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Background and AimsColonoscopy is commonly performed for colorectal cancer screening in the United States. Reports are often generated in a non-standardized format and are not always integrated into electronic health records. Thus, this information is not readily available for streamlining quality management, participating in endoscopy registries, or reporting of patient- and center-specific risk factors predictive of outcomes. We aim to demonstrate the use of a new hybrid approach using natural language processing of charts that have been elucidated with optical character recognition processing (OCR/NLP hybrid) to obtain relevant clinical information from scanned colonoscopy and pathology reports, a technology co-developed by Cleveland Clinic and eHealth Technologies (West Henrietta, NY, USA).MethodsThis was a retrospective study conducted at Cleveland Clinic, Cleveland, Ohio, and the University of Minnesota, Minneapolis, Minnesota. A randomly sampled list of outpatient screening colonoscopy procedures and pathology reports was selected. Desired variables were then collected. Two researchers first manually reviewed the reports for the desired variables. Then, the OCR/NLP algorithm was used to obtain the same variables from 3 electronic health records in use at our institution: Epic (Verona, Wisc, USA), ProVation (Minneapolis, Minn, USA) used for endoscopy reporting, and Sunquest PowerPath (Tucson, Ariz, USA) used for pathology reporting.ResultsCompared with manual data extraction, the accuracy of the hybrid OCR/NLP approach to detect polyps was 95.8%, adenomas 98.5%, sessile serrated polyps 99.3%, advanced adenomas 98%, inadequate bowel preparation 98.4%, and failed cecal intubation 99%. Comparison of the dataset collected via NLP alone with that collected using the hybrid OCR/NLP approach showed that the accuracy for almost all variables was >99%.ConclusionsOur study is the first to validate the use of a unique hybrid OCR/NLP technology to extract desired variables from scanned procedure and pathology reports contained in image format with an accuracy >95%.  相似文献   
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At present chronic liver disease(CLD),the third commonest cause of premature death in the United Kingdom is detected late,when interventions are ineffective,resulting in considerable morbidity and mortality.Injury to the liver,the largest solid organ in the body,leads to a cascade of inflammatory events.Chronic inflammation leads to the activation of hepatic stellate cells that undergo transdifferentiation to become myofibroblasts,the main extra-cellular matrix producing cells in the liver;over time increased extra-cellular matrix production results in the formation of liver fibrosis.Although fibrogenesis may be viewed as having evolved as a“wound healing”process that preserves tissue integrity,sustained chronic fibrosis can become pathogenic culminating in CLD,cirrhosis and its associated complications.As the reference standard for detecting liver fibrosis,liver biopsy,is invasive and has an associated morbidity,the diagnostic assessment of CLD by non-invasive testing is attractive.Accordingly,in this review the mechanisms by which liver inflammation and fibrosis develop in chronic liver diseases are explored to identify appropriate and meaningful diagnostic targets for clinical practice.Due to differing disease prevalence and treatment efficacy,disease specific diagnostic targets are required to optimally manage individual CLDs such as non-alcoholic fatty liver disease and chronic hepatitis C infection.To facilitate this,a review of the pathogenesis of both conditions is also conducted.Finally,the evidence for hepatic fibrosis regression and the mechanisms by which this occurs are discussed,including the current use of antifibrotic therapy.  相似文献   
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The purpose of this systematic review was to locate and synthesize peer‐reviewed evidence regarding the effectiveness of providing suicide prevention education to nursing students. Systematic searches were conducted in seven databases (EMBASE, EmCare, Joanna Briggs, MEDLINE, PsycINFO, Scopus, and Web of Science). Results were screened in duplicate at two stages: title and abstract, and full text. Critical appraisal and data extraction were also completed in duplicate. Initial database searching yielded 303 results. Following the addition of seven records from relevant reference lists, and the removal of duplicates, a total of 118 results were included for screening. Eight articles were deemed eligible for inclusion in this review; most (n = 5) were quantitative. While all were conducted within university settings, half were stand‐alone education sessions, while the remaining were integrated with existing programmes/courses. The types of education programmes varied considerably across studies, with only three being established, evidence‐based programmes. The studies explore a range of outcomes, which have been narratively categorized as enhanced skills, abilities, and self‐confidence; development of positive attitudes and beliefs; acquisition of knowledge; and programme experience and evaluation. While there is a small body of evidence indicating that suicide prevention education programmes contribute to improvements in skills, abilities, self‐confidence, and attitudes among nursing students, the variability in educational interventions and outcomes, coupled with short‐term evaluation time frames, makes it difficult to fully understand the impact of this important suicide prevention strategy.  相似文献   
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Objectives. We examined Hispanic men’s recent risky and protective sexual behaviors with female partners by acculturation.Methods. Using the 2006–2010 National Survey of Family Growth, we performed bivariate analyses to compare acculturation groups (Hispanic Spanish-speaking immigrants, Hispanic English-speaking immigrants, Hispanic US natives, and non-Hispanic White men) by demographics and recent sexual behaviors with women. Multivariable logistic regression models for sexual behaviors by acculturation group were adjusted for demographics.Results. Compared with Hispanic Spanish-speaking immigrants, non-Hispanic White men were less likely to report exchange of money or drugs for sex (adjusted odds ratio [AOR] = 0.3; 95% confidence interval [CI] = 0.1, 0.9), but were also less likely to report condom use at last vaginal (AOR = 0.6; 95% CI = 0.4, 0.8) and anal sex (AOR = 0.4; 95% CI = 0.3, 0.7). Hispanic US natives were less likely to report condom use at last vaginal sex than were Spanish-speaking immigrants (AOR = 0.6; 95% CI = 0.4, 0.8). English- and Spanish-speaking immigrants did not differ in risky or protective sexual behaviors.Conclusions. Our findings suggest that targeted interventions focusing on unique sexual risks and sociodemographic differences by acculturation level, particularly nativity, may be helpful for preventing sexually transmitted infections.In the United States, Hispanics are one of the subpopulations disproportionately affected by sexually transmitted infections (STIs).1 In 2010, reported cases of chlamydia were 2.7 times higher for Hispanics than for non-Hispanic Whites.1 Similarly, primary and secondary syphilis cases were 2.2 times higher for Hispanics than for non-Hispanic Whites, an increase of 9.5% since 2009.1 Reported gonorrhea rates were also 2.2 times higher for Hispanics than for non-Hispanic Whites. Regarding gender, the racial/ethnic disparity in gonorrhea rates was higher for men (48.7 per 100 000 for Hispanics vs 19.5 per 100 000 for non-Hispanic Whites) than for women (51.1 per 100 000 for Hispanics vs 26.6 per 100 000 for non-Hispanic Whites).1 Among young adult men (18–26 years), STI disparities were even greater; among Hispanic men, the prevalence of chlamydia and gonorrhea was 5.3 and 4.1 times higher than for non-Hispanic White men, respectively.2Research has shown that Hispanics face many unique challenges that increase their risks for STIs, including immigration-related challenges, living apart from their spouse or regular partner, language barriers, racism, social isolation, and limited access to health care.1,3–5 Compared with non-Hispanic Whites, Hispanics often also have higher poverty, unemployment, and high school dropout rates, and are younger.1,4,6 From 2000 to 2010, the Hispanic population in the United States increased by more than 15.2 million (an increase of 43%), contributing to half of the total population growth in the country.7 Because of the growing Hispanic population, the disproportionate burden of STIs, and the numerous barriers and challenges increasing their risk for STIs, an assessment of the sexual behaviors of Hispanics, including risk and protective behaviors, are of public health importance.An epidemiological concept known as the Hispanic paradox posits that health outcomes for Hispanics tend to be more similar to those of non-Hispanic Whites than those of non-Hispanic Blacks because of less acculturation, or “Americanization,” among Hispanics, which has been shown to be associated with lower sexual risk behaviors and better health outcomes.8–10 Some research suggests that the Hispanic paradox is variable and fluid or may not exist at all.11,12 Although many studies have examined the relationship between acculturation and sexual risk behaviors that are related to STI transmission, most of this research has focused on Hispanic women, adolescents, or men who have sex with men.13–22 Fewer studies have examined differences among Hispanic men in their sexual behaviors with female partners in terms of acculturation group. One study found that low-income, recent-immigrant Hispanic men (living in the United States less than 5 years) were more likely to commercially exchange sexual services and less likely to have a main sex partner than established immigrants (living in the United States for more than 5 years).23 Conversely, established Hispanic immigrant men were more likely to report unprotected sexual intercourse and multiple sex partners than recent immigrants.23 For protective behaviors, condom use at last sex did not significantly differ by acculturation among Hispanic men, although condom use is positively associated with acculturation for women.18,24,25 All of these studies were restricted to specific local areas.Acculturation of Hispanics has been measured in many ways—the use of a single variable, a combination of variables, or scales developed to capture the various aspects of acculturation. Complex measures of acculturation include attitudinal and behavioral factors focused on cultural values.10 More intricate scales of acculturation include heritage and mainstream scales with measures of attitude, behavior, and social relations.10,26 However, it is difficult to include comprehensive measures of acculturation in national surveys that have limited space and competing interests. Measures such as language, country of origin, nativity, and length of time in the country are considered proxy measures of acculturation.11,13,19,27–29 The most frequently used variable to measure acculturation is language of interview (English or Spanish) or the language spoken at home.3,13,14,17,19,21,22,24,27–33 Although acculturation is a multifaceted concept, research suggests that language preference may be a reliable proxy for more complex acculturation measures of Hispanics living in the United States.17For an examination of differences in Hispanic men’s sexual behaviors with female partners by level of acculturation, a national-level examination is useful given the diversity of the Hispanic population in the United States, where origin (Mexican, Puerto Rican, Cuban, Central American, etc.) differs by geography.34 Using data from a national survey, we analyzed the recent sexual behaviors of acculturation groups of Hispanic men (categorized by language of interview and nativity) and compared them with those of non-Hispanic White men. Specifically, we sought to examine differences in recent risky and protective sexual behaviors with female partners among acculturation groups using the 2006–2010 National Survey of Family Growth (NSFG).  相似文献   
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Learning and memory are fundamental processes that are disrupted in many neurological disorders including Alzheimer’s disease and epilepsy. The hippocampus plays an integral role in these functions, and modulation of synaptic transmission mediated by γ-aminobutyric acid (GABA) type-A receptors (GABAARs) impacts hippocampus-dependent learning and memory. The protein diazepam binding inhibitor (DBI) differentially modulates GABAARs in various brain regions, including hippocampus, and changes in DBI levels may be linked to altered learning and memory. The effects of genetic loss of DBI signaling on these processes, however, have not been determined. In these studies, we examined male and female constitutive DBI knockout mice and wild-type littermates to investigate the role of DBI signaling in modulating multiple forms of hippocampus-dependent spatial learning and memory. DBI knockout mice did not show impaired discrimination of objects in familiar and novel locations in an object location memory test, but did exhibit reduced time spent exploring the objects. Multiple parameters of Barnes maze performance, testing the capability to utilize spatial reference cues, were disrupted in DBI knockout mice. Furthermore, whereas most wild-type mice adopted a direct search strategy upon learning the location of the target hole, knockout mice showed higher rates of using an inefficient random strategy. In addition, DBI knockout mice displayed typical levels of contextual fear conditioning, but lacked a sex difference observed in wild-type mice. Together, these data suggest that DBI selectively influences certain forms of spatial learning and memory, indicating novel roles for DBI signaling in modulating hippocampus-dependent behavior in a task-specific manner.  相似文献   
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