全文获取类型
收费全文 | 1946篇 |
免费 | 208篇 |
国内免费 | 13篇 |
专业分类
耳鼻咽喉 | 24篇 |
儿科学 | 142篇 |
妇产科学 | 25篇 |
基础医学 | 190篇 |
口腔科学 | 48篇 |
临床医学 | 223篇 |
内科学 | 402篇 |
皮肤病学 | 13篇 |
神经病学 | 143篇 |
特种医学 | 186篇 |
外科学 | 320篇 |
综合类 | 55篇 |
预防医学 | 119篇 |
眼科学 | 14篇 |
药学 | 99篇 |
中国医学 | 9篇 |
肿瘤学 | 155篇 |
出版年
2022年 | 13篇 |
2021年 | 33篇 |
2019年 | 19篇 |
2018年 | 53篇 |
2017年 | 54篇 |
2016年 | 50篇 |
2015年 | 57篇 |
2014年 | 63篇 |
2013年 | 97篇 |
2012年 | 70篇 |
2011年 | 87篇 |
2010年 | 81篇 |
2009年 | 80篇 |
2008年 | 77篇 |
2007年 | 82篇 |
2006年 | 75篇 |
2005年 | 54篇 |
2004年 | 59篇 |
2003年 | 47篇 |
2002年 | 53篇 |
2001年 | 48篇 |
2000年 | 35篇 |
1999年 | 29篇 |
1998年 | 77篇 |
1997年 | 69篇 |
1996年 | 63篇 |
1995年 | 59篇 |
1994年 | 32篇 |
1993年 | 45篇 |
1992年 | 37篇 |
1991年 | 31篇 |
1990年 | 37篇 |
1989年 | 30篇 |
1988年 | 33篇 |
1987年 | 32篇 |
1986年 | 32篇 |
1985年 | 19篇 |
1984年 | 18篇 |
1983年 | 26篇 |
1982年 | 11篇 |
1981年 | 21篇 |
1980年 | 14篇 |
1979年 | 11篇 |
1978年 | 10篇 |
1977年 | 15篇 |
1976年 | 15篇 |
1974年 | 10篇 |
1973年 | 11篇 |
1971年 | 10篇 |
1969年 | 11篇 |
排序方式: 共有2167条查询结果,搜索用时 15 毫秒
61.
Patrick L. Wagner MD Frances Austin MD Ugwuji Maduekwe MD Arun Mavanur MD Lekshmi Ramalingam MD Heather L. Jones PA Matthew P. Holtzman MD Steven A. Ahrendt MD Amer H. Zureikat MD James F. Pingpank MD Herbert J. Zeh MD David L. Bartlett MD Haroon A. Choudry MD 《Annals of surgical oncology》2013,20(4):1056-1062
Background
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) are frequently used to treat appendiceal carcinomatosis. Some patients require multivisceral resection because of the volume of disease. It is unclear whether extent of CRS impacts survival in appendiceal carcinomatosis.Methods
We analyzed 282 patients undergoing attempted CRS/HIPEC for appendiceal carcinomatosis. Patients were defined as having undergone Extensive CRS (n = 60) if they had >3 organ resections or >2 anastomoses; a subgroup of Extreme CRS patients (n = 10) had ≥5 organ resections and ≥3 anastomoses. Kaplan–Meier survival curves and multivariate Cox-regression models were used to identify prognostic factors affecting outcomes.Results
Relative to the comparison group, patients undergoing Extensive CRS had a higher median peritoneal carcinomatosis index, operative duration, blood loss, and length of stay. No difference in completeness of cytoreduction, severe morbidity, or 60-day mortality was evident. Subgroup analysis of 10 patients undergoing extreme CRS likewise revealed no increase in severe morbidity or mortality. Median progression-free (PFS) and overall survival (OS) were 23.5 and 74 months in the comparison group; 18.5 (p = 0.086) and 51 (p = 0.85) months in the Extensive CRS group; and 40 months and not reached in the Extreme CRS subgroup. In a multivariable analysis, extent of CRS was not independently associated with PFS or OS.Conclusions
Extensive CRS is associated with greater OR time, blood loss, and length of stay, but is not associated with higher morbidity, mortality, or inferior oncologic outcomes in patients with appendiceal carcinomatosis. 相似文献62.
April Saval PA 《The journal of spinal cord medicine》2013,36(4):394-397
Background/Objective: Intrathecal baclofen (ITB) has been shown to be an effective treatment for severe spasticity of spinal or cerebral origin. Although most patients respond well to an ITB trial, there are often difficulties in achieving and/or maintaining such effectiveness with ITB pump treatment. There are few published guidelines for dosing efficacy and no studies looking at the effect of concentration of ITB on spasticity management.Methods: Case series of 3 adults with severe spasticity treated with ITB pump: a 44-year-old man with C7 tetraplegia using a 40-mL Medtronic SynchroMed II pump with 500-μg/mL concentration; a 35-year-old woman with traumatic brain injury with right spastic hemiplegia using a 18-mL Medtronic SynchroMed EL pump with 2,000-μg/mL concentration; and a 43-year-old woman with spastic diplegic cerebral palsy using a 40-mL Medtronic SynchroMed II pump with 2,000-μg/mL concentration.Results: After reducing ITB concentrations in the pump, either as part of a standard protocol for dye study to assess the integrity of pump and catheter system or secondary to plateau in therapeutic efficacy, patients experienced temporary, significant reduction in spasticity based on range of motion, Modified Ashworth scores, and verbal feedback.Conclusions: Decreasing the concentration of ITB seems to affect spasticity control. Further research in this area is needed for those patients with refractory spasticity to optimize efficacy of ITB therapy. 相似文献
63.
Crispin Schneider Paul M. Bevis Paul Durdey Michael G. Thomas Paul A. Sylvester Robert J. Longman 《The surgeon》2013,11(3):141-146
AimThe colorectal two-week wait fast track (FT) referral system was nationally implemented in the UK in 2000 to ensure patients with colorectal cancer (CRC) received prompt access to specialized services. The aim of this study was to determine the association between the mechanism of referral to colorectal services and the 5-year outcomes for patients with CRC.MethodsConsecutive patients with newly diagnosed CRC presenting between October 2002 and September 2004 were identified retrospectively. Analysis for survival and recurrence of disease at 5 years from presentation was undertaken. Outcomes for patients were compared between fast track (FT), non-fast track (NFT) and emergency referral (ER) routes, using Kaplan–Meier survival estimates.ResultsOut of 189 patients, 96 (51%) presented via the FT, 41 (22.5%) via the NFT and 52 (27.5%) via the ER referral route. The 5-year overall survival was 52.6% ± 5.1, 41.5% ± 7.7 and 38.5% ± 6.7 for the FT-, NFT- and ER groups respectively (p = 0.075). The 5-year cancer specific survival was 60.3% ± 5.2, 58.8% ± 5.3 and 43.5% ± 7.2 for the FT-, NFT- and ER groups respectively (p = 0.056). Patients referred as emergencies had worse 5-year overall survival; 49.3% ± 4.3 (FT&NFT) vs. 38.5% ± 6.7 (ER) (p = 0.042) and 5-year cancer specific survival 59.8% ± 4.4 (FT&NFT) vs. 43.5% ± 7.2 (ER) (p = 0.016). A total of 136 patients (FT n = 71, NFT n = 34, ER n = 31) underwent potentially curative surgery. Differences in 5-year survival did not reach statistical significance in these patients.ConclusionReferral route to specialist services for patients with CRC via the fast track pathway compared to non-fast track pathway was not associated with improved survival. 相似文献
64.
65.
66.
67.
68.
SJ Smith CV Rahman PA Clarke AA Ritchie TW Gould JH Ward KM Shakesheff RG Grundy R Rahman 《Annals of the Royal College of Surgeons of England》2014,96(7):495-501
Introduction
The median survival of patients with glioblastoma multiforme (astrocytoma grade 4) remains less than 18 months despite radical surgery, radiotherapy and systemic chemotherapy. Surgical implantation of chemotherapy eluting wafers into the resection cavity has been shown to improve length of survival but the current licensed therapy has several drawbacks. This paper investigates in vivo efficacy of a novel drug eluting paste in glioblastoma.Methods
Poly(lactic-co-glycolic acid)/poly(ethylene glycol) (PLGA/PEG) self-sintering paste was loaded with the chemotherapeutic agent etoposide and delivered surgically into partially resected tumours in a flank murine glioblastoma xenograft model.Results
Surgical delivery of the paste was successful and practical, with no toxicity or surgical morbidity to the animals. The paste was retained in the tumour cavity, and preliminary results suggest a useful antitumour and antiangiogenic effect, particularly at higher doses. Bioluminescent imaging was not affected significantly by the presence of the paste in the tumour.Conclusions
Chemotherapy loaded PLGA/PEG paste seems to be a promising technology capable of delivering active drugs into partially resected tumours. The preliminary results of this study suggest efficacy with no toxicity and will lead to larger scale efficacy studies in orthotopic glioblastoma models. 相似文献69.
Jorg R. Oddens Richard J. Sylvester Maurizio A. Brausi Wim J. Kirkels Cees van de Beek George van Andel Theo M. de Reijke Stephen Prescott J. Alfred Witjes Willem Oosterlinck 《European urology》2014
Background
Although maintenance bacillus Calmette-Guérin (BCG) is the recommended treatment in high-risk non–muscle-invasive bladder cancer (NMIBC), its efficacy in older patients is controversial.Objective
To determine the effect of age on prognosis and treatment outcome in patients with stage Ta T1 NMIBC treated with maintenance BCG.Design, setting, and participants
A total of 957 patients with intermediate- or high-risk Ta T1 (without carcinoma in situ) NMIBC were randomized in European Organization for Research and Treatment of Cancer (EORTC) trial 30911 comparing six weekly instillations of epirubicin, BCG, and BCG plus isoniazid followed by three weekly maintenance instillations over 3 yr.Outcome measurements and statistical analysis
Cox multivariate proportional hazards regression models were used to assess the relative importance of age for recurrence, progression, overall survival, and NMIBC-specific survival with adjustment for EORTC risk scores.Results and limitations
Overall, 822 eligible patients were included: 546 patients in the BCG with or without INH arms and 276 in the epirubicin arm. In patients treated with BCG with or without INH, 34.1% were >70 yr of age and 3.7% were >80 yr. With a median follow-up of 9.2 yr, patients >70 yr had a shorter time to progression (p = 0.028), overall survival (p < 0.001), and NMIBC-specific survival (p = 0.049) after adjustment for EORTC risk scores in the multivariate analysis. The time to recurrence was similar compared with the younger patients. BCG was more effective than epirubicin for all four end points considered, and there was no evidence that BCG was any less effective compared with epirubicin in patients >70 yr.Conclusions
In intermediate- and high-risk Ta T1 urothelial bladder cancer patients treated with BCG, patients >70 yr of age have a worse long-term prognosis; however, BCG is more effective than epirubicin independent of patient age.Patient summary
Intravesical bacillus Calmette-Guérin for non–muscle-invasive bladder cancer is less effective in patients >70 yr of age, but it is still more effective than epirubicin.Trial registration
This study was registered with the US National Cancer Institute clinical trials database (protocol ID: EORTC 30911; http://www.cancer.gov/clinicaltrials/search/view?cdrid=77075&version=HealthProfessional&protocolsearchid=12442243#StudyIdInfo_CDR0000077075). 相似文献70.
Neuropeptide Y Attenuates Stress‐Induced Bone Loss Through Suppression of Noradrenaline Circuits 下载免费PDF全文
PA Baldock S Lin L Zhang T Karl Y Shi F Driessler A Zengin B Hörmer NJ Lee IPL Wong EJD Lin RF Enriquez B Stehrer MJ During E Yulyaningsih S Zolotukhin ST Ruohonen E Savontaus A Sainsbury H Herzog 《Journal of bone and mineral research》2014,29(10):2238-2249
Chronic stress and depression have adverse consequences on many organ systems, including the skeleton, but the mechanisms underlying stress‐induced bone loss remain unclear. Here we demonstrate that neuropeptide Y (NPY), centrally and peripherally, plays a critical role in protecting against stress‐induced bone loss. Mice lacking the anxiolytic factor NPY exhibit more anxious behavior and elevated corticosterone levels. Additionally, following a 6‐week restraint, or cold‐stress protocol, Npy‐null mice exhibit three‐fold greater bone loss compared to wild‐type mice, owing to suppression of osteoblast activity. This stress‐protective NPY pathway acts specifically through Y2 receptors. Centrally, Y2 receptors suppress corticotropin‐releasing factor expression and inhibit activation of noradrenergic neurons in the paraventricular nucleus. In the periphery, they act to control noradrenaline release from sympathetic neurons. Specific deletion of arcuate Y2 receptors recapitulates the Npy‐null stress response, coincident with elevated serum noradrenaline. Importantly, specific reintroduction of NPY solely in noradrenergic neurons of otherwise Npy‐null mice blocks the increase in circulating noradrenaline and the stress‐induced bone loss. Thus, NPY protects against excessive stress‐induced bone loss, through Y2 receptor‐mediated modulation of central and peripheral noradrenergic neurons. © 2014 American Society for Bone and Mineral Research. 相似文献