全文获取类型
收费全文 | 120650篇 |
免费 | 9886篇 |
国内免费 | 3024篇 |
专业分类
耳鼻咽喉 | 1243篇 |
儿科学 | 7183篇 |
妇产科学 | 4243篇 |
基础医学 | 13462篇 |
口腔科学 | 1570篇 |
临床医学 | 13075篇 |
内科学 | 20435篇 |
皮肤病学 | 2369篇 |
神经病学 | 10378篇 |
特种医学 | 2731篇 |
外国民族医学 | 4篇 |
外科学 | 11118篇 |
综合类 | 17465篇 |
现状与发展 | 16篇 |
预防医学 | 6774篇 |
眼科学 | 2174篇 |
药学 | 6320篇 |
51篇 | |
中国医学 | 11024篇 |
肿瘤学 | 1925篇 |
出版年
2024年 | 114篇 |
2023年 | 2067篇 |
2022年 | 3209篇 |
2021年 | 5485篇 |
2020年 | 5382篇 |
2019年 | 4275篇 |
2018年 | 4325篇 |
2017年 | 4441篇 |
2016年 | 4575篇 |
2015年 | 4346篇 |
2014年 | 8512篇 |
2013年 | 8822篇 |
2012年 | 6949篇 |
2011年 | 8090篇 |
2010年 | 6276篇 |
2009年 | 6071篇 |
2008年 | 5916篇 |
2007年 | 6082篇 |
2006年 | 5475篇 |
2005年 | 4557篇 |
2004年 | 3854篇 |
2003年 | 3427篇 |
2002年 | 2368篇 |
2001年 | 2116篇 |
2000年 | 1797篇 |
1999年 | 1611篇 |
1998年 | 1179篇 |
1997年 | 1048篇 |
1996年 | 1035篇 |
1995年 | 1261篇 |
1994年 | 1066篇 |
1993年 | 946篇 |
1992年 | 850篇 |
1991年 | 666篇 |
1990年 | 623篇 |
1989年 | 513篇 |
1988年 | 510篇 |
1987年 | 453篇 |
1986年 | 393篇 |
1985年 | 513篇 |
1984年 | 429篇 |
1983年 | 275篇 |
1982年 | 350篇 |
1981年 | 320篇 |
1980年 | 255篇 |
1979年 | 221篇 |
1978年 | 139篇 |
1977年 | 103篇 |
1976年 | 86篇 |
1975年 | 43篇 |
排序方式: 共有10000条查询结果,搜索用时 31 毫秒
991.
Acute respiratory distress syndrome (ARDS) is an acute inflammatory process that impairs the ability of the lungs to oxygenate and ultimately leads to respiratory failure. Patients who develop ARDS often have prolonged and complicated hospital courses putting them at risk for intensive care unit (ICU) delirium. Patients with ICU delirium often need chemical sedation, mechanical ventilation, prolonged duration of ICU and hospital stays, and they experience long‐term cognitive impairment and increased mortality. In a patient with ARDS, ICU delirium further complicates the hospital course and increases the risk of morbidity and mortality. Antipsychotics are prescribed to decrease the severity and duration of ICU delirium, thus potentially decreasing their risk of morbidity and mortality. However, antipsychotics are associated with many adverse effects including respiratory failure. Given the long‐term sequelae associated with the development of ICU delirium and the risks associated with antipsychotic use, clinicians must weigh the risks and benefits of antipsychotic use. This review investigates the interrelationship between ARDS, delirium, and antipsychotic use. In addition to discussing relevant studies evaluating antipsychotics for the prevention and treatment of delirium, we investigate safety concerns with the use of antipsychotics, especially as they relate to ARDS. Using the data compiled in this review, clinicians can make an informed decision about the use of antipsychotics for the prevention or treatment of delirium, with special consideration for their patients with ARDS. Future studies are needed to critically evaluate antipsychotic timing, dose, and duration for the prevention and treatment of ICU delirium and specifically evaluate the impact in special populations, particularly patients with ARDS. 相似文献
992.
Implications of Off‐Target Serotoninergic Drug Activity: An Analysis of Serotonin Syndrome Reports Using a Systematic Bioinformatics Approach 下载免费PDF全文
Vaughn L. Culbertson Shaikh E. Rahman Grayson C. Bosen Matthew L. Caylor Megan M. Echevarria Dong Xu 《Pharmacotherapy》2018,38(9):888-898
Study Objective
Serotonergic adverse drug events (ADEs) are caused by enhanced intrasynaptic concentrations of 5‐hydroxytryptamine (5‐HT). No systematic process currently exists for evaluating cumulative 5‐HT and off‐target toxicity of serotonergic drugs. The primary study aim was to create a Serotonergic Expanded Bioactivity Matrix (SEBM) by using a molecular bioinformatics, polypharmacologic approach for assessment of the participation of individual 5‐HT drugs in serotonin syndrome (SS) reports.Data Sources
Publicly available databases including the U.S. Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS), ChEMBL, DrugBank, PubChem, and Kyoto Encyclopedia of Genes and Genomes (KEGG) were queried for computational and pharmacologic data.Design
An in‐house bioinformatics TargetSearch program ( http://dxulab.org/software ) was used to characterize 71 serotonergic drugs interacting at 13 serotonin receptor subtypes and serotonin reuptake transporter protein (SERT). In addition, off‐target interactions at norepinephrine transporter (NET), monoamine oxidase (MAO), and muscarinic receptors were included to define seven polypharmacological drug cohorts. Serotonin syndrome reports for each serotonergic drug were extracted from FAERS by using the Sternbach and Hunter criteria.Measurements and Main Results
A proportional reporting adverse drug reaction (ADR) ratio (PRR) was calculated from each drug's total ADEs and SS case reports and aggregated by drug bioactivity cohorts. Triple‐receptor interactions had a disproportionately higher number of SS cases using both the Hunter criteria (mean PRR 1.72, 95% CI 1.05–2.39) and Sternbach (mean PRR 1.54, 95% CI 1.29–1.79). 5‐Hydroxytryptamine agonists were associated with a significantly lower proportion of SS cases using the Hunter and Sternbach criteria, respectively (mean PRR 0.49, 95% CI 0.17–0.81 and mean PRR 0.49, 95% CI 0.15–0.83). Drugs with disproportionately higher participation in SS vary considerably between the two diagnostic criteria.Conclusion
The SEBM model suggests a possible polypharmacological role in SS. Although further research is needed, off‐target receptor activity may help explain differences in severity of toxicity and clinical presentation. 相似文献993.
Lauren T. Ptomey Amanda N. Szabo Erik A. Willis Anna M. Gorczyca J. Leon Greene Jessica C. Danon Joseph E. Donnelly 《Disability and health journal》2018,11(3):486-490
Background
Between 250,000 and 400,000 individuals in the United States are diagnosed with Down syndrome (DS). Nearly all adults with DS will develop Alzheimer's disease pathology starting in their thirties. Recent studies suggest that increased physical activity (PA) may be important for maintaining components of cognition, including memory.Objective
The purpose of this study was to evaluate changes in cognitive function after completion of a 12-week exercise intervention in adults with DS.Methods
Participants were randomized to attend 30-minute group exercise sessions 1 or 2 times a week for 12 weeks. The exercise sessions were delivered via video conferencing on a tablet computer to groups of 5–8 participants. Sessions consisted of aerobic based exercises such as walking and jogging to music, dancing, as well as strength based exercises such as vertical jumps, bicep curls, and squats. Cognitive function was measured at baseline and end of study using the Cantab Dementia Battery for iPads, which assessed the cognitive domains of memory, attention, and reaction time.Results
Twenty-seven participants (27.9?±?7.1 years of age, 40.7% female) enrolled and completed the 12-week intervention. Participants randomized to 1 session/week averaged 26.6?±?3.0?min/week of PA from the group exercise session. Participants randomized to 2 sessions/week averaged 57.7?±?15.3?min/week of PA from the group exercise sessions. Participants improved their performance on the two memory variables (p?=?0.048 and p?=?0.069).Conclusion
Increased exercise may have positive changes on memory and other cognitive functions. 相似文献994.
995.
Background
Many young adults, specifically those with a diagnosis of autism spectrum disorder (ASD), do not meet the national physical activity (PA) guidelines. One way to address this problem may be to examine the factors that motivate individuals to engage in PA. However, the majority of current literature does not consider the unique characteristics of individuals with ASD, which may influence their motivation.Objective
The purpose of this research was to examine Self-Determination Theory predictors for PA for young adults with ASD.Methods
Respondents included 143 young adults with ASD who completed a survey pertaining to their motivational process to engage in physical activity, based on self-determination theory variables.Results
Goodness of fit indices reported from a path analysis suggests the current data closely align with the self-determination theory (χ2 (3, N?=?143)?=?11.99, p?>?.01, GFI?=?0.97, NFI?=?0.95, CFI?=?. 96, RMSEA?=?0.15). The three basic psychological needs explained 39% of the variance within respondents' self-determined motivation, and self-determined motivation explained 8% of the variance in PA levels.Conclusions
These findings support utilizing the self-determination theory within health promotion efforts for young adults with ASD. Practitioners should focus on enhancing the perceived basic psychological needs of young adults within physical activity settings. 相似文献996.
目的 探讨中性粒细胞与淋巴细胞比值(NLR)与急性冠状动脉综合征(ACS)患者冠脉严重程度之间的关
系,并分析NLR对急性心肌梗死的诊断价值。方法 回顾性分析2016年11月—2017年3月于我院行冠状动脉造影
检查的259例ACS患者的临床资料,其中不稳定型心绞痛组(UA组)148例、急性非ST段抬高型心肌梗死组(NSTEMI组)46例、急性ST段抬高型心肌梗死组(STEMI组)65例。比较3组的白细胞计数(WBC)、中性粒细胞计数(N)、淋巴细胞计数(L)、NLR、高敏C反应蛋白(hs-CRP)、心肌酶谱、血脂、血糖、肝功能等指标的差异。根据冠状动脉造影结果将患者按照冠状动脉病变支数分为单支病变组(70例)、双支病变组(70例)和三支病变组(119例),比较不同病变支数组间炎性细胞的差异。同时绘制NLR的受试者工作特征(ROC)曲线,评价NLR对急性心肌梗死的预测价值。结果 UA组、NSTEMI组及STEMI组间WBC、N、NLR、hs-CRP、cTnT、CK、CK-MB水平依次升高,STEMI组L值低于UA组,差异有统计学意义(P<0.05);WBC、NLR随冠状动脉病变支数的增加而呈上升趋势,但仅三支病变组与单支病变组间差异有统计学意义;NLR诊断急性心肌梗死的ROC曲线下面积(AUC)为0.865(95%CI:0.814~0.916)。当NLR=4.22时,其对急性心肌梗死的诊断效能最高,敏感度为72.1%,特异度为95.3%。结论 NLR水平与ACS患者病情严重程度呈正相关,并对诊断急性心肌梗死具有较高的诊断价值,可作为ACS患者病情的预测因素。 相似文献
997.
随着重症医学的发展和急性呼吸窘迫综合征(ARDS)呼吸支持手段的进步,ARDS短期病死率大大下降,存活者越来越多,存活者的长期结局越来越受到关注。ARDS存活者肺功能恢复比较完全,但可遗留多种后遗症,包括生理功能(肌无力、活动能力受限)、认知功能和精神心理(焦虑、抑郁、创伤后应激障碍)障碍,被称为重症监护后综合征,可持续到ARDS后5年,导致生命质量下降,增加了家庭负担和医疗资源消耗。ARDS患者患病前的健康情况(如并存病、肥胖、自理能力、精神状况)、生活方式(如吸烟)以及重症监护病房(ICU)期间相关变量(如谵妄、皮质
激素、阿片类药物、获得性肌无力、低氧血症)对存活者的长期结局有重要影响。发现ARDS长期结局不良的高危患者及可改变的危险因素,并及时采取干预措施,对减少ARDS后的功能障碍有重要意义。ICU内及ICU后干预措施是否可有效改善ARDS存活者的长期结局,还需要进一步研究和验证。 相似文献
998.
999.
骨髓增生异常综合征 (MDS) 是一种由遗传学异常驱动的克隆性造血干细胞或祖细胞性疾病, 通常表现为全血细胞减少、 病态造血及向白血病转化的高风险。细胞形态学和细胞遗传学异常是目前确立MDS诊断的主要参数。近年来, 随着基因测序技术, 尤其是二代测序技术的快速发展和广泛应用, 大多数MDS患者可检出基因突变。本文就基因突变在MDS诊断、 分型、 危险度分层和治疗中的应用作一评述。 相似文献
1000.
Pharmacological modulation of C‐X‐C motif chemokine receptor 4 influences development of acute respiratory distress syndrome after lung ischaemia–reperfusion injury 下载免费PDF全文
Sean P Nassoiy Favin S Babu Heather M LaPorte Matthias Majetschak 《Clinical and experimental pharmacology & physiology》2018,45(1):16-26
Activation of C‐X‐C motif chemokine receptor 4 (CXCR4) has been reported to result in lung protective effects in various experimental models. The effects of pharmacological CXCR4 modulation on the development of acute respiratory distress syndrome (ARDS) after lung injury, however, are unknown. Thus, we studied whether blockade and activation of CXCR4 influences development of ARDS in a unilateral lung ischaemia–reperfusion injury rat model. Anaesthetized, mechanically ventilated animals underwent right lung ischaemia (series 1, 30 minutes; series 2, 60 minutes) followed by reperfusion for 300 minutes. In series 1, animals were treated with vehicle or 0.7 μmol/kg of AMD3100 (CXCR4 antagonist) and in series 2 with vehicle, 0.7 or 3.5 μmol/kg ubiquitin (non‐cognate CXCR4 agonist) within 5 minutes of reperfusion. AMD3100 significantly reduced PaO2/FiO2 ratios, converted mild ARDS with vehicle treatment into moderate ARDS (PaO2/FiO2 ratio<200) and increased histological lung injury. Ubiquitin dose‐dependently increased PaO2/FiO2 ratios, converted moderate‐to‐severe into mild‐to‐moderate ARDS and reduced protein content of bronchoalveolar lavage fluid (BALF). Measurements of cytokine levels (TNFα, IL‐6, IL‐10) in lung homogenates and BALF showed that AMD3100 reduced IL‐10 levels in homogenates from post‐ischaemic lungs, whereas ubiquitin dose‐dependently increased IL‐10 levels in BALF from post‐ischaemic lungs. Our findings establish a cause‐effect relationship for the effects of pharmacological CXCR4 modulation on the development of ARDS after lung ischaemia–reperfusion injury. These data further suggest CXCR4 as a new drug target to reduce the incidence and attenuate the severity of ARDS after lung injury. 相似文献