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51.
Background: The prognostic relevance of complete revascularization (CR) in patients with multivessel coronary artery disease (MV‐CAD) has been established so far for surgical treatment strategies rather than for percutaneous coronary revascularization (PCI). In addition, different definitions of CR have further complicated the interpretation of clinical studies. Methods: Procedural characteristics and long‐term overall survival were assessed in 679 consecutive “all‐comer” patients, who underwent PCI in at least two main vessels. We adapted three definitions of CR from the coronary artery bypass grafting (CABG) trials. CR was achieved if following MV‐PCI one of the three criteria was met: (1) no residual stenosis in a main coronary vessel, (2) no residual stenosis in any coronary segment, or (3) no residual stenosis in the left anterior descending (LAD) and at least one further main branch. The main objective was the evaluation of predictors of incomplete revascularization and the prognostic impact of CR in MV‐PCI patients. Results: CR was achieved in 76%, 67%, and 95%, respectively, (definitions 1–3). Patients without CR were older, had a lower ejection fraction, and presented more often with acute coronary syndromes (ACS). Clinical long‐term follow‐up regarding survival was available in 664 patients (98%) with a mean follow‐up of 2.5 ± 1.6 years. Independent of the specific definition, CR was associated with a reduced long‐term mortality by approximately 50%. After adjusting for relevant baseline parameters, only absence of residual stenosis in all coronary segments remained as an independent predictor of long‐term prognosis (hazard ratio [HR]= 0.51, 95% confidence interval [CI]: 0.28–0.93; P = 0.025). Conclusions: CR of all coronary segments is associated with improved overall survival after MV‐PCI. (J Interven Cardiol 2010;23:256–263)  相似文献   
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Coronary Venous Geometry in Patients Undergoing CRT . Introduction: The coronary sinus (CS) is often distorted in patients with advanced cardiomyopathy, making CS cannulation difficult. The objective of this study was to examine the impact of the underlying cardiac pathology on the variability of the CS anatomy, using rotational coronary venous angiography (RCVA). Methods and Results: Seventy‐nine patients undergoing RCVA for cardiac resynchronization therapy (CRT) were evaluated: age 63 ± 15 years, 43% with prior coronary artery bypass grafting (CABG). Aspects of the CS anatomy which could impact cannulation were examined: the CS ostial angle, the posterior displacement of the CS away from the atrioventricular groove, a measure of CS curvature, and the presence of stenoses and aneurysmal dilatations. The CS ostial angle was variable (65–151°, mean 119 ± 19°, <90° in 8 patients) and decreased significantly (P = 0.0022) with increasing severity of tricuspid regurgitation (TR), reaching 94 ± 18° in patients with severe TR. The posterior displacement of the CS was significantly more accentuated in patients with prior CABG when compared with the patients without CABG (7.1 ± 3.7 vs 4.5 ± 2.8 mm; P = 0.0246). The decrease in luminal diameter at the CS–great cardiac vein (GCV) junction was 2.0 ± 1.0 mm, being more pronounced in patients with prior CABG versus nonCABG (26 vs 20%; P = 0.042). Stenoses and aneurysmal dilatations of the CS–GCV were encountered in 4 (5%) and 6 (8%) of patients, respectively, all of them with prior CABG, representing 12% and 18% of the CABG group. Conclusion: The CS anatomy in patients undergoing CRT is variable, and is impacted by the severity of the underlying TR and history of a prior CABG. (J Cardiovasc Electrophysiol, Vol. 21, pp. 436–440, April 2010)  相似文献   
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Summary. Tc P CO2 monitoring of the fetus during labour was evaluated as an atraumatic tool to identify or exclude fetal acidosis in 224 high-risk deliveries. A heated electrochemical sensor with a measuring temperature of 39°C ( n = 105) or 44°C( n =119) was applied to the fetal scalp. There was a statistically significant correlation between the Tc P CO2 and the fetal blood pH at both temperatures. The sensitivity of the method was 0.90 and 0.61 at the two measuring temperatures of 44° or 39° respectively and the specificity was 0.93 and 0.79 respectively. The negative predictive value was high (0.99 and 0.95 respectively), but the respective positive predictive values were only 0.53 and 0.24. We conclude that the continuous measurement of the Tc P CO2 is a valid additional tool to exclude fetal acidosis in most cases where fetal distress is indicated by the heart rate pattern but a Tc P CO2 value above the cut-off point should be verified by an additional method to avoid unnecessary-operative deliveries.  相似文献   
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The prognosis of operated patients with non-small cell lung cancer (NSCLC) is poor despite thorough pre-operative staging. An improved preselection is needed of patients likely to profit from surgery. This study was undertaken to evaluate the prognostic significance of nuclear p53 overexpression in a cohort of 247 surgically treated patients with NSCLC. It showed that the prevalence of immunohistochemically detectable p53 overexpression varied between different tumour types. p53 overexpression was equally frequent in large cell carcinoma (53 per cent) and in squamous cell carcinoma (54 per cent), but significantly less frequent in adenocarcinoma (34 per cent; P =0·009). p53 overexpression was particularly rare in bronchioloalveolar carcinoma (positivity in 1 of 17 cases). These variations may reflect aetiological differences between the histological subtypes. p53 overexpression was also associated with high tumour grade ( P =0·0157) and the presence of lymph node metastasis ( P =0·0259), but not with advanced tumour stage. Survival analysis showed no difference in clinical outcome between p53-positive and p53-negative tumours within 101 node-positive tumours. In contrast, survival time was significantly better in p53-negative tumours than in p53-positive tumours within the group of 113 node-negative tumours ( P =0·032). Stepwise regression analysis showed that p53 overexpression is an independent prognostic factor in node-negative NSCLC.  相似文献   
58.
This clinical pilot study on finger elongation for induction of hypnosis attempts to determine whether the observed response is a hypnotic phenomenon or a simple physiologic reaction. Sixteen volunteers participated in the 5-phase study, which measured relative and absolute changes in the length of each finger prior to and after each phase. A distinctive elongation was statistically significant for the hypnosis condition. In addition, findings suggest changes in the metacarpus. Further investigation is indicated to shed light on this apparent phenomenon.  相似文献   
59.
Introduction: This study aimed to determine the age‐specific bolus dose of remifentanil (ED50) to facilitate tracheal intubation without the use of neuromuscular blocking agents. Methods: ASA 1–2 subjects were recruited into three groups of 0–3 months (group I), 4–12 months (group II), and 1–3 years (group III) of age. A sequential up‐and‐down design determined the remifentanil bolus dose, which was initially started at 3 mcg·kg?1 and adjusted in 1 mcg·kg?1 increments (range 1–6 mcg·kg?1). Following pretreatment with glycopyrrolate 10 μg·kg?1 and an induction dose of propofol 5 mg·kg?1, remifentanil was administered with a blinded study investigator commencing tracheal intubation after 60 s. After tracheal intubation, the time to return of spontaneous ventilation was measured. Logistic regression was used to predict the ED50 and ED95 of remifentanil. Results: Sixty‐four subjects were recruited. Tracheal intubation was successful at first attempt in over 90% of subjects in each age group. Satisfactory intubating conditions were achieved in 85%, 63%, and 75% of subjects in groups I, II, and III, respectively. The logistic regression results for ED50 (95% CI) were 3.1 (2.5–3.8), 3.7 (2.0–5.4), and 3.0 (2.1–3.9) mcg·kg?1, and ED95 (95% CI) were 5.0 (3.0–7.0), 9.4 (1.5–17.4), and 5.6 (2.9–8.4) mcg·kg?1 in groups I, II, and III, respectively. Infants aged 4–12 months (group II) showed a marked variability in dose response; however, the mean ED50 and ED95 were not different to groups I and III. Older children had a longer duration of apnea than infants, 331 vs 180 s (P < 0.05). Discussion: The ED50 of remifentanil for tracheal intubation was higher in all age groups than previously reported. Ideal intubating conditions were achieved in 50% of subjects with remifentanil doses of 3.1–3.7 mcg·kg?1. Higher doses will be required for higher success rates and with anticholinergic pretreatment, doses of up to 6 mcg·kg?1 were tolerated, without adverse effects, in two patients. Further investigation of the variability in dose response in infants and assessment of the safety this technique is warranted.  相似文献   
60.
The objective was to evaluate the efficiency of a biological material-free medium and the role of seminal plasma (SP) in the cryopreservation of human spermatozoa. Normal semen samples and low-quality semen samples were used for this study. After centrifugation of 300 microL fractions of whole semen, pellets were resuspended either in autologous SP or in a chemically defined medium (BM) supplemented or not with 3% bovine serum albumin (BSA); after 15 min at 37 degrees C, the samples were diluted (V/V) with cryoprotective medium (30 mM NaCl; 22 mM sodium citrate, 19.4 mM fructose; 80 mM glutamine; 14%, V/V, glycerol) and maintained for 15 min at room temperature before freezing. Assessment of viability and motility was performed using fresh semen (T0), after centrifugation and resuspension prior to adding the cryoprotectant (T15), after adding the cryoprotectant (T30) and after freezing and thawing (Tpost). In all three resuspending media used, sperm viability and motility (forward and total) decreased (p < 0.05) during both the equilibration period especially before addition of the cryoprotective medium (between T0 and T15) and during the freeze-thaw process comparison between T30 and Tpost. The recovery of viable and motile spermatozoa (post-thaw values/values of fresh samples) was higher (p < 0.05) in normal semen than in low-quality semen. In both groups, the recovery was slightly, but significantly, higher with SP than with BM and the presence of BSA has no beneficial effect. To conclude, these data suggest that SP may reduce the deleterious effects of cryopreservation. Nevertheless cryopreservation of spermatozoa in a medium containing neither SP nor biological substances could offer an acceptable cryoprotection of spermatozoa to be used in assisted fertilization procedures, especially for intracytoplasmic sperm injection.  相似文献   
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