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Rationale:Uterine arteriovenous malformation (UVM), which can be congenital or acquired, is a relatively rare disorder that can cause life-threatening hemorrhage. Acquired UVM occurs predominantly after previous uterine procedures; rarely, it may occur after a hysterectomy. Although the best treatment option for UVM remains controversial, transcatheter arterial embolization (TAE) has recently been introduced as a safe and effective treatment.Patient concerns:A 34-year-old woman who underwent hysterectomy for uncontrolled postpartum bleeding continued to have hemoperitoneum.Diagnosis:Two days after surgery, massive hemoperitoneum was identified on computed tomography scan, and acquired UVM was diagnosed by angiography.Interventions:The patient was successfully treated using TAE with an n-Butyl cyanoacrylate.Outcomes:After embolization, hemodynamic stability was achieved. A day after embolization, hemoglobin was 10.2 g/dL, and the patient was discharged from the hospital 4 days thereafter.Lessons:Although the overall incidence of acquired UVM after hysterectomy is low, bleeding from acquired UVM should be considered as one of the differential diagnoses in the immediate postpartum period, especially when the clinical symptoms do not correlate with the amount of blood loss. A high index of suspicion, prompt diagnosis and intervention, and a multidisciplinary approach in the management were the elements of a successful outcome in this case.  相似文献   
146.
Aim:   Most studies looking at the relation between medication use and fall among the hospitalized elderly patients, were done in Western countries. So, a study was planned to investigate the role of medications in causing falls in hospitalized Asian elderly patients.
Methods:   Case note review was done for all patients age 65 years and above, who fell at least once during their hospital stay over a 12-month period. Information obtained from the case notes included: (i) demographic information; (ii) Modified Morse Fall scale; (iii) circumstances and time of fall; and (iv) medication use. From the hospital admission database, an age- and sex-matched control group was selected for comparison.
Results:   Over the 12-month study period, 298 patients met the study criteria. Average age of the patients was 75.8 years, 60.4% were male and 84.9% were Chinese. Multivariate analysis showed that fallers had longer lengths of stay and were more likely to have a history of falls. Fallers were also more likely to be taking hypnotics, cough preparations and anti-platelets, but less likely to be taking paracetamol. Fallers were on fewer medications.
Conclusion:   Elderly hospitalized patients on hypnotic drugs, cough preparations and anti-platelets were more likely to fall. Appropriate usage of analgesics, especially paracetamol, to relieve pain may reduce falls.  相似文献   
147.
The influence of interferon (IFN) on cellular proliferation, blast transformation, and differentiation was studied in lymph node cells from 17 patients with B-cell lymphomas, one patient with T-cell lymphoma, and eight patients with enlarged, non-malignant lymph nodes. The effects of IFN on lymph node cells were compared with effects on mononuclear blood cells from chronic lymphocytic leukemia (CLL) patients and healthy donors. Natural IFN-alpha (nIFN-alpha) induced a proliferative response in cells from seven of 17 of the B-cell lymphomas, in two of eight of the non-malignant lymph nodes, and in lymphoid blood cells from two of 32 CLL patients. With few exceptions, the proliferating cells were B cells and the data suggest that IFN acts directly on the B cells. Proliferation was not induced with IFN in cells from the T-cell lymphoma or in mononuclear blood cells from 13 healthy donors. nIFN-alpha induced blast transformation in cells from ten of 14 of the B-cell lymphomas and in four of seven of the non- malignant lymph nodes. Also beta- and gamma-IFN were shown to induce proliferation and blast transformation in lymph node cells from some patients. No major effect on the expression of various differentiation markers could be observed following culture in the presence of nIFN- alpha. We conclude that IFNs can induce proliferation and blast transformation in malignant and non-malignant B cells from lymph nodes.  相似文献   
148.
Aspergillosis (a fungal infection by an organism of the Aspergillus species) of the oral cavity is an uncommon condition which most frequently occurs in immunocompromised patients, such as those with haematological malignancies. In such patients, prolonged neutropenia secondary to chemotherapeutic agents enables the spread of invasive aspergillosis, which is unaffected by anatomical barriers. Early detection and treatment of the condition is essential to avoid more serious complications, such as disseminated infection, which results in increased morbidity and mortality. This case report describes a patient with acute myeloid leukaemia who developed localized invasive Aspergillus flavus of the palate. High‐dose antifungal therapy was instituted along with surgical removal of the involved tissues. Aspergillosis of the palate was successfully eradicated with no long‐term ill effects from the treatment. Management of invasive aspergillosis includes early aggressive antifungal medication combined with surgical removal of the involved tissues.  相似文献   
149.
Blood pressure variability (BPV) has been shown to be independently associated with cardiovascular (CV) mortality and morbidity. Patients with type 2 diabetes mellitus (T2DM) have also been shown to have increased BPV. We aimed to compare BPV in hypertensive patients with diabetes with those without diabetes. A total of 1443 hypertensive patients measured their blood pressure (BP) twice in the morning and twice before bed at home for a week. Demographic data, history of T2DM, and anti‐hypertensive use were captured. Clinic BP was measured twice in the clinic. Control of BP was defined as clinic systolic BP (SBP) <140 mm Hg and home SBP < 135 mm Hg. BPV was based on home SBP measurements. A total of 362(25.1%) hypertensives had diabetes and 47.4% were male. Mean age was 62.3 ± 12.1 years. There was no difference in the mean clinic SBP in both groups (139.9 mm Hg vs 138.4 mm Hg P = .188). However, the mean morning home SBP was significantly higher and control rate lower in hypertensives with diabetes than those without (132.3 ± 15 mm Hg vs 129.7 ± 14.4 mm Hg P = .005, 39.4% vs 47.6% P = .007), respectively. Masked uncontrolled morning hypertension was higher in those with diabetes versus those without (12.8% vs 8.4%, respectively). There was no statistically significant difference in BPV between those with and without diabetes. In summary, clinic SBP was similar in hypertensives with or without diabetes. However, control of BP based on both clinic and home SBP thresholds was poorer in hypertensives with diabetes compared to those without. Masked uncontrolled morning hypertension was higher in those with diabetes than those without. There was no difference in BPV between the two groups.  相似文献   
150.
Increased heart rate is a predictor of cardiovascular disease, heart failure, and all‐cause mortality. In those with high heart rates, interventions for heart rate reduction have been associated with reductions in coronary events. Asia is a diverse continent, and the prevalences of hypertension and cardiovascular disease differ among its countries. The present analysis of AsiaBP@Home study data investigated differences among resting heart rates (RHRs) in 1443 hypertensive patients from three Asian regions: East Asia (N = 595), Southeast Asia (N = 680), and South Asia (N = 168). This is the first study to investigate self‐measured RHR values in different Asian countries/regions using the same validated home BP monitoring device (Omron HEM‐7130‐AP/HEM‐7131‐E). Subjects in South Asia had higher RHR values compared with the other two regions, and the regional tendency found in RHR values was different from that found in BP values. Even after adjusting for age, sex, BMI, habitual alcohol consumption, current smoking habit, shift worker, hyperlipidemia, diabetes, chronic kidney disease, history of heart failure, and beta‐blocker use, both office and home RHR values in South Asia were the highest among Asia (mean values ± SE of office: East Asia [E] 75.2 ± 1.5 bpm, Southeast Asia [Se] 76.7 ± 1.5 bpm, South Asia [S] 81.9 ± 1.4 bpm; home morning: [E] 69.0 ± 1.2 bpm, [Se] 72.9 ± 1.2 bpm, [S] 74.9 ± 1.1 bpm; home evening: [E] 74.6 ± 1.2 bpm, [Se] 78.3 ± 1.2 bpm, [S] 83.8 ± 1.1 bpm). Given what is known about the impact of RHR on heart disease, our findings suggest the possible benefit of regionally tailored clinical strategies for cardiovascular disease prevention.  相似文献   
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