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1.
Rajnish Mago MD John-Paul Gomez MD Namita Gupta MBBS Elisabeth J. S. Kunkel MD 《Current psychiatry reports》2006,8(3):228-233
Anxiety disorders and anxiety symptoms are highly prevalent in the general population and more so in the medically ill. They
have a number of negative consequences for these patients and may worsen the outcome of the medical illness and increase health
care utilization. In the evaluation of these patients, it is of paramount importance to identify the etiology of the anxiety
and, in particular, to differentiate primary from secondary anxiety. Management includes medications (especially benzodiazepines
and selective serotonin reuptake inhibitors) and psychotherapy (particularly cognitive-behavioral therapy). 相似文献
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3.
Résumé Dans le cadre d'une étude rétrospective sur l'incidence des fractures du fémur proximal (FFP) dans le canton de Vaud, tous les cas de FFP survenus en 1986 et traités dans les hôpitaux du canton ont été enregistrés sur la base de leur dossier. Au moins deux sources d'identification des cas ont été utilisées pour chaque hôpital, dont en particulier les statistiques médicales VESKA chaque fois qu'elles étaient disponibles, soit dans 9 des 18 hôpitaux qui ont participé à cette étude. Le nombre de cas obtenus par les statistiques VESKA est comparé au nombre final obtenu après cumul des deux sources d'identification et vérification des diagnostics dans les dossiers médicaux des patients. Pour les 9 hôpitaux concernés, les statistiques VESKA ont enregistré 407 cas de FFP; le nombre final obtenu est 392, soit près de 4% inférieur. Pour le diagnostic de FFP, les statistiques VESKA fournissent une bonne approximation du nombre réel de cas, nombre qu'elles ont tendance à surestimer plutôt qu'à sous-estimer. Toutefois il serait indispensable qu'une plus grande proportion des hôpitaux y participe (actuellement 50% au niveau cantonal et 35% au niveau national) pour établir des courbes d'incidence sur cette seule base statistique.
Summary Within the framework of a retrospective study of the incidence of hip fractures in the canton of Vaud (Switzerland), all cases of hip fracture occurring among the resident population in 1986 and treated in the hospitals of the canton were identified from among five different information sources. Relevant data were then extracted from the medical records. At least two sources of information were used to identify cases in each hospital, among them the statistics of the Swiss Hospital Association (VESKA). These statistics were available for 9 of the 18 hospitals in the canton that participated in the study. The number of cases identified from the VESKA statistics was compared to the total number of cases for each hospital. For the 9 hospitals the number of cases in the VESKA statistics was 407, whereas, after having excluded diagnoses that were actually status after fracture and double entries, the total for these hospitals was 392, that is 4% less than the VESKA statistics indicate. It is concluded that the VESKA statistics provide a good approximation of the actual number of cases treated in these hospitals, with a tendency to overestimate this number. In order to use these statistics for calculating incidence figures, however, it is imperative that a greater proportion of all hospitals (50% presently in the canton, 35% nationwide) participate in these statistics.
Zusammenfassung Im Rahmen einer retrospektiven Studie über die Inzidenz der Oberschenkelhalsfrakturen (OSHF) im Kanton Waadt wurden alle Fälle, die 1986 vorgekommen und in den Spitälern behandelt worden sind, anhand ihrer Krankengeschichte registriert. Mindestens zwei Quellen der Identifikation der Fälle wurden in jedem Spital benützt, wovon eine die medizinischen Statistiken VESKA gewesen sind; soweit diese vorhanden waren. Das traf in 9 von 18 Spitälern, die an der Studie teilgenommen haben, zu. Die Anzahl der erhaltenen Fälle aus den VESKA Statistiken wurde in jedem Spital mit der Anzahl aller Fälle verglichen. Für diese 9 Spitäler wurden 407 Fälle von OSHF registriert. Die Anzahl aller Fälle betrug 392, das heisst 4% weniger. Für die Diagnose der OSHF liefert die VESKA also eine gute annähernde Berechnung der tatsächlich vorkommenden Fälle, mit der Tendenz eher über-als unterzubewerten. Aber es wäre unbedingt notwendig, dass mehr Spitäler mitmachen (zur Zeit 50% im Kanton Waadt und 35% in der Schweiz), um diese Statistiken für Inzidenzberechnungen benutzen zu können.相似文献
4.
Setor K. Kunutsor Michael R. Whitehouse Ashley W. Blom Tim Board Peter Kay B. Mike Wroblewski Valérie Zeller Szu-Yuan Chen Pang-Hsin Hsieh Bassam A. Masri Amir Herman Jean-Yves Jenny Ran Schwarzkopf John-Paul Whittaker Ben Burston Ronald Huang Camilo Restrepo Javad Parvizi Sergio Rudelli Emerson Honda David E. Uip Guillem Bori Ernesto Muñoz-Mahamud Elizabeth Darley Alba Ribera Elena Cañas Javier Cabo José Cordero-Ampuero Maria Luisa Sorlí Redó Simon Strange Erik Lenguerrand Rachael Gooberman-Hill Jason Webb Alasdair MacGowan Paul Dieppe Matthew Wilson Andrew D. Beswick The Global Infection Orthopaedic Management Collaboration 《European journal of epidemiology》2018,33(10):933-946
One-stage and two-stage revision strategies are the two main options for treating established chronic peri-prosthetic joint infection (PJI) of the hip; however, there is uncertainty regarding which is the best treatment option. We aimed to compare the risk of re-infection between the two revision strategies using pooled individual participant data (IPD). Observational cohort studies with PJI of the hip treated exclusively by one- or two-stage revision and reporting re-infection outcomes were retrieved by searching MEDLINE, EMBASE, Web of Science, The Cochrane Library, and the WHO International Clinical Trials Registry Platform; as well as email contact with investigators. We analysed IPD of 1856 participants with PJI of the hip from 44 cohorts across four continents. The primary outcome was re-infection (recurrence of infection by the same organism(s) and/or re-infection with a new organism(s)). Hazard ratios (HRs) for re-infection were calculated using Cox proportional frailty hazards models. After a median follow-up of 3.7 years, 222 re-infections were recorded. Re-infection rates per 1000 person-years of follow-up were 16.8 (95% CI 13.6–20.7) and 32.3 (95% CI 27.3–38.3) for one-stage and two-stage strategies respectively. The age- and sex-adjusted HR of re-infection for two-stage revision was 1.70 (0.58–5.00) when compared with one-stage revision. The association remained consistently absent after further adjustment for potential confounders. The HRs did not vary importantly in clinically relevant subgroups. Analysis of pooled individual patient data suggest that a one-stage revision strategy may be as effective as a two-stage revision strategy in treating PJI of the hip. 相似文献
5.
6.
Mauro Oddo Claudio Sandroni Giuseppe Citerio John-Paul Miroz Janneke Horn Malin Rundgren Alain Cariou Jean-François Payen Christian Storm Pascal Stammet Fabio Silvio Taccone 《Intensive care medicine》2018,44(12):2102-2111
Purpose
To assess the ability of quantitative pupillometry [using the Neurological Pupil index (NPi)] to predict an unfavorable neurological outcome after cardiac arrest (CA).Methods
We performed a prospective international multicenter study (10 centers) in adult comatose CA patients. Quantitative NPi and standard manual pupillary light reflex (sPLR)—blinded to clinicians and outcome assessors—were recorded in parallel from day 1 to 3 after CA. Primary study endpoint was to compare the value of NPi versus sPLR to predict 3-month Cerebral Performance Category (CPC), dichotomized as favorable (CPC 1–2: full recovery or moderate disability) versus unfavorable outcome (CPC 3–5: severe disability, vegetative state, or death).Results
At any time between day 1 and 3, an NPi?≤?2 (n?=?456 patients) had a 51% (95% CI 49–53) negative predictive value and a 100% positive predictive value [PPV; 0% (0–2) false-positive rate], with a 100% (98–100) specificity and 32% (27–38) sensitivity for the prediction of unfavorable outcome. Compared with NPi, sPLR had significantly lower PPV and significantly lower specificity (p? <?0.001 at day 1 and 2; p ?=?0.06 at day 3). The combination of NPi?≤?2 with bilaterally absent somatosensory evoked potentials (SSEP; n?=?188 patients) provided higher sensitivity [58% (49–67) vs. 48% (39–57) for SSEP alone], with comparable specificity [100% (94–100)].Conclusions
Quantitative NPi had excellent ability to predict an unfavorable outcome from day 1 after CA, with no false positives, and significantly higher specificity than standard manual pupillary examination. The addition of NPi to SSEP increased sensitivity of outcome prediction, while maintaining 100% specificity.7.
Raffaella Franciotti Nicola Walter Falasca Laura Bonanni Francesca Anzellotti Valerio Maruotti Silvia Comani Astrid Thomas Armando Tartaro John-Paul Taylor Marco Onofrj 《Neurobiology of aging》2013
Default mode network resting state activity in posterior cingulate cortex is abnormally reduced in Alzheimer disease (AD) patients. Fluctuating cognition and electroencephalogram abnormalities are established core and supportive elements respectively for the diagnosis of dementia with Lewy bodies (DLB). Our aim was to assess whether patients with DLB with both of these features have different default mode network patterns during resting state functional magnetic resonance imaging compared with AD. Eighteen patients with DLB, 18 AD patients without fluctuating cognition, and 15 control subjects were selected after appropriate matching and followed for 2–5 years to confirm diagnosis. Independent component analysis with functional connectivity (FC) and Granger causality approaches were applied to isolate and characterize resting state networks. FC was reduced in AD and DLB patients compared with control subjects. Posterior cingulate cortex activity was lower in AD than in control subjects and DLB patients (p < 0.05). Right hemisphere FC was reduced in DLB patients in comparison with control subjects but not in patients with AD, and was correlated with severity of fluctuations (ρ = −0.69; p < 0.01). Causal flow analysis showed differences between patients with DLB and AD and control subjects. 相似文献
8.
Stavros M Stivaros Robert Alston Neville B Wright Kate Chandler Denise Bonney Robert F Wynn Andrew M Will Maqsood Punekar Sean Loughran John-Paul Kilday Detlev Schindler Leena Patel Stefan Meyer 《The British journal of radiology》2015,88(1056)
Objective:
Fanconi anaemia (FA) is an inherited disease associated with congenital and developmental abnormalities resulting from the disruption of a multigenic DNA damage response pathway. This study aimed to define the MRI appearances of the brain in patients with FA in correlation with their genetic and clinical features.Methods:
A review of the brain MRI in 20 patients with FA was performed. Pituitary size and frequencies of the radiological findings of individuals with FA and age-matched controls were determined.Results:
Abnormalities were identified in 18 (90%) patients with FA, the commonest being a small pituitary (68%, p < 0.01 females and p < 0.001 males). In five cases (25%, p = 0.02), the pituitary morphology was also abnormal. Posterior fossa abnormalities were seen in six cases (30%, p = 0.01) including Chiari I malformation (n = 3), Dandy–Walker variant (n = 2) and cerebellar atrophy (n = 2). Six patients (30%, p = 0.01) had morphological structural variation of the corpus callosum (CC).Conclusion:
The incidence of central nervous system (CNS) abnormalities in FA is higher than previously reported, with a midline predominance that points to impact in the early stages of CNS development. MRI brain imaging is important for endocrine assessment and pre-transplant evaluation and can make an important contribution to clinical decision-making.Advances in knowledge:
The incidence of brain structural abnormalities in FA is higher than previously reported, with abnormalities of the posterior fossa, CC and pituitary being common. There is an association with gender and reduction in pituitary size which does not strongly correlate with biochemically evident endocrine abnormality. 相似文献9.
Pregnancy and Crohn's disease 总被引:3,自引:0,他引:3
Mottet C Juillerat P Gonvers JJ Froehlich F Burnand B Vader JP Michetti P Felley C 《Digestion》2005,71(1):54-61
Crohn's disease commonly affects women of childbearing age. Available data on Crohn's disease and pregnancy show that women with Crohn's disease can expect to conceive successfully, carry to term and deliver a healthy baby. Control of disease activity before conception and during pregnancy is critical, to optimize both maternal and fetal health. Generally speaking, pharmacological therapy for Crohn's disease during pregnancy is similar to pharmacological therapy for non-pregnant patients. Patients maintained in remission by way of pharmacological therapy should continue it throughout their pregnancy. Most drugs, including sulfasalazine, mesalazine, corticosteroids, and immunosuppressors such as azathioprine and 6-mercaptopurine, are safe, whereas methotrexate is contraindicated. 相似文献
10.
John-Paul Kilday Ute Katharina Bartels Eric Bouffet 《Current neurology and neuroscience reports》2014,14(4):1-9
Collectively, pediatric low-grade gliomas account for most brain tumors reported in children. Surgery is typically curable for operable lesions. However, more effective therapies are required for inaccessible tumors, both to overcome refractory disease and to minimize the toxicity associated with conventional adjuvant chemotherapy and radiotherapy regimens. Recent years have witnessed rapid improvements in our understanding of the molecular pathogenesis of several childhood tumors, including low-grade gliomas. As a result, several novel compounds targeting and inhibiting critical components of molecular signaling pathways purported to be overactive in the disease have been developed. This article summarizes the most recent literature evaluating such novel targeted agents in childhood low-grade gliomas. 相似文献