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左心室成形术临床应用评价 总被引:3,自引:0,他引:3
目的 总结左心室成形术治疗缺血性心肌病的临床应用经验。方法 1998至 2 0 0 0年意大利米兰SanDonato医院收治合并室壁瘤的缺血性心肌病病人 4 6例。在低温体外循环下完成冠状动脉旁路移植远端吻合后切开心尖部室壁瘤 ,沿室壁瘤边缘行心室内环缩成形术 (Dor手术 ) ,之后用补片或直接闭合室壁瘤壁 ,重塑左室形态。结果 围术期死亡 7例 ,死亡率为 15 2 % ;术后左室收缩末期及舒张末期容积均显著降低 (P <0 0 0 1) ;肺动脉压亦显著下降 (P <0 0 5 )。中期随访生存率为 71 8%。结论 左心室成形术治疗缺血性心肌病是一种有效的方法 相似文献
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Deja MA Grayburn PA Sun B Rao V She L Krejca M Jain AR Leng Chua Y Daly R Senni M Mokrzycki K Menicanti L Oh JK Michler R Wróbel K Lamy A Velazquez EJ Lee KL Jones RH 《Circulation》2012,125(21):2639-2648
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Anastasia L Piccoli M Garatti A Conforti E Scaringi R Bergante S Castelvecchio S Venerando B Menicanti L Tettamanti G 《Current pharmaceutical biotechnology》2011,12(2):146-150
Generation of pluripotent stem cells (iPSCs) from adult fibroblasts starts a "new era" in stem cell biology, as it overcomes several key issues associated with previous approaches, including the ethical concerns associated with human embryonic stem cells. However, as the genetic approach for cell reprogramming has already shown potential safety issues, a chemical approach may be a safer and easier alternative. Moreover, a chemical approach could be advantageous not only for the de-differentiation phase, but also for inducing reprogrammed cells into the desired cell type with higher efficiency than current methodologies. Finally, a chemical approach may be envisioned to activate resident adult stem cells to proliferate and regenerate damaged tissues in situ, without the need for exogenous cell injections. 相似文献
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Carlo Pappone Giuseppe Ciconte Francesco Manguso Gabriele Vicedomini Valerio Mecarocci Manuel Conti Luigi Giannelli Paolo Pozzi Valeria Borrelli Lorenzo Menicanti Zarko Calovic Giuseppe Della Ratta Josep Brugada Vincenzo Santinelli 《Journal of the American College of Cardiology》2018,71(15):1631-1646
Background
Guidelines recommend the use of implanted cardioverter-defibrillators in patients with Brugada syndrome and induced ventricular tachyarrhythmias, but there is no evidence supporting it.Objectives
This prospective registry study was designed to explore clinical and electrophysiological predictors of malignant ventricular tachyarrhythmia inducibility in Brugada syndrome.Methods
A total of 191 consecutive selected patients with (group 1; n = 88) and without (group 2; n = 103) Brugada syndrome–related symptoms were prospectively enrolled in the registry. Patients underwent electrophysiological study and substrate mapping or ablation before and after ajmaline testing (1 mg/kg/5 min).Results
Overall, before ajmaline testing, 53.4% of patients had ventricular tachyarrhythmia inducibility, which was more frequent in group 1 (65.9%) than in group 2 (42.7%; p < 0.001). Regardless of clinical presentation, larger substrates with more fragmented long-duration ventricular potentials were found in patients with inducible arrhythmias than in patients without inducible arrhythmias (p < 0.001). One extrastimulus was used in more extensive substrates (median 13 cm2; p < 0.001), and ventricular fibrillation was the more frequently induced rhythm (p < 0.001). After ajmaline, patients without arrhythmia inducibility had arrhythmia inducibility without a difference in substrate characteristics between the 2 groups. The substrate size was the only independent predictor of inducibility (odds ratio: 4.51; 95% confidence interval: 2.51 to 8.09; p < 0.001). A substrate size of 4 cm2 best identified patients with inducible arrhythmias (area under the curve: 0.98; p < 0.001). Substrate ablation prevented ventricular tachyarrhythmia reinducibility.Conclusions
In Brugada syndrome dynamic substrate variability represents the pathophysiological basis of lethal ventricular tachyarrhythmias. Substrate size is independently associated with arrhythmia inducibility, and its determination after ajmaline identifies high-risk patients missed by clinical criteria. Substrate ablation is associated with electrocardiogram normalization and not arrhythmia reinducibility. (Epicardial Ablation in Brugada Syndrome [BRUGADA_I]; NCT02641431; Epicardial Ablation in Brugada Syndrome: An Extension Study of 200 BrS Patients; NCT03106701) 相似文献49.
If the Surgical Treatment of Ischemic Heart Failure (STICH) trial demonstrates that surgical therapy is superior to medical therapy, early aggressive evaluation of coronary artery disease as a potentially correctable cause of new-onset heart failure would be the preferred strategy. This strategy could tremendously change the treatment of ischemic heart disease. Confirming the STICH revascularization hypothesis will dramatically increase the use of coronary artery bypass grafting among the millions of patients now being medically treated without evaluation for an ischemic cause. 相似文献
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Menicanti L DiDonato M Castelvecchio S Santambrogio C Montericcio V Frigiola A Buckberg G;RESTORE group 《Heart failure reviews》2004,9(4):317-327
Ischemic functional mitral regurgitation following ischemic cardiomyopathy is a secondary phenomenon to ventricular dilation, and therapeutic approaches to this complication are not uniform. Solutions to improve mitral function include either mitral repair or observing the effects of coronary revascularization and/or ventricular rebuilding during surgical ventricular restoration (SVR). The present study of 108 patients (comprising 18% of our 588 SVR population) reports the effects of mitral repair following SVR and CABG by comparing geometric, functional, hemodynamic and outcome changes to SVR patients without mitral repair. The degree of mitral regurgitation went from 2.9 +/- 1.2 before to 0.7 +/- 0.7 after SVR and mitral repair. SVR improved EF from 29 +/- 7% to 34 +/- 10% p 0.001; reduced end diastolic volume from 243 +/- 74 to 163 +/- 53 ml and end systolic volume from 170 +/- 63 to 107 +/- 41 ml, p 0.000. Ventricular size and shape geometric measurements improved in all patients, either with and without mitral repair. SVR improved tenting and papillary muscle width between muscle heads in all patients, but alterations in mitral annular size improved only following mitral repair.Preoperative mitral regurgitation occurred in patients with larger ventricular volume and lower ejection fraction and was an independent predictor of operative mortality risk. 相似文献