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981.
Transbronchial needle aspiration in diagnosing intrathoracic tuberculous lymphadenitis 总被引:7,自引:0,他引:7
STUDY OBJECTIVE: To assess the role of transbronchial needle aspiration (TBNA) in diagnosing intrathoracic tuberculous lymphadenitis (TB-LA). METHODS: In a tertiary referral center for thoracic medicine and surgery, using a CT scan as a guide, transbronchial aspirates were obtained with a 19-gauge flexible histology needle in consecutively enrolled patients with sputum smears negative for acid-fast bacilli, and with isolated mediastinal or hilar adenopathy suspicious for tuberculosis (TB). RESULTS: Of 84 eligible patients who were all found to be HIV-negative, 63 (75%) cases of TB were diagnosed by TBNA (histology, 48 patients [76%]; cytology, 9 patients [14%]; and bacteriologic studies, 21 patients [33%; smear, 8 patients; culture, 17 patients]). TBNA was used to diagnose sarcoidosis in two patients, angioimmunoblastic lymphadenopathy in one patient, and Hodgkin lymphoma in one patient. In the 17 TBNA-negative patients, the results of transthoracic needle aspiration were positive in 12 patients (TB, nine patients; lung cancer, two patients; sarcoidosis, one patient), the results of mediastinoscopy were positive in three patients (TB, two patients; Hodgkin lymphoma, one patient), and the results of thoracotomy were positive in two patients (TB, two patients). Thus, 76 patients had TB, and all responded to anti-TB treatment. TB was corroborated by culture or histology of another specimen obtained from subsequently developed lesions in 40 patients (53%) during anti-TB treatment or posttreatment follow-up. TBNA was immediately diagnostic in 59 patients (78%), and exclusively in 52 patients (68%), among all bronchoscopic procedures and prebronchoscopic sputum studies. Sensitivity, specificity, positive and negative predictive values, and accuracy of TBNA for TB were 83%, 100%, 100%, 38%, and 85%, respectively. The only complication, self-limiting hemorrhage of < 30 mL volume, occurred in 65 patients (77%), with a volume of < 5 mL in 59 patients (70%). CONCLUSION: TBNA is efficient and safe in the bacteriologic and pathologic diagnosis of intrathoracic TB-LA in HIV-negative and sputum smear-negative patients. 相似文献
982.
A novel non‐surgical,minimally invasive technique for parathyroid autotransplantation: A case report 下载免费PDF全文
Erhan Aysan Ulkan Kilic Ozlem Gok Burcugul Altug Cilem Ercan Ufuk Oguz Idiz Cemile Kesgin Mahmut Muslumanoglu 《Pediatric transplantation》2015,19(2):E37-E40
We present a case report of intramuscular autotransplantation of the parathyroid cell suspension acquired after total parathyroidectomy. A 15‐yr‐old female patient who had been undergoing hemodialysis due to chronic renal failure for eight yr was diagnosed with secondary hyperthyroidism and subsequently underwent total parathyroidectomy. The parathyroid cells were acquired from the resected tissues, processed through isolation and cultivation phases, and counted using a cell counter. A total of two million cells were injected into the left deltoid muscle using a 22‐gauge needle. After surgery, five and 10 million cells were injected in the fifth and 12 week, respectively. The desired serum levels of parathyroid hormones and calcium were not achieved after the first two transplantations. In addition, there was no regression in the patient's symptoms. However, at four wk after the third transplantation, serum parathyroid hormone level did not decrease to <3 pg/mL, the patient was asymptomatic, and the oral treatment was stopped. Our findings indicate that this new technique is applicable because it is minimally invasive, and it can be easily repeated. 相似文献
983.
Previous research has identified a strong association between posttraumatic stress disorder (PTSD) and substance use disorder (SUD), necessitating the development of treatments that address both conditions. Some pharmacotherapies are effective for the treatment of PTSD and SUD alone, however; no medications have been proven to be effective for the combination of these conditions. We review the recent advances in pharmacological treatment of comorbid PTSD and SUD. A randomized clinical trial of sertraline, a serotonin reuptake inhibitor (SSRI), did not show overall efficacy for comorbid PTSD and alcohol dependence (AD), although it may have efficacy among light drinkers. Another clinical trial demonstrated the efficacy of both disulfiram and naltrexone for the treatment of AD in individuals with PTSD. A more recent clinical trial suggested that norepinephrine uptake inhibitors may also have efficacy for the treatment of comorbid PTSD and AD. In animal and preliminary human studies, brain norepinephrine and glutamate/GABA have emerged as potential treatment targets for comorbid PTSD and SUD. Noradrenergic medications that are promising for comorbid PTSD and SUD include prazosin, guanfacine, and atomoxetine. Promising glutamate/GABA medications include topiramate, memantine, acamprosate, N-acetylcysteine (NAC), and ketamine. The safety and efficacy of these medications for the treatment of PTSD and SUD need to be tested in controlled clinical trials. 相似文献
984.
Dilek B Yemez B Kizil R Kartal E Gulbahar S Sari O Akalin E 《Rheumatology international》2012,32(4):915-920
The aim of this study was to investigate the role of psychological factors in the development of complex regional pain syndrome
(CRPS) type I following the fracture of the distal radius. Fifty patients (average age 57.70 ± 13.43 years) with a distal
radius fracture were enrolled in the present study. All of the patients were treated by closed reduction and cast immobilization.
The Toronto Alexithymia Scale-20, Anxiety Sensitivity Index, State-Trait Anxiety Inventory, and Beck Depression Inventory
were used to determine the patients’ psychological features 2 days after the fracture. The patients were followed for 2 months
after cast immobilization was completed using the International Association for the Study of Pain criteria to diagnose CRPS
type I. CRPS type I developed in 13 (26%) patients of the 32 (34.4%) female patients and 18 (11.1%) male patients. The risk
of CRPS type I was significantly increased in patients with high trait anxiety scores (P = 0.038). The results show that, after fracturing the distal radius, patients who have an anxious personality have a higher
risk of developing CRPS type I. Following these patients closely for the development of CRPS type I may be advantageous for
early preventative and therapeutic interventions. 相似文献
985.
Hatice Bodur ?ebnem Ataman Derya Soy Bu?dayc? Aylin Rezvani Kemal Nas Kaan Uzunca Emel Emlak??o?lu Alt?nay G?ksel Karatepe Bekir Durmu? Melek Sezgin Figen Ayhan Pelin Yazgan Tuncay Duru?z Mahmut Yener Alev Gürgan Mehmet K?rnap Engin ?akar Lale Altan Raikan Soydemir Erhan ?apk?n ?brahim Tekeo?lu Gülümser Ayd?n Zafer Günendi Bar?? Nac?r Ali Sall? Cihat ?ztürk Asuman Memi? Yasemin Turan Erkan Kozano?lu Kon?uy Sivrio?lu 《Rheumatology international》2012,32(1):169-176
A web-based application patient follow-up program was developed to create a registry of patients with ankylosing spondylitis
(AS) by the Turkiye Romatizma Arastirma Savas Dernegi (TRASD) AS Study Group. This study describes the methodological background
and patient characteristics. The patient follow-up program is a web-based questionnaire, which contains sections on socio-demographic
data, anamnesis, personal and family history, systemic and musculoskeletal examination, laboratory and imaging data and treatment.
Between October 1, 2007 and February 28, 2009, 1,381 patients from 41 centers were included in the registry (1,038 males [75.2%];
mean age 39.5 ± 10.7 years). Mean disease duration was 12.1 ± 8.5 years, and mean time from initial symptom to diagnosis was
5 ± 6.8 years (median 2 years). HLA-B27 positivity was detected in 73.7% of 262 patients tested. Manifestations of extraarticular
involvement were anterior uveitis (13.2%), psoriasis and other skin and mucous membrane lesions (6%) and inflammatory bowel
disease (3.8%). The prevalence of peripheral arthritis was 11.2%. In 51.7% of patients, the Bath AS Disease Activity Index
was ≥4. But since our patients consisted of the ones with more severe disease who referred to the tertiary centers and needed
a regular follow-up, they may not represent the general AS population. Disease-modifying anti-rheumatic drugs were being used
by 41.9% of patients, with 16.4% using anti-TNF agents. TRASD-IP (Izlem Programi: Follow-up program) is the first AS registry
in Turkey. Such databases are very useful and provide a basis for data collection from large numbers of subjects. TRASD-IP
gives information on the clinical and demographic profiles of patients, and the efficacy and safety of anti-TNF drugs, examines
the impact on quality of life, and provides real-life data that may be used in cost-effectiveness analyses. 相似文献
986.
Uçar F Karkucak M Alemdaroğlu E Capkin E Yücel B Sönmez M Tosun M Karaca A 《Rheumatology international》2012,32(4):1003-1007
Rheumatoid arthritis (RA [MIM 180300]) is a complex, polygenic inflammatory autoimmune disease, resulting from interactions
between genetic and environmental factors. Some of the RA-associated HLA-DRB1 alleles have shared epitope, but their distribution
varies among different racial/ethnic groups. This study was aimed at investigating the distribution of HLA-DRB1 alleles in
patients with RA in eastern Black Sea region of Turkey. DNA samples of 320 patients with RA and 360 healthy controls were
studied for the determination of HLA-DRB1 allele distribution using PCR–SSP method. The allele frequencies of HLA-DRB1*01,
*04, and *09 were higher in patients with RA compared with the controls (P < 0.005, P < 0.0001, and P < 0.01, respectively). On the other hand, in patients with RA, HLA-DRB1*13 allele was lower than the controls (P < 0.001). Of the HLA-DRB1*04 subgroups, *0401 (40.83% vs. 18.75%, P < 0.001) was the most frequent allele in patients with RA, while DRB1*0402 (30.00% vs. 12.50%, P < 0.005) allele in the controls. HLA-DRB1 allele frequencies in the patients with RA and the controls showed Hardy–Weinberg
rule compliance. Results of this study indicate that HLA-DRB1*01, *04, and *09 alleles were associated with RA, and HLA-DRB1*13
was protective allele against RA. Among the subgroups of HLA-DRB1*04, *0401 was detected to be RA associated, while *0402
was being protective. These results have some differences compared with previous reports originating from other regions of
Turkey. 相似文献
987.
Yalcindag E Elguero E Arnathau C Durand P Akiana J Anderson TJ Aubouy A Balloux F Besnard P Bogreau H Carnevale P D'Alessandro U Fontenille D Gamboa D Jombart T Le Mire J Leroy E Maestre A Mayxay M Ménard D Musset L Newton PN Nkoghé D Noya O Ollomo B Rogier C Veron V Wide A Zakeri S Carme B Legrand E Chevillon C Ayala FJ Renaud F Prugnolle F 《Proceedings of the National Academy of Sciences of the United States of America》2012,109(2):511-516
The origin of Plasmodium falciparum in South America is controversial. Some studies suggest a recent introduction during the European colonizations and the transatlantic slave trade. Other evidence--archeological and genetic--suggests a much older origin. We collected and analyzed P. falciparum isolates from different regions of the world, encompassing the distribution range of the parasite, including populations from sub-Saharan Africa, the Middle East, Southeast Asia, and South America. Analyses of microsatellite and SNP polymorphisms show that the populations of P. falciparum in South America are subdivided in two main genetic clusters (northern and southern). Phylogenetic analyses, as well as Approximate Bayesian Computation methods suggest independent introductions of the two clusters from African sources. Our estimates of divergence time between the South American populations and their likely sources favor a likely introduction from Africa during the transatlantic slave trade. 相似文献
988.
Arikanoglu Z Aygen E Camci C Akbulut S Basbug M Dogru O Cetinkaya Z Kirkil C 《World journal of gastroenterology : WJG》2012,18(5):453-457
AIM: To share our experience of the management and outcomes of patients with pneumatosis cystoides intestinalis (PCI).METHODS: The charts of seven patients who underwent surgery for PCI between 2001 and 2009 were reviewed retrospectively. Clinical features, diagnoses and surgical interventions of patients with PCI are discussed.RESULTS: Seven patients with PCI (3 males, 4 females; mean age, 50 ± 16.1 years; range, 29-74 years) were analyzed. In three of the patients, abdominal pain was the only complaint, whereas additional vomiting and/or constipation occurred in four. Leukocytosis was detected in four patients, whereas it was within normal limits in three. Subdiaphragmatic free air was observed radiologically in four patients but not in three. Six of the patients underwent an applied laparotomy, whereas one underwent an applied explorative laparoscopy. PCI localized to the small intestine only was detected in four patients, whereas it was localized to the small intestine and the colon in three. Three patients underwent a partial small intestine resection and four did not after PCI was diagnosed. Five patients were diagnosed with secondary PCI and two with primary PCI when the surgical findings and medical history were assessed together. Gastric atony developed in one case only, as a complication during a postoperative follow-up of 5-14 d.CONCLUSION: Although rare, PCI should be considered in the differential diagnosis of acute abdomen. Diagnostic laparoscopy and preoperative radiological tests, including computed tomography, play an important role in confirming the diagnosis. 相似文献
989.
990.
Serkan Dogan Ozden Piskin Dilek Solmaz Servet Akar Aytac Gulcu Faize Yuksel Volkan Cakır Ismail Sari Nurullah Akkoc Fatos Onen 《Rheumatology international》2014,34(8):1129-1138
The current clinical and laboratory parameters of Takayasu arteritis (TA) are insufficient for proper assessment of disease activity. The aims of this study were to investigate the markers of endothelial injury and repair, including circulating endothelial cell (CEC), circulating endothelial progenitor cell (CEPC) and vascular endothelial growth factor (VEGF), and evaluate their associations with disease activity in patients with TA. Thirty-two patients with TA and 30 healthy age- and sex-matched controls were included in this study. Disease activity was assessed in TA patients using various tools, including Kerr’s criteria, the Indian Takayasu’s Arteritis Scoring (ITAS2010) and physician’s global assessment (PGA). CECs and CEPCs were measured by flow cytometry, and VEGF was measured using an enzyme-linked immunosorbent assay. The CEC level was found to be higher in TA patients than in the healthy controls (HC) (p < 0.001). There was no significant difference in CEC level between the active and inactive patients, but its level was slightly correlated with C-reactive protein (CRP) level. CEPC and VEGF levels in TA patients with active disease were higher than those in the inactive patients and HC. CEPC and VEGF levels were positively correlated with ITAS-CRP and PGA scores. This study shows increased level of CEC in patients with TA. It also suggests that the CEPC and VEGF levels may be correlated with disease activity. 相似文献