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101.
急性重症肝炎患者发生肝性脑病危险因素多元Logistic回归研究 总被引:1,自引:0,他引:1
目的探索急性重症肝炎患者发生肝性脑病的危险因素,以便进行早期干预。方法收集血浆凝血酶原时间(PT)延长,活动度〈40%的急性重症肝炎患者69例,对69例患者的年龄、性别和基础疾病等临床背景资料和总胆红素、直接胆红素、谷草转氨酶(AST)、谷丙转氨酶(ALT)、血浆白蛋白、胆碱脂酶、血浆凝血酶原时间(PT)、白细胞计数(WBC)、血小板计数(Plt)等实验室检查数据进行单因素分析和多元Logistic回归分析。结果单因素分析和多元Logistic回归分析均提示年龄、血胆红素水平和血浆凝血酶原时间在肝性脑病组和非肝性脑病组之间有统计学差异。结论约30%的急性重症肝炎患者发展成为肝性脑病。高龄、血浆凝血酶原时间延长、活动度下降、高血浆总胆红素等是急性重症肝炎患者发展成为肝性脑病的潜在危险因素。 相似文献
102.
Acute Cellular Rejection with CD20-Positive Lymphoid Clusters in Kidney Transplant Patients Following Lymphocyte Depletion 总被引:1,自引:0,他引:1
L. K. Kayler F. G. Lakkis C. Morgan A. Basu D. Blisard H. P. Tan J. McCauley C. Wu R. Shapiro P. S. Randhawa 《American journal of transplantation》2007,7(4):949-954
Lymphoid clusters (LC) containing CD20-positive B cells in kidney allografts undergoing acute cellular rejection (ACR) have been identified in small studies as a prognostic factor for glucocorticoid resistance and graft loss. Allograft biopsies obtained during the first episode of ACR in 120 recipients were evaluated for LC, immunostained with CD20 antibody, and correlated with conventional histopathologic criteria, response to treatment and outcome. LC were found in 71 (59%) of the 120 biopsies. All contained CD20 positive B cells that accounted for 5-90% of the LC leukocyte content. The incidence of LC was highest in the patients who had no lymphoid depletion or had been treated with Thymoglobulin preconditioning (79% vs. 75%, respectively) compared to 37% in patients pretreated with Campath (p = 0.0001). Banff 1a/1b ACR were more frequent in the LC-positive than the LC-negative group (96% vs. 80%, respectively; p = 0.0051). With a posttransplant follow-up of 953 +/- 430 days, no significant differences were detected between LC-postitive and LC-negative groups in time to ACR, steroid resistance, serum creatinine and graft loss. CD20+LC did not portend glucocorticoid resistance or worse short to medium term outcomes. CD20+LC may represent a heterogenous collection in which there may be a small still to be fully defined unfavorable subgroup. 相似文献
103.
目的 探讨高龄急性脑梗死患者接受阿替普酶静脉溶栓治疗有效性、安全性和临床预后的影响
因素。
方法 前瞻性连续纳入江苏省苏北人民医院2016年9月-2018年9月收治入院进行阿替普酶静脉溶
栓治疗的急性脑梗死患者,按照年龄将患者分为年龄≥80岁组和年龄<80岁组。比较两组患者入院
时、溶栓24 h NIHSS评分,6个月mRS评分及死亡率,观察两组溶栓相关出血转化、症状性颅内出血及
肺部感染的发生情况。应用多因素Logistic回归分析观察所有患者静脉溶栓预后的独立影响因素。
结果 最终共纳入患者119例,男性69例(58.0%),年龄范围46~94岁,平均70.12±10.55岁,入院
NIHSS评分4~38分。其中年龄≥80岁患者29例,年龄<80岁患者90例。静脉溶栓后,两组患者溶栓
24 h NIHSS评分较入院时均明显降低(均P<0.05),两组治疗24 h NIHSS评分比较差异无统计学意义;
两组的出血转化、症状性颅内出血、肺部感染、6个月预后良好及死亡率比较,差异均无统计学意义。
多因素Logistic回归分析显示,入院到静脉溶栓时间、入院时NIHSS评分及肺部感染是脑梗死静脉溶
栓6个月预后的独立危险因素(P<0.05),高龄不是影响预后的因素(P>0.05)。
结论 高龄急性脑梗死患者静脉溶栓治疗安全有效,未增加颅内出血转化风险、死亡率及不良预
后。入院到静脉溶栓时间、入院时NIHSS评分及肺部感染是急性脑梗死患者静脉溶栓6个月预后不良
的独立危险因素。 相似文献
104.
联合应用纳洛酮与甲基强的松龙对大鼠急性肺损伤的保护作用 总被引:4,自引:0,他引:4
目的 探讨联合应用甲基强的松龙、纳洛酮对内毒素所致急性肺损伤大鼠的防治作用及可能机制。方法 建立大鼠内毒素吸入性ALI模型 (LPS ,3mg/kg气管内注射 ) ,85只大鼠随机分为生理盐水对照组、内毒素损伤组、甲基强的松龙组 (内毒素 甲基强的松龙 )、纳洛酮组 (内毒素 纳洛酮 )、联合用药组 (内毒素 甲基强的松龙 纳洛酮 )。采用放射免疫方法检测大鼠血清TNF -α、IL - 8水平 ,并观察动脉血气分析及肺组织病理变化。结果 内毒素损伤组较生理盐水组TNF -α、IL - 8水平明显增高 ,动脉血氧分压明显降低 ,肺组织可见肿胀、淤血、炎细胞浸润。联合用药组各项指标较内毒素损伤组均轻。结论 联合应用甲基强的松龙和纳洛酮可降低气管内注入内毒素致大鼠ALI血清TNF -α、IL - 8升高水平 ,减轻肺损伤病理改变程度 ,对大鼠ALI有防治作用 相似文献
105.
Eran Maman David M. Steinberg Batia Stark Shai Izraeli Shlomo Wientroub 《Journal of children's orthopaedics》2007,1(1):63-68
Purpose Studies on musculoskeletal manifestations (MSM) of childhood acute lymphoblastic leukemia (ALL) have yielded variable findings
with regard to their clinical impact. We investigated the significance for differential diagnosis, treatment and outcome of
musculoskeletal complaints as presenting symptoms of ALL, and their correlation with leukemia immunophenotypes, for which
data is lacking.
Methods Data on 783 children in the national study for childhood ALL between 1984 and 2003 were reviewed retrospectively. Statistical
analysis examined possible relationships between MSM at the time of diagnosis and demographic and clinical data, biological
features of leukemia (peripheral blood counts, immunophenotype and main cytogenetic aberration), response to initial prednisone
treatment, and outcome.
Results Of 765 children with data on orthopaedic complaints, 240 presented with MSM (31.4%). Among these children, B cell precursor
(BCP) was much more common (209/576, 36.3%) than T cell ALL (25/176, 14.2%). Patients with MSM had lower white blood cell
counts (WBC) (median of 9 vs. 20 × 109/L, P < 0.001) and percentage of blast cells in the peripheral blood at diagnosis compared to those without (median of 27 vs. 53%,
P < 0.001). Hepatomegaly and splenomegaly were less common in MSM group (67 vs. 53% <3 cm, P < 0.001, and 63 vs. 50% <3 cm, P < 0.001, respectively). Poor response to initial treatment with prednisone was recorded in 7.1% of patients with MSM versus
11.5% of those without (P = 0.086). The analysis revealed no independent effect of MSM on event-free survival (EFS), after correcting for differences
in EFS related to immunophenotype or initial WBC.
Conclusions MSM occur mostly in children with BCP ALL who present with less involvement of extramedullary organs, low peripheral blood
blasts and white blood cells counts. These findings highlight the importance of including ALL in the differential diagnosis
of MSM even in the presence of an apparently normal peripheral blood count. Our study also suggests that MSM are caused by
leukemic cells with enhanced biological propensity to remain relatively confined within the intramedullary bone-marrow space. 相似文献
106.
The Hemodynamic Mechanisms of Lung Injury and Systemic Inflammatory Response Following Brain Death in the Transplant Donor 总被引:7,自引:2,他引:5
Vassilios S. Avlonitis Christopher H. Wigfield John A. Kirby John H. Dark 《American journal of transplantation》2005,5(4):684-693
Brain-dead donors are the major source of lungs for transplantation. Brain death is characterized by two hemodynamic phases. Initially, massive sympathetic discharge results in a hypertensive crisis. This is followed by neurogenic hypotension. Up-regulation of pro-inflammatory mediators occurs in all organs and lung injury develops; this can adversely affect graft function post-transplantation. The mechanisms of the systemic and lung inflammation are unknown. We hypothesized that the hemodynamic changes are responsible for these inflammatory phenomena. Brain death was induced by intra-cranial balloon inflation in rats. This resulted in hypertensive crisis, followed by hypotension. There was a significant increase in blood neutrophil CD11b/CD18 expression and pro-inflammatory cytokine levels in serum and bronchoalveolar lavage, compared with control animals. Rupture of the capillary-alveolar membrane was demonstrated by electron microscopy. Elimination of the hypertensive response by α-adrenergic antagonist pre-treatment prevented inflammatory lung injury, reduced the systemic inflammatory markers and preserved capillary-alveolar membrane integrity. Correction of the neurogenic hypotension with noradrenaline ameliorated the systemic inflammatory response and improved oxygenation. We conclude that the sympathetic discharge triggers systemic and lung inflammation, which can be further enhanced by neurogenic hypotension. Management of the brain-dead donor with early anti-inflammatory treatment and vasoconstrictors is warranted. 相似文献
107.
急性胰腺炎恢复期并Wernicke脑病一例 总被引:1,自引:0,他引:1
患者男,34岁。大量饮酒后出现剑突下疼痛,伴恶心、发热,体温最高达38.5℃,发病3天入住当地医院治疗,诊断为“急性胰腺炎”。经禁食、胃肠减压、抑制胰酶分泌、抑酸、抗感染治疗,3天后疼痛明显减轻,血淀粉酶恢复正常、尿淀粉酶仍高于正常值。维持原治疗,治疗16天后,自觉上述症状消失后拔除胃管,但化验检查发现尿淀粉酶高(1294u/L),1天后再次留置胃管行胃肠减压,治疗33天后拔除胃管。出现头晕、恶心呕吐,呕吐物为胃内容物,予以“吗丁啉、思密达、多酶片”等药物对症治疗,效差。治疗38天后出现复视、视物不清、耳鸣,为进一步诊治,以“尿淀粉酶升高42天,呃逆1天,复视、乓鸣5天”为主诉入住我院。 相似文献
108.
Andr ia Kist Fernandes Felipe Mallmann Ana Maria Pasquali Steinhorst Fernando Lopes Nogueira Eduardo Mü ller vila Dumitriu Zunino Saucedo Francisco Juchem Machado Marcelo Greg rio Raymundi S rgio Saldanha Menna Barreto Paulo de Tarso Roth Dalcin 《The Journal of asthma》2003,40(6):683-690
Asthma patients that depend on emergency department (ED) services are generally considered to have extremely poor disease control and prognosis. It is important to identify characteristics related to poor disease control and frequent visits to the ED to apply appropriate clinical management. This study comprised a cross-sectional survey of consecutive patients with asthma exacerbation (age ≥12 years) presenting at the adult ED of a large, tertiary care, university-affiliated hospital over a 2-month period. The frequent visitors (FV) were defined by ≥3 visits to the ED in the preceding year, and the occasional visitors (OV) by ≤2 visits. Eighty-six patients (61 females and 25 males) were included in the study (mean age 38 ± 18 years). Of these patients, 51.2% were FV and 48.8% were OV. Sixty-nine percent had annual income lower than A$3000 and 66.3% had ≤8 years of the formal education. Only 18.6% had used inhaled corticosteroids, 79.1% identified the asthma attack severity, 70.9% increased or initiated inhaled β-agonist, 20.9% increased or initiated steroid therapy, and 55.8% had an asthma action plan for attack. The number of hospital admissions in past year (OR 4.3, P = .02), use of home nebulizer (OR 3.6, P = .05) and the lack of a written asthma action plan (OR 3.3, P = .03) were independently associated with frequent visits to the ED. We conclude that a substantial proportion of the patients that visit the ED are FV. These patients are more likely to have hospital admission in the past year, to use a home nebulizer, and to lack a written asthma action plan. They should be considered the most important target for asthma education. 相似文献
109.
110.
Monoclonal Antibody Specific for TIRC7 Induces Donor-specific Anergy and Prevents Rejection of Cardiac Allografts in Mice 总被引:1,自引:0,他引:1
Yusuke Kumamoto Antje Tomschegg Fatima Bennai-Sanfourche Anke Boerner Arthur Kaser Isabella Schmidt-Knosalla Thomas Heinemann Mirko Schlawinsky Richard S. Blumberg Hans-Dieter Volk Nalan Utku 《American journal of transplantation》2004,4(4):505-514
T cell immune response c-DNA (TIRC7) is up-regulated during the early stages of T-cell activation in response to alloantigens. In this study, we analyzed the effects of newly developed monoclonal antibodies (mAb) against TIRC7 in acute cardiac allograft rejection. Fully vascularized heterotopic allogeneic heart transplantation was performed in mice across a full-mismatch barrier (C57Bl/10 into CBA). Recipients received seven injections (day 0-7) of a novel anti-TIRC7 mAb or remained untreated. Graft survival, histology and ex vivo lymphocyte functions were tested. Targeting of TIRC7 with an anti-TIRC7 mAb diminishes lymphocyte infiltration into grafts resulting in delay of morphological graft damage and prolongation of allograft survival. The lymphocytes from anti-TIRC7 mAb-treated animals exhibit hypo-responsiveness without evidence of lymphocyte depletion against the donor allo-antigens. Proliferation and expression of interferon-gamma (IFN-gamma) and tumor necrosis factor-alpha (TNF-alpha) were down-regulated while interleukin-4 (IL-4) and IL-10 expression were spared. Moreover, anti-TIRC7 mAb enhanced up-regulation of CTLA-4 expression but suppressed up-regulation of CD25 on stimulated lymphocytes in vitro and in vivo. Ligation of TIRC7 has important effects on the regulation of co-stimulatory signaling pathways associated with suppressing of T-cell activation. Targeting of TIRC7 may therefore provide a novel therapeutic approach for modulating T cell immune responses during organ transplantation. 相似文献