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11.
Flavio Roberto Takeda Marcus Fernando Kodama Pertille Ramos Marina Alessandra Pereira Renan Rosetti Muniz Francisco Tustumi Tiago Biachi de Castria Rubens Antonio Aissar Sallum Bruno Zilberstein Ulysses Ribeiro Junior Ivan Cecconello 《American journal of surgery》2021,221(3):631-636
IntroductionAdenocarcinoma of the esophagogastric junction (AEGJ) represents a poor prognostic tumor. We evaluated the recurrence pattern and risk factors associated with recurrence in patients undergoing surgical resection by AEJG.MethodsRecurrences were categorized as locoregional, peritoneal, or distant. These three recurrence groups and a non-recurrence group were compared, and overall survival (OS) and disease-free survival (DFS) for each one was obtained.ResultsWe analyzed 188 patients with curative surgical treatment. Recurrence was observed in 72 (38.3%) patients. Locoregional recurrence was observed in 17 (23.6%); 20 (27.8%) peritoneal recurrence and 35 (48.6%) distant metastasis. DFS was 9, 5, and 8 months, and OS was 21.8, 13.2, and 20.8, respectively. Tumors larger than 5 cm are risk factors for peritoneal recurrence (OR:2.88, p = 0.012). Positive lymph nodes were related to distant metastasis (OR:9.15, p = 0.040), and lymphatic invasion for locoregional recurrence (OR:3.81, p = 0.028).ConclusionAEGJ is associated with high rates of early recurrence. 相似文献
12.
Roberto Iglesias Lopes Caio Vinicius Suartz Rubens Pedrenho Neto Ricardo Haidar Berjeaut Berenice Mendonca Madson Q. Almeida Maria Cândida Villares Fragoso Francisco Tibor Dénes 《Journal of pediatric surgery》2021,56(4):768-771
AimThe aim of this study is to present our experience in the management of hormonally active adrenal tumors in children.Material and methodsWe did a retrospective chart review of all children with hormonally active adrenal tumors evaluated at the endocrinology clinic and operated at our institution between 1983 and 2019.ResultsThere were 75 patients included in the study, 58 with adrenocortical tumors (ACTs) and 17 with pheochromocytomas (PCCs). Within the group of patients with ACTs, there were 41 females and 17 males. The mean age was 58.3 (SD: 87.9; range: 9–211) months. The clinical manifestation of the tumor's hormonal activity was virilization in 37 cases, Cushing syndrome in 5, and mixed in 16. A positive family history was present in 11 patients (18.9%). The mean tumor size was 48.2 (SD: 22.4; range: 7–120) mm. The pathological diagnosis was adenoma in 42 cases, carcinoma in 15 cases, and macronodular hyperplasia in 1. Median follow-up was 192 (range: 50–290) months. Tumor recurrence occurred in 6 patients (10.3%), and there were three disease-related deaths (5%). Within the group of patients with PCCs, there were 11 males and 6 females. The mean age was 146.7 (SD: 71.2; range: 60–216) months. A positive family history was present in 7 patients (41.2%). The mean tumor size was 36.6 (SD: 16.7; range: 7–120) mm. The pheochromocytoma was classified as benign in 15 cases and as malignant in 2. During a median follow-up of 180 (range: 127–300) months, recurrence was observed in 6 cases (35.3%) and disease-related death in 1 case (5.9%).ConclusionsProper diagnosis and management at our referral center were associated with a high cure rate, even in cases of malignant tumors. Familial surveillance is highly recommended.Level of evidenceLevel IV. 相似文献
13.
S Z Rapcsak L B Krupp A B Rubens J Reim 《Stroke; a journal of cerebral circulation》1990,21(6):953-956
We report two patients with mixed transcortical aphasia following left frontal lobe infarctions. Although there was no evidence of anatomic isolation of the speech area on computed tomograms or magnetic resonance imaging scans, single-photon emission computed tomography in one case demonstrated diminished blood flow over the left parietal convexity suggestive of "functional isolation" of the posterior perisylvian language zone. 相似文献
14.
PURPOSE: To evaluate the effectiveness of the Actronics Interactive Learning System to teach the psychomotor skills of advanced airway management compared to the traditional method of lecture/demonstration. METHODS: The study was a nonrandomized, nonequivalent comparison group design of a convenience sample of 86 American Heart Association (AHA), advanced cardiac life support (ACLS) students, who obtained instruction in airway management by the interactive videodisc (IVD) learning system (n = 41), or by the traditional method of demonstration/return demonstration (n = 45). The evaluation criteria for the students were based on the number of attempts required to perform successfully endotracheal (ET) intubation and esophageal obturator airway (EOA) insertion. RESULTS: No statistically significant differences in the performance of ET insertion between the IVD and the traditional method of instruction could be demonstrated. However, initial certifiers for ACLS learning EOA insertion by the IVD method had a treatment effect (p = 0.004) compared to ACLS students learning by the traditional method. This treatment effect was not noted with ET intubation and EOA insertion for students seeking recertification. In a post-test satisfaction questionnaire, 34 IVD students reported satisfaction with learning airway management using this instructional method, but also expressed a preference to have an ACLS instructor available. CONCLUSION: This study highlights the role of IVD in teaching the complex skills of advanced airway management. 相似文献
15.
Christopher J. Twelves Nicola A. Dobbs Helen C. Gillies Christopher A. James Robert D. Rubens Peter G. Harper 《Cancer chemotherapy and pharmacology》1998,42(3):229-234
We studied variability in doxorubicin pharmacokinetics in 24 patients with abnormal liver biochemistry tests. Blood samples
were collected after the first cycle of single-agent doxorubicin given as an i.v. bolus and plasma levels were measured by
high-performance liquid chromatography. The relationship between doxorubicin clearance (dose/AUC) and liver biochemistry tests
(AST, bilirubin, albumin, alkaline phosphatase and indocyanine green clearance) was investigated. Patients with a raised bilirubin
level had reduced doxorubicin clearance, but there was no clear relationship between the extent of this elevation and the
reduction in doxorubicin clearance. Doxorubicin clearance was lower in patients with an isolated increase in AST than in those
with normal liver biochemistry, but this difference was not statistically significant. Nevertheless, there was a significant
correlation between reduced doxorubicin clearance and both raised serum AST levels and low indocyanine green clearance. These
pharmacokinetic data suggest that current dose reductions based solely on the extent to which bilirubin is elevated may not
be optimal.
Received: 20 October 1997 / Accepted: 20 January 1998 相似文献
16.
OBJECTIVE: This paper presents our experience with gunshot wounds to the temporal bone and discusses facial nerve lesions, surgical indication, surgical timing, and other findings. STUDY DESIGN: We performed a retrospective review of patients treated for facial nerve lesion after gunshot injury to the temporal bone. SETTING: The study was performed in the Otolaryngology Department of the University of Sao Paulo Medical School, Sao Paulo, Brazil. PATIENTS: Ninety-eight patients treated between 1988 and 1999 were analyzed. INTERVENTION: Facial nerve lesions, bullet locations, and surgical techniques were analyzed. Patients were monitored for 2 years. RESULTS: Gunshot trauma to the temporal bone presented considerable tissue loss resulting from the abrasion effect and severity of the impact. The third segment of the facial nerve was most affected, and the bullet was typically found lodged in the mastoid tip. Postoperative infection was common. Such cases required revision surgery, resulting in worse cosmetic outcomes than in cases of closed trauma. CONCLUSIONS: Surgical exploration of the facial nerve should be performed as soon as possible, since long delays increase the chance of traumatic neuroma and more pronounced scarring around the facial nerve. Open mastoidectomy with meatoplasty is the surgical technique recommended for repairing the mastoid and the facial nerve. In the majority of cases, a cable graft is necessary. Since nerve lesion in proximity to the stylomastoid foramen and extratemporal facial nerve is common, these areas must be explored carefully. 相似文献
17.
R C Coombes A Howell M Emson C Peckitt C Gallagher C Bengala A Tres R Welch P Lawton R Rubens E Woods J Haviland D Vigushin E Kanfer J M Bliss 《Annals of oncology》2005,16(5):726-734
BACKGROUND: The purpose of this study was to assess whether a short course of anthracycline containing chemotherapy followed by high dose therapy with autologous stem-cell support improves disease-free and overall survival as compared with conventional, anthracycline containing chemotherapy, in patients with primary breast cancer and four or more histologically involved lymph nodes. PATIENTS AND METHODS: Two hundred and eighty one patients entered into a randomised clinical trial were allocated to receive standard, conventional treatment (5-fluorouracil, epirubicin and cyclophosphamide-FEC for six cycles) or FEC for three cycles followed by high dose therapy consisting of cyclophosphamide, thiotepa and carboplatin and stem cell rescue (HDT). To be eligible, patients had to be free of overt metastatic disease and be < or =60 years of age. Analyses were according to intention to treat. RESULTS: At a median follow up of 68 months, 118 patients have experienced a relapse or death from breast cancer (62 in the FEC followed by HDT arm and 56 in the conventional FEC arm) and a total of 100 patients have died (54 in the FEC followed by HDT arm and 46 in the conventional FEC arm). No significant difference was observed in relapse-free survival [hazard ratio 1.06, 95% CI 0.74-1.52, p = 0.76] or overall survival [hazard ratio 1.18, 95% CI 0.80-1.75, p = 0.40]. Five patients died from treatment related causes, three as a consequence of HDT and two in the conventional FEC arm. CONCLUSIONS: At the present time, no benefit has been observed from replacing three cycles of conventional chemotherapy with the HDT regimen described here. Patients should continue to receive conventional chemotherapy as adjuvant therapy for breast cancer. 相似文献
18.
Rubens Caliento Dmitry José de Santana Sarmento Érika Mont’alverne Pereira Silva Tânia Regina Tozetto-Mendoza Priscila Lie Tobouti Vanda Benini 《Acta odontologica Scandinavica》2013,71(8):539-544
Objective: Previous research demonstrated that salivary shedding of HSV-1 and EBV occurs often in adult renal transplant recipients, but there is a lack of studies on the presence of them in the saliva of paediatric population. Therefore, the objective of this study is to describe oral characteristics and to compare the shedding profile of HSV-1 and EBV in the saliva of children with renal transplant to that of chronic kidney disease patients and controls.Methods: This is a cross-sectional study involving 100 children, being 25 renal transplant recipients, 25 chronic kidney disease patients and 50 healthy children. Demographic and oral clinical characteristics were assessed. Saliva samples were collected and submitted to screening for EBV and HSV-1 by using nested polymerase chain reaction technique. Fisher’s exact, Pearson’s chi-square and Kruskal–Wallis tests were used for statistical analysis at a significance level of 5%.Results: Oral shedding of HSV-1 (28%) and EBV (60%) were significantly higher in renal transplant recipients compared to the other groups. Single vesicles in the oral mucosa were statistically associated with the presence of HSV-1 (p?=?.035). In children with chronic kidney disease, there was a higher prevalence of pale oral mucosa (32%) and enamel hypoplasia (40%) compared to paediatric renal transplant recipients and controls. Dental calculus (36%), candidiasis (8%), drug-induced gingival overgrowth (16%), mouth blisters (8%), xerostomia (12%) and salivary gland enlargement (20%) were more common in paediatric renal transplant recipients.Conclusions: Therefore, it can be concluded that salivary shedding of HSV-1 and EBV in paediatric patients was more often found in renal transplant recipients than in the renal failure and control children. Transplanted recipients showed more oral manifestations than renal failure and control children did. 相似文献
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