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91.
92.
93.
Norbert Donner-Banzhoff Lothar Kreienbrock Erika Baum 《Zeitschrift fur Gesundheitswissenschaften》1994,2(4):324-333
Objective
To estimate the impact of different systems of family practitioners’ payment on process of care: fee-for-service vs. capitation.Design
Cross sectional international survey using cardiovascular prevention as an indicator of the quality of care.Setting
Family physicians’ practices in Germany (fee-for-service) and the UK (capitation).Subjects
778 patients attending for consultation regardless of morbidity or risk factor status.Main outcome measures
Intervals since last consultation, since last BP-measurement, prevalence of known hypertension.Results
There is a higher overall level of activity under FFS, but under capitation FPs seem to concentrate their efforts on the more severely ill or at risk. This would explain that under different systems of remuneraton the quality of care (outcome) is usually similar.Conclusions
In areas of uncertainty FFS seems to stimulate activity or intervention, whereas under capitation FPs are rather reluctant to engage in procedures or interventions that are not sufficiently evaluated. Under prepaid remuneration FPs adjust in a way that the quality of care does not suffer. 相似文献94.
Yamazaki Hiroshi; Mimura Mayumi; Oda Yoshimitsu; Gonzalez Frank J.; El-Bayoumy Karam; Chae Young-Heum; Guengerich F.Peter; Shimada Tsutomu 《Carcinogenesis》1994,15(3):465-470
In order to address the hypothesis that 6-aminochrysene (6-AC)is converted to genotoxic products by cytochrome P450 enzymesvia two activation pathways (N-hydroxylation and epoxidation),the activation of 6-AC and trans-l,2-dihydro-l,2-dihydroxy-6-aminochrysene(6-AC-diol) to genotoxic metabolites was examined in rat andhuman liver microsomal cytochrome P450 enzymes using Salmonellatyphimurium TA1535/pSK1002 and TA1535/pSK1002/pNM12 (NM2009)as tester strains. The latter bacteria, an O-acetyl-transferase-overexpressingstrain, was highly sensitive to metabolites derived from activationof 6-AC, but not those from 6-AC-diol, using liver microsomesfrom phenobarbital-treated rats or a reconstituted monooxygenasesystem containing P4502B1 or -2B2, thus suggesting the rolesof P450 and acetyltransferase systems in the activation process.6-AC-diol, on the other hand, was activated very efficientlyby liver microsomes prepared from ß-naphthoflavone-treatedrats or a reconstituted system containing P4501A1 or -1A2; theactivation reaction is considered to proceed through diol-epoxideformation. The contribution of rat P4501A enzymes towards activationof 6-AC-diol was confirmed by the inhibitory effects on theactivation process of -naphthoflavone, a specific inhibitorof P4501 A-related activities, and antibodies raised againstpurified P4501A1 and -1A2. In humans, P4501A2 was found to bethe major enzyme involved in the activation of 6-AC-diol togenotoxic metabolites while the parent compound 6-AC was activatedmainly by P4503A4. Experiments using recombinant P450 proteinsexpressed in human lymphoblastoid cells lines showed that humanP4501A1 could also activate 6-AC-diol to reactive metabolitesat almost the same rate measured with P4501A2. In addition,P4502B6 was found to efficiently catalyze the activation of6-AC to genotoxic metabolites, and P4503A4 was active in theactivation of 6-AC-diol as well as 6-AC. Addition of purifiedrat epoxide hydrolase to the incubation mixture containing purifiedrat P4501A1 or microsomes expressing human P4501A1 caused inhibitionof activation of 6-AC-diol. These results suggest the existenceof different enzymatic activation pathways for 6-AC and 6-AC-diol.The former carcinogen may be N-hydroxylated principally by P4502Benzymes in rats and P4503A4 and -2B6 in humans and activationto its ultimate metabolites may proceed through esterificationof the N-hydroxy metabolites by an N-acetyltransferase. The6-AC-diol is metabolized to its ultimate diolepoxide productby P4501A enzymes in rat and human liver microsomes. P4503A4(humans) and P4503A2 (rats) may also contribute to some extentin the activation of 6-AC-diol, albeit at lower rates than thoseof P4501A enzymes. 相似文献
95.
Summary Transforming growth factor- (TGF-) is a mitogenic peptide hormone produced extracellularly, by tumor cells, and by virally and chemically transformed cells in culture. TGF- is almost certainly derived from its precursor protein (pro-TGF-) by limited endoproteolysis, but physiologically relevant processing enzyme(s) of the pro-TGF- protein and the cellular or subcellular compartment in which processing takes place are not known with certainty. We previously detailed [Cappelluti, E. and Harris, R.B., Biochemistry, 32 (1993) 551] the discovery, characterization and purification of novel, elastase-like enzymes (molecular weight 38 000) from oncogenically transformed rat liver epithelial cells or cultural Schwann cells transfected with SV40-large T antigen. The elastase-like enzyme appeared to be specifically induced in the transformed epithelial cells compared with the level of enzyme in the nontransformed parental cells. In the intervening time, other elastase-like serine proteinases have been implicated in processing pro-TGF- in other human carcinoma cell lines. We now report that the elastase-like enzymes, purified from transformed Schwann or liver epithelial cells, are inhibited in a time- and concentration-dependent fashion with three differently substituted monocyclic -lactam-based compounds originally developed as specific inhibitors of polymorphonuclear leukocyte elastase, thus further supporting the elastase-like character of the putative pro-TGF- processing enzymes. We also report the presence of the elastase-like enzyme in two different human malignant mammary cell lines, but even though MCF-7 cells receiving high doses of radiation in vitro show an increased level of expression of TGF-, the elastase-like enzyme does not appear to be induced in these cells following irradiation. 相似文献
96.
Yanagimoto S Sone T Nagai K Otsuka N Mimura H Tomomitsu T Muranaka A Itaya M Kitayama A Fukunaga M 《Kaku igaku. The Japanese journal of nuclear medicine》1999,36(2):103-112
We have developed a simple method to correct the washout of tracer from the brain based on the two-compartment model in brain early SPECT using N-isopropyl-p-[123I]iodoamphetamine (123I-IMP). This correction was applied to a new quantitative method of regional cerebral blood flow (rCBF) in combination with the microsphere method by continuous arterial sampling previously reported. Data acquisition of 123I-IMP early SPECT was started from 35 min after 123I-IMP i.v. injection, and the time activity curve of whole brain on anterior head planar images was monitored immediately after 123I-IMP i.v. injection for the correction of washout of tracer from the brain. The usefulness of this method was evaluated in 12 patients with various brain diseases by comparison with the results obtained from the super-early SPECT at 7-10 min after 123I-IMP i.v. injection. The washout rates in cases of early SPECT corrected by this method ranged from 16.91% to 39.34% with a mean +/- SD of 27.72 +/- 5.44%. The contrast of hypo- to hyperperfusion regions on early SPECT was improved by the correction of the washout, and its intracerebral distribution was similar to the simultaneously obtained super-early SPECT images. These results indicated that the present correction method for the washout was useful for more correct quantification of rCBF. 相似文献
97.
Zinc may have an antioxidant effect mediated by induction of metallothionein. Based on the assumption that metallothionein can scavenge oxygen free radicals, we examined whether zinc administration prior to renal ischemia would improve renal dysfunction caused by ischemia-reperfusion injury in rats. Wistar rats weighing 265 g were treated with an intraperitoneal injection of 20 mg/kg zinc 24 h prior to the renal ischemia-reperfusion procedure, which was achieved by a 30-min clamping of the bilateral renal vessels and subsequent 90-min reperfusion. Thirty-minute renal clearance tests were performed before and after renal ischemia in zinc- (n = 11) and saline-treated (n = 8) rats. Thiobarbituric acid reactive substance, conjugated diene, and metallothionein levels in the renal tissues were also determined. Sham-operated rats (n = 5 in each treatment) served as control for the ischemia-reperfusion rats. Ischemia-reperfusion resulted in significantly lower glomerular filtration rate values and marked increases in tissue concentrations of thiobarbituric acid reactive substance and conjugated diene compared with sham-operation. Zinc administration improved the reduced glomerular filtration rate values seen after the ischemia-reperfusion procedure, but not to the extent of pre-ischemic levels. Zinc pretreatment significantly reduced the increased levels of thiobarbituric acid reactive substance and conjugated diene during ischemia-reperfusion and increased metallothionein levels compared with saline injection. These findings suggest that zinc has an antioxidant effect mediated through the induction of metallothionein, but appears only to have a minor protective effect on renal function induced by renal ischemia-reperfusion injury. Copyright Copyright 1999 S. Karger AG, Basel 相似文献
98.
99.
In vivo imaging of the human zonular apparatus with high-resolution ultrasound biomicroscopy 总被引:4,自引:0,他引:4
K. Ludwig Erika Wegscheider J. P. Hoops Anselm Kampik 《Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie》1999,237(5):361-371
· Background: To investigate the potential of high-resolution ultrasound biomicroscopy (UBM) for studying the zonular apparatus
of human beings in vivo. · Methods: Using transducer frequencies of 34 MHz and 50 MHz, criteria were developed to identify
transcorneal and transscleral sections that allowed reproducible identification of the different fiber groups of the zonular
architecture. For that purpose, 10 volunteers between the ages of 14 and 41 years underwent high-resolution ultrasound biomicroscopy
under conditions of consensual far- and near-accommodation. The online video recordings of the respective UBM investigations
were afterwards analyzed image by image. Good visibility of zonular fibers was obtained when the ultrasound wave propagation
comprised an angle close to 90° with the fiber orientation and when the oscillations of the UBM scan had a strict radial orientation
towards the limbus and avoided, simultaneously, the ciliary processes. · Results: In all the volunteers, high-resolution ultrasound
biomicroscopy imaged the zonular fiber groups known from histology. In addition, it detected fibers that do not follow the
course of the inner ciliary body surface but take a direct route from the ora serrata to the lens. It also demonstrated that
fibers that seem to change direction at crossings with other fibers. Under conditions of near-accommodation, the zonular fibers
showed signs of relaxation. · Conclusions: High-resolution ultrasound biomicroscopy seems well suited for in vivo investigations
of the zonular apparatus and of accommodation in man. The results support the fundamental features of the Helmholtz theory
on accommodation.
Received: 8 June 1998 Revised version received: 7 September 1998 Accepted: 14 September 1998 相似文献
100.
Yamakawa M Maeda J Nakamura T Mimura Y Sugisaki K Fujita T Hayashi N Kondo Y Oohara T 《Clinical nutrition (Edinburgh, Scotland)》1996,15(3):133-140
The distribution of carnitine was investigated in male Wistar rats with sepsis or acute liver failure. Sepsis was produced by cecal ligation and puncture, while acute liver failure was induced by intraperitoneal injection of carbon tetrachloride. Then 14C-carnitine or L-carnitine was injected intravenously. In healthy control rats and rats with sepsis, both 14C-radioactivity and carnitine were increased in the liver and kidneys. When the carnitine fractions were investigated, it was found that free carnitine and short-chain acylcarnitine were increased. In the rats with acute liver failure, 14C-radioactivity decreased in the liver, but carnitine increased, with free carnitine and short-chain acylcarnitine levels rising. These findings suggested that exogenous free carnitine accumulated directly in the organs with carnitine deficiency in rats with sepsis and acute liver failure. In addition, there was differential regulation of the fractions of both exogenous and endogenous carnitine (free carnitine, short-chain acylcarnitine, and long-chain acylcarnitine). Furthermore, the distribution of exogenous carnitine differed between sepsis and acute liver failure. 相似文献