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991.
Schmidt P Pruggmayer M Steinborn A Schippert C Staboulidou I Hillemanns P Scharf A 《Archives of gynecology and obstetrics》2007,276(3):259-262
Introduction First-trimester screening according to Nicolaides uses maternal age to obtain a common background risk for trisomy 21. The
likelihood ratios by nuchal translucency, free β-human chorionic gonadotropin and pregnancy-associated plasma protein-A are
not with respect to maternal age. It was the aim of this study to investigate if likelihood ratios should better take care
of it.
Materials Pearson’s correlation and different models of regression analysis had been performed on the results of 8,116 first-trimester
screenings. The total number of pregnancies was subdivided into three subgroups of healthy fetuses (n = 8,038); fetuses with Down’s syndrome (n = 46) and fetuses with other genetic abnormalities (n = 32). Statistical testing was applied to each of the three groups.
Results Strong independence from maternal age could be found for each of the first-trimester screening measurement parameter, as well
for healthy and as for affected fetuses. Neither Pearson’s test nor nonlinear regression models could detect a correlation.
Accordingly significance of Pearson’s test is not given.
Discussion First-trimester screening would not be improved by considering the maternal age in the calculation of the likelihood ratios.
Therefore the currently used algorithm is adequate. According, to the results, it seems to be proper as well to disregard
the maternal age in newer test strategies advanced first-trimester screening (AFS) at all. 相似文献
992.
Levgur M 《Archives of gynecology and obstetrics》2007,276(1):1-15
Background To review the literature on various therapeutic modalities for uterine adenomyosis.
Methods Reviews, case-controlled studies and reports from November 1949 until August 2006 written in English or summarized in English
abstracts retrieved from Medline and Pubmed using the key words: adenomyosis and adenomyosis therapy.
Results Symptoms of adenomyosis may be alleviated by antiprostaglandins, sex hormones, danazol and GnRH analogs. Minor surgical procedures
for therapy include endomyometrial ablation, laparoscopic myometrial electrocoagulation and adenomyoma excision. Patient’s
age and symptoms, desired fertility, site and extent of lesion and surgeon’s skills should be considered in choosing the appropriate
procedure. Endomyometrial ablation is effective for lesions deeper than the endometrial–myometrial junction whereas the efficacy
of hysteroscopic ablation is limited to foci 2–3 mm deep. Focal and diffuse disease may be managed by laparoscopic electrocoagulation
or myometrial excision with preservation of fertility but risk of recurrence exists. Uterine artery embolization assumingly
invokes infarction and necrosis. Encouraging results reported in some cases warrant expanding its use for more experience.
Hysterectomy is the ultimate solution for women with deep myometrial involvement or if future fertility is not desired.
Conclusions Various therapeutic options for adenomyosis, including few minimally invasive procedures became available in the last two
decades but need evaluation and improvement. 相似文献
993.
Schmidt P Staboulidou I Soergel P Wüstemann M Hillemanns P Scharf A 《Archives of gynecology and obstetrics》2007,275(6):469-474
Objective The individual risk assessment of fetal Down’s syndrome based on measurement of nuchal translucency (NT) according to Nicolaides,
optionally complemented by the determination of PAPP-A and free beta HCG has progressively supplanted other search strategies
for fetal aneuploidies. It could be shown that this diagnostic strategy equally detects other numeric aneuploidies at a comparable
rate. A positive test result is also predictive for the presence of a fetal malformation. In this field, several computer
programs are available for clinical use. The objective of our study was to re-evaluate the first consecutive 1463 NT-risk
calculations determined by Nicolaides’ method and to compare the risk calculation to the JOY software (NT-risk calculation
module, JOY Patient Database) introduced in 2002.
Material and methods At the Department of Obstetrics and Gynecology, Hannover Medical School, 1463 consecutive complete data sets comprising first
trimester screening performed between May 2, 2000 and June 26, 2003 and corresponding fetal outcome were analysed using risk
assessment based on the Nicolaides method (PIA Fetal Database NT-Module) and compared with the risk evaluation as determined
by the JOY software (JOY Patient Database NT module). A risk exceeding 1:300 was considered to indicate the need for further
invasive testing. In a first step, only cytogenetically detectable chromosomal aberrations were analysed. Then, a second evaluation
including fetal malformations was performed.
Results Among the 1463 cases, 1445 (98.77%) fetuses revealed to be cytogenetically healthy. Both softwares showed identical detection
rates at the genetic and somatic level:13 cases of Down-Syndrome (0.89%), 2 cases of trisomy 18 (0.14%), one case of triploidy,
one Turner-Syndrome, one Klinefelter-Syndrome (0.07% each) were detected. A positive test result was found in 15 cases ending
in a spontaneous abortion, intrauterine death or peripartum death (1.03%) and in 22 cases of fetal malformation (1.50%). At
the level of genetic detection the test positive rate dropped from 92 (PIA) to 71 (JOY) (-22.8%). At the level of combined
adverse outcome the test positive rate was reduced from 100 (PIA) to 76 (JOY) (-22.0%), thus yielding in a marked improvement
of the characteristic test performance parameters.
Conclusion The novel, recently developed JOY software package allowed reliable evaluation of the risk for aneuploidy with increased specificity
whereas sensitivity was unchanged. Our data suggest an improvement of the screening for aneuploidy when using this novel software:
With an identical detection rate, the number of unnecessary invasive measures may be reduced. 相似文献
994.
Hermans C 《Archives of gynecology and obstetrics》2007,276(3):271-276
Backgroud Hereditary angioedema (HAE) is a rare genetic disorder caused by a deficiency of the plasma protein C1 inhibitor (C1-INH).
HAE is characterised by the onset of angioedema, which may develop in one or several organs, and may last from a few hours
to several days. Oedema of the upper airway can be life-threatening. As a result of hormonal changes, some women experience
more frequent angioedema attacks during pregnancy. During pregnancy, antifibrinolytic agents should only be used with caution,
and attenuated androgens are contraindicated; therefore, replacement therapy with C1-INH concentrate represents one of few
therapeutic options, but it is not widely documented.
Case study We report the first case study of the successful management with regular infusions of C1-INH concentrate, of two successive
pregnancies in a patient with HAE. During the second half of the first pregnancy, C1-INH was administered on demand at home.
For the second pregnancy, on demand treatment was intensified to prophylactic therapy, with once or twice weekly infusions
from the middle of the second trimester in order to efficiently control the frequent attacks.
Conclusions This report illustrates that HAE can be successfully managed during pregnancy with C1-INH infusions at home. Since the number
of crises may vary between pregnancies, the treatment regimen must be adapted to the patient’s need. 相似文献
995.
Srivastava G Pilkington A Nallala D Polson DW Holt E 《Archives of gynecology and obstetrics》2007,276(5):555-557
Objective Ogilvies syndrome (OS) is a rare condition in obstetrics but occurs most commonly after caesarean section. Mortality rates
from OS can be as high as 36–50% when bowel perforation or ischemia develops which highlights the early recognition of this
condition. Early diagnosis is therefore essential to prevent serious morbidity and mortality.
Conclusion We, therefore report a case of OS after caesarean section in which early detection by senior clinicians resulted in successful
management of the condition and an excellent outcome. 相似文献
996.
Objective Case report of a rare combination of a trisomy 18 and 21 in a dizygotic twin pregnancy in a woman with a history of recurrent
miscarriage, a neonatal death, no living offspring and Graves disease.
Methods Case report and literature search.
Results Only one other report in the literature of a combined trisomy 18 and 21 twin pregnancy was found.
Conclusion The combination of a trisomy 18 and 21 in a dizygotic twin pregnancy is very rare. Despite the high frequency and clinical
importance of aneuploidy, very little is known about the factors that may modulate meiotic non-disjunction. 相似文献
997.
Araujo Júnior E Guimarães Filho HA Saito M Pires AB Pontes AL Nardozza LM Moron AF 《Archives of gynecology and obstetrics》2007,275(2):141-144
Context
The cervical teratomas are rare, benign tumors, they are formed by the three embryonic layers, and they represent only 6%
of teratomas. The prognosis depends mainly on the size and location of the lesion, on the tumor growth rate, and on the level
of tracheal compression. Prenatal diagnosis is usually reached with the aid of a two-dimensional ultrasonography (2DUS) after
the 15th week of gestation, which shows a large heterogeneous mass in the cervical region, plus a polyhydramnios, on the Doppler
mode which also shows the vascularization of the tumor.
Case report
We report a case of cervical teratoma diagnosed on the 31st week of gestation with the aid of a 2DUS and color Doppler mode.
We focus on the main findings obtained with the three-dimensional ultrasonography in surface mode, and we highlight the importance
of this methodology for the indirect evaluation of the neonatal prognosis. 相似文献
998.
Wiwanitkit V 《Archives of gynecology and obstetrics》2007,276(6):629-631
Background Consequences of syphilis in mother, pregnancy, fetus and child are considerable, but preventable. Serological screening must
be offered at the first prenatal visit. Presently, the diagnosis of syphilis is dependent mainly on serological tests. The
most widely used screening tests for syphilis are the VDRL and the rapid plasma reagin (RPR) and for confirmation the fluorescent
treponemal antibody (FTA) and the treponema pallidum hemagglutination (TPHA) tests.
Method The four alternative nodes for diagnosis of can be a) VDRL + FTA, b) VDRL + TPHA, c) RPR + FTA and d) RPR + TPHA. Here the
author reports an evaluation of cost utility of those tests in obstetrical practice. According to this study, it can be shown
that the cost per accurate diagnosis for VDRL + TPHA is the least expensive choice and for RPR + FTA is the most expensive
choice.
Conclusion Therefore, this alternative is the best method for serological diagnosis of syphilis, based on medical laboratory economics
principles. 相似文献
999.
Staboulidou I Soergel P Schmidt P Steinborn A Hillemanns P Scharf A 《Archives of gynecology and obstetrics》2007,276(1):35-42
Introduction
The proper function of the fetal heart is indispensable for the fetal development and the normal fetal growth. For prenatal medicine, Doppler sonography offers the possibility of a non-invasive method to examine the fetal cardiovascular function under normal and pathological circumstances. The role of the Doppler sonography is to identify those fetuses who have a high risk factor for developing a pre- or intrapartual asphyxia and therefore have to be delivered promptly. This study aimed at evaluating the clinical value of the intracardiac Doppler sonography (IDS) and at scrutinizing its usefulness during the supervision of the pregnancy of intrauterine growth restricted (IUGR) fetuses.Materials and methods
In a prospective research at the Medical School of Hanover, fetal IDS was applied to 174 pregnant women between the 21 and 37 weeks of gestation (WG). The e-wave and the a-wave, the E/A ratio, and the TVI (time velocity integral) were measured at the atrioventricular (AV) valves. The PV (peak velocity) as well as the TVI were determined at both the aortic and the pulmonary valve. Normal range curves were compiled for all measured parameters.Results
Alongside a control group with untroubled gravidity, which consisted of 153 patients, IUGR fetuses, who formed a collective of 21 patients, were Doppler sonographically examined.While the gestational age advanced, an increase of both the e-wave and the a-wave above the AV-valves could be ascertained, which lead to an E/A ratio <1. Above the semilunar valves there was indicated a slight steady increase of the TPV, the PV as well as the TVI. Normal range curves, which largely correspond to those described in the literature, were compiled for the collective of the pregnancies without pathological findings (n = 153). In comparison to the standard collective, there were no significant differences from the collective of the growth restricted fetuses (n = 21).Conclusion
A temporal informational advantage of pathological intracardiac Doppler values for high risk pregnancies (IUGR) could not be retraced in the examined collective.Doppler sonography traces acute and chronic deficits, which are indicated by hemodynamic changes of the fetus’s blood supply. The clinical importance of IDS as regards dystrophic fetuses has to be ascertained in continuative studies: In the stage of compensatory placental insufficiency (IUGR, arterial Doppler without ARED-flow, venous Doppler without pathological findings) the IDS cannot provide an informational advantage. Contrastingly, the diagnostic potential of the IDS as a screening method of fetal cardiac insufficiency during decompensative placental insufficiency (IUGR, arterial Doppler with ARED-flow, venous Doppler normal or pathological) remains indistinct and should therefore be prospectively evaluated within this high risk group and contrastingly compared to the significance of the venous Doppler sonography (informational advantage?).1000.
Successful pregnancy in Noonan’s syndrome and balanced Robertsonian translocation women is extremely rare. This is because
pregnancies in these women usually end in spontaneous miscarriage or termination before 24 weeks gestation due to severe congenital
anomaly. In this article, we report the case of a 41-years-old woman with Noonan’s syndrome and balanced Robertsonian translocation.
She was delivered by an elective caesarean section at 38 weeks of a live male infant following a second attempt of in vitro
fertilisation (IVF) and embryo transfer from donor oocytes. The use of donor eggs and IVF in these women means more of them
will achieve successful term pregnancy as in this case. It is therefore important that Obstetricians understand this rare
condition and optimise care. This case highlights some of the medical problems encountered by Obstetricians in managing patients
in this high risk group. 相似文献