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81.
The prenatal environment plays an important role in many conditions, particularly those with onset early in life, such as childhood cancers and birth defects. Because both maternal and fetal genotypes can influence risk, investigators sometimes use a case-mother/control-mother design, with mother-offspring pairs as the unit of analysis, to study genetic factors. Risk models should account for both the maternal genotype and the correlated fetal genotype to avoid confounding. The usual logistic regression analysis, however, fails to fully exploit the fact that these are mothers and offspring. Consider an autosomal, diallelic locus, which could be related to disease susceptibility either directly or through linkage with a polymorphic causal locus. Three nested levels of assumptions are often natural and plausible. The first level simply assumes Mendelian inheritance. The second further assumes parental mating symmetry for the studied locus in the source population. The third additionally assumes parental allelic exchangeability. Those assumptions imply certain nonlinear constraints; the authors enforce those constraints by using Poisson regression together with the expectation-maximization algorithm. Calculations reveal that improvements in efficiency over the usual logistic analysis can be substantial, even if only the Mendelian assumption is honored. Benefits are even more marked if, as is typical, information on genotype is missing for some individuals. 相似文献
82.
83.
Tanner CM Kamel F Ross GW Hoppin JA Goldman SM Korell M Marras C Bhudhikanok GS Kasten M Chade AR Comyns K Richards MB Meng C Priestley B Fernandez HH Cambi F Umbach DM Blair A Sandler DP Langston JW 《Environmental health perspectives》2011,119(6):866-872
Background
Mitochondrial dysfunction and oxidative stress are pathophysiologic mechanisms implicated in experimental models and genetic forms of Parkinson’s disease (PD). Certain pesticides may affect these mechanisms, but no pesticide has been definitively associated with PD in humans.Objectives
Our goal was to determine whether pesticides that cause mitochondrial dysfunction or oxidative stress are associated with PD or clinical features of parkinsonism in humans.Methods
We assessed lifetime use of pesticides selected by mechanism in a case–control study nested in the Agricultural Health Study (AHS). PD was diagnosed by movement disorders specialists. Controls were a stratified random sample of all AHS participants frequency-matched to cases by age, sex, and state at approximately three controls: one case.Results
In 110 PD cases and 358 controls, PD was associated with use of a group of pesticides that inhibit mitochondrial complex I [odds ratio (OR) = 1.7; 95% confidence interval (CI), 1.0–2.8] including rotenone (OR = 2.5; 95% CI, 1.3–4.7) and with use of a group of pesticides that cause oxidative stress (OR = 2.0; 95% CI, 1.2–3.6), including paraquat (OR = 2.5; 95% CI, 1.4–4.7).Conclusions
PD was positively associated with two groups of pesticides defined by mechanisms implicated experimentally—those that impair mitochondrial function and those that increase oxidative stress—supporting a role for these mechanisms in PD pathophysiology. 相似文献84.
85.
Review of tumor markers for ovarian cancer 总被引:2,自引:0,他引:2
G Umbach 《Medical hypotheses》1984,13(3):329-339
Forty-two substances having been described as potential tumor markers for ovarian cancer are reviewed regarding sensitivity, specificity, and correlation with clinical course of disease. At present, there is no reliable marker for the primary diagnosis of the vast majority of ovarian cancers. Tumor markers may however serve as adjunctive tools in monitoring ovarian cancer patients after treatment. 相似文献
86.
Jenna K. Waggoner Paul K. Henneberger Greg J. Kullman David M. Umbach Freya Kamel Laura E. Beane Freeman Michael C. R. Alavanja Dale P. Sandler Jane A. Hoppin 《International archives of occupational and environmental health》2013,86(2):177-187
Purpose
To assess whether pesticide use practices were associated with injury mortality among 51,035 male farmers from NC and IA enrolled in the Agricultural Health Study.Methods
We used Cox proportional hazards models adjusted for age and state to estimate fatal injury risk associated with self-reported use of 49 specific pesticides, personal protective equipment, specific types of farm machinery, and other farm factors collected 1–15 years preceding death. Cause-specific mortality was obtained through linkage to mortality registries.Results
We observed 338 injury fatalities over 727,543 person-years of follow-up (1993–2008). Fatal injuries increased with days/year of pesticide application, with the highest risk among those with 60+ days of pesticide application annually [hazard ratio (HR) = 1.87; 95% confidence interval (CI) = 1.10, 3.18]. Chemical-resistant glove use was associated with decreased risk (HR = 0.73; 95% CI = 0.58, 0.93), but adjusting for glove use did not substantially change estimates for individual pesticides or pesticide use overall. Herbicides were associated with fatal injury, even after adjusting for operating farm equipment, which was independently associated with fatal injury. Ever use of five of 18 herbicides (2,4,5-T, paraquat, alachlor, metribuzin, and butylate) were associated with elevated risk. In addition, 2,4-D and cyanazine were associated with fatal injury in exposure–response analyses. There was no evidence of confounding of these results by other herbicides.Conclusion
The association between application of pesticides, particularly certain herbicides, and fatal injuries among farmers should be interpreted cautiously but deserves further evaluation, with particular focus on understanding timing of pesticide use and fatal injury. 相似文献87.
88.
R. Umbach B. Weidmann J. Kohnke M. Tontch M. O. Tauchert J. D. Ringe 《Intensivmedizin und Notfallmedizin》1999,33(8):293-299
Paradoxe Embolien sind in der Theorie gut bekannt, in der Praxis aber recht selten. Pathophysiologisch liegt typischerweise die Konstellation aus ven?ser Thrombose, erh?htem rechtsatrialen Druck und konsekutivem Rechts-Links-Shunt über ein offenes Foramen ovale oder einen Vorhofseptumdefekt zugrunde. Wir berichten über einen 65j?hrigen Patienten, der wegen eines akuten Schmerzereignisses mit Abblassen der Hautfarbe des linken Unterschenkels aufgenommen wurde. Zugleich hatte heftige Luftnot eingesetzt. 相似文献
89.
Therapy of Established Postmenopausal Osteoporosis with Monofluorophosphate plus Calcium: Dose-Related Effects on Bone Density and Fracture Rate 总被引:1,自引:0,他引:1
Recent experience from different groups suggests that low fluoride doses resulting in moderate increases in bone mineral
density (BMD) may be advantageous in terms of fracture-reducing potency. In a randomized prospective 3-year study we examined
the therapeutic efficacy of different dosages of monofluorophosphate (MFP) plus calcium in comparison with calcium alone in
134 women with established postmenopausal osteoporosis (mean age 64.0 years, average vertebral fractures per patient 3.6).
Group A received 1000 mg calcium/day and a low-dose intermittent MFP regimen (3 months on, 1 month off) corresponding to an
average daily fluoride ion dose of 11.2 mg. Group B received 1000 mg calcium/day plus continuous MFP corresponding to 20 mg
fluoride ions per day. Group C was treated with 1000 mg calcium alone throughout the study period. Bone density was measured
with dual-energy X-ray absorptiometry at L2–4 and three proximal femur areas and with single photon absorptiometry at two
radius sites. New vertebral fractures were identified from annual lateral radiographs of the spine. A significant reduction
in subjective complaints as measured by a combined pain–mobility score (CPMS) was found in both fluoride groups in comparison
with the calcium monotherapy group. Group A showed increases in BMD at all six measuring sites, reaching +12.6% at the spine
after 3 years. In group B we found significant increases at the spine, Ward’s triangle and distal radius, but slight decreases
at the femoral neck and radius shaft. For the spine the average change amounted to +19.5% after 3 years. In group C losses
of BMD were observed at all six sites, with an average loss of 1.6% for the spine at the end of the study. The incidence of
new vertebral fractures per 100 patient-years was 8.6, 17.0 and 31.6 in groups A, B and C, respectively. In conclusion, both
calcium–MFP regimens resulted in significantly lower vertebral fracture rates than calcium monotherapy. However, the low intermittent
MFP regimen, leading to a mean annual increase in spinal BMD of only 4.2%, showed a clear trend to greater effectiveness in
reducing vertebral fracture than the higher fluoride dosage that was followed by an average spinal BMD increase of 6.5% per
year. Furthermore the rate of fluoride-specific side effects (lower-extremity pain syndrome) was 50% lower in patients receiving
the lower fluoride dosage.
Received: 3 November 1997 / Accepted: 4 June 1998 相似文献
90.