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C-reactive protein (CRP) is part of a battery of “routine bloods” performed by residents on patients when they are admitted into a rehabilitation unit. Generally, an elevated CRP is considered to be an indicator of an acute infective process. Numerous studies have indicated that the CRP peaks on the 2nd or 3rd day post total hip arthroplasty (THR) and total knee arthroplasty (TKR) and returns to normal by day 7. When the CRP level remains elevated, it is generally felt that infection should be excluded.We performed a prospective study on 45 consecutive patients admitted into a rehabilitation unit post hip and knee arthroplasty over a 6 months period, to evaluate the incidence of an elevated CRP on admission, to determine whether an isolated elevated CRP on admission to a rehabilitation setting should not be considered as an indicator of an infective process.We found all patients (100%) had elevated CRP''s on admission, ranging from 8.6 mg/L to 139.2 mg/L, between days 5–7 post-operatively. By day 14, CRP''s reduced, but 91% of patients still had elevated CRP''s, ranging from 2.1 mg/L to 47.3 mg/L after THR and 4.8 mg/L to 40 mg/L after TKR at day 14.These results suggest that even in uncomplicated elective joint arthroplasty, CRP''s can remain elevated up to 14 days post-procedure, in the absence of an infective process.An isolated elevated CRP on admission to a rehabilitation setting should not be considered as an indicator of an infective process, but rather part of the normal post-operative inflammatory response. The elevated CRP should be monitored and only an upward trend requires further investigation and management. 相似文献
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Amidolytic assay of human factor XI in plasma: comparison with a coagulant assay and a new rapid radioimmunoassay 总被引:6,自引:0,他引:6
The traditional coagulant assay for plasma factor XI suffers from a relatively high coefficient of variation, the need for rare congenitally deficient plasma, and a poor correlation between precision and sensitivity. We have developed a simple functional amidolytic assay for factor XI in plasma using the chromogenic substrate PyrGlu-Pro-Arg- p-nitroanilide (S-2366). After inactivation of alpha 1-antitrypsin, CI inhibitor, and other plasma protease inhibitors with CHCI3, plasma was incubated with kaolin, in the absence of added calcium, which limited the enzymes formed to those dependent on contact activation. Soybean trypsin inhibitor was used to minimize the action of kallikrein on the substrate. Once the reaction was complete, corn trypsin inhibitor was used to inactive factor XIIa, the enzyme generated by exposure of plasma to negatively charged surfaces, which had activated the factor XI. The assay is highly specific for factor XI, since plasma totally deficient in that zymogen yielded only 1%-3% of the enzymatic activity in normal plasma under identical conditions. The requirements for complete conversion of factor XI to XIa in plasma within 60 min were, respectively, factor XII, 0.6 U/ml, and high molecular weight kininogen, 0.2 U/ml. Prekallikrein was not an absolute requirement for complete activation but did accelerate the reaction. The intraassay coefficient of variation was 3.4%, and the mean of 35 normal plasmas was 1.00 U +/- 0.24 SD. In addition, a new rapid radioimmunoassay was devised using staphylococcal protein A as the precipitating agent for a complex of factor XI antigen with monospecific rabbit antibody. The mean was 1.01 U +/- 0.30 SD. The correlation coefficients for amidolytic versus coagulant and amidolytic versus radioimmunoassay were r = 0.95 for the former and 0.96 for the latter. Thus, a simple, accurate amidolytic assay and a radioimmunoassay have been devised for measuring factor XI in plasma that correlate well with the coagulant activity of factor XI, as determined in our laboratory. 相似文献
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Bipadabhanjan Mallick Narendra Dhaka Vishal Sharma Sarthak Malik Saroj K. Sinha Usha Dutta Pankaj Gupta Ajay Gulati Thakur D. Yadav Vikas Gupta Rakesh Kochhar 《Pancreatology》2019,19(1):143-148
Background and objectives
Despite improvement in outcomes of acute pancreatitis (AP), some subgroups remain at increased risk. We studied the impact of onset-to-admission interval to a tertiary care centre on outcomes in AP.Methods
Retrospective analysis of consecutive patients with first episode of AP admitted between 2009 and 2017 on the basis of onset-to-admission interval: ≤7 days, 8–21 days and >21 days was done. Patients were assessed for severity and managed using a step-up approach. Primary outcome measures were surgical necrosectomy and mortality.Results
Of 745 patients (age 39.26?±?13.18?yrs, 69% male), 380 (51%) had presented ≤7 days, 229 (30.7%) between 8 and 21 days and 136 (18.3%) >21 days after pain onset. Severe pancreatitis was highest in 8–21 days group (129; 56.3%) followed by?≤?7 days (166; 43.7%) and >21 days of illness (52; 38.2%).Surgical intervention rates were highest in the 8–21 days group(14%) followed by?>?21 days (12.5%) and ≤7 days (6.6%) respectively (p?=?0.007). Also, mortality was highest in patients with onset to admission interval of 8–21 days (24%) followed by?>?21 days (15.4%) and ≤7 days (14.2%) (P?=?0.007). On the multivariate analysis, age, late presentation, and the presence of organ failure were found to predict the mortality.Conclusion
Patients presenting between 8 and 21 days after onset perform poorly than those presenting earlier or later than them in terms of severity, organ failure, need for surgery and mortality although organ failure remains the most important determinant of outcome. This data can help in devising guidelines for referral of such patients. 相似文献106.
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Mahendran B. Sharma R. K. Sinha S. R. 《Proceedings of the National Academy of Sciences, India. Section B.》2018,88(1):305-311
Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - Intercropping is one of the important components of habitat management based on the principle of reducing... 相似文献
109.
Ashok Kumar Reddy Raja Rami Reddy Muralidhar Rao Paruvelli Srinivas Ambatipudi Alka Rani Sikander A. K. Lodhi Juturi Maruthi Lokabhi Reddy K. Ramakanth Reddy Niraj Pandey Rituraj Videkar Manish Kumar Sinha Ajit Babu Majji Nilanjana Deb-Jorder Atul Kumar Sahu Jyostna Myneni Anina Abraham 《International ophthalmology》2015,35(1):37-42
110.