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1.
PurposeIn 2018, The Journal of Vascular and Interventional Radiology (JVIR) updated its guidelines regarding periprocedural antibiotics. However, some institutions are slower to adopt these new guidelines. Additionally, antibiotic-resistant bacteria and sepsis are serious concerns due in part to incorrect usage of antibiotics. The purpose of this study is to assess institutional adherence to 2018 JVIR guidelines for the purpose of improving antibiotic stewardship.Materials and methodsA total of 800 cases over a 10-month time period were retrospectively identified and charted following the release of guidelines. Inclusion criteria for the study were adults aged 21 years or older undergoing mediport placement, tunneled central line (TCL) placement, nephrostomy tube exchange, percutaneous biliary drain, or cholecystostomy tube exchange. Exclusion criteria included immunocompromised and pregnant individuals as 2018 guidelines may not fit these patient populations. Guideline adherence for each procedure was recorded as a percentage; the timing of the antibiotic usage was also recorded and compared to the guidelines (within 60 minutes before incision).ResultsIn total, 49 mediport placements, 118 tunneled central line placements – 44 hemodialysis (HD) catheters and 74 nonhemodialysis (non-HD) catheters, 100 nephrostomy exchanges, and 82 biliary tube exchanges were included. Antibiotics were used in 83.6% (41/49) of mediport patients, 11.3% (5/44) of non-HD TCL patients, 20.5% (15/74) of HD TCL patients, 55% (55/100) nephrostomy tube changes, and 65.4% (55/84) of biliary or cholecystostomy tube exchanges. Out of those given prophylaxis, guideline-recommended antibiotics were used in 100% (41/41) of mediport, 100% (20/20) of TCL (both HD and non-HD catheters), 9% (5/55) of nephrostomy tube exchanges, and 1.8% (1/55) of biliary tube exchanges. Guideline-recommended timing was followed in 75.3% across all cases (ranging from 72.2% in mediports to 79.3% in biliary exchanges).ConclusionThis study of antibiotic practices at a single university-based academic institution revealed that antibiotic usage is not fully up to date with 2018 guidelines. For mediports, non-HD TCL placements, and nephrostomy tube exchanges, institutional changes should be made to reduce periprocedural antibiotic use, as antibiotics are no longer recommended for these procedures. For HD TCL and biliary exchanges, proper adherence to recommended prophylactic antibiotics should be followed. In addition, education about the correct antibiotic timing should be emphasized to increase compliance with guidelines.  相似文献   
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《Injury》2023,54(6):1702-1710
IntroductionPatients with cirrhosis are at higher risk for morbidity after injury. Acetabular fractures represent a highly morbid injury pattern. Few studies have specifically examined an effect of cirrhosis on risk of complications after acetabular fracture. We hypothesized that cirrhosis is independently associated with increased risk of inpatient complications following operative treatment of acetabular fractures.MethodsAdults patients with acetabular fracture who underwent operative treatment were identified from Trauma Quality Improvement Program data from 2015 to 2019. Patients with and without cirrhosis were matched on a propensity score predicting cirrhotic status and inpatient complications based on patient, injury, and treatment characteristics. The primary outcome was overall complication rate. Secondary outcomes included serious adverse event rate, overall infection rate, and mortality.ResultsAfter propensity score matching, 137 cirrhosis+ and 274 cirrhosis- remained. No significant differences existed in observed characteristics after matching. Compared to cirrhosis- patients, cirrhosis+ patients experienced 43.4% (83.9 vs 40.5%, p < 0.001) greater absolute risk difference of any inpatient complication, 29.9% (51.8 vs 21.9%, p < 0.001) greater absolute risk difference of serious adverse events, 28.5% (41.6 vs 13.1%, p < 0.001) greater absolute risk difference of any infection, and 2.9% (2.9% vs 0.0%, p = 0.02) greater absolute risk difference of inpatient mortality.ConclusionCirrhosis is associated with higher rates of inpatient complications, serious adverse events, infection, and mortality among patients undergoing operative repair of acetabular fracture.Level of EvidencePrognostic Level III.  相似文献   
4.
目的:探讨SPECT/CT融合显像在评价下肢骨折远期愈合能力方面的价值。方法:回顾性分析59例下肢骨折患者术后6个月后的SPECT/CT融合图像,分析骨折愈合情况,并与随访或手术比较,计算SPECT/CT融合显像对下肢骨折远期愈合的诊断准确率。结果:59例常规影像学检查均不能判断是否具有远期愈合可能。SPECT/CT示51例放射性核素通过骨折线,提示具有远期愈合的可能;其中,44例随访X线显示愈合,7例手术治疗后X线片显示未愈合。8例SPECT/CT融合显像未见放射性核素通过骨折线,提示骨折不愈合,愈合可能性较小;经再次手术证实为骨折不愈合。SPECT/CT诊断骨折愈合的准确率为88.1%(52/59)。结论:SPECT/CT可较准确地评价骨折远期愈合情况,对临床具有很大的指导意义。  相似文献   
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《Fu? & Sprunggelenk》2022,20(3):165-176
Starting with Lorenz Heister, ankle fractures are dealt within German textbooks since the early 18th century. The Austrian surgeon Hönigschmied, in 1877, published a landmark series of biomechanical studies on the mechanism of fractures and avulsions around the ankle that are still valid today. German-speaking authors contributed particularly to the recognition and treatment of posterior malleolar fractures and fractures of the anterolateral distal tibia. The term “Volkmann Triangle”, however, is historically incorrect, as Volkmann most likely was the first to treat an anterolateral distal tibial fracture by resection but never described a posterior malleolar fracture. The founding of the AO (Arbeitsgemeinschaft für Osteosynthesefragen) by Swiss surgeons and engineers profoundly influenced evaluation and treatment of fractures worldwide. Proponents like Weber and Heim coined the modern principles of the treatment of malleolar and pilon fractures that are still in use and continue to evolve.  相似文献   
6.
目的:探讨锁边悬吊联合三道钢丝垂直固定技术在髌骨下极粉碎性骨折中的临床应用。方法:自2016年8月至2019年5月,采用锁边悬吊联合三道钢丝垂直固定治疗23例髌骨下极粉碎性骨折患者,其中男14例,女9例;年龄34~68(55.0±1.2)岁。术后1年,采用疼痛视觉模拟评分(visual analogue scale,VAS),膝关节屈伸活动范围评估疼痛与功能,采用Lysholm膝关节评分标准评价临床疗效。结果:23例患者均获得随访,时间12~14(13.0±0.5)个月。1例出现钢丝尾部刺激皮肤外,其余均未出现切口感染、内固定松动、骨折移位等术后并发症。23例患者骨折均获得愈合,愈合时间10~14(12.0±1.1)周。VAS评分由术前的(7.96±0.93)分降到术后1年的(0.83±0.65)分,膝关节屈伸活动范围由术前的(20.30±8.69)°提高到术后1年的(127.39±6.55)°,Lysholm膝关节评分由术前的(18.48±4.00)分提高到术后1年的(96.09±4.91)分,差异均有统计学意义(P<0.05)。结论:锁边悬吊联合三道钢丝垂直固定治疗髌骨下极粉碎性骨折,固定可靠,骨折愈合率高,可满足快速康复功能锻炼要求,早期临床疗效满意。  相似文献   
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The aim of the study was to compare automated and manually conducted (slice-by-slice) virtual orbital wall reconstruction in terms of PSI design, manufacture, and clinical application for orbital fracture management.Patients with orbital wall fractures were evaluated for the potential for treatment with PSI, based on automated virtual wall reconstruction; these formed the main group. The surgical outcomes of these main-group patients' treatments were compared with those of the control group, which comprised patients randomly selected for this study, each of whom had the same orbital trauma patterns and were also managed with PSI. However, the control group patients were treated using ‘slice-by-slice’ virtual orbital reconstruction.Mean volume differences between the intact and reconstructed orbit were 0.65 ± 0.26 cm3 in the main group (n = 23) and 0.57 ± 0.23 cm3 in the control (n = 27; p = 0.837). In both groups, no cases of implant malposition or enophthalmos were detected after surgery. Orbital shape difference was similar for the main group and the control, at ?3.3 ± 3.5% and 3.25 ± 2.5%, respectively (p = 0.929). Diplopia was diagnosed at the 3-month follow-up in 13.0% of the main group and in 11.1% of the control (p = 0.651). The average times spent on computer-aided design (CAD) procedures, including segmentation, virtual orbital reconstruction, and PSI design, were 36.7 ± 6.9 min in the main group and 72.9 ± 7.7 min in the control group (p < 0.001).Within the limitations of the study it seems that PSI based on automated virtual reconstruction is a relevant alternative treatment option for orbital fractures because of its clinical efficacy that is similar to PSI based on a ‘slice-by-slice’ CAD protocol.  相似文献   
8.
目的:探讨胫骨后Pilon骨折分型指导个体化治疗的临床疗效。 方法:回顾性研究分析我院自2017年3月至2020年4月收治入院手术的诊断为胫骨后Pilon骨折的19例患者的临床资料,其中男性9人,女性10人;年龄24-67岁,平均年龄49.89岁;受伤机制:行走跌倒14例,交通伤4例,重物砸伤 1例;所有患者行CT检查,根据CT检查分型后采用不同的手术入路和内固定方法。术后采用Burwell-Charnley放射学标准评价踝关节面的复位情况,同时采用AOFAS踝关节评分和疼痛视觉模拟评分(VAS)评价患者踝关节功能恢复情况。 结果:19例患者术后获12-24个月(平均15.79月)随访,根据Bruwell-Charnley评价标准评估术后踝关节面复位质量:13例优,6例可。术后一年AOFAS评分平均为85.95分,VAS评分平均为1.11分。 结论:胫骨后Pilon骨折根据受伤机制骨折类型多样,结合CT及AGH分型指导胫骨后Pilon骨折分型及个体化治疗后临床疗效满意。  相似文献   
9.
《Cancer cell》2022,40(8):835-849.e8
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10.
IntroductionPhenotypic drug susceptibility testing is the most common approach to assess drug-resistant isolates; however, molecular methods of drug susceptibility testing are fast, accurate hence, offer less time for transmission during the diagnosis period. As data on the molecular methods regarding injectable drug resistance in the Punjab province of Pakistan is limited, therefore in this study, we aimed to analyze the mutations in the rrs gene behind second-line injectable drug resistance.Material and methodsMycobacterium tuberculosis isolates were collected from the sputum of 5362 TB suspects. The strains confirmed for resistant to injectable drugs through drug susceptibility testing were further proceeded. The 1537bp rrs gene was amplified with the help of three sets of primers with overlapping regions and DNA sequencing was performed. Obtained sequences were aligned with reference sequence to find mutations. RFLP-PCR method was also optimized for rapid detection of a common (143bp and 205bp) rrs gene mutation.ResultsAmong 172 rifampicin resistance isolates, 163(95%) were resistant to both rifampicin and isoniazid, and 9 (5%) were resistant to only rifampicin. Among the resistant samples, 12 (6.9%) samples were resistant to all three injectable drugs. Sixty out of 172 (34.9%) samples showed resistance to at least one drug and 10 (5.8%) samples were resistant to two drugs among the 3 s-line drugs. Sequencing analysis showed novel mutations in different samples at positions 443InsC, 19DelT, 29G>A, 48C>T, 50G>C, 265InsT, 423T>G, 476InsA, 446A>G, 563DelA, 695G>A, 805DelA, 900G>A, and 1510A>G, while some already reported mutations at position 1401A>G, 1402A>G, and 1484G>T were also observed. MIC of novel rrs gene mutations in KAN, CAP, and AMK resistant isolates were found between 2.5 mg/L-3.05 mg/L, 2.08 mg/L-3.0 mg/L, and 2.1 mg/L-2.7 mg/L respectively.ConclusionNovel mutations in the rrs gene reported in this study may confer second-line injectable drugs resistance in Mtb. This molecular insight into second-line injectable drug resistance is useful for better management of resistance Mtb in high burden countries.  相似文献   
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