收费全文 | 2428篇 |
免费 | 793篇 |
国内免费 | 133篇 |
耳鼻咽喉 | 21篇 |
儿科学 | 41篇 |
妇产科学 | 35篇 |
基础医学 | 216篇 |
口腔科学 | 32篇 |
临床医学 | 370篇 |
内科学 | 395篇 |
皮肤病学 | 65篇 |
神经病学 | 147篇 |
特种医学 | 146篇 |
外科学 | 342篇 |
综合类 | 310篇 |
现状与发展 | 1篇 |
预防医学 | 443篇 |
眼科学 | 158篇 |
药学 | 203篇 |
6篇 | |
中国医学 | 219篇 |
肿瘤学 | 204篇 |
2024年 | 75篇 |
2023年 | 164篇 |
2022年 | 393篇 |
2021年 | 506篇 |
2020年 | 361篇 |
2019年 | 258篇 |
2018年 | 228篇 |
2017年 | 215篇 |
2016年 | 176篇 |
2015年 | 254篇 |
2014年 | 293篇 |
2013年 | 46篇 |
2012年 | 41篇 |
2011年 | 50篇 |
2010年 | 30篇 |
2009年 | 20篇 |
2008年 | 38篇 |
2007年 | 32篇 |
2006年 | 28篇 |
2005年 | 19篇 |
2004年 | 15篇 |
2003年 | 11篇 |
2002年 | 21篇 |
2001年 | 11篇 |
2000年 | 17篇 |
1999年 | 21篇 |
1998年 | 3篇 |
1997年 | 13篇 |
1993年 | 1篇 |
1992年 | 3篇 |
1991年 | 4篇 |
1990年 | 2篇 |
1989年 | 1篇 |
1987年 | 1篇 |
1986年 | 1篇 |
1974年 | 2篇 |
Background:
There are limited data on longer-term outcomes (>5 years) for patients with unprotected left main coronary artery (ULMCA) disease who underwent percutaneous coronary intervention (PCI) in the drug-eluting stents (DES) era. This study aimed at comparing the long-term (>5 years) outcomes of patients with ULMCA disease underwent PCI with DES and coronary artery bypass grafting (CABG) and the predictors of adverse events.Methods:
All consecutive patients with ULMCA disease treated with DES implantation versus CABG in our center, between January 2003 and July 2009, were screened for analyzing. A propensity score analysis was carried out to adjust for potential confounding between the two groups.Results:
Nine hundred and twenty-two patients with ULMCA disease were enrolled for the analyses (DES = 465 vs. CABG = 457). During the median follow-up of 7.1 years (interquartile range 5.3–8.2 years), no difference was found between PCI and CABG in the occurrence of death (P = 0.282) and the composite endpoint of cardiac death, myocardial infarction (MI) and stroke (P = 0.294). Rates of major adverse cardiac and cerebrovascular events were significantly higher in the PCI group (P = 0.014) in large part because of the significantly higher rate of repeat revascularization (P < 0.001). PCI was correlated with the lower occurrence of stroke (P = 0.004). Multivariate analysis showed ejection fraction (EF) (P = 0.012), creatinine (P = 0.016), and prior stroke (P = 0.031) were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age (P = 0.026) and EF (P = 0.002) were independent predictors in the CABG group.Conclusions:
During a median follow-up of 7.1 years, there was no difference in the rate of death between PCI with DES implantation and CABG in ULMCA lesions in the patient cohort. CABG group was observed to have significantly lower rates of repeat revascularization but higher stroke rates compared with PCI. EF, creatinine, and prior stroke were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age and EF were independent predictors in the CABG group. 相似文献Skull base chordoma (SBC) is rare and one of the most challenging diseases to treat. We aimed to assess the optimal timing of adjuvant radiation therapy (RT) and to evaluate the factors that influence resection and long-term outcomes.
MethodsIn total, 284 patients with 382 surgeries were enrolled in this retrospective study. Postsurgically, 64 patients underwent RT before recurrence (pre-recurrence RT), and 47 patients underwent RT after recurrence. During the first attempt to achieve gross-total resection (GTR), when the entire tumor was resected, 268 patients were treated with an endoscopic midline approach, and 16 patients were treated with microscopic lateral approaches. Factors associated with the success of GTR were identified using χ2 and logistic regression analyses. Risk factors associated with chordoma-specific survival (CSS) and progression-free survival (PFS) were evaluated with the Cox proportional hazards model.
ResultsIn total, 74.6% of tumors were marginally resected [GTR (40.1%), near-total resection (34.5%)]. History of surgery, large tumor volumes, and tumor locations in the lower clivus were associated with a lower GTR rate. The mean follow-up period was 43.9 months. At the last follow-up, 181 (63.7%) patients were alive. RT history, histologic subtype (dedifferentiated and sarcomatoid), non-GTR, no postsurgical RT, and the presence of metastasis were associated with poorer CSS. Patients with pre-recurrence RT had the longest PFS and CSS, while patients without postsurgical RT had the worst outcome.
ConclusionGTR is the goal of initial surgical treatment. Pre-recurrence RT would improve outcome regardless of GTR.
相似文献