收费全文 | 5414篇 |
免费 | 521篇 |
国内免费 | 3篇 |
耳鼻咽喉 | 163篇 |
儿科学 | 158篇 |
妇产科学 | 150篇 |
基础医学 | 647篇 |
口腔科学 | 173篇 |
临床医学 | 609篇 |
内科学 | 934篇 |
皮肤病学 | 66篇 |
神经病学 | 449篇 |
特种医学 | 333篇 |
外科学 | 653篇 |
综合类 | 152篇 |
一般理论 | 5篇 |
预防医学 | 468篇 |
眼科学 | 172篇 |
药学 | 419篇 |
中国医学 | 2篇 |
肿瘤学 | 385篇 |
2021年 | 75篇 |
2019年 | 69篇 |
2018年 | 85篇 |
2017年 | 65篇 |
2016年 | 77篇 |
2015年 | 105篇 |
2014年 | 102篇 |
2013年 | 179篇 |
2012年 | 217篇 |
2011年 | 222篇 |
2010年 | 145篇 |
2009年 | 122篇 |
2008年 | 192篇 |
2007年 | 207篇 |
2006年 | 212篇 |
2005年 | 216篇 |
2004年 | 203篇 |
2003年 | 183篇 |
2002年 | 155篇 |
2001年 | 191篇 |
2000年 | 163篇 |
1999年 | 156篇 |
1998年 | 93篇 |
1997年 | 95篇 |
1996年 | 92篇 |
1995年 | 75篇 |
1994年 | 61篇 |
1993年 | 66篇 |
1992年 | 134篇 |
1991年 | 117篇 |
1990年 | 138篇 |
1989年 | 128篇 |
1988年 | 120篇 |
1987年 | 112篇 |
1986年 | 118篇 |
1985年 | 113篇 |
1984年 | 79篇 |
1983年 | 83篇 |
1982年 | 56篇 |
1981年 | 64篇 |
1979年 | 83篇 |
1978年 | 65篇 |
1977年 | 56篇 |
1976年 | 60篇 |
1975年 | 47篇 |
1974年 | 49篇 |
1973年 | 41篇 |
1972年 | 47篇 |
1971年 | 43篇 |
1970年 | 40篇 |
Introduction
We hypothesized that an elevated preoperative alkaline phosphatase (AP) predicted worse outcomes for patients undergoing transarterial chemoembolization (TACE) for neuroendocrine tumor (NET) liver metastases.Methods
We reviewed all patients who underwent TACE for metastatic NET between 2009 and 2013. Survival was evaluated using preprocedure variables.Results
One hundred and nine patients underwent 210 TACE procedures. The average age was 57.7 years (range 20–78). Primary sites included pancreas (N?=?20), other gastrointestinal (N?=?52), lung (N?=?9), and unknown (N?=?28). The tumor was grade 1 in 68 (62 %), grade 2 in 21 (19 %), and grade 3 in 3 (3 %). Extrahepatic disease was present in 54 (50 %) and greater than 50 % hepatic tumor burden by imaging in 63 (58 %). Elevated bilirubin occurred in 8 (7 %), elevated AP in 22 (20 %), elevated ALT in 21 (19 %), and elevated AST in 41 (38 %). Univariate predictors included tumor grade (43 vs 27 vs 21 months, p?=?0.015), hepatic tumor burden (59 vs 37 months, p?=?0.009), and elevated AP (59 vs 23 months, p?<?0.001). On multivariate analysis, only elevated AP (p?=?0.001) predicted worse survival.Conclusions
Elevated AP prior to TACE for metastatic NET portends a worse survival outcome, even more so than tumor grade or extent of hepatic disease.Background
Thirty-day readmission post-bariatric surgery is used as a metric for surgical quality and patient care. We sought to examine factors driving 30-day readmissions after laparoscopic sleeve gastrectomy (LSG).Methods
We reviewed 1257 LSG performed between March 2012 and June 2014. Readmitted and nonreadmitted patients were compared in their demographics, medical histories, and index hospitalizations. Multivariable regression was used to identify risk factors for readmission.Results
Forty-five (3.6 %) patients required 30-day readmissions. Forty-seven percent were readmitted with malaise (emesis, dehydration, abdominal pain) and 42 % with technical complications (leak, bleed, mesenteric vein thrombosis). Factors independently associated with 30-day readmission include index admission length of stay (LOS) ≥3 days (OR 2.54, CI?=?[1.19, 5.40]), intraoperative drain placement (OR 3.11, CI?=?[1.58, 6.13]), postoperative complications (OR 8.21, CI?=?[2.33, 28.97]), and pain at discharge (OR?8.49, CI?=?[2.37, 30.44]). Patients requiring 30-day readmissions were 72 times more likely to have additional readmissions by 6 months (OR?72.4, CI?=?[15.8, 330.5]).Conclusions
The 30-day readmission rate after LSG is 3.6 %, with near equal contributions from malaise and technical complications. LOS, postoperative complications, drain placement, and pain score can aid in identifying patients at increased risk for 30-day readmissions. Patients should be educated on postoperative hydration and pain management, so readmissions can be limited to technical complications requiring acute inpatient management.Background
This study utilized a multi-institutional database to evaluate risk factors for readmission in patients undergoing curative gastrectomy for gastric adenocarcinoma with the intent of describing both perioperative risk factors and the relationship of readmission to survival.Methods
Patients who underwent curative resection of gastric adenocarcinoma from 2000 to 2012 from seven academic institutions of the US Gastric Cancer Collaborative were analyzed. In-hospital deaths and palliative surgeries were excluded, and readmission was defined as within 30 days of discharge. Univariate and multivariable logistic regression analyses were employed and survival analysis conducted.Results
Of the 855 patients, 121 patients (14.2 %) were readmitted. Univariate analysis identified advanced age (p?<?0.0128), American Society of Anesthesiology status ≥3 (p?=?0.0045), preexisting cardiac disease (p?<?0.0001), hypertension (p?=?0.0142), history of smoking (p?=?0.0254), increased preoperative blood urea nitrogen (BUN; p?=?0.0426), concomitant pancreatectomy (p?=?0.0056), increased operation time (p?=?0.0384), estimated blood loss (p?=?0.0196), 25th percentile length of stay (<7 days, p?=?0.0166), 75th percentile length of stay (>12 days, p?=?0.0256), postoperative complication (p?<?0.0001), and total gastrectomy (p?=?0.0167) as risk factors for readmission. Multivariable analysis identified cardiac disease (odds ratio (OR) 2.4, 95 % confidence interval (CI) 1.6–3.3, p?<?0.0001), postoperative complication (OR 2.3, 95 % CI 1.6–5.4, p?<?0.0001), and pancreatectomy (OR 2.2, 95 % CI 1.1–4.1, p?=?0.0202) as independent risk factors for readmission. There was an association of decreased overall median survival in readmitted patients (39 months for readmitted vs. 103 months for non-readmitted). This was due to decreased survival in readmitted stage 1 (p?=?0.0039), while there was no difference in survival for other stages. Stage I readmitted patients had a higher incidence of cardiac disease than stage I non-readmitted patients (58 vs. 24 %, respectively, p?=?0.0002).Conclusions
Within this multi-institutional study investigating readmission in patients undergoing curative resection for gastric cancer, cardiac disease, postoperative complication, and concomitant pancreatectomy were identified as significant risk factors for readmission. Readmission was associated with decreased overall median survival, but on further analysis, this was driven by differences in survival for stage I disease only.Methods: Infertile women trying to conceive, and specialist nurses were recruited across 6 European countries. In total 18 patients and 19 nurses took part in the testing, which included both nurse-patient pairings and in-depth interviews. A standardized list of expected and pre-defined critical steps according to the Instructions for Use (IFU), was used to assess the correct handling of the pen.
Results: During the user experience testing, no critical errors, related to the use of the pen, which could affect the success of the injection process were identified. In general, both nurses and patients found the pen very easy to learn, use and would be confident using the pen for self-injection. Nurses also found the pen very easy to train the patients.
Conclusions: The study provides valuable information on the pen from both patient and nurse perspectives in different simulated scenarios reflecting standard practice. 相似文献