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991.
Introduction Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory breast disease that presents with variable local manifestations.
We describe here the different management protocols based on the clinical presentation of these patients.
Methods A retrospective review of 20 histopathologic confirmed cases of IGM seen over a period of 10 years was performed.
Results The median age was 34 years (age range: 21–45 years). All were married, parous with history of breast feeding. Ill-defined
mass mimicking carcinoma was the commonest presentation (70%); however, with the presence of signs of inflammation like pain
(55%), redness (40%), and peau d’orange (40%), an inflammatory process appeared more likely. Axillary lymph node enlargement
was infrequently seen (40%). Radiologic findings (mammography and ultrasound) were nonspecific. Histopathology showed the
characteristic lobular distribution of granulomatous inflammation in all cases. Surgically, 7 patients had abscess drainage
with open biopsy, and 7 patients had lumpectomy. Six patients with diffuse breast involvement were diagnosed by core needle
biopsy only. Microbial cultures showed no growth. Antibiotics were given empirically when signs of inflammation where present.
Two patients needed further abscess drainage followed by persistent sinus excision 3–6 weeks later. The median follow-up was
24 months (range: 15–42 months). Seventeen patients (85%) were recurrence-free, and 3 patients (15%) were lost to follow-up.
Conclusions Management of IGM cases needs to be tailored according to the clinical presentation. Precise radiologic and pathologic data
interpretation by a multidisciplinary breast team will facilitate diagnosis and minimize unnecessary intervention. 相似文献
992.
Emanuele Soricelli Giovanni Casella Mario Rizzello Benedetto Calì Giorgio Alessandri Nicola Basso 《Obesity surgery》2010,20(8):1149-1153
Background
The prevalence of gastroesophageal reflux disease (GERD) and/or hiatal hernia (HH) is significantly increased in morbidly obese patients. Laparoscopic bariatric procedures such as gastric banding (LGB) and Roux-en-Y gastric bypass have been shown to improve both obesity and reflux symptoms. The aim of this paper is to evaluate the effectiveness of laparoscopic sleeve gastrectomy (LSG) and hiatal hernia repair (HHR) for the treatment of obesity complicated by HH. 相似文献993.
A 60-year-old man, who suffered from advanced rectal cancer accompanied with liver metastasis, underwent an abdominoperineal
resection and a partial hepatectomy. He remained well until 4 months after surgery when he developed a biopsy-proven recurrent
intrapelvic mass and multiple liver tumors. At 6 months after surgery, the metastatic liver tumors grew larger and almost
completely occupied both lobes of the liver. However, 9 months after surgery, the liver tumors regressed remarkably and his
clinical condition improved without any specific treatment for cancer. Although he died of cancerous peritonitis 18 months
after surgery, the autopsy findings did not indicate any apparent regrowth of the liver tumors. To date, only one case report
of a spontaneous regression of a metastatic liver tumor from colorectal cancer has been published in the English literature.
We herein describe this rare case and discuss some of the reasons potentially responsible for the regression.
Received: July 16, 2001 / Accepted: March 5, 2002 相似文献
994.
Zsolt Balogh Cino Bendinelli Timothy Pollitt Rosemary A. Kozar Frederick A. Moore 《European journal of trauma and emergency surgery》2008,34(4):369-377
Postinjury abdominal compartment syndrome (ACS) has evolved during the 1980s together with the introduction of damage control
surgery (DCS) principles. DCS made it possible to salvage severely injured trauma patients who previously would have exsanguinated
due to uncontrollable coagulopathic bleeding. These patients had severe hemorrhagic shock; their abdomens were tightly packed
and had ongoing massive resuscitation. ACS is a lethal complication of the damage control patients. For today the pathophysiological
characteristics of ACS are described, the intra-abdominal pressure is measured on many intensive care units. Postinjury ACS
(primary and secondary) is one of the better characterized etiological types of ACS: risk factors, diagnostic criteria, independent
predictors and preventive strategies are all well documented. Since the mortality of full-blown postinjury ACS is still unacceptably
high and does not seem to improve with earlier decompression, prevention is the recommended strategy to decrease the morbidity
and mortality. Open abdomen is one of the important preventive strategies but it is not free from morbidity and mortality.
With aggressive open abdomen management in postinjury ACS these complications can be minimized. More importantly, timely hemorrhage
control and hemostatic resuscitation are the likely solutions for more efficient prevention of the postinjury ACS. 相似文献
995.
Kavin G. Shah Derry Rajan Jeffrey Nicastro Ernesto P. Molmenti Gene Coppa 《The Indian journal of surgery》2012,74(2):146-148
Bariatric surgery has been demonstrated to be an effective treatment for morbid obesity. The purpose of this study is to investigate
the incidence of pre- and post-operative deep venous thrombosis (DVT) in Lap-Band surgical patients. This study group comprised
56 consecutive patients who underwent Lap-Band surgery. Mean age and body mass index were 38 years (range: 18–64 years) and
50.9 kg/m2 (range: 53–74 kg/m2), respectively. All the patients were screened with duplex ultrasonography pre- and post-operatively. There were no iliac,
femoral, or popliteal vein thromboses detected at any given point of time. No patient had any clinical signs or symptoms of
DVT post-operatively. There were no observable differences attributable to DVT prophylaxis. This data suggest that in the
setting of chemical and mechanical prophylaxis, the incidence of DVT in patients undergoing Lap-Band surgery at an established
bariatric centre is minimal. 相似文献
996.
Hai-Tao Chen Quan-Cai Cai Jian-Ming Zheng Xiao-Hua Man Hui Jiang Bin Song Gang Jin Wei Zhu Zhao-Shen Li 《Annals of surgical oncology》2012,19(3):464-474
Background
Delta-like ligand 4 (DLL4)-Notch signaling plays a key role in tumor angiogenesis, but its prognostic value in patients with pancreatic ductal adenocarcinoma (PDAC) remains unclear. Our aim was to determine whether high DLL4 expression is correlated with poor prognosis after curative resection for PDAC.Methods
Surgical specimens obtained from 89 patients with PDAC were immunohistochemically assessed for DLL4 and vascular endothelial growth factor receptor 2 (VEGFR-2) expression. Prognostic significance of DLL4 expression was evaluated by Kaplan–Meier method and Cox regression. The correlations of DLL4 expression with VEGFR-2 expression, tumor stage, and lymph node metastasis were examined by chi-square test and multivariate logistic regression.Results
There were 38 (42.7%) and 51 patients who showed high and low DLL4 expression, respectively. Survival curves showed that patients with low DLL4 expression had a significantly better survival than those with high DLL4 expression (P < .001). Multivariate survival analysis demonstrated that high DLL4 expression was independently associated with both reduced overall survival (hazard ratio [HR] 2.24; 95% confidence interval [95% CI] 1.14–4.38) and reduced progression-free survival (HR 2.37; 95% CI 1.22–4.60). Multivariate logistic regression analyses showed that high DLL4 expression was independently associated with both advanced tumor stage (odds ratio [OR] 6.84; 95% CI 2.42–9.36) and lymph node metastasis (OR 3.27; 95% CI 1.04–10.34). We also found a positive correlation between DLL4 and VEGFR-2 expression (P < .001).Conclusions
High DLL4 expression is significantly associated with poor prognosis for surgically resected PDAC, advanced tumor stage, and lymph node metastasis. Application of adjuvant therapy targeting DLL4-Notch signaling may improve prognosis.997.
PURPOSE: We report our experience of diagnosing and treating hepatic angiomyolipoma (HAML), a rare benign mesenchymal tumor. METHODS: We analyzed retrospectively the clinicopathologic, radiological, and operative data of 25 patients who underwent surgery for HAML at our institute between November 2001 and May 2006. RESULTS: Most patients (20/25) were asymptomatic and had normal liver function. Ultrasonography (US) showed a heterogeneous hyperechoic mass in 13 of 23 patients, precontrast computed tomography (CT) showed that all of 12 lesions scanned were hypodense, and magnetic resonance imaging (MRI) showed hypointensity on T1-weighted images and hyperintensity on T2-weighted images in most (5/6) lesions. Marked enhancement in the arterial phase was seen in 10 of 12 lesions on CT scans and in 6 of 6 lesions on MRI scans. All tumors were composed of varying proportions of smooth muscle, adipose tissue, and blood vessels, and showed positive immunohistochemical staining for HMB-45. All patients underwent partial hepatectomy and there was no evidence of recurrence after a median follow-up of 43 months. CONCLUSION: The radiological features of HAML vary according to its histological components. The definitive diagnosis of HAML is challenging and depends on the presence of HMB-45-positive myoid cells. Hepatic angiomyolipoma is treated effectively with surgery and the prognosis is good. 相似文献
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