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1.
目的:评价腹水多形核细胞(PMN)数量与自发性腹膜炎(SBP)的预后关系。方法连续收集近2年间收治的291例 SBP 患者的临床资料。排除继发性、结核性腹膜炎,恶性腹水,并剔除未行腹穿或穿刺失败者40例,纳入研究的患者251例。以腹水 PMN 计数是否﹥250×106/ L 分为两组。比较两组间的一般情况、实验室检查、临床症状体征、合并症、治疗效果和生存率。结果在251例 SBP 患者中,PMN ﹥250×106/ L 者63例(25%),PMN ﹤250×106/ L 者188例(75%)。腹水细菌培养阳性的9例患者中,PMN ﹥250×106/ L 者占77.8%(7/9),PMN ﹤250×106/ L 者占22.2%(2/9)。两组患者在 SBP 主要症状体征方面无明显差别,均表现为有不同程度的发热、腹痛、腹胀,腹部张力增高,程度不等的压痛、反跳痛。抗菌药物治疗总有效率为67.3%(169/251),其中,PMN ﹤250×106/ L 组抗菌药物治疗有效率为70.7%(133/188),PMN ﹥250×106/ L 组为57.1%(36/63),两组比较差异有统计学意义(P ﹤0.05)。在合并症方面,与 PMN ﹤250×106/ L 组比较,PMN ﹥250×106/ L 组合并消化道出血、MODS、感染性休克较高(P均﹤0.05),其住院病死率及其1年内病死率均较高,差异均有统计学意义(P ﹤0.05)。结论以 PMN ﹥250×106/ L 作为 SBP 的诊断标准,在 SBP 患者预后评估中具有重要意义。与 PMN ﹤250×106/ L 的 SBP 患者比较,PMN ﹥250×106/ L 的 SBP 患者抗菌药物治疗有效率低,合并症较高,预后较差。  相似文献   
2.
BackgroundHip fractures represent major source of morbidity in elderly patients. There is little evidence about the impact of inflammatory changes induced by hip trauma and surgery on long term survival.MethodsWe evaluated the prognostic significance of the surgery-related dynamics of white blood cell count (WBC), neutrophil to lymphocyte ratio (NLR), C-reactive protein (CRP), interleukin-6 (IL-6) and soluble adhesion molecules (including P-selectin, E-selectin and VCAM) on survival in 104 consecutive patients with traumatic hip fractures recruited within the 2 years period.ResultsIn surviving patients, the minimum follow-up length was 48 and maximum 84 months (median 60 months). The mean age of the population was 80 ± 9 years, 72% were women. The survival rates were 69%, 45% and 38% at one, three and five years of the follow-up, respectively. Baseline serum creatinine, older age and subdural anesthesia type were associated with worse survival. The acute inflammatory response failed to predict the long term survival. In contrast, elevated WBC and IL-6 as assessed 21 days after the surgery were associated with a significantly worse outcome.ConclusionThe survival of elderly patients undergoing the surgery for acute hip fracture is unfavorable. In contrast to previous reports, we did not confirm that acute inflammatory response to the surgery predicts the long-term survival. On the contrary, persistent elevation of WBC and IL-6 three weeks after the surgery indicates a poor outcome.  相似文献   
3.
原发性肝癌是全球最常见的恶性肿瘤之一,影响原发性肝癌预后的因素很多,大致可分为患者因素、肿瘤本身因素、治疗相关因素3大类。笔者就以上影响原发性肝癌预后因素做一综述。  相似文献   
4.
目的:研究活化细胞黏附分子(ALCAM)在甲状腺癌组织中表达及其临床意义。方法:免疫组织化学法检测52例甲状腺癌组织及对应癌旁正常甲状腺组织中ALCAM的表达,比较ALCAM在两种组织中表达的差异,并分析其表达与甲状腺癌患者临床病理因素及预后的关系。结果:ALCAM在甲状腺癌组织中的阳性表达率明显高于癌旁正常甲状腺组织(71.2%vs.34.6%,P0.05),但在ALCAM在甲状腺癌组织中表达越低,甲状腺癌组织病理分化程度越低,患者5年总生存率越低(均P0.01)。结论:ALCAM表达增高可能参与甲状腺癌发生发展进程,然而,在恶性度高、预后差的甲状腺癌的肿瘤组织中ALCAM表达反而降低的原因推测可能与其脱落释放入血有关。  相似文献   
5.
目的:探讨基质金属蛋白酶2(MMP-2)与基质金属蛋白酶9(MMP-9)在肝内胆管细胞癌(ICC)组织中的表达及其与ICC患者临床病理特征及预后的关系。方法:收集2011年1月—2014年12月收治的50例ICC患者的癌组织与癌旁组织手术标本,采用免疫组织化学方法及RT-PCR方法检测MMP-2和MMP-9在以上组织中的表达,分析MMP-2和MMP-9表达与ICC患者临床病理参数以及术后生存率的关系。结果:免疫组织化学结果显示,ICC组织中MMP-2和MMP-9蛋白阳性表达率分别为34.0%和32.0%,而两者在癌旁组织中无阳性表达;RT-PCR结果显示,ICC组织中MMP-2和MMP-9的相对表达均明显高于癌旁组织(均P0.05)。MMP-2和MMP-9表达与ICC患者是否存在淋巴结转移和肿瘤分化程度有关(均P0.05),而与患者性别、年龄和肿瘤分期无关(均P0.05);MMP-2和MMP-9阳性患者生存率明显低于各自阴性者,而两者均阳性患者的生存率最低(均P0.05)。结论:ICC组织中MMP-2和MMP-9表达明显上调,且两者的表达与ICC患者恶性临床病理特征及不良预后密切相关。  相似文献   
6.
《Urologic oncology》2015,33(2):85-94
Prostate cancer (CaP) is the most commonly diagnosed malignancy in men in the Western world. In North America, more than 275,000 men are diagnosed annually, whereby approximately 1 in 6 men will be diagnosed with CaP in their lifetime, and 1 in 34 men will die from castration-resistant metastatic disease. Unfortunately, current clinical prognostic factors explain only a proportion of the observed variation in clinical outcome from patient to patient. Furthermore, overtreatment of indolent and low-risk cancers leads to inappropriate morbidity following radiotherapy or surgery. As such, better predictors of individualized prognosis and treatment response are urgently needed to triage patients to customized and intensified CaP treatment. Recent developments in next-generation sequencing have made it possible to identify prognostic and predictive signatures based on genomic profiles. We discuss the genetic basis of CaP progression from localized to systemic disease (e.g., point mutations, copy-number alterations, and structural variants) in relation with unique features of CaP biology, including intraprostatic and interprostatic heterogeneity, multifocality and multiclonality, TMPRSS2:ERG, and other ETS-family gene fusions. Finally, we focus on the use of genomic markers as prognostic factors for local failure and for systemic disease, as novel risk-stratification tools, in triaging patients to existing treatment options, and ultimately the potential of genomics for the identification of molecular targets for therapy of CaP.  相似文献   
7.
《Urologic oncology》2015,33(2):71.e11-71.e19
PurposeHistologic grade analyses for prostate cancer (PCa) have traditionally included Gleason scores (GS) of ≤6, 7, and 8-10. Stratified biochemical progression-free survival has increasingly been reported within these groups on analyses of primary-secondary patterns (PSPs) (e.g., 3+4 vs. 4+3) and overall GS (e.g., 8 vs. 9 vs. 10) but with limited data regarding stratified survival outcomes. In this analysis, outcomes for biopsy-assigned GS 6 to 10 were comprehensively evaluated to identify stratifications prognostic for survival in patients undergoing external beam radiation therapy (EBRT).MethodsThe Surveillance, Epidemiology, and End Results database was examined for T1–4 N0 M0, GS 6 to 10 PCa managed with EBRT alone from 2004 to 2006. GS and PSP variations were analyzed for PCa-specific survival (PCSS) and overall survival (OS).ResultsOverall, 26,885 patients were evaluated. Preliminary PSP analyses identified stratifications for 3+4 vs. 4+3 = 7 and 4+4 = 8 vs. GS 8 with pattern 5 (P5) (i.e., 3+5 and 5+3) as significant; however, no differences were observed for 4+5 vs. 5+4 = 9. The primary analysis included stratifications for GS 6, 3+4, 4+3, 4+4, 8 w/P5, 9, and 10, where the 7.5-year PCSS rates were 99%, 97%, 95%, 91%, 86%, 81%, and 78% and 7.5-year OS rates were 83%, 76%, 72%, 67%, 66%, 58%, and 54%, respectively. PCSS differences for sequential score increases were all significant on univariate analyses (all P<0.05). In sequential multivariate analyses of PCSS accounting for age, prostate-specific antigen, T stage, year, marital status, race, and tumor registry, the identified GS stratifications remained significant (all P<0.05), with the exception of GS 8 w/P5 vs. 9 (P = 0.11). In overall multivariate analyses, the identified GS stratifications represented the strongest prognostic factor for survival. Subgroup analyses demonstrated that presence of any P5 was an independent prognostic factor for survival.ConclusionIn the largest reported survival analysis of Gleason stratifications, biopsy-assigned GS 6, 3+4, 4+3, 4+4, 8 w/P5, 9, and 10 represented sequential prognostic factors for survival in patients managed with definitive EBRT.  相似文献   
8.
《Urologic oncology》2015,33(5):204.e9-204.e16
ObjectiveTo evaluate the prognostic effect of concomitant variant histology (CVH) on survival outcomes in patients with upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy.Materials and methodsData on 417 patients with UTUC treated with radical nephroureterectomy without preoperative adjuvant therapy were retrospectively reviewed with a focus on CVH. Clinicopathological features and prognostic factors were compared between patients with pure UTUC and patients with UTUC with CVH. The primary end points were cancer-specific survival (CSS), disease recurrence-free survival (DFS), and overall survival (OS).ResultsUTUC with CVH was present in 90 (21.6%) of 417 patients. At a median follow-up of 26 months, 153 (36.7%) had died of UTUC, 161 (38.6%) had experienced a relapse, and 176 (42.2%) had died of other causes. UTUC with CVH was significantly associated with advanced tumor stage, high tumor grade, tumor diameter, lymphovascular invasion, lymph node metastasis, positive surgical margins, and tumor architecture compared with pure UTUC (all P<0.01). The estimated 5-year CSS, DFS, and OS rates were 64.9%, 61.1%, and 62.1%, respectively, in the pure UTUC group, compared with 36.3%, 34.3%, and 26.5%, respectively, in the UTUC with CVH group (P<0.001). Multivariate analysis demonstrated that CVH was an independent predictor of CSS (hazard ratio [HR] = 1.594; 95% CI: 1.125–2.259; P = 0.009), DFS (HR = 1.549; 95% CI: 1.077–2.152; P = 0.017), and OS (HR = 1.685; 95% CI: 1.212–2.343; P = 0.002).ConclusionsApproximately one-fifth of the specimens of patients with UTUC were observed to exhibit CVH. CVH was an independent prognostic factor for CSS, DFS, and OS in patients with UTUC on both univariate and multivariate analyses. Genitourinary pathologists should look for potential CVH components in UTUC specimens and report this in routine pathological practice. The presence of CVH should identify patients as candidates for consultation regarding early adjuvant therapy and intensive surveillance protocols.  相似文献   
9.
《Urologic oncology》2015,33(5):201.e9-201.e16
ObjectivesRecent evidence suggests that the presence of a systemic inflammatory response plays an important role in the progression of several solid tumors. The platelet-to-lymphocyte ratio (PLR) has been proposed as an easily assessable marker of systemic inflammation and has been shown to represent a prognostic marker in different cancer entities. To evaluate the prognostic value of the PLR in prostate cancer, we performed the present study.Methods and materialsData from 374 consecutive patients with prostate cancer, treated with 3D conformal radiotherapy from 1999 to 2007, were analyzed. Distant metastases–free survival (MFS), cancer-specific survival (CSS), overall survival (OS), biochemical disease–free survival, and time to salvage systemic therapy were assessed using the Kaplan-Meier method. Cox proportional hazards analysis was performed to calculate hazard ratio (HR) and 95% CI. Multivariate Cox regression analysis was performed to adjust for other covariates.ResultsUsing receiver operating characteristics analysis, the optimal cutoff level for the PLR was 190. Kaplan-Meier analyses revealed that PLR≥190 was a prognostic factor for decreased MFS (P = 0.004), CSS (P = 0.004), and OS (P = 0.024) whereas a significant association of an elevated PLR with biochemical disease–free survival (P = 0.740) and time to salvage systemic therapy (P = 0.063) was not detected. In multivariate analysis, an increased PLR remained a significant prognostic factor for poor MFS (HR = 2.24, 95% CI: 1.06–4.76, P = 0.036), CSS (HR = 3.99, 95% CI: 1.19–13.4, P = 0.025), and OS (HR = 1.87, 95% CI: 1.02–3.42, P = 0.044).ConclusionsOur findings indicate that the PLR may predict prognosis in patients with prostate cancer and may contribute to future individual risk assessment in them.  相似文献   
10.
《Urologic oncology》2015,33(7):331.e9-331.e15
IntroductionGene fusion between TMPRSS2 and ERG has a causal role in prostate cancer initiation. However, studies evaluating its role clinically have shown conflicting results. We investigated simultaneously multiple aspects of ERG, namely, “presence” and “strength” of ERG expression and “correlation” of ERG with other common clinicopathological parameters.Materials and methodsFrom January 2012 to November 2013, the status of ERG, androgen receptor (AR), and p53 was prospectively determined by immunohistochemistry unselectively in all types of specimens positive for prostate cancer. “Strength” of expression was measured in terms of “intensity” as well as “percentage positivity,” with each parameter given a score from 0 to 3 based on fixed protocol, which was tested for interrater variability as well as test-retest reliability. Data were collected for age, Gleason score, prostate specific antigen levels, presence of perineural invasion and lymphovascular invasion, high-grade prostatic intraepithelial neoplasia, and cancer stage.ResultsIn total, 100 specimens were analyzed, and overall 51 patients had ERG-positive immunostaining. ERG-positive tumors had lower presence of high-grade prostatic intraepithelial neoplasia and p53 positivity, with no significant difference in prostate specific antigen levels, Gleason scores, and presence of lymphovascular invasion. Moreover, 54 patients had complete stage information, and the absolute number of patients with ERG positivity increased with increasing clinical stage. Among these, 30 patients were ERG positive, and ERG score had strong positive correlation with AR expression (Spearman correlation coefficient 0.677). However, median ERG scores showed a significant decline (consistent across percentage positivity and intensity) in patients with stage 4 disease, and score≤2 had 88.2% specificity in identifying patient with stage 4 disease. Cohen׳s κ = 0.81, whereas intraclass correlation coefficient was 0.95, indicating substantial agreement and near-perfect reproducibility of scoring scheme for immunohistochemistry.ConclusionERG-positive tumors increase in proportion with increasing stage of disease, but strength of ERG expression in ERG-positive patients shows a significant decline, or “loss,” in patients with stage 4 disease. This may have potential therapeutic implications as ERG expression score showed strong positive correlation with AR expression score.  相似文献   
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