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991.
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Holly C. Gooding MD MS Shannon McGinty MD Tracy K. Richmond MD MPH Matthew W. Gillman MD SM Alison E. Field ScD 《Journal of general internal medicine》2014,29(8):1098-1104
BACKGROUND
Young adults are less likely than older adults to be aware they have hypertension or to be treated for hypertension.OBJECTIVE
To describe rates of hypertension awareness and control in a cohort of young adults and understand the impact of health insurance, utilization of preventive care, and self-perception of health on rates of hypertension awareness and control in this age group.DESIGN AND PARTICIPANTS
Cross-sectional study of 13,512 young adults participating in Wave IV of the National Longitudinal Study of Adolescent Health in 2007–2008.MAIN MEASURES
We defined hypertension as an average of two measured systolic blood pressures (SBP) ≥ 140 mmHg, diastolic blood pressures (DBP) ≥ 90 mmHg, or self-report of hypertension. We defined hypertension awareness as reporting having been told by a health care provider that one had high blood pressure, and assessed awareness among those with uncontrolled hypertension. We considered those aware of having hypertension controlled if their average measured SBP was < 140 mmHg and DBP was < 90 mmHg.KEY RESULTS
Of the 3,303 young adults with hypertension, 2,531 (76 %) were uncontrolled, and 1,893 (75 %) of those with uncontrolled hypertension were unaware they had hypertension. After adjustment for age, sex, race/ethnicity, weight status, income, education, alcohol and tobacco use, young adults with uncontrolled hypertension who had (vs. didn’t have) routine preventive care in the past 2 years were 2.4 times more likely (95 % confidence interval [CI] 1.68–3.55) to be aware, but young adults who believed they were in excellent (vs. less than excellent) health were 64 % less likely to be aware they had hypertension (OR 0.36, 95 % CI 0.23–0.57). Neither preventive care utilization nor self-rated health was associated with blood pressure control.CONCLUSIONS
In this nationally representative group of young adults, rates of hypertension awareness and control were low. Efforts to increase detection of hypertension must address young adults’ access to preventive care and perception of their need for care. 相似文献993.
Carlos O. Weiss MD Ravi Varadhan PhD Milo A. Puhan MD PhD Andrew Vickers PhD Karen Bandeen-Roche PhD MS Cynthia M. Boyd MD MPH David M. Kent MD CM MSc 《Journal of general internal medicine》2014,29(4):653-660
Most people with a chronic disease actually have more than one, a condition known as multimorbidity. Despite this, the evidence base to prevent adverse disease outcomes has taken a disease-specific approach. Drawing on a conference, Improving Guidelines for Multimorbid Patients, the goal of this paper is to identify challenges to the generation of evidence to support the care of people with multimorbidity and to make recommendations for improvement. We identified three broad categories of challenges: 1) challenges to defining and measuring multimorbidity; 2) challenges related to the effects of multimorbidity on study design, implementation and analysis; and 3) challenges inherent in studying heterogeneity of treatment effects in patients with differing comorbid conditions. We propose a set of recommendations for consideration by investigators and others (reviewers, editors, funding agencies, policymaking organizations) involved in the creation of evidence for this common type of person that address each of these challenges. The recommendations reflect a general approach that emphasizes broader inclusion (recruitment and retention) of patients with multimorbidity, coupled with more rigorous efforts to measure comorbidity and comorbidity burden and the influence of multimorbidity on outcomes and the effects of therapy. More rigorous examination of heterogeneity of treatment effects requires careful attention to prioritizing the most important comorbid-related questions, and also requires studies that provide greater statistical power than conventional trials have provided. Relatively modest changes in the orientation of current research along these lines can be helpful in pointing to and partially addressing selected knowledge gaps. However, producing a robust evidence base to support patient-centered decision making in complex individuals with multimorbidity, exposed to many different combinations of potentially interacting factors that can modify the risks and benefits of therapies, is likely to require a clinical research enterprise fundamentally restructured to be more fully integrated with routine clinical practice. 相似文献
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Shalender Bhasin MB BS Thomas G. Travison PhD Todd M. Manini PhD Sheena Patel MS Karol M. Pencina PhD Roger A. Fielding PhD Jay M. Magaziner PhD Anne B. Newman MD MPH Douglas P. Kiel MD Cyrus Cooper DM FMedSci Jack M. Guralnik MD PhD Jane A. Cauley Dr.PH Hidenori Arai MD PhD Brian C. Clark PhD Francesco Landi MD PhD Laura A. Schaap PhD Suzette L. Pereira PhD Daniel Rooks PhD Jean Woo MD PhD Linda J. Woodhouse PhD Ellen Binder MD Todd Brown MD Michelle Shardell PhD Quian-Li Xue PhD Ralph B. DʼAgostino Sr PhD Denise Orwig PhD Greg Gorsicki PhD Rosaly Correa-De-Araujo MD PhD Peggy M. Cawthon PhD 《Journal of the American Geriatrics Society》2020,68(7):1410-1418
999.
Sonja Zweegman Claudia A.M. Stege Einar Haukas Fredrik H. Schjesvold Mark-David Levin Anders Waage Rineke B.L. Leys Saskia K. Klein Damian Szatkowski Per Axelsson Trung Hieu Do Dorota Knut-Bojanowska Ellen van der Spek Asta Svirskaite Anja Klostergaard Morten Salomo Celine Blimark Paula F. Ypma Ulf-Hendrik Mellqvist Pino J. Poddighe Marian Stevens-Kroef Niels W.C.J. van de Donk Pieter Sonneveld Markus Hansson Bronno van der Holt Niels Abildgaard 《Haematologica》2020,105(12):2879
1000.
Victor A. Chow MD Joseph G. Rajendran MD Darrell R. Fisher Frederick R. Appelbaum MD Ryan D. Cassaday MD Paul S. Martin MD Leona A. Holmberg MD PhD Theodore A. Gooley PhD Philip A. Stevenson MS John M. Pagel MD PhD Damian J. Green MD Oliver W. Press MD PhD Ajay K. Gopal MD 《American journal of hematology》2020,95(7):775-783
Radiation is the most effective treatment for localized lymphoma, but treatment of multifocal disease is limited by toxicity. Radioimmunotherapy (RIT) delivers tumoricidal radiation to multifocal sites, further augmenting response by dose-escalation. This phase II trial evaluated high-dose RIT and chemotherapy prior to autologous stem-cell transplant (ASCT) for high-risk, relapsed or refractory (R/R) B-cell non-Hodgkin lymphoma (NHL). The primary endpoint was progression free survival (PFS). Secondary endpoints were overall survival (OS), toxicity, and tolerability. Patients age < 60 years with R/R NHL expressing CD20 were eligible. Mantle cell lymphoma (MCL) patients could proceed to transplant in first remission. Patients received I-131-tositumomab delivered at ≤25Gy to critical normal organs, followed by etoposide, cyclophosphamide and ASCT. A group of 107 patients were treated including aggressive lymphoma (N = 29), indolent lymphoma (N = 45), and MCL (N = 33). After a median follow-up of 10.1 years, the 10-year PFS for the aggressive, indolent, and MCL groups were 62%, 64%, 43% respectively. The 10-year OS for the aggressive, indolent, and MCL groups were 61%, 71%, 48% respectively. Toxicities were similar to standard conditioning regimens and non-relapse mortality at 100 days was 2.8%. Late myeloid malignancies were seen in 6% of patients. High-dose I-131-tositumomab, etoposide and cyclophosphamide followed by ASCT appeared feasible, safe, and effective in treating NHL, with estimated PFS at 10-years of 43%-64%. In light of novel cellular therapies for R/R NHL, high-dose RIT-containing regimens yield comparable efficacy and safety and could be prospectively compared. 相似文献