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951.
952.
Mineji Hayakawa Kenichi Katabami Takeshi Wada Yousuke Minami Masahiro Sugano Hidekazu Shimojima Nobuhiko Kubota Shinji Uegaki Atsushi Sawamura Satoshi Gando 《Inflammation》2011,34(3):193-197
Migration inhibitory factor (MIF) is associated with multiple organ dysfunction syndrome (MODS) in patients with systemic
inflammatory response syndrome (SIRS). Our purposes were to determine the serum MIF, cortisol, and tumor narcosis factor-α
(TNF-α) and to investigate the influences of the balance between the levels of MIF and cortisol in patients with blunt trauma.
The cortisol levels were identical between the patients with and without MODS. However, the MIF and TNF-α levels in the patients
with MODS were statistically higher than those of the patients without MODS. The cortisol/MIF ratios in the patients with
MODS were statistically higher than those of the patients without MODS. The results show that MIF and TNF-α play an important
role together in posttraumatic inflammatory response. An excessive serum MIF elevation overrides the anti-inflammatory effects
of cortisol and leads to persistent SIRS followed by MODS in blunt trauma patients. 相似文献
953.
Kudo Y Morohashi S Takasugi K Tsutsumi S Ogasawara H Hanabata N Yoshimura T Sato F Fukuda S Kijima H 《Biomedical research (Tokyo, Japan)》2011,32(2):127-134
Recent advances in endoscopic submucosal dissection (ESD) techniques contribute to endoscopic treatment of early gastric cancer (EGC). Recognition of chronic atrophic gastritis as the background is important for high-quality detection and diagnosis of EGC. But, relationships between EGC and atrophy of the background gastric mucosa caused by Helicobacter pylori are not well understood. The present study demonstrated histopathological phenotypes of EGC, as well as chronic atrophic gastritis as background mucosa of EGC. We evaluated mucosal heights, number of glands, and degree of intestinal metaplasia (IM) of the background gastric mucosa, using 81 cases of EGC resected by ESD. Gastric phenotype cancer cases showed IM of the background gastric mucosa less frequently, compared with intestinal phenotype cancer cases (score of IM, 1.15 vs. 1.65, P = 0.012). The average mucosal heights around EGC were lower in moderately to poorly differentiated adenocarcinoma cases than well differentiated adenocarcinoma cases (442.6 μm vs. 500.2 μm, P = 0.011). The mucosal atrophy indicated by average heights of background mucosa was low in the gastric phenotype cancer cases, compared with the intestinal phenotype cancercases (452.8 μm vs. 505.6 μm, P = 0.018). In the fundic gland area, the mucosal heights were low in the gastric phenotype cancer cases, compared with the intestinal phenotype cancer cases (413.2 μm vs. 495.5 μm, P = 0.015). Our results using EGC specimens indicated that gastric phenotype cancer and moderately to poorly differentiated adenocarcinoma had atrophic background mucosa with lower mucosal heights and less IM. The atrophic gastric mucosa with less IM is thought to play an important role in gastric carcinogenesis, especially tumoriogenesis of gastricphenotype cancer. 相似文献
954.
955.
The cortical potentials evoked by cutaneous application of a laser stimulus (laser evoked potentials, LEP) often include potentials in the primary somatic sensory cortex (S1), which may be located within the subdivisions of S1 including Brodmann areas 3A, 3B, 1, and 2. The precise location of the LEP generator may clarify the pattern of activation of human S1 by painful stimuli. We now test the hypothesis that the generators of the LEP are located in human Brodmann area 1 or 3A within S1. Local field potential (LFP) source analysis of the LEP was obtained from subdural grids over sensorimotor cortex in two patients undergoing epilepsy surgery. The relationship of LEP dipoles was compared with dipoles for somatic sensory potentials evoked by median nerve stimulation (SEP) and recorded in area 3B (see Baumg?rtner U, Vogel H, Ohara S, Treede RD, Lenz FA. J Neurophysiol 104: 3029-3041, 2010). Both patients had an early radial dipole in S1. The LEP dipole was located medial, anterior, and deep to the SEP dipole, which suggests a nociceptive dipole in area 3A. One patient had a later tangential dipole with positivity posterior, which is opposite to the orientation of the SEP dipole in area 3B. The reversal of orientations between modalities is consistent with the cortical surface negative orientation resulting from superficial termination of thalamocortical neurons that receive inputs from the spinothalamic tract. Therefore, the present results suggest that the LEP may result in a radial dipole consistent with a generator in area 3A and a putative later tangential generator in area 3B. 相似文献
956.
Takaaki Fujii Toshihiro Nakabayashi Shinji Hashimoto Hiroyuki Kuwano 《Surgery today》2009,39(9):807-810
Parkinson’s disease is a chronic progressive disease with symptoms of tremors, rigidity, and akinesia. Parkinson’s disease
is a major risk factor for postoperative complications and it is difficult to manage patients with Parkinson’s disease after
gastrointestinal surgery. This report presents the cases of three patients with Parkinson’s disease who underwent gastrointestinal
surgery and had no serious postoperative complications. Antiparkinsonian medications were reduced before surgery and replaced
by an intravenous infusion of levodopa until the patients could take oral antiparkinson drugs after surgery to prevent malignant
syndrome or exacerbate parkinsonism. Prokinetics were also used for the prevention of paralytic ileus. These cases demonstrate
an effective method to administer antiparkinson drugs during perioperative management of patients with Parkinson’s disease
and also indicate that sufficient doses of antiparkinson drugs can control the symptoms of parkinsonism and prevent complications
in cases of surgery with parkinsonism. 相似文献
957.
Takafumi Machimoto Ryuichiro Doi Kohei Ogawa Toshihiko Masui Satoru Seo Shinji Uemoto 《Surgery today》2009,39(1):72-76
A 74-year-old woman was diagnosed with hilar bile duct cancer, and underwent a curative resection of the bile duct and the
left and caudate lobes of the liver in 1995. Ten years later (April 2005), she noted a small mass in the abdominal wall. The
mass slowly enlarged to reach 4 cm in diameter by January 2007. With a diagnosis of a possible recurrence of bile duct cancer,
a laparotomy was thus performed. The abdominal wall tumor was buried in the rectus abdominis muscle and was tightly attached
to the ileum. The lesion was resected en bloc with the associated rectus muscle and ileocecal region. A histopathological
examination of the resected specimen revealed tubular adenocarcinoma that closely resembled the original primary bile duct
cancer. In addition, the immunohistochemical staining pattern of the abdominal tumor was identical to that of the original
bile duct cancer. This indicated that the abdominal tumor represented a local recurrence (probably due to peritoneal implantation)
at 12 years after the resection of the hilar bile duct cancer. This case emphasizes that long-time surveillance is required
for patients with bile duct cancer, even if they have survived without recurrence for more than 5 years after a curative resection. 相似文献
958.
Tomotaka Akatsu Shinji Murai Satoshi Kamiya Kenji Kojima Yoshikazu Mizuhashi Hirotoshi Hasegawa Yuko Kitagawa 《Surgery today》2009,39(4):340-343
We report what seems to be the second documented case of perineal hernia after laparoscopic abdominoperineal resection (APR)
and describe its successful repair with transperineal intraperitoneal mesh. An 89-year-old woman complained of a large, painful
perineal swelling 4 months after APR for rectal cancer. Computed tomography (CT) showed small intestine protruding through
the pelvic floor into the perineal area. However, opening of the hernia sac revealed no intra-abdominal adhesions. An oval,
8 × 12 cm Bard Composix Kugel Patch (Davol, Cranston, RI, USA) was inserted into the intraperitoneal space and secured over
the defect in the pelvic floor; then firmly attached to the pelvic wall with 16 interrupted nonabsorbable sutures. There has
been no sign of hernia recurrence in 10 months of follow-up. We speculate that because laparoscopic surgery is minimally invasive,
fewer postoperative adhesions in the abdominal cavity can result in the small bowel sliding more readily into the perineal
area. Based on our experience, perineal hernia after laparoscopic APR can be repaired easily and effectively with a Composix
Kugel Patch. 相似文献
959.
Hideki Ijichi Takashi Nishizaki Takahiro Terashi Takeshi Shiraishi Ikuo Takahashi Hiroya Wada Kouji Joko Shinji Yoshioka Shigetoshi Murata Yumi Oshiro 《Surgery today》2009,39(10):897-900
Mucinous cystic neoplasms (MCN) of the pancreas are rare tumors that are almost exclusively located in the body or the tail
of the pancreas. A 60-year-old woman with no history of pancreatic disease was referred to our hospital with a chief complaint
of dull pain in the upper abdomen. Abdominal computed tomography showed a multilocular cystic mass of 7.0 cm in the head of
the pancreas, and endoscopic retrograde cholangiopancreatography showed no communication between the cystic mass and the main
pancreatic duct. A pancreatoduodenectomy was performed for the complete resection of the tumor, and an annular pancreas was
discovered by accident. The pathological examination of the tumor led to a definitive diagnosis of MCN with ovarian-type stroma.
To our knowledge this is the first documented case of MCN occurring in the head of the pancreas and associated with annular
pancreas. 相似文献
960.
Michio Ueda Itaru Endo Masayuki Nakashima Yuta Minami Kazuhisa Takeda Kenichi Matsuo Yasuhiko Nagano Kuniya Tanaka Yasushi Ichikawa Shinji Togo Chikara Kunisaki Hiroshi Shimada 《World journal of surgery》2009,33(1):104-110
Objectives The purpose of this study was to identify important prognostic factors related to the status of a pancreatic tumor, its treatment,
and the patient’s general condition.
Methods Between April 1992 and December 2006, 140 patients underwent a pancreatic resection for invasive ductal carcinoma. Prognostic
factors were defined by univariate and multivariate analyses.
Results The study included 103 tumors in the head of the pancreas and 37 tumors in the body or tail. The median survival time and
the actuarial 5-year survival rate for all patients were 14.5 months and 12.3%, respectively. Using the significant prognostic
factors identified by univariate analysis, multivariate analysis revealed that a preoperative serum CA19-9 concentration >100
U/ml (HR = 1.84, p = 0.0074), a tumor size >3 cm (HR = 1.74, p = 0.0235), venous involvement (HR = 2.39, p = 0.0006), a transfusion requirement of ≥1000 ml (HR = 2.23, p = 0.0006), and a serum albumin concentration on 1 postoperative month (1POM) < 3 g/dl (HR = 2.40, p = 0.0009) were significant adverse prognostic factors. The presence of hypoalbuminemia on 1POM significantly correlated with
a longer surgical procedure (p = 0.0041), extended nerve plexus resection around the superior mesenteric artery (p = 0.0456), and a longer postoperative hospital stay (p = 0.0063).
Conclusion To improve long-term survival, preserving the patient’s general condition by performing a curative resection with a short
operation time and minimal blood loss should be the most important principle in the surgical treatment of pancreatic cancer. 相似文献