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31.
This brief paper explains why the art of negotiation has become far more important for general dental practitioners. It explains that negotiations take place with patients, with practice staff, and with funding agencies such as Primary Care Trusts. It sets out the principles for successful negotiation and gives two examples of how they can be applied. It concludes that negotiation is a skill that can be learned and that it will be a key skill as the profession faces future challenges. 相似文献
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Roxana Mehran Michela Faggioni Jaya Chandrasekhar Dominick J. Angiolillo Barry Bertolet Robert Lee Jobe Bassam Al-Joundi Somjot Brar George Dangas Wayne Batchelor Anand Prasad Hitinder S. Gurm James Tumlin Gregg W. Stone 《JACC: Cardiovascular Interventions》2018,11(16):1601-1610
Objectives
The aim of the AVERT (AVERT Clinical Trial for Contrast Media Volume Reduction and Incidence of CIN) trial was to test the efficacy of the AVERT system to reduce the contrast media volume (CMV) used during coronary angiographic procedures without impairing image quality and to prevent contrast-induced acute kidney injury (CI-AKI) in patients at risk for CI-AKI.Background
CI-AKI is a common complication of percutaneous coronary procedures, associated with increased morbidity and mortality. The AVERT system alters the coronary injection pressure profile by diverting contrast away from the patient during coronary injection.Methods
The AVERT trial was a prospective, multicenter, 1:1 randomized clinical trial in 578 subjects with either baseline estimated glomerular filtration rate 20 to 30 ml/min/1.73 m2 or estimated glomerular filtration rate 30 to 60 ml/min/1.73 m2 and at least 2 additional risk factors for CI-AKI. Patients undergoing coronary angiography with planned or possible percutaneous coronary intervention (PCI) were randomized to hydration plus the AVERT system (n = 292) or hydration only (n = 286). The primary effectiveness endpoints were: 1) the total CMV used; and 2) the incidence of CI-AKI, defined as a ≥0.3 mg/dl increase in serum creatinine within 5 days post-procedure.Results
Patient demographics were well balanced between the groups, with mean baseline serum creatinine of 1.6 ± 0.4 mg/dl and 64.9% patients with diabetes mellitus. PCI was performed in 42.2% of procedures, with coronary angiography in the remainder. Use of AVERT resulted in a 15.5% relative reduction in CMV overall (85.6 ± 50.5 ml vs. 101.3 ± 71.1 ml; p = 0.02) and a 22.8% relative reduction in CMV among PCI patients (114 ± 55 ml vs. 147 ± 81 ml; p = 0.001). The maximum relative reduction in CMV was 46% (124 ± 48 ml vs. 232 ± 97 ml; p = 0.01) when ≥3 lesions were treated. There were no differences in the rates of CI-AKI (27.0% vs. 26.6%; p = 0.70) between the study groups.Conclusions
Use of the AVERT system was feasible and safe, with acceptable image quality during coronary angiography and PCI. AVERT significantly reduced CMV, with the extent of CMV reduction correlating with procedural complexity. No significant differences in CI-AKI were observed with AVERT in this trial. (AVERT Clinical Trial for Contrast Media Volume Reduction and Incidence of CIN [AVERT]; NCT01976299) 相似文献35.
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Rachel Batchelor Matteo Catanzano Ellie Kerry Sophie D. Bennett Anna E. Coughtrey Holan Liang Vicki Curry Isobel Heyman Roz Shafran 《Child and Adolescent Mental Health》2020,25(3):175-177
The coronavirus pandemic has highlighted the need for remote technologies to be used in child and adolescent mental health services. With the UK being placed in lockdown one week before a scheduled ‘face-to-face’ low-intensity CBT training day due to COVID-19, there was a need for rapid adaptations to be made to the content, structure and format of a training day for practitioners in mental health services, to suit the online environment. The content covered the core areas of low-intensity CBT in children and adolescents. Findings showed that the one-day low-intensity training day increased knowledge and understanding in all key areas measured, and was positively received, providing further evidence for the effectiveness and acceptability of remote delivery. Given discussed benefits of remote delivery, as well as rapid developments in technologies helping to address some of the challenges raised, going forward, remote delivery could continue to be beneficial for increasing access to much needed evidence-based interventions. 相似文献
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S A Robb A H Fielder C E Saunders N J Davey M W Burley D H Lord J R Batchelor V Dubowitz 《Human immunology》1988,22(1):31-38
Twenty probands with juvenile dermatomyositis and their relatives were studied to determine the inherited segregation patterns of class I, II, and III HLA region markers including C4A, C4B, Bf, and C2 complement polymorphisms. The extended haplotype B8, DR3, C4A*Q0, C4B*1, C2*C, and Bf*S was present in 13 of the 20 probands. Three other probands also carried a haplotype with a null allele for C4A and two further probands carried a null allele for C4B; only two probands had no detectable C4 null allele. These data confirm previous studies showing high frequencies of B8 and DR3 in patients with juvenile dermatomyositis, but show that there is a higher association with null alleles of C4. This suggests that the C4 genes are either themselves the disease-susceptibility genes or are in very strong linkage disequilibrium with such genes. 相似文献
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Niloufar Zarinabad Amedeo Chiribiri Gilion L. T. F. Hautvast Masaki Ishida Andreas Schuster Zoran Cvetkovic Philip G. Batchelor Eike Nagel 《Magnetic resonance in medicine》2012,68(6):1994-2004
The purpose of this study is to enable high spatial resolution voxel‐wise quantitative analysis of myocardial perfusion in dynamic contrast‐enhanced cardiovascular MR, in particular by finding the most favorable quantification algorithm in this context. Four deconvolution algorithms—Fermi function modeling, deconvolution using B‐spline basis, deconvolution using exponential basis, and autoregressive moving average modeling —were tested to calculate voxel‐wise perfusion estimates. The algorithms were developed on synthetic data and validated against a true gold‐standard using a hardware perfusion phantom. The accuracy of each method was assessed for different levels of spatial averaging and perfusion rate. Finally, voxel‐wise analysis was used to generate high resolution perfusion maps on real data acquired from five patients with suspected coronary artery disease and two healthy volunteers. On both synthetic and perfusion phantom data, the B‐spline method had the highest error in estimation of myocardial blood flow. The autoregressive moving average modeling and exponential methods gave accurate estimates of myocardial blood flow. The Fermi model was the most robust method to noise. Both simulations and maps in the patients and hardware phantom showed that voxel‐wise quantification of myocardium perfusion is feasible and can be used to detect abnormal regions. Magn Reson Med, 2012. © 2012 Wiley Periodicals, Inc. 相似文献
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A.L. Batchelor A.W. Horne E.V. Hulse C.E. Stuart 《International journal of radiation biology》2013,89(6):583-591
SummaryRabbits were given acute whole-body irradiation with either neutrons (mean energy 0·7 mev, dose range 400–1500 rads) or gamma-rays (mean energy 2·5 mev, dose range 1000–3000 R). The last acute death was at 32 days and the LD50/32 was 572 rads for neutrons and 1389 R for gamma-rays, giving an RBE of 2·4.Acute deaths were primarily due to haemopoietic failure, but damage to the alimentary tract probably also played a part. Coprophagia (re-ingestion), which is normal in rabbits, may have increased the liability to post-irradiation infection.Sub-acute lesions, between 2 and 7 months after irradiation, occurred only after exposure to neutrons and not after gamma-rays. Just over half were local lesions of limbs, related to the entry dose of neutrons, and the remainder were intrathoracic effusions. When these sub-acute effects were taken into account the RBE rose to 3·0. 相似文献