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91.
Ashish Correa Achint Patel Kinsuk Chauhan Harshil Shah Aparna Saha Mihir Dave Priti Poojary Abhishek Mishra Narender Annapureddy Shaman Dalal Ioannis Konstantinidis Renu Nimma Shiv Kumar Agarwal Lili Chan Girish Nadkarni Sean Pinney 《Journal of cardiac failure》2018,24(7):442-450
Background
Dialysis-requiring acute kidney injury (D-AKI) is a serious complication in hospitalized heart failure (HF) patients. However, data on national trends are lacking after 2002.Methods
We used the Nationwide Inpatient Sample (2002–2013) to identify HF hospitalizations with and without D-AKI. We analyzed trends in incidence, in-hospital mortality, length of stay (LoS), and cost. We calculated adjusted odds ratios (aORs) for predictors of D-AKI and for outcomes including in-hospital mortality and adverse discharge (discharge to skilled nursing facilities, nursing homes, etc).Results
We identified 11,205,743 HF hospitalizations. Across 2002–2013, the incidence of D-AKI doubled from 0.51% to 1.09%. We found male sex, younger age, African-American and Hispanic race, and various comorbidities and procedures, such as sepsis and mechanical ventilation, to be independent predictors of D-AKI in HF hospitalizations. D-AKI was associated with higher odds of in-hospital mortality (aOR 2.49, 95% confidence interval [CI] 2.36–2.63; P?<?.01) and adverse discharge (aOR 2.04, 95% CI 1.95–2.13; P?<?.01). In-hospital mortality and attributable risk of mortality due to D-AKI decreased across 2002–2013. LoS and cost also decreased across this period.Conclusions
The incidence of D-AKI in HF hospitalizations doubled across 2002–2013. Despite declining in-hospital mortality, LoS, and cost, D-AKI was associated with worse outcomes. 相似文献92.
Papanikolaou IS Adler A Wegener K Al-Abadi H Dürr A Koch M Pohl H Abou-Rebyeh H Veltzke-Schlieker W Wiedenmann B Rösch T 《European journal of gastroenterology & hepatology》2008,20(4):342-348
OBJECTIVES: Endoscopic ultrasonography (EUS) with the adjunct of EUS-guided fine needle aspiration has become an important diagnostic modality in gastroenterologic oncology. EUS-guided fine needle aspiration mainly relies on cytology; data are scarce that compare cytology and histology. While testing a 22-gauge prototype needle, we prospectively compared the yield for both. METHODS: Forty-two consecutive patients (27 male, 15 female; mean age 59.2 years, range: 17-90 years) were included. In each patient we aimed to make two needle passes, and if the material acquired appeared insufficient macroscopically (no in-room cytopathology was available), further passes were done. The material was sent for cytological and histological assessment. RESULTS: A median number of two passes (range: 2-3) were uneventfully performed for pancreatic lesions (n=30), mediastinal and other lymph nodes/masses (n=8) and various other lesions (n=4) and yielded adequate material for cytology, histology or at least one of the two investigations in 62, 67 and 74% of patients, respectively. No false positive results were found (specificity 100%). Sensitivities were 58.6 and 65.5%, respectively, for cytology and histology alone; combined assessment increased sensitivity to 79.3%. When adjusted values were calculated, based only on those cases with adequate material, sensitivity was 89.5% for cytology and 85.7% for histology, and increased to 100% with combined assessment. CONCLUSION: The new needle achieves sensitivities similar to those previously reported with no significant differences in sensitivity between cytology and histology. More effective tissue acquisition methods must be sought to improve overall results. 相似文献
93.
Katritsis DG Pantos I Efstathopoulos EP Tzanalaridou E Korovesis S Kourlaba G Paxinos G Voridis E 《Coronary artery disease》2008,19(4):265-270
OBJECTIVE: This study aimed at comparing three-dimensional (3-D) reconstruction with two-dimensional coronary angiograms with respect to anatomical parameters that might affect plaque formation and rupture. METHODS: Sixty patients with stable left anterior descending (LAD) lesions and 60 patients with an anteroseptal myocardial infarction and recanalized LAD were studied. RESULTS: Conventional angiography significantly underestimated the distance of the stenosis from the ostium of the LAD, 29.4+/-14.5 versus 35.3+/-18.5 mm, P<0.001. Vessel curvature at the site of the lesion was overestimated by conventional angiography compared with 3-D reconstruction, 147.6+/-30.6 degrees versus 162.3+/-11.2 degrees , P<0.001, as was axial bending of the LAD owing to ventricular contraction (17.8+/-7.78 degrees vs. 8.9+/-8.9 degrees , P<0.001). No agreement was observed between two-dimensional and 3-D analysis for either curvature on lesion or axial bending assessment, with intraclass correlation coefficient values 0.155 (-0.009, 0.315) and -0.022 (-0.183, 0.174), respectively. No significant agreement was found between the two methods in the detection of on-stenosis bifurcations (1.7%, kappa=0.086, P=0.349). CONCLUSION: Conventional coronary angiography cannot provide accurate estimates of anatomical parameters, such as distance of a coronary stenosis from the ostium of the vessel, coronary artery curvature at the site of stenosis, axial deformity and bending because of ventricular contraction, and classification of bifurcations. Reconstruction of the coronary tree in 3-D space is necessary for such estimations. 相似文献
94.
Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables 总被引:9,自引:0,他引:9
Dangas G Iakovou I Nikolsky E Aymong ED Mintz GS Kipshidze NN Lansky AJ Moussa I Stone GW Moses JW Leon MB Mehran R 《The American journal of cardiology》2005,95(1):13-19
We previously found that contrast-induced nephropathy (CIN) complicating percutaneous coronary intervention adversely affects patients with chronic kidney disease (CKD). Therefore, we further investigated whether the predictors and outcome of CIN after percutaneous coronary intervention differ among patients with versus without CKD. Among 7,230 consecutive patients, CIN (>or=25% or >or=0.5 mg/dl increase in preprocedure serum creatinine 48 hours after the procedure) developed in 381 of 1,980 patients (19.2%) with baseline CKD (estimated glomerular filtration rate [eGFR] <60 ml/min/1.73 m(2)) and in 688 of 5,250 patients (13.1%) without CKD. Decreased eGFRs, periprocedural hypotension, higher contrast media volumes, lower baseline hematocrit, diabetes, pulmonary edema at presentation, intra-aortic balloon pump use, and ejection fraction <40% were the most significant predictors of CIN in patients with CKD. Apart from intra-aortic balloon pump use, predictors of CIN in patients without CKD were the same as mentioned, plus older age and type of contrast media. Regardless of baseline renal function, CIN correlated with longer in-hospital stay and higher rates of in-hospital complications and 1-year mortality compared with patients without CIN. By multivariate analysis, CIN was 1 of the most powerful predictors of 1-year mortality in patients with preexisting CKD (odds ratio 2.37, 95% confidence interval 1.63 to 3.44) or preserved eGFR (odds ratio 1.78; 95% confidence interval 1.22 to 2.60). Thus, regardless of the presence of CKD, baseline characteristics and periprocedural hemodynamic parameters predict CIN, and this complication is associated with worse in-hospital and 1-year outcomes. 相似文献
95.
96.
Giovanna Leoni Philipp-Alexander Neumann Nazila Kamaly Miguel Quiros Hikaru Nishio Hefin R. Jones Ronen Sumagin Roland S. Hilgarth Ashfaqul Alam Gabrielle Fredman Ioannis Argyris Emile Rijcken Dennis Kusters Chris Reutelingsperger Mauro Perretti Charles A. Parkos Omid C. Farokhzad Andrew S. Neish Asma Nusrat 《The Journal of clinical investigation》2015,125(3):1215-1227
Epithelial restitution is an essential process that is required to repair barrier function at mucosal surfaces following injury. Prolonged breaches in epithelial barrier function result in inflammation and further damage; therefore, a better understanding of the epithelial restitution process has potential for improving the development of therapeutics. In this work, we demonstrate that endogenous annexin A1 (ANXA1) is released as a component of extracellular vesicles (EVs) derived from intestinal epithelial cells, and these ANXA1-containing EVs activate wound repair circuits. Compared with healthy controls, patients with active inflammatory bowel disease had elevated levels of secreted ANXA1-containing EVs in sera, indicating that ANXA1-containing EVs are systemically distributed in response to the inflammatory process and could potentially serve as a biomarker of intestinal mucosal inflammation. Local intestinal delivery of an exogenous ANXA1 mimetic peptide (Ac2-26) encapsulated within targeted polymeric nanoparticles (Ac2-26 Col IV NPs) accelerated healing of murine colonic wounds after biopsy-induced injury. Moreover, one-time systemic administration of Ac2-26 Col IV NPs accelerated recovery following experimentally induced colitis. Together, our results suggest that local delivery of proresolving peptides encapsulated within nanoparticles may represent a potential therapeutic strategy for clinical situations characterized by chronic mucosal injury, such as is seen in patients with IBD. 相似文献
97.
Shazli Azmi Maryam Ferdousi Ioannis N. Petropoulos Georgios Ponirakis Uazman Alam Hassan Fadavi Omar Asghar Andrew Marshall Andrew J. Atkinson Wendy Jones Andrew J.M. Boulton Mitra Tavakoli Maria Jeziorska Rayaz A. Malik 《Diabetes care》2015,38(8):1502-1508
OBJECTIVEImpaired glucose tolerance (IGT) through to type 2 diabetes is thought to confer a continuum of risk for neuropathy. Identification of subjects at high risk of developing type 2 diabetes and, hence, worsening neuropathy would allow identification and risk stratification for more aggressive management.RESULTSTen subjects who developed type 2 diabetes had a significantly lower CNFD (P = 0.003), CNBD (P = 0.04), and CNFL (P = 0.04) compared with control subjects at baseline and a further reduction in CNFL (P = 0.006), intraepidermal nerve fiber density (IENFD) (P = 0.02), and mean dendritic length (MDL) (P = 0.02) over 3 years. Fifteen subjects who remained IGT and 5 subjects who returned to normal glucose tolerance had no significant baseline abnormality on CCM or IENFD but had a lower MDL (P < 0.0001) compared with control subjects. The IGT subjects showed a significant decrease in IENFD (P = 0.02) but no change in MDL or CCM over 3 years. Those who returned to NGT showed an increase in CNFD (P = 0.05), CNBD (P = 0.04), and CNFL (P = 0.05), but a decrease in IENFD (P = 0.02), over 3 years.CONCLUSIONSCCM and skin biopsy detect a small-fiber neuropathy in subjects with IGT who develop type 2 diabetes and also show a dynamic worsening or improvement in corneal and intraepidermal nerve morphology in relation to change in glucose tolerance status. 相似文献
98.
Xin Chen Jim Graham Mohammad A. Dabbah Ioannis N. Petropoulos Georgios Ponirakis Omar Asghar Uazman Alam Andrew Marshall Hassan Fadavi Maryam Ferdousi Shazli Azmi Mitra Tavakoli Nathan Efron Maria Jeziorska Rayaz A. Malik 《Diabetes care》2015,38(6):1138-1144
OBJECTIVE
Quantitative assessment of small fiber damage is key to the early diagnosis and assessment of progression or regression of diabetic sensorimotor polyneuropathy (DSPN). Intraepidermal nerve fiber density (IENFD) is the current gold standard, but corneal confocal microscopy (CCM), an in vivo ophthalmic imaging modality, has the potential to be a noninvasive and objective image biomarker for identifying small fiber damage. The purpose of this study was to determine the diagnostic performance of CCM and IENFD by using the current guidelines as the reference standard.RESEARCH DESIGN AND METHODS
Eighty-nine subjects (26 control subjects and 63 patients with type 1 diabetes), with and without DSPN, underwent a detailed assessment of neuropathy, including CCM and skin biopsy.RESULTS
Manual and automated corneal nerve fiber density (CNFD) (P < 0.0001), branch density (CNBD) (P < 0.0001) and length (CNFL) (P < 0.0001), and IENFD (P < 0.001) were significantly reduced in patients with diabetes with DSPN compared with control subjects. The area under the receiver operating characteristic curve for identifying DSPN was 0.82 for manual CNFD, 0.80 for automated CNFD, and 0.66 for IENFD, which did not differ significantly (P = 0.14).CONCLUSIONS
This study shows comparable diagnostic efficiency between CCM and IENFD, providing further support for the clinical utility of CCM as a surrogate end point for DSPN. 相似文献99.
100.
Stamatis Adamopoulos Jean‐Paul Schmid Paul Dendale Daniel Poerschke Dominique Hansen Athanasios Dritsas Alexandros Kouloubinis Toon Alders Aggeliki Gkouziouta Ilse Reyckers Vasiliki Vartela Nikos Plessas Costas Doulaptsis Hugo Saner Ioannis D. Laoutaris 《European journal of heart failure》2014,16(5):574-582