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1.
American Indian and Alaska Native (AIAN) individuals are diverse culturally and geographically but share a high prevalence of chronic illness, largely because of obstacles to high-quality health care. The authors comprehensively examined cancer incidence and mortality among non-Hispanic AIAN individuals, compared with non-Hispanic White individuals for context, using population-based data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries. Overall cancer rates among AIAN individuals were 2% higher than among White individuals for incidence (2014 through 2018, confined to Purchased/Referred Care Delivery Area counties to reduce racial misclassification) but 18% higher for mortality (2015 through 2019). However, disparities varied widely by cancer type and geographic region. For example, breast and prostate cancer mortality rates are 8% and 31% higher, respectively, in AIAN individuals than in White individuals despite lower incidence and the availability of early detection tests for these cancers. The burden among AIAN individuals is highest for infection-related cancers (liver, stomach, and cervix), for kidney cancer, and for colorectal cancer among indigenous Alaskans (91.3 vs. 35.5 cases per 100,000 for White Alaskans), who have the highest rates in the world. Steep increases for early onset colorectal cancer, from 18.8 cases per 100,000 Native Alaskans aged 20–49 years during 1998 through 2002 to 34.8 cases per 100,000 during 2014 through 2018, exacerbated this disparity. Death rates for infection-related cancers (liver, stomach, and cervix), as well as kidney cancer, were approximately two-fold higher among AIAN individuals compared with White individuals. These findings highlight the need for more effective strategies to reduce the prevalence of chronic oncogenic infections and improve access to high-quality cancer screening and treatment for AIAN individuals. Mitigating the disparate burden will require expanded financial support of tribal health care as well as increased collaboration and engagement with this marginalized population.  相似文献   
2.
ObjectiveWomen are increasingly informed about their breast density due to state density reporting laws. However, accuracy of personal breast density knowledge remains unclear. We compared self-reported with clinically assessed breast density and assessed knowledge of density implications and feelings about future screening.MethodsFrom December 2017 to January 2020, we surveyed women aged 40 to 74 years without prior breast cancer, with a normal screening mammogram in the prior year, and ≥1 recorded breast density measures in four Breast Cancer Surveillance Consortium registries with density reporting laws. We measured agreement between self-reported and BI-RADS breast density categorized as “ever-dense” if heterogeneously or extremely dense within the past 5 years or “never-dense” otherwise, knowledge of dense breast implications, and feelings about future screening.ResultsSurvey participation was 28% (1,528 of 5,408), and 59% (896 of 1,528) of participants had ever-dense breasts. Concordance between self-report versus clinical density was 76% (677 of 896) among women with ever-dense breasts and 14% (89 of 632) among women with never-dense breasts, and 34% (217 of 632) with never-dense breasts reported being told they had dense breasts. Desire for supplemental screening was more frequent among those who reported having dense breasts 29% (256 of 893) or asked to imagine having dense breasts 30% (152 of 513) versus those reporting nondense breasts 15% (15 of 102) (P = .003, P = .002, respectively). Women with never-dense breasts had 6.3-fold higher odds (95% confidence interval:3.39-11.80) of accurate knowledge in states reporting density to all compared to states reporting only to women with dense breasts.DiscussionStandardized communications of breast density results to all women may increase density knowledge and are needed to support informed screening decisions.  相似文献   
3.
目的:分析在实施胎儿畸形诊断的过程中产前系统筛查的临床应用价值。方法:纳入2020年4月~2021年4月本院收治的接受产前检查且疑似胎儿畸形的孕妇34例为实验研究对象,所有孕妇均给予产前系统筛查与二维超声检查,并以引产或者是分娩结果作为标准,对产前系统筛查与二维超声在胎儿畸形中的诊断效果进行比较。结果:产前系统筛查检查神经系统畸形、四肢畸形、泌尿生殖系统畸形、面部畸形、消化系统畸形、心血管系统畸形的检出率与总检出率分别为66.7%、100.0%、75.0%、88.9%、85.7%、100.0%、86.7%;二维超声检查分别为0.0%、50.0%、25.0%、55.6%、42.9%、33.3%、40.0%。统计学分析后可知,在实施产前胎儿畸形诊断的过程中产前系统筛查对于胎儿畸形的检出率明显高于二维超声,差异具有统计学意义(P<0.05)。结论:在实施产前胎儿畸形诊断的过程中,产前系统筛查是临床应用较多的一种方式,具有相对较高的胎儿畸形检出率,与引产或分娩结果具有较为理想的符合度,有助于优生优育和人口质量的提升。  相似文献   
4.
目的 调查广州地区肺癌高危人群筛查依从性现状及影响因素,并分析肺癌筛查结果。方法 选取2020年1月至2021年12月广州地区常住居民为研究对象,通过问卷收集其社会人口学资料及肺癌危险因素资料,筛查出肺癌高危人群,肺癌高危者由专业放射科医生进行低剂量螺旋CT(LDCT)扫描并根据诊断标准完成诊断。采用描述性分析方法对高危人群筛查依从性及筛查结果进行分析,并采用单、多因素分析方法对肺癌高危人群筛查依从性影响因素进行分析。结果 17 980名研究对象中肺癌高危评估率为19.96%(3 589/17 980),LDCT筛查依从率为34.99%(1 256/3 589)。3 589例肺癌高危人员的肺癌确诊率为2.17%(78/3 589),其中男性占61.54%(48/78),女性占38.46%(30/78),40~50岁占17.95%(14/78)、51~60岁占33.33%(26/78)、61~74岁占48.72%(38/78)。Logistic回归分析显示,女性(OR=2.130)、年龄越大(OR=1.408)、BMI≥24.0 kg/m2OR=2.349、2.375)、中专及以上受教育程度(OR=2.008、3.251)、饮酒(OR=1.498)、吸烟(OR=2.239)、被动吸烟(OR=2.428)、有肺癌家族史(OR=2.081)、有慢性呼吸系统疾病史(OR=2.006)及不经常体育锻炼(OR=2.130)的肺癌高危者具有更高的筛查依从性。结论 广州地区肺癌高危人群筛查依从性普遍较低,年龄、受教育程度、家族病史等均与筛查依从性有关,肺癌高危筛查有助于早期诊断肺癌及相关疾病,改善国民生活质量。  相似文献   
5.
The prevalence of infertility among the population of reproductive age continues to increase year after year in Western societies and the therapeutic resource in most cases will be assisted reproductive techniques, mainly in vitro fertilization. Although the advances made in vitro fertilization have had an undeniable impact on the chances of achieving pregnancy, the efficiency of the technique, in global terms, remains low. One of the factors with the greatest impact on in vitro fertilization results is embryo selection. That is why among the main future challenges that arise in the field of assisted human reproduction, is that of obtaining reliable embryo selection methods that allow the transfer of the embryo with greater competence to implant. In this article, the different embryo selection methods used in in vitro fertilization are reviewed.  相似文献   
6.
青光眼是世界第一大不可逆致盲性眼病,早期诊断和及时治疗是预防青光眼致盲的有效措施。眼底图像中的杯盘比是青光眼早期筛查与临床诊断的重要指标。因此,精确的视杯视盘分割是准确计算杯盘比并提高青光眼计算机辅助诊断技术的关键。针对这一问题,在对眼底图像进行极坐标变换的基础上,提出一种融合感受野模块的卷积神经网络Seg-RFNet,以实现视杯视盘联合分割。Seg-RFNet以SegNet框架为基础,使用ResNet50作为编码层,增强图像的特征提取能力,并对编码层进行分支处理,进一步获得更多的深层语义信息;同时在编码层和解码层之间加入感受野模块,模拟人类视觉系统,在增大感受野的同时增强了有用特征的响应。使用MICCAI 2018公开数据集REFUGE中的800张眼底图像对所提出方法与其他方法进行性能验证和比较。结果表明,Seg-RFNet分割视杯和视盘的Jaccard相似度分别0.951 5和0.872 0,F分数达到了0.974 9和0.930 1,与常用的U-Net、SegNet 网络相比,Seg-RFNet具有更好的视杯视盘联合分割精度,为计算杯盘比提供了精确分割基础。  相似文献   
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9.
目的:了解医护人员健康体检甲状腺结节和甲状腺弥漫性病变的检出率情况。方法:选择2020年9-11月在西部战区总医院体检中心进行健康查体的2634例医务人员进行甲状腺超声检查,剔除既往有甲状腺手术史者23人,共2611人纳入该研究,其中男性1109例,女性1502例,年龄为15-99岁,平均39.6±17.0岁。根据年龄分为五组,分别为<36岁、36-45岁、46-55岁、56-65岁、>65岁组,分析不同年龄不同性别甲状腺结节的检出率及性质和甲状腺弥漫性病变的检出情况。 结果:1.2611名医务人员共检出甲状腺结节582例,其中男性290例(26.15%);女性292例(19.44%)。男性甲状腺结节检出率显著高于女性(P<0.001)。甲状腺结节检出率随着年龄增长而增加,其中65岁以上组检出率最高(63.18%)。2. <36岁组女性甲状腺良性结节检出率显著高于男性(13.62% VS 7.82%,P=0.002),其余年龄组女性检出率均高于男性,但无统计学差异。不同年龄组男、女疑似恶性结节检出率无明显差异。3.甲状腺弥漫性病变共73例,总检出率2.95%,其中男性16例(1.44%),女性56例(3.73%),女性检出率显著高于男性( =12.429 P<0.001)。<36岁组女性甲状腺结节合并甲状腺弥漫性病变检出率显著高于男性(P<0.05)。结论:年轻女性是甲状腺结节和甲状腺弥漫性病变的高发人群,这类人群常常存在桥本氏甲状腺炎。因此,对患有桥本氏甲状腺炎的年轻女性应警惕甲状腺癌的发生,早发现,早诊断,早治疗。  相似文献   
10.
ImportanceChicago is one of the most racially segregated cities in the US, with the largest mortality gap between neighborhoods. Computed tomographic coronary artery calcium scoring (CACS) is an excellent risk stratification tool, but costs about $200 out-of-pocket, making it inaccessible to some.ObjectiveTo determine whether this ACC/AHA guideline-recommended screening tool is accessible to all populations and neighborhoods, we evaluated the price and availability of CACS in Chicago area hospitals.DesignWe used the Illinois Department of Public Health list of area hospitals to inquire about CACS availability and price. We compared these results to US Census Bureau data for each hospital's service area's demographic, ethnic and socioeconomic population characteristics.ResultsOut of the 40 hospitals in Chicagoland, 30 offered CACS. The 10 hospitals without CACS were smaller hospitals in zip codes with a higher population density (p ?< ?0.01), higher poverty rates (22% vs. 13%, p ?< ?0.01), lower percentage of white population (p ?< ?0.02), lower frequency of higher education (35% vs. 51%, p ?< ?0.05), and a trend toward more black residents (p ?< ?0.10). Life expectancy was greater in areas with CACS available (78 vs. 75 years, p ?< ?0.05).Even in areas with CACS, there was wide price variation, with higher prices in poorer areas (r ?= ?0.57, p ?< ?0.01). The highest vs. lowest quintile of income had higher education, larger white population (80% vs. 14%, p ?< ?0.0001), and longer life expectancy (81 vs. 72 years, p ?< ?0.0002), but tended to have a lower price of CACS ($86 vs. $487, p ?< ?0.08).Conclusions and relevanceCACS is a powerful, evidenced-based clinical tool, but the availability and price vary widely in Chicagoland, and directly correlate with the socioeconomic and health care disparities that are known to exist. Removing these barriers to coronary artery disease screening may be one method to improve the poor cardiovascular outcomes in these areas.  相似文献   
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