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1.
BackgroundInvasive Fungal Diseases (IFD), account for high morbidity and mortality in immunocompromised and seriously ill patients worldwide. Early, faster and accurate diagnosis with timely and appropriate patient management is critical for improved patient outcome and antifungal stewardship. Clinical/radiological presentations in IFD are non-specific and microscopy/culture based tests have low sensitivity and long turnaround time. Biomarkers have clinical utility for diagnosing IFD but their interpretation is not straight forward.ObjectivesThis review discusses the salient characteristics, clinical usefulness and limitations of common biomarkers such as Galactomannan (GM), 1–3, β D glucan (βDG), mannan, anti-mannan antibody (Mn/antiMn), Cryptococcal antigen test (CrAg), Nucleic Acid Amplification (NAA) tests and next generation sequencing for diagnosing IFD.ContentsFungal biomarkers are useful adjuncts as screening and diagnostic tools for IFD and are much more suited for ‘ruling out’ rather than ‘ruling in’ disease. GM, NAA tests are promising biomarkers for screening of invasive Aspergillosis in high risk asymptomatic patients who are not on antifungal therapy and for diagnosis of breakthrough infections in symptomatic patients. 1–3, β D glucan has limitations both as a ‘rule in’ and ‘rule out’ test and is useful in only specific clinical settings. Two consecutive positive 1-3-βDG tests or combined positivity with GM increases its specificity. Mn/antiMn, T2Candida nano diagnostic panel are promising candidates for diagnosing invasive candidiasis. Combining two or more biomarkers improves the sensitivity for prompt initiation of antifungal therapy and the negative predictive value for suspension of empirical treatment.Serum CrAg test is a good ‘rule in’ rather than a ‘rule out’ test in immunocompetent patients but has good diagnostic accuracy in immunocompromised patients. Detection of single nucleotide polymorphisms by next generation sequencing is useful for fungal characterization and identification of host determinants responsible for increased susceptibility to fungal infections but is still in experimental stages.  相似文献   
2.
AIM: To investigate whether non-canonical autophagy transport receptor cell cycle progression 1 (CCPG1) is involved in the corneal antifungal immune response. METHODS: Human corneal epithelial cells (HCECs) and human myeloid leukemia mononuclear cells (THP-1) macrophages stimulated by Aspergillus fumigatus (A. fumigatus) were used as cell models. The expression of CCPG1 mRNA was detected by qRT-PCR. Western blot was used to determine the protein expression of CCPG1 and interleukin-1β (IL-1β). The dectin-1 neutralizing antibody was used to detect the association between dectin-1 and CCPG1. Immunofluorescence was used to observe the colocalization of CCPG1 and C-type lectin-like receptor-1 (CLEC-1) in THP-1 macrophages. RESULTS: The expression of CCPG1 started to increase at 4h after infection and increased in a time-dependent manner in HCECs and THP-1 macrophages. With dectin-1 neutralizing antibody pretreatment, the expression of IL-1β was down-regulated. CCPG1 up-regulation in response to A. fumigatus infection was independent of dectin-1. Immunofluorescence showed the colocalization of CCPG1 and CLEC-1 in THP-1 macrophages. CONCLUSION: As a specific autophagy protein of non-canonical autophagy pathway, CCPG1 is involved in corneal infection with A. fumigatus.  相似文献   
3.
目的探讨鼻呼出气一氧化氮(FnNO)动态变化对儿童慢性鼻窦炎(CRS)的疗效评估及潜在病因分析的临床意义。方法回顾2018—2020年深圳市儿童医院933例FnNO的检测结果,纳入其中随访FnNO变化的20例CRS住院患儿,根据过敏疾病史分为CRS伴过敏组(10例)和CRS不伴过敏组(10例)。应用Sunvou FnNO测定系统,采用鼻被动呼气+静音技术检测FnNO水平。结果① 20例患儿病程均>3个月,20例伴有慢性咳嗽,16例伴有鼻塞,10例伴有过敏史;②随访36个月,20例患儿治疗前后的FnNO值经比较差异具有统计学意义(150±164)ppb vs(337±280)ppb,P<0.05; ③CRS伴过敏组治疗后较治疗前FnNO明显升高,经比较差异具有统计学意义(136±116)ppb vs(519±280)ppb,P<0.01;而CRS不伴过敏组治疗前后的FnNO差异无统计学意义(164±206)ppb vs(156±120)ppb,P>0.05; ④10例CRS不伴过敏组患者中,4例FnNO水平持续降低,其中3例患儿确诊原发性纤毛运动障碍(PCD),多次复查FnNO均<77 ppb;1例确诊囊性纤维化(CF)。结论儿童CRS存在FnNO水平明显降低,可能与变态反应及鼻腔阻塞相关,而规律治疗后随访FnNO水平可逐渐趋于正常,少部分FnNO水平持续降低的患儿需警惕是否合并PCD、CF等基础疾病。  相似文献   
4.
5.
目的 探讨鼻康片联合色甘萘甲那敏治疗过敏性鼻炎的临床疗效。方法 回顾性分析2020年10月—2021年10月在武汉市红十字医院治疗的110例过敏性鼻炎患者的临床资料,随机分为对照组和治疗组,每组各55例。对照组给予色甘萘甲那敏鼻喷雾剂,每次两侧鼻孔各喷1下,3~5次/d,每次间隔>3 h;在对照组基础上,治疗组口服鼻康片,5片/次,3次/d。两组患者均连续治疗8周。观察两组患者临床疗效,比较治疗前后两组患者过敏性鼻炎生活质量测评量表(RQLQ)、鼻症状总分表(TNSS)、伴随症状总分(TNNSS)和鼻内镜(MLK)评分,血清白细胞介素-13(IL-13)、白细胞介素-23(IL-23)、白细胞介素-27(IL-27)、可溶性血管细胞间黏附分子-1(sICAM-1)、可溶性程序性死亡配体-1(sPD-L1)和可溶性E-选择素(sE-selectin)水平,鼻通气功能指标总鼻气道阻力(NAR)、0~5 cm鼻腔容积(NCV)和鼻腔最小横截面积(NMCA)水平。结果 治疗后,对照组有效率为81.82%,明显低于治疗组96.36%(P<0.05)。治疗后,两组RQLQ、TNSS、TNNSS和MLK评分均明显改善(P<0.05);两组患者血清IL-13、IL-23、sICAM-1和sE-selectin水平均明显降低,而sPD-L1和IL-27水平明显升高(P<0.05);两组0~5 cm NCV、NMCA均明显升高,而NAR均明显降低(P<0.05);且治疗组这些指标较对照组改善更明显(P<0.05)。结论 鼻康片联合色甘萘甲那敏鼻喷雾剂治疗过敏性鼻炎可有效改善患者鼻部症状,提高鼻通气,改善血清细胞因子表达,有利于提高患者生活质量。  相似文献   
6.
A severe pandemic of Coronavirus Disease (COVID-19) has been sweeping the globe since 2019, and this time, it did not stop, with frequent mutations transforming into virulent strains, for instance, B.1.1.7, B.1.351, and B.1.427. In recent months, a fungal infection, mucormycosis has emerged with more fatal responses and significantly increased mortality rate. To measure the severity and potential alternative approaches against black fungus coinfection in COVID-19 patients, PubMed, Google Scholar, World Health Organization (WHO) newsletters, and other online resources, based on the cases reported and retrospective observational analysis were searched from the years 2015–2021. The studies reporting mucormycosis with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) coinfection and/or demonstrating potential risk factors, such as a history of diabetes mellitus or suppressed immune system were included, and reports published in non-English language were excluded. More than 20 case reports and observational studies on black fungus coinfection in COVID-19 patients were eligible for inclusion. The results indicated that diabetes mellitus, hyperglycemic, and immunocompromised COVID-19 patients with mucormycosis were at a higher risk. We found that it was prudent to assess the potential risk factors and severity of invasive mycosis via standardized diagnostic and clinical settings. Large-scale studies need to be conducted to identify early biomarkers and optimization of diagnostic methods has to be established per population and geographical variation. This will not only help clinicians around the world to detect the coinfection in time but also will prepare them for future outbreaks of other potential pandemics.  相似文献   
7.
新生儿重症监护病房中早产儿的侵袭性真菌感染(invasive fungal infection,IFI)发生率较高,且早期临床诊断困难,一旦发生,病情重,疗程长,花费高,病死率较高,预后差。因此预防IFI尤为重要。目前临床常选氟康唑作为预防早产儿IFI的一线药物,但具体剂量、疗程尚不统一,使用对象及预防效果也存在争议。该文对近年来新生儿重症监护病房中药物预防早产儿IFI的研究进展进行综述,供临床医生参考。  相似文献   
8.
目的观察肛窦炎应用针刺配合肠炎散保留灌肠治疗的效果。方法选取2017年10月-2018年10月就诊的72例肛窦炎患者,采用随机数字表法分为观察组(n=36)与对照组(n=36)。对照组给予肠炎散保留灌肠治疗,观察组为针刺配合肠炎散保留灌肠治疗,比较2组症状、疗效及安全性。结果观察组症状(放射痛、指诊症状及镜检症状)少于对照组,总有效率高于对照组,差异有统计学意义(P<0.05);2组安全性相比,差异无统计学意义(P>0.05)。结论针对肛窦炎患者,予以针刺配合肠炎散保留灌肠治疗效果确切,可减少临床症状,加快疾病转归,且治疗安全性较好。  相似文献   
9.
Breakthrough invasive fungal infections (IFIs) have emerged as a significant problem in patients receiving systemic antifungals; however, consensus criteria for defining breakthrough IFI are missing. This position paper establishes broadly applicable definitions of breakthrough IFI for clinical research. Representatives of the Mycoses Study Group Education and Research Consortium (MSG‐ERC) and the European Confederation of Medical Mycology (ECMM) reviewed the relevant English literature for definitions applied and published through 2018. A draft proposal for definitions was developed and circulated to all members of the two organisations for comment and suggestions. The authors addressed comments received and circulated the updated document for approval. Breakthrough IFI was defined as any IFI occurring during exposure to an antifungal drug, including fungi outside the spectrum of activity of an antifungal. The time of breakthrough IFI was defined as the first attributable clinical sign or symptom, mycological finding or radiological feature. The period defining breakthrough IFI depends on pharmacokinetic properties and extends at least until one dosing interval after drug discontinuation. Persistent IFI describes IFI that is unchanged/stable since treatment initiation with ongoing need for antifungal therapy. It is distinct from refractory IFI, defined as progression of disease and therefore similar to non‐response to treatment. Relapsed IFI occurs after treatment and is caused by the same pathogen at the same site, although dissemination can occur. These proposed definitions are intended to support the design of future clinical trials and epidemiological research in clinical mycology, with the ultimate goal of increasing the comparability of clinical trial results.  相似文献   
10.
Antifungal treatment options for allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitisation (SAFS) are largely limited to itraconazole based on the outcome of randomised controlled trials. It is unclear if nebulised amphotericin B deoxycholate (Fungizone®) is a viable therapeutic option. We evaluated the safety and efficacy of nebulised Fungizone® in the long‐term treatment of various forms of pulmonary aspergillosis. We assessed the records of 177 patients with various forms of pulmonary aspergillosis attending the National Aspergillosis Centre in Manchester who had received Fungizone®. Patients first received a challenge test with nebulised Fungizone® in hospital with spirometry pre/post‐Fungizone® and nebulised salbutamol given pre‐Fungizone®. Tolerability and changes in Aspergillus IgE, Aspergillus IgG and total IgE were evaluated. Sixty‐six per cent (117/177) were able to tolerate the test dose of Fungizone® and in all cases, the reason for discontinuation of the first test dose was worsening breathlessness. Twenty six (21%) stopped therapy within 4‐6 weeks, and the commonest reason cited for discontinuation of therapy was increased breathlessness, hoarseness and cough. Eighteen (10.2%) patients continued the Fungizone® for >3 months of which 5 (27.8%) recorded an improvement in total IgE, Aspergillus‐specific IgE and Aspergillus IgG. Eleven had ABPA, four had SAFS, two had Aspergillus bronchitis and one had Aspergillus sensitisation with cavitating nodules. Among these 18 patients, sputum fungal culture results went from positive to negative in five patients, became positive in one patient, remained positive in three patients, and remained negative in seven patients. Nebulised Fungizone® appears to be a poorly tolerated treatment for pulmonary Aspergillosis with high dropout rates. There appears to be both clinical and serological benefits following sustained treatment with nebulised Fungizone® in some patients.  相似文献   
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