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11.
BACKGROUND: The QT interval on the ECG is prolonged by more than 50 marketed drugs, an effect that has been associated with syncope and/or sudden cardiac death due to an arrhythmia. Because changes in heart rate also change the QT interval, it has become standard practice to use a correction formula, such as the Bazett formula, to normalize the QT interval to a heart rate of 60 bpm, that is, the rate-corrected QT or QTc. Numerous other formulas have been devised to make this correction, including the Fridericia, Hodges, and Framingham formulas. OBJECTIVES: The purpose of this study was to investigate how the Bazett formula and three other formulas influence assessment of the QT-prolonging effect of the potassium channel-blocking drug ibutilide. METHODS: Using a standardized physical activity protocol, the QT interval was assessed over a broad range of heart rates before and after an infusion of ibutilide (4.75 microg/kg) that produced a stable 15- to 20-ms QT prolongation in consenting normal subjects (9 men and 9 women). The QT interval was measured digitally over a range of heart rates from 60 to 120 bpm, and then four correction formulas (Bazett, Fridericia, Framingham, or Hodges) were applied. The uncorrected change in QT interval due to ibutilide was compared with the change using each of the formulas by repeated measures analysis of variance. RESULTS: At heart rates from 60 to 120 bpm, the Bazett and Fridericia correction formulas overestimated the change in QT in both men and women (P <.001). However, the Framingham and Hodges formulas did not alter the accuracy of the assessment of QT interval change. CONCLUSION: Rate correction of QT intervals using the standard Bazett and Fridericia formulas can introduce significant errors in the assessment of drug effects on the QT interval. This has implications for the clinical assessment of drug effects and for the safety assessment of new drugs under development. 相似文献
12.
Noah A Goldman Ellen B Katz Alan S Glenn Richard H Weldon Joan G Jones Uticia Lynch Melissa J Fezzari Carolyn D Runowicz Gary L Goldberg Maureen J Charron 《Modern pathology》2006,19(11):1429-1436
Glucose is provided to cells by a family of glucose transport facilitators known as GLUTs. These transporters are expressed in a tissue specific manner and are overexpressed in many primary tumors of these tissues. Regulation of glucose transport facilitator expression has been demonstrated in endometrial tissue and endometrial adenocarcinoma. The following experiments were conducted to quantify and localize the expression of GLUT1 and GLUT8 in benign endometrium and compare this expression to endometrial cancer. Endometrial tissue samples were obtained from random hysterectomy specimens of patients with benign indications for surgery and endometrial cancer. Immunoblot and immunolocatization studies were performed using GLUT1 and GLUT8 specific antisera. Endometrial samples from 65 women who had undergone hysterectomy were examined (n=38 benign, n=27 malignant). A 44 and a 35.4 kDa immunoreacive species was demonstrated in endometrium and endometrial cancer for GLUT1 and GLUT8, respectively. Upregulation of GLUT1 expression was demonstrated with increasing grade of tumors (P<0.002). GLUT8 expression was increased in all tumor subtypes compared to atrophic endometrium (P<0.001). Apical localization by GLUT1 and GLUT8 was demonstrated in endometrial glands. GLUT1 and GLUT8 demonstrated diffuse intracellular localization in the cancer subtypes. GLUT1 and GLUT8 are expressed in both human endometrium and endometrial cancer. There appears to be a step-wise progression in GLUT1 and GLUT8 expression as tumor histopathology worsens. GLUT1 and GLUT8 may be important markers in tumor differentiation, as well as providing energy to rapidly dividing tumor cells. 相似文献
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Ellen A. Eisen Paige E. Tolbert Marilyn F. Hallock Richard R. Monson Thomas J. Smith Susan R. Woskie 《American journal of industrial medicine》1994,26(2):185-202
A case-control study of larynx cancer was conducted within a cohort of automobile workers exposed to metal working fluids, commonly referred to as machining fluids (MF). Results are based on 108 cases of larynx cancer and 5:1 matched controls. Risks associated with specific types of MF, as well as specific components of the fluids were evaluated. Based on a retrospective exposure assessment, lifetime exposures to straight and soluble fluids, grinding particulate, biocides, selected metals, sulfur, and chlorine were examined. Exposure to asbestos and acid mists at two of the three study sites was also characterized. Results suggest that straight mineral oils are associated with almost a two-fold excess in larynx cancer risk. There was also evidence of an association with elemental sulfur, commonly added to straight MF to improve the integrity of the materials under extreme pressure and heat. It is not clear whether sulfur is causally related to an excess relative risk of larynx cancer or whether the observed association is the result of unmeasured confounding by another contaminant or process feature. For example, the high stress operations that require MF enriched with sulfur are also more likely to produce polycyclic aromatic hydrocarbons (PAHs) during the process. Thus, the observed association with sulfur may be due to an association with PAH. The finding of excess risk of laryngeal cancer associated with MF is consistent with several previous reports in the literature. This is the first study, however, to distinguish straight mineral oils from other types of MF. Based on these findings, a general reduction in concentrations of straight mineral oil particulate in occupational environments would be prudent. 相似文献
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To conduct a formative and pilot impact evaluation of the State Technical Assessment Team (STAT) program, a visitation-based (visitatie) peer assessment program designed to enhance the organizational capacity of state health department injury prevention programs. The formative evaluation was based on observational, record review, and key informant interview data collected during the implementation of the first 7 STAT visits. Pilot impact data were derived from semi-structured interviews with state injury prevention personnel one year after the visit. Formative evaluation identified 6 significant implementation problems in the first visits that were addressed by the program planners, resulting in improvements to the STAT assessment protocol. Impact evaluation revealed that after one year, the 7 state injury prevention programs had acted on 81% of the recommendations received during their STAT visits. All programs reported gains in visibility and credibility within the state health department and increased collaboration and cooperation with other units and agencies. Other significant program advancements were also reported. Specific program standards and review procedures are important to the success of peer assessment programs such as STAT. Early impact evaluation suggests that peer assessment protocols using the visitatie model can lead to gains in organizational capacity. 相似文献
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Frank L Cole Laura L Kuensting Susan Maclean Cynthia Abel Joyce Mickanin Patty Brueske Mary Ellen Wilson Maureen Rehwaldt 《Journal of emergency nursing》2002,28(5):414-419
INTRODUCTION: Very little is known about clinical nurse specialists and nurse practitioners (advance practice nurses [APNs]) who practice in emergency care settings. The Advanced Practice Committee of the ENA sought to determine a profile of these individuals. METHODS: Surveys were distributed to all registrants at 2 ENA conferences and posted on the ENA Web site. This survey asked 17 questions concerning the demographic characteristics of the APN respondents (eg, education, experience, certification, state recognition, and practice area). The survey was completed by 166 APNs. RESULTS: APNs had considerable experience as ED registered nurses before becoming an APN. They obtained their APN education at the master's degree or post-master's degree level. State recognition was required for 89.2% of the APNs. The majority of APNs (61.4%) obtained their certification through the American Nurses Credentialing Center. Nurse practitioners were predominantly family nurse practitioners (43%), and clinical nurse specialists were either critical care clinical nurse specialists (8.9%) or had other certifications (5.9%). APNs provided services in both the main emergency department and the fast track (45.7%) and were relatively new to their role as an APN. DISCUSSION: Consistent with current educational and certification requirements, the vast majority of APNs held a master's degree. Although relatively new to their role as APNs in emergency care, they were nonetheless very experienced as ED registered nurses. The majority of APNs were certified, even though that is not required for practice in all states. Continued research is needed to identify the most effective utilization of APNs, document their contributions to patient care outcomes, and develop strategies to meet their educational and practice needs. 相似文献
19.
Mary Ellen Turner Kanwal Kher Tamara Rakusan Lawrence D’Angelo Sudesh Kapur Dena Selby Patricio E. Ray 《Pediatric nephrology (Berlin, Germany)》1997,11(2):161-163
We describe the clinical and pathological findings of the hemolytic uremic syndrome (HUS) in two children with human immunodeficiency
virus (HIV) infection. Both patients presented with microangiopathic hemolytic anemia, thrombocytopenia, and subsequently
developed renal failure. The diagnosis of HUS was confirmed by renal histopathology in both patients. None of these children
presented with bloody diarrhea, evidence of circulating antibody response to Escherichia coli O157 lipopolysaccharide, or other known risk factors for HUS, except for the presence of HIV infection. Each patient was
treated with intravenous plasma infusion and renal replacement therapy. Their clinical course was characterized by non-oliguria
and lack of significant hypertension throughout the acute phase of the disease. Despite these favorable clinical parameters,
both patients developed end-stage renal failure. The etiology of this atypical HUS characterized by poor renal survival remains
unknown and the role of HIV infection in its pathogenesis, although possible, is unclear.
Received March 5, 1996; received in revised form and accepted October 15, 1996 相似文献
20.