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Calciphylaxis – a topical overview 总被引:3,自引:0,他引:3
G Arseculeratne† AT Evans‡ SM Morley† 《Journal of the European Academy of Dermatology and Venereology》2006,20(5):493-502
'Calciphylaxis', a calcification syndrome associated with ischaemic cutaneous necrosis, is acquired naturally in humans in disease states. It is a life and limb-threatening complication, usually observed in patients with renal disease and secondary hyperparathyroidism, but known to occur in the absence of renal or parathyroid disease. The reported mortality rate, which ranges from 60-80%, relates to wound infection, sepsis and organ failure. It is a small-vessel vasculopathy, which is estimated to occur in about 4% of haemodialysis patients. Clinically, violaceous, reticulate areas of cutaneous necrosis and eschar may be evident, particularly in the extremities. In addition to the clinical picture, a raised calcium phosphorous product, an elevated parathyroid hormone level, radiographic evidence of vessel and soft-tissue calcification and the finding of mural calcification affecting small arteries and arterioles on histopathology help to confirm the diagnosis of this entity which generally has a poor prognosis. A high index of suspicion and an active multidisciplinary management approach, with rigorous attention to wound care and prevention of sepsis, are vital in the management of these patients. In this overview, we discuss the pathophysiology, clinical features and associations, risk factors, diagnosis and management issues relating to calciphylaxis. 相似文献
3.
Bastiaan R Klarenbeek Alexander AFA Veenhof Elly SM de Lange Willem A Bemelman Roberto Bergamaschi Piet Heres Antonio M Lacy Wim T van den Broek Donald L van der Peet Miguel A Cuesta 《BMC surgery》2007,7(1):16
Backround
Diverticulosis is a common disease in the western society with an incidence of 33–66%. 10–25% of these patients will develop diverticulitis. In order to prevent a high-risk acute operation it is advised to perform elective sigmoid resection after two episodes of diverticulitis in the elderly patient or after one episode in the younger (< 50 years) patient. Open sigmoid resection is still the gold standard, but laparoscopic colon resections seem to have certain advantages over open procedures. On the other hand, a double blind investigation has never been performed. The Sigma-trial is designed to evaluate the presumed advantages of laparoscopic over open sigmoid resections in patients with symptomatic diverticulitis. 相似文献4.
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A comparison of the prevalence of rheumatoid arthritis and other rheumatic diseases amongst Pakistanis living in England and Pakistan 总被引:3,自引:0,他引:3
The impact of environmental factors on the causation of rheumatoid
arthritis (RA) is thought to be considerable. We explored this by comparing
the prevalence of RA amongst Pakistanis living in England, where it is
relatively high amongst ethnic English, and in Pakistan. The frequency of
other rheumatic diseases was also compared. Information on 2056 adult
Pakistanis in England and 4232 in Pakistan was obtained by house-to-house
surveys using identical protocols. Positive respondents were examined by
the same two clinicians in both countries. Rheumatic complaints increased
with age and were more common in females in both communities. The
standardized morbidity ratio (SMR) (95% CI) of RA in England was 2.1
(1.1-3.1) compared with Pakistan, a difference that was entirely
attributable to females. The SMR (95% CI) for women was 3.0 (0.4-5.6) and
for men 0.86 (-0.84 to 2.56). In Pakistan, there was a trend to more
reporting of some but not all rheumatic complaints amongst the affluent
segment of the population. This was increasingly apparent amongst those
resident in England and the possibility of an impact of easier
ascertainment amongst the more educated cannot be discounted. Low back pain
was significantly more common in England. Furthermore, the colder climate
was frequently invoked as a cause of more symptoms in England. Thus,
several factors may have influenced the observation that RA is more common
amongst Pakistanis in England compared with Pakistan. An environmental
factor cannot be excluded. However, the frequency of non-specific
musculoskeletal pain was similar. The regions of Pakistan from which the
two populations were derived were also different and immunogenetic
heterogeneity might also have contributed to the difference in RA
prevalence.
相似文献
9.
Thirty rhizobacteria isolated from maize grown in Pakistani and Indonesian soils were evaluated for their morphological characteristics, nitrogen fixation, P-solubilization, indole acetic acid (IAA) and siderophores production. Nitrogenase activity was detected in nineteen isolates ranging from 21.8-3624 n moles C2H4 produced/h/mg protein. Most of the isolates produced IAA, ten were capable of siderophore production while four were P-solubilizers. Ultrastructural studies of Pseudomonas sp. F14 indicated characteristic rhizospheric colonization within 48 h that was observed to change considerably with the passage of time from few bacteria to micro colonies. Random amplified polymorphic DNA (RAPD) analysis of 30 bacterial strains using 30 oligonucleotide primers resulted in considerable level of genetic diversity, with genetic distance ranging from 2-16%. Indonesian isolates were found to be more diverse as compared to Pakistani isolates. The characterization and screening of rhizobacteria of maize rhizosphere has helped in selection of isolates F7, LS-1, 3.1.1.C, F2, F3 and F13 as superior strains for use as bioinoculant. Moreover isolate F14 identified, as Pseudomonas fulgida by partial 16S rRNA sequence analysis is a novel strain regarding its tremendous potentials for inoculum production to enhance the yield of maize. 相似文献
10.
Julio C Delgado Ahasan Hameed Juan J Yunis Kailash Bhol Adriana I Rojas Simeen B Rehman Ashfaq A Khan Manzoor Ahmad Chester A Alper A.Razzzaque Ahmed Edmond J Yunis 《Human immunology》1997,57(2):110-119
ABSTRACT: Pemphigus vulgaris (PV) is an autoimmune disease of the skin and mucous membranes characterized by an autoantibody response against an epidermal cadherin. We performed high resolution HLA class II typing in 19 patients with PV from Rawalpindi, Pakistan and 19 non-Jewish European PV patients from Boston by sequence-specific oligonucleotide probe hybridization. The results were compared with two separate ethnically matched control populations. We found that PV patients from Pakistan had significantly increased frequencies of DRB1*1404 ( p = 0.01), DQA1*0101 ( p = 0.02), and DQB1*0503 ( p = 0.01). Among the patients of non-Jewish European ancestry, DRB1*1401 ( p < 10−6), DQA1*0101 ( p < 10−5) and DQB1*0503 ( p < 10−6), were increased in PV patients. Formal linkage analysis between the major histocompatibility complex and the PV antibody was performed in 67 relatives of the 19 Pakistani patients. The results showed strong evidence for linkage of HLA-DRB1*1404, DQA1*0101, DQB1*0503, with the presence of PV antibody in relatives’ families with a significant logarithm of the odds score of 6.06. Based on the three dimensional structure of class II molecules, we propose that HLA-DQA1*0101 and DQB1*0503, encode a negatively charged P9 peptide binding pocket of the DQ molecule and are significantly associated with susceptibility to PV in non-Jewish populations. 相似文献