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91.
Hanratty B Burström B Walander A Whitehead M 《Journal of health services research & policy》2007,12(2):90-94
OBJECTIVE: To investigate the association between public expenditure on health care in the last year of life and individual socioeconomic status in Sweden. METHODS: Population-based study of public expenditure using linked registers for all 16,617 deaths among Stockholm County Council residents in 2002 (population 1.8 million). Age-standardized, total and per capita spend were calculated by income categories, age and specialty. Multivariate analysis examined the association between socioeconomic status and public expenditure. RESULTS: County council expenditure on health care in the last year of life rose with increasing income of the deceased person. Median per capita expenditure increased from 55,417 Swedish Kronor (SEK) (US$ 7542) in the lowest income group to SEK 94,678 (US$ 12,887) in the highest. Total age-standardized spend increased by 60% across the same interval (80,227 [95% confidence interval (CI) 79,946-80,497] to SEK 127,344 [95% CI 126,969-127,719]). Expenditure decreased with increasing age over 65 years in all income groups. Higher income was independently associated with greater total public health spend in multivariate analysis, adjusting for age, sex, health-care utilization and major diagnostic groups. CONCLUSIONS: There is inequality in public expenditure on health care at the end of life across socioeconomic groups in Stockholm. This phenomenon merits attention within Sweden, and beyond, in countries with less comprehensive welfare systems. 相似文献
92.
KJM Jeffery MA MRCP SJ Ellis MA MRCP CG Fink PhD MRCPath 《International journal of clinical practice》1995,49(3):155-156
SUMMARY Described is a confirmed case of non-convulsive status epilepticus, an unusual presentation of M. pneumoniae infection. The postulated pathological mechanisms in this infection are reviewed. 相似文献
93.
George J; Levy Y; Kallenberg CG; Shoenfeld Y 《QJM : monthly journal of the Association of Physicians》1997,90(5):367-373
The association of infections and autoimmune disease has been noted by
various authors. Several mechanisms have been proposed to explain this,
with no current consensus. Wegener's granulomatosis (WG) is an autoimmune
disease involving predominantly the pulmonary and renal systems, and is
associated with a distinct autoantibody-the anti neutrophil cytoplasmic
antibody (ANCA). Although no solid evidence implicates infections in the
emergence of WG, direct and circumstantial data suggest this relation. We
review this evidence and discuss possible underlying mechanisms. We
emphasize the relationship between infections and ANCA, and their role in
the maintenance of the 'on- going' inflammatory response.
相似文献
94.
Barbara Hanratty Frances Drever Ann Jacoby Margaret Whitehead 《European journal of ageing》2007,4(1):35-43
Many countries in Europe are beginning to acknowledge the essential contribution of informal caregivers, as policy changes
leave more people with greater needs being cared for in the community. Carers who are themselves retired are a vulnerable
group. Compared to caregivers in younger age groups, a higher proportion have pre-existing disease; they may be more vulnerable
to the adverse effects of caregiving on health, and many survive on low incomes. This study investigated whether ill health
amongst older carers and hours of caregiving were greater in disadvantaged areas of England and Wales. We also estimated the
cost of replacing this care with formal services. Data were analysed from the 2001 UK census, relating to 9.2 million males
and females of pensionable age living outside of communal establishments in England and Wales. Thirteen percent of people
over retirement age (1.2 million) provided care for others, more than half of whom (742,182) reported poor health. Pensioners
provided care in all areas; the proportion giving care was higher in low deprivation (advantaged) areas, but both the numbers
and proportion of pensioners in poor health providing many hours of care were greater in disadvantaged areas. The annual cost
of replacing all informal with formal social care was estimated to lie between 14.8 and 43.9 billion Euros. Older carers are
an essential support to welfare systems. If demographic shifts require any substitution of formal for informal care, this
will place a significant burden on all areas, with the greatest needs likely to be in the disadvantaged areas.
Competing interests: all authors declare that they have no competing interests.
Ethical permission was not required. 相似文献
95.
96.
Persistence of Staphylococcus aureus as detected by polymerase chain reaction in the synovial fluid of a patient with septic arthritis 总被引:1,自引:0,他引:1
Canvin JM; Goutcher SC; Hagig M; Gemmell CG; Sturrock RD 《Rheumatology (Oxford, England)》1997,36(2):203-206
Septic arthritis commonly occurs in the rheumatoid arthritis population.
The diagnosis is frequently delayed and the associated mortality is high.
In this brief report, we present a patient with rheumatoid arthritis and
prosthetic knee joints who developed septic arthritis and had persisting
evidence of Staphylococcus aureus DNA in synovial fluid, from his knees,
which was detected by polymerase chain reaction (PCR) and a gene probe.
This was detected until 10 weeks of therapy despite adequate antibiotic
treatment and a sterile synovial fluid. In the future, it may be found that
PCR of the synovial fluid will be a valuable investigation for the
diagnosis and management of septic arthritis.
相似文献
97.
Leucocyte membrane expression of proteinase 3 correlates with disease activity in patients with Wegener's granulomatosis 总被引:3,自引:0,他引:3
Wegener's granulomatosis (WG) is an inflammatory disorder characterized by
granulomatous inflammation and vasculitis, and is strongly associated with
antineutrophil cytoplasmic antibodies (ANCA). ANCA in patients with WG are
directed against proteinase 3 (Pr3) in most of the cases. In vitro, upon
neutrophil priming, ANCA antigens are expressed on the cell surface,
thereby becoming available for interaction with ANCA. Subsequently, these
neutrophils become activated. Since ANCA can only interact with leucocytes
when the ANCA antigens are present on the cell surface, we questioned
whether Pr3 is already expressed on the membranes of circulating
granulocytes and monocytes of patients with WG, and whether Pr3 expression
is related to disease activity, so explaining the systemic nature and
severity of the disease. The expression of Pr3, and other ANCA antigens,
i.e. myeloperoxidase (MPO) and human leucocyte elastase (HLE), was analysed
on circulating granulocytes and monocytes by flow cytometry, using a
non-activating whole-blood method. Disease activity was quantitated using
the Birmingham Vasculitis Activity Score (BVAS). Seventeen patients with
active WG and anti-Pr3 antibodies were included in this study. Nine of
these patients were also analysed at the time of remission. Twelve patients
with sepsis served as positive controls, and 10 healthy volunteers as
negative controls for granulocyte/monocyte activation. Pr3 expression on
neutrophils was increased in patients with active WG compared to patients
with quiescent disease and healthy controls. On monocytes, no differences
in Pr3 expression were found between those groups. Furthermore, the
expression of MPO and HLE did not differ between patient groups and healthy
controls. Upon follow-up, the expression of Pr3 on neutrophils from
patients with active WG decreased when patients went into remission. Pr3
expression on neutrophils correlated with the BVAS score (r = 0.40, P <
0.05). In conclusion, circulating neutrophils from patients with active WG
have increased expression of Pr3. In addition, the expression of Pr3
correlates with disease activity, suggesting that the availability of Pr3
for interaction with ANCA plays a central role in the disease process.
相似文献
98.
Hanratty CG McGrath LT McAuley DF Young IS Johnston GD 《Heart (British Cardiac Society)》2001,85(3):326-330
BACKGROUND—Raised homocysteine is a risk factor for vascular disease. Homocysteine is formed from methionine, and dietary manipulation of homocysteine in primates and humans with oral methionine is associated with endothelial dysfunction. A cause-effect relation has not been clearly established.
AIM—To study the effect of oral methionine and then oral homocysteine on endothelial function.
METHODS—22 healthy adults were recruited for two randomised crossover studies, each containing 11 subjects. Endothelial function was determined by measuring forearm blood flow in response to intra-arterial infusion of acetylcholine (endothelium dependent) and sodium nitroprusside (endothelium independent). Subjects received methionine or placebo (study 1), or homocysteine or placebo (study 2). Methionine and homocysteine were determined at baseline and t = 4 hours. Endothelial function was determined at four hours. The responses to the vasoactive substances are expressed as the area under the curve of change in forearm blood flow from baseline.
RESULTS—Study 1: plasma methionine and homocysteine concentrations increased significantly versus placebo. The increases were associated with a reduction of endothelium dependent responses (mean (95% confidence interval), arbitrary units), from 48.8 (95% CI 36.4 to 61.2) to 29.9 (95% CI 18.0 to 41.1), p < 0.04; endothelium independent responses were unchanged. Study 2: homocysteine concentration increased significantly while methionine remained unchanged. Endothelium dependent responses were reduced from 34.6 (95% CI 20.6 to 48.6) to 22.8 (95% CI 12.0 to 33.6), p < 0.03.
CONCLUSIONS—Homocysteine and not methionine is responsible for the changes in endothelial function. This supports the hypothesis that homocysteine promotes atherosclerosis by inducing endothelial dysfunction.
Keywords: homocysteine; methionine; endothelial function; plethysmography 相似文献
AIM—To study the effect of oral methionine and then oral homocysteine on endothelial function.
METHODS—22 healthy adults were recruited for two randomised crossover studies, each containing 11 subjects. Endothelial function was determined by measuring forearm blood flow in response to intra-arterial infusion of acetylcholine (endothelium dependent) and sodium nitroprusside (endothelium independent). Subjects received methionine or placebo (study 1), or homocysteine or placebo (study 2). Methionine and homocysteine were determined at baseline and t = 4 hours. Endothelial function was determined at four hours. The responses to the vasoactive substances are expressed as the area under the curve of change in forearm blood flow from baseline.
RESULTS—Study 1: plasma methionine and homocysteine concentrations increased significantly versus placebo. The increases were associated with a reduction of endothelium dependent responses (mean (95% confidence interval), arbitrary units), from 48.8 (95% CI 36.4 to 61.2) to 29.9 (95% CI 18.0 to 41.1), p < 0.04; endothelium independent responses were unchanged. Study 2: homocysteine concentration increased significantly while methionine remained unchanged. Endothelium dependent responses were reduced from 34.6 (95% CI 20.6 to 48.6) to 22.8 (95% CI 12.0 to 33.6), p < 0.03.
CONCLUSIONS—Homocysteine and not methionine is responsible for the changes in endothelial function. This supports the hypothesis that homocysteine promotes atherosclerosis by inducing endothelial dysfunction.
Keywords: homocysteine; methionine; endothelial function; plethysmography 相似文献
99.
Treatment of the chronic total occlusion: A call to action for the interventional community 下载免费PDF全文
Mauro Carlino MD Caroline J. Magri MD MPHIL Barry F. Uretsky MD Emmanouil S. Brilakis MD PhD Simon Walsh MD James C. Spratt MD Colm Hanratty MD J. Aaron Grantham MD Stéphane Rinfret MD SM Craig A. Thompson MD William L. Lombardi MD Alfredo R. Galassi MD George Sianos MD Azeem Latib MD Roberto Garbo MD Dimitri Karmpaliotis MD PhD David E. Kandzari MD Antonio Colombo MD 《Catheterization and cardiovascular interventions》2015,85(5):771-778
There is substantial evidence that recanalization of a chronic total occlusion is beneficial; nonetheless, it is generally underutilized in clinical practice. We consider the Aesop's fable of the “Fox and the Grapes” as analogous to the current situation in interventional cardiology. The technical challenges in achieving CTO recanalization has led interventionalists, clinical cardiologists, and sometimes even patients to believe that CTO recanalization is not effective, and, therefore, not needed. This perspective reviews available data regarding efficacy and safety of CTO percutaneous coronary intervention (PCI) in the current drug‐eluting stent era, discusses areas where more studies are required, and encourages the interventional community to utilize CTO PCI where appropriate based on current evidence. © 2014 Wiley Periodicals, Inc. 相似文献
100.
A 21-year-old woman presented with acute onset of upper abdominal pain. A diagnosis of Peutz-Jeghers syndrome (PJS) was made based on the clinical picture of perioral pigmentation with imaging findings of transient jejunojejunal intussusceptions and small bowel polyps, and confirmed by characteristic histopathological appearances of Peutz-Jeghers polyps. PJS is a rare hereditary condition characterised by unique hamartomatous polyps, perioral mucocutaneous pigmentations, and increased susceptibility to gastrointestinal and extraintestinal neoplasms. Patients usually present with recurrent abdominal pain due to intussusception caused by polyps. Other modes of presentations include rectal bleeding and melaena. We describe the imaging findings of PJS and provide a brief review of bowel polyposis syndromes. The latter are relatively rare disorders characterised by multiple polyps in the large or small intestine, with associated risk of malignancies and other extraintestinal manifestations. Awareness of the manifestations and early diagnosis of these syndromes is crucial to prevent further complications. 相似文献