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James L. Januzzi Sunil Suchindran Udo Hoffmann Manesh R. Patel Maros Ferencik Adrian Coles Jean-Claude Tardif Geoffrey S. Ginsburg Pamela S. Douglas 《Journal of the American College of Cardiology》2019,73(3):251-260
Background
Evaluation of stable symptomatic outpatients with suspected coronary artery disease (CAD) may be challenging because they have a wide range of cardiovascular risk. The role of troponin testing to assist clinical decision making in this setting is unexplored.Objectives
This study sought to evaluate the prognostic meaning of single-molecule counting high-sensitivity troponin I (hsTnI) (normal range <6 ng/l) among outpatients with stable chest symptoms and suspected CAD.Methods
Participants with available blood samples in PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) were studied, and hsTnI results were analyzed relative to the primary outcome of death, acute myocardial infarction (MI), or hospitalization for unstable angina by 1 year. The secondary outcome was the composite of cardiovascular death or acute MI.Results
The study sample consisted of 4,021 participants; 98.6% had measurable hsTnI concentrations. The median hsTnI value was 1.6 ng/l. In upper hsTnI quartiles, patients had higher-risk clinical profiles. Higher hsTnI concentrations were associated with greater event probabilities for death, acute MI, or hospitalization for unstable angina. In multivariable models, hsTnI concentrations independently predicted death, acute MI, or hospitalization for unstable angina (hazard ratio: 1.54 per increase in log-hsTnI interquartile range; p < 0.001) and cardiovascular death or acute MI (hazard ratio: 1.52 per increase in log-hsTnI interquartile range; p < 0.001) and were particularly associated with near-term events, compared with longer follow-up.Conclusions
In symptomatic outpatients with suspected CAD, higher concentrations of hsTnI within the normal range were associated with heightened near-term risk for death, acute MI, or hospitalization. (Prospective Multicenter Imaging Study for Evaluation of Chest Pain [PROMISE]; NCT01174550) 相似文献3.
周围血白细胞的复制型丙型肝炎病毒RNA的检测及临床意义 总被引:6,自引:0,他引:6
用简并引物作套式反转录。聚合酶链反应检测正、负链丙型肝炎病毒(HCV)RNA。显示30例急、慢性丙型肝炎患者的血清及血浆中,7例无症状抗-HCV阳性者的血清、血浆及周围血白细胞(PBL/C)中,均未检出负链HCVRNA。慢性丙型肝炎者PBI(中正、负链HCVRNA的检出率高于急性丙型肝炎及无症状抗-HCV阳性者(P<0.05~0.001)。17例经肝组织学检查的患者中,急性肝炎(AH)者PBL/C的正、负链HCVRNA检出率低于慢性活动性肝炎(CAH)者(P<0.05)。1例AH及6例CAH患者肝组织内正、负链HCVRNA全部阳性。证实丙型肝炎患者的PBL/C确可被HCV感染,病程越长,被HCV感染的可能性越大;病情活动者,PBL/C中负链HCVRNA的检出率越高。提示HCV不仅可以感染PBLC,而且可在其中复制;负链HCVRNA的出现与病情活动有关。 相似文献
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Todd C. Villines Subhi J. Al’Aref Daniele Andreini Marcus Y. Chen Andrew D. Choi Carlo N. De Cecco Damini Dey James P. Earls Maros Ferencik Heidi Gransar Harvey Hecht Jonathon A. Leipsic Michael T. Lu Mohamed Marwan Pál Maurovich-Horvat Edward Nicol Gianluca Pontone Jonathan Weir-McCall Gudrun M. Feuchtner 《Journal of Cardiovascular Computed Tomography》2021,15(2):180-189
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Despite human leukocyte antigen (HLA) identity between donor and recipient, several patients develop acute graft-versus-host disease (aGVHD) after hematopoetic stem cell transplantation (HSCT) because of minor histocompatibility antigen (mHag) incompatibilities. The impact of multiple mHag disparities on the clinical outcome after HSCT still remains to be determined. We studied the genomic polymorphisms of HA-1, CD31, and CD49b and correlated mHag distribution with the occurrence of aGVHD after HSCT from HLA-matched sibling and unrelated donors. All 163 patients examined in our single-center study underwent HSCT for chronic myeloid leukemia in the first chronic phase. HA-1 and CD31 disparities are associated with increased aGVHD incidence in a subgroup of patients who test HLA-B44 supertype positive in univariate analysis. However, in a multivariate analysis, only increased patient age was confirmed as an independent aGVHD risk factor. Our findings indicate that the impact of mHag disparity on aGVHD development in HSCT from HLA-matched sibling and unrelated donors seems to be subordinated to classic aGVHD risk factors. 相似文献
8.
Dodd JD Ferencik M Liberthson RR Cury RC Hoffmann U Brady TJ Abbara S 《AJR. American journal of roentgenology》2007,188(2):W138-W146
OBJECTIVE: The purpose of this pictorial essay is to review the 64-MDCT appearance of congenital anomalies of the origins of the coronary arteries in adults. CONCLUSION: Increasing use of MDCT for cardiac imaging of adults requires familiarity with the cross-sectional appearance of congenital coronary artery anomalies visualized with noninvasive imaging techniques. Many of these anomalies are benign, but a small number are associated with myocardial ischemia and sudden death. Increasing use of MDCT in cardiac imaging may yield diagnostic information not obtained with coronary angiography. Axial, multiplanar, and 3D volume-rendered reconstructions should aid in detection and improve interpretation of such anomalies. 相似文献
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Coronary CT angiography. 总被引:7,自引:0,他引:7
Udo Hoffmann Maros Ferencik Ricardo C Cury Antonio J Pena 《Journal of nuclear medicine》2006,47(5):797-806
Advances in multidetector CT (MDCT) technology with submillimeter slice collimation and high temporal resolution permit contrast-enhanced imaging of coronary arteries and coronary plaque during a single breath hold. Appropriate patient preparation, detailed technical and technological knowledge with regard to recognition of typical imaging artifacts (such as beam hardening or motion artifacts), and the adequate choice of postprocessing techniques to detect stenosis and plaque are prerequisites to achieving diagnostic image quality. A growing number of studies have suggested that 64-slice coronary CT angiography is highly accurate for the exclusion of significant coronary artery stenosis (>50% luminal narrowing), with negative predictive values of 97%-100%, in comparison with invasive selective coronary angiography. In addition, several studies have indicated that MDCT also can detect calcified and noncalcified coronary atherosclerotic plaques, especially in proximal vessel segments, showing a good correlation with intracoronary ultrasound. Studies on clinical utility, cost, and cost-effectiveness are now warranted to demonstrate whether and how this technique can change and improve the current management of patients with suspected or confirmed coronary artery disease. 相似文献