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目的: 探讨生理发育因素对左乙拉西坦(LEV)在儿童体内药动学特征的影响,评价和优化LEV给药剂量,促进个体化用药。方法: 根据203例0.42~15岁癫痫患者的LEV血药浓度及相关临床资料建立群体药动学模型,考察生理发育因素对LEV药动学参数的影响方式和强度。基于模型,模拟和评价不同体质量和年龄段的儿童患者的LEV给药方案。结果: LEV在儿童体内的药动学特征符合一级吸收和消除的一室模型。在本研究中,LEV的表观分布容积和清除率的群体典型值经过体质量矫正后分别为0.54 L ·kg-1和0.082 L ·h-1 ·kg-1。年龄和体质量对LEV在儿童体内的清除率具有显著影响,可以用指数不固定的年龄成熟模型来表征上述关系。模拟结果显示,为了达到LEV的目标谷浓度范围,7.5~15 kg (0.6~3岁)、15~35 kg (3~10岁)和35~55 kg (10~15岁)的患者分别应采用的最优方案为20 mg ·kg-1 bid、15 mg ·kg-1 bid和10 mg ·kg-1 bid。给予体质量矫正剂量相同的LEV时,高年龄段儿童的谷浓度水平更高。结论: 本研究成功建立了LEV在儿童群体中的生理发育药动学模型,定量阐述了生理发育因素对LEV药动学的影响,可为不同发育程度的患者的个体化用药提供帮助。  相似文献   
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《Vaccine》2022,40(15):2274-2281
We evaluated compliance to the ACIP pneumococcal vaccination recommendations issued in 2014 for adults aged ≥ 65 years and in 2012 for adults with high-risk (HR) conditions. The MarketScan® Commercial and Medicare Supplemental databases (January 2007-June 2019) were used to identify the cohorts of interest. Analyses for adults aged ≥ 65 years were adjusted to account for missing vaccination history. Two HR cohorts were identified. The HR1 cohort included patients with immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leak, or cochlear implant. The HR2 cohort included patients with chronic heart, lung, or liver disease; diabetes mellitus; alcoholism; cirrhosis; or cigarette smoking. Full compliance for those aged ≥ 65 years or in the HR1 cohort was defined as receipt of PCV13 and PPSV23, and partial compliance was defined as receipt of PCV13 or PPSV23. For those in the HR2 cohort, full compliance was defined as receipt of PPSV23. Annual compliance rates were estimated using the Kaplan–Meier method.Among those aged ≥ 65 years, partial compliance at 4 years post index was 53% and full compliance was 17% in adjusted analyses. In subjects ≥ 65 years receiving the first vaccination, 42% received the second vaccination by year 4. For the HR1 cohort, partial compliance was 19% and full compliance was 5% at 6 years post index date. For the HR2 cohort, full compliance was 20% at 6 years, with the highest rate in patients with diabetes (27%) and the lowest rate in patients with alcoholism (8%).Additional efforts are needed to maximize compliance to the ACIP pneumococcal vaccine recommendations among adults ≥ 65 years of age and adults with HR conditions including streamlined recommendations and single-dose vaccines. These efforts may subsequently reduce the incidence and burden of pneumococcal disease.  相似文献   
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《Radiography》2022,28(2):353-359
Patient contact shielding has been in use for many years in radiology departments in order to reduce the effects and risks of ionising radiation on certain organs. New technologies in projection imaging and CT scanning such as digital receptors and automatic exposure control (AEC) systems have reduced doses and improved image consistency. These changes and a greater understanding of both the benefits and the risks from the use of shielding have led to a review of shielding use in radiology. A number of professional bodies have already issued guidance in this regard. This paper represents the current consensus view of the main bodies involved in radiation safety and imaging in Europe: European Federation of Organisations for Medical Physics, European Federation of Radiographer Societies, European Society of Radiology, European Society of Paediatric Radiology, EuroSafe Imaging, European Radiation Dosimetry Group (EURADOS), and European Academy of DentoMaxilloFacial Radiology (EADMFR). It is based on the expert recommendations of the Gonad and Patient Shielding (GAPS) Group formed with the purpose of developing consensus in this area. The recommendations are intended to be clear and easy to use. They are intended as guidance, and they are developed using a multidisciplinary team approach. It is recognised that regulations, custom and practice vary widely on the use of patient shielding in Europe and it is hoped that these recommendations will inform a change management program that will benefit patients and staff.  相似文献   
6.
目的 分析2004—2020年无锡市流腮的流行特征,为进一步制订流腮的防控策略提供参考依据。方法 2004—2020年流腮发病情况来源于中国疾病预防控制信息系统,人口学资料来源于无锡市统计年鉴。采用描述流行病学方法对无锡市2004—2007年[麻疹-流行性腮腺炎-风疹联合减毒活疫苗(MMR疫苗)纳入扩大国家免疫规划(EPI)前]、2008年(过渡期)、MMR疫苗纳入EPI后(2009—2020年)的流腮疫情资料进行分析;采用集中度法和圆形分布法分析流腮的季节性和发病高峰期;运用出生队列分析2004—2019年出生儿童的发病趋势。结果 2004—2020年无锡市水痘共报告10 088例,年平均报告发病率为 9.99 /10 万。年均发病率居前三位的为惠山区(20.77/10万)、梁溪区(11.83/10万)、滨湖区(10.07/10万)。MMR疫苗纳入EPI后,无锡市流腮发病率呈下降趋势。集中度法和圆形分布法分析显示流腮发病存在一定季节性,发病高峰期为3~9月。男性发病率(12.56/10万)高于女性(7.29/10万);3~14岁人群为发病高发年龄。2004—2019年出生儿童的出生队列分析提示同一出生队列儿童高发病高发年龄为3~6岁,学生和托幼儿童是主要发病群体。结论 疫苗纳入EPI后,无锡市流腮的发病控制效果明显,应加强2剂次MMR疫苗免疫接种。  相似文献   
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《Vaccine》2022,40(41):5997-6000
Coronavirus disease 2019 (COVID-19) vaccine administration started in February 2021 in Japan. As of December 2021, approximately 75% of the population aged ≥12 years had received two doses of vaccine. We conducted a study to investigate vasovagal reactions (VVR) after COVID-19 vaccination using data on adverse events following immunization. The crude reporting rate of VVR (cases/1,000,000 doses) after vaccination was 9.6 in all age groups combined, and was more frequent in the younger age groups: 28.6 and 37.2 in individuals aged 10–19 years and 20–29 years, respectively. In individuals aged 10–29 years, the rate was similar in males and females (33.0 and 34.2, respectively, p = 0.53); but was higher after dose 1 than after dose 2 (57.4 and 8.8, respectively, p < 0.001). Based on these results, caution needs to be exercised when vaccinating adolescents and young adults, especially with dose 1 of COVID-19 vaccines.  相似文献   
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经典名方地黄饮子现代临床应用广泛,治疗多科疾病,尤其是内科病中的神经系统疾病较多,临床疗效确切,但目前尚未转化成中成药制剂。故笔者采用文献计量学的方法,搜集记载地黄饮子的中医古籍文献,筛选、整理出有效数据254条,涉及中医古籍144部,系统梳理和分析研究了地黄饮子的历史发展源流、主治病证、制方原理、用药剂量、制剂方法、煎服方法等,以期为经典名方的研发和临床应用提供古代文献证据支持。研究发现,地黄饮子出自金代医家刘河间所著《宣明论方》,由熟地黄、巴戟天、山茱萸、肉苁蓉、石斛、附子、五味子、官桂、白茯苓、麦门冬、藏菖蒲、远志12味药物组成,主治喑痱。后世记载的地黄饮子多遵从《宣明论方》中的方剂组成和主治,且临床应用有所扩展,在有主治病证记载的199条文献中,喑痱最多,约占总病证的一半;其次为中风,约占五分之二;亦用于暴喑、痿证、眩晕、遗尿等病证。地黄饮子治疗病证范围较广,但病机总属"肾中水火俱亏"。其制方独特,上下并治,标本兼顾,尤以治下治本为主。在有药物用量记载的56条文献中,约有三分之一继承了《宣明论方》的记载:"等分,上为末,每服3钱。"药物用量总体偏轻。制剂多为汤剂、煮散,在煎服方法上主张"浊药轻投""数滚即服""不计时候"。  相似文献   
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《Vaccine》2019,37(24):3234-3240
Leucine aminopeptidase (FhLAP) and cathepsin L1 (FhCL1) of Fasciola hepatica play a critical role in parasite feeding, migration through host tissue, and immune evasion. These antigens have been tested for immune protection as single components with variable degrees of success. The chimeric-protein approach could improve protection levels against fasciolosis. Previously, we reported the design and construction of a chimeric protein composed of antigenic sequences of FhLAP and FhCL1 of F. hepatica. The goal of the present study was to express and evaluate the immune-protective capacity of this chimeric protein (rFhLAP-CL1) in sheep. Animals were randomly allocated into five groups with five animals in each group. Groups 1, 2 and 3 were immunized twice with 100 μg, 200 μg and 400 μg of rFhLAP-CL1 emulsified with Quil A adjuvant, whereas groups 4 and 5 were the adjuvant control and infection control groups, respectively. The animals were then challenged with 200 metacercariae two weeks after the rFhLAP-CL1 booster. The fluke burden was reduced by 25.5%, 30.7% (p < 0.05) and 46.5% (p < 0.01) in sheep immunized with 100 μg, 200 μg and 400 μg of chimeric protein, respectively, in comparison to the infection control group. There was a reduction of 22.7% (p < 0.05) and 24.4% (p < 0.01) in fecal egg count in groups 2 and 3, respectively, compared to the infection control group. Sheep immunized with chimeric protein produced F. hepatica excretion-secretion product-specific total IgG antibody, which were increased after challenge. Moreover, the levels of rFhLAP-CL1-specific IgG1 and IgG2 isotypes in immunized sheep increased rapidly two weeks after the first immunization and were significantly more elevated than those of the control groups, indicating a mixed Th1/Th2 response. This is a preliminary evaluation of the chimeric protein rFhLAP-CL1 as a possible immunogen against F. hepatica infection in sheep.  相似文献   
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