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AS Winkler K Friedrich S Velicheti J Dharsee R K?nig A Nassri M Meindl A Kidunda TH Müller L Jilek-Aall W Matuja T Gotwald E Schmutzhard 《African health sciences》2013,13(2):529-540
Background
Onchocerciasis has been implicated in the pathogenesis of epilepsy. The debate on a potential causal relationship between Onchocerca volvulus and epilepsy has taken a new direction in the light of the most recent epidemic of nodding syndrome.Objective
To document MRI changes in people with different types of epilepsy and investigate whether there is an association with O. volvulus infection.Methods
In a prospective study in southern Tanzania, an area endemic for O. volvulus with a high prevalence of epilepsy and nodding syndrome, we performed MRI on 32 people with epilepsy, 12 of which suffered from nodding syndrome. Polymerase chain reaction (PCR) of O. volvulus was performed in skin and CSF.Results
The most frequent abnormalities seen on MRI was atrophy (twelve patients (37.5%)) followed by intraparenchymal pathologies such as changes in the hippocampus (nine patients (28.1%)), gliotic lesions (six patients (18.8%)) and subcortical signal abnormalities (three patients (9.4%)). There was an overall trend towards an association of intraparenchymal cerebral pathologies and infection with O. volvulus based on skin PCR (Fisher''s Exact Test p=0.067) which was most pronounced in children and adolescents with nodding syndrome compared to those with other types of epilepsy (Fisher''s Exact Test, p=0.083). Contrary to skin PCR results, PCR of CSF was negative in all patients.Conclusion
The observed trend towards an association of intraparenchymal cerebral pathological results on MRI and a positive skin PCR for O. volvulus despite negative PCR of CSF is intriguing and deserves further attention. 相似文献35.
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Osamu Ukimura Jonathan A. Coleman Alex de la Taille Mark Emberton Jonathan I. Epstein Stephen J. Freedland Gianluca Giannarini Adam S. Kibel Rodolfo Montironi Guillaume Ploussard Monique J. Roobol Vincenzo Scattoni J. Stephen Jones 《European urology》2013
Context
Prostate cancer (PCa) screening to detect early stage PCa has resulted in increased identification of small-volume, low-grade PCa, many of which meet criteria for clinically indolent disease. Nevertheless, there remains some degree of underdetection of high-risk PCa in substantial numbers of men despite current diagnostic strategies.Objective
To discuss the contemporary role of prostate biopsy (PB), focusing on the indications, techniques, and limitations of current PB techniques and evolving techniques affecting patient care.Evidence acquisition
A comprehensive Medline search was performed using the medical subject heading search terms prostate cancer, detection, prostate biopsy, significant cancer, and diagnosis, with restriction to the English language. Emphasis was given to publications within the past 5 yr.Evidence synthesis
Because abnormal digital rectal examination (DRE) and prostate-specific antigen (PSA) tests alone lack specificity for cancer, there is no universal indication for PB. This lack has inspired exploration for a cancer-specific biomarker and prediction tools such as risk calculators. Indication for biopsy should involve a balance between the underdiagnosis of high-risk cancers and the potential risks for the overdetection of clinically insignificant cancers as well as biopsy-related morbidity. Evidence supports the inclusion of laterally directed cores during transrectal ultrasound (TRUS) PB in addition to the traditional sextant pattern, which significantly improves cancer detection without a demonstrable increase in morbidity. These data indicate that such PB templates, typically 12 cores, represent the optimal template in initial PB. Optimised techniques and templates for repeat PB remain controversial. However, debate continues regarding indications, sampling number, and location as well as on the potential of modern image-guided approaches or three-dimensional (3D) mapping biopsy in this unique setting. Additional limitations of repeat PB techniques include associated procedural risks if general anaesthesia is required and inherent sampling errors of template-based techniques that are not targeted to the specific tumour site.Conclusions
Current data support the utility of extended PB templates for initial TRUS PB intended to detect clinically significant PCa. Repeat PB in the setting of prior negative PB on the grounds of clinical suspicion or for risk-stratified approaches to management of low risk PCa requires balancing overdetection of low-risk cancer with the potential to miss significant cancer. Several options, including modern image-guided targeting, biomarker development, transrectal saturation PB, and 3D template mapping PB, are changing the clinical paradigms for evaluation and management. Evidence to support adopting approaches other than the current established standards should be tested through appropriately designed prospective studies. 相似文献37.
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Primary Immunodeficiency Diseases in Latin America: The Second Report of the LAGID Registry 总被引:4,自引:4,他引:0
Leiva LE Zelazco M Oleastro M Carneiro-Sampaio M Condino-Neto A Costa-Carvalho BT Grumach AS Quezada A Patiño P Franco JL Porras O Rodríguez FJ Espinosa-Rosales FJ Espinosa-Padilla SE Almillategui D Martínez C Tafur JR Valentín M Benarroch L Barroso R Sorensen RU;Latin American Group for Primary Immunodeficiency Diseases 《Journal of clinical immunology》2007,27(1):101-108
This is the second report on the continuing efforts of LAGID to increase the recognition and registration of patients with
primary immunodeficiency diseases in 12 Latin American countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Honduras,
Mexico, Panama, Paraguay, Peru, Uruguay, and Venezuela. This report reveals that from a total of 3321 patients registered,
the most common form of primary immunodeficiency disease was predominantly antibody deficiency (53.2%) with IgA deficiency
reported as the most frequent phenotype. This category was followed by 22.6% other well-defined ID syndromes, 9.5% combined
T- and B-cell inmunodeficiency, 8.6% phagocytic disorders, 3.3% diseases of immune dysregulation, and 2.8% complement deficiencies.
All countries that participated in the first publication in 1998 reported an increase in registered primary immunodeficiency
cases, ranging between 10 and 80%. A comparison of the estimated minimal incidence of X-linked agammaglobulinemia, chronic
granulomatous disease, and severe combined immunodeficiency between the first report and the present one shows an increase
in the reporting of these diseases in all countries. In this report, the estimated minimal incidence of chronic granulomatous
disease was between 0.72 and 1.26 cases per 100,000 births in Argentina, Chile, Costa Rica, and Uruguay and the incidence
of severe combined immunodeficiency was 1.28 and 3.79 per 100,000 births in Chile and Costa Rica, respectively. However, these
diseases are underreported in other participating countries. In addition to a better diagnosis of primary immunodeficiency
diseases, more work on improving the registration of patients by each participating country and by countries that have not
yet joined LAGID is still needed.
Latin American Group for Primary Immunodeficiency Diseases 相似文献
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