首页 | 本学科首页   官方微博 | 高级检索  
文章检索
  按 检索   检索词:      
出版年份:   被引次数:   他引次数: 提示:输入*表示无穷大
  收费全文   1940篇
  免费   226篇
  国内免费   31篇
耳鼻咽喉   7篇
儿科学   23篇
妇产科学   14篇
基础医学   249篇
口腔科学   48篇
临床医学   193篇
内科学   250篇
皮肤病学   6篇
神经病学   182篇
特种医学   110篇
外国民族医学   1篇
外科学   106篇
综合类   122篇
预防医学   425篇
眼科学   47篇
药学   233篇
中国医学   62篇
肿瘤学   119篇
  2023年   56篇
  2022年   79篇
  2021年   112篇
  2020年   114篇
  2019年   125篇
  2018年   100篇
  2017年   106篇
  2016年   83篇
  2015年   63篇
  2014年   105篇
  2013年   162篇
  2012年   96篇
  2011年   78篇
  2010年   92篇
  2009年   106篇
  2008年   96篇
  2007年   64篇
  2006年   62篇
  2005年   55篇
  2004年   61篇
  2003年   49篇
  2002年   43篇
  2001年   28篇
  2000年   24篇
  1999年   19篇
  1998年   14篇
  1997年   14篇
  1996年   12篇
  1995年   11篇
  1994年   14篇
  1993年   15篇
  1992年   13篇
  1991年   13篇
  1990年   11篇
  1989年   15篇
  1988年   10篇
  1987年   15篇
  1986年   11篇
  1985年   9篇
  1984年   3篇
  1983年   4篇
  1982年   7篇
  1981年   8篇
  1980年   8篇
  1978年   4篇
  1977年   1篇
  1976年   1篇
  1975年   3篇
  1971年   1篇
  1970年   1篇
排序方式: 共有2197条查询结果,搜索用时 15 毫秒
1.
目的:探讨双相障碍(BD)缓解期残留症状自评与他评的一致性。方法:收集240例经过急性期治疗有效的BD患者人口学资料、疾病临床特征;分别于急性期治疗后(基线)及此后的3个月和6个月时采用抑郁症状快速评估量表(QIDS-SR16)、心境障碍问卷(MDQ)自评方式与汉密尔顿抑郁量表17项(HAMD-17)、杨氏躁狂量表(YMRS)他评方式对入组者进行残留症状评估;采用组内相关系数(ICC)对连续变量做一致性检验。结果:HAMD-17与QIDS-SR16基线、3个月和6个月的总分、核心条目呈较强一致性(ICC=0.62~0.85;P均<0.01);睡眠条目在基线呈中等一致性(ICC=0.49,P<0.01),3及6个月呈较强一致性(ICC=0.65;P均<0.01);自杀条目随着缓解时间延长,一致性逐渐增强;躯体症状一致性一般(ICC=0.49~0.52;P均<0.01),且随着缓解期延长,一致性减弱。YMRS与MDQ在总分、精力充沛和/或心境高涨、冒险和/或易激惹条目上随着缓解时间延长,从基线呈一般或中等一致性(ICC=0.37~0.50;P均<0.01)到6个月呈较强一致性(ICC=0.60~0.71;P均<0.01)。结论:BD缓解期患者残留抑郁症状多见,QIDS-SR16自评结果与HAMD-17评估结果具有较强的一致性,可作为有效的评估工具;MDQ可作为缓解期筛查躁狂残留症状的工具。  相似文献   
2.
BackgroundOverordering of blood has been a challenge faced by the blood bank staff. The present study addresses the role of maximum surgical blood ordering schedule (MSBOS) in optimizing the blood inventory management.MethodsThe blood requests for elective surgical procedures from various surgical departments were reviewed to constitute MSBOS. Transfusion profile was assessed using crossmatch to transfused units (C/T) ratio, transfusion probability (TP), and transfusion index (TI). A cutoff of 0.3 and 5% value of TI and TP, respectively, was considered to decide on the type of crossmatch. The efficacy of MSBOS implementation has been determined prospectively by unpaired t test using SPSS software, version 20 (IBM, USA).ResultsA total of 2674 patients were studied. Overall red cell usage rate was 15%. The comprehensive C/T ratio was 4.57. The C/T ratios for the various departments ranged from 1 to 8.5 (adjusted C/T ratio). Highest C/T ratio was observed for surgical procedures performed in the specialties of otorhinolaryngology and urology. A C/T ratio greater than 5 was noted in 30.4% of different types of surgical procedures. Of the 176 different types of elective surgical procedures studied, type and screen protocol was applicable for 75.5% (133) of the procedures. After implementation of MSBOS, the number of crossmatches reduced by 2152 and total working time saved in our laboratory is close to 75,320 man hours.ConclusionMSBOS helps in identifying the common surgical procedures with low TP and is one of the efficient tools in preventing the overordering of the blood.  相似文献   
3.
目的:探讨消化道肿瘤中同源重组修复相关基因(homologous recombination repair related gene,HRR)突变的发生情况及临床意义。方法:共92例消化道肿瘤患者,79例患者进行了血液标本HRR检测,53例患者进行了组织标本HRR检测,40例患者同时行血液和组织的HRR基因检测,收集患者基因检测结果及临床相关资料。结果:在79例患者血液标本检测中发现10例(12.6%)有临床意义HRR突变,在53例患者组织标本检测中发现9例(17.0%)有临床意义HRR突变。40例同时行血液和组织的HRR基因检测患者中常见的有临床意义HRR突变为CDK12突变4例(10.0%)、ATM突变3例(7.5%)、BRCA1突变2例(5.0%)。13例有临床意义HRR突变患者中常见共存突变为TP53突变10例(76.9%)、APC突变5例(38.5%)、PIK3CA突变4例(30.8%)。40例患者中13例患者血液和/或组织中有临床意义HRR突变,27例患者血液和组织中均无任何临床意义HRR突变且两组相比,有临床意义HRR突变组肿瘤突变负荷(tumor mutational burden,TMB)为6.17(2.24~11.52),而未携带HRR突变组TMB为0.4(0~3.75),差异有统计学意义(P<0.05)。40例患者组织检测中7例HRR有临床意义的突变,33例无HRR突变,血液检测中10例HRR有临床意义的突变,30例无HRR突变,一致性检验的Kappa值为0.333(P=0.031)。结论:携带有临床意义HRR突变的消化道肿瘤患者TMB更高,血液和组织检测HRR突变有较好的一致性。  相似文献   
4.
BackgroundIn order to avoid excessive treatment of thyroid nodules in the clinic, it is necessary to find a simple and practical analysis method to comprehensively and accurately reflect benign or malignant thyroid nodules. This study aimed to construct and validate a comprehensive and reliable network-based predictive model using a variety of imaging and laboratory criteria for thyroid nodules to stratify the risk of malignancy prior to surgery.MethodsWe retrospectively analyzed data from patients who underwent surgical treatment for thyroid nodules at the Thyroid and Breast Diagnosis and Treatment Center of Weifang Hospital of Traditional Chinese Medicine between January 2018 and December 2020. Binary logical regression analysis was performed to predict whether nodules were malignant or benign. The developmental dataset included 457 patients (January 2018–December 2020). The validation set included separate data points (n = 225, January 2018–December 2020).ResultsIn this study, criteria that showed significant predictive value for malignant nodules included TI-RADS: 4b (p = 0.065); Bethesda IV, Bethesda V, Bethesda VI (P < 0.0001); BRAFV600E mutation (P < 0.0001); Calcitonin>5 pg/ml (p = 0.0037); and FNA-Tg>30 ng/ml (p = 0.0003). A 10-grade risk scoring system was developed. The risk of malignancy risk ranged from 2.06% to 100% and was positively associated with increasing risk grade. The areas under the receiver-operating characteristic curve of the development and validation sets were 0.972 and 0.946, respectively.ConclusionA simple, comprehensive and reliable web-based predictive model was designed using a variety of imaging and laboratory criteria to stratify thyroid nodules by probability of malignancy.  相似文献   
5.
《Saudi Dental Journal》2022,34(5):346-354
BackgroundLipopolysaccharides (LPS) stimulate production of inflammatory cytokines. Chrysin is flavonoid beneficial for treatment of inflammatory conditions. Bone marrow mesenchymal stem cell (BM-MSC) exosomes have regenerative ability in different tissues.ObjectiveTo assess potential role of chrysin and BM-MSC exosomes on ultra-structure, viability and function of human dermal fibroblasts-adult (HDFa) stimulated by LPS.MethodsHDFa cells were divided into: Group I: Cells received no treatment. Group II: Cells were stimulated with LPS. Group III: LPS stimulated cells were treated with chrysin. Group IV: LPS stimulated cells were treated with exosomes.ResultsAfter 48 h, ultrastructural examination of HDFa cells in Group I revealed intact plasma membrane and numerous cytoplasmic organelles. Group II displayed destructed plasma membrane and apoptotic bodies. Group III showed intact plasma membrane with loss of its integrity at some areas. Group IV demonstrated intact plasma membrane that showed fusion with exosomes at some areas. Statistical analysis of MTT represented highest mean value of cell viability% in Group IV followed by Groups III, I and II respectively. Statistical analysis of enzyme-linked immunosorbent assay (ELISA) showed the highest mean value of interleukin-1β (IL-1β) was in Group II followed by Groups III, IV and I, while highest mean values of interleukin-10 (IL-10), nuclear factor-erythroid 2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1) proteins were in Group I, followed by Groups IV, III and II respectively.ConclusionsLPS have harmful consequences on ultra-structure, viability and function of HDFa cells. BM-MSC exosomes have better regenerative action on inflamed fibroblasts in comparison to chrysin.  相似文献   
6.
目的 梳理国家药物安全评价监测中心联合开展的大鼠多终点体内遗传毒性试验数据,比较大鼠肝彗星试验与骨髓微核试验结果的一致性和灵敏性。方法 试验分设阴性物质组、作用机制明确的遗传毒性阳性物质组、受试物组,阴性物质包括超纯水、0.9%氯化钠注射液、玉米油、0.5%羧甲基纤维素钠(CMC-Na)、5%蔗糖和聚山梨酯80,给药体积为10 mL·kg-1;遗传毒性阳性物质包括200 mg·kg-1甲磺酸乙酯(EMS)、40 mg·kg-1N-乙基-N-亚硝基脲(ENU)、40 mg·kg-1环磷酰胺、75 mg·kg-1甲基苄肼、800 mg·kg-1尿烷、75 mg·kg-1对氯苯胺、40 mg·kg-1 1,2-二溴-3-氯丙烷和10 mg·kg-1秋水仙素;受试物包括100、300、1000 mg·kg-1大黄素-8-O-β-D-葡萄糖苷,6.5、65.0、650.0 mg·kg-1单蒽酮和6.5、65.0、650.0 mg·kg-1大黄素甲醚。分别在实验0、24、45 hig给药1次,给药体积为10 mL·kg-1。开展大鼠肝彗星试验和骨髓微核试验,计算每只动物的肝细胞刺猬细胞率和尾DNA百分含量(Tail% DNA),以及每只动物的嗜多染红细胞(PCE)/总红细胞(ERY)比例和嗜多染红细胞微核(MNPCE)率。结果 大鼠肝彗星试验可有效检出DNA断裂剂,对多种烷化剂(甲磺酸乙酯、甲基苄肼和尿烷等)有较好的预测性,但对环磷酰胺和多倍体诱导剂不灵敏。大黄素-8-O-β-D-葡萄糖苷、单蒽酮和大黄素甲醚骨髓微核试验结果均为阴性。大黄素-8-O-β-D-葡萄糖苷在1 000 mg·kg-1剂量下导致的肝Tail% DNA与0.5% CMC-Na组比较显著升高(P<0.05);单蒽酮的肝彗星试验结果为明确阳性,剂量为650 mg·kg-1时,单蒽酮可导致大鼠肝Tail% DNA显著升高(P<0.05),且作用存在剂量相关性;大黄素甲醚的肝彗星试验结果为阴性。结论 大鼠肝彗星试验可与骨髓微核试验互补,有效检出主要作用于肝脏且亲电子性较强的遗传毒性化合物。  相似文献   
7.
Introduction and ObjectivesThe 2019 ESC guidelines on chronic coronary syndromes updated the method for estimating the pre-test probability (PTP) of obstructive coronary artery disease (CAD). We aimed to compare the performance of the new PTP method against the 2013 prediction model in patients with stable chest pain undergoing coronary computed tomography angiography (CCTA) for suspected CAD.MethodsWe conducted a single-center cross-sectional study enrolling 320 consecutive patients undergoing CCTA for suspected CAD. Obstructive CAD was defined as any ≥50% luminal stenosis on CCTA. Whenever invasive coronary angiography was subsequently performed, patients were reclassified accordingly. The two PTP prediction models were assessed for calibration, discrimination and the ability to change the downstream diagnostic pathway.ResultsThe observed prevalence of obstructive CAD was 16.3% (n=52). The 2013 prediction model significantly overestimated the likelihood of obstructive CAD (relative overestimation of 130%, p=0.005), while the updated 2019 method showed good calibration (relative underestimation of 6.5%, p=0.712). The two approaches showed similar discriminative power, with C-statistics of 0.73 (95% CI: 0.66-0.80) and 0.74 (95% CI: 0.66-0.81) for the 2013 and 2019 methods, respectively (p=0.933). Reclassification of PTP using the new method resulted in a net reclassification improvement of 0.10 (p=0.001).ConclusionsThe updated 2019 prediction model provides a more accurate estimation of pre-test probabilities of obstructive CAD than the previous model. Adoption of this new score may improve disease prediction and influence the selection of non-invasive testing.  相似文献   
8.
BackgroundProsthetic choice for mitral valve replacement is generally driven by patient age and patient and surgeon preference, and current guidelines do not discriminate between different etiologies of mitral valve disease. Our objective was to assess and compare short- and long-term outcomes after mitral valve replacement among patients with biological or mechanical prostheses in the setting of severe ischemic mitral regurgitation.MethodsBetween 2000 and 2016, 424 patients underwent mitral valve replacement for severe ischemic mitral regurgitation at our institution, using biological prosthesis in 188 (44%) and mechanical prosthesis in 236 (56%). A 1:1 propensity score match (n = 126 per group) and inverse probability of treatment weighting were used to compare groups. Short-term outcomes included in-hospital mortality and other cardiovascular adverse events. Long-term outcomes included survival and hospital readmission for cardiovascular causes, stroke, and major bleeding.ResultsIn-hospital mortality and early postoperative adverse events were similar between groups in the propensity score match and inverse probability of treatment weighting cohorts. Overall long-term survival was similar at 5 and 9 years, but mechanical prosthesis recipients were more frequently readmitted to hospital for cardiovascular causes, including stroke and non-neurological bleeding in propensity score matching and inverse probability of treatment weighting analyses (all P values < .004). Type of prosthesis did not independently influence all-cause mortality (hazard ratio, 1.01; 95% confidence interval, 0.71-1.43; P = .959), but placement of a mechanical prosthesis was associated with increased risk of readmission for cardiovascular events (hazard ratio, 1.65; 95% confidence interval, 1.17-2.32; P = .004) among matched patients.ConclusionsThe type of prosthesis has no influence on long-term survival among patients with severe ischemic mitral regurgitation undergoing mitral valve replacement. There may be an increased risk of neurologic events and serious bleeding associated with mechanical prostheses.  相似文献   
9.
BackgroundPretest probability (PTP) calculators utilize epidemiological-level findings to provide patient-level risk assessment of obstructive coronary artery disease (CAD). However, their limited accuracies question whether dissimilarities in risk factors necessarily result in differences in CAD. Using patient similarity network (PSN) analyses, we wished to assess the accuracy of risk factors and imaging markers to identify ≥50% luminal narrowing on coronary CT angiography (CCTA) in stable chest-pain patients.MethodsWe created four PSNs representing: patient characteristics, risk factors, non-coronary imaging markers and calcium score. We used spectral clustering to group individuals with similar risk profiles. We compared PSNs to a contemporary PTP score incorporating calcium score and risk factors to identify ≥50% luminal narrowing on CCTA in the CT-arm of the PROMISE trial. We also conducted subanalyses in different age and sex groups.ResultsIn 3556 individuals, the calcium score PSN significantly outperformed patient characteristic, risk factor, and non-coronary imaging marker PSNs (AUC: 0.81 vs. 0.57, 0.55, 0.54; respectively, p ?< ?0.001 for all). The calcium score PSN significantly outperformed the contemporary PTP score (AUC: 0.81 vs. 0.78, p ?< ?0.001), and using 0, 1–100 and ?> ?100 cut-offs provided comparable results (AUC: 0.81 vs. 0.81, p ?= ?0.06). Similar results were found in all subanalyses.ConclusionCalcium score on its own provides better individualized obstructive CAD prediction than contemporary PTP scores incorporating calcium score and risk factors. Risk factors may not be able to improve the diagnostic accuracy of calcium score to predict ≥50% luminal narrowing on CCTA.  相似文献   
10.
目的:评价两厂家的荧光免疫层析法肌钙蛋白I(cTnI)检测试剂质量性能的一致性。方法:检测样本为企业参考品,采用Origin 2019软件对其质量控制的关键技术性能的一致性进行分析。结果:Kolmagorov-Smirnov检验分析显示,在0.05水平下,其最低检测限、重复性(25ng/mL)、批间差(25ng/mL)存在显著不同,其重复性(1ng/mL)、准确度、特异性、批间差(1ng/mL)不存在显著不同;函数拟合分析显示,其线性方程Spearman相关系数r=1,相关性高。结论:其最低检测限、重复性(25ng/mL)、批间差(25ng/mL)不一致;其重复性(1ng/mL)、准确度、特异性、批间差(1ng/mL)一致性良好,线性相关性良好;综合分析认为,其cTnI检测试剂的质量性能不一致。根据分析结果,提出以下建议:选择更合适的抗原抗体原材料、提高试剂生产工艺、应用新兴标记材料等新技术以提高不同厂家检测试剂的质量性能的一致性。  相似文献   
设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号