收费全文 | 2142篇 |
免费 | 168篇 |
国内免费 | 14篇 |
耳鼻咽喉 | 36篇 |
儿科学 | 37篇 |
妇产科学 | 40篇 |
基础医学 | 296篇 |
口腔科学 | 25篇 |
临床医学 | 256篇 |
内科学 | 502篇 |
皮肤病学 | 31篇 |
神经病学 | 221篇 |
特种医学 | 138篇 |
外国民族医学 | 1篇 |
外科学 | 321篇 |
综合类 | 7篇 |
一般理论 | 1篇 |
预防医学 | 100篇 |
眼科学 | 14篇 |
药学 | 131篇 |
中国医学 | 3篇 |
肿瘤学 | 164篇 |
2024年 | 2篇 |
2023年 | 39篇 |
2022年 | 49篇 |
2021年 | 136篇 |
2020年 | 78篇 |
2019年 | 112篇 |
2018年 | 133篇 |
2017年 | 108篇 |
2016年 | 89篇 |
2015年 | 124篇 |
2014年 | 107篇 |
2013年 | 135篇 |
2012年 | 173篇 |
2011年 | 177篇 |
2010年 | 87篇 |
2009年 | 59篇 |
2008年 | 115篇 |
2007年 | 89篇 |
2006年 | 74篇 |
2005年 | 90篇 |
2004年 | 65篇 |
2003年 | 44篇 |
2002年 | 60篇 |
2001年 | 15篇 |
2000年 | 8篇 |
1999年 | 13篇 |
1998年 | 6篇 |
1997年 | 14篇 |
1996年 | 7篇 |
1995年 | 11篇 |
1994年 | 16篇 |
1993年 | 12篇 |
1992年 | 6篇 |
1991年 | 8篇 |
1990年 | 13篇 |
1989年 | 10篇 |
1988年 | 9篇 |
1987年 | 2篇 |
1986年 | 3篇 |
1985年 | 2篇 |
1984年 | 5篇 |
1983年 | 6篇 |
1982年 | 5篇 |
1981年 | 1篇 |
1980年 | 1篇 |
1979年 | 1篇 |
1977年 | 1篇 |
1975年 | 1篇 |
1972年 | 2篇 |
1971年 | 1篇 |
Purpose
Data on purpura fulminans (PF) in adult patients are scarce and mainly limited to meningococcal infections. Our aim has been to report the clinical features and outcomes of adult patients admitted in the intensive care unit (ICU) for an infectious PF, as well as the predictive factors for limb amputation and mortality.Methods
A 17-year national multicenter retrospective cohort study in 55 ICUs in France from 2000 to 2016, including adult patients admitted for an infectious PF defined by a sudden and extensive purpura, together with the need for vasopressor support. Primary outcome variables included hospital mortality and amputation during the follow-up period (time between ICU admission and amputation, death or end of follow-up).Results
Among the 306 included patients, 126 (41.2%; 95% CI 35.6–46.9) died and 180 (58.8%; 95% CI 53.3–64.3) survived during the follow-up period [13 (3–24) days], including 51/180 patients (28.3%, 95% CI 21.9–35.5) who eventually required limb amputations, with a median number of 3 (1–4) limbs amputated. The two predominantly identified microorganisms were Neisseria meningitidis (63.7%) and Streptococcus pneumoniae (21.9%). By multivariable Cox model, SAPS II [hazard-ratio (HR)?=?1.03 (1.02–1.04); p?<?0.001], lower leucocytes [HR 0.83 (0.69–0.99); p?=?0.034] and platelet counts [HR 0.77 (0.60–0.91); p?=?0.007], and arterial blood lactate levels [HR 2.71 (1.68–4.38); p?<?0.001] were independently associated with hospital death, while a neck stiffness [HR?0.51 (0.28–0.92); p?=?0.026] was a protective factor. Infection with Streptococcus pneumoniae [sub-hazard ratio 1.89 (1.06–3.38); p?=?0.032], together with arterial lactate levels and ICU admission temperature, was independently associated with amputation by a competing risks analysis.Conclusion
Purpura fulminans carries a high mortality and morbidity. Pneumococcal PF leads to a higher risk of amputation.Trials registration
NCT03216577.Background
Septic shock is associated with hypovolemia resulting in organs failure and poor prognosis. The first step in hemodynamic resuscitation relies on early fluid expansion. In this study, we describe qualitative and quantitative fluid resuscitation of septic shock initially managed in a pre-hospital setting by a mobile intensive care unit.Methods
Patients with septic shock who received pre-hospital medical care were retrospectively analysed. Qualitative and quantitative fluid resuscitation performed in the pre-hospital setting were analysed. Applying the "grey zone" concept, we define 3 categories of fluid expansion indexed on ideal body weight (IBW): >20ml/kg, 10-20ml/kg and ?<?10ml/kg. The relationship between the pre-specified categories and mortality at day 28 were analyzed.Results
Ninety-five patients were included. The origin of sepsis was mainly pulmonary (68%). Mortality reached 34%. Pre-hospital fluid expansion was performed using serum saline (98%) with a mean of 1158±559ml. An inversed linear relationship between pre-specified categories and mortality was observed. Using logistic regression model, significant association with mortality remained for fluid expansion indexed on IBW: p=0.02, ORa [CI95] = 0.93 [0.89-0.98]. For fluid expansion indexed on IBW?<?10ml/kg, the OR [CI95] was 4.03 [1.78-9.41] (p=0.005) whereas for fluid expansion indexed on IBW?>?20ml/kg, the OR [CI95] was 0.30 [0.13-0.66] (p=0.01).Discussion
Pre-hospital fluid resuscitation in septic shock is mainly performed using crystalloids with quantitative fluid expansion lower than recommended. Low pre-hospital fluid expansion was associated with increased mortality. Further prospective studies are needed to evaluate the impact of optimized early fluid expansion on mortality in the prehospital management of septic shock. 相似文献A substantial number of epileptic patients are resistant to the current medication thus necessitating the search for alternative therapies for intractable forms of the disease. Previous studies demonstrated the acute anticonvulsant properties of the methanol extract of the stem bark of Psychotria camptopus (MEPC) in rats. This study investigated the effects of MEPC on pentylenetetrazole-kindled Wistar rats. Kindling was induced by intraperitoneal injection of pentylenetetrazole (37.5 mg/kg) on every alternate day, 1 h after each daily oral pretreatment of rats (8?≤?n?≤?10) with MEPC (40, 80 and 120 mg/kg), vehicle or diazepam (3 mg/kg) for 43 days. The kindling development was monitored based on seizure episodes and severity. Rats’ brains were collected on day 43 for the determination of oxidative stress parameters. The histomorphological features and neuronal cell viability of the prefrontal cortex (PFC) and hippocampus were also assessed using H&E and Cresyl violet stains. Chronic administration of pentylenetetrazole time-dependently decreased the latency to myoclonic and generalized seizures, and increased seizure scores and the number of kindled rats. MEPC and diazepam significantly increased the latencies to myoclonic jerks and generalized tonic-clonic seizures. These substances also reduced seizure score and the number of rats with PTZ-kindling. MEPC improved glutathione status and decreased lipid peroxidation in the brains of kindled rats. MEPC also exhibited neuroprotection against pentylenetetrazole-induced hippocampal and PFC neuronal damages. These results suggest that P. camptopus has antiepileptogenic activity, which might be related to the augmentation of antioxidant and neuroprotective defense mechanisms, and further confirm its usefulness in the management of epilepsy.
相似文献