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Purpose
To investigate the efficacy of tamsulosin monotherapy and tamsulosin with low-dose sildenafil combination therapy on lower urinary tract symptoms (LUTS) following low-dose-rate (LDR) brachytherapy in early prostate cancer patients.Methods
From March 2008 to June 2014, of the 212 prostate cancer patients with a Gleason score ≤7 who received LDR brachytherapy, 80 patients with a prostate volume ≤35 g and progressed LUTS following implantation were selected. All 80 patients took tamsulosin 0.4-mg monotherapy until 1 month after implantation. Then, the patients were divided into two groups; 45 patients received tamsulosin 0.4-mg monotherapy, and 35 patients received tamsulosin 0.4-mg plus sildenafil 25-mg combination therapy due to erectile dysfunction. LUTS were compared between the two groups using the International Prostate Symptom Score (IPSS), the mean maximum flow rate (Q max) and the pre-implantation post-voiding residual (PVR) volume at 1 and 3 months after implantation.Results
The pre-implantation total IPSS, Q max and PVR for the monotherapy and combination therapy groups were 14.0 ± 6.7, 14.3 ± 3.2 ml/s and 36.3 ± 16.7 ml and 15.3 ± 5.6, 13.7 ± 4.5 ml/s and 39.0 ± 23.4 ml, respectively. At 1 month post-implantation, both groups showed increases in total IPSS and PVR, but no statistically significant differences were observed (P = 0.078, P = 0.23). At 3 months post-implantation, the combination therapy group showed a greater decrease in total IPSS compared with the monotherapy group (P = 0.035), but there were no statistically significant differences in the Q max and PVR between the two groups.Conclusion
Tamsulosin plus low-dose sildenafil combination therapy is a beneficial treatment for post-implantation progression of LUTS.Purpose
To investigate the spontaneous clearance rates of remnant particles following miniaturized percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS).Methods
Among 624 patients who underwent mini-PCNL or RIRS at our institution from 2011 to 2015, we collected data of 247 patients with 2 years of follow-up. Of these, we included 148 patients with unilateral renal stones between 10 and 30 mm, as well as remnant particles after surgery. The size criteria of dusts and residual fragments (RFs) were, respectively, <1 and <3 mm.Results
After excluding 22 patients, 126 patients (RFs = 21, dusts = 98, and both RFs and dusts = 7) were analyzed. Mean age was 56.5 (±14.4) years, and mean stone size was 19.5 (±12.5) mm. The mean follow-up period was 18.5 (± 12.9) months. In patients whose remnant particles were naturally eliminated following lithotripsy, the mean stone passage time was 9.0 (±9.3) months in the dusts and 13.9 (±11.1) months in the RFs groups (P = 0.135). Remnant particles disappeared in 42 out of 105 patients (40.0 %) in dusts and 7 out of 28 patients (25.0 %) in RFs groups (P = 0.187). The size of dusts and RFs increased, respectively, in 18.1 % (19/105) and 28.6 % (8/28) of patients with remnant particles during the follow-up period.Conclusions
The presence of dusts and RFs was poor prognostic factors in patients underwent renal stone surgery using a holmium laser. Complete residual stone removal by using a basket or dusts eradication by irrigation for an adequate time during surgery can be a good surgical strategy.Purpose
Although amnestic mild cognitive impairment (aMCI) could have various biological characteristics, little attention has been given to the nature of episodic memory decline in aMCI with pathophysiologies other than Alzheimer’s disease (AD), i.e., aMCI with low beta-amyloid (Aβ) burden. This study aimed to identify the functional neural basis of episodic memory impairment in aMCI with Aβ burden negative (aMCI-Aβ?) and to compare these results with aMCI with Aβ burden positive (aMCI-Aβ+).Methods
Individuals with aMCI (n?=?498) were selected from the Alzheimer’s Disease Neuroimaging Initiative database. Based on the mean florbetapir standard uptake value ratio, participants were classified as aMCI-Aβ? or aMCI-Aβ+. Correlations between memory scores and regional cerebral glucose metabolism (rCMglc) were analyzed separately for the two subgroups using a multiple regression model.Results
For aMCI-Aβ?, significant positive correlations between memory and rCMglc were found in the bilateral claustrum, right thalamus, left anterior cingulate cortex, left insula, and right posterior cingulate. For aMCI-Aβ+, significant positive correlations between memory and rCMglc were found in the temporoparietal areas. These correlation patterns remained unchanged when clinical severity was added as a covariateConclusion
Our findings indicate that memory impairment in aMCI-Aβ? is related to multimodal integrative processing and the attentional control system, whereas memory impairment in aMCI-Aβ+?is related to the typical brain memory systems and AD signature. These results suggest that although the two subgroups are clinically in the same category as aMCI, the memory impairment process depends on completely different functional brain regions according to their Aβ burden level.Simpson grade II removal (coagulation of the dural attachment after gross total removal) of spinal meningioma is considered an acceptable alternative, but increased recurrence after more than 10 years has been reported. More attention must be paid to the long-term surgical outcomes after Simpson grade II removal.
MethodsA retrospective review was performed for 20 patients (M:F = 5:15; age, 59 ± 9 years) with Simpson grade II removal (mean follow-up period, 12.9 years; range 10.0–17.5). Magnetic resonance (MR) imaging was conducted in 17 patients at 88 ± 52 months (range 12–157). During the same period, Simpson grade I removal (removal of the dural origin) was performed in 21 patients (follow-up, 89 ± 87 months; range 9–316). Radiological recurrence was defined as a visible tumor on a follow-up MR image, and clinical tumor recurrence was defined as the recurrence of symptoms.
ResultsAt the final follow-up, neurological symptoms had improved in 16/20 patients and remained stable in 4/20. A recurrent tumor was detected in one patient due to increased back pain at 92 months postoperative, but the symptom was stable without surgery until the last follow-up (124 months). The radiological and clinical recurrence-free survival periods were 150 ± 7 months (95 % CI 136–163) and 204 ± 6 months (95 % CI 193–215), respectively. There was no recurrence after Simpson grade I removal, whereas neurological deterioration occurred in two patients after surgery.
ConclusionsSimpson grade II removal may be an alternative option if the risk of complications with Simpson grade I removal is expected to be high.
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