全文获取类型
| 收费全文 | 2652694篇 |
| 免费 | 179710篇 |
| 国内免费 | 4750篇 |
专业分类
| 耳鼻咽喉 | 36552篇 |
| 儿科学 | 85607篇 |
| 妇产科学 | 72392篇 |
| 基础医学 | 384162篇 |
| 口腔科学 | 72410篇 |
| 临床医学 | 240496篇 |
| 内科学 | 509569篇 |
| 皮肤病学 | 59746篇 |
| 神经病学 | 211304篇 |
| 特种医学 | 98998篇 |
| 外国民族医学 | 759篇 |
| 外科学 | 394011篇 |
| 综合类 | 57891篇 |
| 现状与发展 | 13篇 |
| 一般理论 | 958篇 |
| 预防医学 | 207852篇 |
| 眼科学 | 61633篇 |
| 药学 | 193778篇 |
| 80篇 | |
| 中国医学 | 5823篇 |
| 肿瘤学 | 143120篇 |
出版年
| 2021年 | 22015篇 |
| 2019年 | 22835篇 |
| 2018年 | 30564篇 |
| 2017年 | 22971篇 |
| 2016年 | 26247篇 |
| 2015年 | 29476篇 |
| 2014年 | 41786篇 |
| 2013年 | 61891篇 |
| 2012年 | 84993篇 |
| 2011年 | 90088篇 |
| 2010年 | 53702篇 |
| 2009年 | 50513篇 |
| 2008年 | 83540篇 |
| 2007年 | 88579篇 |
| 2006年 | 89261篇 |
| 2005年 | 86689篇 |
| 2004年 | 82990篇 |
| 2003年 | 79017篇 |
| 2002年 | 76650篇 |
| 2001年 | 120808篇 |
| 2000年 | 123770篇 |
| 1999年 | 103902篇 |
| 1998年 | 30329篇 |
| 1997年 | 26992篇 |
| 1996年 | 27102篇 |
| 1995年 | 25468篇 |
| 1994年 | 23526篇 |
| 1993年 | 22068篇 |
| 1992年 | 79819篇 |
| 1991年 | 77609篇 |
| 1990年 | 75473篇 |
| 1989年 | 72694篇 |
| 1988年 | 67005篇 |
| 1987年 | 65122篇 |
| 1986年 | 61181篇 |
| 1985年 | 58537篇 |
| 1984年 | 43924篇 |
| 1983年 | 37478篇 |
| 1982年 | 22721篇 |
| 1979年 | 40044篇 |
| 1978年 | 28460篇 |
| 1977年 | 23684篇 |
| 1976年 | 22670篇 |
| 1975年 | 24016篇 |
| 1974年 | 29034篇 |
| 1973年 | 27618篇 |
| 1972年 | 26094篇 |
| 1971年 | 24412篇 |
| 1970年 | 22849篇 |
| 1969年 | 21563篇 |
排序方式： 共有10000条查询结果，搜索用时 15 毫秒
11.
Michelle Lerman Julia A. Gaebler Sunday Hoy Jessica Izhakoff Laura Gullett Timothy Niecko Pinar Karaca-Mandic Thomas O&#x;Donnell Stanley G. Rockson 《Journal of vascular surgery》2019,69(2):571-580
Objective
Phlebolymphedema (chronic venous insufficiency-related lymphedema) is a common and costly condition. Nevertheless, there is a dearth of evidence comparing phlebolymphedema therapeutic interventions. This study sought to examine the medical resource utilization and phlebolymphedema-related cost associated with Flexitouch (FLX; Tactile Medical, Minneapolis, Minn) advanced pneumatic compression devices (APCDs) relative to conservative therapy (CONS) alone, simple pneumatic compression devices (SPCDs), and other APCDs in a representative U.S. population of phlebolymphedema patients.Methods
This was a longitudinal matched case-control analysis of deidentified private insurance claims. The study used administrative claims data from Blue Health Intelligence for the complete years 2012 through 2016. Patients were continuously enrolled for at least 18 months, diagnosed with phlebolymphedema, and received at least one claim for CONS either alone or in addition to pneumatic compression (SPCDs or APCDs). The main outcomes included direct phlebolymphedema- and sequelae-related medical resource utilization and costs.Results
After case matching, the study included 86 patients on CONS (87 on FLX), 34 on SPCDs (23 on FLX), and 69 on other APCDs (67 on FLX). Compared with CONS, FLX was associated with 69% lower per patient per year total phlebolymphedema- and sequelae-related costs net of any pneumatic compression device-related costs ($3839 vs $12,253; P = .001). This was driven by 59% fewer mean annual hospitalizations (0.13 vs 0.32; P < .001) corresponding to 82% lower inpatient costs and 55% lower outpatient hospital costs. FLX was also associated with 52% lower outpatient physical therapy and occupational therapy costs and 56% lower other outpatient-related costs. Compared with SPCDs, FLX was associated with 85% lower total costs ($1153 vs $7449; P = .008) driven by 93% lower inpatient costs ($297 vs $4215; P = .002), 84% lower outpatient hospital costs ($368 vs $2347; P = .020), and 85% lower other outpatient-related costs ($353 vs $2313; P = .023). Compared with APCDs, FLX was associated with 53% lower total costs ($3973 vs $8436; P = .032) because of lower outpatient costs and lower rates of cellulitis (22.4% vs 44.9% of patients; P = .02).Conclusions
This analysis indicates significant benefits attributable to FLX compared with alternative compression therapies that can help reduce the notable economic burden of phlebolymphedema. 相似文献12.
Julia H. Vermylen Gordon J. Wood Elaine R. Cohen Jeffrey H. Barsuk William C. McGaghie Diane B. Wayne 《Journal of pain and symptom management》2019,57(3):682-687
Introduction
Physician communication impacts patient outcomes. However, communication skills, especially around difficult conversations, remain suboptimal, and there is no clear way to determine the validity of entrustment decisions. The aims of this study were to 1) describe the development of a simulation-based mastery learning (SBML) curriculum for breaking bad news (BBN) conversation skills and 2) set a defensible minimum passing standard (MPS) to ensure uniform skill acquisition among learners.Innovation
An SBML BBN curriculum was developed for fourth-year medical students. An assessment tool was created to evaluate the acquisition of skills involved in a BBN conversation. Pilot testing was completed to confirm improvement in skill acquisition and set the MPS.Outcomes
A BBN assessment tool containing a 15-item checklist and six scaled items was developed. Students' checklist performance improved significantly at post-test compared to baseline (mean 65.33%, SD = 12.09% vs mean 88.67%, SD = 9.45%, P < 0.001). Students were also significantly more likely to have at least a score of 4 (on a five-point scale) for the six scaled questions at post-test. The MPS was set at 80%, requiring a score of 12 items on the checklist and at least 4 of 5 for each scaled item. Using the MPS, 30% of students would require additional training after post-testing.Comments
We developed a SBML curriculum with a comprehensive assessment of BBN skills and a defensible competency standard. Future efforts will expand the mastery model to larger cohorts and assess the impact of rigorous education on patient care outcomes. 相似文献13.
Daniel S. Tsze Sharon S. Pan Kerrin C. DePeter Anju M. Wagh Stephen L. Gordon Peter S. Dayan 《The American journal of emergency medicine》2019,37(6):1128-1132
ObjectivesWe aimed to describe the analgesic efficacy, duration of analgesia, and adverse event profile associated with intranasal hydromorphone in children with acute pain presenting to an emergency department.MethodsProspective dose titration pilot study of otherwise healthy children 4 to 17-years-old with moderate to severe pain who required a parenteral opioid. All patients received an initial intranasal hydromorophone dose of 0.03 mg/kg. The need for additional analgesia was assessed at 15 and 30 min; an additional 0.015 mg/kg was given at each assessment, if required. Need for rescue analgesic, pain intensity and adverse events were assessed until 6 h after hydromorphone administration or until patients were discharged, underwent a procedure to treat their painful condition, or received a rescue analgesic.ResultsWe enrolled 35 children. Fifteen, 11, and 9 children required a total dose of 0.03, 0.045, and 0.06 mg/kg, respectively. Patients in each dose group experienced an absolute decrease in pain score of ≥3/10 and percent reduction >40% within 5–15 min of completing dose-titration administration of hydromorphone. Duration of analgesia (i.e. time until rescue analgesic administered) >1 h was observed in 85.7% of patients. Patients not requiring rescue analgesics had mild or no pain until discharged or their painful conditions were treated. Three (8.6%) patients required a rescue analgesic <1 h after hydromorphone administration. There were no major adverse events.ConclusionsIntranasal hydromorphone led to rapid, clinically significant and frequently sustained decreases in pain intensity in children. No major adverse events were observed in this preliminary sample.Clinical Trials Registration Number: NCT02437669 相似文献
14.
Christopher N. Cooley Tyler J. Beranek Matthew A. Warpinski Robert Alexander Amanda O. Esquivel 《The American journal of emergency medicine》2019,37(2):199-203
Introduction
In the United States there has been a large increase in participation in lacrosse for both males and females. The purpose of this study was to analyze the number of head injuries, injury rates (calculated using the reported number of participants) and types of head injuries that are seen in emergency departments in the United States.Methods
We compared injuries between male and female lacrosse participants. This was a retrospective study using a publicly available database produced by the US Consumer Product Safety Commission and information about lacrosse participation from US Lacrosse.Results
A linear regression was performed and showed a positive correlation between number of head injuries to males and time from 2002 to 2010 (R2?=?0.823; p?=?0.001). While the number of injuries to the head in female lacrosse participants was not significant. There was a negative correlation between the number of head injuries to males from 2010 to 2016 (R2?=?0.800; p?=?0.007), but again, there was no significance for female injury count (R2?=?0.417; p?=?0.117). Other significant differences between head injuries in males and females included the mechanism of injury and the type of injury recorded.Conclusion
The most recent data from 2010 to 2016, suggest that both males and females have had a decrease in injury rate. However the total number of female head injuries is not significantly decreasing and as the sport continues to grow there will likely be more total head injuries and visits to the emergency department. 相似文献15.
Sophia A. Traven Russell A. Reeves Molly G. Sekar Harris S. Slone Zeke J. Walton 《The Journal of arthroplasty》2019,34(1):140-144
Background
While the 11-factor modified frailty index (mFI) has been shown to predict adverse outcomes in patients undergoing total joint arthroplasty, the 5-factor index has not been evaluated in this patient population. The goal of this study was to evaluate the utility of the mFI-5 as a predictor of morbidity and mortality in patients undergoing primary total hip and knee arthroplasty.Methods
A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program's database for patients undergoing total hip arthroplasty and total knee arthroplasty between the years 2005 and 2016 was conducted. The 5-factor score, which includes the presence of comorbid diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functional status, was calculated for each patient. Multivariate logistic regression models were used to assess the relationship between the mFI-5 and postoperative complications while controlling for demographic variables.Results
One hundred forty thousand one hundred fifty-eight patients undergoing total hip arthroplasty and 226,398 patients undergoing total knee arthroplasty were identified. After adjusting for demographic variables and comorbid conditions, logistic regression analyses revealed that the mFI-5 was a strong predictor for total complications, Clavien-Dindo grade IV complications (cardiac arrest, myocardial infarction, septic shock, pulmonary embolism, postoperative dialysis, reintubation, and prolonged ventilator requirement), surgical site infections, readmission, and 30-day mortality (P < .001).Conclusions
The mFI-5 is an independent predictor of postoperative complications including life-threatening medical complications, surgical site infections, hospital readmission, and 30-day mortality after primary hip and knee arthroplasty. This clinical tool can be used to identify high-risk surgical patients and guide preoperative counseling to optimize outcomes.Level of Evidence
III. 相似文献16.
Spyridon G. Deftereos Dimitrios A. Vrachatis Christos Angelidis Agathi-Rosa Vrettou Eleni K. Sarri Sotiria G. Giotaki Efthymia Varytimiadi Charalampos Kossyvakis Eleana Kotsia Gerasimos S. Deftereos Konstantinos Doudoumis Georgios Giannopoulos 《Clinical therapeutics》2019,41(1):21-29
Purpose
The goal of this review was to summarize, analyze, and compare trials studying the efficacy of colchicine in the prevention of atrial fibrillation (AF) post-operatively (POAF) and post–catheter ablation. Ongoing studies and current guidelines are also presented and reviewed.Methods
Published studies on the field were identified through a literature search of the PubMed and clinicaltrials.gov databases.Findings
Four original studies regarding POAF, two original studies regarding post–catheter ablation AF, and six meta-analyses were identified. In addition, the 3 most recent guidelines/expert consensus documents were scrutinized.Implications
AF occurs frequently after cardiac surgery (POAF) and catheter pulmonary vein isolation (postablation AF) and is associated with increased cardiovascular morbidity. A number of trials over the last few years have investigated the role of colchicine in the prevention of POAF and postablation AF targeting the local and systemic inflammatory process that leads to initiation and maintenance of AF. Available data imply that colchicine may have a preventive role in POAF and/or postablation AF. However, certain limitations of these studies underline the need for further investigation. 相似文献17.
18.
Christine A. White Ayub Akbari Celine Allen Andrew G. Day Patrick A. Norman David Holland Michael A. Adams Greg A. Knoll 《Kidney international》2021,99(4):957-966
- Download : Download high-res image (308KB)
- Download : Download full-size image
19.
Yang Liu Yoshifumi Baba Takatsugu Ishimoto Hiroyasu Tsutsuki Tianli Zhang Daichi Nomoto Kazuo Okadome Kensuke Yamamura Kazuto Harada Kojiro Eto Yukiharu Hiyoshi Masaaki Iwatsuki Yohei Nagai Shiro Iwagami Yuji Miyamoto Naoya Yoshida Yoshihiro Komohara Masaki Ohmuraya Xiaoming Wang Jaffer A. Ajani Tomohiro Sawa Hideo Baba 《British journal of cancer》2021,124(5):963
Background Fusobacterium nucleatum (F. nucleatum) is a gut microbe implicated in gastrointestinal tumorigenesis. Predicting the chemotherapeutic response is critical to developing personalised therapeutic strategies for oesophageal cancer patients. The present study investigated the relationship between F. nucleatum and chemotherapeutic resistance in oesophageal squamous cell carcinoma (ESCC).Methods We examined the relationship between F. nucleatum and chemotherapy response in 120 ESCC resected specimens and 30 pre-treatment biopsy specimens. In vitro studies using ESCC cell lines and co-culture assays further uncovered the mechanism underlying chemotherapeutic resistance.Results ESCC patients with F. nucleatum infection displayed lesser chemotherapeutic response. The infiltration and subsistence of F. nucleatum in the ESCC cells were observed by transmission electron microscopy and laser scanning confocal microscopy. We also observed that F. nucleatum modulates the endogenous LC3 and ATG7 expression, as well as autophagosome formation to induce chemoresistance against 5-FU, CDDP, and Docetaxel. ATG7 knockdown resulted in reversal of F. nucleatum-induced chemoresistance. In addition, immunohistochemical studies confirmed the correlation between F. nucleatum infection and ATG7 expression in 284 ESCC specimens.Conclusions F. nucleatum confers chemoresistance to ESCC cells by modulating autophagy. These findings suggest that targeting F. nucleatum, during chemotherapy, could result in variable therapeutic outcomes for ESCC patients.Subject terms: Tumour biomarkers, Oesophageal cancer 相似文献
20.
Emiliano A. Rodríguez-Caulo Ana Guijarro-Contreras Arantza Guzón Juan Otero-Forero María José Mataró Gemma Sánchez-Espín Carlos Porras José M. Villaescusa José María Melero-Tejedor Manuel Jiménez-Navarro 《Seminars in thoracic and cardiovascular surgery》2021,33(2):328-334
- Download : Download high-res image (200KB)
- Download : Download full-size image