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991.
Yong Beom Kim Young Jin Chang Wol Seon Jung Sang Ho Byen Youn Yi Jo 《Journal of anesthesia》2013,27(6):827-831
Purpose
This prospective, randomized trial was designed to assess whether the i-gel supraglottic airway device is suitable for volume-controlled ventilation while applying positive end-expiratory pressure (PEEP) of 5 cmH2O under general anesthesia. It was believed that this device might improve arterial oxygenation.Methods
Forty adult patients (aged 20–60 years) scheduled for elective orthopedic surgery were enrolled in this study. Twenty patients were ventilated without external PEEP [zero positive end-expiratory pressure (ZEEP) group], and the other 20 were ventilated with PEEP 5 cmH2O (PEEP group) after placing an i-gel device. Volume-controlled ventilation at a tidal volume (TV) of 8 ml/kg of ideal body weight, leak volume, and arterial blood gas analysis were investigated.Results
The incidences of a significant leak were similar in the ZEEP and PEEP groups (3/20 and 1/20, respectively; P = 0.605), as were leak volumes. No significant PaO2 difference was observed between the two groups at 1 h after satisfactory i-gel insertion (215 ± 38 vs. 222 ± 54; P = 0.502).Conclusions
The use of an i-gel during PEEP application at 5 cmH2O did not increase the incidence of a significant air leak, and a PEEP of 5 cmH2O failed to improve arterial oxygenation during controlled ventilation in healthy adult patients. 相似文献992.
Kang Hong Lee Joyce Ho Yasir Akmal Rebecca Nelson Alessio Pigazzi 《Surgical endoscopy》2013,27(6):1986-1990
Background
We assessed the short- and long-term outcomes of intracorporeal ileocolic anastomosis (IA) in laparoscopic right hemicolectomy for colon cancer compared with extracorporeal anastomosis (EA).Methods
A retrospective chart review of 86 consecutive patients who underwent laparoscopic right hemicolectomy for colon cancer from March 2005 to June 2010 was performed.Results
There were 51 and 35 patients who underwent intracorporeal and extracorporeal anastomosis, respectively. The two groups were demographically comparable. The conversion rate to open surgery was 8.6 % in the EA group, but none in the IA group (p = 0.064). There was no significant difference in operative time, estimated blood loss, complications (intra-abdominal abscess, anastomotic leak, ileus, and wound infection), and length of hospital stay between the groups. There was no perioperative mortality in both groups. There was no significant difference in median number of retrieved lymph node. The overall survival and the disease-free survival at 3 years were not different between the groups.Conclusions
Compared with the extracorporeal anastomosis technique, intracorporeal ileocolic anastomosis produces comparable short- and long-term outcomes in laparoscopic right hemicolectomy for colon cancer. 相似文献993.
Se Jin Jung Soo-Jeong Cho Il Ju Choi Myeong-Cherl Kook Chan Gyoo Kim Jong Yeul Lee Sook Ryun Park Jun Ho Lee Keun Won Ryu Young-Woo Kim 《Surgical endoscopy》2013,27(4):1211-1218
Background and aims
The best therapeutic modality has not been established for gastric low-grade adenomas or dysplasia (LGD), which can progress to invasive carcinoma despite a low risk. This study aims to investigate the clinical efficacy, safety, and local recurrence after argon plasma coagulation (APC) treatment of gastric LGD compared with endoscopic submucosal dissection (ESD).Patients and methods
A total of 320 patients with gastric LGD ≤2.0 cm treated with APC or ESD between 2004 and 2011 were retrospectively analyzed. We compared local recurrence rate, complication rate, procedure time, and admission to hospital between APC and ESD groups.Results
Of the 320 patients, 116 patients were treated with APC and 204 with ESD. During follow-up, local recurrence was more common in the APC group (3.8 %, 4/106) than the ESD group (0.5 %, 1/188; log-rank test P = 0.036). However, all patients with local recurrence (n = 5) were treated by additional APC, and followed up without further recurrences. ESD was complicated by two perforations (1.0 %, 2/204) compared with no perforations in the APC group (0 %, 0/116). Bleeding complications were not different between the APC (1.7 %, 2/116) and ESD (2.0 %, 4/204) groups. Procedure time was shorter in the APC (7.8 ± 5.1 min) than the ESD (53.1 ± 38.1 min) group (P < 0.001). The proportion of hospitalization was less in the APC group (31.0 %, 36/116) than the ESD group (100.0 %, 204/204) (P < 0.001).Conclusions
APC can be a good treatment option for patients with LGD ≤2.0 cm. 相似文献994.
Joon Sung Kim Byung-Wook Kim Jin Il Kim Jeong Ho Kim Sang Woo Kim Jeong-Seon Ji Bo-In Lee Hwang Choi 《Surgical endoscopy》2013,27(2):501-504
Background
Although the incidence of perforation after endoscopic procedures of the colon is low, the rising number of diagnostic colonoscopies could pose relevant health problems. Optimizing treatment may reduce the probability of severe complications. This study aimed to determine perforation frequency and the management of perforations that occurred during diagnostic colonoscopy.Methods
A retrospective review of patient records was performed for all patients with iatrogenic colonic perforations after sigmoidoscopy/colonoscopy from 2000 to 2011 in three institutions of The Catholic University of Korea. The patients’ demographic data, endoscopic procedure information, perforation location, therapy, and outcomes along with different therapeutic strategies were recorded.Results
In the 12-year period, a total of 115,285 diagnostic sigmoidoscopic/colonoscopic procedures were performed. A total of 27 perforations occurred. Sixteen patients underwent endoscopic clipping, of which three patients failed and were referred for surgery. Fourteen patients in total underwent surgery for perforation. Endoscopic clip closure was successful in 81 % of the patients. No perforation-related major morbidity or mortality occurred.Conclusion
Endoscopic repair using clips can be effective for the treatment of colon perforations that occur during diagnostic colonoscopy. 相似文献995.
Ji Yong Ahn Hwoon-Yong Jung Sue Eun Bae Ji Hoon Jung Ji Young Choi Mi-Young Kim Jeong Hoon Lee Kwi-Sook Choi Do Hoon Kim Kee Don Choi Ho June Song Gin Hyug Lee Jin-Ho Kim Seungbong Han 《Surgical endoscopy》2013,27(3):910-917
Background
Reducing food residue by proper preparation methods before endoscopy after distal gastrectomy can increase the quality of examination and decrease patient discomfort. We evaluated the risk factors for food residue and proper methods of preparation for endoscopy after distal gastrectomy.Methods
Follow-up endoscopy with questionnaires was performed on 1,001 patients who underwent distal gastrectomy at Asan Medical Center between December 2010 and July 2011.Results
Endoscopic examination failed in 94 patients (9.4 %) as a result of large amounts of food residue. Rates of failure were significantly higher in patients who ate a regular diet rather than a soft diet at last dinner before examination (13.9 vs. 6.1 %, p = 0.050), and in those who ate lunch rather than not eating lunch on the day before examination (14.6 vs. 7.7 %, p = 0.020). Multivariate analysis showed that the rate of failed examination was lower in patients who had a history of abdominal surgery (p = 0.011), those who ate a soft (p < 0.001) or liquid (p = 0.003) diet as a last meal rather than a regular diet, those who underwent Billroth I rather than Billroth II reconstruction (p = 0.035), patients with longer fasting time (p = 0.009), and those with a longer gastrectomy-to-endoscopy time interval (p < 0.001).Conclusions
Patients who undergo follow-up endoscopy after surgery should fast more than 18 h and ingest a soft or liquid diet on the day before examination. 相似文献996.
Tracy Ann Moo MD Robert McMillan MD Michele Lee BA Michelle Stempel MPH Sujata Patil PhD Alice Ho MD Mahmoud El-Tamer MD 《Annals of surgical oncology》2013,20(10):3169-3174
Background
Postmastectomy radiotherapy (PMRT) is well established in patients with ≥4 positive axillary lymph nodes (ALN); indications in 1 to 3 positive ALN remains controversial. We examined clinicopathologic criteria used for PMRT selection and compared locoregional recurrence (LRR), recurrence-free survival (RFS), and overall survival (OS) among patients with and without PMRT.Methods
Between 1995 and 2006, a total of 1,331 patients with T1–T2 tumors and 1 to 3 positive ALN underwent mastectomy. We excluded T3/T4 tumors and neoadjuvant chemotherapy; we analyzed 1,087 patients (924 without PMRT, 163 with PMRT). Chi square testing compared clinicopathologic features between groups. The Kaplan–Meier method and Cox regression analysis examined the association between PMRT and LRR, RFS, and OS.Results
PMRT patients were more likely to be ≤50 years old (p = 0.001) and to have larger tumors (p = 0.01), disease of a higher histologic grade (p = 0.03), lymphovascular invasion (LVI) (p < 0.0001), a greater number of positive ALN (p < 0.0001), extranodal invasion (p < 0.0001), and macroscopic ALN metastases (p < 0.0001). With a median follow-up of 7 years, PMRT and no-PMRT groups were similar in LRR (p = 0.57), RFS (p = 0.70), and OS (p = 0.28). On multivariate analysis of the no-PMRT group, age ≤50 years (p = 0.002) and presence of LVI (p < 0.0001) were associated with LRR. Stratified by age and LVI, patients ≤50 years old and with LVI had the highest 5-year LRR, 10.1 versus 1.1 %, than in patients >50 years old without LVI (p < 0.001).Conclusions
By using clinicopathologic features, clinicians delivered PMRT to a select group of patients with T1–T2 tumors and 1 to 3 positive ALN, resulting in similarly low rates of 5-year LRR. Among patients not receiving PMRT, age ≤50 years and LVI were associated with increased LRR rates and warrant PMRT consideration. 相似文献997.
Ho Jung An MD Min-Hee Ryu MD PhD Baek-Yeol Ryoo MD PhD Byeong Seok Sohn MD PhD Ki-Hun Kim MD PhD Sung Tae Oh MD PhD Chang Sik Yu MD PhD Jeong Hwan Yook MD PhD Byung Sik Kim MD PhD Yoon-Koo Kang MD PhD 《Annals of surgical oncology》2013,20(13):4212-4218
Background
Baseline tumor size is one of important prognostic factors for imatinib therapy in patients with advanced gastrointestinal stromal tumor (GIST). The purpose of this study was to determine whether surgical cytoreduction before imatinib therapy can improve the prognosis.Methods
A total of 249 patients with advanced GIST were reviewed retrospectively. Patients were categorized into two groups according to the degree of initial cytoreduction: 35 patients with ≥75 % of initial tumor bulk removed (cytoreduction group) and the other 214 patients (no cytoreduction group). The median follow-up was 44.0 months.Results
Patients in the cytoreduction group were younger, in better performance, showed more initially metastatic disease, peritoneal metastases, but fewer liver metastases. The baseline tumor size when starting imatinib became significantly reduced in the cytoreduction group, which made significant difference between the two groups. By multivariate analyses, mutational status, tumor size, and granulocyte count at presentation were associated with progression-free survival. Age and tumor size were associated with overall survival. However, initial cytoreduction was not significantly related to the prognosis.Conclusions
Cytoreduction before imatinib therapy appears not to improve the prognosis. Imatinib therapy should still represent the initial treatment for advanced GIST. 相似文献998.
Conall M. O’Seaghdha Shih-Jen Hwang Jennifer E. Ho Ramachandran S. Vasan Daniel Levy Caroline S. Fox 《Journal of the American Society of Nephrology : JASN》2013,24(9):1470-1477
Galectin-3, a profibrotic mediator, is linked to the development of renal fibrosis in animal models and inversely correlates with GFR in humans, but whether galectin-3 predicts incident kidney disease is unknown. Here, we assessed renal outcomes for 2450 Framingham Offspring participants who attended examination 6 (1995–1998) and had follow-up data at examination 8 (2005–2008). Renal outcomes of interest included rapid decline in renal function (≥3 ml/min per 1.73 m2 per year decline in estimated GFR [eGFR]), CKD (eGFR < 60 ml/min per 1.73 m2), and albuminuria (albumin-to-creatinine ratio ≥17 mg/g in men or ≥25 mg/g in women). We used multivariable logistic regression models to evaluate associations between galectin-3 with incident renal outcomes at examination 8. During a mean follow-up of 10.1 years, GFR declined rapidly in 241 (9.2%) participants, incident CKD developed in 277 (11.3%), and albuminuria developed in 194 (10.1%). Higher plasma levels of galectin-3 were associated with rapid decline in eGFR (per 1-SD log-galectin-3; adjusted odds ratio [OR], 1.49; 95% confidence interval [CI], 1.28 to 1.73]) and a higher risk of incident CKD (OR, 1.47; 95% CI, 1.27 to 1.71), but not with the risk of incident albuminuria. The addition of galectin-3 to clinical predictors improved the C-statistic (0.837–0.845; P=0.02) but did not reach predefined thresholds for clinically significant improvements to risk prediction based on reclassification indices. In conclusion, elevated levels of plasma galectin-3 are associated with increased risks of rapid GFR decline and of incident CKD in the community, which calls for further study in higher-risk groups.CKD is a major worldwide public health problem1–6 that may result in progressive deterioration in kidney function,7 substantial morbidity,8–10 and increased mortality from both cardiovascular11 and noncardiovascular causes.12 Because of the lack of early clinical signs or symptoms and the poor sensitivity of currently available biomarkers (serum creatinine and urinary protein), CKD is typically detected at an advanced stage. However, when detected early, kidney function decline may be slowed or even reversed and these secondary complications averted.13–15 Hence, there is a pressing clinical need for novel biomarkers that identify at-risk individuals at the earliest possible stage.Galectin-3 is a β-galactoside–binding lectin that has emerged as a key regulator of inflammation and fibrosis.16 Galectin-3 is strongly linked to the development of organ fibrosis in rodent models: Galectin-3 knockout mice are resistant to the development of fibrosis, whereas infusion of recombinant galectin-3 induces TGF-β−dependent tissue fibroblast proliferation and collagen deposition.17,18 In addition, upregulation of galectin-3 has been implicated in fibrosis of multiple organs, including the liver,19,20 lung,21 and heart.17 Galectin-3 has also been linked to the development of renal fibrosis,22,23 as well as fibrosis attenuation via matrix remodeling,24 indicating a context-dependent role.Progressive CKD is characterized by the development of tubulointerstitial fibrosis.25 Galectin-3 expression and secretion by macrophages have previously been shown to promote the development of tubulointerstitial fibrosis in mouse models.23 We believe galectin-3 merits study as a renal biomarker on the basis of this association with renal fibrosis, as well as strong cross-sectional correlations with GFR identified in studies of patients with heart failure and in the general population.26–30 We hypothesized that higher plasma galectin-3 levels would be associated with an increased risk of incident CKD in the general population, defined as estimated GFR (eGFR) < 60 ml/min per 1.73 m2 or incident albuminuria. We also considered whether galectin-3 is associated with rapid decline in kidney function, as assessed by decline in eGFR during the follow-up period. To address these questions, we assessed prospective relations of galectin-3 and these outcomes in unselected participants from the Framingham Heart Study (FHS). 相似文献
999.
1000.