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51.
John T. Mullen M.D. Jeffrey H. Lee M.D. Henry F. Gomez M.D. William A. Ross M.D. Norio Fukami M.D. Robert A. Wolff M.D. Eddie K. Abdalla M.D. Jean-Nicolas Vauthey M.D. Jeffrey E. Lee M.D. Peter W. T. Pisters M.D. Douglas B. Evans M.D. 《Journal of gastrointestinal surgery》2005,9(8):1094-1105
Contemporary treatment programs for patients with potentially resectable pancreatic cancer often involve preoperative therapy.
When the duration of preoperative therapy exceeds 2 months, the risk of plastic endobiliary stent occlusion increases. Metal
stents have much better patency but may complicate subsequent pancreaticoduodenectomy (PD). We evaluated rates of perioperative
morbidity, mortality, and stent complications in 272 consecutive patients who underwent PD at our institution from May 2001
to November 2004. Of these 272 patients, 29 (11%) underwent PD after placement of a metal stent, 141 underwent PD after placement
of a plastic stent, 10 had PD after biliary bypass without stenting, and 92 had PD without any form of biliary decompression.
No differences were found between the Metal Stent group and all other patients in median operative time, intraoperative blood
loss, or length of hospital stay. No perioperative deaths occurred in the Metal Stent group versus 3 (1.2%) deaths in the
other 243 patients. The incidence of major perioperative complications was similar between the two groups, including the rates
of pancreatic fistula, intra-abdominal abscess, and wound infection. Furthermore, there were no differences in the perioperative
morbidity or mortality rates between patients who underwent preoperative biliary decompression with a stent of any kind (metal
or plastic) and those patients who underwent no biliary decompression at all. Metal stent-related complications occurred in
2 (7%) of 29 patients during a median preoperative interval of 4.1 months; in contrast, 75 (45%) of the 166 patients who had
had plastic stents experienced complications, including 98 stent occlusions, during a median preoperative interval of 3.9
months (P < 0.001). We conclude that the use of expandable metal stents does not increase PD-associated perioperative morbidity
or mortality, and as such an expandable metal stent is our preferred method of biliary decompression in patients with symptomatic
malignant distal bile duct obstruction in whom surgery is not anticipated, or in whom there is a significant delay in the
time to surgery.
Presented at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14–18,
2005 (oral presentation).
Supported by the Lockton Fund for Pancreatic Cancer Research, The University of Texas M. D. Anderson Cancer Center, Houston,
Texas. 相似文献
52.
Kazunori Yokohata Hiroshi Kimura Gen Naritomi Hiroyuki Konomi Torahiko Takeda Yoshiaki Ogawa Masao Tanaka 《Journal of Hepato-Biliary-Pancreatic Surgery》1994,1(3):236-239
The role of endoscopic retrograde cholangiopancreatography (ERCP) in the preoperative assessment of anomalous pancreaticobiliary
junction was retrospectively evaluated in 74 consecutive patients (19 males and 55 females; aged 0–80 years). Sixty-three
patients had congenital biliary dilatation and 11 did not. Type classification of congenital biliary dilatation was possible
by ERCP alone in 45 patients (71%). The main causes of classification failure were previous bilio-enteric anastomosis and
restriction of postural changes during ERCP due to general anesthesia in pediatric patients. Classification of anomalous junction
was possible in 69 patients (93%). Technical difficulty in ERCP caused classification failure in 5 patients. Neoplastic lesions
were found in 12 patients (16%) and all but 1 were correctly diagnosed by ERCP. We conclude that ERCP plays an important role
in the preoperative diagnosis and type classification of anomalous pancreaticobiliary junction and congenital biliary dilatation. 相似文献
53.
Vinay K. Kapoor 《Journal of hepato-biliary-pancreatic sciences》2007,14(5):476-479
Laparoscopic cholecystectomy is associated with a two-to-four times higher risk of bile duct injury (BDI) than open cholecystectomy. BDI can lead to significant morbidity and even mortality. The first priority in BDI is to control peritoneal and biliary sepsis and to convert an acute BDI to a controlled external biliary fistula (EBF) — this can be achieved by endoscopic and/ or radiological intervention in most cases. This should be followed by assessment of the extent of injury — both biliary and vascular. Immediate management of BDI recognized during cholecystectomy depends on the type of injury, the condition of the patient, and the experience of the surgeon. For BDI recognized after cholecystectomy, early repair is not recommended, as the results are poor. The EBF may evolve into a benign biliary stricture (BBS), which should be electively repaired by a Roux-en-Y hepatico-jejunostomy. The use of an endoscopic stent as definitive management of BDI is not recommended. Long-term follow-up is essential after the repair of a BBS, as recurrence can occur several years after repair. Recurrent BBS is best treated with endoscopic balloon dilatation. Excellent early and long-term results can be obtained in specialized units at tertiary care referral centers. 相似文献
54.
Kiyotaka KUROSE Toshikazu MASUMOTO S. M. Fazle AKBAR Kojiro MICHITAKA Norio HORIIKE Morikazu ONJI 《Digestive endoscopy》1997,9(1):34-37
Abstract: Fifty -two patients with primary biliary cirrhosis (PBC), 10 of whom were 65 years or older at the time of diagnosis, were investigated by laparo-scopy. Laparoscopic findings in these 10 patients were evaluated and compared with those in younger patients. The 10 cases were composed of nine females and one male, and two had been diagnosed as having symptomatic PBC with skin itching, while the remaining eight had asymptomatic PBC. Two, seven and one case were in Scheuer's stage I, II and III, respectively, and eight had chronic non-suppurative destructive cholangitis (CNSDC) on liver biopsy specimens. The majority of senescent PBC patients had typical findings of the early stage of PBC on the liver surface; mild undulations in nine and reddish patches in eight. The laparoscopic findings in senescent PBC were relatively mild. 相似文献
55.
N. Vidon S. Chaussade J. Ph. Jeanniot B. Huchet C. Franchisseur J. J. Bernier 《European journal of clinical pharmacology》1989,37(5):487-491
Summary The absorption of almitrine from the upper gastrointestinal tract has been evaluated in 6 healthy volunteers by an intubation technique. Almitrine bismesylate dissolved in malic acid was introduced into the stomach after homogenization with a meal containing the marker14C-polyethylene glycol (PEG) 4000. Unlabeled PEG 4000 was infused into the second part of duodenum throughout the experiment. Samples of the luminal content were collected every 15 min for four hours from the stomach and at the ligament of Treitz. Blood was also collected.Almitrine was neither absorbed from nor metabolized in the stomach. About 37% of the quantity of drug emptied from the stomach was absorbed from the duodenum. Almitrine was detected in plasma 50 min after ingestion of the meal and its plasma concentration-time profile reflected the cumulative gastric emptying rate. The metabolite tetrahydroxy almitrine was found in intestinal samples as soon as unchanged drug was detected in plasma. The intraluminal rate of formation of the metabolite increased with time.The results suggest hepatic metabolism of almitrine followed by rapid excretion of the metabolite in the bile. 相似文献
56.
57.
58.
Autoimmune hepatitis type 1 and primary biliary cirrhosis have distinct bone marrow cytokine production 总被引:3,自引:0,他引:3
Zachou K Rigopoulou EI Tsikrikoni A Alexandrakis MG Passam F Kyriakou DS Stathakis NE Dalekos GN 《Journal of autoimmunity》2005,25(4):389-288
We have recently reported differences in the hematopoiesis between autoimmune hepatitis type 1 (AIH-1) and primary biliary cirrhosis (PBC). In view of the notion that cytokines are regulators of hematopoiesis, we investigated in our tertiary center the cytokine production in the bone marrow (BM) of the same consecutive cohort of patients (13 AIH-1, 13 PBC, 10 healthy and 7 patients with cirrhosis due to chronic hepatitis B). Interferon-gamma (IFN-gamma), interleukin-4 (IL-4), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-alpha) and transforming growth factor-beta (TGF-beta) were determined in the supernatants of long-term BM cultures by ELISAs. IL-4, TNF-alpha and TGF-beta were found significantly increased in the BM of PBC patients compared to AIH-1 and both control groups. AIH-1 patients had significantly higher BM IL-10 compared to PBC patients and higher IL-10, IL-4 and TNF-alpha compared to controls. BM IFN-gamma was significantly higher in PBC and AIH-1 patients compared to controls. In AIH-1 patients, IL-10 was positively correlated with CD34+, CD34+/CD38- and CD34+/CD38+ cell proportions. In conclusion, the BM cytokine microenvironment of PBC and AIH-1 patients differs significantly compared to that of healthy individuals and cirrhotic patients of non-autoimmune etiology. Differences were also found between patients with PBC and AH-1. The implication of BM in the pathogenesis of autoimmune liver diseases is possible and needs further investigation. 相似文献
59.
FGF signaling segregates biliary cell-lineage from chick hepatoblasts cooperatively with BMP4 and ECM components in vitro. 总被引:2,自引:0,他引:2
Masaaki Yanai Norifumi Tatsumi Noboru Hasunuma Kenjiro Katsu Fumio Endo Yuji Yokouchi 《Developmental dynamics》2008,237(5):1268-1283
Intrahepatic bile ducts (IHBDs) are indispensable for transporting bile secreted from hepatocytes to the hepatic duct. The biliary epithelial cells (BECs) of the IHBD arise from bipotent hepatoblasts around the portal vein, suggesting the portal mesenchyme is essential for their development. However, except for Notch or Activin/TGF-beta signaling molecules, it is not known which molecules regulate IHBD development. Here, we found that FGF receptors and BMP4 are specifically expressed in the developing IHBD and the hepatic mesenchyme, respectively. Using a mesenchyme-free culture of liver bud, we showed that bFGF and FGF7 induce the hepatoblasts to differentiate into BECs, and that BMP4 enhances bFGF-induced BEC differentiation. The extracellular matrix (ECM) components in the hepatic mesenchyme induced BEC differentiation. Forced expression of a constitutively active form of the FGF receptor partially induced BEC differentiation markers in vivo. These data strongly suggest that bFGF and FGF7 promote BEC differentiation cooperatively with BMP4 and ECMs in vivo. 相似文献
60.
Yasuni Nakanuma Naoko Kono Goroku Ohta Yasuhiro Kato Kenichi Kobayashi 《Virchows Archiv : an international journal of pathology》1982,398(2):149-161
Summary Using wedge liver biopsies from patients with primary biliary cirrhosis (PBC), ultrastructural features of the intrahepatic bile ducts in livers with slight or no bile duct loss were compared with those in livers with advanced bile duct loss and in extrahepatic cholestasis (EHC).Most changes in the biliary epithelium in PBC were similar to those in EHC. Microvillous loss and bleb formation, mitochondrial damage and increase in endoplasmic reticulum and ribosomes were found in PBC irrespective of the degree of bile duct loss, and also in EHC. These changes were present almost equally at any level of the biliary tree, and are presumed to represent a variety of non-specific lesions of biliary epithelial cells. As the loss of bile ducts in PBC progressed, cytoskeletal filaments and cytophagosomes increased in number and basement membranes were more thickened and reduplicated. These changes were more or less conspicuous in smaller branches of the biliary tree, and were also prominent in EHC. They might be causally related to the bile flow disturbance in the liver. Lateral intercellular spaces were irregularly dilated and contained osmiophilic membranous and/or granular material, similar to that found in duct lumena, within and without the basement membrane, and in the cytoplasm of periductal macrophages. Furthermore, pinocytotic vesicles were increased in the biliary cytoplasm facing periphery. These findings suggest possible alteration of the permeability of biliary epithelial cells, probably in the direction from the lumena to the periductal tissue. Such changes were found in PBC livers with virtual absence of bile duct loss, and the significance of this phenomenon is discussed. 相似文献