patients are reflections of altered gastrointestinal physiology, some may be attributed to medical interventions instituted to treat critical illness. Since maintenance of normal hemodynamics cannot always be achieved, pharmacologic prophylactic therapy has become a mainstay in the prevention of gastrointestinal complications in the intensive care unit. Improved understanding of the systemic effects of mechanical ventilation and greater application of lung-protective ventilatory strategies may potentially minimize positive pressure-induced reductions in splanchnic perfusion, systemic cytokine release and, consequently, reduce the incidence of gastrointestinal complications associated with mechanical ventilation. Herein, we discuss the pathophysiology of gastrointestinal complications associated with mechanical ventilation, summarize the most prevalent complications and focus on preventive strategies and available treatment options for these complications. The most common causes of gastrointestinal hemorrhage in mechanically ventilated patients are bleeding from stress-related mucosal damage and erosive esophagitis. In general, histamine H(2) receptor antagonists and proton pump inhibitors prevent stress-related mucosal disease by raising the gastric fluid pH. Proton pump inhibitors tend to provide more consistent pH control than histamine H(2) receptor antagonists. There is no consensus on the drug of choice for stress ulcer prophylaxis with several meta-analyses providing conflicting results on the superiority of any medication. Prevention of erosive esophagitis include careful use of nasogastric tubes and institution of strategies that improve gastric emptying. Many mechanically ventilated patients have gastrointestinal hypomotility and diarrhea. Treatment options for gastrointestinal motility are limited, thus, preventive measures such as correction of electrolyte abnormalities and avoidance of medications that impair gastrointestinal motility are crucial. Treatment of diarrhea depends on the underlying cause. When associated with Clostridium difficile infection antibacterial therapy should be discontinued, if possible, and treatment with oral metronidazole should be initiated.More studies are warranted to better understand the systemic effects of mechanical ventilation on the gastrointestinal tract and to investigate the impact of lung protective ventilatory strategies on gastrointestinal complications.  相似文献   
829.
AIMS: To assess the value of plasma NT proBNP levels for predicting adverse outcomes in patients with dilated cardiomyopathy (DCM). METHODS: Seventy-eight patients with DCM (EF <40%) with sinus rhythm were enrolled. All patients had undergone echocardiographic examination, coronary angiography, and cardiac catheterisation. Blood samples for plasma NT proBNP levels were taken at rest following echocardiographic examination. Patients were followed up for 660+/-270 days for clinical endpoints defined as; death from worsening heart failure, sudden cardiac death and heart transplantation (Tx). RESULTS: Clinical end points were observed in 19 patients (5 Tx, 4 sudden cardiac death, 10 death from worsening heart failure). Variables associated with an increased hazard of clinical endpoints in univariate analysis were log NT proBNP, age, NYHA functional class, left ventricle ejection fraction, mitral valve effective regurgitation orifice area, and E wave deceleration time. The plasma level of NT proBNP (Hazard ratio=2.5 [95% CI: 1.3-4.7], p=0.0024) and age (hazard ratio=0.94 [95% CI: 0.90-0.98], p=0.0005) were the independent variables associated with an increased risk of clinical endpoints. NT proBNP plasma level >4500 pg/ml detected patients with clinical endpoints with a sensitivity, and specificity of 72%, 80%, respectively. The event free survival was found to be significantly lower in patients with NT proBNP levels >4500 pg/ml. CONCLUSION: NT proBNP seems to be a strong predictor of adverse outcomes in patients with DCM with sinus rhythm and may be used as a reliable biological marker in risk stratification.  相似文献   
830.
Abstract Achromobacter xylosoxidans causes infections in patients with underlying disorders. The aim of this study was to evaluate Achromobacter xylosoxidans cases. Eight patients were included, 5 infections and 3 colonizations. Three of them survived and 2 died. The predisposing factor was catheter. Infection control measures could prevent infection.  相似文献   
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