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41.
《Parkinsonism & related disorders》2014,20(8):845-849
BackgroundHereditary spastic paraplegia (HSP) is a clinically and genetically heterogeneous group of neurodegenerative diseases. Mutations in the spastin (SPAST) gene are the most common cause of pure HSP. However, few data are available regarding the clinical and genetic spectrum of HSP among Chinese patients.MethodsClinical data were collected at diagnosis and follow-up of 42 Chinese patients with pure HSP. All seventeen exons of the SPAST gene were directly sequenced. Additionally, we used a multiplex ligation dependent probe amplification (MLPA) assay targeting the SPAST gene to evaluate large exon deletion or insertion mutations in patients without SPAST point mutations.ResultsThe age of disease onset of our patients was 19.6 ± 14.4 years. Six novel variations were found, including three missense mutations (p. L363P, p. D441V, and p. S595R), one insertion (c.1511dupT (p. Y505Ifs*7)), and two larger deletions (exons 5–17 and exons 10–17). Four previously reported mutations, including p. S399L, c.1215_c.1219delTATAA (p. N405Kfs*36), exon 1 deletion, and exon 16 deletion, were detected. The SPAST mutation rate was 40% (4/10) in Chinese familial patients and 33.33% (7/21) in Chinese sporadic pure HSP patients. The frequency of large deletions was high in both AD-HSP (20%, 2/10) and sporadic HSP (14.28%, 3/21).ConclusionSPAST mutations are common in Chinese patients with pure HSP. Large exon deletions are an important cause of AD-HSP and sporadic pure HSP in Chinese patients. Large fragment tests should be performed to explore large SPAST mutations in familial and sporadic HSP patients without SPAST point mutations. 相似文献
42.
43.
Kathie J. Ngo Jessica E. Rexach Hane Lee Lauren E. Petty Susan Perlman Juliana M. Valera Joshua L. Deignan Yuanming Mao Mamdouh Aker Jennifer E. Posey Shalini N. Jhangiani Zeynep H. Coban‐Akdemir Eric Boerwinkle Donna Muzny Alexandra B. Nelson Sharon Hassin‐Baer Gemma Poke Katherine Neas Michael D. Geschwind Wayne W. Grody Richard Gibbs Daniel H. Geschwind James R. Lupski Jennifer E. Below Stanley F. Nelson Brent L. Fogel 《Human mutation》2020,41(2):487-501
Genetic ataxias are associated with mutations in hundreds of genes with high phenotypic overlap complicating the clinical diagnosis. Whole‐exome sequencing (WES) has increased the overall diagnostic rate considerably. However, the upper limit of this method remains ill‐defined, hindering efforts to address the remaining diagnostic gap. To further assess the role of rare coding variation in ataxic disorders, we reanalyzed our previously published exome cohort of 76 predominantly adult and sporadic‐onset patients, expanded the total number of cases to 260, and introduced analyses for copy number variation and repeat expansion in a representative subset. For new cases (n = 184), our resulting clinically relevant detection rate remained stable at 47% with 24% classified as pathogenic. Reanalysis of the previously sequenced 76 patients modestly improved the pathogenic rate by 7%. For the combined cohort (n = 260), the total observed clinical detection rate was 52% with 25% classified as pathogenic. Published studies of similar neurological phenotypes report comparable rates. This consistency across multiple cohorts suggests that, despite continued technical and analytical advancements, an approximately 50% diagnostic rate marks a relative ceiling for current WES‐based methods and a more comprehensive genome‐wide assessment is needed to identify the missing causative genetic etiologies for cerebellar ataxia and related neurodegenerative diseases. 相似文献
44.
《European journal of paediatric neurology》2014,18(4):502-510
BackgroundRobot-enhanced therapies are increasingly being used to improve gross motor performance in patients with cerebral palsy.AimTo evaluate gross motor function, activity and participation in patients with bilateral spastic cerebral palsy (BS-CP) after Robot-enhanced repetitive treadmill therapy (ROBERT) in a prospective, controlled cohort study.MethodsParticipants trained for 30–60 min in each of 12 sessions within a three-week-period. Changes in Gross Motor Function Measure (GMFM 66) scores, standardized walking distance, self-selected and maximum walking speed (ICF domain “Activity”), and Canadian Occupational Performance Measure (COPM; “Participation”) were measured. Outcome measures were assessed three weeks in advance (V1), the day before (V2) as well as the day after, and 8 weeks after ROBERT (V3 + V4).Results18 patients with BS-CP participated; age 11.5 (mean, range: 5.0–21.8) years, body weight 36.4 (15.0–72.0) kg. GMFCS levels I–IV were: n = 4; 5; 8; 1. There was no significant difference comparing V1 and V2. GMFM 66 (total +2.5 points, Dimension D +3.8 and E +3.2) and COPM (Performance +2.1 points, Satisfaction +1.8 points) showed statistically significant improvements for V3 or V4 compared to V1 or V2 representing clinically meaningful effect sizes. Age, GMFCS level, and repeated ROBERT blocks correlated negatively with GMFM improvement, but not with COPM improvement.InterpretationFollowing ROBERT, this prospective controlled cohort study showed significant and clinically meaningful improvements of function in ICF domains of “activity” and “participation” in patients with BS-CP. Further assessment in a larger cohort is necessary to allow more specific definition of factors that influence responsiveness to ROBERT program. 相似文献
45.
46.
Tarishi Nemani Dora Steel Marios Kaliakatsos Catherine DeVile Athina Ververi Richard Scott Spas Getov Sniya Sudhakar Alison Male Kshitij Mankad Francesco Muntoni Mary M Reilly Manju A Kurian Lucinda Carr Pinki Munot 《Journal of the peripheral nervous system : JPNS》2020,25(2):117-124
KIF1A‐related disorders (KRD) were first described in 2011 and the phenotypic spectrum has subsequently expanded to encompass a range of central and peripheral nervous system involvement. Here we present a case series demonstrating the range of clinical, neurophysiological, and radiological features which may occur in childhood‐onset KRD. We report on all the children and young people seen at a single large tertiary centre. Data were collected through a retrospective case‐notes review. Twelve individuals from 10 families were identified. Eight different mutations were present, including four novel mutations. Two patients displayed a very severe phenotype including congenital contractures, severe spasticity and/or dystonia, dysautonomia, severe sensorimotor polyneuropathy and optic atrophy, significant white matter changes on brain MRI, respiratory insufficiency, and complete lack of neurodevelopmental progress. The remaining 10 patients represented a spectrum of severity with common features including a movement disorder with spasticity and/or dystonia, subtle features of dysautonomia, sensory axonal neuropathy, varying degrees of optic atrophy and of learning and/or behavioural difficulties, and subtle or absent—but sometimes progressive—changes in white matter on MRI. Epilepsy was common among the more severely affected children. This case series demonstrates that KRD comprise a range of neurological disorders, with both the milder and the more severe forms combining central and peripheral (including autonomic) nervous system deficits. 相似文献
47.
目的:探讨仿生训练对痉挛型脑性瘫痪患儿粗大运动功能的影响。方法:选取痉挛型脑性瘫痪患儿40例,随机分为观察组和对照组各20例。2组患儿均进行常规康复训练,观察组在常规康复训练的基础上增加仿生训练(兔子跳跃、蜥蜴行走、猴子攀爬)。在训练前后分别对2组患儿用粗大运动功能评估量表(GMFM)、Peabody粗大运动发育量表(PDMS-GM)进行评估,并利用关节量角器对其内收肌角、足背屈角进行测量。观察训练前后2组痉挛型脑性瘫痪患儿GMFM、PDMS-GM原始分差异及患儿内收肌角、足背屈角差异。结果:治疗12周后,2组GMFM及PDMS-GM评分均较治疗前显著提高(均P<0.05),且观察组均高于对照组(均P<0.05);2组患儿内收肌角及足背屈角均大于治疗前(均P<0.05),且观察组均大于对照组(均P<0.05)。结论:仿生训练可改善痉挛型脑瘫患儿的粗大运动功能。 相似文献
48.
Ruth Ponsford Jo Crichton Rebecca Meiksin Tara Tancred Gemma Morgan Nerissa Tilouche Rona Campbell Chris Bonell 《Lancet》2018
Background
There is increasing emphasis on involving intended beneficiaries and other stakeholders in the development of public health interventions to maximise acceptability and remove barriers to adoption, implementation, and maintenance before costly implementation. Yet the processes whereby key actors are engaged in intervention development are rarely reported, and frameworks for carrying out such work remain limited. We outline our approach to involving stakeholders in the optimisation of two school-based relationships and sex education programmes (Project Respect and Positive Choices) and reflect on the challenges of co-producing with teachers, students, and other partners.Methods
Systematic optimisation of both interventions involved a review of existing literature on effective approaches; consultation with staff and students on intervention content and delivery; drafting of intervention materials; further consultation with schools; and then intervention refinement in preparation for a pilot. Seven focus groups took place in southeast and southwest England involving 75 students aged 13–15 years and 22 school staff. A group of young people trained to advise on public health research were consulted on two occasions and a wide range of sexual health and sex education practitioners and policy makers shared their views at a stakeholder event.Findings
Consultation provided useful insights to inform intervention adaption in relation to who should deliver the programmes in schools; whether lessons should be taught in single sex classes; the format that guidance and lesson plans should take; the relevance and acceptability to students and teachers; and the need for the flexibility for materials to adapt to different school contexts. Genuine consultation and incorporation of school stakeholder views was challenging where stakeholder availability was limited and intervention development and implementation timelines were tight. Challenges also arose in relation to the weight to give divergent opinions among stakeholders and between stakeholders and researchers.Interpretation
Carrying out structured stakeholder engagement activities can yield valuable insights that can improve the applicability of interventions to local contexts before they are formally trialled. To genuinely engage stakeholders in intervention development requires sufficient time to both consult and adapt. In such consultations, it is important to attend not just to the voices of those who are the loudest and most powerful.Funding
National Institute for Health Research (NIHR). 相似文献49.
Background
Routine sources of information on the maternal and child health workforce in China are without clear definition and categorisation. The aim of the study was to systematically review all the evidence on China's maternal and child health workforce profile (ie, level of education, training, qualification, and professional title), and determine the density of the maternal and child health workforce.Methods
We did a systematic review by searching six English (Embase, MEDLINE, CENTRAL, EconLit, Global Health, and Web of Science) and two Chinese (Wanfang and China National Knowledge Infrastructure) databases, from 1949 onwards, using a combination of the search terms “human resources for health”, “maternal and child health services”, and “China” with both thesaurus and free text words. We included studies either describing the profile of the maternal and child health workforce or providing data allowing us to calculate the density of the maternal and child health workforce.Findings
We included 58 studies: 43 reporting profiles of the maternal and child health workforce, and 19 reporting density of the maternal and child health workforce, four of which covered both. 51 (88%) of the 58 studies were done after 1990. The maternal and child health workforce in China covers an array of professions, including obstetricians, gynaecologists, neonatologists, paediatricians, nurses, midwives, general physicians, specialised public health workers, vaccinators, barefoot doctors (ie, farmers who go through short-term medical training), and traditional birth attendants. Definitions of who qualifies as a maternal and child health provider are not clear (eg, the term midwife was used in six studies, and covered a range of training, including clinical medicine, maternal and child health care, nursing, and midwifery). Two studies reported that 7% (24 of 321) and 48% (650 of 1364), respectively, of the maternal and child health workforce at county-level facilities or below held no certificate for maternal and child health care. Only one study reported the density of the maternal and child health workforce at a national level, which was 0·6 health professionals per 1000 population in 2011. The density of the maternal health workforce was between 1·6 and 6·5 times higher than the child health workforce in the same population. The ratio of obstetric nurses to obstetricians ranged from 1·3:1 to 2·0:1, which was higher than the overall nurse-to-doctor ratio at a national level of 1·1:1 in 2017. The ratio of paediatric nurses to paediatricians ranged from 1·1:1 to 1·7:1, which was higher than the national ratio of 1·1:1.Interpretation
The density of the maternal and child health workforce in China is lower than the minimum desired level of 2·3 health professionals (physicians, nurses, and midwives) per 1000 population, as recommended in the World Health Report 2006. The maternal and child health workforce in China is characterised by varied personnel with diverse training backgrounds, a larger maternal health workforce than child health workforce, and more nurses than doctors. A strength of the study is the conceptual understanding of the maternal and child health workforce over the entire period of contemporary China. A limitation of the study is that various data sources prevented us from synthesising the available evidence together.Funding
China Medical Board. 相似文献50.
O.C. Durojaiye E.I. Kritsotakis P. Johnston T. Kenny F. Ntziora K. Cartwright 《Clinical microbiology and infection》2019,21(7):905.e1-905.e7
ObjectivesOutpatient parenteral antimicrobial therapy (OPAT) is increasingly used to treat a wide range of infections. However, there is risk of hospital readmissions. The study aim was to develop a prediction model for the risk of 30-day unplanned hospitalization in patients receiving OPAT.MethodsUsing a retrospective cohort design, we retrieved data on 1073 patients who received OPAT over 2 years (January 2015 to January 2017) at a large teaching hospital in Sheffield, UK. We developed a multivariable logistic regression model for 30-day unplanned hospitalization, assessed its discrimination and calibration abilities, and internally them validated using bootstrap resampling.ResultsThe 30-day unplanned hospitalization rate was 11% (123/1073). The main indication for hospitalization was worsening or nonresponse of infection (52/123, 42%). The final regression model consisted of age (adjusted odds ratio (aOR), 1.18 per decade; 95% confidence interval (CI), 1.04–1.34), Charlson comorbidity score (aOR, 1.11 per unit increase; 95% CI, 1.00–1.23), prior hospitalizations in past 12 months (aOR, 1.30 per admission; 95% CI, 1.17–1.45), concurrent intravenous antimicrobial therapy (aOR, 1.89; 95% CI, 1.03–3.47) and endovascular infection (aOR, 3.51; 95% CI, 1.49–8.28). Mode of OPAT treatment was retained in the model as a confounder. The model had adequate concordance (c-statistic 0.72; 95% CI 0.67–0.77) and calibration (Hosmer-Lemeshow p 0.546; calibration slope 0.99; 95% CI 0.78–1.21), and low degree of optimism (bootstrap optimism corrected c-statistic, 0.70).ConclusionsWe identified a set of six important predictors of unplanned hospitalization based on readily available data. The prediction model may help improve OPAT outcomes through better identification of high-risk patients and provision of tailored care. 相似文献