全文获取类型
| 收费全文 | 4293篇 |
| 免费 | 189篇 |
| 国内免费 | 70篇 |
专业分类
| 耳鼻咽喉 | 41篇 |
| 儿科学 | 89篇 |
| 妇产科学 | 32篇 |
| 基础医学 | 307篇 |
| 口腔科学 | 33篇 |
| 临床医学 | 709篇 |
| 内科学 | 1328篇 |
| 皮肤病学 | 42篇 |
| 神经病学 | 284篇 |
| 特种医学 | 211篇 |
| 外科学 | 540篇 |
| 综合类 | 233篇 |
| 现状与发展 | 1篇 |
| 预防医学 | 276篇 |
| 眼科学 | 111篇 |
| 药学 | 203篇 |
| 1篇 | |
| 中国医学 | 52篇 |
| 肿瘤学 | 59篇 |
出版年
| 2024年 | 10篇 |
| 2023年 | 236篇 |
| 2022年 | 361篇 |
| 2021年 | 523篇 |
| 2020年 | 360篇 |
| 2019年 | 381篇 |
| 2018年 | 359篇 |
| 2017年 | 159篇 |
| 2016年 | 98篇 |
| 2015年 | 115篇 |
| 2014年 | 290篇 |
| 2013年 | 251篇 |
| 2012年 | 131篇 |
| 2011年 | 160篇 |
| 2010年 | 149篇 |
| 2009年 | 129篇 |
| 2008年 | 117篇 |
| 2007年 | 123篇 |
| 2006年 | 85篇 |
| 2005年 | 79篇 |
| 2004年 | 67篇 |
| 2003年 | 56篇 |
| 2002年 | 30篇 |
| 2001年 | 35篇 |
| 2000年 | 24篇 |
| 1999年 | 25篇 |
| 1998年 | 21篇 |
| 1997年 | 17篇 |
| 1996年 | 13篇 |
| 1995年 | 11篇 |
| 1994年 | 11篇 |
| 1993年 | 7篇 |
| 1992年 | 8篇 |
| 1991年 | 5篇 |
| 1990年 | 8篇 |
| 1989年 | 8篇 |
| 1988年 | 6篇 |
| 1987年 | 6篇 |
| 1986年 | 5篇 |
| 1985年 | 12篇 |
| 1984年 | 10篇 |
| 1983年 | 4篇 |
| 1982年 | 6篇 |
| 1981年 | 9篇 |
| 1980年 | 9篇 |
| 1979年 | 6篇 |
| 1978年 | 8篇 |
| 1977年 | 3篇 |
| 1974年 | 3篇 |
| 1973年 | 2篇 |
排序方式： 共有4552条查询结果，搜索用时 15 毫秒
91.
Sim MF Ho SF O'Mahony MS Steward JA Buchalter M Burr M 《European journal of heart failure》2004,6(4):433-438
The European Study Group on diastolic heart failure requires objective evidence of abnormal left ventricular diastolic function to establish the diagnosis of diastolic heart failure, which is common in older people. Reference values for Doppler indices of transmitral flow, used to assess left ventricular diastolic function, have not been reported for people 70 years and over in Europe. The aim of this study was to establish reference values for these Doppler indices of transmitral flow in older people. A random sample of 355 subjects aged 70 and over, living in the community underwent clinical assessment and echocardiography. Asymptomatic subjects with no cardiovascular disease and cardiovascular risk factors were identified. Measurements of five commonly used Doppler indices of transmitral flow from these subjects were obtained and reference range expressed as mean+/-2 standard deviations and as percentiles. We have therefore generated reference Doppler values of transmitral flow for people aged over 70 in a British population. 相似文献
92.
《Vaccine》2015,33(26):3010-3015
In regions where hepatitis B virus (HBV) is endemic, perinatal transmission is common. Infected newborns have a 90% chance of developing chronic HBV infection, and 1 in 4 will die prematurely from HBV-related liver disease. In 2010, the Hepatitis B Foundation and the Haimen City CDC launched the Gateway to Care campaign in Haimen City, China to improve awareness, prevention, and control of HBV infection citywide. The campaign included efforts to prevent perinatal HBV transmission by screening all pregnant women for hepatitis B surface antigen (HBsAg), following those who tested positive, and administering immunoprophylaxis to their newborns at birth. Of 5407 pregnant women screened, 185 were confirmed HBsAg-positive and followed until delivery. At age one, 175 babies were available for follow up testing. Of those, 137 tested negative for HBsAg and positive for antibodies to HBsAg, indicating protection. An additional 34 HBsAg-negative babies also tested negative for antibodies to HBsAg or had indeterminate test results, were considered to have had inadequate immune responses to the vaccine, and were given a booster dose. A higher prevalence of nonresponse to HBV vaccine was observed among babies born to hepatitis B e antigen (HBeAg)-positive mothers and mothers with high HBV DNA titers. The remaining 4 babies tested positive for HBsAg and negative for antibodies, indicative of active HBV infection. The mothers of all 4 had viral loads ≥8 × 106 copies/ml in the third trimester. Although inadequate response or nonresponse to HBV vaccine was more common among babies born to HBeAg-positive and/or high viral load mothers, these risk factors did not completely predict nonresponsiveness. All babies born to HBV-infected mothers should be tested upon completion of the vaccine series to ascertain adequate protection. Some babies of HBeAg-positive mothers with high viral load may still become HBV infected despite timely immunoprophylaxis with HBV vaccine and HBIG. 相似文献
93.
94.
Melissa Soohoo Elani Streja Yoshitsugu Obi Connie M. Rhee Daniel L. Gillen Keiichi Sumida Danh V. Nguyen Csaba P. Kovesdy Kamyar Kalantar-Zadeh 《Mayo Clinic proceedings. Mayo Clinic》2018,93(8):1074-1085
Objective
To determine whether kidney function level and its rate of decline in the immediate predialysis period among veterans transitioning to end-stage renal disease (ESRD) predict postdialysis mortality and hospitalization.Patients and Methods
In 19,985 veterans transitioning to ESRD during the period October 1, 2007, to March 30, 2014, we examined kidney function and its slope over the final year of the pre-ESRD(prelude) period. Two categories of low vs high estimated glomerular filtration rate (eGFR, dichotomized at 10 mL/min/1.73 m2) and slow vs fast slope (dichotomized at ?10 mL/min/1.73 m2/y) were combined into 4 groups. Their associations with 12-month post-ESRD all-cause and cardiovascular (CV) mortality and hospitalization rates were examined in adjusted models accounting for clinical characteristics and laboratory measurements at transition.Results
Patients, 66±11 years old, and 34% blacks, had a median (interquartile range) eGFR at transition and slope of 9.7 (7.1-13.3) mL/min/1.73 m2 and ?10.5 (?18.8 to ?5.9) mL/min/1.73 m2/y, respectively. Patients with a low eGFR and slow slope had the lowest 12-month all-cause and CV mortality risks and hospitalization rate. Conversely, patients with high eGFR and fast slope had the highest risk of all-cause and CV mortality and hospitalization rate compared with patients with a low eGFR and slow slope. This relationship persisted in sensitivity analyses, including propensity scoring.Conclusion
A kidney profile of a low eGFR and slow slope in the prelude period is associated with favorable early dialysis outcomes in veteran patients. Trials to examine a more conservative approach to dialysis are warranted. 相似文献95.
Lindsey M. Philpot Priya Ramar Muhamad Y. Elrashidi Tiffany A. Sinclair Jon O. Ebbert 《Mayo Clinic proceedings. Mayo Clinic》2018,93(10):1431-1439
Objective
To evaluate the impact of opioid controlled substance agreements (CSAs) enrollment on health care utilization.Patients and Methods
We retrospectively evaluated health care utilization changes among 772 patients receiving long-term opioid therapy for chronic noncancer pain enrolled in a CSA between July 1, 2015, and December 31, 2015. We ascertained patient characteristics and utilization 12 months before and after CSA enrollment. Decreased utilization was defined as a decrease of 1 or more hospitalizations or emergency department visits and 3 or more outpatient primary and specialty care visits. Multivariate modeling assessed demographic characteristics associated with utilization changes.Results
The 772 patients enrolled in an opioid CSA during the study period had a mean ± SD age of 63.5±14.9 years and were predominantly female, white, and married. The CSA enrollment was associated with decreased outpatient primary care visits (odds ratio [OR], 0.16; 95% CI, 0.14-0.19) and increased diagnostic radiology services (OR, 1.22; 95% CI, 1.02-1.47). After CSA enrollment, patients with greater comorbidity (Charlson Comorbidity Index score >3) were more likely to have reduced hospitalizations (adjusted OR, 2.8; 95% CI, 1.3-6.0; P=.008), reduced outpatient primary care visits (adjusted OR, 2.0; 95% CI, 1.2-3.2; P=.005), and reduced specialty care visits (adjusted OR, 2.0; 95% CI, 1.2-3.3; P=.006).Conclusion
For patients receiving long-term opioid therapy for chronic noncancer pain, CSA enrollment is associated with reductions in primary care visits and increased radiologic service utilization. Patients with greater comorbidity were more likely to have reductions in hospitalizations, outpatient primary care visits, and outpatient specialty clinic visits after CSA enrollment. The observational nature of the study does not allow the conclusion that CSA implementation is the primary reason for these observed changes. 相似文献96.
Meimei Zhou Fang Li Weibo Lu Junfa Wu Song Pei 《Archives of physical medicine and rehabilitation》2018,99(9):1730-1739
Objective
To compare the efficacy of neuromuscular electrical stimulation (NMES) and transcutaneous nerve stimulation (TENS) on hemiplegic shoulder pain (HSP).Design
This is a prospective randomized controlled trial.Setting
A rehabilitation hospital.Participants
Participants (N=90) were randomized into NMES (n=36), TENS (n=36), or control groups (n=18).Interventions
NMES (15Hz, pulse width 200μs) was applied to supraspinatus and deltoids (medial and posterior parts), whereas TENS (100Hz, pulse width 100μs) was used on the same areas. The surface electrodes were placed near the motor points of the supraspinatus and medial or posterior bundle of deltoids. The 4-week treatment consisted of 20 sessions, each session composed of 1 hour of stimulation per day. Routine rehabilitation program without any stimulation was administered to the control and the NMES/TENS groups. Numerical rating scale (NRS), active/passive range of motion (AROM/PROM) of shoulder, upper extremity Fugl-Meyer Assessment (FMA), modified Ashworth scale (MAS), Barthel Index (BI), and stroke-specific quality of life scale (SSQOLS) were assessed in a blinded manner at baseline, 2, 4, and 8 weeks after treatment, respectively.Main Outcome Measures
The primary endpoint was the improvement from baseline in NRS for HSP at 4 weeks.Results
NRS scores in NMES, TENS, and control groups had decreased by 2.03, 1.44, and 0.61 points, respectively after 4 weeks of treatment, with statistically significant differences among the 3 groups (P<.001). The efficacy of the NMES group was significantly better than that of the TENS group (P=.043). Moreover, the efficacy of NMES and TENS groups was superior to that of the control group (P<.001, P=.044, respectively). The differences in the therapeutic efficacy on shoulder AROM/PROM, FMA, MAS, BI, and SSQOLS scores were not significant among the 3 groups.Conclusions
TENS and NMES can effectively improve HSP, the efficacy of NMES being distinctly superior to that of TENS in maintaining long-term analgesia. However, NMES was not more efficacious than the TENS or control group in improving the shoulder joint mobility, upper limb function, spasticity, the ability of daily life activity, and stroke-specific quality of life in HSP patients. 相似文献97.
Meng-Ting Lin Ming-Yen Hsiao Yu-Kang Tu Tyng-Guey Wang 《Archives of physical medicine and rehabilitation》2018,99(7):1383-1394.e6
Objective
To compare the efficacy of intra-articular (IA) steroid injection and distension in patients with frozen shoulder.Data Sources
Databases, including MEDLINE (via PubMed), Embase, Scopus, and Cochrane Library, were searched for studies published up to November 2016.Study Selection
We included all published randomized controlled trials (RCTs), quasi-experimental studies, and observational studies investigating the effectiveness of IA steroid injection, distension, and physiotherapy in patients with frozen shoulder. Sixteen RCTs and 1 observational study were enrolled in meta-analysis.Data Extraction
Full texts were independently reviewed, and quality of RCTs was assessed with The Cochrane Collaboration's tool. The primary outcome was functional improvement; the secondary outcomes included pain reduction and external rotation (ER) improvement.Data Synthesis
In pairwise meta-analysis, pooled standardized mean difference (SMD) of functional improvement and pain reduction revealed equal efficacy at 3 follow-up time points. With respect to ER improvement, distension has a superior effect compared with IA steroid injection in the short term [(2–4wk; SMD, ?.36; 95% confidence interval [CI], ?.68 to ?.04) and medium term (6–16wk; SMD, ?0.80; 95% CI, ?1.32 to ?0.29). The network meta-analysis indicated a better efficacy for distension than for IA steroid injection in ER improvement only in the medium term (6–16wk; SMD, ?0.70; 95% CI, ?1.19 to ?0.21).Conclusions
IA steroid injection was as effective as distension in shoulder function improvement, pain reduction, and increasing ER of the shoulder. Distension yielded better ER improvement in the medium term but to a minor extent in the long term. For patients with predominant ER limitation, early distension could be considered the primary choice of treatment. 相似文献98.
Gabriela Lopes Santos Thiago Luiz Russo Angela Nieuwenhuys Davide Monari Kaat Desloovere 《Archives of physical medicine and rehabilitation》2018,99(3):501-511.e4
Objective
To compare sitting posture and movement strategies between chronic hemiparetic and healthy subjects while performing a drinking task, using statistical parametric mapping (SPM) and feature analysis.Design
Cross-sectional study.Setting
A university physical therapy department.Participants
Participants (N=26) consisted of chronic hemiparetic (n=13) and healthy individuals (n=13) matched for sex and age.Interventions
Not applicable.Main Outcome Measures
The drinking task was divided into phases: reaching, transporting the glass to mouth, transporting the glass to table, and returning to initial position. An SPM 2-sample t test was used to compare the entire kinematic waveforms of different joint angles (trunk, scapulothoracic, humerothoracic, elbow). Joint angles at the beginning and end of the motion, movement time, peak velocity timing, trajectory deviation, normalized integrated jerk, and range of motion were extracted from the motion data. Group differences for these parameters were analyzed using independent t tests.Results
At the static posture and beginning of the reaching phase, patients showed a shoulder position more deviated from the midline and externally rotated with increased scapula protraction, medial rotation, anterior tilting, trunk anterior flexion and inclination to the paretic side. Altered spatiotemporal variables throughout the task were found in all phases, except for the returning phase. Patients returned to a similar posture as the task onset, except for the scapula, which was normalized after the reaching phase.Conclusions
Chronic hemiparetic subjects showed more deviations in the proximal joints during seated posture and reaching. However, the scapular movement drew nearer to the healthy individuals' patterns after the first phase, showing an interesting point to consider in rehabilitation programs. 相似文献99.
Mattia Morri Paolo Chiari Cristiana Forni Antonella Orlandi Magli Domenica Gazineo Natalia Franchini Lorenzo Marconato Tiziana Giamboi Andrea Cotti 《Archives of physical medicine and rehabilitation》2018,99(5):893-899
Objective
To identify the factors associated with recovering autonomy in activities of daily living (ADL) in patients who have had a hip fracture.Design
A prospective cohort study.Setting
The orthopedic and orthogeriatric departments of 2 regional hospitals.Participants
Patients (N=742) aged ≥65 years with a diagnosis of fragility hip fracture.Main Outcome Measures
The level of autonomy at 4 months was assessed using the ADL scale.Results
The median score on the ADL scale at 4 months was 3 (interquartile range, 5). Half of the population was unable to recover their prefracture autonomy levels. The following were found to be risk factors: increasing age (B=.02, P<.001); an elevated number of comorbidities (B=.044, P=.005); a lower level of prefracture autonomy (B=.087, P<.001); more frequent use of an antidecubitus mattress (B=.211, P<.001); an increased number of days with disorientation (B=.002, P=.012); failure to recover deambulation (B=.199, P<.001); an increased number of days with diapers (B=.003, P<.001), with a urinary catheter (B=.03, P<.001), and with bed rails (B=.001, P=.014); and a nonintensive care pathway (B=.199, P=.014).Conclusions
Recovery of deambulation, treatment of disorientation and management of incontinence are modifiable factors significantly associated with the functional recovery of autonomy. 相似文献100.
Ettore Beghi Elisa Gervasoni Elisabetta Pupillo Elisa Bianchi Angelo Montesano Irene Aprile Michela Agostini Marco Rovaris Davide Cattaneo 《Archives of physical medicine and rehabilitation》2018,99(4):641-651