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31.
CC Thorn M Smith O Aziz TC Holme 《Annals of the Royal College of Surgeons of England》2013,95(1):52-56
Introduction
Perioperative scoring systems aim to predict outcome following surgery and are used in preoperative counselling to guide management and to facilitate internal or external audit. The Waterlow score is used prospectively in many UK hospitals to stratify the risk of decubitus ulcer development. The primary aim of this study was to assess the potential value of this existing scoring system in the prediction of mortality and morbidity in a general surgical and vascular cohort.Methods
A total of 101 consecutive moderate to high risk emergency and elective surgical patients were identified through a single institution database. The preoperative Waterlow score and outcome data pertaining to that admission were collected. The discriminatory power of the Waterlow score was compared against that of the American Society of Anesthesiologists (ASA) grade and the Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM).Results
The inpatient mortality rate was 17% and the 30-day morbidity rate was 29%. A statistically significant association was demonstrated between the preoperative Waterlow score and inpatient mortality (p<0.0001) and 30-day morbidity (p=0.0002). Using a threshold Waterlow score of 20 to dichotomise risk, accuracies of 0.84 and 0.76 for prediction of mortality and morbidity were demonstrated. In comparison with P-POSSUM, the preoperative Waterlow score performed well on receiver operating characteristic analysis. With respect to mortality, the area under the curve was 0.81 (0.80–0.85) and for morbidity it was 0.72 (0.69–0.76). The ASA grade achieved a similar level of discrimination.Conclusions
The Waterlow score is collected routinely by nursing staff in many hospitals and might therefore be an attractive means of predicting postoperative morbidity and mortality. It might also function to stratify perioperative risk for comparison of surgical outcome data. A prospective study comparing these risk prediction scores is required to support these findings. 相似文献32.
Oxidative metabolism of the human eosinophil 总被引:14,自引:1,他引:14
We have compared the oxidative metabolism of human eosinophils (80%-90% purity) to that of neutrophils. Hexose monophosphate (HMP) shunt activity of eosinophils was higher than that of neutrophils under either resting or phagocytizing conditions. Eosinophil HMP shunt activity also was stimulated by phorbol myristate acetate, a membrane- active agent. Eosinophils showed a marked incorporation of 125I into trichloroacetic acid-insoluble material under resting conditions, which increased markedly during phagocytosis. Eosinophils likewise showed a greater reduction of nitroblue tetrazolium dye during phagocytosis than did neutrophils. Measurement of other parameters of oxidative metabolism indicated that eosinophils generated superoxide anion following phagocytosis and also elicited a burst of chemiluminescence similar to that observed during phagocytosis by neutrophils. Measurement of NADPH oxidase activity demonstrated that this enzyme was 3-6 times more active in fractions isolated from eosinophils than in corresponding fractions isolated from neutrophils; this was observed over a range of substrate concentrations. The eosinophil enzyme sedimented differently than the neutrophil enzyme with differential centrifugation; neither showed sedimentation characteristics of peroxidase. These data indicate that eosinophils possess a similar, although in some ways more potent, oxidative burst than neutrophils and are consistent with a role for NADPH oxidase in the initiation of that burst. 相似文献
33.
OBJECTIVE: To study the predictive factors for avascular necrosis (AVN) of
bone in patients with systemic lupus erythematosus (SLE). METHOD: The
records of 38 SLE patients who developed clinically apparent AVN during the
course of their disease were reviewed. Information on clinical
presentation, corticosteroid usage and autoantibody profiles was obtained,
and comparison was made between these patients and 143 consecutive control
SLE patients who did not have AVN. RESULTS: The point prevalence of AVN in
our SLE population was 12%. Patients with AVN, when compared with controls,
had a significantly higher incidence of neurological disease (39% vs 14%; P
< 0.001) and Cushingoid body habitus after steroid treatment (79% vs
53%; P = 0.004). The highest cumulative prednisolone dose in 1 and 4 months
was significantly higher in the AVN group than the controls (1.8 vs 1.1 and
4.5 vs 2.8 g, respectively; P < 0.01 in both) and showed a linear trend
with the incidence of AVN (chi2 test for trend, P < 0.01 in both). Lupus
anticoagulant was associated with AVN (P = 0.02, odds ratio 2.88 [1.14-
7.28]). Logistic regression analysis revealed that the highest cumulative
prednisolone dose administered in 4 months, the maximum and mean daily
prednisolone dosage, and the lupus anticoagulant were independent risk
factors for AVN. CONCLUSIONS: Corticosteroid remains the major predisposing
factor for AVN in SLE. Patients who require an initial high-dose steroid
for disease control are at risk of AVN, especially if they are positive for
the lupus anticoagulant or develop Cushingoid habitus after steroid
treatment. High-risk patients should be closely monitored so that early AVN
can be diagnosed by sensitive techniques such as magnetic resonance imaging
and radioisotope bone scanning.
相似文献
34.
Spontaneous outgrowth of immortalized Epstein-Barr virus (EBV) infected B-cell clones will occur from cultures of peripheral blood mononuclear cells (PBMNCs) of some persons with a history of EBV infection. We determined that outgrowth of such clones may be reproducibly modulated by supplementation of cultures with the hematopoietic growth factors GM- CSF and interleukin-3 (IL-3). Continuous supplementation of cultures with GM-CSF facilitates emergence of immortalized B-cell clones, whereas supplementation with IL-3 completely prevents their emergence. The effect of GM-CSF may be direct, at least in part, as the proliferation of pure clones of EBV-transformed B lymphocytes was augmented in response to GM-CSF. An indirect mechanism appears to be responsible for the inhibition of transformed B-cell outgrowth in response to IL-3, as IL-3 had no inhibitory effect on proliferation of pure transformed B-cell clones and IL-3-mediated inhibition could be eliminated by antibody neutralization of gamma-interferon (gamma-IFN) or tumor necrosis factor-alpha (TNF-alpha) early in culture. The mechanisms of these effects deserve further study and may have clinical relevance to use of hematopoietic growth factors for support of bone marrow (BM) function in immunocompromised patients. 相似文献
35.
JY Nagata TF Rocha‐Lima BP Gomes CC Ferraz AA Zaia FJ Souza‐Filho A De Jesus‐Soares 《Australian dental journal》2015,60(3):416-420
Immature avulsed teeth are not usually treated with pulp revascularization because of the possibility of complications. However, this therapy has shown success in the treatment of immature teeth with periapical lesions. This report describes the case of an immature replanted tooth that was successfully treated by pulp revascularization. An 8‐year‐old boy suffered avulsion on his maxillary left lateral incisor. The tooth showed incomplete root development and was replanted after 30 minutes. After diagnosis, revascularization therapy was performed by irrigating the root canal and applying a calcium hydroxide paste and 2% chlorhexidine gel for 21 days. In the second session, the intracanal dressing was removed and a blood clot was stimulated up to the cervical third of the root canal. Mineral trioxide aggregate was placed as a cervical barrier at the entrance of the root canal and the crown was restored. During the follow‐up period, periapical repair, apical closure and calcification in the apical 4 mm of the root canal was observed. An avulsed immature tooth replanted after a brief extra‐alveolar period and maintained in a viable storage medium may be treated with revascularization. 相似文献
36.
Renal vein thrombosis can occur as a complication of nephrotic syndrome. We present the case of a young man with nephrotic syndrome caused by minimal change disease who developed acute inferior vena cava and left renal vein thrombosis. He was treated initially with intravenous heparin. Because of the persistence of severe left flank pain and gross hematuria, local infusion of recombinant tissue plasminogen activator was tried, with resolution of thrombi and subsidence of symptoms. Functional preservation of the involved kidney is good, as indicated by Tc-99m DMSA scan (involved kidney, 47.4%; uninvolved kidney, 52.6%). Anticoagulation is usually recommended as the treatment of choice in renal vein thrombosis. We believe that in cases with critical presentations, such as bilateral involvement, extension into inferior vena cava, acute renal failure, pulmonary embolism or severe flank pain, thrombolytic therapy should be considered as a second-line treatment if good response is not obtained with heparin. 相似文献
37.
Ageing appearance in China: biophysical profile of facial skin and its relationship to perceived age
AE Mayes PG Murray DA Gunn CC Tomlin SD Catt YB Wen LP Zhou HQ Wang M Catt SP Granger 《Journal of the European Academy of Dermatology and Venereology》2010,24(3):341-348
Background Perceived age is important to women and is a primary driver for topical product use and facial cosmetic surgery. Changes in facial features and biophysical skin parameters with chronological age and their associations with perceived age have not been described in Asian populations. Objective To investigate the relationship between biophysical properties of the skin, visual features of skin ageing and perceived facial age in Chinese women. Methods Facial photographs were collected of 250 Chinese women, aged 25–70 years in Shanghai, China. The perceived facial age was determined and related to the chronological age for each participant and to a range of visual assessments of skin appearance and objective biophysical measurements of the skin. The profile of changes in these parameters with age was investigated together with the differences in those parameters for women judged to look younger than their chronological age and those judged to look older than their chronological age. Results Large discrepancies in perceived age (up to 29 years) were found in women of the same chronological age. Each objective skin measure and visual assessment parameter had a stronger correlation with perceived age than with chronological age. The strongest relationships to perceived age were for wrinkles and hyperpigmentation. Skin colour, hydration and trans‐epidermal water loss (TEWL) had weaker associations with perceived age. Women judged to look older than their chronological age had significantly higher scores than those judged to look younger for coarse wrinkles and hyperpigmentation across all age groups. The appearance differences between these groups were evident in composite facial images of the same average chronological age. Conclusions We have identified the skin attributes which differ with perceived age in Chinese women. Perceived age is a better measure of the biological age of facial skin than is chronological age in this population. 相似文献
38.
BA DARLOW TE INDER KB SLUIS G NUTHALL N MOGRIDGE CC WINTERBOURN 《Journal of paediatrics and child health》1995,31(4):339-344
Objective: New Zealand soils are deficient in the essential micronutrient, selenium. New Zealand infants have low selenium levels at birth and experience a further decline if fed cows milk based formula. This study examined the selenium status of infants fed with a new commercially available selenium supplemented formula.
Methodology Forty-four newborn infants, whose mothers wished to formula feed, were randomized in an open controlled trial to be fed a commercially available selenium supplemented cows milk formula (containing 17 μg Se/L) or an unsupplemented formula (containing 4.6 μg Se/L). Cord, 1 and 3 month blood samples were obtained for selenium status (plasma and red cell selenium and glutathione peroxidase) and thyroid function.
Results Mean plasma selenium and glutathione peroxidase values were significantly higher in supplemented than unsupplemented infants at 1 month (unpaired t -tests; P <0.0001 and P = 0.001 respectively) and 3 months ( P <0.0001 and P = 0.0005). Analysis within treatment groups between time points (paired t -tests) showed that selenium supplementation prevented the fall in plasma selenium from birth to 1 month seen in unsupplemented infants and was associated with a rise in levels between 1 and 3 months ( P = 0.002).
Conclusions Supplementing cows milk formula with selenium to replicate the levels found in breast milk is nutritionally sound. Feeding from a few days of age with a formula containing 17 μg Se/L in infants with low selenium status at birth is sufficient to cause a rise to 80% of adult levels at 3 months of age. 相似文献
Methodology Forty-four newborn infants, whose mothers wished to formula feed, were randomized in an open controlled trial to be fed a commercially available selenium supplemented cows milk formula (containing 17 μg Se/L) or an unsupplemented formula (containing 4.6 μg Se/L). Cord, 1 and 3 month blood samples were obtained for selenium status (plasma and red cell selenium and glutathione peroxidase) and thyroid function.
Results Mean plasma selenium and glutathione peroxidase values were significantly higher in supplemented than unsupplemented infants at 1 month (unpaired t -tests; P <0.0001 and P = 0.001 respectively) and 3 months ( P <0.0001 and P = 0.0005). Analysis within treatment groups between time points (paired t -tests) showed that selenium supplementation prevented the fall in plasma selenium from birth to 1 month seen in unsupplemented infants and was associated with a rise in levels between 1 and 3 months ( P = 0.002).
Conclusions Supplementing cows milk formula with selenium to replicate the levels found in breast milk is nutritionally sound. Feeding from a few days of age with a formula containing 17 μg Se/L in infants with low selenium status at birth is sufficient to cause a rise to 80% of adult levels at 3 months of age. 相似文献
39.
Wang WS; Fan FS; Hsieh RK; Chiou TJ; Lin JK; Lin TC; Yen CC; Liu JH; Hsu H; Chen PM 《Japanese journal of clinical oncology》1997,27(3):174-179
5-Fluorouracil in combination with leucovorin has been shown to be active
in therapeutic trials of metastatic colorectal carcinoma. In this study, we
administered these drugs to 72 patients with metastatic colorectal
carcinoma. Thirty-six of them without previous exposure to 5-fluorouracil
were treated with weekly bolus injections of 5-fluorouracil (425 mg/m2) and
leucovorin (25 mg/m2) supplemented with oral levamisole. Another 36
patients with or without prior 5-fluorouracil treatment received
5-fluorouracil 3,000 mg/m2 and leucovorin 300 mg/m2 in a 48-hour continuous
infusion every two weeks. Clinical efficacy and toxicity were assessed by
WHO criteria. Variables were tested for relations to response and survival
by univariate and multivariate analysis. The response rate was 19.4% in
weekly bolus arm and 13.9% in biweekly high-dose infusion arm (P = 0.527).
Median survivals in the two arms were 18.4 months (weekly) and 21 months
(biweekly) respectively (P = 0.708). Gastrointestinal side effects
including nausea, vomiting, diarrhea and mucositia were the major
toxicities of these regimens. By multivariate analysis, the only factor to
influence response rate was the site of metastases (P = 0.009). The only
factor to affect survival was performance status of the patient (P =
0.0001). We concluded that the two 5-fluorouracil based regimens are
well-tolerated and shown to have a response rate comparable with previous
reports of similar regimens in patients with metastatic colorectal cancer.
Only liver metastases seemed to have a better response to therapy.
Performance status is the most important prognostic factor in patients with
metastatic colorectal cancer.
相似文献
40.
Wang WS; Liu JH; Chiou TJ; Hsieh RK; Yen CC; Chen PM 《Japanese journal of clinical oncology》1997,27(3):180-184
A 28-year-old woman was admitted to our Hospital with a chief complaint of
progressive gingival swelling and loosening of teeth over about a year.
According to past history, she had received total thyroidectomy 2 years
previously due to thyromegaly. The thyroidectomy specimen was at first
interpreted as 'poorly differentiated carcinoma of the thyroid'. One year
ago, she began to be aware of gingival swelling and loosening of teeth. A
gum biopsy was taken and the pathologic features were similar to her
'thyroid carcinoma'. Subsequent investigations, including
immunohistochemical stain, showed the gum was heavily infiltrated with
histiocyte-like Langerhans' cells which were positive for S-100 protein.
Ultrastructural examination of the cells under electron microscope revealed
many typical intra-cytoplasmic Birbeck granules. Langerhans' cell
histiocytosis was diagnosed. Langerhans' cell histiocytosis with thyroid
involvement is extremely rare and may run a relatively indolent course.
Even on a retrospective examination, it may easily be confused with poorly
differentiated carcinoma of the thyroid. We suspect that this error may
have been made on other occasions and that the occurrence of this condition
may be underreported.
相似文献