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71.
72.
Increased emphasis on strict glycaemic control of insulin dependent diabetes mellitus (IDDM) in young patients may be expected to cause increases in rates of significant hypoglycaemia. To evaluate whether this is the case for a large population based sample of IDDM children and adolescents rates of severe (coma, convulsion) and moderate (requiring assistance for treatment) hypoglycaemia were studied prospectively over a four year period. A total of 709 patients were studied yielding 2027 patient years of data (mean (SD) age: 12.3 (4.4); range 0-18 years, duration IDDM: 4.9 (3.8) years). Details of hypoglycaemia were recorded at clinic visits every three months when glycated haemoglobin (HbA1c) was also measured. Overall the incidence of severe hypoglycaemia was 7.8 and moderate was 15.4 episodes/100 patient years. Over the four years mean (SD) clinic HbA1c steadily fell from 10.2 (1.6)% in 1992 to 8.8 (1.5)% in 1995. In parallel with this there was a dramatic increase in the rate of hypoglycaemia, especially in the fourth year of the study, when severe hypoglycaemia increased from 4.8 to 15.6 episodes/100 patient years. This increase was particularly marked in younger children (< 6 years) in whom severe hypoglycaemia increased from 14.9 to 42.1 episodes/100 patient years in 1995. It is concluded that attempts to achieve improved metabolic control must be accompanied by efforts to minimise the effects of significant hypoglycaemia, particularly in the younger age group. 相似文献
73.
A. Gonzalvo N. Hall J.H.A. McMahon G.C. Fabinyi 《Journal of clinical neuroscience》2009,16(1):142-144
We report a 40-year-old male who presented with a two year history of thoracic cord compression. MRI of the thoracic spine demonstrated a diffuse, non-gadolinium enhancing intramedullary spinal cord tumour, extending from the C7 to T2 vertebral body levels. The lesion was surgically resected and the pathology revealed an epidermoid cyst. Epidermoid cysts are rare slow-growing lesions apparently resulting from inclusion of ectodermal tissue during the closure of the neural tube. The average age of presentation is about 35 years and the history of the symptoms is usually long. The treatment is surgical, and complete removal is the goal, if possible. 相似文献
74.
75.
V. Girre M. Debled D. Giely C. Terret E. Fourme I Pauporte J. Genève E. GC Brain 《Oncologie》2006,8(1):3-9
Résumé:
Malgré une incidence croissante du cancer du sein dans la population agée, les données spécifiques prospectives concernant
sa prise en charge après 70 ans, tout particulièrement pour les indications de chimiothérapie adjuvante, sont rares dans la
littérature, gênant l’application de recommandations standards établies essentiellement chez les sujets plus jeunes. La plupart
des données dérivent d’essais multicentriques ayant étendu l’age limite supérieur d’inclusion à 65 ou 70 ans. Un seul essai
multicentrique, fran?ais, a spécifiquement abordéle r?le d’une chimiothérapie adjuvante à base d’anthracyclines ajoutée au
tamoxifène chez le sujet de plus de 65 ans. Pourtant plusieurs revues rétrospectives de groupes coopérateurs internationaux
semblent démontrer lemame béneéfice potentiel d’une chimiothérapie adjuvante chez les sujets agés que chez les sujets plus
jeunes, sous réserve d’une vigilance accrue à l’égard des effets secondaires. Avec l’aide ajustée d’échelles spécifiques gériatriques,
les cliniciens doivent apprendre à intégrer bénéfice absolu, espérance de vie et tolérance, trois volets essentiels pour abandonner
la discrimination ancienne reposant sur l’age, inadaptée à l’évolution de nos moyens et pratiques.
相似文献
76.
Robert J. S. Briggs Gavin Fabinyi Andrew H. Kaye 《Journal of clinical neuroscience》2000,7(6):521-526
The management options for patients with acoustic neuromas is discussed with a review of 164 patients assessed and treated between 1994 and 1998. Twenty-one patients have neurofibromatosis type II. In 33 cases initial observation was undertaken with repeated imaging. Surgical removal of 122 tumours was performed in 121 patients. Eleven of these patients have NF2, of whom three underwent Auditory Brainstem Implantation. Hearing preservation tumour removal was attempted in 37 and was successful in 20 (54%). The middle cranial fossa approach was used in ten cases with 100% successful hearing preservation. The retrosigmoid approach was used in 27 cases with 36% successful hearing preservation. Non-hearing preservation tumour removal was performed in 85 cases where hearing was poor or the tumour measured more than 2 cm within the cerebellopontine angle. The translabyrinthine approach was used in 80 of these patients. Postoperative facial nerve outcome was dependent on tumour size. All 38 patients with tumours = 1.5 cm have normal (Grade 1) facial function. For all sized tumours, 90% of patients have good facial function (82% Grade 1, 8% Grade 2), 7% of patients have moderate function (6% Grade 3 and 1% Grade 4) and only 3% of patients have poor function (2% Grade 5, 1% Grade 6). Lasting complications were minimal with no operative mortality and eight patients (6.4%) suffering CSF fistulae. Seven patients in this series have had stereotactic radiation with variable outcome. The radiobiology of both single dose and fractionated stereotactic radiation is described and the current role of stereotactic radiation in the management of acoustic neuromas is discussed. Surgical tumour removal by an experienced multi-disciplinary team remains the primary treatment modality for acoustic neuromas. The middle cranial fossa approach is recommended for management of intracanalicular tumours. The translabyrinthine approach facilitates facial nerve preservation, particularly in patients with large tumours. 相似文献
77.
Kibbelaar RE; Mulder JW; Dreef EJ; van Kamp H; Fibbe WE; Wessels JW; Beverstock GC; Haak HL; Kluin PM 《Blood》1993,82(3):904-913
Fluorescence in situ hybridization (FISH) is a powerful tool for detection of numerical and structural chromosomal aberrations. We have compared conventional banding techniques and FISH for the detection of monosomy 7 (-7) and trisomy 8 (+8) in 89 patients with myeloid malignancies. Of these patients, 21 had -7, 30 had +8, four had both, and 34 had no aberrations or aberrations other than -7 or +8 as assessed by banding techniques. Sequential samples were available in 23 patients. Alphoid DNA probes specific for chromosomes no. 7 and 8 were used for FISH. As controls, 10 normal bone marrow (BM) samples were hybridized with the chromosomes no. 7 and 8 probes, and in addition all tumor samples were hybridized with a chromosome no. 1 specific probe. The cut-off value for -7 was 18% one-spot cells, and for +8 was 3% three-spot cells. FISH analysis of 44 samples with -7 or +8, and at least 10 metaphases evaluated, showed that the proportions of aberrant metaphase cells mirrored the interphase clone sizes. Most samples with nonclonal metaphase aberrations, including those with only a few metaphases, had increased numbers of aberrant interphase cells: 20% to 80% for -7, and 3% to 43% for +8. Interphase cytogenetics of the 34 samples without -7 or +8 did not show significant cell populations with -7 or +8. In four patients, -7 or +8 could not be confirmed by FISH due to additional structural aberrations, marker chromosomes, or wrongly interpreted banding results. As FISH will be used more and more in cytogenetic diagnosis, clinical follow-up, and therapy monitoring, it will be necessary to standardize FISH procedures and supplement the Standing Committee on Human Cytogenetic Nomenclature (ISCN) definitions of a clone with criteria specifically for in situ hybridization. 相似文献
78.
79.
Middle ear endoscopy should be considered a useful adjunctive or alternative method to microscopic surgical exploration for middle ear pathology. This minimally invasive technique provides excellent visualization for viewing the surgical micromorphology and pathological findings of the middle ear. Selected patients underwent middle ear endoscopy using a transtympanic approach. Rigid endoscopes of 2.7 mm and 1.9 mm caliber and 0°, 30° and 70° viewing angles were introduced into the tympanic cavity through small tympanostomy incisions. The indications and technique with video monitoring are discussed. 相似文献
80.
McIntosh AM Averill CA Kalnins RM Mitchell LA Fabinyi GC Jackson GD Berkovic SF 《Epilepsia》2012,53(6):970-978
Purpose: We aimed to assess long‐term seizure outcome and risk factors for seizure recurrence in a cohort of patients who have undergone extratemporal resection for management of refractory seizures. Methods: Eighty‐one patients underwent extratemporal resection at Austin Health, Melbourne, Australia (1991–2004). Seizure recurrence was any postoperative disabling seizure (complex partial seizure [CPS] ± secondary generalization). Multivariate Cox proportional hazards regression models examined potential preoperative and perioperative risk factors and the risk associated with early postoperative seizures (≤28 days postsurgery). The change between preoperative and postoperative seizure frequency was also measured. Key Findings: Median follow‐up was 10.3 years (range 1–17.7). The probabilities of freedom from disabling seizures (on or off antiepileptic medication) were 40.7% (95% confidence interval [CI] 30–51) at 1 month, 23.5% (95% CI 15–33) at 1 year, and 14.7% (95% CI 8–23) at 5 years postoperative. Reduction of disabling seizures to at least 20% of preoperative frequency was attained by 57% of patients at 5 postoperative years. Of the preoperative/perioperative factors, focal cortical dysplasia (FCD) type 1 (hazard ratio [HR] 1.90, 95% CI 1.08–3.34, p = 0.025) and incomplete resection (HR 1.71, 95% CI 1.06–2.76, p = 0.028) were independent recurrence risks. After surgery, an early postoperative seizure was the only factor associated with higher risk (HR 4.28 [2.42–7.57], p = 0.00). Significance: Distinction between subtypes of focal cortical dysplasia, which can be made using magnetic resonance imaging (MRI) criteria, may be useful for preoperative prognostication. Early seizures after surgery are not benign and may be markers of factors that contribute to seizure recurrence. Most patients achieve substantial reduction in seizure frequency. Further study of the significance of this reduction in terms of surgical “success” or otherwise is required. 相似文献