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Second malignancies after treatment for laparotomy staged IA-IIIB Hodgkin's disease: long-term analysis of risk factors and outcome 总被引:2,自引:1,他引:2
Mauch PM; Kalish LA; Marcus KC; Coleman CN; Shulman LN; Krill E; Come S; Silver B; Canellos GP; Tarbell NJ 《Blood》1996,87(9):3625-3632
The survival of patients with Hodgkin's disease has dramatically improved over the past 30 years because of advances in treatment. However, concern for the risk of long-term complications has resulted in a number of trials to evaluate reduction of therapy. The consequences of these trials on recurrence, development of long-term complications, and survival remain unknown. One major consequence of successful treatment of Hodgkin's disease is the development of second malignant neoplasms. We sought to determine the factors most important for development of second tumors in pathologically staged and treated Hodgkin's disease patients followed for long intervals to provide background information for future clinical trials and guidelines for routine patient follow-up. Between April 1969 and December 1988, 794 patients with laparotomy staged (PS) IA-IIIB Hodgkin's disease were treated with radiation therapy (RT) alone or combined radiation therapy and chemotherapy (CT). There were 8,500 person-years of follow-up (average of 10.7 person-years per patient). Age and gender-specific incidence rates were multiplied by corresponding person-years of observation to obtain expected numbers of events. Observed to expected results were calculated by type of treatment, age at treatment, sex, and time after Hodgkin's disease. Absolute (excess) risk was expressed as number of excess cases per 10,000 person-years. Seventy-two patients have developed a second malignant neoplasm. Eight patients developed acute leukemia, 10 had non-Hodgkin's lymphoma (NHL), and 53 patients developed solid tumors at a median time of 5 years, 7.25 years, and 12.2 years, respectively, after Hodgkin's disease. One patient developed multiple myeloma 16.5 years after Hodgkin's disease. The relative risk (RR) of developing a second malignancy was 5.6. The absolute excess risk per 10,000 person-years (AR) of developing a second malignancy was 69.6 (7.0% excess risk per person per decade of follow-up). The highest RR occurred for the development of leukemia (RR = 66.2), however because of the low expected risk, the AR was only 9.3. The RR of solid tumors after Hodgkin's disease was lower (4.7); however, the AR was greater (49) than for acute leukemia. Among the solid tumors, breast, gastrointestinal, lung, and soft tissue cancers had the highest absolute excess risks. The risk for developing breast cancer after Hodgkin's disease was greatest in women who were under the age of 25 at treatment. The most significant risk factor for the development of both leukemia and solid tumors was the combined use of radiation therapy and chemotherapy. The RR following RT alone was 4.1 (AR = 51.1); for RT + CT (initially or at relapse) the RR was 9.75 (P < 0.05, nonoverlapping confidence limits, AR = 123.9). Survival following development of a second malignancy was poor in patients with leukemia, gastrointestinal tumors, lung cancer, and sarcoma. Survival from other malignancies including NHL and breast cancer was more encouraging. Second malignant neoplasms are a major cause of late morbidity and mortality following treatment for Hodgkin's disease. The most significant risk factor for the development of second tumors is the extent of treatment for Hodgkin's disease. Recommendations are presented for both prevention and early detection of these tumors. 相似文献
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NJ Gogtay KD Kamtekar SS Dalvi SS Mehta AR Chogle U Aigal NA Kshirsagar 《BMC infectious diseases》2006,6(1):16-4
Background
The WHO recommends that adults with uncomplicated P. falciparum successfully treated with a blood schizonticide receive a single dose of primaquine (PQ) 45 mg as a gametocytocidal agent. An earlier pilot study suggested that 75 mg of bulaquine (BQ), of which PQ is a major metabolite, may be a useful alternate to PQ. 相似文献107.
埃索美拉唑能有效控制内镜阴性胃食管反流症状——6个月"按需治疗"对照试验 总被引:3,自引:0,他引:3
对于大多数胃食管反流病 (GERD)病人而言 ,治疗的主要目的在于控制症状和防止复发。而伴有糜烂性食管炎者 ,其主要目标则为愈合糜烂和 /或防止并发症。目前发现 ,大多数GERD病人 ,不论其内镜表现如何 ,短时间内使用抑酸药后 ,症状在 6个月内复发。要维持原来的疗效 ,确保糜烂愈合 ,用最小剂量质子泵抑制剂 (PPI)作维持治疗已是公认的较理想方法。当然长期维持治疗的选择也应顾及病人意愿。如果症状发作不频繁 ,那么按需治疗是一个合理的处理方案。事实上 ,病人也仅在症状复发时才会正规、持续地服药。对这类病人 ,以PPI作为按… 相似文献
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AD Greenhalgh J Galea A Dénes PJ Tyrrell NJ Rothwell 《British journal of pharmacology》2010,160(1):153-159
Background and purpose:
Limited data on the brain penetration of potential stroke treatments have been cited as a major weakness contributing to numerous failed clinical trials. Thus, we tested whether interleukin-1 receptor antagonist (IL-1RA), established as a potent inhibitor of brain injury in animals and currently in clinical development, reaches the brain via a clinically relevant administration route, in experimental stroke.Experimental approach:
Male, Sprague-Dawley rats [either naïve or exposed to middle cerebral artery occlusion (MCAo)] were given a single s.c. dose of IL-1RA (100 mg·kg−1). The pharmacokinetic profile of IL-1RA was assessed in plasma and CSF up to 24 h post-administration. Brain tissue distribution of administered IL-1RA was assessed using immunohistochemistry. In a separate experiment, the neuroprotective effect of the single s.c. dose of IL-1RA in MCAo was assessed versus a placebo control group.Key results:
A single s.c. dose of IL-1RA reduced damage caused by MCAo by 33%. This dose resulted in sustained, high concentrations in plasma and CSF, penetrated brain tissue exclusively in areas of blood–brain barrier breakdown and co-localized with morphologically viable neurones. CSF concentrations did not reflect massive parenchymal infiltration of IL-1RA in MCAo animals compared to naïve.Conclusions and implications:
These data are the first to show that a potential treatment for stroke, IL-1RA, rapidly reaches salvageable brain tissue via an administration route that is clinically relevant. This allows confidence that IL-1RA, as a candidate for further clinical development, is able to confer its protective actions both peripherally and centrally. 相似文献110.
C De Casso Moxo FRCS NJ Eynon Lewis FRCS F Rapado FRCS 《International journal of clinical practice》2001,55(5):337-338
Lymphangiomas are uncommon congenital lesions of the lymphatic system which usually present in childhood. We report a case of adult lymphangioma, localised in the neck, and discuss the presentation, diagnosis and management of this tumour. 相似文献