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71.
72.
The paper discusses the role of unconventional methods in palliative care of cancer patients. A review of the literature as well an interview of the palliative care units of Thuringia showed that problems increase regarding CAM during ongoing cancer disease. The art of palliative care is to minimize different therapies without a lost of compliance in our patients and their relatives. The selected use of proven CAM methods may effectively support this aim. 相似文献
73.
74.
Pulmonary cystic disease: comparison of Pneumocystis carinii pneumatoceles and bullous emphysema due to intravenous drug abuse 总被引:6,自引:0,他引:6
A rare pulmonary manifestation of the acquired immunodeficiency syndrome or intravenous (IV) drug abuse is upper lobe cystic disease--pneumatoceles in Pneumocystis carinii pneumonia (PCP) and bullous emphysema in IV drug abuse. Because these disorders overlap, the radiographic findings in 56 patients were compared. During a 12-month period, 16 patients less than 40 years of age were found to have bullous emphysema; the 10 who were IV drug abusers constituted group 1. In the same time period, 40 patients with PCP were encountered; the eight (20%) who had or developed pneumatoceles constituted group 2. In both groups, the conventional radiographic manifestations of upper lobe cystic disease were similar. Eight patients underwent computed tomography of the chest. In five patients with bullous disease, the distribution of the bullous lesions was peripheral, with sparing of the central portions of the lungs. In contrast, PCP pneumatoceles in three patients were dispersed throughout the lung parenchyma. 相似文献
75.
Pulmonary embolism is a potentially fatal condition that is extremely difficult to accurately diagnose clinically, usually relying on radiological investigations to make the diagnosis. These confirmatory tests are expensive, time consuming and may be associated with considerable morbidity. Thus, the utility of a blood test that reliably makes or refutes the diagnosis is apparent. Most blood tests involve the later stages of thrombolysis. Of these, the D-Dimer tests are the most sensitive, and when combined with monoclonal antibody technology, are of clinical value. Enzyme-linked immunosorbent assay D-Dimer tests have good sensitivity (95%) and moderate specificity (30–45%), but technical considerations prevent their routine use. Latex agglutination tests overcome these technical problems, but their sensitivity is variable (46–100%). Two recently introduced tests show promise. The NYCO-CARD D-Dimer test is a semiquantitative modified enzyme-linked immunosorbent assay test. Relatively few clinical studies have been performed and further validation studies are required. The SimpliRED D-Dimer test uses a new bispecific antibody technique, allows bed-side testing, and has good sensitivity (84–100%) and negative predictive values (92–99%). These tests could be used to screen low risk patients, thus avoiding ventilation-perfusion scans, or in combination with ventilation-perfusion scans and lower limb studies to avoid angiograms in intermediate probability pulmonary embolism patients. Future research will define where these tests show greatest utility, particularly in which patient subgroups, or symptom time intervals. 相似文献
76.
Ann B. Nguyen Laura Lourenço Ben Bow Chung Teruhiko Imamura Daniel Rodgers Stephanie A. Besser Catherine Murks Tiana Riley JoDel Powers Jayant Raikhelkar Sara Kalantari Nitasha Sarswat Valluvan Jeevanandam Gene Kim Gabriel Sayer Nir Uriel 《The Journal of heart and lung transplantation》2018,37(11):1322-1328
77.
The chances that an emergency physician will demonstrate three abdominal aortic aneurysms by ultrasound in the emergency department for credentialing: A statistician's view
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Kevin H Chu Anita Pelecanos Nathan J Brown Anthony FT Brown 《Emergency medicine Australasia : EMA》2017,29(4):464-466
The Australasian College for Emergency Medicine requires 15 proctored examinations of the aorta for credentialing in ultrasonography for abdominal aortic aneurysm (AAA). Furthermore, at least three examinations need to be positive for an aneurysm. In the ED where AAA presentations are sporadic, what are the chances that an emergency physician (EP) will have the opportunity to demonstrate three AAAs in the next 12 months? The probability of an event occurring within a given time‐frame can be modelled by the Poisson distribution. Central to the Poisson distribution is the infrequency of the event such as encountering an AAA in the ED. An EP working 30 clinical hours/week in our tertiary‐referral hospital ED can be expected to encounter 15.6 (3.6 symptomatic + 12 asymptomatic) AAA in the next 12 months. The probability of seeing three or more cases during this time is 99.9%. Assuming a proctor can be found for half the cases, the probability of an EP performing proctored ultrasound examinations in at least three AAAs is 98%. This probability drops to 89% if a proctor can be found for only one‐third of cases. For an EP to be almost 100% certain of meeting the credentialing requirements, he/she would need almost 10 proctored ultrasound cases of AAA to be available within his/her shifts during the year. The Poisson distribution has enabled us to model the probability of encountering a given number of AAA in the ED. Analysis such as this may help rationalise the numbers needed for credentialing. 相似文献
78.
Double‐dorsal versus single‐volar digital subcutaneous anaesthetic injection for finger injuries in the emergency department: A randomised controlled trial
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79.
A structural gap in Dpo4 supports mutagenic bypass of a major benzo[a]pyrene dG adduct in DNA through template misalignment 总被引:1,自引:0,他引:1
Bauer J Xing G Yagi H Sayer JM Jerina DM Ling H 《Proceedings of the National Academy of Sciences of the United States of America》2007,104(38):14905-14910
Erroneous replication of lesions in DNA by DNA polymerases leads to elevated mutagenesis. To understand the molecular basis of DNA damage-induced mutagenesis, we have determined the x-ray structures of the Y-family polymerase, Dpo4, in complex with a DNA substrate containing a bulky DNA lesion and incoming nucleotides. The DNA lesion is derived from an environmentally widespread carcinogenic polycyclic aromatic hydrocarbon, benzo[a]pyrene (BP). The potent carcinogen BP is metabolized to diol epoxides that form covalent adducts with cellular DNA. In the present study, the major BP diol epoxide adduct in DNA, BP-N(2)-deoxyguanosine (BP-dG), was placed at a template-primer junction. Three ternary complexes reveal replication blockage, extension past a mismatched lesion, and a -1 frameshift mutation. In the productive structures, the bulky adduct is flipped/looped out of the DNA helix into a structural gap between the little finger and core domains. Sequestering of the hydrophobic BP adduct in this new substrate-binding site permits the DNA to exhibit normal geometry for primer extension. Extrusion of the lesion by template misalignment allows the base 5' to the adduct to serve as the template, resulting in a -1 frameshift. Subsequent strand realignment produces a mismatched base opposite the lesion. These structural observations, in combination with replication and mutagenesis data, suggest a model in which the additional substrate-binding site stabilizes the extrahelical nucleotide for lesion bypass and generation of base substitutions and -1 frameshift mutations. 相似文献
80.
Sayer NA Chiros CE Sigford B Scott S Clothier B Pickett T Lew HL 《Archives of physical medicine and rehabilitation》2008,89(1):163-170
Sayer NA, Chiros CE, Sigford B, Scott S, Clothier B, Pickett T, Lew HL. Characteristics and rehabilitation outcomes among patients with blast and other injuries sustained during the Global War on Terror.