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81.
Hans-Josef Feistritzer Thomas Kurz Georg Stachel Philipp Hartung Philipp Lurz Ingo Eitel Christoph Marquetand Holger Nef Oliver Doerr Ursula Vigelius-Rauch Alexander Lauten Ulf Landmesser Sascha Treskatsch Mohamed Abdel-Wahab Marcus Sandri David Holzhey Michael Borger Jörg Ender Holger Thiele 《Journal of the American College of Cardiology》2021,77(17):2204-2215
BackgroundThe randomized SOLVE-TAVI (compariSon of secOnd-generation seLf-expandable vs. balloon-expandable Valves and gEneral vs. local anesthesia in Transcatheter Aortic Valve Implantation) trial compared newer-generation self-expanding valves (SEV) and balloon-expandable valves (BEV) as well as local anesthesia with conscious sedation (CS) and general anesthesia (GA) in patients undergoing transfemoral transcatheter aortic valve replacement (TAVR). Both strategies showed similar outcomes at 30 days.ObjectivesThe purpose of this study was to compare clinical outcomes during 1-year follow-up in the randomized SOLVE-TAVI trial.MethodsUsing a 2 × 2 factorial design 447 intermediate- to high-risk patients with severe, symptomatic aortic stenosis were randomly assigned to transfemoral TAVR using either the SEV (Evolut R, Medtronic Inc., Minneapolis, Minnesota) or the BEV (Sapien 3, Edwards Lifesciences, Irvine, California) as well as CS or GA at 7 sites.ResultsIn the valve-comparison strategy, rates of the combined endpoint of all-cause mortality, stroke, moderate or severe paravalvular leakage, and permanent pacemaker implantation were similar between the BEV and SEV group (n = 84, 38.3% vs. n = 87, 40.4%; hazard ratio: 0.94; 95% confidence interval: 0.70 to 1.26; p = 0.66) at 1 year. Regarding the anesthesia comparison, the combined endpoint of all-cause mortality, stroke, myocardial infarction, and acute kidney injury occurred with similar rates in the GA and CS groups (n = 61, 25.7% vs. n = 54, 23.8%; hazard ratio: 1.09; 95% confidence interval: 0.76 to 1.57; p = 0.63).ConclusionsIn intermediate- to high-risk patients undergoing transfemoral TAVR, newer-generation SEV and BEV as well as CS and GA showed similar clinical outcomes at 1 year using a combined clinical endpoint. (SecOnd-generation seLf-expandable Versus Balloon-expandable Valves and gEneral Versus Local Anesthesia in TAVI [SOLVE-TAVI]; NCT02737150) 相似文献
82.
Johannes Blumenstein Steffen Daniel Kriechbaum Jürgen Leick Alexander Meyer Won-Keun Kim Jan Sebastian Wolter Maisun Abu-Samra Kay Weipert Matthias Bayer Oliver Dörr Claudia Walther Christian W. Hamm Holger Nef Christoph Liebetrau Helge Möllmann 《Journal of thrombosis and thrombolysis》2018,45(2):240-249
The use of thrombus aspiration (TA) prior to primary percutaneous coronary intervention (PPCI) has undergone a radical change in intervention guidelines. The clinical implications, however, are still under scrutiny. This study investigated the clinical effects and outcome of TA before PPCI in patients with ST-segment elevation myocardial infarction (STEMI). Overall 1027 patients with STEMI were analyzed in this retrospective, propensity score-adjusted, multicenter study. The primary endpoints were in-hospital and long-term mortality. There were 418 patients in the TA group and 609 in the conventional PPCI group. The in-hospital mortality rate was significantly higher in the TA group (8.7 vs. 5.0%; P?=?0.03). During long-term follow-up [median follow-up duration 689 days (IQR 405–959)] the mortality rates were similar (TA 14.3%, conventional PPCI 15.0%; P?=?0.85). Survival analysis for the complete observation period revealed no significant benefit of TA [hazard ratio (HR) 1.12; 97.5% CI 0.90–0.71; P?=?0.63]. There were also no significant differences between the groups in the following secondary endpoints: composite of cardiovascular death and non-fatal reinfarction at discharge (P?=?0.39), post-PPCI thrombolysis in myocardial infarction flow-grade-3 (P?=?0.14), left ventricular ejection fraction (P?=?0.47), and non-fatal reinfarction during follow-up (P?=?0.17). Rehospitalization rate (1.82 vs. 10.3%; P?<?0.0001) and Canadian Cardiovascular Society (CCS) grading (P?=?0.02) during follow-up were significantly lower in the TA group. In our cohort the in-hospital mortality rate was significantly higher for TA patients, but during long-term follow-up the mortality rates did not differ. The incidence of rehospitalization and CCS grading were lower in the TA-treated patients. 相似文献
83.
84.
Collagen-induced arthritis in rhesus monkeys: evaluation of markers for inflammation and joint degradation 总被引:1,自引:0,他引:1
't Hart BA; Bank RA; De Roos JA; Brok H; Jonker M; Theuns HM; Hakimi J; Te Koppele JM 《Rheumatology (Oxford, England)》1998,37(3):314-323
The objective of this study was to analyse parameters in rhesus monkey
collagen-induced arthritis (CIA) with which the inflammation and
destruction of the joints can be described in quantitative terms. CIA was
induced in genetically susceptible and resistant monkeys, which can be
distinguished on the basis of the dominant resistance marker Mamu- A26. The
disease course was monitored daily using a semiquantitative scoring system.
Plasma samples were collected once or twice weekly and analysed for
C-reactive protein (CRP). Urines were collected overnight once a week and
analysed for excretion rates of the collagen cross- links
hydroxylysylpyridinoline (HP) and lysylpyridinoline (LP). The results show
that periods of active CIA are characterized by substantial weight loss and
increased plasma CRP levels, followed shortly thereafter by increased
excretion rates of the collagen cross- links HP and LP. Remission of the
disease can be recognized by a decline in plasma CRP levels and especially
an increase in body weight. The highest CRP levels were found in the most
severely arthritic monkeys, indicating a possible relationship of the
absolute plasma CRP levels to the severity of inflammation. During periods
of active arthritis, increased excretion rates of collagen cross-links HP
and LP in the urine were found. In particular, the major collagen
cross-link in articular cartilage, HP, showed a strong increase (9- to
15-fold). The excretion rates of LP, which is considered as a bone-specific
degradation marker, only increased 4- to 6-fold, thus indicating
predominant destruction of cartilage and less of bone. In conclusion, the
severity of CIA can be monitored in a quantitative manner using plasma CRP
levels, urinary excretion rates of HP and LP, and body weights,
superimposed on semiquantitative clinical scores. The parameters also
facilitate a more objective assessment of the effect of anti-arthritic
drugs in the model than with the clinical scores alone.
相似文献
85.
Phase I study of Topotecan, a new topoisomerase I inhibitor, in patients with refractory or relapsed acute leukemia 总被引:5,自引:1,他引:5
Kantarjian HM; Beran M; Ellis A; Zwelling L; O'Brien S; Cazenave L; Koller C; Rios MB; Plunkett W; Keating MJ 《Blood》1993,81(5):1146-1151
The purpose of this study was to define, in a phase I study in leukemia, the maximally tolerated dose (MTD), major toxicities, and possible antitumor activity of Topotecan, a new topoisomerase I (topo I) inhibitor. Topotecan was delivered by a 5-day continuous infusion every 3 to 4 weeks to patients with refractory or relapsed acute leukemia, at doses ranging from 3.5 mg/m2 to 18 mg/m2 per course. Twenty-seven patients were treated, including 17 patients with acute myelogenous or undifferentiated leukemia, 7 with acute lymphocytic leukemia, and 3 with chronic myelogenous leukemia in blastic phase. Severe mucositis was the dose-limiting toxicity occurring in two of five patients treated with Topotecan 11.8 mg/m2 per course; a third patient had prolonged myelosuppression. At the MTD of 10 mg/m2 per course, 1 of 12 patients had severe mucositis and 5 had mild-to- moderate mucositis. Nausea, vomiting, diarrhea, and prolonged myelosuppression were uncommon. Three patients (11%) achieved a complete response, two (7%) had a partial response, and one (4%) had a hematologic improvement. The overall complete plus partial response rate was 19%, and 24% in acute myelogenous or undifferentiated leukemia. A novel in vitro assay that quantifies Topotecan-stabilized topo I-DNA complexes in patient samples was used, which demonstrated heterogeneity in the ability of Topotecan to interact with topo I, the intracellular target of Topotecan. This phase I study defined the MTD of Topotecan to be 10 mg/m2 by continuous infusion over 5 days every 3 to 4 weeks in patients with refractory or relapsed acute leukemia. Severe mucositis was the dose-limiting toxicity. Future studies will define the precise activity of Topotecan in different leukemia subsets, its efficacy in combination with other antileukemic drugs, and correlations between Topotecan-induced topo I-DNA complex formation and individual patient response to Topotecan. 相似文献
86.
Sickle erythrocyte-endothelial interactions in microcirculation: the role of von Willebrand factor and implications for vasoocclusion 总被引:1,自引:0,他引:1
To determine the role of von Willebrand factor (vWF) in adhesion of sickle (SS) erythrocytes in microvascular flow conditions, we have perfused the ex vivo mesocecum vasculature of the rat with desmopressin, an analogue of vasopressin that causes the release of endothelial vWF. Analysis of vWF in the venous effluent of the isolated vasculature showed mainly the presence of extra-large molecular weight forms characteristic of endothelial vWF, which in the presence of desmopressin showed an average increase of 54%. Also, desmopressin induced a significant increase in adhesion of washed oxygenated (oxy) unseparated SS erythrocytes, accompanied by a persistent microvascular obstruction and a pronounced increase in the peripheral resistance (PRU). In contrast, infusion of SS deformable discocytes (SS2) in desmopressin-perfused vasculature resulted in a significant adhesion but not in persistent vasoocclusion, showing that SS2 discocytes alone are not sufficient for microvascular obstruction. Furthermore, SS4 erythrocytes (dense discocytes and irreversibly sickled erythrocytes) caused a persistent microvascular blockage and a significantly higher PRU than SS2 discocytes. However, the increase in PRU for SS4 erythrocytes following desmopressin treatment was 50% less compared with a corresponding increase for SS2 discocytes over the control values, which showed a smaller effect of desmopressin on the hemodynamic behavior of SS4 dense erythrocytes. Incubation of desmopressin-treated vasculature with anti-vWF antibodies resulted in a pronounced decrease in adhesion and significantly improved hemodynamic behavior of SS cells. Also, in untreated vasculature, similarly incubated with anti-vWF antibodies, there was almost complete inhibition of adhesion. Under the described perfusion conditions, antibodies to fibronectin and thrombospondin, as well as incubation of SS erythrocytes with anti-vWF antibodies did not affect adhesion. These results are compatible with a model for SS vasoocclusion in which extra- large vWF-mediated adhesion of deformable SS erythrocytes is the first step followed by an accelerated entrapment of dense SS erythrocytes. 相似文献
87.
Ross AA; Cooper BW; Lazarus HM; Mackay W; Moss TJ; Ciobanu N; Tallman MS; Kennedy MJ; Davidson NE; Sweet D 《Blood》1993,82(9):2605-2610
Although peripheral blood stem cell collections (PBSC) are thought to have less tumor involvement than bone marrow (BM), the incidence of circulating tumor cells in patients with breast cancer has not been widely investigated. We prospectively investigated the incidence and viability of tumor cell involvement in PBSC and BM collections from breast cancer patients undergoing high-dose chemotherapy/hematopoietic stem cell transplantation. Paired samples of PBSC and BM from 48 patients were analyzed using an immunocytochemical technique that detects one epithelial-derived tumor cell per 5 x 10(5) mononuclear cells. Immunostained tumor cells were detected in 9.8% (13/133) PBSC specimens from 9/48 (18.7%) patients and in 62.3% (38/61) BM specimens from 32/48 (66.7%) patients, a significantly higher rate than in PBSC (P < .005). The geometric mean concentration of tumor cells in contaminated PBSC specimens was 0.8/10(5) mononuclear cells (range 0.33 to 2.0/10(5)) compared with 22.9/10(5) mononuclear cells in BM (range 1 to 3,000/10(5), P < .0001). In culture experiments, clonogenic tumor colonies grew in 21/26 immunocytochemically positive specimens. No tumor colony growth was detected in 30/32 immunocytochemically negative specimens. Immunocytochemical detection of tumor involvement in BM and PBSC correlated significantly with in vitro clonogenic growth (P < .0001). We conclude that PBSC contain fewer tumor cells than paired BM specimens from patients with advanced breast cancer and that these tumor cells appear to be capable of clonogenic growth in vitro. 相似文献
88.
Ferguson JJ Fathy Waly HM Le D Thomakos N Wilson JM 《The Journal of invasive cardiology》1998,10(6):318-322
Considerable controversy exists as to the appropriate dosing of heparin for PTCA. We retrospectively reviewed records of 335 patients undergoing PTCA to determine: 1) the effects of correcting for weight and body surface area (BSA) on the heparin dose-response distribution; and 2) the average dose of heparin (standard, weight-based, and BSA-based) required to achieve an activated clotting time (ACT) of 300 seconds. For each patient, height, weight, BSA, baseline ACT (HemoTec), bolus heparin dose, and post-heparin ACT were recorded and the heparin response calculated. There were no significant differences in the distributions of standard (SD =.017 +/- 006 sec/U, 34% of mean), weight-based (SD = 1.41 +/- 0.46 sec/U/kg, 33% of mean), and BSA-based (SD = 0.033 +/- 0.011 sec/U/m2, 32% of mean) heparin response. There were slight, but significant correlations between heparin response and weight (r = 0.37) and heparin response and BSA (r = 0.36). The estimated doses of heparin to achieve a HemoTec ACT of 300 seconds were 10,650 +/- 1270 U, 130 +/- 15 U/kg, and 5390 +/- 640 U/m2. CONCLUSIONS: There are slight but significant correlations between heparin response and both weight and BSA. The distributions of weight- and BSA-corrected heparin response are similar to that of standard heparin dosing. Thus, weight adjusted heparin dosing would not appear to be likely to provide a more reliable ACT response to bolus doses of heparin. 相似文献
89.
Timm Bauer Anselm K. Gitt Matthias Hochadel Helge Möllmann Holger Nef Franz Weidinger Ralf Zahn Christian W. Hamm Jean Marco Uwe Zeymer 《International journal of cardiology》2013
Background/objectives
Little is known about angiographic and clinical differences in patients presenting with left circumflex artery (LCX)-related ST elevation myocardial infarction (STEMI) and non ST elevation myocardial infarction (NSTEMI). We sought to determine the clinical significance of ST elevations in patients with LCX-related myocardial infarction.Methods and results
Between 2005 and 2008 10,503 consecutive patients with acute STEMI and NSTEMI undergoing percutaneous coronary intervention (PCI) were prospectively enrolled into the Euro Heart Survey PCI-Registry. For the present analysis patients with LCX-related STEMI (n = 1100, 54.7%) were compared to those with LCX-related NSTEMI (n = 910, 45.3%). NSTEMI-patients were older, more often female and had a higher incidence of prior cardiac events. Patients with STEMI more frequently presented with shock (8.0 versus 3.9%, P < 0.001) or had been resuscitated (8.5 versus 2.7%, P < 0.0001). TIMI 0–1 before PCI was much more often found among those with STEMI (58.2 versus 25.1%, P < 0.0001). In the univariate analysis there were no significant differences in hospital mortality (STEMI: 4.8%, NSTEMI: 3.5%, P = 0.17), however after adjustment for age, female gender, diabetes and chronic renal failure hospital mortality was significantly higher in STEMI patients (odds ratio 1.71, 95%-CI 1.08–2.72, P < 0.05).Conclusions
Over 50% of the patients with LCX-related myocardial infarction treated with PCI had ST elevations in the initial electrocardiogram. STEMIs were more often associated with total vessel occlusions or haemodynamic instability. In-hospital mortality was significantly higher in patients with LCX-related STEMI. 相似文献90.
高效液相色谱法测定消痰咳片的含量 总被引:2,自引:0,他引:2
目的:采用反相色谱法同时测定消痰咳片中两种主要成分甲氧苄啶和磺胺体的含量。方法:以乙腈:0.1%H3PO4(15:85)为流动相,检测波长254nm,HPLC法测定含量。结果:试验表明,甲氧苄啶和磺胺林在0.8-8ug范围内呈良好的线性关系,回归方程分别为Y=-1127.1+110.2x(r=0.9994),Y=-1852.3 256.2x(r=0.9996),相对标准偏差分别为2.1%和0.8%。结论:该方法简便、准确、可靠。 相似文献