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61.
B E Johnson N Patronas W Hayes J Grayson B Becker D Gnepp J Rowland A Anderson E Glatstein D C Ihde 《Journal of clinical oncology》1990,8(1):48-56
To determine the subsequent evolution of neurologic, neuropsychologic, and intracranial anatomic findings in long-term survivors of small-cell cancer, we repeated an evaluation done 4 years previously in patients 6 to 13 years after treatment. Fifteen patients were reevaluated with a history and physical examination, mental status examination, neuropsychologic testing, computed cranial tomographic (CCT) scans, and magnetic resonance imaging (MRI). All but one was ambulatory and none were institutionalized. Thirteen of 15 had neurologic complaints, 10 of 15 had an abnormal neurologic examination, seven of 14 had an abnormal mental status examination, 12 of 14 had abnormal neuropsychologic testing, 12 of 15 had abnormal CCT scans, and seven of 15 had white-matter abnormalities on MRI scans. No dramatic decline in performance status, functional status, neurologic symptoms, or neurologic examination occurred in these patients with 4 years of additional follow-up. More patients showed a decline in mental status examinations and neuropsychologic testing than demonstrated improvement. Anatomic studies showed no dramatic changes in the CCT scans and MRI confirmed these findings. From these data we conclude that there is a slow decline in neuropsychologic function in some of the patients surviving more than 6 years from a diagnosis of small-cell lung cancer. The anatomic abnormalities documented by CCT scans and MRI are more frequent in patients with abnormal neuropsychologic function. 相似文献
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Since the NHS reforms, health authorities have been purchasing health care and have been advised that publichealth considerations must inform all NHS activities, and that the Director of Public Health must be supported by a team of qualified support staff. This survey of directors of public health and health authority chief executives in England shows the skills currently available to support health authority purchasing, and the perceived importance of this wide range of skills to the purchasing process. Future models of purchasing will need to ensure access by purchasers to public health and multi-disciplinary advice. 相似文献
64.
Detection of malignant bone tumors: MR imaging vs scintigraphy 总被引:11,自引:0,他引:11
J A Frank A Ling N J Patronas J A Carrasquillo K Horvath A M Hickey A J Dwyer 《AJR. American journal of roentgenology》1990,155(5):1043-1048
One hundred six patients with a known or suspected diagnosis of bone cancer (11 patients with biopsy-proved primary tumors, 95 patients with metastatic disease) were evaluated with scintigraphy and MR imaging to determine the relative sensitivity of each technique in the detection of bone disease. MR imaging was performed at 0.5 T as part of the entry evaluation into Intramural Research Board protocols (30%), for evaluation of cord compression, or because of an equivocal scintigram. MR was performed with T1-weighted (e.g., 300-500/10-20 [TR/TE]), T2-weighted (e.g., 2000/80) spin-echo (SE), and a short-TI inversion recovery (STIR) pulse sequence. Scintigrams were performed with 99mTc-methylene diphosphonate. A retrospective analysis showed that in 30 (28%) of 106 patients, MR imaging performed over a limited region of interest revealed a focal abnormality consistent with tumor that was not observed on scintigraphy. Only one patient had an abnormality on scintigraphy, caused by a metastasis, that was not found on MR images. In 73 (69%) of the 106 patients, the results of MR imaging and scintigraphy were equivalent; in 41 cases results of both techniques were normal. A McNemar analysis of the discordant cases showed MR imaging to be more sensitive than scintigraphy was (p less than .001). Our results suggest that although MR imaging has a greater sensitivity in detecting focal disease, scintigraphy is still the most useful screening test for evaluating the entire skeleton. MR imaging should be reserved for clarification of scintigraphic findings when suspicion is high for tumor. 相似文献
65.
Counts of Pick bodies (PB), Pick cells (PC), senile plaques (SP) and neurofibrillary tangles (NFT) were made in the frontal and temporal cortex from patients with Pick's disease (PD). Lesions were stained histologically with hematoxylin and eosin (HE) and the Bielschowsky silver impregnation method and labeled immunohistochemically with antibodies raised to ubiquitin and tau. The greatest numbers of PB were revealed by immunohistochemistry. Counts of PB revealed by ubiquitin and tau were highly positively correlated which suggested that the two antibodies recognized virtually identical populations of PB. The greatest numbers of PC were revealed by HE followed by the anti-ubiquitin antibody. However, the correlation between counts was poor, suggesting that HE and ubiquitin revealed different populations of PC. The greatest numbers of SP and NFT were revealed by the Bielschowsky method indicating the presence of Alzheimer-type lesions not revealed by the immunohistochemistry. In addition, more NFT were revealed by the anti-ubiquitin compared with the anti-tau antibody. The data suggested that in PD: (i) the anti-ubiquitin and anti-tau antibodies were equally effective at labeling PB; (ii) both HE and anti-ubiquitin should be used to quantitate PC; and (iii) the Bielschowsky method should be used to quantitate SP and NFT. 相似文献
66.
Quantitative liver function in patients with rheumatoid arthritis treated with low-dose methotrexate: a longitudinal study 总被引:4,自引:0,他引:4
Beyeler C; Reichen J; Thomann SR; Lauterburg BH; Gerber NJ 《Rheumatology (Oxford, England)》1997,36(3):338-344
The objectives were to determine quantitative liver function prospectively
in patients with rheumatoid arthritis (RA) treated with low-dose
methotrexate (MTX), to search for risk factors for a loss of quantitative
liver function and to assess the relationship between quantitative liver
function and histological staging. A total of 117 patients with RA (ACR
criteria, 85 women, mean age 59 yr) had measurements of galactose
elimination capacity (GEC), aminopyrine breath test (ABT) and liver enzymes
[aspartate amino transferase (AST), alanine amino transferase (ALT),
alkaline phosphatase (AP), 7-glutamyl transferase (GGT), bile acids,
bilirubin, albumin] before treatment with weekly i.m. MTX injections and
every year thereafter. In 16 patients, liver biopsies were performed.
Before the introduction of MTX, mean GEC was 6.6 mg/min/kg [5th to 95th
percentile (5-95 PC) 5.1- 8.5; reference range 6.0-9.1] and mean ABT was
0.80% kg/mmol (5-95 PC 0.42-1.30: reference range 0.6-1.0). During
treatment with MTX [mean weekly dose 11.8 mg (5-95 PC 5.4-20.2), mean
observation period 3.8 yr (5-95 PC 0.4-6.9)], significant declines of GEC
(-0.12 mg/min/kg per year. t = 3.30, P < 0.002) and ABT (-0.06% kg/mmol
per year, t = 4.81, P < 0.001) were observed. Negative correlations were
found between the annual change in GEC and GEC at baseline (Rs = -0.40, P
< 0.0001), and the annual change in ABT and ABT at baseline (Rs = -0.43,
P < 0.0001). No correlations were found between the annual change in GEC
or ABT and weekly MTX dose, age or percentage of increased liver enzymes,
and no effect of a history of alcohol consumption > 30 g/week became
evident. Two patients with Roenigk grade III had impaired quantitative
liver function, while 14 patients with Roenigk grades I and II exhibited a
high variability of GEC and ABT from normal to abnormal values. The
continuous declines in GEC and ABT observed deserve attention in patients
with prolonged treatment. Patients with a low GEC or ABT at baseline seem
not to be at increased risk for a further loss of quantitative liver
function. An impaired GEC or ABT does not necessarily concur with hepatic
fibrosis on histological examination.
相似文献
67.
S C Saris N J Patronas S A Rosenberg J T Alexander J Frank D J Schwartzentruber J T Rubin D Barba E H Oldfield 《Journal of neurosurgery》1989,71(2):169-174
Parenteral treatment with interleukin-2 (IL-2) is effective against certain advanced cancers outside the central nervous system. Prior to commencement of Phase II trials in patients with brain tumors, the neurological and neuroradiological features of 10 patients treated with intravenous administration of repeated doses of IL-2 were studied. Three patients had malignant gliomas, and seven patients had extracranial cancer without evidence of intracranial metastasis. All were treated with intravenous doses of 10(5) U/kg three times daily for up to 5 days. The patients with gliomas received cranial computerized axial tomography (CT) scans before IL-2 therapy was initiated and during the later stages of treatment. The patients with extracranial cancer underwent T2-weighted magnetic resonance (MR) imaging before and later during therapy. After two to 11 doses of IL-2, the patients with gliomas had marked neurological deterioration that was associated with a mild to marked increase in peritumoral edema and mass effect visible on CT scans. With cessation of treatment and appropriate supportive care, all returned to their pretreatment state. The patients with extracranial cancer were either neurologically unchanged or underwent minor transient changes in mental status (lethargy and confusion). In these patients, the MR signal intensity was quantified and compared in eight anatomic regions of interest. In six of the seven patients, there were increases in gray and white matter signal intensity consistent with increased cerebral water content. The percentage changes (means +/- standard error of the means) were 12.6% +/- 7.3% in the gray matter and 17.0% +/- 6.2% in the white matter. This study demonstrates that treatment with a high parenteral dose of IL-2 is not tolerated by patients with gliomas due to increased cerebral edema. In patients with extracranial cancer but no brain disease, parenteral IL-2 induces an increase in the cerebral water content of both gray and white matter. 相似文献
68.
69.
70.
Norman L. Foster Thomas N. Chase Luigi Mansi Rodney Brooks Paul Fedio Nicholas J. Patronas Giovanni Di Chiro 《Annals of neurology》1984,16(6):649-654
Regional cerebral glucose metabolism, an index of neuronal activity, was compared in 20 patients with Alzheimer's disease and 8 age-matched normal volunteers by positron emission tomography following {18F}2-fluoro-2-deoxy-D-glucose administration. Overall cortical glucose utilization in the Alzheimer's group was 10 to 49% below that of control individuals. The posterior parietal cortex and contiguous portions of posterior temporal and anterior occipital lobes were most severely affected; frontal cortex was relatively spared. This pattern of cortical involvement is consistent with the major clinical features of Alzheimer's disease. Comparison of patients with early and more advanced dementia suggested that a substantial decline in glucose metabolism occurs before cognitive impairment becomes evident; once the patient is symptomatic, however, small additional metabolic decrements are associated with a marked deterioration in intellectual function. 相似文献