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1.
M Kühne B Schaer C Kaufmann N Moulay T Cron T Cueni P Weiss C Schindler C Sticherling S Osswald 《Europace : European pacing, arrhythmias, and cardiac electrophysiology》2007,9(12):1185-1190
AIMS: DDD-pacemakers are favoured in patients with sick-sinus-syndrome or AV-block. However, AAI-pacemakers for sick-sinus-syndrome or VDD-pacemakers for AV-block may provide similar benefit with lower costs. The aim is to show that a tailored approach (TA) with arrhythmia-specific pacemaker selection was equal to a standard approach (SA) regarding quality of life (QoL) at lower costs. METHODS AND RESULTS: The study was prospective and randomized with QoL as primary endpoint. Secondary endpoints were a combined endpoint of all-cause mortality, worsening heart failure or angina, atrial fibrillation (AF), stroke, these endpoints individually and costs. Of 198 patients (age 77 +/- 10 years, 43% female, ejection fraction 54 +/- 12%, follow-up 38 +/- 15 months), 94 were randomized to SA and 104 to TA. Thirty-two patients (34%) died in the SA group vs. 25 (24%) in the TA (P= ns). QoL showed no differences in all dimensions. The combined secondary endpoint was reached more frequently with SA (51%) compared to TA (37%, P = 0.045). There was no difference regarding all single secondary endpoints. Hardware costs were reduced by 15% (P < 0.0001). CONCLUSION: In long-term follow-up, a TA is equal to SA regarding the primary endpoint QoL and secondary endpoints as AF and mortality. Depending on the healthcare system, it may significantly reduce costs. 相似文献
2.
研究了19例AVB的希氏束电图(HBE)。经皮穿刺股静脉将三极导管送至心脏希氏束部位,记录HBE。一度AVB5例,其中4例阻滞于房室结内,1例在希氏束内;二度AVB4例,3例阻滞于房室结,1例在希浦系;三度AVB10例,5例阻滞于房室结内,4例在希氏束,1例在希浦系。HBE能确定房室传导的阻滞部位,对指导安装起搏器和判断预后有一定意义。 相似文献
3.
4.
José M. Icardo 《Anatomy and embryology》1989,179(5):443-448
Summary This paper presents a scanning electron microscope study of the morphologic changes undergone by the endocardium during development of the atrioventricular (A-V) endocardial cushions. Prior to cell seeding into the cushions, endocardial cells show a regular, uniform morphology, many of them appearing to be oriented in the direction of the blood flow. Concomitant with the appearance of cells in the A-V cushions, endocardial cells lose their elongated appearance, become more flattened and adopt a variable morphology. Endocardial cells at this stage develop filopodia and lamellipodia, overlap each other and show a variable number of microvilli and different degrees of flattening. After completion of endocardial migration, the endocardial cells that remain in the plane of the endocardium become extremely flattened, the degree of overlapping decreases and the cells adopt a polygonal morphology. These changes in endocardial cell morphology appear to be related to endocardial cell activity. It is suggested that the whole endocardial cushion, not just the cells that migrate into the cushions, is involved in cushion development. The activity of the endocardial cells may be related to the maintenance of the integrity of the endocardium. 相似文献
5.
F. C. Howarth Allan J. Levi Jules C. Hancox 《Pflügers Archiv : European journal of physiology》1996,431(5):713-722
The delayed rectifier potassium current (I
K) is known to be important in action potential repolarisation and may contribute to the diastolic pacemaker depolarisation
in pacemaker cells from the heart. In this study, using whole-cell patch clamp, we investigated the characteristics of I
K in morphologically normal cells from the atrioventricular node (AVN) and ventricle of the rabbit heart. Cells were held at
−40 mV and 5 μM external nifedipine was used to block L-type calcium current (I
Ca,L). Significant I
K was observed with pulses to potentials more positive than −30 mV. The steady-state activation curve in both cell types showed
maximal activation at between + 10 and + 20 mV. Half-maximal activation of I
K occurred at −4.9 and −4.1 mV with slope factors of 8.3 and 12.4 mV in ventricular and AVN cells, respectively. Using pulses
of increasing duration, significant I
K tails after repolarisation from + 40 mV were observed with pulses of 20 ms and increased with pulses up to 100–120 ms in
both cell types. Pulses of longer duration did not activate further I
K and this suggested that only the rapid component of I
K, called I
Kr, was present in either cell type. Moreover, I
K tails after pulses to all potentials were blocked completely by E-4031, a selective blocker of I
Kr. The reversal potential of I
K varied with the concentration of external K. Superfusion of AVN cells with medium containing 4, 15 and 40 mM [K+]o resulted in reversal potentials of −81, −56 and −32 mV, respectively, which are close to values predicted if the I
K channel were highly selective for K. The time constants for deactivation of I
K in ventricle and AVN on return to −40 mV after a 500-ms activating pulse to + 60 mV were 480 ms and 230 ms, respectively.
The faster deactivation of I
K in AVN cells was a distinguishing feature and suggests that there may be differences in the I
Kr channel protein between ventricular and AVN cells.
Received: 24 July 1995 /Received after revision: 20 October 1995 /Accepted: 23 October 1995 相似文献
6.
Verga L Concardi M Pilotto A Bellini O Pasotti M Repetto A Tavazzi L Arbustini E 《Virchows Archiv : an international journal of pathology》2003,443(5):664-671
Mutations of the LMNA gene encoding the lamin A and C nuclear envelope proteins cause an autosomal dominant form of dilated cardiomyopathy (DCM) with atrioventricular block (AVB). The aim of this study was to investigate ultrastructural nuclear membrane changes by conventional electron microscopy and protein expression by immuno-electron microscopy in the heart of patients with DCM and AVB due to LMNA gene mutations. Four immunohistochemical techniques were used: pre-embedding and post-embedding in Epon-Araldite resin and London Resin White (LRW), with and without silver enhancement. Parallel light microscopy immunohistochemistry studies were performed. Conventional electron microscopy showed a loss of integrity of the myocyte nuclei with blebs of the nuclear membrane, herniations and delamination of the nuclear lamina and nuclear pore clustering. Post-embedding LRW was the most informative technique for morphology and immuno-labelling. Immuno-labelling was almost absent in the nuclear envelope of patients with LMNA gene mutations, but intensely present in controls. The loss of labelling selectively affected myocyte nuclei; the endothelial cell nuclei were immunostained in patients and controls. Light immunohistochemistry confirmed the results. These findings confirm the hypothesis that LMNA gene defects are associated with a loss of protein expression in the selective compartment of non-cycling myocyte nuclei. 相似文献
7.
Michio Tanaka Shutaro Satake Yutaka Kawahara Masaya Sugiura Kenzo Hirao Kazushi Tanaka Tokuhiro Kawara Akihiro Masuda Toshio Nishikawa Takeshi Kasajima 《Pathology international》1991,41(7):487-498
Radiofrequency catheter ablation of the atrioventricular (AV) node or bundle of His was performed in 12 adult mongrel dogs. The aim was to create chronic incomplete AV block (first- and second-degree AV block) and to examine the histopathology of the ablated lesions. However, the late electrophysiological results (2 4 weeks follow up) were various: normal in 2 dogs, mild PR prolongation (< 50%) in 2 dogs, first-degree AV block (PR prolongation a 50%) in 2 dogs, second degree AV block in 2 dogs, complete AV block in 4 dogs. The maximally ablated area (%) of the atrioventricular conduction system in serial histologic sections from dogs with these conditions was 69%, 75%, 89.5%, 95% and 99.5%, respectively. The number of intact conduction cells at the maximally ablated site varied from 6 to 30 in the four cases of incomplete AV block. The mean ablated volume (%) of either the AV node or penetrating His bundle correlated roughly with the degree of AV block. The ablated lesions were well demarcated and almost replaced by dense fibrous tissue at 4 weeks. Interruption (3 dogs) or thinning (1 dog) of the endocardial elastic lamellae was detected, in association with endocardial thickening (mean 913 μm). Endocardial thrombi were found in 3 dogs (2 fresh, 1 organized). We conclude that radiofrequency catheter ablation does not cause severe complicated lesions. Several possible conditions for creating chronic incomplete AV block are discussed. Acta Pathol Jpn 41: 487–498, 1991. 相似文献
8.
目的评价起搏电极的植入途径及永久起搏器的类型.方法选择1987~1999年安置的80例永久起搏器患者.结果经颈外静脉植入电极6例,手术时间为256±75分;经头静脉植入电极48例,手术时间为247±65分(P>0.05);经锁骨下静脉途径植入电极26例,手术时间为118±35分(P均<0.01).其中,AAI型3例(4%),DDD型5例(6%),VVI型72例(90%).结论经锁骨下静脉植入起搏电极,方法简单,组织损伤小,手术时间短,优于其它途径.VVI型起搏器在我国仍然是主要使用的起搏器. 相似文献
9.
经导管射频消融治疗阵发性室上性心动过速(PSVT)262例,探讨RFCA治疗PSVT的安全性及疗效。方法:房室结双径路改良采用下位法;左侧旁道采用冠状窦电极粗标,大头电极在心室国标。右侧旁道采用左前斜45度。大头电极在心房侧三尖瓣环处细标;房扑时标测心房激动顺序,用隐匿必拖法确定折返环部位,在心房内行线性消融方法治疗。结果:262例中慢-快型房室结折生心动过速(AVNRT)78例。,房室折返性心动 相似文献
10.
Electrocardiological profile and proarrhythmic effects of quinidine,verapamil and their combination: a mapping study 总被引:2,自引:0,他引:2
S. Dhein M. Schott E. Gottwald W. Klaus 《Naunyn-Schmiedeberg's archives of pharmacology》1995,353(1):94-101
Quinidine and verapamil are widely used as antiarrhythmic agents and their combination is often used in the treatment of supraventricular tachycardia. This study was undertaken to clarify, whether these drugs exert proarrhythmic effects on the ventricles in therapeutic concentrations and whether possible arrhythmogenic effects might be enhanced by combination. Isolated rabbit hearts perfused according to the Langendorff technique were treated with increasing concentrations of quinidine (0.05 to 3.5 M) or verapamil (5 to 50 M) or of their combination (70:1 or 10:1; quinidine:verapamil) corresponding to common low, medium and high free therapeutic concentrations. The epicardial activation process was measured using a computer assisted mapping system for unipolar multichannel recording (256 channels simultaneously).Both substances prolonged the atrioventricular conduction time PQ. This effect was even more pronounced if the 70:1 combination was administered. The activation pattern was altered by both drugs and their combination to the same extent as became obvious from analysis of local activation vectors and of localisation of breakthroughpoints of epicardial activation for heart beats under control conditions and under drug treatment. The epicardial potential durations were prolonged by quinidine and to the same degree by the combinations, but not by verapamil alone. The total activation time was prolonged under the influence of quinidine and if the 70:1 combination was given. Both substances exerted a negative inotropic effect which was enhanced in an additive manner if both drugs were combined. In parallel the coronary flow was diminished.From these results it is concluded that (1) in this therapeutic concentration range quinidine possess a greater proarrhythmic risk than verapamil, (2) that both drugs' PQ prolonging effect can be enhanced by combination, (3) that combination does not enhance the proarrhythmic effects but the negative inotropic effects. 相似文献