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91.
BackgroundProviding comprehensive information about the risks and benefits of cancer screening is ethically necessary, but information about risks may decrease participation. This study explored the impact of information on intended participation using a randomised factorial design.MethodsWe conducted a mail survey of 2333 adults living in Geneva, Switzerland. Each participant was given one randomly chosen version of a scenario that described a hypothetical cancer screening test, and was asked whether he or she would accept to undergo screening. The versions varied in terms of the amount of information about risks and benefits.ResultsRespondents who received information about risks associated with screening were more likely to refuse participation (odds ratio 2.6 (95% confidence interval (CI) 2.0–3.5)) than those who received minimal information. In contrast, information about benefits had no impact on intended participation (odds ratio 1.0 (95% CI 0.8–1.2)). The impact of information about risks was significantly stronger in women than in men, in respondents who were in poorer health, who have had a doctor visit in the past 6 months, those who have had a cancer screening test in the past 3 years, and those who reported a high desire for autonomy in medical decisions.ConclusionsInforming potential participants about the risks of screening may reduce participation rates. Enhanced information about the benefits of screening does not counterbalance this effect.  相似文献   
92.
The aims of our study were to characterize the psychological dimensions of eating behaviour of young French adults as measured by the Three Factor Eating Questionnaire (TFEQ) and to analyze the association between the 3 TFEQ mean scores (main scales and subscales) and gender, Body Mass Index (BMI) and socio-demographic data in this population. An online TFEQ questionnaire was used with a nationally representative sample of 1000 young French people (aged 20-39yrs). The average scores were 6.3±0.1 (sem) for dietary restraint, 6.0±0.1 for disinhibition and 5.0±0.1 for hunger. Compared to the limit commonly used in human food studies, young French adults were characterized by low restraint and low disinhibition levels. There was a significant gender effect on both restraint and disinhibition scores, with women showing significantly higher scores than men. Concerning the link between TFEQ scores and BMI, there was a significant effect of the BMI category on cognitive restraint, disinhibition and hunger. Disinhibition was the factor most strongly associated to BMI, independently of gender. Our results highlight both the importance of taking into account not only disinhibition but also cognitive restraint and the usefulness of subscales when studying eating behaviour and its link to body weight. We characterize the eating behaviour of a French cohort with criteria often chosen for healthy volunteers in human food studies. Consequently, we suggest new TFEQ limits (6 for cognitive restraint and disinhibition, 5 for hunger) lower than those traditionally used for this category of the population in clinical food studies.  相似文献   
93.
Hepatitis B vaccination is recommended in HIV-infected patients. Achieving seroprotection rates (anti-HBs ≥ 10I U/L) comparable to the general population remains a challenge. The aim of this study was to analyze the proportion of responders among patients infected with HIV receiving primary HBV vaccination and identify factors associated with seroprotection rates. We analyzed the response to vaccination (antiHBs titers) in 474 HIV-infected patients receiving ≥ 1 doses of vaccine between 1994 and 2009. Factors associated with response to vaccination were analyzed using a logistic regression model. Considering the first vaccine courses administered, a response rate of 60.3% (286/474) was obtained. Eighty-seven patients began a second course, responding in 58.6% of cases. Regardless of the number of doses, schedules, and whether or not they completed the course, the response rates were 71.1% (337/474). After adjustment for year of reception of the first dose, responders were less likely to have a higher baseline HIV 1-RNA viral load (OR: 0.78 95% CI: 0.68-0.91) and more likely to have a CD4 count ≥ 350 cells/μL (OR: 1.64, 95% CI: 1.03-3.62). Patients receiving less than three doses of vaccine (OR: 0.31 95% CI 0.15-0.61) or three doses of the rapidly accelerated schedule (OR: 0.35 95% CI 0.15-0.81) had a lower probability of response in comparison with those receiving three doses of an accelerated schedule. In patients diagnosed with HIV, HBV vaccination before evolution to greater immunosuppression (CD4 < 350 cells/μL) or delaying vaccination until the CD4 count is higher could provide better seroprotection rates. The rapidly accelerated vaccination schedule should be used with caution, due to its lower effectiveness. If seroprotection is not achieved after the first course, revaccination seems to be effective in increasing the proportion of responders.  相似文献   
94.
The present study used a measure of trait binge eating (Binge Eating Scale; BES) to examine its association with behavioural markers of appetite and food reward. Non-obese female participants consumed a preload before freely selecting and consuming from a test meal. Subjective hunger and hedonic measures of explicit liking and implicit wanting for food were obtained. Food selection and intake of the test meal were measured. Findings were compared according to individual differences in trait binge eating. BES scores correlated with BMI, food intake and selection of high fat sweet foods in the test meal. Comparison of BES scores revealed that higher scores were associated with weaker suppression of hunger after the preload, greater explicit liking for food generally, and increased implicit wanting for high fat sweet food. Trait binge eating is functional at low levels and implicit wanting measured simultaneously with explicit liking may be useful markers for reward-driven overconsumption in this susceptible phenotype.  相似文献   
95.
The Indonesian province of Papua faces a growing HIV epidemic, particularly amongst remote highland Papuans, such as the Western Dani. The specific, challenging political and sociocultural context of Papuan highland communities greatly influences the transmission of HIV. Different initiatives have struggled to meet the sexual and reproductive health needs of Papuan communities and of minority ethnic communities and the challenges they pose. The prolonged cultural tensions between Papuan and Indonesian communities are a major barrier to effective dialogue between the Indonesian state and its minority ethnic communities, the absence of which only exacerbates the epidemic. Tackling HIV in Papua requires responses that are both culturally and politically sensitive, in direct challenge to existing development paradigms.  相似文献   
96.
These guidelines were produced at the request of the General Directorate of Health within the scope of the French Nutrition and Health Program (PNNS). They concern the management of malnutrition in elderly persons living at home, in institutional care, or in hospital. They belong to a recent series of studies published by ANAES(1) or HAS. Preceding studies concerned the "Diagnostic assessment of protein-energy malnutrition in hospitalized adults" (ANAES, September 2003) and the work conducted by the Committee for the Assessment of Devices and Health Technologies (CEPP) on "Reimbursement procedures for dietary foods for special medical purposes for nutritional supplementation and home enteral nutrition" (HAS, September 2006). The objective of these guidelines is to develop a tool for identifying and managing elderly subjects who are malnourished or at risk of malnutrition.  相似文献   
97.

Background

Routine collection of cytology specimens from bronchial aspirate or washing is thought to increase the sensitivity of bronchoscopy for diagnosing malignant lung lesions. However, the added value of this practice has not been reappraised in a context of changing epidemiology.

Patients and Methods

In a retrospective monocenter study, all cytology specimens from bronchial aspirate or washing collected between May 2011 and December 2014 and the corresponding patients' files were reviewed. The final diagnosis of malignancy was based on all available pathologic information.

Results

Bronchoscopy was performed in 2750 patients, and bronchial cytology specimens were collected during 667 procedures, including 474 aspirate or washing cytology specimens collected during conventional (n = 366) or ultrasound-guided (EBUS) (n = 108) bronchoscopy in 455 patients with malignant lung lesion(s). The predominant histologic types were lung adenocarcinoma (43.9%) and squamous cell carcinoma (25.2%), and 271 tumors (59.6%) were endoscopically visible. At least 1 endoscopic sample (bronchial cytology and/or biopsies and/or endobronchial ultrasound-guided samples) was positive for malignancy during 329 (69.4%) of the 474 endoscopies, including 79 samples obtained in nonvisible lesions. Only 67 bronchial cytology specimens proved positive (sensitivity, 14.7%; 95% confidence interval, 11.8%-18.3%), and only 1 specimen (0.2%) produced a diagnosis not made by other samples during the same procedure.

Conclusion

In contrast with older studies, the added value of collecting cytology specimens from bronchial aspirate or washing during bronchoscopy in this series proved negligible, reflecting mainly the increasing prevalence of adenocarcinomas. Abandoning this technique could be considered in centers with similar expertise and patient populations.  相似文献   
98.
It is unclear whether introducing organised mammography screening programmes in a population where opportunistic screening is prevalent results in the two types of screening mainly competing against each other or attracting different groups of women. To compare women who participate in organised screening and those who prefer opportunistic screening, we conducted a prospective study of 932 women followed for 8 months after an invitation to participate in the first round of an organised screening programme in Geneva, Switzerland. All women were aged 50-69 years and were due for a mammogram according to local guideline. Of the 932 participants, 11.6% had an organised and 39.4% an opportunistic mammogram during follow-up. Women who were in the stage of contemplation, had favourable attitude toward mammography screening, and perceived their risk of breast cancer to be high were more likely to have a mammogram (either organised or opportunistic). Compared to women who had an opportunistic mammogram, women with an organised mammogram were less positive about screening, less likely to be in maintenance at baseline (adjusted odds ratio (OR), 3.0; 95% confidence interval (CI), 1.7-5.5), to have a history of benign breast disease (OR, 2.4; 95% CI, 1.2-5.1) and to perceive their financial situation as comfortable (OR, 1.7; 95% CI, 1.1-2.8). Although screening uptake was low, the programme appeared to attract women in lower socio-economic strata who did not usually undergo mammography screening.  相似文献   
99.

Purpose

Various segmentation methods for 18F-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT) images were correlated with pathological volume in breast cancer patients as a model of small mobile tumours.

Methods

Thirty women with T2–T3/M0 breast invasive ductal carcinoma (IDC) were included prospectively. A FDG-PET/CT was acquired 4 ± 3 d before surgery in prone and supine positions, with/without respiratory gating. The segmentation methods were as follows: manual (Vm), relative (Vt%) and adaptive (Va) standard uptake value (SUV) threshold and semi-automatic on CT (Vct). Pathological volumes (Vpath) were measured for 26 lesions.

Results

The mean (±SD) Vpath was 4.1 ± 2.9 mL, and the lesion displacements were 3.9 ± 2.8 mm (median value: 3 mm). The delineated VOIs did not vary with the acquisition position nor with respiration, regardless of the segmentation method. The Vm, Va, Vct and Vt% methods, except Vt30%, were correlated with Vpath (0.5 < r < 0.8). The Vt50% and Vm were the most accurate methods (mean ± SD: 0.0 ± 1.6 mL and +0.6 ± 1.8 mL, respectively), followed by the Vct method.

Conclusions

When compared with pathology, small lesions (diameter <50 mm) with limited respiratory displacement (i.e., breast or apical lung lesions) are best delineated on FDG-PET/CT using a 50% SUVmax threshold. The acquisition position and respiratory gating did not modify the delineated volumes.  相似文献   
100.
(1) Background: In literature, approximately 20% of mCRPC present somatic DNA damage repair (DDR) gene mutations, and their relationship with response to standard therapies in mCRPC is not well understood. The objective was to evaluate outcomes of mCRPC patients treated with standard therapies according to somatic DDR status. (2) Methods: Eighty-three patients were recruited at Caen Cancer Center (France). Progression-free survival (PFS) after first-line treatment was analyzed according to somatic DDR mutation as primary endpoint. PFS according to first exposure to taxane chemotherapy and PFS2 (time to second event of disease progression) depending on therapeutic sequences were also analyzed. (3) Results: Median first-line PFS was 9.7 months in 33 mutated patients and 8.4 months in 50 non-mutated patients (p = 0.9). PFS of first exposure to taxanes was 8.1 months in mutated patients and 5.7 months in non-mutated patients (p = 0.32) and significantly longer among patients with ATM/BRCA1/BRCA2 mutations compared to the others (10.6 months vs. 5.5 months, p = 0.04). PFS2 was 16.5 months in mutated patients, whatever the sequence, and 11.7 months in non-mutated patients (p = 0.07). The mutated patients treated with chemotherapy followed by NHT had a long median PFS2 (49.8 months). (4) Conclusions: mCRPC patients with BRCA1/2 and ATM benefit from standard therapies, with a long response to taxanes.  相似文献   
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