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11.
Prenatal care: a comparative evaluation of nurse-midwives and family physicians. 总被引:3,自引:3,他引:0 下载免费PDF全文
We evaluated the prenatal care provided to 44 low-risk women by nurse-midwives (NMs) at a special clinic of a large obstetric referral hospital and a sample of 88 low-risk women attended by family physicians (FPs) in their offices. The women were matched on the basis of date of delivery, age, parity, number of previous miscarriages, gravidity, socioeconomic status and delivery after 32 weeks' gestation. The Burlington Randomized Controlled Trial criteria, which reflect community standards of care, were updated and used to assess the information, which was provided on standard provincial prenatal care forms. Scoring was carried out blindly, and interrater reliability was high. A highly significant difference was found in the proportions of NM and FP charts that were rated adequate, superior or inadequate: 77% v. 24%, 7% v. 16% and 16% v. 60% respectively. The rate at which procedures were omitted (leading to an inadequate score) in the categories of initial assessment, monitoring and management also varied between the two patient groups. These findings, even when considered in terms of several biases that may have resulted in the high proportion of NM charts rated at least adequate, suggest that NMs provide prenatal care to low-risk women that is comparable, if not superior, to the care provided by FPs. 相似文献
12.
P L Glick C L Leach G E Besner E A Egan F C Morin A Malanowska-Kantoch L K Robinson A Brody A S Lele M McDonnell 《Journal of pediatric surgery》1992,27(7):866-869
Exogenous surfactant therapy (EST) in surfactant-deficient premature infants has been shown to improve lung compliance, decrease morbidity, and improve survival. Reports have demonstrated that newborns with congenital diaphragmatic hernia (CDH) have lung compliance, pressure-volume curves, and hyaline membrane formation resembling those changes seen in surfactant deficient premature newborns. We hypothesize that EST may also benefit infants with CDH. All high risk cases of prenatally diagnosed CDH at Children's Hospital of Buffalo from November 1988 to February 1991 were prospectively evaluated for EST. In those families who chose to participate, the surfactant preparation, Infasurf (100 mg/kg), was instilled into the newborn's lungs prior to the first breath. The remainder of the perinatal, neonatal, and surgical care was performed in a routine manner. Three high-risk prenatally diagnosed newborns with left CDH were treated with EST. All showed signs of decreased pulmonary compliance, but could still be adequately oxygenated and ventilated. Surgical correction was performed after stabilization and all required patch closures. Two of the three infants suffered no life-threatening episodes of pulmonary hypertension and all survived. These infants had many known indicators for poor outcome in CDH with an expected survival of less than 20%. We believe that EST in these neonates with CDH contributed to their survival with minimum morbidity. These results suggest that surfactant replacement for the high-risk neonate with CDH warrants further consideration and a randomized clinical trial is being planned. 相似文献
13.
MN Tabrizi† C Chams-Davatchi† N Esmaeeli† P Noormohammadpoor† F Safar† H Etemadzadeh† HA Ettehadi‡ F Gorouhi† 《Journal of the European Academy of Dermatology and Venereology》2007,21(1):79-84
BACKGROUND: Pemphigus vulgaris (PV) is a severe blistering disease involving the skin and mucous membranes. The most common causes of death in these patients are adverse effects of drugs, and infection. Skin lesions are one of the important sources of infection. Thus, any local treatment that could reduce healing time of lesions and consequently reduce the total dosage of drugs needed to treat is favourable. OBJECTIVE: To evaluate the efficacy of epidermal growth factor (EGF) in reducing healing time of lesions in patients with pemphigus vulgaris. METHODS: In this randomized, double-blind, within-patient, left/right, controlled trial, 20 hospitalized patients with pathologial and immunohistologial (direct and indirect immunoflourecence) proven pemphigus vulgaris (PV) were chosen. In addition, all patients had at least one appropriate pemphigus lesion on each side of the body that had not healed after 2-week systemic therapy and sterile saline washing. EGF (10 microg/g) in 0.1% silver sulfadiazine cream vs. 0.1% silver sulfadiazine cream alone was applied randomly on one side of the body. RESULTS: Kaplan-Meier survival analysis suggested that median time to heal with application of EGF plus silver sulfadiazine cream was 9 days, in comparison with 15 days for silver sulfadiazine cream alone (log-rank test, P=0.0003). No intervention-related adverse effect was observed during the study. CONCLUSIONS: EGF can significantly reduce healing time of skin lesions in patients with pemphigus vulgaris, at least when this cream base is applied (Cochrane skin group identifier: CSG20). 相似文献
14.
Iodine toxicity secondary to continuous povidone-iodine mediastinal irrigation in dogs 总被引:1,自引:0,他引:1
P L Glick B J Guglielmo M E Winter W Finkbeiner K Turley 《The Journal of surgical research》1990,49(5):428-434
Mediastinitis is a devastating complication following median sternotomy. Continuous povidone-iodine (PVP-I) irrigation has been advocated as therapy because of its broad antimicrobial spectrum and its apparent safety. However, several recent clinical reports have warned of suspected local and systemic iodine toxicity. The purpose of this study is to determine if significant amounts of iodine can be absorbed systemically via the mediastinum, and if so, what toxicity (local and/or systemic) may result. PVP-I (0.5%) was continuously irrigated into the pericardial sacs of three dogs via catheters for 48 hr. Serial serum and urine iodine levels were determined. The serum steady-state concentration (Css), the rate elimination constant (k), the urinary clearance (Cl), and the serum half-life (t 1/2) for iodine were assessed. Serum electrolytes, Bun, Cr, and arterial pH were measured to assess systemic iodine toxicity. Tissue samples of the heart, pericardium, liver, and kidney were examined histologically for evidence of local or end-organ iodine toxicity. This study demonstrated that the absorption of iodine during continuous mediastinal irrigation with PVP-I follows zero-order pharmacokinetics, just as if it were being given by continuous intravenous infusion. The baseline serum iodine concentration was 145.9 +/- 64.3 micrograms/dl, Css was 29,290 +/- 101.4 micrograms/dl, k was 0.0996 +/- 0.009/hr, Cl was 872.4 +/- 119.3 ml/hr, and t1/2 was 6.22 hr. Urinary excretion of iodine increased in proportion to the serum iodine. Measured serum chloride increased in a linear manner (r = 0.949), while serum Na, K, Bun, Cr, and pH were unchanged.(ABSTRACT TRUNCATED AT 250 WORDS) 相似文献
15.
D L Braff I D Glick M H Johnson S Zisook 《The Journal of nervous and mental disease》1988,176(4):213-220
The occurrence and clinical significance of thought disorder, as measured by general abstraction ability and idiosyncratic abstractions, remains a complex and ambiguous area of inquiry. We studied 49 subjects in a longitudinal design in which the effects of general psychopathology and depression on abstraction function were assessed. Results indicate that a) depressive patients have a generalized abstraction dysfunction not limited to specific content areas, b) some depressive patients have a residual abstraction deficit on discharge from the hospital, c) idiosyncratic abstractions are a characteristic but not pathognomonic marker for schizophrenia, and d) across all subjects, abstraction difficulties represent a seemingly state-dependent "final common pathway" that significantly correlates with general psychopathological impairment rather than level of depression. 相似文献
16.
J C York J B Cousar A D Glick J M Flexner R Stein R D Collins 《American journal of clinical pathology》1985,84(1):35-43
Composite lymphoma (CL) may be defined as two lymphomas, differing as to their cell of origin, that occur simultaneously in the same tissue specimen. While CL usually is indicated histopathologically by at least two morphologically distinct lymphomatous proliferations, the proof that these proliferations are separate and distinct neoplasms requires immunologic analysis. Many so-called cases of CL actually represent the well-known phenomenon of lymphoid transformation, in which there is a small cell and a large cell component in the same specimen. Immunologic studies in these cases have shown that the cytologically distinct neoplastic cells represent different stages in the same cell line. While studying a large series of follicular center cell (FCC) lymphomas, the authors recognized three cases in which there was both morphologic and immunologic evidence of a true CL. Following an initial diagnosis of a nodular FCC lymphoma, rebiopsies from 21 to 62 months later showed the coexistence of a nodular FCC (B-cell) component and a diffuse large cell (T-cell) component. 相似文献
17.
Linkage of the MHC to familial multiple sclerosis suggests genetic heterogeneity. The Multiple Sclerosis Genetics Group 总被引:5,自引:0,他引:5
Haines JL; Terwedow HA; Burgess K; Pericak-Vance MA; Rimmler JB; Martin ER; Oksenberg JR; Lincoln R; Zhang DY; Banatao DR; Gatto N; Goodkin DE; Hauser SL 《Human molecular genetics》1998,7(8):1229-1234
Multiple sclerosis (MS) is a demyelinating autoimmune disease of the
central nervous system. While its etiology is not well understood, genetic
factors are clearly involved. Until recently, most genetic studies in MS
have been association studies using the case-control design testing
specific candidate genes and studying only sporadic cases. The only
consistently replicated finding has been an association with the HLA-DR2
allele within the major histocompatibility complex (MHC) on chromosome 6.
Using the genetic linkage design, however, evidence for and against linkage
of the MHC to MS has been found, fostering suggestions that sporadic and
familial MS have different etiologies. Most recently, two of four genomic
screens demonstrated linkage to the MHC, although specific allelic
associations were not tested. Here, a dataset of 98 multiplex families was
studied to test for an association to the HLA-DR2 allele in familial MS and
to determine if genetic linkage to the MHC was due solely to such an
association. Three highly polymorphic markers (HLA-DR, D6S273 and TNFbeta)
in the MHC demonstrated strong genetic linkage (parametric lod scores of
4.60, 2.20 and 1.24, respectively) and a specific association with the
HLA-DR2 allele was confirmed (TDT; P < 0.001). Stratifying the results
by HLA-DR2 status showed that the linkage results were limited to families
segregating HLA-DR2 alleles. These results demonstrate that genetic linkage
to the MHC can be explained by the HLA-DR2 allelic association. They also
indicate that sporadic and familial MS share a common genetic
susceptibility. In addition, preliminary calculations suggest that the MHC
explains between 17 and 62% of the genetic etiology of MS. This
heterogeneity is also supported by the minority of families showing no
linkage or association with loci within the MHC.
相似文献
18.
Androgen receptor YAC transgenic mice carrying CAG 45 alleles show trinucleotide repeat instability 总被引:1,自引:15,他引:1
La Spada AR; Peterson KR; Meadows SA; McClain ME; Jeng G; Chmelar RS; Haugen HA; Chen K; Singer MJ; Moore D; Trask BJ; Fischbeck KH; Clegg CH; McKnight GS 《Human molecular genetics》1998,7(6):959-967
X-linked spinal and bulbar muscular atrophy (SBMA) is caused by a CAG
repeat expansion in the first exon of the androgen receptor (AR) gene.
Disease-associated alleles (37-66 CAGs) change in length when transmitted
from parents to offspring, with a significantly greater tendency to shift
size when inherited paternally. As transgenic mice carrying human AR cDNAs
with 45 and 66 CAG repeats do not display repeat instability, we attempted
to model trinucleotide repeat instability by generating transgenic mice
with yeast artificial chromosomes (YACs) carrying AR CAG repeat expansions
in their genomic context. Studies of independent lines of AR YAC transgenic
mice with CAG 45 alleles reveal intergenerational instability at an overall
rate of approximately 10%. We also find that the 45 CAG repeat tracts are
significantly more unstable with maternal transmission and as the
transmitting mother ages. Of all the CAG/CTG repeat transgenic mice
produced to date the AR YAC CAG 45 mice are unstable with the smallest
trinucleotide repeat mutations, suggesting that the length threshold for
repeat instability in the mouse may be lowered by including the appropriate
flanking human DNA sequences. By sequence-tagged site content analysis and
long range mapping we determined that one unstable transgenic line has
integrated an approximately 70 kb segment of the AR locus due to
fragmentation of the AR YAC. Identification of the cis - acting elements
that permit CAG tract instability and the trans -acting factors that
modulate repeat instability in the AR YAC CAG 45 mice may provide insights
into the molecular basis of trinucleotide repeat instability in humans.
相似文献
19.
Embryonic and posthatched differentiation of bursal secretory dendritic cells, which express vimentin intermediate filaments, were studied with anti-vimentin (clone 3B4) and anti-cytokeratin (clone Lu5) monoclonal antibodies. Anti-cytokeratin staining revealed that medullary reticular epithelial cells formed a continuous network at every age, whereas the vimentin positive cells were single and showed dendritic appearance. On the basis of location, number, shape, polarized appearance, and Ia staining, the vimentin-positive cells and secretory dendritic cells appeared to be the same cell. Secretory dendritic cell precursors entered the bursal epithelium between 11 and 13 days of embryogenesis. The first vimentin positive cell appeared in the bud of 14-day embryos. Bud formation preceded the appearance of vimentin-positive cells. These observations suggested that the secretory dendritic cell precursor did not express vimentin when it entered the epithelium. Between 15 days of embryogenesis and 2 weeks of posthatch development, the changes in vimentin staining pattern revealed a cytological differentiation of the vimentin-positive cell. During rapid bursal growth, the number of secretory dendritic cells (vimentin-positive cells) increased about 18 times possibly by proliferation of vimentin-negative precursors in the epithelial arches of the corticomedullary border. © 1992 Wiley-Liss, Inc. 相似文献
20.
Neulen J; Raczek S; Pogorzelski M; Grunwald K; Yeo TK; Dvorak HF; Weich HA; Breckwoldt M 《Molecular human reproduction》1998,4(3):203-206
Vascularization is a prominent event during corpus luteum formation,
providing low density lipoproteins for steroid biosynthesis and enabling
transport of secreted steroids. The process of vascularization is
controlled by specific regulators. Vascular endothelial growth factor
(VEGF), otherwise named vascular permeability factor (VPF), induces
endothelial cell proliferation as well as angiogenesis in vivo and
increases capillary permeability. Here we report the expression of VEGF/VPF
mRNA by cultured human luteinized granulosa cells (GC) for at least 10
days. Without HCG VEGF/VPF expression declined after day 4 and by day 10
was reduced to approximately 30% of the value at day 4. However, after
culture in the presence of 1 U/ml human chorionic gonadotrophin (HCG),
expression of VEGF/VPF mRNA by GC was four times greater than control
experiments by day 10, and increased 100% from day 4 to day 10.
Simultaneously, HCG supplementation increased VEGF/VPF secretion by GC.
Medium VEGF/VPF on day 3 was 13 pM without and 11 pM with HCG. Medium
VEGF/VPF on day 10 was 6 pM without HCG and 29 pM with HCG. These results
suggest that vascularization of the corpus luteum is induced by
HCG-mediated effects of VEGF/VPF.
相似文献