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71.
Background
Hospitalization for older patients with community-acquired pneumonia (CAP) is associated with functional decline. Little is know about the relationship between inflammatory markers and determinants of functional status in this population. The aim of the study is to investigate the association between tumor necrosis factor (TNF)-α, C-reactive protein (CRP) and Activities of Daily Living, and to identify risk factors associated with one year mortality or hospital readmission.Methods
301 consecutive patients hospitalized for CAP (mean age 73.9 ± 5.3 years) in a University affiliated hospital over 18 month period were included. All patients were evaluated on admission to identify baseline demographic, microbiological, cognitive and functional characteristics. Serum levels for TNF-α and CRP were collected at the same time. Reassessment of functional status at discharge, and monthly thereafter till 3 months post discharge was obtained and compared with preadmission level to document loss or recovery of functionality. Outcome was assessed by the composite endpoint of hospital readmission or death from any cause up to one year post hospital discharge.Results
36% of patients developed functional decline at discharge and 11% had persistent functional impairment at 3 months. Serum TNF-α (odds ratio [OR] 1.12, 95% CI 1.08–1.15; p < 0.001) and the Charlson Index (OR = 1.39, 95% CI 1.14 to 1.71; p = 0.001) but not age, CRP, or cognitive status were independently associated with loss of functionality at the time of hospital discharge. Lack of recovery in functional status at 3 months was associated with impaired cognitive ability and preadmission comorbidities. In Cox regression analysis, persistent functional impairment at 3 months, impaired cognitive function, and the Charlson Index were highly predictive of one year hospital readmission or death.Conclusion
Serum TNF-α levels can be useful in determining patients at risk for functional impairment following hospitalization from CAP. Old patients with impaired cognitive function and preexisting comorbidities who exhibit delay in functional recovery at 3 months post discharge may be at high risk for hospital readmission and death. With the scarcity of resources, a future risk stratification system based on these findings might be proven helpful to target older patients who are likely to benefit from interventional strategies. 相似文献72.
Finger counting method is more accurate than age‐based weight estimation formulae in estimating the weight of Hong Kong children presenting to the emergency department 下载免费PDF全文
73.
Glanzmann thrombasthenia (GT) is the most common inherited disorder of platelets. Most of the molecular defects previously identified in GT have been caused by point (or other small) mutations in the genes for glycoprotein (GP) IIb or GPIIIa. We have used single-strand conformation polymorphism (SSCP) analysis to rapidly identify single- base changes in the GPIIIa gene. Using genomic DNA from normal individuals and patients with GT, each GPIIIa exon and a short stretch of flanking intronic sequence was amplified, heat-denatured, and separated in nondenaturing acrylamide gels. Only those fragments with an abnormal migration pattern were isolated and the nucleotide sequence determined. Using SSCP, we detected the polymorphism in the HPA-1 (P1A) system and all three known silent polymorphisms in the GPIIIa gene. Screening 14 GPIIIa exons from 5 patients with GT, one mutant allele was identified. The nucleotide sequence of the abnormal 240-bp SSCP fragment was determined and a G-->A substitution in the splice donor site of exon iv was identified. Analysis of platelet RNA resulting from this mutation showed two mRNA species: one contained a deletion of exon iv, whereas the other had a 27-bp addition to exon iv due to the use of a cryptic splice site in the downstream intron. Single-base substitutions are the most common mutation in GT and often result in abnormal mRNA splicing. SSCP is a rapid and sensitive technique for identifying mutations or polymorphisms in the GPIIIa gene. 相似文献
74.
The deleterious effects of low-dose corticosteroids on bone density in patients with polymyalgia rheumatica 总被引:4,自引:1,他引:4
Pearce G; Ryan PF; Delmas PD; Tabensky DA; Seeman E 《Rheumatology (Oxford, England)》1998,37(3):292-299
The beneficial effects of corticosteroid therapy in the treatment of
rheumatic diseases may be offset by the occurrence of corticosteroid-
related osteoporosis. This problem may be overcome by using low-dose
corticosteroids; however, the dose of corticosteroids that is both
efficacious and skeletal sparing is uncertain. Therefore, the aim of this
study was to determine whether low-dose prednisolone treatment results in
bone loss and modifies bone turnover. Nineteen patients (12 female, seven
male) suffering from polymyalgia rheumatica received 10 mg or less daily,
given in reducing dosage, with a range of 2.5-10 mg and an average of
6.0+/-0.2 mg daily (+/-S.E.M.). Prior to the commencement of therapy and at
regular intervals during treatment, bone mineral density (BMD) using dual
X-ray absorptiometry and circulating biochemical and hormonal determinants
of bone turnover were measured. The patients were followed for 14.4+/-1.6
months (range 6-27). They were compared to 19 age-matched controls. Despite
a mean exposure dose of 6 mg/day and disease remission, BMD decreased in
the patients at the lumbar spine (2.6+/-0.8%, P < 0.01), femoral neck
(2.9+/-1.5%, P=0.06), Ward's triangle (5.5+/-2.9%, P=0.06) and the
trochanter (4.3+/-1.9%, P < 0.05). Total body bone mass decreased by
50+/-19 g in the first 6 months (P < 0.02), and by 39+/-30 g in the
remaining 8 months of follow- up [not significant (NS)]. In the first 6
months, BMD decreased at the lumbar spine (1.7+/-0.9%, P = 0.06). From 6
months to the end of follow- up, BMD decreased by 8.5+/-3.5% at Ward's
triangle (P < 0.05) and by 4.8+/-2.5% at the femoral neck (P=0.08). The
fall in BMD correlated with the cumulative prednisolone dose at
trabecular-rich regions (trunk r=-0.72, P < 0.001; ribs r=-0.53, P <
0.05). Bone resorption, assessed by urinary cross-laps, was 54.7% higher
than controls before treatment was started (P < 0.05) and decreased by
23.5+/-7.1% in the first month of treatment when the mean prednisolone dose
was 9.1 mg/day, range 5-10 (P < 0.0001). Serum osteocalcin was not
suppressed by disease before treatment, decreased by 27.4+/-5.1% during the
first month of treatment (P < 0.001), remained suppressed while the
daily dose of prednisolone was > 5 mg/day, but returned to baseline
below this dose. Serum parathyroid hormone was 19.3% lower in the patients
than controls at baseline (NS), and increased by 46.1% (P < 0.05) but
was no higher than controls at any time. Muscle strength increased by
20-60% (P < 0.05 to < 0.01). Prophylaxis should be considered in
patients receiving > or = 5 mg/day prednisolone daily as bone loss is 2-
to 3-fold expected rates. Earlier trabecular bone loss may predispose to
spine and rib fracture; later cortical bone loss may predispose to hip
fractures. Doses of prednisolone of < 5 mg daily may be skeletal
sparing, but may not be efficacious.
相似文献
75.
76.
Helfand SC; Modiano JF; Moore PF; Soergel SA; MacWilliams PS; Dubielzig RD; Hank JA; Gelfand EW; Sondel PM 《Blood》1995,86(2):636-645
We identified a dog with large granular lymphocytic leukemia and cutaneous lymphoma that exhibited constitutive expression of interleukin-2 (IL-2) receptors by the leukemic peripheral blood lymphocytes. The leukemic cells phenotypically resembled natural killer (NK) cells, and their surface IL-2 receptors were functional, as determined by the capacity to bind human recombinant IL-2 with high- affinity resulting in the transduction of proliferation signals and in the development of lymphokine-activated killer cell activity. These cells produced IL-2 spontaneously, and they may have maintained their proliferative state through an IL-2-dependent autocrine growth pathway. Our results indicate that neoplastic lymphocytes of syndromes that involve circulating leukemic cells with dermotropism can originate from NK-like cells. Additionally, the data also suggest that proliferative conditions such as these may be the result of the aberrant production of IL-2. Further, this case illustrates the potential for the use of hematopoietic malignancies in the dog as a suitable animal model for immune targeting of IL-2 receptors as a novel treatment approach for similar malignancies of human beings. 相似文献
77.
Recombinant human factor IX: replacement therapy, prophylaxis, and pharmacokinetics in canine hemophilia B 总被引:1,自引:2,他引:1
Brinkhous KM; Sigman JL; Read MS; Stewart PF; McCarthy KP; Timony GA; Leppanen SD; Rup BJ; Keith JC Jr; Garzone PD; Schaub RG 《Blood》1996,88(7):2603-2610
Recombinant human factor IX (rFIX) has been expressed in transduced cultured cell systems since 1985. Because there has been limited in vivo testing of rFIX in hemophilia B subjects, this study was undertaken using the severe hemophilia B canines of the Chapel Hill strain. Three groups of hemophilic dogs received either 50, 100, or 200 IU/kg of rFIX. As a control, a fourth group of hemophilic dogs received 50 IU/kg of a high purity, plasma-derived human FIX (pdFIX). The coagulant and hemostatic effects of rFIX and pdFIX were similar with all comparative dosing regimens. Based on activity data, the elimination half-life of rFIX was 18.9 +/- 2.3 hours and pdFIX was 17.9 +/- 2.1 hours. A prophylactic regimen administering rFIX daily resulted in a continuous therapeutic level of plasma FIX and was accompanied by a two-fold increase in recovery levels by day 5, compared to that observed with administration of a single bolus. The mechanisms of the high to complete recovery of FIX with the prophylactic regimen could depend not only on the degree of saturation of the vascular endothelial binding sites but also on the altered dynamics of the balance of FIX distribution between the intravascular and extravascular compartments. The pharmacokinetic (PK) parameters for rFIX and pdFIX were similar. However, the relative PK values for V1 and V5s of both products on day 5 differed greatly from day 1 and may reflect the changing equilibrium of FIX between compartments with elevated levels of plasma FIX. Neutralizing antihuman FIX antibodies resulting from human FIX antigen being administered to FIX deficient dogs were observed beginning at 14 days. The antigenicity of rFIX and pdFIX appeared to be comparable. Despite the very different procedures used for production of rFIX and pdFIX products, in vivo testing in hemophilia B dogs showed the functional behavior of these products is similar; they are highly effective for replacement therapy and for prophylaxis. 相似文献
78.
Anti-My-28, an antigranulocyte mouse monoclonal antibody, binds to a sugar sequence in lacto-N-neotetraose 总被引:5,自引:0,他引:5
Spitalnik SL; Schwartz JF; Magnani JL; Roberts DD; Spitalnik PF; Civin CI; Ginsburg V 《Blood》1985,66(2):319-326
Anti-My-28 is an IgM kappa monoclonal antibody produced by a hybridoma prepared from spleen cells of a mouse immunized with normal human granulocytes. By immunofluorescence it binds to human granulocytes but not to monocytes and lymphocytes. However, after treating cells with neuraminidase, the antibody also binds to lymphocytes and monocytes and to many leukemic cell lines and patient leukemic blast cells. Anti-My- 28 binds to several neutral glycolipids and desialylated gangliosides of leukocytes and erythrocytes as detected by radioimmunoassay and immunostaining of thin-layer chromatograms. It recognizes a sugar sequence in lacto-N-neotetraose, Gal beta 1-4GlcNAc beta 1-3Gal beta 1- 4Glc. This tetrasaccharide occurs in the glycolipids paragloboside and sialosylparagloboside, and its distal trisaccharide sequence is found in higher glycolipids and in glycoproteins. 相似文献
79.
Karen L Andrews Xiao L Moore Jaye PF Chin‐Dusting 《Clinical and experimental pharmacology & physiology》2010,37(7):736-742
1. The endothelium is critical in the control of vascular haemodynamics and haemostasis. Endothelial dysfunction, typically characterized by decreased nitric oxide bioavailability and response to endothelium‐dependent agonists, is well accepted as a defining characteristic of early atherosclerosis. 2. Numerous epidemiological studies have reported that increased levels of circulating HDL are vasculoprotective and reduce the incidence of adverse cardiovascular events. Traditionally, these effects have been attributed to the ability of HDL to remove cholesterol from cells via reverse cholesterol transport. However, there is increasing evidence that the beneficial effects on the endothelium by HDL encompass its anti‐inflammatory, antithrombotic and anti‐oxidative properties, which include the release of nitric oxide (NO). 3. This review highlights recent findings on the importance of HDL in reducing atherosclerotic risk. We focus on the beneficial effects of HDL‐induced NO release and how this relates to endothelial dysfunction and on the effect of HDL on vascular repair via endothelial progenitor cells. 相似文献
80.
Aline PF Caetano Thiago O Sousa Mariana R Oliveira Karine Evanglista Juliano M Bueno Maria AG Silva 《Dento maxillo facial radiology》2021,50(3)
Objectives :The aim of this study was to compare the accuracy of vertical root fracture (VRF) detection using three tomography devices and two software systems in teeth with different endodontic fillings.Methods:The sample consisted of 45 premolars divided into 3 groups: No filling (NF, n=15); Gutta percha (GP, n=15) and Metallic Post (MP, n=15). Cone-beam computed tomography (CBCT) images were acquired in Kodak 9000 3D, Orthopantomography 300 (OP300) and PreXion 3D devices, before and after induced root fractures. Two oral radiologists analyzed all images using InVivoDental and e-Vol DX software systems. The analysis was repeated after 15 days in 30% of the sample. Data analysis compared receiver operating characteristic (ROC) curves, as well the areas under the ROC curves. Accuracy, sensitivity, specificity, positive and negative predictive value were calculated according to each tomographic device and software. Intra- and interexaminer reliability were tested using the Kappa coefficient.Results:The highest accuracy was seen in the image set from the PreXion 3D, using InVivo (0.96) or e-Vol DX (0.92) in image analysis. The OP300 device presented a similar performance of the PreXion 3D in teeth with different endodontic fillings. When using e-Vol DX, the accuracy of Kodak 9000 3D improved from 0.62 to 0.74.Conclusions:The PreXion 3D device is the most accurate when detecting VRF, with a performance similar to the OP300 in endodontic filled teeth. Kodak 9000 3D is indicated for teeth without fillings, with better accuracy using e-Vol DX software. 相似文献