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991.
Lipomas and lipomatosis of colon are rare in clinical practice. We herein report a case of diffuse colonic lipomatosis, fifth
such case in literature which presented as perforation peritonitis, a presentation, never been reported earlier. On laparotomy,
the findings suggested malignancy and appropriate surgery was done. Diffuse Colonic Lipomatosis, a rare and benign condition
mimicks malignancy and should be kept as a differential diagnosis is unusual cases of colonic perforations. 相似文献
992.
Spontaneous non-traumatic renal hemorrhage known as Wunderlich's syndrome is known to occur in renal angiomyolipoma and may
be the first manifestation of the disease. Angiomyolipomas in tuberous sclerosis are usually bilateral and multicentric. A
25yr old female, a case of Tuberous sclerosis with bilateral renal angiomyolipomas presented with right loin pain of increasing
severity. On evaluation she had acute abdomen with increasing abdominal distension. Investigations revealed large right perinephric
hematoma with bilateral renal angiomyolipomas. Exploratory laparotomy and right nephrectomy was done. Spontaneous hemorrhage
in renal angiomyolipoma in a case of tuberous sclerosis and management are discussed. 相似文献
993.
Eddie K. Abdalla 《Journal of gastrointestinal surgery》2011,15(3):416-419
Introduction
The gold-standard treatment for colorectal liver metastases (CLM) is liver resection. Advances in staging, surgical technique, perioperative care and systemic chemotherapy have contributed to steady improvement in oncologic outcomes for patients following surgery in this subset of patients with stage IV colorectal cancer. The limits of resection continue to expand to include patients with more, larger and bilateral CLM, yet outcomes continue to improve with 5-year overall survival exceeding 50% following resection. Chemotherapy is an important element of treatment for patients with CLM, and chemotherapy can be combined safely with surgery to improve outcomes further. 相似文献994.
Dementia in Parkinson’s disease encompasses a spectrum relating to motor, psychiatric, and cognitive symptoms that are classified
as either Dementia with Lewy Bodies (DLB) (initial cognitive symptoms) or Parkinson’s Disease Dementia (PDD) (initial motor
signs preceding cognitive symptoms by at least a year). Anticholinergic and antipsychotic drugs have a high risk of adverse
cognitive and/or motor effects, so their use should be minimized or avoided. Neuroleptic sensitivity is a severe psychomotor
adverse reaction that is particularly associated with potent dopamine-blocking agents such as haloperidol. It occurs in up
to 50% of individuals with PDD or DLB. Mild psychotic symptoms should first be addressed by reducing anticholinergic and/or
dopaminergic agents, if possible. Patients with psychotic symptoms that threaten the safety of the patient or caregiver may
benefit from treatment with quetiapine or, in refractory cases, clozapine. Cholinesterase inhibitors as a drug class have
been shown to have beneficial effects on cognition in DLB and PDD, and may help to alleviate some psychiatric symptoms, such
as apathy, anxiety, hallucinations, and delusions. Memantine may help to moderate cognitive symptoms in DLB and PDD, although
current data suggest a more variable response, particularly in PDD. Parkinsonian motor signs that are accompanied by clinically
significant cognitive impairment should be treated with carbidopa/levodopa only, as dopamine agonists and other antiparkinsonian
medications generally carry a higher risk of provoking or exacerbating psychotic symptoms. Excessive daytime sleepiness and
REM sleep behavior disorder are common associated features of PDD and DLB. Minimizing sedating medications during the day
and promoting nocturnal sleep may help the daytime sleepiness; melatonin, clonazepam, gabapentin, and possibly memantine may
be useful in treating REM sleep behavior disorder. Orthostatic hypotension can be managed with various nonpharmacologic interventions,
and if needed, fludrocortisone and pyridostigmine. Midodrine should be used cautiously, if at all. 相似文献
995.
No current disease-modifying treatments have been shown definitively in randomized clinical trials to reduce or reverse diabetic
sensory polyneuropathy (DSP). It is increasingly recognized that individuals with “prediabetes” or impaired glucose regulation
can already have a “small-fiber” neuropathy, or mild DSP, in which sensory axons of both small and larger diameter are damaged.
Small-fiber neuropathy is frequently associated with pain, and these patients may present to a neurologist for evaluation
before the underlying glucose dysregulation has been diagnosed. It is important to identify these individuals, because aggressive
diabetic control and lifestyle interventions can delay the onset of diabetes and may reverse small-fiber neuropathy associated
with early diabetes mellitus. Although treatment currently focuses on pain associated with DSP, attention should be paid to
potential risk factors for neuropathy. For example, glycemic control and hyperlipidemia should be improved with diet, exercise,
and medications. Hypertension that is a risk marker for more severe neuropathy should be treated. Angiotensin-converting enzyme
inhibitors or angiotensin-receptor blockers not only treat hypertension but also may directly reduce the progression of neuropathy.
Class I or II clinical studies support the use of sodium valproate, pregabalin, duloxetine, amitriptyline, gabapentin, venlafaxine,
opioids, and topical capsaicin in treating diabetic neuropathic pain. Pregabalin and gabapentin are relatively well tolerated
and have few medication interactions. Sodium valproate has been shown to be effective but is not recommended for use in women
of childbearing potential, and patients must be monitored for hepatotoxicity and thrombocytopenia. Tricyclic antidepressants
such as amitriptyline are often used for nocturnal pain but require caution in the elderly or anyone with cardiac disease.
Venlafaxine and duloxetine successfully treat neuropathic pain independently of their effect on depression. Opioid medications
are associated with a high rate of adverse effects but with careful monitoring, they can be effective in treating resistant
neuropathic pain. Capsaicin is an effective topical treatment that lacks systemic side effects. The lidocaine patch is effective
in relieving pain associated with postherpetic neuralgia, but only class III evidence supports its use for diabetic neuropathic
pain. No current Class I or II studies support other treatment modalities. 相似文献
996.
Mogi A Kosaka T Yamaki E Tanaka S Kuwano H 《General thoracic and cardiovascular surgery》2011,59(12):815-818
Extracutaneous glomus tumors are uncommon, and their occurrence in the trachea is rare. We present a case of a surgically
resected glomus tumor of the trachea in a 56-year-old woman who presented with worsening dyspnea and cough. Bronchoscopy and
computed tomography showed a polypoid tumor arising from the posterior membrane of the lower trachea just above the carina;
the tracheal lumen was approximately 80% occluded. The patient underwent successful tracheal sleeve resection with primary
reconstruction. The histological characteristics and immunohistochemical profile were typical for this tumor. The clinicopathological
features of this unusual neoplasm are discussed, and the literature is reviewed. 相似文献
997.
Orradre Burusco I Romero R Brun M López Blasco JJ 《Archives of orthopaedic and trauma surgery》2011,131(12):1711-1716
Background
Recent data indicate that enhanced wear resistance can be obtained with new cross-linked ultra-high-molecular weight polyethylene (CL-UHMWPE) liners, in comparison with previous-generation liners. The current prospective, cohort study was undertaken to analyse whether the use of a new CL-UHMWPE (Rexpol) results in a lower wear rate than ultra-high-molecular weight polyethylene (UHMWPE) in a group of similar patients undergoing total hip arthroplasty (THA). This study provides the first clinical data with this particular CL-UHMWPE. 相似文献998.
Introduction
Fractures of femoral fracture are among the most common fractures encountered in orthopedic practice. Intramedullary nailing is the treatment choice for femoral shaft fractures in adults. The objective of this article is to determine the effects of reamed intramedullary nailing versus unreamed intramedullary nailing for fracture of femoral shaft in adults. 相似文献999.
Tamminen IS Isaksson H Aula AS Honkanen E Jurvelin JS Kröger H 《Journal of bone and mineral metabolism》2011,29(4):442-448
The use of micro-computed tomography (micro-CT) to study bone microstructure is continuously increasing. Thus, it is important
to ensure that micro-CT can differentiate healthy and pathological bone. This study aimed to determine whether the reproducibility
of bone histomorphometry and micro-CT, and agreement between the techniques, vary in bone samples with different metabolic
status. Iliac crest biopsies (n = 36) were obtained from healthy subjects (n = 10) and from patients with osteoporosis (OP) (n = 15) or renal osteodystrophy (ROD) (n = 11). Micro-CT and histomorphometry analyses were repeated twice. Results were analyzed in separate groups and after pooling
the data. Bone histomorphometry detected generally known differences between the diseases, whereas micro-CT did not detect
differences between normal and ROD samples as effectively. Repeated measurements for BV/TV, Tb.Th, Tb.N, and Tb.Sp exhibited
linear correlation coefficients (ρ) of 0.87–0.92 [coefficients of variations (CV), 8.3–27.2%] for histomorphometry and of
0.66–0.94 (CV, 4.4–23.4%) for micro-CT. There were no significant differences in reproducibility among samples from different
study groups. Correlations between BV/TV (micro-CT) and mineralized bone volume (Md.V/TV, histomorphometry) were weaker than
between BV/TV (micro-CT) and BV/TV (histomorphometry). When comparing the techniques, BV/TV, Tb.Th, and Tb.N displayed moderate
correlations (ρ = 0.39–0.62, P < 0.05), and the agreement for BV/TV was highest in OP samples. The agreement between the techniques using clinical bone
samples was moderate. Especially, micro-CT was less effective than bone histomorphometry in differentiating ROD from normal
samples. The reproducibility was not affected by the health status of bone. Histomorphometry is still needed in clinical practice
to study the remodeling balance in bone, and the methods are complementary. 相似文献
1000.