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1.
ObjectiveThe use of mechanical circulatory support (MCS) in lung transplantation has been steadily increasing over the prior decade, with evolving strategies for incorporating support in the preoperative, intraoperative, and postoperative settings. There is significant practice variability in the use of these techniques, however, and relatively limited data to help establish institutional protocols. The objective of the AATS Clinical Practice Standards Committee (CPSC) expert panel was to review the existing literature and establish recommendations about the use of MCS before, during, and after lung transplantation.MethodsThe AATS CPSC assembled an expert panel of 16 lung transplantation physicians who developed a consensus document of recommendations. The panel was broken into subgroups focused on preoperative, intraoperative, and postoperative support, and each subgroup performed a focused literature review. These subgroups formulated recommendation statements for each subtopic, which were evaluated by the entire group. The statements were then developed via discussion among the panel and refined until consensus was achieved on each statement.ResultsThe expert panel achieved consensus on 36 recommendations for how and when to use MCS in lung transplantation. These recommendations included the use of veno-venous extracorporeal membrane oxygenation (ECMO) as a bridging strategy in the preoperative setting, a preference for central veno-arterial ECMO over traditional cardiopulmonary bypass during the transplantation procedure, and the benefit of supporting selected patients with MCS postoperatively.ConclusionsAchieving optimal results in lung transplantation requires the use of a wide range of strategies. MCS provides an important mechanism for helping these critically ill patients through the peritransplantation period. Despite the complex nature of the decision making process in the treatment of these patients, the expert panel was able to achieve consensus on 36 recommendations. These recommendations should provide guidance for professionals involved in the care of end-stage lung disease patients considered for transplantation.  相似文献   
2.
目的 基于文本挖掘技术和生物医学数据库对新型冠状病毒肺炎(COVID-19)相关文献进行数据挖掘分析,探究COVID-19及其主要症状发热、咳嗽、呼吸障碍相关基因靶点,筛选潜在有效的化学药和中药。方法 使用GenCLiP 3网站获取COVID-19和其主要症状咳嗽、发热、呼吸障碍共4个关键词的共有靶点,在METASCAPE数据库中对其进行基因本体(GO)和通路富集分析,再利用String数据库和Cytoscape软件构建共有靶点的蛋白质相互作用网络,筛选获得核心基因,运用DGIdb数据库、SymMap数据库针对核心基因进行中西医治疗药物预测。结果 获得COVID-19及其主要症状共有基因靶点28个,其中有IL2、IL1B、CCL2等核心基因16个,使用DGIdb数据库筛选获得与16个关键靶点相互作用的化学药包括沙利度胺、来氟米特、环孢素等28种,中药包括虎杖、黄芪、芦荟等70味。结论 COVID-19及其主要症状的病理机制可能和CD4、KNG1、VEGFA等28个共有基因相关,可能通过介导TNF、IL-17等信号通路参与COVID-19病理过程。潜在有效药物可能通过作用相关靶点通路起到治疗COVID-19的作用。  相似文献   
3.
The effectiveness of telehealth and personalized digital health became evident during the coronavirus disease 2019 pandemic. This article defines what personalized digital health is and provides selected examples of the various personalized digital health devices patients may be using. The article also delves into how to implement and incorporate these personalized digital health devices in practice and presents suggestions on political actions that nurse practitioners need to advocate for with regard to telehealth and personalized digital health policy.  相似文献   
4.
Gastrointestinal cancer (GIC) is the most common cancer with a poor prognosis. Currently, surgery is the main treatment for GIC. However, the high rate of postoperative recurrence leads to a low five-year survival rate. In recent years, immunotherapy has received much attention. As the only immunotherapy drugs approved by the Food and Drug Administration (FDA), immune checkpoint blockade (ICB) drugs have great potential in cancer therapy. Nevertheless, the efficacy of ICB treatment is greatly limited by the low immunogenicity and immunosuppressive microenvironment of GIC. Therefore, the targets of immunotherapy have expanded from ICB to increasing tumor immunogenicity, increasing the recruitment and maturation of immune cells and reducing the proportion of inhibitory immune cells, such as M2-like macrophages, regulatory T cells and myeloid-derived suppressor cells. Moreover, with the development of nanotechnology, a variety of nanoparticles have been approved by the FDA for clinical therapy, so novel nanodrug delivery systems have become a research focus for anticancer therapy. In this review, we summarize recent advances in the application of immunotherapy-based nanoparticles in GICs, such as gastric cancer, hepatocellular carcinoma, colorectal cancer and pancreatic cancer, and described the existing challenges and future trends.  相似文献   
5.
The coronavirus disease 2019 (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Hepatic involvement is common in SARS-CoV-2-infected individuals. It is currently accepted that the direct and indirect hepatic effects of SARS-CoV-2 infection play a significant role in COVID-19. In individuals with pre-existing infectious and non-infectious liver disease, who are at a remarkably higher risk of developing severe COVID-19 and death, this pathology is most medically relevant. This review emphasizes the current pathways regarded as contributing to the gastrointestinal and hepatic ailments linked to COVID-19-infected patients due to an imbalanced interaction among the liver, systemic inflammation, disrupted coagulation, and the lung.  相似文献   
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7.
The coronavirus disease 2019 pandemic disrupted health care, requiring organizational leaders to act quickly to manage the health-related concerns of individuals and communities. The ability to offer a variety of digitally enabled telehealth services with 24/7 access to nurse practitioners and physician assistants allowed us to care for patients in their homes. It reduced the spread of the virus, protected our employees from further disease spread, and provided early interventions to those in need. The roles of nurse practitioner leaders, the enacted strategies, and patient outcomes demonstrate the impact of an innovative digital care delivery model on care across the continuum.  相似文献   
8.
目的了解上海市医务人员对新冠肺炎消毒相关知识知晓情况。方法通过问卷调查,收集上海市医务人员社会人口学信息及消毒相关知识知晓情况,通过Logistic回归模型分析影响其知晓的因素。结果本次调查共纳入研究对象1426人,三级医院人员占37.66%,社区医院人员占37.10%;护士占58.41%,公卫医生占11.71%,临床医生占10.80%。消毒知识平均得分为(60.62±22.74)分,80分及以上占26.09%。与民营医院医务人员相比,三甲医院和社区医院医务人员知晓率更高(P<0.001);与临床医生相比,公卫医生知晓率更高(P=0.026)。结论上海市医务人员对常用消毒剂及消毒方式等部分消毒相关知识知晓率较高,但总体知晓率仍较低,特别是对过度消毒、常量喷雾器消毒对象等知识存在认知误区;影响知晓的主要因素为医院等级和职业类型。  相似文献   
9.
目的 比较新型口服硫酸盐溶液(OSS)和小剂量聚乙二醇(PEG)溶液对结肠镜检查质量的影响。方法 通过PubMed、Embase、Web of Science,搜索2000年1月-2020年12月发表的文章,使用Review Manager 5.4和Stata 12.0进行分析,比较新型OSS和小剂量PEG加维生素C(PEG + VC)溶液的肠道准备合格率、肠道准备优良率和不良反应发生率的差异。结果 6项研究共1 876名受试者符合纳入标准。在肠道准备合格率方面,OSS组和PEG + VC组比较,差异无统计学意义(93.4%和91.9%,RR^ = 1.02,95%CI:0.99~1.04,P > 0.05),OSS组的肠道准备优良率高于PEG + VC组,差异有统计学意义(50.2%和42.6%,RR^ = 1.18,95%CI:1.06~1.31,P < 0.05)。与PEG + VC组相比,OSS组恶心风险增加18.0%,差异有统计学意义(38.5%和32.6%,RR^ = 1.18,95%CI:1.05~1.33,P < 0.05),呕吐风险增加1倍以上(10.8%和4.7%,RR^ = 2.30,95%CI:1.63~3.23,P < 0.05)。Begg检验和Egger检验均未见明显发表偏倚。结论 使用新型OSS进行肠道准备,恶心和呕吐风险较低的患者有可能获得更好的肠道准备,因为与使用小剂量PEG溶液的患者相比,其增加了恶心和呕吐的风险。  相似文献   
10.
IntroductionSafe vaccination worldwide is critical to end the coronavirus disease 2019 (COVID-19) pandemic. We aimed to evaluate adverse reactions to vaccination using a web-based questionnaire and examine the risk factors for the occurrence of immunisation stress-related response (ISRR).MethodsWe conducted a questionnaire survey using Google Form® among the employees of St. Marianna University Hospital who had received the COVID-19 vaccine between April 2021 and May 2021, 1 week after the first and second vaccinations. We developed and used a questionnaire to identify individuals with ISRR according to the World Health Organization diagnostic criteria. A generalised linear mixed model was constructed with ISRR onset as the dependent variable, subjects as the random factor, and each parameter as a fixed factor. A multivariate model was constructed using the forced imputation method with factors that were significant in the univariate analysis.ResultsWe enrolled 2,073 and 1,856 respondents in the first and second questionnaire surveys, respectively. Fifty-five and 33 ISRR cases were identified in the first and second vaccinations, respectively. In the univariate analysis, strong pre-vaccination anxiety (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.30–4.12, p = 0·004) and history of allergy (OR, 1.6; 95% CI, 1.14–2.24, p = 0·007) were significant risk factors. Multivariate analysis also showed that strong pre-vaccination anxiety (OR, 2.1; 95% CI, 1.15–3.80, p = 0.016) and history of allergy (OR, 1.5; 95% CI, 1.09–2.15, p = 0.014) were significant risk factors.ConclusionsConfirmation of allergy prior to vaccination and subsequent action are essential for addressing ISRR.  相似文献   
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