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《Health policy (Amsterdam, Netherlands)》2019,123(8):756-764
In 2002, the New Zealand government introduced universal capitated subsidies for general practitioner consultations amid a broader programme of reform intended to reduce inequities in access and encourage more preventive healthcare visits. While consultation numbers increased in the short run, the issue of cost barriers to access has once more garnered significant policy attention, with many commentators concerned that the funding necessary to maintain low fees has not kept up with cost pressures. A longer-term assessment is useful in understanding the relationship between evolving policy conditions and service use.This article explores how the distribution of access to GPs changed in the short and long run using New Zealand Health Survey data from 2002/03 to 2015/16. I find that the capitation subsidies were associated with improved access for indigenous Māori and more preventive visits as intended by 2006/07. However, from 2006/07 onward patients with the greatest health need began reporting fewer and less frequent doctors’ visits per annum. I discuss potential explanations, focussing on the role of capitation subsidies and the successor price-capping scheme. This research contributes evidence to international scholarship on the long-term factors necessary for universal capitated subsidisation to sustainably reduce access inequities, with attention to local nuance. 相似文献
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Background
The selection of optimal donor is crucial for successful hematopoietic stem cell transplantation (HSCT). Thereby, it is appropriate to know, in addition to basic human leukocyte antigen (HLA) gene matches, other immunogenic or nonimmunogenic parameters predicting the outcome of transplant.Objective
A unified approach is necessary to provide a comprehensive view of the patient-donor compatibility characterization outside of standard HLA genes. The approach should be applicable as a tool for optimizing procedures for extended donor typing and/or verification typing of a donor.Methods
The study used the summary, unification, and innovation of existing practical knowledge and experience of the Czech National Marrow Donor Registry of various factors beyond HLA matching with impact on transplant outcome.Results
An information technology system–implemented procedure (a verification algorithm) is presented as the decision support approach for prematurely discarding less suitable donors from the transplantation process. It is intended primarily for the transplant specialist to help establish optimal procedures for verifying and determining donor critical factors.Conclusions
A process defining HLAs, killer cell immunoglobulin–like receptors, and cytokine typing strategies was proposed to provide support to a transplant specialist in refining the choice of a suitable donor. 相似文献994.
John M. Creasy Eran Sadot Bas Groot Koerkamp Joanne F. Chou Mithat Gonen Nancy E. Kemeny Vinod P. Balachandran T. Peter Kingham Ronald P. DeMatteo Peter J. Allen Leslie H. Blumgart William R. Jarnagin Michael I. DAngelica 《Surgery》2018,163(6):1238-1244
Background
Hepatic resection of colorectal liver metastases is associated with long-term survival. This study analyzes actual 10-year survivors after resection of colorectal liver metastases, reports the observed rate of cure, and identifies factors that preclude cure.Methods
A single-institution, prospectively maintained database was queried for all initial resections for colorectal liver metastases for the years 1992–2004. Observed cure was defined as actual 10-year survival with either no recurrence or resected recurrence with at least 3 years of disease-free follow-up. Clinical risk score was dichotomized into low (0–2) and high (3–5). Semiparametric proportional hazards mixture cure model was utilized to estimate probability of cure.Results
We included 1,211 patients with a median follow-up for survivors of 11 years. Median disease-specific survival was 4.9 years (95% CI: 4.4–5.3). 295 patients (24.4%) were actual 10-year survivors. The observed cure rate was 20.6% (n?=?250). Among 250 cured patients, 192 (76.8%) had no recurrence and 58 (23.2%) had a resected recurrence with at least 3 years of disease-free follow-up. Extrahepatic disease (n?=?88), carcinoembryonic antigen >200?ng/mL (n?=?119), positive margin (n?=?109), and >10 tumors (n?=?31) had observed cure rates less than 10%. In cure model analysis, patients with both extrahepatic disease and high clinical risk score (n?=?31) had an estimated probability of cure of 3.5%.Conclusion
Actual 10-year survival after resection of colorectal liver metastases is 24% with an observed 20% cure rate. Patients with both high clinical risk score and extrahepatic disease have an estimated probability of cure less than 5%. When such factors are identified, strong consideration may be given to preoperative strategies, such as neoadjuvant chemotherapy, to help select patients for surgical therapy. 相似文献995.
996.
Impact of transporter-mediated drug absorption, distribution, elimination and drug interactions in antimicrobial chemotherapy 总被引:1,自引:0,他引:1
Akira Tsuji 《Journal of infection and chemotherapy》2006,12(5):241-250
A comprehensive list of drug transporters has recently become available as a result of extensive genome analysis. Membrane
transporters play important roles in determining the pharmacokinetic aspects of intestinal absorption, tissue distribution,
and the urinary and biliary excretions of a wide variety of therapeutic drugs. The identification and characterization of
transporters responsible for the transfer of nutrients and xenobiotics, including drugs, is expected to provide a scientific
basis for understanding drug disposition, as well as the molecular mechanisms of drug–drug/drug–food/drug–protein interactions
and inter-individual/inter-species differences. This review focuses on the influence of transporters on the pharmacokinetics
of β-lactam antibiotics, new quinolones, and other antimicrobial agents, as well as focusing on the drug–drug interactions
associated with transporter-mediated uptake from the small intestine and transporter-mediated elimination from the kidney
and liver. 相似文献
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