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1.
BackgroundWhile studies have demonstrated favorable outcomes in utilization of primary total shoulder arthroplasty (TSA) for the treatment of glenohumeral osteoarthritis (OA), adverse events such as infections can still occur. Periprosthetic joint infections (PJIs) are associated with worse outcomes and patient morbidity. The purpose of this study was to: (1) compare patient demographics amongst TSA patients with and without PJIs following primary TSA; and (2) identify patient-related risk factors for PJIs following primary TSA.MethodsPatients undergoing primary TSA for the treatment of glenohumeral OA were identified using the Mariner administrative claims database by CPT code 23,472. Laterality modifiers were utilized to ensure PJIs were developing in the correct laterality as those patients undergoing primary TSA. Inclusion for the study group consisted of patients who developed PJIs within 2-years after the index procedure, whereas patients who did not develop PJIs served as the comparison cohort. Primary outcomes analyzed included patient demographics and patient-related risk factors for PJIs following primary TSA. A stepwise backwards elimination multivariate binomial logistic regression analyses was performed to determine the odds (OR) of PJIs in patients undergoing primary TSA. A P value less than .05 was considered statistically significant.ResultsThe query yielded 15,396 patients who underwent primary TSA for glenohumeral OA, of which 191 patients developed PJIs and 15,205 did not develop PJIs. The study found statistically significant differences amongst patients who did and did not develop PJIs following primary TSA with respect to age, sex, and presence of comorbid conditions. Risk factors associated with developing PJIs following primary TSA included: pathologic weight loss (OR: 2.06, P < .0001), obesity (OR: 1.56, P = .0001), male sex (OR: 1.52, P = .007), and peripheral vascular disease (OR: 1.46, P = .022).ConclusionAs the number of primary TSAs for the treatment of glenohumeral OA increase worldwide, identifying modifiable risk-factors to reduce the incidence of infection is critical. The study found various modifiable and non-modifiable risk factors associated with developing PJIs following primary TSA. This study is valuable to orthopedists in order to identify and risk-stratify patients with regard to PJI in the setting of primary TSA for OA.Level of EvidenceLevel III; Case-Control Study  相似文献   
2.
Recently, there has been a call for research-informed and research-developed practice in health sciences education. This prompts the consideration of alternative suitable research approaches that could be used to enhance health sciences education practice, including medical radiation sciences education (MRSE) practice. In this discussion paper, the authors uphold design science research (DSR) methodology as a suitable research approach to enhance MRSE practice and research. An overview of the DSR methodology and an example of a project that used DSR methodology are presented to demonstrate the application of this methodology in MRSE practice and research. The paper concludes that the use of DSR methodology could be instrumental in addressing practice related challenges while developing a theoretical contribution to the discipline.  相似文献   
3.
【摘要】 目的 总结婴幼儿先天性色素痣的临床及病理特征。方法 回顾性分析2015年1月至2020年1月在西京皮肤医院确诊的126例婴幼儿先天性色素痣患儿的临床及病理资料。计数资料比较采用χ2检验。结果 126例婴幼儿先天性色素痣患儿中,男68例,女58例;86.5%的患儿出生即有皮损;57.9%就诊年龄2 ~ 3岁。皮损发生部位包括头面部(76例,60.3%)、躯干(24例,19.1%)、四肢 (26例,20.6%)。36例(28.6%)为先天性小痣,68例(54.0%)为M1型中型痣,13例(10.3%)为M2型,9例(7.1%)为巨痣。121例(96.0%)皮损单发,5例(4.0%)多发,44例(34.9%)痣伴粗毛,15例(11.9%)伴丘疹/增生性结节,6例(4.8%)有卫星灶。病理亚型包括混合痣120例(95.2%)、皮内痣4例(3.2%)和交界痣2例(1.6%)。38例(30.1%)镜下皮损深度< 1 mm,61例(48.4%)1 ~ 2 mm,25例(19.8%) > 2 mm,45例(35.7%)浸润至皮下脂肪层或更深。126例色素痣皮损中,常见病理特征包括痣组织成熟现象(100%,不包括2例交界痣),角质层色素颗粒(42.1%),分布紊乱/不对称(63.5%),表皮痣细胞散在分布(72.2%)和呈Paget样扩散(53.2%),真皮可见噬黑素细胞(56.4%),痣细胞沿毛囊皮脂腺分布(65.1%)等。特殊病理特征包括痣细胞嵌入血管/淋巴管腔内(33.3%)、痣细胞松解(35.7%)、纤维瘤样改变(19.8%)、累及立毛肌(24.6%)、肥大细胞浸润(23.8%)等。不同临床表现的婴幼儿先天性色素痣病理模式:浸润深度 > 2 mm、角质层色素颗粒和角质层柱状色素颗粒在巨痣中的发生率明显高于其他大小皮损(χ2 = 7.93、10.76、5.89,均P < 0.05);浸润深度 > 2 mm、表皮海绵水肿伴痣细胞散在分布、痣细胞巢沿毛囊皮脂腺分布、纤维瘤样改变、肥大细胞浸润在伴有粗毛皮损中的发生率明显高于不伴粗毛者(χ2 = 28.29、8.11、6.22、7.92、8.19,均P < 0.01);表皮痣细胞呈Paget样扩散、痣细胞有异型性在伴丘疹/增生性结节的皮损中的发生率高于不伴丘疹增生性结节的皮损(χ2 = 4.92、6.30,均P < 0.05)。结论 婴幼儿先天性色素痣的临床及组织病理具有独特性,细胞常见不典型性,确诊及治疗选择需要密切结合临床与病理特征。  相似文献   
4.
《Value in health》2022,25(6):869-886
ObjectivesDeliberative processes for health technology assessment (HTA) are intended to facilitate participatory decision making, using discussion and open dialogue between stakeholders. Increasing attention is being given to deliberative processes, but guidance is lacking for those who wish to design or use them. Health Technology Assessment International (HTAi) and ISPOR—The Professional Society for Health Economics and Outcomes Research initiated a joint Task Force to address this gap.MethodsThe joint Task Force consisted of 15 members with different backgrounds, perspectives, and expertise relevant to the field. It developed guidance and a checklist for deliberative processes for HTA. The guidance builds upon the few, existing initiatives in the field, as well as input from the HTA community following an established consultation plan. In addition, the guidance was subject to 2 rounds of peer review.ResultsA deliberative process for HTA consists of procedures, activities, and events that support the informed and critical examination of an issue and the weighing of arguments and evidence to guide a subsequent decision. Guidance and an accompanying checklist are provided for (i) developing the governance and structure of an HTA program and (ii) informing how the various stages of an HTA process might be managed using deliberation.ConclusionsThe guidance and the checklist contain a series of questions, grouped by 6 phases of a model deliberative process. They are offered as practical tools for those wishing to establish or improve deliberative processes for HTA that are fit for local contexts. The tools can also be used for independent scrutiny of deliberative processes.  相似文献   
5.
Previous event-related potential (ERP) studies show that a salient lateral sound activates the visual cortex more strongly contralateral to the sound, observed as an auditory-evoked contralateral occipital positivity (ACOP). Studies showed that this activation enhances the early cortical processing of co-localized visual stimuli presented after, reflected by better detection rates, better discrimination, and sharper perceived contrast. We replicated the ACOP, using earphones, and tested whether auditory cuing can influence temporal order judgments (TOJ) for two visual stimuli (horizontal arrangement) as well as if the ACOP would predict the amplitude of this influence. A lateral salient sound was followed, after 150 or 630 ms, by the visual presentation of a pair of disks, one in left and one in right hemifield, with variable SOA. The TOJ task was to indicate which disk appeared first or which disk appeared second (controlling for response bias). We observed an ACOP at posterior electrode sites and confirmed our hypothesis that the lateral sound influenced TOJ by accelerating the perception of the disk presented on the cued side, even though the sound was irrelevant to the task. Furthermore, the ACOP amplitude was correlated to this visual perceptual change, indicating that a larger change in brain activity was associated with a faster processing of co-localized visual stimuli.  相似文献   
6.
BackgroundAxillary lymph node (LN) dissection after neoadjuvant chemotherapy (NAC) still remains a standard treatment of initially LN-positive primary breast cancer because of the difficulty of assessment of LN status. The aim of this study was to assess the LN status after NAC in initially LN-positive primary breast cancer patients who were assessed as clinically LN-negative after NAC (ycN0) and identify factors associated with loss of LN metastasis.Patients and MethodsThe study cohort comprised 279 patients with cytology-proven LN-positivity before NAC. LN status was assessed by ultrasonography. Regional recurrence-free survival and overall survival according to pathologic LN after NAC (ypN) status were assessed in patients with ycN0.ResultsOf the 279 patients, 179 patients (64.2%) had ycN0. High nuclear grade, estrogen receptor-negative (ER?), and human epidermal growth factor receptor 2-positive (HER2+), were significant predictors of ycN0/ypN0 (P < .001, .007, and .046, respectively). Metastases persisted in 1 or 2 LNs for 5 (20.0%) of 25 patients with ER?/HER2+ and for 4 (21.1%) of 19 patients with ER?/HER2?, and in 3 or more LNs for 0 (0%) of 25 patients with ER?/HER2+ and for 1 (5.3%) of 19 patients with ER?/HER2?. Patients with ER+ tumors had more numerous residual LN metastases than those with ER? tumors (P < .001). Among patients with ycN0, ypN status was not associated with regional recurrence-free survival or overall survival.ConclusionsThree or more residual LN metastases were rare in patients with ER? tumors if assessed as ycN0 by ultrasonography. Prospective studies are needed to confirm the prognostic impact of not performing axillary lymph node dissection in such patients.  相似文献   
7.
While we often engage in conversational reminiscing with loved ones, the effects of these conversations on our memory performance remain poorly understood. On the one hand, Wegner's transactive memory theory predicts that intimate groups experience benefits from remembering together. On the other hand, research on collaborative recall has shown costs of shared remembering in groups of strangers—at least in terms of number of items recalled—and even in intimate groups there is heterogeneity in outcomes. In the current research, we studied the effects of particular communicative features in determining the outcomes of collaborative recall in intimate groups. We tested 39 older, long‐married couples. They completed a non‐personal recall task (name all the countries in Europe) and a personal recall task (name all your mutual friends), both separately and together. When they collaborated, we recorded their conversation. We coded for specific “communication variables” and obtained measures of “conversational style.” Overall, we found two clusters of communication variables positively associated with collaborative success: (a) cuing each other, responding to cues, and repeating each other; and (b) making positive statements about memory performance and persisting with the task. A negative cluster of behaviors—correcting each other, having uneven expertise, and strategy disagreements—was associated with less interactive, more “monologue” style of collaboration, but not with overall recall performance. We discuss our results in terms of the importance of different conversational processes in driving the heterogeneous outcomes of group remembering in intimate groups, suggesting that a focus on recall output alone limits our understanding of conversational remembering.  相似文献   
8.
9.

Background

In colorectal cancer liver metastases (CRCLM), bevacizumab-based neoadjuvant strategies provide increased pathologic response. We aimed at assessing the activity of perioperative capecitabine, oxaliplatin, irinotecan, and bevacizumab (COI-B regimen) in patients with potentially resectable CRCLM, and investigating biomarkers for early prediction of pathologic response.

Patients and Methods

This was a single-center phase II study enrolling patients with liver-limited, borderline resectable disease and/or high-risk features. Patients received 5 preoperative and 4 postoperative cycles of biweekly COI-B (irinotecan 180 mg/m2 and bevacizumab 5 mg/Kg on day 1, oxaliplatin 85 mg/m2 on day 2, and capecitabine 1000 mg/m2 twice a day on days 2 to 6). The primary endpoint was pathologic response rate in the intention-to-treat population. A Simon 2-stage design was adopted to detect an increase from 30% to 50% with a power of 90%. Dynamic imaging biomarkers (early tumor shrinkage [ETS], deepness of response, maximum standardized uptake volume [SUVmax]/regression index) and next generation sequencing data were explored as surrogates.

Results

From June 2013 to March 2017, 46 patients were enrolled. Pathologic response was achieved in 63% patients (endpoint met), and responders achieved significantly better survival outcomes with respect to non-responders. The most frequent grade 3/4 adverse events were diarrhea and neutropenia (8.7%) in the preoperative phase and thromboembolic events (5.9%) in the postoperative phase. ETS and lower SUV-2 were significantly associated with pathologic response.

Conclusion

The COI-B regimen is a feasible and highly active perioperative strategy in patients with molecularly unselected, potentially resectable CRCLM. ETS and SUV-2 have a promising role as imaging-based biomarkers for pathologic response.  相似文献   
10.
《Clinical breast cancer》2020,20(4):e490-e509
PurposeTo determine the overall performance of contrast-enhanced ultrasound (CEUS) in differentiating between benign and malignant breast lesions and in predicting the pathologic response to neoadjuvant chemotherapy (NAC) in patients with breast cancer (BC).Materials and MethodsArticles published up to April 2019 were systematically searched in Medline, Web of Science, and China National Knowledge Infrastructure. The sensitivities and specificities across studies, the calculations of positive and negative likelihood ratios (LR+ and LR), diagnostic odds ratio (OR), and constructed summary receiver operating characteristic curves were determined. Methodologic quality was assessed using the QUADAS (Quality Assessment of Diagnostic Accuracy Studies) tool. Subgroup analyses and metaregression were performed on prespecified study-level characteristics.ResultsFifty-one studies involving 4875 patients with 5246 breast lesions and 10 studies involving 462 patients with BC receiving NAC were included. Methodologic quality was relatively high, and no publication bias was detected. The overall sensitivity, specificity, diagnostic OR, LR+, and LR for CEUS were 0.88 (95% confidence interval [CI], 0.86-0.89), 0.82 (95% CI, 0.80-0.83), 30.55 (95% CI, 21.40-43.62), 4.29 (95% CI, 3.51-5.25), and 0.16 (95% CI, 0.13-0.21), respectively, showing statistical heterogeneity. Multivariable metaregression analysis showed contrast mode to be the most significant source of heterogeneity. The overall sensitivity, specificity, LR+, LR, and diagnostic OR of CEUS imaging in predicting the overall pathologic response to NAC in patients with BC were 0.89 (95% CI, 0.83-0.93), 0.83 (95% CI, 0.78-0.88), 4.49 (95% CI, 3.04-6.62), 0.16 (95% CI, 0.10-0.24,), and 32.21 (95% CI, 16.74-62.01), respectively, showing mild heterogeneity.ConclusionOur data confirmed the excellent performance of breast CEUS in differentiating between benign and malignant breast lesions as well as pathologic response prediction in patients with BC receiving NAC.  相似文献   
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