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Purpose
To externally validate the performance characteristics of the Briganti’s risk stratification tool for baseline staging bone scan in patients with newly diagnosed prostate cancer (PCa).Methods
From 2009 onwards, a consecutive series of patients with PCa were enrolled. All patients were staged to evaluate the presence of bone metastasis (BM) with a conventional total-body Tc 99 m MDP scintigraphy performed regardless of baseline PCa characteristics. The area under the curve (AUC) estimates were used to test the accuracy of the Briganti’s risk stratification tool that recommended staging baseline bone scan for patients with a biopsy Gleason score >7 or with a prostate-specific antigen (PSA) >10 ng/ml and palpable disease (cT2/T3). The new tool was compared to the European Association of Urology (EAU) guideline.Results
A total of 313 patients were consecutively enrolled. Median age was 68 (range 49–95 years), and median PSA was 7 ng/ml (range 0.81–2,670). Twenty (6.4 %) patients presented BMs. Patients with BMs were significantly older, with higher PSA and a higher Gleason score (p = 0.001). The novel Briganti’s model was significantly (p = 0.001) more accurate (AUC: 0.75; CI: 0.632–0.859) than the EAU guideline (AUC: 0.64; CI: 0.52–0.761) for the prediction of BMs.Conclusions
Our study validated in a group of patients with PCa the novel risk stratification tool proposed by Briganti, which presented a higher accuracy for baseline staging bone scan when compared with the EAU guideline. In our experience, this approach would further reduce (about 60 %) the use of staging baseline bone scan without compromising the ability to detect BMs in patients with PCa. 相似文献Purpose
Sympathetic nervous system (SNS) hyperactivity is a salient characteristic of chronic heart failure (HF) and contributes to the progression of the disease. Iodine-123 meta-iodobenzylguanidine (123I-mIBG) imaging has been successfully used to assess cardiac SNS activity in HF patients and to predict prognosis. Importantly, SNS hyperactivity characterizes also physiological ageing, and there is conflicting evidence on cardiac 123I-mIBG uptake in healthy elderly subjects compared to adults. However, little data are available on the impact of ageing on cardiac sympathetic nerve activity assessed by 123I-mIBG scintigraphy, in patients with HF.Methods and results
We studied 180 HF patients (age?=?66.1?±?10.5 years [yrs]), left ventricular ejection fraction (LVEF?=?30.6?±?6.3 %) undergoing cardiac 123I-mIBG imaging. Early and late heart to mediastinum (H/M) ratios and washout rate were calculated in all patients. Demographic, clinical, and echocardiographic data were also collected. Our study population consisted of 53 patients aged >75 years (age?=?77.7?±?4.0 year), 67 patients aged 62–72 years (age?=?67.9?±?3.2 years) and 60 patients aged ≤61 year (age?=?53.9?±?5.6 years). In elderly patients, both early and late H/M ratios were significantly lower compared to younger patients (p?<?0.05). By multivariate analysis, H/M ratios (both early and late) and washout rate were significantly correlated with LVEF and age.Conclusions
Our data indicate that, in a population of HF patients, there is an independent age-related effect on cardiac SNS innervation assessed by 123I-mIBG imaging. This finding suggests that cardiac 123I-mIBG uptake in patients with HF might be affected by patient age.Adjacent segment disease (ASDz) is a potential complication following lumbar spinal fusion. A common nomenclature based on etiology and ASDz type does not exist and is needed to assist with clinical prognostication, decision making, and management.
Questions/PurposesThe objective of this study was to develop an etiology-based classification system for ASDz following lumbar fusion.
MethodsWe conducted a retrospective chart review of 65 consecutive patients who had undergone both a lumbar fusion performed by a single surgeon and a subsequent procedure for ASDz. We established an etiology-based classification system for lumbar ASDz with the following six categories: “degenerative” (degenerative disc disease or spondylosis), “neurologic” (disc herniation, stenosis), “instability” (spondylolisthesis, rotatory subluxation), “deformity” (scoliosis, kyphosis), “complex” (fracture, infection), or “combined.” Based on this scheme, we determined the rate of ASDz in each etiologic category.
ResultsOf the 65 patients, 27 (41.5%) underwent surgery for neurogenic claudication or radiculopathy for adjacent-level stenosis or disc herniation and were classified as “neurologic.” Ten patients (15.4%) had progressive degenerative disc pathology at the adjacent level and were classified as “degenerative.” Ten patients (15.4%) had spondylolisthesis or instability and were classified as “instability,” and three patients (4.6%) required revision surgery for adjacent-level kyphosis or scoliosis and were classified as “deformity.” Fifteen patients (23.1%) had multiple diagnoses that included a combination of categories and were classified as “combined.”
ConclusionThis is the first study to propose an etiology-based classification scheme of ASDz following lumbar spine fusion. This simple classification system may allow for the grouping and standardization of patients with similar pathologies and thus for more specific pre-operative diagnoses, personalized treatments, and improved outcome analyses.
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