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11.
Tarek Mohey El-Gammacy Noha Refaat Mohamed Amany Rasmy Al-Halag 《Scandinavian journal of clinical and laboratory investigation》2013,73(5):352-357
AbstractPreterm neonates with respiratory distress syndrome (RDS) are at increased risk of acute kidney injury (AKI). Our study aimed at determining whether serum cystatin C (sCysC) on day 3 of life (D3) can early predict AKI in preterm neonates with RDS. This prospective study was conducted on 75 preterm neonates; 50 with RDS and 25 without RDS. On D3, sCysC, serum creatinine (sCr) and blood urea nitrogen (BUN) were measured and estimated glomerular filtration rate (eGFR) was calculated. sCr and BUN levels were measured again on days 5 and 7. Neonates were evaluated for development of AKI during first week of life according to the modified pediatric RIFLE (pRIFLE) criteria. Thirteen neonates with RDS developed AKI (26%).There was no significant difference between RDS and control groups with respect to sCysC. RDS neonates with AKI had significantly higher sCysC than those without AKI (1.62?±?0.12 versus 1.16?±?0.09?mg/l; p?<?.001). RDS grade III–IV neonates had significantly higher sCysC than RDS grade I–II. There was a significant positive correlation between D3 sCysC and (D5 and D7 sCr and BUN). Receiver operating characteristic (ROC) curve showed that D3 sCysC can predict AKI in preterm neonates with RDS at a cutoff point of >1.3?mg/l with sensitivity of 92.30% and specificity of 96%. We conclude that neonates with RDS are at increased risk of AKI. sCysC on day 3 of life can predict AKI earlier than Cr and eGFR. 相似文献
12.
13.
Nerve transection is commonly followed by the development of neuroma at the proximal stump. It can be very painful especially
at exposed sites. It may arise spontaneously or after mechanical irritation. Neuroma and its high recurrence rate might be
resisting problems to treat. Various treatment modalities for neuroma and its recurrence have been proposed, but none has
provided satisfactory results. The present study was conducted to evaluate the neodymium:yttrium aluminum garnet (Nd:YAG)
laser (1,064 nm) nerve transection technique for prevention of neuroma formation. There were 48 facial nerves out of 24 Rex
rabbits divided into two equal groups. The 24 left-sided facial nerves at group A were subjected to Nd:YAG laser for nerve
transection, while the 24 right-sided facial nerves at group B were subjected to scalpel nerve transection. The results were
grossly and histopathologically evaluated. Grossly, laser-transected nerves showed an infrequent incidence of neuroma formation.
Histopathologically, laser-transected nerves showed photothermal degenerative changes of the axons and myelin sheaths with
intact perineurium and endoneurium. No Schwann cell hyperactivity could also be elicited among laser-transected nerves. Nd:YAG
laser was found to be an effective tool that could be applied, whenever it is possible, for division of major nerves to prevent
the formation of the subsequent stump neuroma. Moreover, this technique should be considered during treatment of well-established
neuroma to prevent the challenging reported high incidence of recurrence. 相似文献
14.
Radwan Kassir Karine Abboud Joelle Dubois Sylviane Baccot Tarek Debs Jean-Pierre Favre Jean Gugenheim Pauline Gastaldi Imed Ben Amor Olivier Tiffet 《International journal of surgery case reports》2014,5(12):1190-1192
INTRODUCTION
Although diverticular disease of the colon is frequent, perforated diverticulitis causing subcutaneous emphysema is a uncommon entity. We wish to present this extremely rare case of perforated colonic diverticulum in the subcutaneous tissue, which is the first one that we have encountered in our practice, along with the accompanying diagnostic and therapeutic issues and a review of the literature.PRESENTATION OF CASE
We report the case of an 83-year-old man who admitted to the emergency room due to an abdominal subcutaneous emphysema. Physical examination revealed a severe subcutaneous emphysema especially in the left iliac fossa and abdominal pain. An urgent contrast enhanced abdominal CT scan showed multiple diverticula in the sigmoid colon and multiple air bubbles in the subcutaneous tissue. The exploratory laparotomy identified a perforation of diverticular in subcutaneous tissue. Forty centimeters of colon were resected. The subcutaneous emphysema resolved without specific treatment. The postoperative period was uncomplicated.DISCUSSION
Subcutaneous emphysema of anterior abdomen wall is an obvious physical sign but its etiology is complex to determine and may be potentially lethal. The pathophysiological mechanism involved is the emergence of a pressure gradient between the peritoneum and surrounding structures, causing rupture of the anterior abdominal wall, allowing gas from a perforation to diffuse along tissue planes.CONCLUSION
This physical sign may be of especial value in elderly patient groups amongst whom perforation may be less clinically obvious. General surgeons should bear in mind this rare complication of colonic diverticulosis. 相似文献15.
Tarek F. Tammam 《Journal of anesthesia》2014,28(4):532-537
Purpose
Our aim was compare onset time of sciatic nerve blockade (SNB) performed distal to the subgluteal fold using four different ultrasound (US)-guided approaches in patients undergoing foot or ankle surgery.Methods
Patients were assigned to one of four groups: SI patients received SNB using short-axis (SA) view of the SN and in-plane (IP) placement of block needle (SA-IP approach); LI patients received SNB using long-axis (LA) view of the SN and IP needle placement (LA-IP approach); SO patients received the block using SA view of the SN and out-of-plane (OP) needle placement (SA-OP approach); LO patients received SNB using LA view of the SN and OP needle placement (LA-OP). Primary outcome included onset time of sensory and motor SNB. Patient satisfaction concerning the postoperative analgesia was noted.Results
The LI group had significantly faster onset of sensory blockade on the distribution of tibial nerve (16.0 ± 5.6 vs. 23.5 ± 3.6) and common peroneal nerve (12.5 ± 4.3 vs. 19.1 ± 5.4 min) in comparison with the LO group. The LI group had significantly faster onset of motor blockade on the distribution of tibial nerve (21.1 ± 6.2 vs. 26 ± 3.1) and common peroneal nerve (17.7 ± 4.8 vs. 23.7 ± 5.8 min.) in comparison with the LO group. The LI group had the highest rate of patient satisfaction for postoperative analgesia and the LO group had the lowest.Conclusion
The LA-IP approach resulted in a rapid onset of SNB and was associated with the best satisfaction for postoperative analgesia in comparison with LA-OP, SA-IP, and SA-OP approaches for patients undergoing foot and ankle surgery. 相似文献16.
Paolo Preziosa Maria A. Rocca Elisabetta Pagani Maria Laura Stromillo Christian Enzinger Antonio Gallo Hanneke E. Hulst Matteo Atzori Deborah Pareto Gianna C. Riccitelli Massimiliano Copetti Nicola De Stefano Franz Fazekas Alvino Bisecco Frederik Barkhof Tarek A. Yousry Maria J. Arévalo Massimo Filippi and the MAGNIMS Study Group 《Human brain mapping》2016,37(4):1627-1644
In a multicenter setting, we applied voxel‐based methods to different structural MR imaging modalities to define the relative contributions of focal lesions, normal‐appearing white matter (NAWM), and gray matter (GM) damage and their regional distribution to cognitive deficits as well as impairment of specific cognitive domains in multiple sclerosis (MS) patients. Approval of the institutional review boards was obtained, together with written informed consent from all participants. Standardized neuropsychological assessment and conventional, diffusion tensor and volumetric brain MRI sequences were collected from 61 relapsing‐remitting MS patients and 61 healthy controls (HC) from seven centers. Patients with ≥2 abnormal tests were considered cognitively impaired (CI). The distribution of focal lesions, GM and WM atrophy, and microstructural WM damage were assessed using voxel‐wise approaches. A random forest analysis identified the best imaging predictors of global cognitive impairment and deficits of specific cognitive domains. Twenty‐three (38%) MS patients were CI. Compared with cognitively preserved (CP), CI MS patients had GM atrophy of the left thalamus, right hippocampus and parietal regions. They also showed atrophy of several WM tracts, mainly located in posterior brain regions and widespread WM diffusivity abnormalities. WM diffusivity abnormalities in cognitive‐relevant WM tracts followed by atrophy of cognitive‐relevant GM regions explained global cognitive impairment. Variable patterns of NAWM and GM damage were associated with deficits in selected cognitive domains. Structural, multiparametric, voxel‐wise MRI approaches are feasible in a multicenter setting. The combination of different imaging modalities is needed to assess and monitor cognitive impairment in MS. Hum Brain Mapp 37:1627‐1644, 2016. © 2016 Wiley Periodicals, Inc. 相似文献
17.
INTRODUCTIONSeveral congenital anomalies of the spleen have been reported. The polysplenia is a rare anomaly in which the normal spleen is replaced with two or more smaller spleens. The wandering spleen is another anomaly resulting from the laxity of the splenic ligaments. The concomitance of both anomalies is very rare.PRESENTATION OF A CASEA 22-year old female patient presented with intermittent left hypochondrial pain for more than a year. After a thorough examination of the patient, she only had bilateral accessory nipples. Routine laboratory investigations were all normal. An abdominal ultrasound U/S scan was unremarkable except for a ptotic spleen. with a large splenule 5 cm × 3 cm located near the fundus of the stomach. These findings were confirmed by a CT scan. A decision for a surgical intervention was then made, and the laparoscopic approach was chosen which revealed the condition. Laparoscopic removal of the wandering part was executed. The patient discharged on the first post-operative day.DISCUSSIONThe decision making in cases of wandering spleen is not always the same. The association of a wandering spleen with polysplenia is an asset to the surgical decision, along with the age of the patient.CONCLUSIONThe laparoscopic approach is an important tool in the diagnosis and management of wandering spleen. The diagnosis of polysplenic anomaly could provide a guidance for the surgical strategy in patients with wandering spleen. 相似文献
18.
Cox G Boxall SA Giannoudis PV Buckley CT Roshdy T Churchman SM McGonagle D Jones E 《BONE》2012,50(2):510-517
Aspiration of iliac crest bone marrow (ICBM) remains the most frequent technique used in harvesting multipotential stromal cells (MSCs) for bone regeneration. Although this tissue type is easily accessed by a surgeon, it has a low frequency of MSCs, which is significant given the high cell numbers required for bone regeneration strategies. Lipoaspirates possess higher MSC frequencies, albeit cells with a differentiation profile less suited to orthopaedic interventions. Intra-medullary cavities of long bones have previously been shown to harbour MSCs in animals, however evaluation of their frequency, differentiation capacity and phenotype in humans had not previously been performed. Long bone fatty bone marrow (LBFBM) was collected prior to harvesting bone graft. Basic cellular compositions of donor-matched LBFBM and ICBM aspirates, including the numbers of CD34(+) hematopoietic stem cells and CD31(+) endothelial cells, were similar. MSCs were enumerated using colony-forming-unit-fibroblast assays and flow cytometry for the presence of a resident LBFBM CD45(-/low) CD271(+) MSC population and revealed a trend for higher MSC numbers (average 5 fold, n=6) per millilitre of LBFBM compared to donor-matched ICBM. Functional characteristics of resident MSCs, including their growth rates, differentiation potentials and surface phenotypes (CD73(+)CD105(+)CD90(+)) before and after culture-amplification, were similar. Enhanced numbers of MSCs could be recovered following brief enzymatic treatment of solid fragments of LBFBM. Our findings therefore reveal that the intramedullary cavity of the human femur is a depot of MSCs, which, although closely associated with fat, have a differentiation profile equivalent to ICBM. This anatomical site is frequently accessed by the orthopaedic/trauma surgeon and aspiration of the intramedullary cavity represents a 'low-tech' method of harvesting potentially large numbers of MSCs for regenerative therapies and research. 相似文献
19.
Charles de Mestral Tarek Razek Kosar Khwaja Paola Fata 《European journal of trauma and emergency surgery》2008,34(6):595-600
Background Extrahepatic biliary tract injuries following blunt abdominal trauma are very rare and pose a diagnostic and therapeutic challenge.
Case Report We report a case of blunt liver injury with left extrahepatic duct transection following a motor vehicle collision. Technetium
99m dimethyliminodiacetic acid scan confirmed a bile leak and endoscopic retrograde cholangiopancreatography (ERCP) diagnosed
the injury of the left extrahepatic duct. Management was initially conservative, consisting of external drainage along with
trials of stent placement. Ultimately, partial left hepatectomy was required to definitively treat the injury.
Conclusion In the setting of suspected biliary tract injury, early ERCP is essential to localize a leak and guide management decisions.
In the event of a confirmed bile leak, a trial of nonoperative management consisting of endoscopic ductal decompression along
with percutaneous drainage may initially be warranted although is not always successful. 相似文献
20.
Sheir KZ Elhalwagy SM Abo-Elghar ME Ismail AM Elsawy E El-Diasty TA Dawaba ME Eraky IA El-Kenawy MR 《BJU international》2008,101(11):1420-1426