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1.
IntroductionThe main aim of this study was to assess the utility of differential white cell count and cell population data (CPD) for the detection of COVID-19 in patients admitted for community-acquired pneumonia (CAP) of different etiologies.MethodsThis was a multicenter, observational, prospective study of adults aged ≥18 years admitted to three teaching hospitals in Spain from November 2019 to November 2021 with a diagnosis of CAP. At baseline, a Sysmex XN-20 analyzer was used to obtain detailed information related to the activation status and functional activity of white cells.ResultsThe sample was split into derivation and validation cohorts of 1065 and 717 patients, respectively. In the derivation cohort, COVID-19 was confirmed in 791 patients and ruled out in 274 patients, with mean ages of 62.13 (14.37) and 65.42 (16.62) years, respectively (p < 0.001). There were significant differences in all CPD parameters except MO-Y. The multivariate prediction model showed that lower NE-X, NE-WY, LY-Z, LY-WY, MO-WX, MO-WY, and MO-Z values and neutrophil-to-lymphocyte ratio were related to COVID-19 etiology with an AUC of 0.819 (0.790, 0.846). No significant differences were found comparing this model to another including biomarkers (p = 0.18).ConclusionsAbnormalities in white blood cell morphology based on a few cell population data values as well as NLR were able to accurately identify COVID-19 etiology. Moreover, systemic inflammation biomarkers currently used were unable to improve the predictive ability. We conclude that new peripheral blood biomarkers can help determine the etiology of CAP fast and inexpensively.  相似文献   
2.
[摘要] 目的 了解开封地区无偿献血人群HIV感染状况和流行特征,为献血招募、降低输血途径传播HIV及确保临床用血安全提供依据。方法 采用2种不同厂家ELISA试剂和核酸试剂对2013—2020年间539 015例献血者标本进行HIV初筛,结果呈阳性者送开封市疾病预防控制中心确证实验室确证。分析和比较不同特征献血人群HIV感染状况和流行特征。结果 539 015例献血者标本中,HIV初筛阳性120例(2.23/万),经确证HIV阳性53例(0.98/万)。2013—2020年男性献血者HIV阳性率和献血者HIV总阳性率均呈下降趋势。确证后标本HIV阳性率男性(1.34/万)高于女性(0.39/万),首次献血(3.17/万)高于重复献血(0.38/万),全血(1.05/万)高于单采血小板(0.22/万),外地户籍(2.39/万)高于本市户籍(0.91/万),差异均有统计学意义(P均<0.05)。26~35岁(1.52/万)HIV阳性率高于其他年龄段,差异有统计学意义(P<0.05)。53例HIV阳性献血者中,单纯HIV阳性41例(77.36%),HIV合并其他病原体感染者12例(22.64%)。结论 2013年以来开封地区献血人群HIV阳性率呈下降趋势,HIV感染者主要发生于青年男性、捐献全血、首次献血、低学历、公司职员及外地户籍献血人群。加强献血前征询及建立低危/稳定的献血队伍可降低/避免输血传播HIV风险。  相似文献   
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4.
目的研究独活凝胶贴膏穴位贴敷治疗类风湿关节炎(RA)模型家兔的药物代谢动力学(PK)与药物效应动力学(PD)。方法取10只健康新西兰雌性家兔,2只作为正常对照组;其余8只家兔肩胛区注射卵清蛋白佐剂构建RA模型,随机分为模型组(空白凝胶贴膏)和穴位给药组(独活凝胶贴膏),各4只。采用微透析取样技术对模型家兔的关节腔液取样,采用超高效液相色谱-串联质谱(UPLC-MS/MS)法测定关节腔液中独活有效成分二氢欧山芹醇当归酸酯和蛇床子素的含量,并建立PK参数;采用酶联免疫吸附(ELISA)法测定血清中白细胞介素1β(IL-1β)、肿瘤坏死因子-α(TNF-α)的水平,并计算抑制率,作为PD指标;采用WinNonlin ExamplesGuide 5.2.1软件拟合PK-PD模型。结果穴位给药组家兔关节腔液中蛇床子素一级吸收速率常数(k01)为0.22 h-1,一级消除速率常数(k10)为0.10 h-1,0~14 h的血药浓度-时间曲线下面积(AUC_(0~14 h))为6584.18(ng?h)/mL,吸收相半衰期(k01_LH)为2.54 h,消除相半衰期(k10_LH)为5.89 h,达峰时间(tmax)为5.70 h,达峰浓度(Cmax)为454.31 ng/mL;关节腔液中二氢欧山芹醇当归酸酯k01为0.20 h-1,k10为0.12 h-1,AUC_(0~14 h)为2185.67(ng?h)/mL,k01_HL为2.69 h,k10_HL为5.94 h,tmax为6.52 h,Cmax为150.53 ng/mL。穴位给药组家兔血清中IL-1β和TNF-α水平建立的抑制百分数(EIR)与药效中效应室浓度(Ce)的PK-PD模型方程分别为EIR=91.72Ce/598.35+Ce,EIR=95.72 Ce/568.08+Ce。结论蛇床子素和二氢欧山芹醇当归酸酯在RA模型家兔体内的PK行为与药效紧密联系,独活凝胶贴膏经穴位给药可达到预期疗效。  相似文献   
5.
Human auditory ossicles, the malleus, the incus, and the stapes, are located in the tympanic cavity in the temporal bone and through forming a chain for the sound transmission from the tympanic membrane to the cochlea, they play an important role in the hearing process. Despite their clinical, phylogenetic, and evolutionary significance, the morphometry of the human ear bones has not been examined systematically. The ear ossicles are the smallest bones of the human skeleton, attaining their final size and morphology already at birth. Initially, they have been found to exhibit minimal morphometric variation, but further studies brought the opposite results. The aim of this study was to examine the morphometric variation of human auditory ossicles recovered from medieval and postmedieval subadult skeletons from Poland, Central Europe. The analysis involved in a total of 166 ear bones. Their measurements were performed on microscopic images using CorelDraw x4, according to a protocol of Quam and Rak with modification of Flohr et al. and Wadhwa et al. Our study showed a significant metric variation in the measurements taken at areas of the greatest morphological variability of the ossicles. We found that greater linear dimensions were associated with lower values of angular measurements. These results reveal the inherent variation found in these supposed functionally constrained structures. Representation of even greater number of populations, time periods, and developmental stages are needed. Further study will expand our understanding of the global scope of variation found in ear ossicular morphology and its functional implications for paleoanthropology.  相似文献   
6.
Acute diarrhea is a condition of increased water stool content, stool volume, and number of bowel movements that lasts less than 14 days. Mild diarrhea is usually self-limiting; however, undertreated moderate to severe diarrhea may cause severe dehydration and lead to hypovolemic shock. In order to prevent severe dehydration and treat patients appropriately, it is crucial for health care providers to determine the right diagnosis of patients with acute diarrhea. This article focuses on pathophysiology, general patient presentation, diagnostic tests and differential diagnosis lists of acute diarrhea to discuss which diagnosis should be made based on patient presentation and objective data.  相似文献   
7.
PurposeTo report the 5-year results from the Pivotal Multicenter Trial of Ultrasound-Guided Percutaneous Arteriovenous Fistula (pAVF) Creation for Hemodialysis Access.Materials and MethodsThe retrospective review of 107 intent-to-treat (ITT) patients from the pivotal trial provided a long-term follow-up population (LTP) of 85 patients with a median follow-up duration of 50 months (range, 12–60 months). Data evaluated in the LTP group were fistula maturation and usage, secondary procedures, and complications. The Kaplan-Meier analysis of primary patency, assisted primary patency, cumulative patency, and functional patency (time from 2-needle cannulation to abandonment) were performed for the ITT population.ResultsIn the LTP, 99% (84 of 85) of fistulae were mature, with 99% (78 of 79) of patients requiring hemodialysis using their pAVF. Sustained fistula use (2-needle cannulation at the prescribed rate, 2 of 3 sessions) was achieved in 92% (78 of 85) of patients, with 7 patients not using their pAVF because they were not on dialysis (n = 4), were on peritoneal dialysis (n = 2), and refused to use fistula (n = 1). Fistula maintenance was required in 31.8% (27 of 85) of patients and included fistula dysfunction (21.2%), thrombosis (5.9%), cannulation injury (12.9%), and arm swelling (4.7%). The number of procedures performed per patient per year to maintain function and patency was 0.32 (91 of 288) for years 2–5. The cumulative patency rates were 89.5%, 88.4%, 88.4%, 85.6%, and 82.0% for years 1, 2, 3, 4, and 5, respectively. The functional patency was 91.8% at the end of the study. There were no major complications related to pAVF during the long-term follow-up.ConclusionsPercutaneous fistulae have provided clinically effective and durable access for hemodialysis with low complications. The continued use and evaluation of pAVF are warranted.  相似文献   
8.
IntroductionThe purpose of this study was to explore factors influencing meropenem pharmacokinetics (PKs) in critically ill patients by developing a population PK model and to determine the optimal dosing strategy.MethodsThis prospective observational study involved 12 critically ill patients admitted to the intensive care unit and treated with meropenem 1 g infused over 1 h every 8 h. Blood samples were collected on days 1, 2, and 5 immediately prior to dosing, and at 1, 2, 4, and 6 h after the start of infusion. Population PK parameters were estimated using nonlinear mixed-effects model software.ResultsMeropenem PK was adequately described using a two-compartment model. Typical values of total and inter-compartmental clearance were 9.30 L/h and 9.70 L/h, respectively, and the central and peripheral compartment volumes of distribution were 12.61 L and 7.80 L, respectively. C-reactive protein (CRP) was identified as significant covariate affecting total meropenem clearance. The probability of target attainment (PTA) predicted by Monte Carlo simulations varied according to the patients’ CRP. The PTA of 100% time above the minimum inhibitory concentration ≤2 mg/L for bacteria was achieved after a dose of 1 and 2 g infused over 4 h every 8 h in patients with CRP of 30 and 5 mg/dL, respectively.ConclusionThe findings of this study suggest that CRP might be helpful in managing meropenem dosing in critically ill patients. Higher doses and extended infusion may be required to achieve optimal pharmacodynamic targets.  相似文献   
9.
PurposeTo investigate the pharmacokinetics (PK) and early effects of conventional transarterial chemoembolization (TACE) using sorafenib and doxorubicin on tumor necrosis, hypoxia markers, and angiogenesis in a rabbit VX2 liver tumor model.Materials and MethodsVX2 tumor-laden New Zealand White rabbits (N = 16) were divided into 2 groups: 1 group was treated with hepatic arterial administration of ethiodized oil and doxorubicin emulsion (DOX-TACE), and the other group was treated with ethiodized oil, sorafenib, and doxorubicin emulsion (SORA-DOX-TACE). Animals were killed within 3 days of the procedure. Levels of sorafenib and doxorubicin were measured in blood, tumor, and adjacent liver using mass spectrometry. Tumor necrosis was determined by histopathological examination. Intratumoral hypoxia-inducible factor (HIF) 1α, vascular endothelial growth factor (VEGF), and microvessel density (MVD) were determined by immunohistochemistry.ResultsThe median intratumoral concentration of sorafenib in the SORA-DOX-TACE group was 17.7 μg/mL (interquartile range [IQR], 7.42–33.5 μg/mL), and its maximal plasma concentration (Cmax) was 0.164 μg/mL (IQR, 0.0798–0.528 μg/mL). The intratumoral concentration and Cmax of doxorubicin were similar between the groups: 4.08 μg/mL (IQR, 3.18–4.79 μg/mL) and 0.677 μg/mL (IQR, 0.315–1.23 μg/mL), respectively, in the DOX-TACE group and 1.68 μg/mL (IQR, 0.795–4.08 μg/mL) and 0.298 μg/mL (IQR, 0.241–0.64 μg/mL), respectively, in the SORA-DOX-TACE group. HIF-1α expression was increased in the SORA-DOX-TACE group than in the DOX-TACE group. Tumor volume, tumor necrosis, VEGF expression, and MVD were similar between the 2 groups.ConclusionsThe addition of sorafenib to DOX-TACE delivered to VX2 liver tumors resulted in high intratumoral and low systemic concentrations of sorafenib without altering the PK of doxorubicin.  相似文献   
10.
目的 分析我国中老年人群抑郁症状,探讨健康相关行为与抑郁间的关联性,为改善中老年抑郁干预措施及政策制定提供依据。方法 采用2018年中国健康与养老追踪调查数据,运用关联规则Apriori算法分析健康相关行为与抑郁症状间的关联,并依据支持度、置信度、提升度评价健康行为对抑郁症状的影响。结果 在8 681名调查对象中,抑郁症状的发生率为40.3%;健康相关行为与抑郁症状的关联规则中的强关联规则为无体力活动、睡眠不足、不饮酒的人更易产生抑郁症状;男性中为无体力活动、吸烟、无社交活动的人更易产生抑郁症状;女性中无体力活动、无社交活动、睡眠不足的人更易产生抑郁症状。结论 健康相关行为与抑郁是相互关联的,可通过针对多种行为的联合干预,改善中老年人的抑郁症状。  相似文献   
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