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41.
Fascia augmentation of the vocal fold: graft yield in the canine and preliminary clinical experience 总被引:6,自引:0,他引:6
INTRODUCTION: Glottal insufficiency resulting from vocal fold bowing, hypomobility, or scar is frequently treated by injection augmentation. Injection augmentation with fat, collagen, gel foam, polytef, and recently, fascia lata has been previously reported. Variable graft yield and poor host-tissue tolerance have motivated the continued search for an ideal graft substance. STUDY DESIGN: A prospective trial of autologous fascia augmentation of the vocal cord in the human and in an animal model. METHODS: Autologous fascia injection augmentation (AFIA) was evaluated in 8 canines and 40 patients at our institution between 1998 and 2000. The animal study compared graft yield from AFIA with autologous fat yield. The outcome measure was graft yield calculated from histological examination of larynges 12 weeks after injection augmentation. Clinical trial outcome measures included symptom surveys, acoustical voice analyses, and subjective voice assessments. Mean follow-up was 9 months. RESULTS: In the canine larynx, the mean graft yield for AFIA was 33% (range, 5%-84%) compared with autologous lipoinjection (47%; range, 7%-96%; P =.57). Subjective improvement in vocal quality was reported by 95% of patients (38 of 40) after AFIA. Preoperative and postoperative voice analysis data were obtained from 26 patients. Subjective voice rating demonstrated a significant improvement after AFIA (P <.0001). Acoustical parameters of jitter, shimmer, noise-to-harmonic ratio, phonatory range, and degree unvoiced improved significantly (P <.05) in all patients after fascia augmentation. CONCLUSIONS: Based on the animal study, we concluded that graft yields are excellent but variable for AFIA. The result is similar in variability and overall yield to autologous lipoinjection. Subjective and objective analyses of voice outcomes after AFIA are universally improved. Fascia appears to be an excellent alternative to lipoinjection in properly selected cases of glottic insufficiency. 相似文献
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In the early insidious phase of Amyotrophic Lateral Sclerosis (ALS), the patient will often present initially to the otolaryngologist for a presumed speech problem or dysphagia. Adult onset hypernasality, breathiness, articulation defects and voice harshness should all be seen as possible early signs of ALS and may allow the otolaryngologist to be the primary diagnostician for that disease; three such cases are reported here. Once the diagnosis of ALS is made, the otolaryngologist may be involved at different stages in the disease, offering treatment such as Teflon® injections, pharyngeal flap, obturator fitting, cricopharyngeal myotomy, tracheostomy, and cervical esophagostomy for speech, swallowing and aspiration problems. Although they do not halt the progression of this fatal disease, these procedures provide an improved quality of life for the patient whose intellectual function is preserved while his motor functions progressively deteriorate. This is most important for the minority of patients having prolonged survival. 相似文献
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STUDIES ON THE ETIOLOGY OF RENAL HYPERTENSION 总被引:3,自引:0,他引:3
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Centrilobular emphysema: CT-pathologic correlation 总被引:5,自引:0,他引:5
Foster WL Jr; Pratt PC; Roggli VL; Godwin JD; Halvorsen RA Jr; Putman CE 《Radiology》1986,159(1):27-32
Over a 5-year period, 25 patients who had undergone chest computed tomography (CT) died and were autopsied. Their lungs were fixed in the inflated state and were assessed for the presence and severity of centrilobular emphysema (CLE). Three radiologists independently evaluated the CT scans for nonperipheral low-attenuation areas, peripheral low-attenuation areas, pulmonary vascular pruning, pulmonary vascular distortion, and pulmonary density gradient. The CT criterion that best correlated with the presence and severity of CLE was the nonperipheral low-attenuation area. With this CT criterion, lung destruction was correctly identified in 13 of 15 cases. The absence of this criterion resulted in correct identification of eight of ten normal lungs. These preliminary data suggest that CLE can be reliably identified and quantified with current CT scanners. 相似文献
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Open-ended interviews with 107 patients documented specific patient expectations of radiologic procedures during which there was no direct radiologist-patient interaction. Patient expectations could be classified into those related to the facility and those related to interactions with radiology staff. Among facility-related expectations, waiting time far outweighed all other concerns. Interpersonal skills were the predominant expectation of radiology staff. The role of the radiologist in fulfilling patient expectations was less clear. Only 10% of unprompted patients cited the radiologist as a factor in their expectations. When patients were specifically prompted to discuss the radiologist's role, communication skills, accuracy of interpretation, and interpersonal skills were the predominant concerns. 相似文献
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Tristano Pancani Katie L. Anderson Lawrence D. Brewer Inga Kadish Chris DeMoll Philip W. Landfield Eric M. Blalock Nada M. Porter Olivier Thibault 《Neurobiology of aging》2013
The prevalence of obesity and type 2 diabetes increases with age. Despite this, few studies have examined these conditions simultaneously in aged animals, and fewer studies have measured the impact of these conditions on brain function. Using an established animal model of brain aging (F344 rats), we investigated whether a high-fat diet (HFD) exacerbates cognitive decline and the hippocampal calcium-dependent afterhyperpolarization (a marker of age-dependent calcium dysregulation). Young and mid-aged animals were maintained on control or HFD for 4.5 months, and peripheral metabolic variables, cognitive function, and electrophysiological responses to insulin in the hippocampus were measured. HFD increased lipid accumulation in the periphery, although overt diabetes did not develop, nor were spatial learning and memory altered. Hippocampal adiponectin levels were reduced in aging animals but were unaffected by HFD. For the first time, however, we show that the AHP is sensitive to insulin, and that this sensitivity is reduced by HFD. Interestingly, although peripheral glucose regulation was relatively insensitive to HFD, the brain appeared to show greater sensitivity to HFD in F344 rats. 相似文献
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