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Symptomatic and Clinical Improvement in Morbidly Obese Patients with Gastroesophageal Reflux Disease Following Roux-en-Y Gastric Bypass 总被引:3,自引:0,他引:3
Background: Patients who suffer with gastroesophageal reflux Disease (GERD) endure a worsening of symptoms as their weight
increases. When medical treatment of this condition in the morbidly obese patients fails, surgical intervention may be indicated.
Choosing a procedure which not only helps achieve weight control but which also relieves symptoms and complications of GERD
is the goal. We present a review of patients who have undergone Roux-en-Y Gastric Bypass (RYGBP) and related procedures for
this disease. Methods: One hundred eighty-eight patients undergoing surgery for morbid obesity and for GERD in 1992-1996 were
contacted by mail or phone. All of these patients had undergone preoperative esophagogastroduodenoscopy to grade the severity
of their disease. Their preoperative symptoms were compared to those experienced postoperatively. Results: One hundred thirty
patients underwent a RYGBP with modified Hill fundopexy, 22 patients underwent a distal gastrectomy with modified Hill fundopexy,
8 patients underwent distal gastrectomy alone and 28 patients underwent RYGBP alone. There have been no deaths. There were
nine surgical complications, eight early and one at 2.5 years postoperation. Follow-up is 4-48 months. The average BMI dropped
from 43 to 30.2 kg/m2. Whereas all patients were on some form of medical therapy before surgery, only 14 reported the need for medication postoperatively.
Conclusions: Surgical intervention for weight control and treatment of GERD has been highly successful in our experience both
with respect to weight control and to the reduction of reflux symptoms. Depending upon endoscopic and operative findings a
RYGBP with or without an antireflux procedure can provide dramatic improvement. Gastrectomy with antireflux modifications
is appropriate in selected cases. 相似文献
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Lamiya Samad Chris Hollis Martin Prince Robert Goodman 《International journal of methods in psychiatric research》2005,14(4):230-230
The original article to which this Erratum refers was published in International Journal of Methods in Psychiatric Research, 2005; Vol.14, No.3, 158–166. Copyright © 2005 John Wiley & Sons, Ltd. 相似文献
18.
Detecting pediatric autoimmune neuropsychiatric disorders associated with streptococcus in children with obsessive-compulsive disorder and tics. 总被引:6,自引:0,他引:6
Tanya K Murphy Muhammad Sajid Ohel Soto Nathan Shapira Paula Edge Mark Yang Mark H Lewis Wayne K Goodman 《Neuropsychopharmacology》2004,55(1):61-68
BACKGROUND: A subgroup of children with obsessive-compulsive and tic disorders are proposed to have an infectious trigger. The purpose of this study was to investigate the relationship between group A streptococcal titers and symptom fluctuations in children with a clinical course resembling that described for pediatric autoimmune neuropsychiatric disorders associated with streptococcus. METHODS: Twenty-five children with obsessive-compulsive disorder and/or tic disorder were evaluated for neuropsychiatric severity and group A streptococcal antibody titers (streptolysin O, deoxyribonuclease B, and carbohydrate A) at 6-week intervals for > or = six consecutive evaluations (total visits=277). RESULTS: Children with large symptom fluctuations (n=15) were compared with children without dramatic fluctuations (n=10). Co-movements of obsessive-compulsive/tic severity and group A streptococcal antibodies were assessed. In subjects with large symptom changes, positive correlations were found between streptococcal titers and obsessive-compulsive severity rating changes (p=.0130). These subjects were also more likely to have elevated group A streptococcal titers during the majority of observations (p=.001). Tic symptom exacerbations occurred more often in the fall/winter months than spring/summer months (p=.03). CONCLUSIONS: Patients with marked obsessive-compulsive/tic symptom changes may be characterized by streptococcal titer elevations and exhibit evidence of seasonal tic exacerbations. 相似文献
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D. Le Elizabeth Eric R. Powers Jian-Ping Bin Howard Leong-Poi N. Craig Goodman Sanjiv Kaul 《Journal of nuclear cardiology》2007,14(2):207-214
Background The mechanism by which transmyocardial revascularization (TMR) offers clinical benefit is controversial. We hypothesized that
TMR ameliorates ischemia by reversing paradoxical catecholamine-induced vasoconstriction.
Methods and Results Chronic ischemic cardiomyopathy was created in 11 dogs by placing ameroid constrictors on the proximal coronary arteries and
their major branches. Six weeks later, 35 channels were created percutaneously in the left circumflex artery region, with
the left anterior descending artery region serving as control. At rest, wall thickening and myocardial blood flow did not
change in the treated region, whereas they deteriorated in the control bed. Contractile and myocardial blood flow reserve
increased in the treated region but deteriorated in the control region. There was diminished iodine 123 metaiodobenzylguanidine
uptake and a significant reduction in noradrenergic nerves in the treated region compared with the control region, with a
corresponding reduction in tissue tyrosine hydroxylase activity.
Conclusions We conclude that the absence of a catecholamine-induced reduction in MBF reserve and contractile reserve in the TMR-treated
region with associated evidence of neuronal injury indicates that the relief of exercise-induced ischemia after TMR most likely
results from reversal of paradoxical catecholamine-induced vasoconstriction. These findings may have implications in selecting
patients who would benefit from TMR.
Supported in part by grants from the National Institutes of Health (R01-HL66034 and K-08-HL074290-01). Bethesda. Md. The radio-labeled
microspheres were provided by DuPont Pharmaceuticals, North Billerica. Mass, and the ultrasound equipment was supplied by
Philips. Andover, Mass. Dr Leong-Poi was the recipient of a Fellowship Training Grant from the Canadian Institute of Health
Research and the Heart and Stroke Foundation of Canada. 相似文献