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1.
《Vaccine》2022,40(26):3490-3494
The current WHO Recommendations to assure the quality, safety and efficacy of live attenuated yellow fever vaccines were adopted in 2010. This document recommends that vaccine virus master and working seed lots should be tested for viscerotropism, immunogenicity and neurovirulence in monkeys. A vaccine manufacturer has reported, recently, discrepancies on the clinical scoring of monkeys during assessment of working seed lots and suggested aligning neurotropism assessment of yellow fever vaccines virus seed lots with that of neurovirulence testing of polio vaccines virus seed lots. In this approach, clinical signs are recorded but do not form part of the assessment or pass/fail criteria. At its 71st meeting in August 2020, the ECBS agreed to establish a drafting group and to consult with manufacturers and other stakeholders on the proposed amendment. Then a survey had been conducted to seek opinions of stakeholders on the neurotropism testing and revision of current WHO Recommendations for yellow fever vaccines. It was recognized from the answers of the survey that the test for neurovirulence in monkeys presents several technical challenges which could be addressed in the amended version of the Recommendations.On 18–19 March 2021, a virtual WHO working group meeting was held to discuss a proposed draft of the amended text with participants of yellow fever vaccine manufacturers and relevant regulators. Overall, there was a consensus among manufacturers and regulators that clinical evaluation provides important information and should be retained as part of the neurotropism test. However, there was also agreement that the test is somewhat subjective, and that analysis can be difficult. It was recognized that there was potential for improvement in both test execution and analysis to increase harmonization between manufacturers. Alternative tests to the non-human primates neurovirulence test would be useful but it was agreed that none seem to be sufficiently developed at present. Based on these working group discussions, it was proposed that the appendix on neurotropism test to be further revised by the WHO drafting group and submitted to ECBS for review and adoption.Issues other than neurotropism test were discussed in the meeting as well. There were a number of points identified during the meeting, such as new platform of production, animal models, deep sequencing, international standards, that are outside the current recommendations that are worthy of further discussion. Therefore, it is recommended that there would be a future meeting with various stakeholders to discuss the potential revision of the whole Recommendations for yellow fever vaccines in order to meet the current needs. 相似文献
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目的 分析2015–2017年长江江苏段流域钉螺时空分布现状,为江苏省消除血吸虫病、制定精准防治策略和措施提供依据。方法 2015–2017年在长江江苏段流域南京、镇江市和扬州市江滩中选取75块进行抽样调查,对3年各项螺情指标进行统计分析,采用空间自相关分析、核密度分析和“热点分析”工具探索钉螺时空分布及变化趋势。结果 2015–2017年长江江苏段流域钉螺平均密度存在空间自相关。扬州市活螺数、活螺密度整体下降,但2016年稍有上升。核密度及热点分析均发现长江江苏段流域活螺分布热点区域为扬州市和镇江市交界江滩附近区域。结论 江苏省长江流域钉螺分布存在空间自相关且存在“热点区域”,江滩钉螺监测工作仍然不可忽视。 相似文献
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《Vaccine》2019,37(32):4511-4517
IntroductionThe strategy to Eliminate Yellow Fever Epidemics (EYE) is a global initiative that includes all countries with risk of yellow fever (YF) virus transmission. Of these, 40 countries (27 in Africa and 13 in the Americas) are considered high-risk and targeted for interventions to increase coverage of YF vaccine. Even though the World Health Organization (WHO) recommends that YF vaccine be given concurrently with the first dose of measles-containing vaccine (MCV1) in YF-endemic settings, estimated coverage for MCV1 and YF vaccine have varied widely. The objective of this study was to review global data sources to assess discrepancies in YF vaccine and MCV1 coverage and identify plausible reasons for these discrepancies.MethodsWe conducted a desk review of data from 34 countries (22 in Africa, 12 in Latin America), from 2006 to 2016, with national introduction of YF vaccine and listed as high-risk by the EYE strategy. Data reviewed included procured and administered doses, immunization schedules, routine coverage estimates and reported vaccine stock-outs. In the 30 countries included in the comparitive analysis, differences greater than 3 percentage points between YF vaccine and MCV1 coverage were considered meaningful.ResultsIn America, there were meaningful differences (7–45%) in coverage of the two vaccines in 6 (67%) of the 9 countries. In Africa, there were meaningful differences (4–27%) in coverage of the two vaccines in 9 (43%) of the 21 countries. Nine countries (26%) reported MVC1 stock-outs while sixteen countries (47%) reported YF vaccine stock-outs for three or more years during 2006–2016.ConclusionIn countries reporting significant differences in coverage of the two vaccines, differences may be driven by different target populations and vaccine availability. However, these were not sufficient to completely explain observed differences. Further follow-up is needed to identify possible reasons for differences in coverage rates in several countries where these could not fully be explained. 相似文献
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《Vaccine》2019,37(22):2952-2959
CD8+ T cells are known to control infections, but their role in preventing latent infection from establishing has not been thoroughly investigated.We hypothesized that a potent CD8+ T cell response patrolling the mucosal viral entry points could kill the first infected cells and thereby abrogate the infection before latency is established.To investigate this, replication deficient adenovirus serotype 5 vectors encoding murine γ-herpesvirus-68 CD8+ T cell epitopes linked to the T cell adjuvant Invariant chain, were developed. We show that intranasal vaccination of mice reduces the risk of establishment of latent infection from multiple intranasal ID50 challenges with murine γ-herpesvirus-68 by 81% per exposure at 14 days post vaccination. Protection waned over time, but immune responses were extended by heterologous prime-boost vaccination applied simultaneously intramuscularly and intranasally, and animals vaccinated 66 days prior to challenge showed a strong trend of long-term protection.Our data provides evidence that CD8+ T cells are able to protect against establishment of latent infection. Although the protective efficacy is difficult to maintain over time, this proof-of-concept study suggests a role for a CD8+ T cell arm in future vaccine strategies against latent human viral infections caused by pathogens such as HIV and multiple herpes virus. 相似文献
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BackgroundChanging health care needs are driving new models of care that emphasize care coordination, health promotion, and disease management by registered nurses (RNs). A skill-mix favoring professional (baccalaureate or above) over technical (less than baccalaureate) education is promoted by national initiatives.PurposeTo examine the academic preparation and progression of general practice RNs in practice settings across the care continuum.MethodSecondary analyses of data from the Texas Board of Nurses RN Licensure databases in 2008 and 2014.FindingsOverall the professional skill-mix for general practice RNs improved from 47.1% to 50.2%. Disparities were identified in home health (31.6%), long-term care (27.8%) and nonmetropolitan areas (31.7%). Role change was the strongest correlate of academic progression.DiscussionNon-hospital and rural practice settings may be vulnerable to the effects of an undereducated RN workforce. More effective reimbursement policies and employer incentives are needed to drive academic progression and address disparities across practice settings. 相似文献
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从《黄帝内经》成书与多学科的关系角度出发,探讨中医学学科体系形成的客观原因,认为构建中医理论的经典著作《黄帝内经》的面世有深刻的时代烙印,是当时多学科融合的必然产物。开放包容并不断吸收多学科的学术成果不仅是中医学发展的规律和内在动力,对解决目前中医学的发展困境亦有重要的借鉴意义。当下的中医药科研工作者,应该借助现代科学技术来研究和解读中医,把宝贵的医学经验继承好、发展好、利用好。 相似文献
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目的:讨论我国长三角地区卫生发展的问题并提出相关建议。方法:运用数据包络分析方法建立区域卫生发展效率比较模型,测算各地区卫生发展的技术效率和配置效率。结果:上海和浙江卫生发展的技术效率和配置效率较高,但存在资源配置不合理、资源过度扩张等现象;江苏卫生发展技术效率低于上海和浙江,但其社会办医富有活力;安徽卫生发展效率在长三角地区中相对落后。结论:推进分级诊疗是长三角地区面临的共同挑战;同时,先发地区应进一步发挥市场在卫生资源配置中的作用,后发地区应以卫生人才建设为突破口,合力形成长三角地区卫生一体化发展新局面。 相似文献
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模型化推理是指以模型特别是思维模型为中介或工具,由一个或几个前提推出结论的思维方法。《黄帝内经》由于其历史条件的限定,较多地采用了天然实物模型进行推理,而水与人类生活密切相关,自然也就成了人类认识事物乃至人体生命活动的最为普遍的天然模型。通过阐述水模型与《黄帝内经》血脉气血循环、经脉气血运行、十二经脉体系建构、六淫病因认识、气血津液病机以及相关临床诊治思维的关系,分析指出《黄帝内经》天然模型化推理具有直观性、经验性、功能性、非结构性、整体全息性、时序性等特征。 相似文献