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71.
S. Aziz L. A. Soine S. L. Lewis A. P. Kruse W. C. Levy K. M. Wehe D. P. Fishbien M. D. Allen 《Transplant international》1997,10(6):446-450
A review of factors contributing to early mortality after cardiac transplantation revealed that up to 25 % of deaths were
due to primary graft dysfunction unrelated to rejection or infection. In light of this finding, evaluation of a donor heart
with regard to its suitability for transplantation takes on added importance. In an effort to screen the suitability of donor
hearts in the region covered by the Northwest Organ Procurement Agency (USA), all donors are evaluated by two-dimensional
transthoracic echocardiography as part of the initial evaluation. A total of 110 donor echocardiograms were reviewed and an
attempt was made to correlate the 30-day outcome with the parameters measured. An unexpected finding was that the presence
of left ventricular hypertrophy in the donor heart was associated with an increase in the incidence of donor heart dysfunction
compared with donors with normal echocardiographic profiles (33 % vs 3 %, P = 0.007).
Received: 12 February 1996 Received after resision: 27 June 1997 Accepted: 14 July 1997 相似文献
72.
Cytomegalovirus (CMV) is regarded as a predominant infectious agent in solid organ transplants. CMV disease has highly protean
clinical manifestations. Nevertheless, urinary tract involvement seems to be very rare during CMV infection. We report two
cases of renal transplant recipients in whom ureteral stricture developed in the course of CMV disease. Histologic data were
available for them and were consistent with CMV infection. We discuss previous case reports and propose physiopathologic mechanisms.
Received: 3 October 1996 Received after revision: 13 February 1997 Accepted: 17 February 1997 相似文献
73.
A rat model of monitoring liver allograft rejection 总被引:5,自引:0,他引:5
Timi Martelius Heikki Mäkisalo Krister Höckerstedt Eero Taskinen Irmeli Lautenschlager 《Transplant international》1997,10(2):103-108
Rat models are often used to study liver allograft rejection. We have established a model for rat liver allograft rejection,
monitored by fine needle aspiration biopsy (FNAB), in the strain combination PVG-to-BN with a mean survival time of 37 ± 20
days. In this model, we observed acute rejection with an intense peak of lymphoid blasts and lymphocyte-dominated inflammation
in the FNAB [9.1 ± 3.0 corrected increment units (CIU)], and an eventual increase in macrophages (up to 4.2 ± 4.4 CIU), together
with fibrosis and parenchymal necrosis in the graft. Markers of immune activation, such as an increase in IL-2-receptor (from
1 % ± 2 % to 21 % ± 13 %) and class II (from 20 % ± 9 % to 43 % ± 13 %) expressing lymphoid cells and induction of ICAM-1
in the graft, were consistent with the overall cellular response. The FNAB correlated well with parallel graft histology.
In this rat model, the atraumatic monitoring makes a close follow-up possible without having to sacrifice the experimental
animals. This saves work, animals, and costs in the study of liver rejection.
Received: 2 July 1996 Accepted: 28 October 1996 相似文献
74.
P. Peeters J. Sennesael H. De Raeve M. De Waele D. Verbeelen 《Transplant international》1997,10(6):471-474
Lymphoma in immunocompromised transplant patients is a feared cause of morbidity and mortality. Superimposed on the lymphoma
and the transplantation immunosuppression is a rare condition: hemophagocytic syndrome (HS). HS is characterized by fever,
hepatosplenomegaly and lymphadenopathy, skin rashes, jaundice, coagulopathy, and phagocytosis of blood elements with pancytopenia.
Here we describe a rare but fatal case of a kidney transplant patient who developed T-cell lymphoma and HS, without evidence
of EBV replication. A short review of the diagnosis, treatment, and prognosis of HS is given.
Received: 4 March 1997 Received after revision: 6 June 1997 Accepted: 30 June 1997 相似文献
75.
Homologous testis transplantation in dogs 总被引:4,自引:0,他引:4
Evert J. Barten Hayrabet Garybian Pieter J. Klopper Donald W. W. Newling 《Transplant international》1997,10(5):362-368
There is growing interest in the possible use of homologous testis transplantation for the treatment of anorchia and male
infertility. In order to test the surgical and immunological feasibility of this therapy, three series of experimental studies
of homologous testis transplantation were carried out in dogs. In the first pilot study, four beagles from the same litter
were transplanted using microsurgical techniques for end-to-end anastomosis of the testicular vessels and the vas deferens.
These dogs received cyclosporin A (CyA) for 3 months after transplantation. The longest functional graft survival in this
series was 163 days, strongly suggesting that long-term survival of a homologously transplanted testis graft is possible.
A second series of operations was performed on ten mongrel dogs. The same surgical technique was employed and the series was
divided into three groups.
Group 1 received CyA monotherapy, group 2 a combination of CyA and prednisolone, and group 3 received no immunosuppression.
The average graft survival time in this series was 18 days, significantly less than the 71 days in the first series. The dogs
in group 2, however, had graft survival times that were three times longer than those in the other two groups, suggesting
that CyA in combination with prednisolone yields the best graft survival. In the third series, five littermates received a
testis graft after castration. Immunosuppression was achieved by administration of CyA and prednisolone for 3 months. In three
out of five animals, the graft survived until the immunosuppressive therapy was suspended. Histological biopsies of the graft
3 months after transplantation showed the same maturation of sperm cells as in the control testis of the same dog. The results
of the last series suggest that long-term survival of homologously transplanted testis grafts in dogs is, indeed, possible
with the aid of CyA and prednisolone.
Received: 14 August 1996 Received after revision: 21 March 1997 Accepted: 24 April 1997 相似文献
76.
J. G. Boonstra Johan W. van der Pijl Yves F. C. Smets Herman H. P. J. Lemkes Jan Ringers Leendert A. van Es F. J. van der Woude Jan A. Bruijn 《Transplant international》1997,10(6):451-456
To examine the incidence of interstitial and vascular
rejection in pancreas allografts and its impact on graft survival, we studied 36 percutaneous pancreas biopsies and 10 pancreas
transplantectomy specimens from 32 patients who had undergone simultaneous pancreas-kidney transplantation. Interstitial rejection
(IR) was predominantly found in the biopsies, while vascular rejection (VR) was most prominent in the transplantectomies.
Pancreas graft survival was significantly decreased for pancreas grafts that had suffered from vascular rejection when compared
to those with only interstitial rejection. Potential rejection markers, i. e., serum amylase, glucose, creatinine, and urinary
amylase, did not correlate with histological signs of rejection, although increased levels of serum amylase were, in all but
one case, associated with rejection.We conclude that a percutaneous pancreas biopsy remains the most reliable method to determine
pancreas rejection, and that by distinguishing between IR andVR, a pancreas biopsy may provide important diagnostic as well
as prognostic information.
Received: 6 March 1997 Received after revision: 5 June 1997 Accepted: 30 June 1997 相似文献
77.
T. Scholz Ø. Mathisen A. Bergan S. Osnes R. Innes T. Pedersen A. O. Aasen O. Søreide 《Transplant international》1997,10(3):180-184
We have introduced and evaluated several modifications of the conventional venovenous bypass (VVBP) in 29 adult patients
undergoing liver transplantation (OLT). A percutaneous technique for insertion of a jugular venous return cannula and a femoral
vein cannula was applied. The inferior mesenteric vein (IMV) was used for splanchnic decompression, which facilitated dissection
of the recipient liver and allowed portal anastomosis to be performed without disconnecting the portal bypass. A heat exchanger
was introduced into the bypass circuit to prevent heat loss. The percutaneous technique prevented complications related to
dissection in the axilla and groin. Hemodynamic characteristics corresponded to those found using the traditional technique.
Complications related to the VVBP were seen in only one patient in whom the femoral catheter was accidentally introduced into
the femoral artery. We conclude that percutaneous cannulas, use of the IMV for splanchnic decompression and the introduction
of a heat exchanger offer significant benefits and that they are safe and reliable.
Received: 23 August 1996 Received after revision: 14 January 1997 Accepted: 27 January 1997 相似文献
78.
At our center, since 1982, a body mass index (BMI) of less than 30 has been a prerequisite for placing a patient on the waiting
list for renal transplantation. This decision was made because obese transplant recipients seemed to have a less than favorable
post-transplant outcome. The aim of this study was to evaluate whether this requirement is still justified. Forty-six patients
with a BMI above 30 underwent primary cadaveric renal transplantation between 1972 and 1993. For each of these obese patients,
five consecutive non-obese (BMI 20–25) control patients were selected. Patient and graft survival, causes of graft loss, and
acute rejection rate were evaluated for the two patient groups before and after the year 1982. Within the first 30 post-transplant
days, one patient (2 %) and 11 grafts (24 %) were lost in the group of obese patients whereas seven patients (3 %) and 36
grafts (16 %) were lost in the control group. Among the obese patients, renal circulatory complications were a major cause
of graft loss. In the period 1973–1981, the 1-year patient survival rate was 65 % among obese patients versus 75 % among controls
from 1982 to 1993, this was 90 % versus 93 %. From 1973 to 1981, the 1-year graft survival rate was 25 % among obese patients
versus 53 % among controls (P < 0.05); from 1982 to 1993, it was 68 % versus 84 % (P = NS). Multivariate analysis showed that the immunosuppressive regimen,
age of the patient, BMI, and cold ischemia time of the graft had a significant influence on graft survival. The acute rejection
rate within the first 30 days was 28 % among obese patients and 35 % among controls (P = NS). We conclude that a BMI below
or equal to 30 is still justified as a prerequisite for placement on the waiting list for renal transplantation, for despite
an overall improvement, the outcome of renal transplantation in obese patients remains worse than that in non-obese patients.
Received: 3 February 1997 Received after revision: 4 April 1997 Accepted: 8 April 1997 相似文献
79.
K. Hamano Hiroshi Ito Andrew Bushell Kathryn J. Wood Kensuke Esato 《Transplant international》1997,10(4):293-298
In this study, the effect of combining anti-CD4 monoclonal antibody (mAb) and cyclosporin (CyA) therapy at the time of transplantation
was examined. A mouse cardiac allograft model was used. Anti-CD4 mAb administered perioperatively induces long-term survival.
The addition of a short course of CyA given subcutaneously in a regimen of either a high-dose treatment or a standard dose
treatment to the anti-CD4 mAb treatment protocol did not have a detrimental effect on graft survival. Despite having no significant
effect on graft survival, the addition of CyA to the treatment protocol did result in a significant decrease in the level
of IL-2 present in the hearts 7 days after transplantation. The decrease in IL-2 production was directly related to the presence
of CyA in vivo. When CyA treatment was continued throughout the period during which unresponsiveness to the graft is induced
by anti-CD4 mAb therapy, 50 % of the grafted hearts were rejected once the CyA was discontinued. In conclusion, the combined
use of anti-CD4 mAb therapy and CyA did not have a negative effect on graft survival in this model when the two agents were
used concurrently at the time of transplantation.
Received: 2 October 1996 Received after revision: 31 January 1997 Accepted: 5 February 1997 相似文献
80.
Abstract One hundred eighty-one consecutive patients with fulminant hepatic failure (FHF) presenting in a 2-year period were reviewed. In this cohort we examined the impact of pretransplant renal failure on mortality and morbidity following orthotopic liver transplantation (OLTx). Twenty-seven patients (18 female, 9 male) with a median age of 43.5 years (range 19–65 years) underwent OLTx. FHF was due to idiosyncratic drug reaction ( n = 4), paracetamol overdose ( n = 3), seronegative hepatitis ( n = 17), hepatitis B ( n = 1), veno-occlusive disease ( n = 1), and Wilson's disease ( n = 1). Renal failure was present in 14 patients, 7 of whom died (whereas there was 100 % survival in patients without renal failure). Pretransplant renal failure was associated with prolonged mechanical ventilation (13 days vs 6 days, P = 0.05), prolonged intensive care stay (17 days vs 8 days, P - 0.01) and prolonged hospital stay (27 vs 21 days, P = NS). Pretransplant renal failure did not predict renal dysfunction at 1 year after OLTx. We conclude that the survival of patients transplanted for FHF is inferior to that of patients transplanted for chronic liver disease (67 % vs 88 % 1-year survival in Birmingham). For patients with FHF undergoing transplantation, pretransplant renal failure strongly predicts poor outcome with significantly greater consumption of resources. 相似文献