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ObjectiveThis study compared the effects of 90 s of manual compressive therapy (MCT) on latent myofascial trigger points (LTPs) for 3 sessions per week for 4 weeks to determine changes in individual pressure pain threshold (PPT). A total of 30 (15 males, 15 females; age = 22 ± 4 y/o, height = 175 ± 18 cm, weight = 162.5 ± 57.5 kg) symptomatic subjects with LTPs volunteered for the study.MethodsPPT was measured at baseline and pre- and post-treatment for all 12 sessions with a pressure algometer across the 4-week treatment time frame. The MCT was applied to the control group on their LTP at pressure intended to provide a sham condition (1/10 on verbalized analog scale (VAS)). Two experimental groups had MCT applied either directly on the LTP (d-TP) or in close-proximity to their LTP (cp-TP) at moderate pressure (7/10 on VAS).ResultsThere was a significant increase in PPT from the first through twelfth treatment sessions (p < 0.001, partial η2 = 0.914). A significant increase in PPTs between treatment groups was acutely observed from pre- to post-therapy tests (p = 0.001, partial η2 = 0.146). The differences between pre- versus post-treatment PPT measures indicated significant differences (d-TP vs. control, p < 0.001; cp-TP vs. control, p = 0.007). No differences were observed between experimental groups (p = 0.215).ConclusionsPPT continued to increase after several weeks of MCT when applied directly on or within 2.5 cm of an identified LTP compared to control.  相似文献   
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ObjectiveThe purpose of this study was to describe associations between episiotomy at the time of forceps or vacuum-assisted delivery and obstetrical anal sphincter injuries (OASIS).MethodsThis population-based retrospective cohort study used delivery information from a provincial perinatal clinical database. Full-term, singleton, in-hospital, operative vaginal deliveries of vertex-presenting infants from April 1, 2006 to March 31, 2016 were identified. Odds ratios (ORs) and 95% confidence intervals (CIs) for associations between episiotomy and third- or fourth-degree lacerations were calculated in multiple logistic regression models (Canadian Task Force Classification II-2).ResultsEpisiotomy was performed in 34% of 52 241 operative vaginal deliveries. OASIS occurred in 21% of forceps deliveries and 7.6% of vacuum deliveries. Episiotomy was associated with increased odds of severe perineal lacerations for vacuum deliveries among women with (OR 2.48; 95% CI 1.96–3.13) and without (OR 1.12; 95% CI 1.02–1.22) a prior vaginal delivery. Among forceps deliveries, episiotomy was associated with increased odds of OASIS for those with a previous vaginal delivery (OR 1.52; 95% CI 1.12–2.06), but it was protective for women with no previous vaginal delivery (OR 0.73; 95% CI 0.67–0.79). Midline compared with mediolateral episiotomy increased the odds of OASIS in forceps deliveries (OR 2.73; 95% CI 2.37–3.13) and vacuum deliveries (OR 1.94; 95% CI 1.65–2.28).ConclusionIn conclusion, results suggest that episiotomy should be used with caution, particularly among women with a previous vaginal delivery and in the setting of vacuum-assisted delivery. Episiotomy may protect against OASIS in forceps-assisted deliveries for women without a prior vaginal delivery.  相似文献   
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The aim of this review is to report the occurrence of pregnancies in women with premature ovarian insufficiency (POI), naturally or with different treatments (hormonal replacement therapy, IVF, in-vitro maturation and stem cell therapy). This study involved an exhaustive search of the electronic databases MEDLINE, PubMed and Embase covering the period January 2000 to January 2018. A combination of Medical Subject Heading and text words was used to generate a subset of citations, including studies involving POI (‘premature menopause’ or ‘premature ovarian failure’ or ‘POI’ or ‘hypergonadotrophic amenorrhoea’). This subset of citations was then combined with ‘AND’ to the Medical Subject Heading term ‘pregnancy’. Fifteen studies were included in this review. Two randomized controlled trials, two observational studies, and 11 interventional studies reporting cases of pregnancy in women with POI were included. This review reports pregnancy rates across studies ranging from 2.2% to 14.2%. Mean age in patients who achieved a pregnancy was 30 years, highlighting that oocyte quality in these patients is likely unaffected. No treatment has thus far shown its superiority in improving fertility in women with POI. Recent advances in options such as in-vitro maturation and stem-cell therapy, however, are likely to be the future of treatment and may generate new hope for these patients.  相似文献   
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Actinic keratoses are rough patches of skin caused by years of sun damage. There is a small risk that AK patches could progress into a form of skin cancer called cutaneous Squamous Cell Carcinoma (cSCC). Treatment of AK might therefore provide an effective strategy for cSCC prevention, although this theory has not been rigorously tested. Also, the patient perspective on potential benefits of AK treatment in terms of skin cancer reduction has received little attention to date. Treatments for AK include freezing with liquid nitrogen (cryotherapy), surgical removal, topical treatments such as creams or gels (5-fluorouracil, imiquimod, ingenol mebutate gel, diclofenac and retinoic acid), photodynamic (light) therapy, or laser treatment. The aims of this study were (i) to investigate patient preferences for topical treatments for AK using a discrete-choice experiment (DCE); (ii) to evaluate patient willingness to trade between clinical benefit (i.e. how well it works) and medical burden (e.g. inconvenience and unwanted side effects). 109 patients were presented with a series of choices between two hypothetical topical treatments for AK, and a ‘no treatment’ opt-out option in each choice set. Different attributes of the hypothetical treatments related to the burden of medication, (intensity and length of treatment, severity of local skin reaction, and occurrence of flu-like side effects) and the efficacy of treatment (improvement in skin appearance and reduction in skin cancer risk). The analysis of the data is complex, but showed that most patients would be prepared to accept a lower reduction in skin cancer risk (e.g. a 50% reduction in the risk of skin cancer as opposed to a 60% reduction in the risk) and reduced efficacy of treatment (e.g. 50% clearance of AK lesions as opposed to 100% clearance) in order to reduce the length and intensity of the regimen, and side effects including skin inflammation and pain. This highlights the importance for doctors of taking individual patient preferences into account, to improve their views of their AK treatment and the likelihood that they will stick with their treatment.  相似文献   
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Bone marrow‐derived mesenchymal stem/stromal cells (BMSCs) can differentiate into bone‐forming osteoblasts, playing a crucial role in bone regeneration. Exosomes are naturally cell‐secreted nanovesicles and are lately regraded as an emerging mediator of cellular communication in physiological and pathological conditions. The present study aimed at investigating the complex cellular communications, especially those among the differentiating BMSCs, immune cells (e.g., macrophages), and newly recruited BMSCs via exosome‐mediated pathways. Exosomes were first isolated from osteogenically differentiating BMSCs at various stages (Day 0, Day 3, Day 7, and Day 14, respectively). The cellular uptake of isolated exosomes was examined in macrophages and human BMSCs (hBMSCs). The exosomes collected at various osteogenic differentiation stages (0d‐exo, 3d‐exo, 7d‐exo, and 14d‐exo) had no effect on the viability of hBMSCs. The uptake of exosomes (0d‐exo, 3d‐exo, and 7d‐exo) significantly decreased proinflammatory‐gene expression and the level of an M1 phenotypic marker. Our results then revealed that 3d‐exo, 7d‐exo, and 14d‐exo led to a remarkable increase in mesenchymal stem/stromal cell migration. In addition, 0d‐exo significantly promoted the expression of early osteogenic markers, such as alkaline phosphatase and bone morphogenetic protein 2, indicating a pro‐osteogenic role of hBMSC‐derived exosomes. Collectively, these results suggest that exosomes derived from differentiating mesenchymal stem/stromal cells play a unique osteoimmunomodulatory role in the regulation of bone dynamics.  相似文献   
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