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1.
In this paper, we argue that understanding and addressing the problem of poor-quality medical products requires a more interdisciplinary approach than has been evident to date. While prospective studies based on rigorous standardized methodologies are the gold standard for measuring the prevalence of poor-quality medical products and understanding their distribution nationally and internationally, they should be complemented by social science research to unpack the complex set of social, economic, and governance factors that underlie these patterns. In the following sections, we discuss specific examples of prospective quality surveys and of social science studies, highlighting the value of cross-sector partnerships in driving high-quality, policy-relevant research in this area.  相似文献   
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When the COVID-19 pandemic hit, blood transfusion services worldwide started collection of convalescent plasma as early as possible, as exemplified by the response in Norway. There were challenges related to donor selection, donor safety, testing for relevant antibodies and indications for and dosing of the convalescent plasma. As more knowledge became available, the product quality was more standardised. Multiple case reports, observational studies and some randomized studies were published during the pandemic, as well as laboratory studies reporting different approaches to antibody testing. The results were conflicting and the importance of convalescent plasma was disputed.Even though there has been strong international collaboration with involvement of many key organisations, we may better prepare for the next pandemic. An even stronger, more formalised collaboration between these organisations could provide more clear evidence of the importance of convalescent plasma, based on the principles of passive immunisation.  相似文献   
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ObjectiveTo determine the long-term cardiovascular disease risk of astronauts with spaceflight exposure compared with a well-matched cohort.MethodsNational Aeronautics and Space Administration (NASA) astronauts are selected into their profession based upon education, unique skills, and health and are exposed to cardiovascular disease risk factors during spaceflight. The Cooper Center Longitudinal Study (CCLS) is a generally healthy cohort from a preventive medicine clinic in Dallas, Texas. Using a matched cohort design, astronauts who were selected beginning April 1, 1959, (and each subsequent selection class through 2009) and exposed to spaceflight were matched to CCLS participants who met astronaut selection criteria; 1514 CCLS participants matched to 303 astronauts in a 5-to-1 ratio on sex, date of birth, and age. The outcome of cardiovascular mortality through December 31, 2016, was determined by death certificate or National Death Index.ResultsThere were 11 deaths caused by cardiovascular disease (CVD) among astronauts and 46 among CCLS participants. There was no evidence of increased mortality risk in astronauts (hazard ratio [HR]=1.10; 95% confidence interval [CI], 0.50 to 2.45) with adjustment for baseline cardiovascular covariates. However, the secondary outcome of CVD events showed an increased adjusted risk in astronauts (HR=2.41; 95% CI, 1.26 to 4.63).ConclusionNo increased risk of CVD mortality was observed in astronauts with spaceflight exposure compared with a well-matched cohort, but there was evidence of increased total CVD events. Given that the duration of spaceflight will increase, particularly on missions to Mars, continued surveillance and mitigation of CVD risk is needed to ensure the safety of those who venture into space.  相似文献   
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《Pancreatology》2022,22(2):270-276
Backgroundand purpose: Zinc is an essential element for human health and plays an important role in metabolic, immunological and other biological processes. The present study was conducted to investigate the association between zinc deficiency (ZD) and the perioperative clinical course in patients with pancreatic ductal adenocarcinoma (PDAC).MethodsOf 216 patients with PDAC who underwent elective pancreatectomy between 2013 and 2017 at our institution, 206 patients with sufficient clinical data were retrospectively reviewed. The perioperative variables were compared and the risk factors associated with infectious complications were identified.ResultsZD was preoperatively present in 36 (17.5%) of 206 patients with PDAC. In the patients of the ZD group, a higher proportion of males, higher preoperative modified Glasgow prognostic scores, a higher neutrophil-to-lymphocyte ratio, and a higher occurrence of postoperative infectious complications after pancreatectomy were observed, compared to the non-ZD group. By a univariate analysis, three risk factors were significantly associated with infectious complications after pancreatectomy: ZD (vs non-ZD: p = 0.002), serum albumin <3.5 g/dl (vs ≥ 3.5 g/dl: p = 0.005), and the procedure of pancreaticoduodenectomy (vs others: p = 0.013). By multivariate logistic regression analysis, the occurrence of infectious complications was significantly associated with ZD (OR 3.430, 95%CI 1.570 to 7.490, p = 0.002) and the procedure of pancreaticoduodenectomy (OR 2.030, 95%CI 1.090 to 3.770, p = 0.025).ConclusionsThe current study newly demonstrated that ZD could serve as a preoperative predictor of infectious complications after pancreatectomies in the patients with PDAC.  相似文献   
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目的联合使用国际子宫内膜肿瘤分析(IETA)经阴道常规超声与超声造影评估子宫内膜癌(EC)患者肌层浸润深度及宫颈有无侵犯,预测EC的病理分期;比较此2种方法的诊断价值。 方法将南方医科大学深圳医院及中山大学附属第七医院2017年1月至2020年12月间83例已手术的EC患者纳入研究,所有患者术前1个月内均行经阴道常规超声及超声造影检查,由2名具有10年以上妇产超声工作经验的超声医师,掌握IETA专家小组拟定的子宫内膜病变共识的具体内容,对所有入组病例的常规超声及超声造影图像进行盲法分析,以病理结果为参考,比较分析常规超声主、客观测量法及超声造影主、客观测量法对EC病理分期的诊断符合率,采用Kappa检验分析超声与病理结果的一致性。同时采用受试者操作特征(ROC)曲线分析超声客观测量方法对EC深肌层浸润及宫颈有无侵犯的诊断效能。 结果本研究发现IETA专家共识总结的子宫内膜厚度、病灶回声、宫腔线的形状、子宫内膜-肌层交界处(结合带)情况、无“亮边”征及子宫内膜病灶血管模式在不同病理分期的EC中,均有较高的特异度及一致性,是预测EC较好的超声指标。超声造影主观评估法(Kappa=0.873,P<0.001)、超声造影客观测量法(Kappa=0.842,P<0.001)、IETA常规超声主观评估法(Kappa=0.811,P<0.001)、IETA常规超声客观测量法(Kappa=0.764,P<0.001)此4种诊断方法与病理结果一致性均良好,超声造影较常规超声对EC病理分期的诊断符合率有一定程度的提高[主观评估法、客观评估法:(90.36%、87.95%) vs(85.54%、81.93%)]。常规超声或超声造影显示病灶前后径、病灶的体积、病灶与子宫前后径的比值对预测EC深肌层浸润(浸润深度≥1/2)均有较好的诊断效能,ROC曲线下面积(AUC)均≥0.945,常规超声或超声造影显示病灶外缘与浆膜层的最小距离评估法诊断效能较差,AUC仅为0.414、0.462。常规超声或超声造影显示病灶下缘与宫颈外口距离评估法对预测EC有无宫颈侵犯的诊断效能一般,AUC为0.521、0.559。 结论IETA经阴道常规超声声像特征与超声造影对EC的诊断及预测病理分期均具有较好的效果,且对超声术语进行规范化描述,临床上值得推荐使用。超声造影较经阴道常规超声的诊断效能有一定程度提高,能更好地显示病变对周围肌层及宫颈的浸润深度、侵犯范围;超声造影联合经阴道常规超声,可能达到EC早期发现、准确分期、早期治疗的目的。  相似文献   
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【目的】 探讨建设促进公共卫生学术交流与传播的国际化英文科技期刊的有效途径,为我国科技期刊,特别是新创办的英文科技期刊提供借鉴和参考。【方法】 结合《生物安全与健康(英文)》(Biosafety and Health,B&H)的办刊实践,归纳新创办的英文科技期刊的办刊背景、提升国际影响力的举措及获得的成效。【结果】 B&H创刊3 年以来,先后被国内外重要数据库,如DOAJ、RCCSE、CSCD、Scopus、CSTPCD等收录,期刊的国际影响力正在快速提升,期刊的开放获取政策、出版质量和规范性达到国际评估机构的认可标准。【结论】 B&H可填补我国生物安全学科领域期刊的空白,通过坚持国际化办刊之路、吸引优质稿源、积极策划专刊出版、多渠道宣传推广等特色举措,使期刊国际影响力得到快速提升,从而助力公共卫生领域的学术交流与传播。  相似文献   
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目的 研究《国际功能、残疾和健康分类》(ICF)在作业治疗中的理论架构、方法体系及其在临床实践中的系统应用。方法 基于ICF理论,结合世界作业治疗师联合会的相关政策文件,分析作业治疗发展的理论架构,探讨基于ICF框架下临床情境下系统化的作业治疗。结果 基于ICF构建作业治疗的理论架构与方法体系,明确现代康复服务中综合作业治疗干预的目标、原则与应用方法。作业治疗干预目标是通过多学科、跨领域地应用综合作业治疗方案,提高个体的活动和参与,使功能最佳化。作业治疗基于生物-心理-社会模式,坚持以人为本和功能定向的原则,在不同情景下实施个性化的干预方案。在临床实践中,建议系统应用世界卫生组织国际健康分类家族,构建系统化的作业治疗服务体系,即功能与需求分析(ICHI)-功能分类、评估及编码(ICF)-疾病分类、诊断及编码(ICD)-作业治疗干预(ICHI)。结论 构建了基于ICF的作业治疗理论架构与方法体系,建立了综合性的临床作业治疗应用模式,明确了以活动和参与为导向的作业治疗干预目标,提高了作业治疗的系统化、结构化、标准化及精细化水平。  相似文献   
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Introduction and objectivesNon-alcoholic steatohepatitis (NASH) is a severe form of non-alcoholic fatty liver disease (NAFLD) that can progress to liver cirrhosis, liver failure and hepatocellular carcinoma. It is the second leading cause of liver transplant in the US. We aim to investigate the prevalence, demographics and risk factors NASH patients in the US.Patients and methodsWe used a large database (Explorys IBM) that aggregates electronic health records from 26 nationwide healthcare systems. We identified adults with NASH between 2010-2020. Demographics including age, gender and race were collected. NASH risk factors including Diabetes Millets (DM), Hyperlipidemia (HLD), Hypertension (HTN) and Obesity were also collected. Cochran-Armitage test was used to assess the statistical significance of year-by-year trend. Univariable and multivariable logistic regression were used to estimate the odds ratio (OR) of risk factors.ResultsNASH annual prevalence rate increased from 1.51% in 2010 to 2.79% in 2020 (p < 0.0001). The proportion of patients with NASH by gender was 54.1% female vs 45.9% male (OR 1.04 [0.91-1.11]). Caucasian had higher odds of NASH than non-Caucasian (OR 1.42 [1.31-1.54]). NASH is strongly associated with DM and obesity (OR 18.61 [17.35-19.94]) and (OR 20.97 [17.87-23.21]), respectively. Other components of metabolic syndrome were associated with NASH to a lesser degree; HTN (OR 3.24 [3.20-3.28]) and HLD (OR 4.93 [4.85-4.01]).ConclusionThe prevalence of NASH has significantly increased in the US in the last decade. This is likely related to the increased prevalence of risk factors as well as increased awareness of the disease.  相似文献   
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