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71.
Andrea S. Gantner Lena Braunschweig Konstantinos Tsaknakis Heiko M. Lorenz Anna K. Hell 《The spine journal》2018,18(4):567-574
Background Context
In several studies, vertical expandable prosthetic titanium rib (VEPTR) implants have shown good scoliosis control in children with the longest reported follow-up of 3.6 years. For growing rods, recent studies suggest a decreased efficiency of correction starting just after that time. To our knowledge, no long-term results of children with VEPTR treatment are available.Purpose
This study aimed to evaluate spinal deformity in scoliotic children and to investigate correction potential of VEPTR implants at several time points of treatment, particularly after long-term follow-up.Study Design/Setting
We performed a retrospective case series of 32 children with spinal deformity and VEPTR treatment with analysis of clinical and radiological data pre- and post-VEPTR implantation and every 2 years during the follow-up period.Patient Sample
Thirty-two patients with spinal deformity and VEPTR treatment comprised the patient sample.Outcome Measures
Patients had a primary VEPTR implantation due to spinal deformity and thoracic insufficiency syndrome and repeated lengthening procedures every 6 months. Clinical data were assessed and radiological parameters were analyzed. The main thoracic scoliotic curve and associated curves as well as kyphosis, lordosis, pelvic obliquity, and spinal length were measured in all radiographs until the end of VEPTR treatment or the last available examination.Methods
Development of the different parameters during follow-up was evaluated and statistical analysis was performed with Statistica version 13.0. No funding was obtained for this study. The authors have no conflicts of interest to declare.Results
Directly after VEPTR implantation, thoracic and lumbar curves corrected significantly, were stable at 2.8-year follow-up, and increased at 5.5-year follow-up, whereas cervical scoliosis was not affected by the treatment. The sagittal profile was initially improved both in kyphosis and lordosis. However, at 5.5-year follow-up, hyperkyphosis had deteriorated beyond the initial deformity. Pelvic obliquity was significantly restored especially in neuromuscular patients, and increasing spinal length was achieved within the 5.5-year follow-up.Conclusion
In children with spinal deformity, implantation of the VEPTR device sufficiently corrected the deformity in all planes. During long-term follow-up, scoliosis increased slightly and was rather well controlled, whereas the implant system was not able to prevent deterioration of hyperkyphosis. Pelvic obliquity was well balanced and spinal lengthening was achieved during long-term follow-up. 相似文献72.
Chronic graft-versus-host disease after allogeneic blood stem cell transplantation 总被引:9,自引:9,他引:9 下载免费PDF全文
Przepiorka D Anderlini P Saliba R Cleary K Mehra R Khouri I Huh YO Giralt S Braunschweig I van Besien K Champlin R 《Blood》2001,98(6):1695-1700
The incidence, characteristics, risk factors for, and impact of chronic graft-vs-host disease (GVHD) were evaluated in a consecutive series of 116 evaluable HLA-identical blood stem cell transplant recipients. Minimum follow-up was 18 months. Limited chronic GVHD occurred in 6% (95% confidence interval [CI], 0%-13%), and clinical extensive chronic GVHD in 71% (95% CI, 61%-80%). The cumulative incidence was 57% (95% CI, 48%-66%). In univariate analyses, GVHD prophylaxis other than tacrolimus and methotrexate, prior grades 2 to 4 acute GVHD, use of corticosteroids on day 100, and total nucleated cell dose were significant risk factors for clinical extensive chronic GVHD. On multivariate analysis, GVHD prophylaxis with tacrolimus and methotrexate was associated with a reduced risk of chronic GVHD (hazard ratio [HR], 0.35; P =.001), whereas the risk was increased with prior acute GVHD (HR, 1.67; P =.046). When adjusted for disease status at the time of transplantation, high-risk chronic GVHD had an adverse impact on overall mortality (HR, 6.6; P <.001) and treatment failure (HR, 5.2; P <.001) at 18 months. It was concluded that there is a substantial rate of chronic GVHD after HLA-identical allogeneic blood stem cell transplantation, that clinical factors may alter the risk of chronic GVHD, and that high-risk chronic GVHD adversely affects outcome. 相似文献
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75.
Does enteral nutrition affect clinical outcome? A systematic review of the randomized trials 总被引:11,自引:0,他引:11
Koretz RL Avenell A Lipman TO Braunschweig CL Milne AC 《The American journal of gastroenterology》2007,102(2):412-429
BACKGROUND: Both parenteral nutrition (PN) and enteral nutrition (EN) are widely advocated as adjunctive care in patients with various diseases. A systematic review of 82 randomized controlled trials (RCTs) of PN published in 2001 found little, if any, effect on mortality, morbidity, or duration of hospital stay; in some situations, PN increased infectious complication rates. OBJECTIVE: The objective was to assess the effect of EN or volitional nutrition support (VNS) in individual disease states from available RCTs. DESIGN: We conducted a systematic review. RCTs comparing EN or VNS with untreated controls, or comparing EN with PN, were identified and separated according to the underlying disease state. Meta-analysis was performed when at least three RCTs provided data. The evidence from the RCTs was summarized into one of five grades. A or B, respectively, indicated the presence of strong or weak (low-quality RCTs) evidence supporting the use of the intervention. C indicated a lack of adequate evidence to make any decision about efficacy. D indicated that limited data could not support the intervention. E indicated either that strong data found no effect, or that either strong or weak data suggested that the intervention caused harm. PATIENTS AND SETTINGS: RCTs could include either hospitalized or nonhospitalized patients. The EN or VNS had to be provided as part of a treatment plan for an underlying disease process. INTERVENTIONS: The RCT had to compare recipients of either EN or VNS with controls not receiving any type of artificial nutrition or had to compare recipients of EN with recipients of PN. OUTCOME MEASURES: These were mortality, morbidity (disease specific), duration of hospitalization, cost, or interventional complications. SUMMARY OF GRADING: A: No indication was identified. B: EN or VNS in the perioperative patient or in patients with chronic liver disease; EN in critically ill patients or low birth weight infants (trophic feeding); VNS in malnourished geriatric patients. (The low-quality trials found a significant difference in survival favoring the VNS recipients in the malnourished geriatric patient trials; two high-quality trials found nonsignificant differences that favored VNS as well.) C: EN or VNS in liver transplantation, cystic fibrosis, renal failure, pediatric conditions other than low birth weight infants, well-nourished geriatric patients, nonstroke neurologic conditions, AIDS; EN in acute pancreatitis, chronic obstructive pulmonary disease, nonmalnourished geriatric patients; VNS in inflammatory bowel disease, arthritis, cardiac disease, pregnancy, allergic patients, preoperative bowel preparation. D: EN or VNS in patients receiving nonsurgical cancer treatment or in patients with hip fractures; EN in patients with inflammatory bowel disease; VNS in patients with chronic obstructive pulmonary disease. E: EN in the first week in dysphagic, or VNS at any time in nondysphagic, stroke patients who are not malnourished; dysphagia persisting for weeks will presumably ultimately require EN. CONCLUSIONS: There is strong evidence for not using EN in the first week in dysphagic, and not using VNS at all in nondysphagic, stroke patients who are not malnourished. There is reasonable evidence for using VNS in malnourished geriatric patients. The recommendations to consider EN/VNS in perioperative/liver/critically ill/low birth weight patients are limited by the low quality of the RCTs. No evidence could be identified to justify the use of EN/VNS in other disease states. 相似文献
76.
77.
Septic diseases of the bone and immediately surrounding soft tissue (i.e., osteitis) are among the most alarming findings in traumatology and orthopedic practice. The paramount goal is to preserve the stable weight-bearing bones, maintaining a correct axis and proper working muscles and joints, in order to avoid permanent disability in the patient. State-of-the-art therapy for osteitis/osteomyelitis has two priorities: eradication of the infection and reconstruction of the bone and soft tissue. Surgical treatment with resection of the affected bone segments and soft tissue, followed by reconstruction, continues to be the main basic therapy. Deciding whether the affected bone segment must be resected or if bone continuity can be preserved is sometimes very difficult. This article provides strategies and decision-making guidance for this problem. 相似文献
78.
Zoppi M Braunschweig S Kuenzi UP Maibach R Hoigné R 《European journal of clinical pharmacology》2000,56(5):427-430
Objectives: Realising the limitations of spontaneous drug monitoring systems concerning the epidemiological aspects, a comprehensive
program was founded. It was based on previous publications from the US, Canada and Northern Ireland, mainly those of the BCDSP
(Boston Collaborative Drug Surveillance Programme).
Methods: Drug monitoring was carried out by a group of physicians which included the medical head of each of the divisions of internal
medicine, a statistician and an informatician. Only probable or definite drug event relationships were included. A probable
event is defined as one in which the drug interaction was more likely to be the cause than any non-drug-related cause. The
same criteria were valid for the lethal reactions.
Results: In the present evaluation, we found 26 probable lethal adverse drug reactions out of a total of 48,005 patients consecutively
admitted to the divisions of internal medicine of three Swiss teaching hospitals during the years 1974–1993, an incidence
of 0.054%. The median age of the cohort was 68 years (range 11–103 years), of which 49% were women. The median hospital stay
was 14 days and the median number of drugs was eight per patient.
Conclusion: The patients with a lethal outcome were presented under the eight pharmacologic–therapeutic classes of drugs and the classification
proposed by NS Irey. This is based on long histopathologic experience and helps to identify preventable risks.
Received: 30 June 1999 / Accepted in revised form: 10 April 2000 相似文献
79.
Skeletal muscle is one of the most unusual sites of metastasis from any malignancy. We report a patient with rapidly progressive
contractures due to metastatic infiltration of a carcinoma of unknown origin into the skeletal muscle. This 61-year-old man
presented with a 1-month history of rapidly evolving, painful restriction of mobility of his right arm and his legs. Computed
tomography showed diffuse metastatic nodules in all muscles, particularly in the hip abductors. Muscle biopsy revealed extensive
infiltration of the muscle with carcinoma cells.
Received: 18 December 1998; Revision received: 1 April 1998; Accepted: 5 May 1998 相似文献
80.
Alterations of the Wnt signaling pathway during the neoplastic progression of Barrett's esophagus 总被引:8,自引:0,他引:8
Aberrant activation of the Wnt signaling pathway has been reported during neoplastic progression in Barrett's esophagus (BE). However, mutations in APC and CTNNB1 genes were rarely observed. In this study, expression pattern of Wnt ligands, Frizzled receptors and APC, as well as the methylation status of the APC, SFRP1 and SFRP2 promoter genes were investigated in normal esophageal mucosa and in preneoplastic and neoplastic lesions of BE patients. Promoter methylation of APC was found in all BE samples and in 95% of esophageal adenocarcinomas (EAC). Full methylation of APC correlated with lack of expression. In EAC, nuclear translocation of beta-catenin was observed regardless of the expression of APC. WNT2 expression was higher in dysplasia and EAC than in BE, with 20/26 (77%) of the EAC showing high expression of WNT2. SFRP1 methylation occurred in all BE samples and in 96% of EAC, while SFRP2 was methylated in 73% of the normal squamous esophageal mucosa samples. In conclusion, (1) alterations of key regulators of the Wnt signaling are frequent in the pathogenesis of BE; (2) the APC and SFRP1 genes are inactivated by promoter methylation in BE; (3) the WNT2 gene is upregulated along the progression from low-grade dysplasia to EAC. 相似文献