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1.
Katrice M. Karanfilian MD Monica N. Valentin MD Rajendra Kapila MD Chinmoy Bhate MD Mahnaz Fatahzadeh DMD MSD FRCP Edin Giuseppe Micali MD FRCP Edin Robert A. Schwartz MD MPH DSc FRCP 《International journal of dermatology》2020,59(10):1185-1190
Cervicofacial actinomycosis is an uncommon, chronic, suppurative, and granulomatous bacterial infection. It is often of dental origin and tends to mimic other dental infections, granulomatous disorders, and cancers. The initial diagnostic workup, predicated upon imaging and tissue biopsies, is frequently nonspecific. A definitive diagnosis is usually rendered only after surgical excision and histologic examination of the cervicofacial mass. We propose a classification of three stages: localized infection without sinus involvement, localized infection with sinus involvement, and disseminated infection, to facilitate recognition, diagnosis, and early aggressive treatment. Untreated infection may be life-threatening. Therapy may require long-term antibiotics; however, many cases may also necessitate complete surgical excision. 相似文献
2.
Nita S. Nair Garvit Chitkara Rohini W. Hawaldar Vani Parmar Shalaka Joshi Purvi Thakkar Tanuja Shet Tabbassum Wadasadawala Rajendra A. Badwe 《Clinical breast cancer》2021,21(3):e228-e234
IntroductionSurgery is the primary treatment of phyllodes tumor of the breast, and margins are the most important risk factor associated with local recurrence. We conducted a retrospective audit of 433 patients treated at our center.Patients and MethodsWomen who presented with phyllodes tumors between 1999 and 2017 were included in the analysis. Data was collected from the hospital medical records, telephonic interviews, and electronic mail.ResultsOf the 433 women included in this study, 177 (40.9%) had benign phyllodes tumors, 84 (19.4%) were borderline, 131 (30.3%) were malignant, and 41 (9.5%) had sarcoma. A history of previous excision was noted in 154 (35.6%) patients, of which 104 presented with local recurrence. Of the total patients, 209 (48.3%) underwent breast conservation surgery; the median pT was 6 cm. At a median follow-up of 37.9 months, the 5-year disease-free survival (DFS) was 82.9%. On multivariate analysis, the factors that impacted DFS were histology (hazard ratio, 4.1; 95% confidence interval [CI], 1.5-10.9; P = .005) and history of previous excision biopsy (hazard ratio, 3.39; 95% CI, 1.76-6.52; P < .001). We analyzed 231 women who presented without any prior excision separately, wherein at a median follow-up of 44.1 months, the DFS was 92.1% (95% CI, 92.05%-92.15%). In addition, less recurrences were noted in this cohort (5.6% [13/231] in no-excision biopsy vs. 12.5% with surgery done prior to presentation to our institute).ConclusionA previous history of excision and the histologic subtype of phyllodes tumor are factors that have an impact on DFS, thus emphasizing the need for appropriate surgical planning and en bloc excision of the phyllodes at presentation. 相似文献
3.
4.
Influence of circadian rhythm on mortality after myocardial infarction: data from a prospective cohort of emergency calls 总被引:1,自引:0,他引:1
Manfredini R Boari B Bressan S Gallerani M Salmi R Portaluppi F Mehta RH 《The American journal of emergency medicine》2004,22(7):555-559
Myocardial infarction (MI) occurs more frequently in the morning as a result of the concomitant unfavorable timing of several physiological parameters and/or biochemical conditions. However, little is known about the possible influence of this circadian pattern on prognosis. To evaluate whether the time of symptom onset could potentially influence mortality from acute MI, this prospective study considered all consecutive MIs admitted to the ED of Ferrara, Italy, after a call to the Emergency Coordinating Unit from January 1, 1998, to December 31, 2001. The total sample consisted of 442 MIs (mean age, 68.7 years; males, 72%). Eighty patients (males, 82.5%) died in the ED; the remaining 362 were admitted to the hospital. Of these, 50 (males, 60%) died during their hospital stay. Based on the timing of their symptom onset, cases were categorized both into 24 1-hour intervals and four 6-hour intervals (midnight to 5:59 am, 6:00 am to 11:59 am, noon to 5:59 pm, and 6:00 pm to 11:59 pm), and the circadian distributions of fatal versus nonfatal MIs were compared. The circadian variation of MI peaked between 6:00 am and noon (P < .001), and in this period, there was a trend toward a higher frequency of fatal cases (41.5% vs. 35.2%; chi(2) = 1.911, P = .167). To verify whether this higher frequency of fatal events in the morning hours could be related to possible higher severity of cases observed in that hours, a further separate analysis considering age, infarct site, and peak levels of MB was made. Again, no significant temporal differences among the four 6-hour intervals were found between fatal and nonfatal Mis, although a trend toward older age was observed in morning MIs. Not only the frequency, but also the mortality, of acute MI could be increased in the morning hours. This could be of practical interest for emergency doctors and could have significant implications for acute treatment, because several studies have reported a lowered efficacy of thrombolytic drugs in the morning hours. 相似文献
5.
Hao-Yuan Lee Tsu-Lan Wu Lin-Hui Su Hsin-Chieh Li Rajendra Prasad Janapatla Chyi-Liang Chen Cheng-Hsun Chiu 《Journal of microbiology, immunology, and infection》2018,51(4):500-509
Background
Invasive pneumococcal disease (IPD) was associated with mortality, but the risk factors associated with mortality remains controversial.Methods
A retrospective cohort study was designed. All patients with IPD from 2011 to 2013 admitted in a medical center were screened and collected for their clinical presentations and laboratory characteristics.Results
Approximately half of the 134 IPD isolates derived from these patients belonged to three major serotypes (19A, 6A and 3), which are included in 13-valent pneumococcal conjugate vaccine (PCV13), but not in 7-valent pneumococcal conjugate vaccine (PCV7). Ceftriaxone resistance according to non-meningitis criteria was identified in 38% of the IPD isolates, and was the major independent risk factor associated with inappropriate initial therapy that subsequently contributed to mortality of the patients. Infection by serotype 6A, 15B, 19A, 19F, or 23F was the major independent risk factor associated with ceftriaxone resistance (non-meningitis criteria). 77.6% of these isolates belonged to additional PCV13 serotypes, with more than 40% expressing resistance to ceftriaxone. In terms of serotype coverage, PCV13 covered 94.1% of the IPD isolates with ceftriaxone resistance, in comparison to 21.6% only by PCV7.Conclusions
The increase of ceftriaxone resistance in pneumococci in part driven by PCV7 vaccination in Taiwan is worrisome. The use of PCV13 in children as well as in the elderly population is likely to offer protection from the infection caused by ceftriaxone-resistant pneumococci. It is important to give an effective drug such as penicillin, fluoroquinolones or vancomycin in 2 days for improving outcome of IPD patients. 相似文献6.
Filippo Molinari U. Raghavendra Anjan Gudigar Kristen M. Meiburger U. Rajendra Acharya 《Medical & biological engineering & computing》2018,56(9):1579-1593
Atherosclerosis is a type of cardiovascular disease which may cause stroke. It is due to the deposition of fatty plaque in the artery walls resulting in the reduction of elasticity gradually and hence restricting the blood flow to the heart. Hence, an early prediction of carotid plaque deposition is important, as it can save lives. This paper proposes a novel data mining framework for the assessment of atherosclerosis in its early stage using ultrasound images. In this work, we are using 1353 symptomatic and 420 asymptomatic carotid plaque ultrasound images. Our proposed method classifies the symptomatic and asymptomatic carotid plaques using bidimensional empirical mode decomposition (BEMD) and entropy features. The unbalanced data samples are compensated using adaptive synthetic sampling (ADASYN), and the developed method yielded a promising accuracy of 91.43%, sensitivity of 97.26%, and specificity of 83.22% using fourteen features. Hence, the proposed method can be used as an assisting tool during the regular screening of carotid arteries in hospitals. 相似文献
7.
Unexpected link between iron and drug resistance of Candida spp.: iron depletion enhances membrane fluidity and drug diffusion, leading to drug-susceptible cells 下载免费PDF全文
Prasad T Chandra A Mukhopadhyay CK Prasad R 《Antimicrobial agents and chemotherapy》2006,50(11):3597-3606
Inthis study, we show that iron depletion in Candida albicans with bathophenanthrolene disulfonic acid and ferrozine as chelators enhanced its sensitivity to several drugs, including the most common antifungal, fluconazole (FLC). Several other species of Candida also displayed increased sensitivity to FLC because of iron restriction. Iron uptake mutations, namely, Deltaftr1 and Deltaftr2, as well as the copper transporter mutation Deltaccc2, which affects high-affinity iron uptake in Candida, produced increased sensitivity to FLC compared to that of the wild type. The effect of iron depletion on drug sensitivity appeared to be independent of the efflux pump proteins Cdr1p and Cdr2p. We found that iron deprivation led to lowering of membrane ergosterol by 15 to 30%. Subsequently, fluorescence polarization measurements also revealed that iron-restricted Candida cells displayed a 29 to 40% increase in membrane fluidity, resulting in enhanced passive diffusion of the drugs. Northern blot assays revealed that the ERG11 gene was considerably down regulated in iron-deprived cells, which might account for the lowered ergosterol content. Our results show a close relationship between cellular iron and drug susceptibilities of C. albicans. Considering that multidrug resistance is a manifestation of multifactorial phenomena, the influence of cellular iron on the drug susceptibilities of Candida suggests iron as yet another novel determinant of multidrug resistance. 相似文献
8.
Prabha S. Yadav Vinay K. Shankhdhar Jaiswal Dushyant Sakthipalan Selva SeethaRaman Gujjalanvar Rajendra 《Indian Journal of Plastic Surgery》2012,45(3):459-465
In the past two decades, the advancement in the microsurgical techniques has revolutionised the reconstruction of post-oncological head and neck defects. Free fibula osteocutaneous flap (FFOCF) has been considered as the treatment of choice by many for mandible reconstruction. The improvement in the surgical resection and adjuvant treatment has improved the survival rates even in patients with advanced cancer. Simultaneously the reconstruction is addressed towards more functional and aesthetic aspects to improve the quality of life in these patients. In this respect, a double free flap is advocated in certain cases of extensive composite oromandibular defects (COMDs). But in our institute, we have managed two such cases of extensive COMD with a single FFOCF unit – fibula bone with a skin paddle for inner lining and a perforator-based skin paddle from the proximal part of the FFOCF unit, anastomosed separately for outer cover. Compared to two separate free flaps, this method has the advantage of single donor site and reduction in reconstruction time. Though the technique of divided paddle, deepithelisation and supercharging has been mentioned for FFOCF, no such clinical cases of two free flaps from a single FFOCF unit have been mentioned in the literature.KEY WORDS: Composite oromandibular defect, double free flap, free fibula osteocutaneous flap 相似文献
9.
Gandy SJ Waugh SA Nicholas RS Rajendra N Martin P Houston JG 《The international journal of cardiovascular imaging》2008,24(6):627-632
AIM: Quantitative MRI assessments of cardiac structure and function are possible and potentially useful for longitudinal clinical monitoring. The aim of this study was to compare the magnitude and repeatability of left ventricular (LV) ejection fraction (EF) and mass (LVM) measurements in patients with clinically distinct cardiac conditions. MATERIALS AND METHODS: Patients were recruited into four groups: (i) congestive heart failure (CHF), (ii) left ventricular hypertrophy (LVH), (iii) recent post myocardial infarct (PMI), and (iv) healthy normal volunteers (HNV). LV short-axis images were acquired on a 1.5T MRI scanner and analysed on a satellite workstation. EF and LVM (at ED) values were derived from myocardial segmentations, and intra-observer test-retest coefficients of repeatability (CoR) were determined for each cohort. RESULTS: The mean EF for the CHF patients (30.3%) was lower than for the other cohorts (LVH 72.7%, PMI 53.0%, HNV 67.0%; P < 0.0002). As expected, the mean LVM for the CHF patients (143 g) was greater than for the other cohorts (LVH 122 g, PMI 124 g, HNV 107 g), but only significant when compared to the HNV cohort (P = 0.004). The intra-observer CoR values for EF were 1.5% (LVH), 1.6% (HNV), 2.6% (PMI) and 5.5% (CHF), and 4.6 g (HNV), 6.7 g (PMI), 8.3 g (CHF) and 9.8 g (LVH) for LVM. CONCLUSION: The EF, LVM and associated repeatability parameters are variable and dependent upon the clinical condition under investigation. It is important that reproducibility data for EF and LVM are acquired individually and specifically on a per-cohort basis if the parameters are to form reliable endpoints for longitudinal clinical follow-up assessments. 相似文献
10.
Chandra Mohan Sharma Rajendra Kumar Pandey Banshi Lal Kumawat Dinesh Khandelwal 《Annals of Indian Academy of Neurology》2016,19(2):267-268
Cognitive decline and epilepsy are well recognized complication of Down syndrome (DS). Here, we intend to present a case of 28 year old male who presented with progressive mental regression, gait ataxia and myoclonic jerking especially on awakening in morning. His EEG was normal and karyotyping revealed trisomy of chromosome 21. Very few cases had been described in literature of late-onset myoclonic epilepsy in DS. This is first case report from India and our aim is to propose the inclusion of this entity in the spectrum of progressive myoclonic epilepsies but still more cases are yet to be found. 相似文献