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971.
Patrick L. Wagner MD Frances Austin MD Ugwuji Maduekwe MD Arun Mavanur MD Lekshmi Ramalingam MD Heather L. Jones PA Matthew P. Holtzman MD Steven A. Ahrendt MD Amer H. Zureikat MD James F. Pingpank MD Herbert J. Zeh MD David L. Bartlett MD Haroon A. Choudry MD 《Annals of surgical oncology》2013,20(4):1056-1062
Background
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) are frequently used to treat appendiceal carcinomatosis. Some patients require multivisceral resection because of the volume of disease. It is unclear whether extent of CRS impacts survival in appendiceal carcinomatosis.Methods
We analyzed 282 patients undergoing attempted CRS/HIPEC for appendiceal carcinomatosis. Patients were defined as having undergone Extensive CRS (n = 60) if they had >3 organ resections or >2 anastomoses; a subgroup of Extreme CRS patients (n = 10) had ≥5 organ resections and ≥3 anastomoses. Kaplan–Meier survival curves and multivariate Cox-regression models were used to identify prognostic factors affecting outcomes.Results
Relative to the comparison group, patients undergoing Extensive CRS had a higher median peritoneal carcinomatosis index, operative duration, blood loss, and length of stay. No difference in completeness of cytoreduction, severe morbidity, or 60-day mortality was evident. Subgroup analysis of 10 patients undergoing extreme CRS likewise revealed no increase in severe morbidity or mortality. Median progression-free (PFS) and overall survival (OS) were 23.5 and 74 months in the comparison group; 18.5 (p = 0.086) and 51 (p = 0.85) months in the Extensive CRS group; and 40 months and not reached in the Extreme CRS subgroup. In a multivariable analysis, extent of CRS was not independently associated with PFS or OS.Conclusions
Extensive CRS is associated with greater OR time, blood loss, and length of stay, but is not associated with higher morbidity, mortality, or inferior oncologic outcomes in patients with appendiceal carcinomatosis. 相似文献972.
973.
M. Wang W. Ridderberg C.R. Hansen N. Høiby S. Jensen-Fangel H.V. Olesen M. Skov L.E. Lemming T. Pressler H.K. Johansen N. Nørskov-Lauritsen 《Journal of cystic fibrosis》2013,12(6):638-643
ObjectivesIn this nationwide retrospective study, we analysed species distribution, antimicrobial susceptibility and time to next occurrence of Achromobacter in Danish cystic fibrosis (CF) patients from 2000 to 2011.MethodsThirty-four primary isolates were identified to species level and subjected to antimicrobial susceptibility testing. Effectiveness of early antimicrobial treatment was assessed by a Kaplan–Meier estimation of time to recurrence.ResultsAchromobacter xylosoxidans accounted for 13 (38%) of the isolates, and an unnamed species accounted for 11 (32%) of the isolates. Meropenem, piperacillin–tazobactam and trimethoprim–sulfamethoxazole were highly active against chemotherapy-naïve Achromobacter, while ceftazidime, colistin and tobramycin were judged adequate for inhalation therapy. Fifty-five percent of 25 patients treated with inhaled ceftazidime, colistin, or tobramycin remained free of Achromobacter three years after acquisition, in contrast to 17% of 22 patients who did not receive inhaled antibiotics (P < 0.01).ConclusionsEarly treatment with inhaled antibiotics may prevent or postpone chronic infection with Achromobacter in CF patients. 相似文献
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978.
Hidekazu Sugawara Todd A. Linsenmeyer Heather Beam J. Russell Parsons 《The journal of spinal cord medicine》2013,36(4):302-308
AbstractPathologic fractures may occur with minimal trauma after spinal cord injury (SCI) because of osteoporosis. Rats were evaluated to determine whether they could be used as an SCI animal model. Male Sprague-Dawley rats underwent spinal cord transection at the ninth thoracic vertebrae. Control rats underwent a sham procedure. Mechanical testing of the humeral shaft, femoral shaft, tibial shaft, femoral neck, distal femur, and proximal tibia was performed separately at 0, 8, and 24 weeks after surgery. At 24 weeks, significant differences between SCI and control rats were found in maximum torque needed to produce failure in the femoral shaft (63 percent of control, p < 0.05) and tibial shaft (63 percent, p < 0.01), and in compressive load to produce failure in cross-sectional specimens of the distal femur (51 percent, p < 0.05) and proximal tibia (50 percent, p < 0.01 ). No differences were found in the maximum torque needed to produce failure of the humeral shaft (106 percent, p = 0.77) between SCI and control rats. Reductions in relative bone strength in SCI rats at 24 weeks were similar in magnitude to bone mineral density changes reported in humans with chronic paraplegia. Thus, Sprague-Dawley rats appear to be good animal models in which to evaluate changes in bone strength following SCI. U Spinal Cord Med 1998; 21:302-308) 相似文献
979.
Hans-Henrik Tilsted Hansen Leif Thuesen Klaus Rasmussen Henning Rud Andersen Thomas Vesterlund Anton Boel Villadsen Anne Pauline Schroeder Steen Elkjær Husted Torsten Toftegaard Nielsen 《Scandinavian cardiovascular journal : SCJ》2013,47(4):365-370
The aim of this study was to evaluate the outcome of primary percutaneous transluminal coronary angiography (PTCA) in the treatment of acute myocardial infarction (AMI) The study included patients with electrocardiographic signs of transmural AMI, symptom duration of less than 12 h, and with no contraindications to thrombolytic therapy. Patients who had undergone primary PTCA were matched consecutively, for age, gender, infarct localization and duration of symptoms, to patients who had received thrombolytic therapy (82 patients to each group). Patients who were admitted to hospital during daytime had a primary PTCA, whereas those admitted outside daytime were given thrombolytic therapy. In the primary PTCA group, 9 patients had a combined endpoint compared with 22 patients in the thrombolysis group (p < 0.02 ). In-hospital mortality was 3.7% in the PTCA group and 4.9% in the thrombolysis group (ns). At six months, a combined endpoint occurred in 23 patients in the primary PTCA group and in 50 patients in the thrombolysis group (p < 0.00005). Six months' mortality was 4.9% in the PTCA group and 7.3% in the thrombolysis group (ns). Among patients in the PTCA group, left ventricular ejection fraction was significantly higher, stay in hospital was shorter and there were significantly fewer incidences of heart failure and severe arrhythmias than among patients in the thrombolysis group. The results of primary PTCA implemented in our departments are comparable with those reported in randomized trials from experienced centres. Our study indicates that patients treated with primary PTCA have fewer complications, a better left ventricular systolic function and a shorter hospital stay compared with patients treated with thrombolysis. 相似文献
980.
Torben Baek Hansen Inge Agergaard Jakobsen 《Journal of plastic surgery and hand surgery》2013,47(6):313-315
Intra-articular injection of local anaesthetic is a confirmed method of treatment of postoperative pain, particularly after arthroscopy of the knee. The wrist however, has a limited capacity for intra-articular instillation of local anaesthetic, and the aim of this study was to investigate the effect of intra-articular bupivacaine on postoperative pain after arthroscopy of the wrist. We did a prospective, non-randomised study with two comparable, consecutive series of patients undergoing diagnostic/therapeutic wrist joint arthroscopy 20 of whom were given intra-articular 0.5% bupivacaine 5 ml at the end of the arthroscopic procedure and 20 of whom were not. Postoperative pain and use of analgesics (morphine, non-steroidal anti-inflammatory drugs (NSAID) and paracetamol) were recorded in all patients during the following five postoperative days using a visual analogue scale (VAS) and a pain diary. The bupivacaine group reported less pain and less use of analgesics in the first postoperative hours, but for the remaining five postoperative day's pain and the use of analgesics were similar in the two groups. We conclude that intra-articular injection of 0.5% bupivacaine 5 ml after wrist joint arthroscopy reduces pain and use of analgesics during the first postoperative hours, but has no effect during the following five days. 相似文献