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Background
Reducing food residue by proper preparation methods before endoscopy after distal gastrectomy can increase the quality of examination and decrease patient discomfort. We evaluated the risk factors for food residue and proper methods of preparation for endoscopy after distal gastrectomy.Methods
Follow-up endoscopy with questionnaires was performed on 1,001 patients who underwent distal gastrectomy at Asan Medical Center between December 2010 and July 2011.Results
Endoscopic examination failed in 94 patients (9.4 %) as a result of large amounts of food residue. Rates of failure were significantly higher in patients who ate a regular diet rather than a soft diet at last dinner before examination (13.9 vs. 6.1 %, p = 0.050), and in those who ate lunch rather than not eating lunch on the day before examination (14.6 vs. 7.7 %, p = 0.020). Multivariate analysis showed that the rate of failed examination was lower in patients who had a history of abdominal surgery (p = 0.011), those who ate a soft (p < 0.001) or liquid (p = 0.003) diet as a last meal rather than a regular diet, those who underwent Billroth I rather than Billroth II reconstruction (p = 0.035), patients with longer fasting time (p = 0.009), and those with a longer gastrectomy-to-endoscopy time interval (p < 0.001).Conclusions
Patients who undergo follow-up endoscopy after surgery should fast more than 18 h and ingest a soft or liquid diet on the day before examination. 相似文献Background
Iatrogenic vascular injury as a result of closed hip nailing is not common, but is a regularly reported complication after hip fracture surgeries.Methods
To prevent vascular injury in closed hip nailing by identifying the range of distances and angles between deep and superficial femoral arteries (DFAs and SFAs) and distal screws.Patients and methods
Forty subjects who underwent computed tomography angiographies were included in this study. Imaginary lines marking the distal screws (proximal femoral nail antirotation-II [PFNA-II], 180 and 300 mm; inter-trochanteric/sub-trochanteric nails [ITST], 200 and 300 mm) were drawn on the scout film. On arterial phase images, angles between distal screw lines and those marking DFAs or SFAs, as well as the distance between each artery and far cortex, were measured using the cross-reference capabilities of the picture archiving and communication system.Results
The short nails (PFNA-II 200 mm and ITST 180 mm) were closest to the DFAs, indicating that these nails are most likely to cause injury (PFNA-II 200 mm: 11.2 ± 13.7° anterior and 9.87 ± 5.83 mm; ITST 180 mm: 22.56 ± 15.92° posterior and 9.24 ± 4.74 mm). The short nails were relatively distant from the SFAs, which were located posteriorly to the long nails (PFNA-II 300 mm and ITST 300 mm).Conclusions
These data indicate that insertion of distal screws into intramedullary nails increases the risk of injury to vascular structures. Surgeons must take care in drilling or inserting screws to ensure the prevention of vascular injury. 相似文献Background
Baseline tumor size is one of important prognostic factors for imatinib therapy in patients with advanced gastrointestinal stromal tumor (GIST). The purpose of this study was to determine whether surgical cytoreduction before imatinib therapy can improve the prognosis.Methods
A total of 249 patients with advanced GIST were reviewed retrospectively. Patients were categorized into two groups according to the degree of initial cytoreduction: 35 patients with ≥75 % of initial tumor bulk removed (cytoreduction group) and the other 214 patients (no cytoreduction group). The median follow-up was 44.0 months.Results
Patients in the cytoreduction group were younger, in better performance, showed more initially metastatic disease, peritoneal metastases, but fewer liver metastases. The baseline tumor size when starting imatinib became significantly reduced in the cytoreduction group, which made significant difference between the two groups. By multivariate analyses, mutational status, tumor size, and granulocyte count at presentation were associated with progression-free survival. Age and tumor size were associated with overall survival. However, initial cytoreduction was not significantly related to the prognosis.Conclusions
Cytoreduction before imatinib therapy appears not to improve the prognosis. Imatinib therapy should still represent the initial treatment for advanced GIST. 相似文献Epidermal growth factor receptor (EGFR) mutation alone may be insufficient to predict clinical outcomes in the response to EGFR-tyrosine kinase inhibitor (TKI) therapy. The secondary mutation T790 M and MET amplification are mechanisms of acquired resistance to EGFR-TKI in approximately 50 % of patients, but the remaining mechanisms are unknown.
MethodsEight metastatic lesions and specimens from 41 non-small cell lung carcinoma (NSCLC) patients harbouring activating EGFR mutations who underwent surgical resection and EGFR-TKI therapy were available. Immunohistochemistry was used to evaluate E-cadherin, β-catenin, and PTEN. Chromogenic in situ hybridisation and silver-enhanced in situ hybridisation were used to evaluate EGFR and MET amplification.
ResultsPatients with E-cadherin/β-catenin alteration showed a poor objective response rate (ORR) (p = 0.005) and shorter overall survival (p = 0.059). Additionally, β-catenin alteration was associated with a poor ORR (p = 0.012). Of the metastatic tumours, three cases (37.5 %) showed the acquisition of altered E-cadherin/β-catenin and PTEN loss and two cases (25 %) demonstrated MET/EGFR amplification.
ConclusionsAltered E-cadherin/β-catenin expression in NSCLC harbouring EGFR mutations was associated with a poor response to EGFR-TKI. During metastatic progression, changes in E-cadherin/β-catenin were found. These results may suggest that E-cadherin/β-catenin alteration is related to poor TKI response and resistance.
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