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101.
The Workup for Bariatric Surgery Does Not Require a Routine Upper Gastrointestinal Series 总被引:1,自引:0,他引:1
Andrew J Ghassemian Kenneth G MacDonald MD Paul G Cunningham MD Melvin Swanson PhD Brenda M Brown MRA Patricia G Morris BSN Walter J Pories MD 《Obesity surgery》1997,7(1):16-18
Background: Morbid obesity is a serious disease that afflicts over five million Americans, threatening their health with such
co-morbidities as diabetes, arthritis, pulmonary failure and stroke. Surgery is the only effective therapy, providing long-term
control of weight, diabetes, pulmonary failure, and hypertension for as long as 14 years. Because the operation presents a
major expense, this study examined whether X-ray examination of the gut could be omitted safely as a cost-saving measure.
Methods: The records of 814 consecutive morbidly obese patients who underwent gastric bypass were reviewed to determine: (1)
whether these individuals had undergone an upper gastro-intestinal (GI) series, and (2) if these studies influenced therapy
or caused cancellation or postponement of surgery. Results: Of the 814 patients, 657 (80.7%) underwent a preoperative GI radiography.
Of these examinations, 393 (59.8%) were normal, with the following abnormalities in the remaining 264: hiatal hernia, 164;
esophageal reflux, 39; Schatzki's ring, 18; small bowel diverticula, four; renal stones, four; malrotation, three; gall stones,
two; pyloric ulcer, one; possible pelvic mass, one; calcified leiomyoma, one; and dysphagial lusoria, one. None of these findings
resulted in cancellation or a delay in surgery. Conclusions: The upper GI series can be safely omitted from the routine preoperative
evaluation of patients undergoing gastric bypass. At a cost of $741.00 per examination, this change represents significant
potential savings. Similar evaluations of other routine preoperative tests may well provide a better basis for the evaluation
of these complex patients. 相似文献
102.
103.
R E Glasgow D J Toobert S E Hampson J E Brown P M Lewinsohn J Donnelly 《Patient education and counseling》1992,19(1):61-74
A 10-session, self-management training program was designed specifically for persons over 60 years of age having Type II diabetes. It targeted social learning variables, especially problem-solving skills and self-efficacy, found to be related to diabetes self-care in earlier correlational research. One hundred two adults were randomized to immediate or delayed intervention conditions. At posttest, subjects in the immediate intervention condition showed significantly greater reductions in caloric intake and percent of calories from fat than control subjects. The intervention also produced greater weight reductions and increases in the frequency of glucose testing than did the control condition. Improvements among immediate intervention subjects were generally maintained at a 6-month follow-up. Intervention results from subjects receiving delayed intervention closely replicated those for immediate intervention subjects. We conclude that a relatively short-term program can improve self-management skills of older diabetic adults, and that there is an important need for such interventions. 相似文献
104.
105.
B.H. Lim MRCOG FRNZCOG C.L. Barry MBBS G.H. Brown MRCOG 《The Australian & New Zealand journal of obstetrics & gynaecology》1991,31(1):20-21
We describe a case of preeclampsia with the HELLP (Haemolysis, Elevated Liver enzymes, Low Platelets) syndrome and highlight the delayed diagnosis due to its nonspecific presentation. This syndrome is associated with significant maternal and perinatal mortality and morbidity and we discuss the importance of early recognition of the condition, aggressive management and a multidisciplinary approach. 相似文献
106.
S P Brown E R Anderson Q He S Liu Q Wu H Li R Whittle 《The Journal of sports medicine and physical fitness》1992,32(3):288-292
To compare the oxygen cost of submaximal exercise on the Stairobic stepping (SS) machine with bench stepping (BS), 12 healthy men and women (mean age 23 years) underwent six different five minute exercise bouts that were randomly assigned. Tests were conducted using standard open circuit calorimetry. SS at 40 and 60 st/min was equal to BS at 20 st/min and SS at 80 st/min was equal to BS at 30 st/min for VE and RER. VO2 was equal at 20 st/min (BS) and 60 st/min (SS), and 30 st/min (BS) and 80 st/min (SS). Stairobic MET (SM) displayed values over-estimated actual MET (AM) values at the two lowest SS rates and under-estimated the AM value at the highest SS rate. Forty-eight observations of the MET response of SS were conducted and analyzed (BMDP2R) in a forward stepping solution. The multiple regression equation calculated for AM was: AM = -0.567 + -0.012 (WT) + 0.063 (rate) + 0.612 (SM) with an adjusted R2 of 0.82 and a SEE of 0.90. The physiologic cost of BS was approximately equal to SS at two to three times the BS rate of stepping. 相似文献
107.
Mycosis fungoides (MF) is a malignant T-cell lymphoma that primarily involves the skin, but may, in its advanced stages, metastasize to internal organs. From autopsy series, CNS involvement of MF can be seen in 14% of patients. We describe the CT and MR findings in three patients with CNS metastases. The images showed various manifestations of CNS MF, including parenchymal homogeneously intensely enhancing masses and ependymal enhancement. The CSF and biopsy results were eventually diagnostic in all three cases. One patient was treated prior to pathologic diagnosis, the other two were treated after diagnosis. The tumor improved following treatment in two patients. Although the imaging findings of CNS MF are nonspecific, they can be the first evidence of the disease. 相似文献
108.
The effect of restraint on the activation of macrophages was evaluated based on the induction of I-A expression following injection of viable Mycobacterium bovis (strain BCG) or treatment in vitro with recombinant interferon-gamma (rIFN-gamma). We found that restraint suppressed the induction of I-A expression when applied just prior to or at the same time as the injection of the microorganisms but had no effect if applied after the injection of the Mycobacteria. The effect of stress was attenuated by increasing the number of microorganisms or by incubating macrophages from stressed mice with higher doses of rIFN-gamma. The suppressive effect of restraint does not appear to be associated with uptake, processing or presentation of antigen but rather to an alteration in the response of the macrophages to rIFN-gamma. 相似文献
109.
Effects of inotropes on human leucocyte numbers, neutrophil function and lymphocyte subtypes 总被引:1,自引:1,他引:0
Burns A. M.; Keogan M.; Donaldson M.; Brown D. L.; Park G. R. 《British journal of anaesthesia》1997,78(5):530-535
We have investigated the effects of inotropes with different adrenergic
receptor specificity on differential white cell count, lymphocyte subtypes
and neutrophil function in healthy volunteers. Six healthy, male volunteers
were enrolled into this randomized, placebo-controlled pilot study. Each
volunteer was studied on four separate occasions during a 2-h infusion of
various agents, and for 2 h after stopping the infusion. The agents
investigated were adrenaline 0.1 microgram kg-1 min-1, dobutamine 5
micrograms kg-1 min-1, dopexamine 2 micrograms kg-1 min-1 and 5% glucose
0.5 ml kg-1 h-1. Venous blood was sampled at 0, 30, 120 and 240 min.
Haemodynamic monitoring was continued throughout the study. Full blood
count, white cell differential count and enumeration of lymphocyte subtypes
were performed. Neutrophil function tests included chemoluminescence, and
assessment of neutrophil chemotaxis, phagocytosis and adhesion. The
Wilcoxon signed rank test was used to compare differences between placebo
and active drugs at each time compared with baseline. There was a
significant increase in white cell count, lymphocyte count and neutrophil
count with adrenaline, and a small but significant decrease in these
variables with dobutamine and dopexamine. These changes were also apparent
for absolute CD3+, CD4+ and CD8+ lymphocyte counts. Neutrophil respiratory
burst in response to f-methionyl-leucyl-phenylalanine increased
significantly only with adrenaline at 30 min (P = 0.046). There were no
other significant changes in tests of neutrophil function. Infusion of
inotropes was associated with changes in white cell numbers, lymphocyte
subtypes and neutrophil respiratory burst. In healthy volunteers,
adrenaline had effects different from those of dobutamine and dopexamine.
The clinical relevance of such effects requires further investigation in
critically ill patients.
相似文献
110.
T M Kim H R Brown S H Lee C V Powell P Bethune N L Goller H T Tran J S Mackay 《Modern pathology》1992,5(3):348-352
A 9-yr-old girl developed delayed acute measles inclusion body encephalitis, which was different from subacute sclerosing panencephalitis (SSPE) in clinical course. Measles virus was demonstrated by electron microscopy, immunohistochemistry, and in situ hybridization. Contrary to the most previous reports, matrix (M) protein was present in the brain, cerebrospinal fluid, and serum and was demonstrated by Western blot analysis and in situ hybridization. The hybridization was performed by a nonradioactive digoxigenin method. 相似文献