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81.
Aim: To examine the evidence of benefit in initiating immediate chemotherapy in patients with newly diagnosed asymptomatic metastatic incurable cancer, compared with delaying chemotherapy until symptomatic progression. Methods: Through an extensive review of published reports, we examined the biological, clinical, psychological and ethical background of the issue and reported on the available clinical trial evidence in a variety of tumor types. Results: Only a limited number of clinical trials have directly examined the role of immediate versus delayed chemotherapy in patients with incurable asymptomatic metastatic cancer. Small studies in mesothelioma, colorectal cancer, breast cancer, myeloma, and low‐grade lymphoma suggest no survival benefit for the immediate initiation of chemotherapy. However, there was no evidence in other tumor types. Conclusion: The appropriate timing of chemotherapy initiation in an asymptomatic patient with metastatic cancer remains a substantial question in oncology. Many factors are likely to impact on the decision. However, little if any evidence demonstrates a clear advantage in the immediate initiation of chemotherapy in this setting. 相似文献
82.
H. GALLION W.A. CHRISTOPHERSON† R.L. COLEMAN‡ L. DEMARS§ T. HERZOG S. HOSFORD¶ H. SCHELLHAS# A. WELLS & B.-U. SEVIN†† 《International journal of gynecological cancer》2006,16(1):194-201
The study objective was to determine the effectiveness of a phenotypic chemoresponse assay in predicting response to chemotherapy measured by progression-free interval (PFI) in a retrospective series of ovarian cancer patients whose tumor specimens had been tested with the ChemoFx assay. A statistically significant correlation between assay prediction of response and PFI was observed in 256 cases with an exact or partial match between drug(s) assayed and received. In 135 cases with an exact match, the hazard ratio for progression of the resistant group was 2.9 (confidence interval [CI]: 1.4-6.3; P < 0.01) compared to the sensitive group and 1.7 (CI: 1.2-2.5) for the intermediate compared to the sensitive group. The median PFI for patients treated with drugs assayed as resistant was 9 months, 14 months for those with drugs assayed as intermediately sensitive, and PFI had not been achieved for those with drugs assayed as sensitive. These data indicate that the ChemoFx assay is predictive of PFI in ovarian cancer. As the majority of ovarian cancers display different degrees of response to different chemotherapy agents ex vivo, the incorporation of assay information into treatment selection has the potential to improve clinical outcomes in ovarian cancer patients. 相似文献
83.
脉搏指示连续心排血量技术在心脏前负荷测量的应用近况 总被引:1,自引:1,他引:0
监测心脏负荷变化对了解心脏功能具有十分重要的临床意义。中心静脉压(CVP)与右心前负荷虽存在一定关系,但不能完全反映左心前负荷。经动脉插管入左心房及肺动脉漂浮导管(Swan-Ganz导管)测量肺小动脉嵌顿压(PCWP)评估左心前负荷的方法,虽能为判断心脏前负荷提供较为可靠的依据, 相似文献
84.
观察雾化吸入IL-2联合化疗对非小细胞肺癌的临床疗效并与静滴IL-2及单纯化疗进行对比。方法:IL-2的雾化10万u/次,2次/d,连用1月,化疗后3d开始用;IL-2静滴40万u/次,1次/d,加入500ml液体中静滴,连用1月;化疗采用动脉灌注或全身化疗,药物及剂量为环磷酰胺400mg/m2+DDP80mg/m2。结果:用IL-2的两组CR+PR显著高于单纯化疗组(P<0.01);雾化IL-2组CR+PR与静滴IL-2差别无显著性(P>0.05),但不良反应的发生率显著低于后者,而与单纯化疗类似,结论:雾化吸入IL-2联合化疗对非小细胞肺癌有较好的疗效,且副作用小,值得扩大样本进一步验证其疗效。 相似文献
85.
86.
Anders Wahlin Lorentz Brinch Per Hrnsten Stein A. Evensen Gunnar
berg Bengt Simonsson Michael Hedenus 《European journal of haematology》1997,58(4):233-240
Abstract: The results of an intensive treatment program for patients 16–60 yr of age with de novo acute myeloid leukemia are presented. The patients were given conventional induction treatment with daunorubicin and cytarabine. Patients not entering complete remission (CR) after 1 course of daunorubicin/cytarabine were given 1 course of amsacrine/etoposide/cytarabine. Those entering complete remission received 3 consolidation courses using mitoxantrone, etoposide, amsacrine and cytarabine. One hundred and eighteen patients were enrolled. Complete remission was attained after 1–2 courses in 90 patients (76%). Another 6 patients reached CR after 3–4 induction courses for a total CR rate of 81%. If feasible, patients were offered either allogeneic or unpurged autologous bone marrow transplantation. Twenty-four patients underwent allogeneic bone marrow transplantation; 15 in first remission, 8 in second remission, 1 in early relapse. Thirty patients below 56 yr of age underwent autologous bone marrow transplantation in first remission. The overall probability of survival at 4 yr was 34%, and for patients below 40 yr of age 50%. Leukemia-free survival was 35% for the whole cohort of patients; 52% for patients below 40 yr of age. Patients undergoing allogeneic or autologous bone marrow transplantation in first remission had an overall survival of 86% and 47%, respectively, while the probability of leukemia-free survival in these groups was 87% vs. 40% at 4 yr. The CR rate and long-term results of this intensive treatment program compare favorably with other recent studies using intensive consolidation with allogeneic or autologous bone marrow transplantation or high dose cytarabine. 相似文献
87.
Jin S. Lee Herman I. Libshitz William K. Murphy Diane Jeffries Waun K. Hong 《Investigational new drugs》1990,8(3):299-304
Summary Thirty-one patients with stage IIIB or IV non-small cell lung cancer (NSCLC) were treated with intravenous 10-EdAM on a weekly basis. The starting dose was 80 mg/m2, with subsequent doses adjusted depending on evidence of toxicity. There were 20 men and 11 women with a median age of 58 years (range, 33–75). Response was evaluated in 30 patients, 5 with evaluable but not measurable tumors and 25 with measurable indicator lesions. There were no complete remissions; 3 patients achieved partial remission. Nine patients had a minor response, 6 showed no change, and 12 had progressive disease. Median survival for all 31 patients was 43 weeks (range, 12–65+). During the first 3-week period, the 10-EdAM dose was reduced or withheld in 19 patients (because of stomatitis in 12, SGPT elevation in 3, skin rash in 2, and granulocytopenia in 2), escalated in 11 patients, and unchanged in 1 patient. A mean of 34–88 mg/m2of 10-EdAM (median, 50) was given per week during the first 5-week period. Myelotoxicity was infrequent and there was no significant nephrotoxicity. Considering the modest side effects of this treatment and the conservative dose-modification schedule which mandated substantial dose reductions, we conclude that 10-EdAM is a promising antitumor agent for NSCLC. 相似文献
88.
Acute myeloid leukaemia (AML) is predominantly a disease of the elderly; the median age of incidence is 64 years, and 60% of all cases are over 60. With improved chemotherapy regimens and maximal supportive care, remission rates of up to 60% may be achieved in selected elderly patients. Whilst intensive chemotherapy is the treatment of choice for fit patients, it may be inappropriate for debilitated patients with poor prognosis disease in whom supportive care or palliative chemotherapy may be more suitable. AML in the elderly exhibits biological differences from AML in younger patients, and elderly patients may be unable to withstand the rigors of the intensive treatment regimens given to younger patients. 相似文献
89.
90.
Doug Joshua Max Wolf Jane Matthews Lee Tan William Sheridan Glenn Pilkingtonh Fiona Page 《Leukemia & lymphoma》1994,14(3):303-309
The Australian Leukaemia Study Group myeloma study (MM1) aimed to determine the prognostic significance of clinical and immunophenotypic markers in patients with multiple myeloma. All patients were treated with standard dose melphalan and prednisone. Seventy-four patients were entered and the median survival was 27 months. Serum beta 2-microglobulin (βM) and albumin levels were the only significant clinical factors influencing survival (p = 0.007 and p = 0.008, respectively). Patients with raised levels of CD38+ lymphocytes at presentation had a significantly shorter survival than patients with normal levels (p = 0.01, logrank test, median 19 months vs 33 months). CD38 antigen expression was independent of β2M but patients with raised levels of CD38 had significantly lower levels of albumin than patients with normal levels (p = 0.001) which may explain their poorer survival. Salmon and Durie stage was not associated with antigen expression. No other B-cell antigens (CD10, CD19, CD20, CD21, CD22, CD23, FMC1 or FMC7) or plasma cell antigens tested (PCA-1) were found to be associated with prognosis. Patients who achieved plateau phase had a better prognosis than those who did not (p = 0.04 in a landmark analysis). Patients who achieved plateau phase following an objective response appeared to have a better prognosis than those who were in plateau phase at presentation (p = 0.09 in a landmark analysis). Light chain isotype suppression (LCIS) was not associated with a significant survival advantage and did not correlate with any known prognostic indicator. We conclude that phenotypic analysis of peripheral blood lymphocytes for CD38 antigen at diagnosis may be useful as a prognostic indicator in patients with myeloma. 相似文献