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ObjectiveTo compare the outcomes of patients with multifocal hepatoblastoma (HB) treated at our institution with either orthotopic liver transplant (OLTx) or hepatic resection to determine outcomes and risk factors for recurrence.BackgroundMultifocality in HB has been shown to be a significant prognostic factor for recurrence and worse outcome. The surgical management of this type of disease is complex and primarily involves OLTx to avoid leaving behind microscopic foci of disease in the remnant liver.MethodsWe performed a retrospective chart review on all patients <18 years of age with multifocal HB treated at our institution between 2000 and 2021. Patient demographics, operative procedure, post-operative course, pathological data, laboratory values, short- and long-term outcomes were analyzed.ResultsA total of 41 patients were identified as having complete radiologic and pathologic inclusion criteria. Twenty-three (56.1%) underwent OLTx and 18 (43.9%) underwent partial hepatectomy. Median length of follow-up across all patients was 3.1 years (IQR 1.1–6.6 years). Cohorts were similar in rates of PRETEXT designation status identified on standardized imaging re-review (p = .22). Three-year overall survival (OS) estimate was 76.8% (95% CI: 60.0%–87.3%). There was no difference in rates of recurrence or overall survival in patients who underwent either resection or OLTx (p = .54 and p = .92 respectively). Older patients (>72 months), patients with a positive porta hepatis margin, and patients with associated tumor thrombus experienced worse recurrence rates and survival. Histopathology demonstrating pleomorphic features independently associated with worse rates of recurrence.ConclusionsThrough proper patient selection, multifocal HB was adequately treated with either partial hepatectomy or OLTx with comparable outcome results. HB with pleomorphic features, increased patient age at diagnosis, involved porta hepatis margin on pathology, and the presence of associated tumor thrombus may be associated with worse outcomes regardless of the local control surgery offered.Level of EvidenceIII.  相似文献   
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Background

Long-term cognitive impairment occurs in up to 60% of intensive care unit (ICU) survivors. Early use of functional and cognitive rehabilitation interventions, while patients are still in ICU, may reduce cognitive decline. We aim to describe the functional and cognitive interventions used during the ICU stay, the healthcare professionals providing interventions, and the potential impact on functional and cognitive rehabilitation.

Method

In this integrative systematic review, we will include empirical qualitative, quantitative, mixed- and multiple-methods studies assessing the use of functional and cognitive rehabilitation provided in ICU. We will identify studies in relevant electronic databases from 2012 to 2022, which will be screened for eligibility by at least two reviewers. Literature reported as narrative reviews and editorials will be excluded. We will assess the impact of interventions evaluating a cognitive and functional function, quality of life, and all-cause mortality at 6–12 months after ICU discharge. The Revised Cochrane risk-of-bias Tool will be used for assessing risk of bias in clinical trials. For observational studies, we will use the National Institutes of Health Quality Assessment tool for Observational Cohort and Cross-Sectional Studies. Furthermore, we will use the critical appraisal skills programme for qualitative studies and the mixed methods appraisal tool for mixed methods studies. We will construct four matrices, including results describing which ICU patients and healthcare professionals were engaged in rehabilitation, which interventions were included in early rehabilitation in ICU, the potential impact on patient outcomes of rehabilitation interventions provided in ICU and a narrative synthesis of themes. A summary of the main results will be reported using modified GRADE methodology.

Impact

This integrative review will inform the feasibility randomised clinical trial testing the development of a complex intervention targeting functional and cognitive rehabilitation for patients in ICU.  相似文献   
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BackgroundLiver resection is commonly performed for hepatic tumors, however preoperative risk stratification remains challenging. We evaluated the performance of contemporary prediction models for short-term mortality after liver resection in patients with and without cirrhosis.MethodsThis retrospective cohort study examined National Surgical Quality Improvement Program data. We included patients who underwent liver resections from 2014 to 2019. VOCAL-Penn, MELD, MELD-Na, ALBI, and Mayo risk scores were evaluated in terms of model discrimination and calibration for 30-day post-operative mortality.ResultsA total 15,198 patients underwent liver resection, of whom 249 (1.6%) experienced 30-day post-operative mortality. The VOCAL-Penn score had the highest discrimination (area under the ROC curve [AUC] 0.74) compared to all other models. The VOCAL-Penn score similarly outperformed other models in patients with (AUC 0.70) and without (AUC 0.74) cirrhosis.ConclusionThe VOCAL-Penn score demonstrated superior predictive performance for 30-day post-operative mortality after liver resection as compared to existing clinical standards.  相似文献   
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Introduction and objectivesHypertrophic cardiomyopathy (HCM) is accompanied by pathophysiological changes that predispose to the development of atrial fibrillation (AF). This arrhythmia impacts negatively on the morbidity, mortality and quality of life of these patients. Our objective was to evaluate the behavior of left atrial function, by means of atrial strain (derived from speckle tracking) and volumetric analysis by three-dimensional echocardiography, in patients with HCM with paroxysmal AF.MethodWe analysed left atrial function in 53 patients with HCM, 25 of whom were paroxysmal AF carriers (mean age 61.7±9.9 years; 56% female) compared with 28 members of the control group (mean age 60.5±10 years; 53.6% female) who were matched especially for sex, age and other demographic data.ResultsIt was observed that patients with HCM and a history of paroxysmal AF had lower left atrial emptying fractions than individuals in the control group; and the active atrial emptying fraction was a factor independently associated with the presence of this arrhythmia (p=0.018; odds ratio=0.93). Moreover, we found a significant reduction of the left atrial strain in all its components in the total sample of patients, with no difference between the groups.ConclusionsMeasurements of atrial emptying fractions by three-dimensional echocardiography allowed differentiating patients with HCM with and without paroxysmal AF.  相似文献   
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Background and aimsThe LISTEN trial (ClinicalTrial.gov accession: NCT01950884) is a phase IV 52 weeks double blind parallel randomized controlled trial that evaluated the effect of ezetimibe plus lifestyle and dietary intervention (eze) vs. lifestyle and dietary intervention alone (placebo) on progression and complications of non-alcoholic steatohepatitis (NASH) evaluated by liver histology.Methods and resultsForty patients with NASH ascertained by histology were randomly allocated on the two study groups and subjected to a follow-up of 52 weeks, when they underwent a second liver biopsy. Main composite end point (EP) was based on the histological improvement in the severity of NASH.Thirty patients completed the study, Eze treatment was not able to improve the primary EP in comparison with placebo, with and odds ratio of 1.029 (0.18–6.38), p = 0.974. Treatment emergent adverse events registered during the study were not more prevalent in the treatment arm.Conclusionsezetimibe administered on top of lifestyle and dietary modification failed to improve the histology of NASH in comparison with lifestyle and dietary modification alone.Trial accession numberClinicalTrial.gov: NCT01950884.  相似文献   
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背景 我国代谢综合征(MS)患病率逐年升高,血尿酸(SUA)水平与MS的发生密切相关,由于SUA受肾功能影响,采用标化SUA〔SUA/血肌酐比值(SUA/Scr)〕可更好地预测MS。内脏脂肪指数(VAI)是衡量内脏脂肪蓄积程度的重要指标,可更直接地预测MS的发生风险。但目前在甲状腺功能正常人群中,关于VAI是否介导SUA/ Scr与MS关联的研究较少。 目的 探讨VAI在甲状腺功能正常人群中SUA/Scr与MS发生风险间的中介效应。 方法 选取2020年1月至2021年6月于河北省人民医院体检中心进行年度体检的10 042例体检人群。收集研究对象的基本信息,并进行体格检查和生化检测,计算SUA/Scr和VAI。采用中华医学会糖尿病学分会制定的标准诊断MS。将研究对象分别按照SUA/Scr水平四分位数和VAI四分位数,各分为4组:Q1~Q4组和V1~V4组。采用Pearson相关分析探究SUA/Scr与VAI的相关性;多因素Logistic回归分析探讨SUA/Scr和VAI对MS发生的影响;采用bootstrap方法分析VAI是否介导SUA/Scr与MS之间的关联。 结果 10 042例研究对象中,MS患者1 833例(18.25%),非MS患者8 209例(81.75%)。Pearson相关分析结果显示,SUA/Scr与VAI呈正相关(P<0.05)。多因素Logistic回归分析结果显示,与Q1组相比,Q2组〔OR=1.310,95%CI(1.039,1.651)〕、Q3组〔OR=1.372,95%CI(1.089,1.729)〕、Q4组〔OR=1.744,95%CI(1.381,2.203)〕人群发生MS的风险增加(P<0.05);与V1组相比,V3组〔OR=6.721,95%CI(4.600,9.819)〕、V4组〔OR=33.327,95%CI(21.509,51.640)〕人群MS的发病风险增加(P<0.01)。中介效应分析表明,SUA/Scr对MS发病率具有直接影响〔β=0.154,95%CI(0.104,0.205)〕,并且VAI部分介导了SUA/Scr对MS发病率的影响〔β=0.183,95%CI(0.156,0.213)〕,中介效应占总效应的54.25%。 结论 甲状腺功能正常人群SUA/Scr和VAI是MS发生风险的预测指标,VAI部分介导了SUA/Scr对MS发病率的影响。  相似文献   
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