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101.
Alexandriah Alas Neeraja Chandrasekaran Hemikaa Devakumar Laura Martin Eric Hurtado G. Willy Davila 《International urogynecology journal》2018,29(1):139-144
Introduction and hypothesis
There is a paucity of data on the success of vaginal surgery for severe prolapse. The authors hypothesized that the success rates of total vaginal hysterectomy (TVH) with McCall culdoplasty in women with advanced pelvic organ prolapse (POP) and in women with less severe POP are similar.Methods
This was a retrospective review of women undergoing TVH with McCall culdoplasty from 2005 to 2014. Advanced POP was defined as exteriorized uterovaginal prolapse with Pelvic Organ Prolapse Quantification (POP-Q) point C, Ba or Bp ≥50% of the total vaginal length. The primary aim was to compare surgical success of TVH with McCall culdoplasty for the repair of advanced POP and less severe POP at ≥1 year.Results
A total of 311 women were included, 38 with advanced POP and 273 with less severe POP. Women with advanced POP were older (71.6 vs. 61.8 years, respectively; p < 0.0001), but there were no significant differences in the length of follow-up (102.5 vs. 117 weeks, p = 0.2378), success rates (76.3% vs. 68.5%, p = 0.3553) or reoperation rates (2.6% vs. 4%, p > 0.9999) between women with advanced POP and less severe POP, respectively. There was a higher failure rate in the anterior compartment in those with advanced POP (18.4% vs. 6.2%, p = 0.0168), but not in the apical or posterior compartment.Conclusions
TVH with McCall culdoplasty is equally effective for the treatment of advanced uterovaginal prolapse as for the treatment of less severe POP. Surgeons should consider this traditional surgery for their patients even if they have high-stage uterovaginal prolapse.102.
Multiparametric Analysis of Heart Rate Variability Used for Risk Stratification Among Survivors of Acute Myocardial Infarction 总被引:5,自引:0,他引:5
ANDREAS VOSS KATERINA HNATKOVA NIELS WESSEL JUERGEN KURTHS RE SANDER ALEXANDER SCHIRDEWAN A JOHN CAMM MAREK MALIK 《Pacing and clinical electrophysiology : PACE》1998,21(1):186-196
A multiparametric heart rate variability analysis was performed to prove if combined heart rate variability (HRV) measures of different domains improve the result of risk stratification in patients after myocardial infarction. In this study, standard time domain, frequency domain and non-linear dynamics measures of HRV assessment were applied to 572 survivors of acute myocardial infarction. Three parameter sets each consisting of 4 parameters were applied and compared with the standard measurement of global heart rate variability HRVi. Discriminant analysis technique and t-test were performed to separate the high risk groups from the survivors. The predictive value of this approach was evaluated with receiver operator (ROC) and positive predictive accuracy (PPA) curves. Results - The discriminant analysis shows a separation of patients suffered by all cause mortality in 80% (best single parameter 74%) and sudden arrhythmic death in 86% (73%). All parameters of set I show a high significant difference (p<0.001) between survivors and non-survivors based on two-tailed t-test. The specificity level of the multivariate parameter sets is at the 70% sensitivity level (ROC) about 85–90%, whereas HRVi shows maximum levels of 70%. The PPA in the all cause mortality group is at the 70% sensitivity level twice as high as the univarihate HRV measure and increases to more than fourfold as high within the VT/VF group. In conclusion, in this population, the multiparametric approach with the combination of four parameters from all domains especially from NLD seems to be a better predictor of high arrhythmia risk than the standard measurement of global heart rate variability. 相似文献
103.
M. LEMNAOUAR E. CHASTRE† A. PAUL M. MERGEY D. VEISSIÈRE G. CHERQUT P. BARBRY‡ B. SIMON-BOUY§ P. FANEN¶ C. GESPACH† J. PICARD 《European journal of clinical investigation》1993,23(3):151-160
Abstract. Primary tracheal epithelial cells obtained from two fetuses with cystic fibrosis (CF) were successfully transfected with a plasmid vector recombined with the large T oncogene of SV40. The resulting tracheal cells were propagated in culture for up to 25 passages and retained the mutations of the CF genes carried by the two fetuses, one heterozygous for the S549N and N1303K substitutions (CFT-I cells), and the other homozygous for the most common deletion ΔF508 (CFT-2 cells). The transfected cells: (a) expressed the SV40 large T oncogene, as determined by immunofluorescence and Northern blot analysis; (b) retained typical epithelial morphology, as assessed by the presence of microvilli, desmosomes, gap junctions, and cytokeratin expression; (c) were fully responsive to the cAMP-stimulating agents isproterenol, forskolin and vasoactive intestinal peptide for cAMP production and PKA activation; (d) do not produce any tumour in the athymic nude mice; (e) were diploid and tetraploid with a normal chromosomal complement at early passages, and (f) exhibited the abnormal regulation of chloride conductance characteristic of CF.
These results indicate that CFT-1 and CFT-2 cells constitute a suitable model for: (a) comparison of the maturation and function of the CFTR protein mutated in the two nucleotide-binding domains; (2) analysis of the biochemical defect in CF epithelial airway cells, (c) development of new therapeutic agents, and correction of the CF defect by gene replacement therapy in vitro . 相似文献
These results indicate that CFT-1 and CFT-2 cells constitute a suitable model for: (a) comparison of the maturation and function of the CFTR protein mutated in the two nucleotide-binding domains; (2) analysis of the biochemical defect in CF epithelial airway cells, (c) development of new therapeutic agents, and correction of the CF defect by gene replacement therapy in vitro . 相似文献
104.
VERONIQUE MAHAUX YVES VERBOVEN RE WALEFFE HENRI KULBERTUS 《Pacing and clinical electrophysiology : PACE》1992,15(11):1862-1866
A sensor driven algorithm limiting ventricular pacing rate during supraventricular tachycardia (SVT) is included in a dual chamber rate modulated pacemaker sensitive to acceleration forces (Relay, 294-03, Intermedics Inc.). According to the intensity of concomitant exercise, the ventricular pacing rate is limited either to the programmed maximum pacing rate (MPR) or to an interim lower limit, called "conditional ventricular tracking limit" (CVTL). The MPR prevails over the CVTL when the sensor calculated pacing rate exceeds the minimal rate by more than 20 beats/mm. The purpose of the study is to determine the clinical safety and efficacy of this algorithm in patients with intermittent SVT. Method: a Relay was implanted in four patients with a bradycardia/tachycardia syndrome and in four patients with complete atrioventricular block (CAVB). All had episodes of paroxysmal atrial tachycardia. The units were programmed in DDDR: rate responsive parameters were adjusted by simulating the rate response during three levels of exercise to let the MPR override the CVTL only during strenuous exercise. Holter monitors and exercise testings were performed at 3-month follow-up. Results: in seven patients, Holter recordings showed Supraventricular arrhythmias at rest with a ventricular pacing rate limited to the CVTL. Appropriate rate increases during exercise testings were also demonstrated. Three devices had to be reprogrammed in DDIR tone patient suffering from nearly permanent atrial flutter and two patients not tolerating the CVTL pacing rate at rest). Conclusion: the CVTL algorithm is effective in protecting against high ventricular pacing rates during Supraventricular arrhythmias. It allows the selection of the DDDR mode even with a high MPR in patients with intermittent SVT. 相似文献
105.
ALADAR RONASZEKI HUGO ECTOR BOUDEWIJN DENEF RE E. AUBERT VAN DE WERF HILAIRE DE GEEST 《Pacing and clinical electrophysiology : PACE》1990,13(12):1728-1731
RONASZEKI, A., ET AL.: Effect of Short Atrioventricular Delay on Cardiac Output. Short atrioventricular (AV) delay modifies late diastolic filling dynamics. The effect of this change on cardiac output [CO) was studied in closed chest, AV blocked canine preparations (N: 10), during AV sequential pacing (80 bpm). CO (thermodilution technique) and transmitral flow velocity (TMFV, pulsed-wave Doppler) were measured and compared (paired t-test) on the basis of TMFV pattern, when atrial contraction (A wave) started just after early diastolic transmitral flow deceleration [PR:219 ± 25 ms, mean ± SD) and when A wave occurred at the end of late diastole and shortened due to the next ventricular contraction (PR: 56 ± 11 ms). The short AV delay resulted in 12.0 ± 5.9% decrease of CO, reflecting the interrupted late diastolic atrial transport. Properly timed atrial contraction is necessary for optimal AV sequential pacing. 相似文献
106.
Coxon RE; Fekade D; Knox K; Hussein K; Melka A; Daniel A; Griffin GG; Warrell DA 《QJM : monthly journal of the Association of Physicians》1997,90(3):213-221
Severe Jarisch Herxheimer reaction (J-HR) precipitated by antibiotic
treatment of louse-borne relapsing fever (LBRF) is associated with a
transient, marked rise in circulating tumour necrosis factor alpha (TNF
alpha), interleukin 6 (IL-6) and interleukin 8 (IL-8). Ovine polyclonal
anti-TNF alpha antibody fragments (Fab) were used in a randomized double
blind placebo controlled trial in an attempt to prevent this reaction.
Within 4 h after penicillin, in controls (n = 29), a several- fold rise in
cytokines occurred, concomitant with a fall in spirochaetes and maximal
clinical manifestations of the J-HR. An intravenous infusion of anti-TNF
alpha Fab, 30 min before penicillin in 20 patients reduced peak plasma
levels of IL-6 and IL-8 (but not IL-1 beta) compared with controls (p =
0.01 and < 0.001, respectively) and the incidence of the J-HR,
indicating some neutralization of TNF alpha. An apparent fall in TNF alpha
reflected interference of anti-TNF alpha in the immunoassay.
相似文献
107.
Emma C. Scott Parameswaran Hari Sathish Kumar Raphael Fraser Omar Davila Nina Shah Robert Peter Gale Miguel Angel Diaz Vaibhav Agrawal Robert F. Cornell Siddhartha Ganguly Gorgun Akpek Cesar Freytes Shahrukh Hashmi Ehsan Malek Rammurti T. Kamble Hillard Lazarus Melhem Solh Anita DSouza 《Biology of blood and marrow transplantation》2018,24(12):2443-2449
The Revised International Staging System (R-ISS) and the International Myeloma Working Group 2014 (IMWG 2014) are newer staging systems used to prognosticate multiple myeloma (MM) outcomes. We hypothesized that these would provide better prognostic differentiation for newly diagnosed multiple myeloma (MM) compared with ISS. We analyzed the Center for International Blood and Marrow Transplant Research database from 2008 to 2014 to compare the 3 systems (N?=?628) among newly diagnosed MM patients undergoing upfront autologous hematopoietic cell transplantation (AHCT). The median follow-up of survivors was 48 (range, 3 to 99) months. The R-ISS provided the greatest differentiation between survival curves for each stage (for overall survival [OS], the differentiation was 1.74 using the R-ISS, 1.58 using ISS, and 1.60 using the IMWG 2014) . Univariate analyses at 3 years for OS showed R-ISS I at 88% (95% confidence interval [CI], 83% to 93%), II at 75% (95% CI, 70% to 80%), and III at 56% (95% CI, 3% to 69%; P < .001). An integrated Brier score function demonstrated the R-ISS had the best prediction for PFS, though all systems had similar prediction for OS. Among available systems, the R-ISS is the most optimal among available prognostic tools for newly diagnosed MM undergoing AHCT. We recommend that serum lactate dehydrogenase and cytogenetic data be performed on every MM patient at diagnosis to allow accurate prognostication. 相似文献
108.
National clinical practice guidelines for allergen immunotherapy: An international assessment applying AGREE‐II 下载免费PDF全文
109.
110.