全文获取类型
收费全文 | 30593篇 |
免费 | 4594篇 |
国内免费 | 605篇 |
专业分类
耳鼻咽喉 | 119篇 |
儿科学 | 472篇 |
妇产科学 | 394篇 |
基础医学 | 1434篇 |
口腔科学 | 670篇 |
临床医学 | 7022篇 |
内科学 | 2054篇 |
皮肤病学 | 148篇 |
神经病学 | 1262篇 |
特种医学 | 343篇 |
外国民族医学 | 1篇 |
外科学 | 3878篇 |
综合类 | 4082篇 |
现状与发展 | 2篇 |
一般理论 | 23篇 |
预防医学 | 6509篇 |
眼科学 | 184篇 |
药学 | 2439篇 |
73篇 | |
中国医学 | 3764篇 |
肿瘤学 | 919篇 |
出版年
2024年 | 237篇 |
2023年 | 988篇 |
2022年 | 1297篇 |
2021年 | 1862篇 |
2020年 | 2108篇 |
2019年 | 1854篇 |
2018年 | 1671篇 |
2017年 | 1747篇 |
2016年 | 1584篇 |
2015年 | 1498篇 |
2014年 | 2279篇 |
2013年 | 2847篇 |
2012年 | 1880篇 |
2011年 | 2010篇 |
2010年 | 1517篇 |
2009年 | 1368篇 |
2008年 | 1427篇 |
2007年 | 1347篇 |
2006年 | 1193篇 |
2005年 | 872篇 |
2004年 | 727篇 |
2003年 | 708篇 |
2002年 | 478篇 |
2001年 | 415篇 |
2000年 | 400篇 |
1999年 | 258篇 |
1998年 | 226篇 |
1997年 | 196篇 |
1996年 | 177篇 |
1995年 | 132篇 |
1994年 | 90篇 |
1993年 | 79篇 |
1992年 | 50篇 |
1991年 | 40篇 |
1990年 | 53篇 |
1989年 | 29篇 |
1988年 | 25篇 |
1987年 | 18篇 |
1986年 | 17篇 |
1985年 | 22篇 |
1984年 | 10篇 |
1983年 | 6篇 |
1982年 | 8篇 |
1981年 | 6篇 |
1980年 | 10篇 |
1979年 | 5篇 |
1978年 | 3篇 |
1977年 | 3篇 |
1975年 | 3篇 |
1974年 | 8篇 |
排序方式: 共有10000条查询结果,搜索用时 15 毫秒
111.
Cathy Logan Ily Yumul Javier Cepeda Victor Pretorius Eric Adler Saima Aslam Natasha K. Martin 《American journal of transplantation》2021,21(2):657-668
Outcomes following hepatitis C virus (HCV)-viremic heart transplantation into HCV-negative recipients with HCV treatment are good. We assessed cost-effectiveness between cohorts of transplant recipients willing and unwilling to receive HCV-viremic hearts. Markov model simulated long-term outcomes among HCV-negative patients on the transplant waitlist. We compared costs (2018 USD) and health outcomes (quality-adjusted life-years, QALYs) between cohorts willing to accept any heart and those willing to accept only HCV-negative hearts. We assumed 4.9% HCV-viremic donor prevalence. Patients receiving HCV-viremic hearts were treated, assuming $39 600/treatment with 95% cure. Incremental cost-effectiveness ratios (ICERs) were compared to a $100 000/QALY gained willingness-to-pay threshold. Sensitivity analyses included stratification by blood type or region and potential negative consequences of receipt of HCV-viremic hearts. Compared to accepting only HCV-negative hearts, accepting any heart gained 0.14 life-years and 0.11 QALYs, while increasing costs by $9418/patient. Accepting any heart was cost effective (ICER $85 602/QALY gained). Results were robust to all transplant regions and blood types, except type AB. Accepting any heart remained cost effective provided posttransplant mortality and costs among those receiving HCV-viremic hearts were not >7% higher compared to HCV-negative hearts. Willingness to accept HCV-viremic hearts for transplantation into HCV-negative recipients is cost effective and improves clinical outcomes. 相似文献
112.
Jonathan Kentley Rina Allawh Swati Rao Alden Doyle Amar Ahmad Kumar Nadhan Charlotte Proby Catherine A. Harwood Christina L. Chung 《American journal of transplantation》2021,21(3):1215-1226
Organ transplant recipients (OTRs) are at increased risk of cutaneous malignancy. Skin disorders in OTRs of color (OTRoC) have rarely been systematically assessed. We aimed to ascertain the burden of skin disease encountered in OTRoC by prospectively collecting data from OTRs attending 2 posttransplant skin surveillance clinics: 1 in London, UK and 1 in Philadelphia, USA. Retrospective review of all dermatological diagnoses was performed. Data from 1766 OTRs were analyzed: 1024 (58%) white, 376 (21%) black, 261 (15%) Asian, 57 (3%) Middle Eastern/Mediterranean (ME/M), and 48 (2.7%) Hispanic; and 1128 (64%) male. Viral infections affected 45.1% of OTRs, and were more common in white and ME/M patients (P < .001). Fungal infections affected 28.1% and were more common in ME/M patients (P < .001). Inflammatory skin disease affected 24.5%, and was most common in black patients (P < .001). In addition, 26.4% of patients developed skin cancer. There was an increased risk of skin cancer in white vs nonwhite OTRs (HR 4.4, 95% CI 3.5-5.7, P < .001): keratinocyte cancers were more common in white OTRs (P < .001) and Kaposi sarcoma was more common in black OTRs (P < .001). These data support the need for programs that promote targeted dermatology surveillance for all OTRs, regardless of race/ethnicity or country of origin. 相似文献
113.
114.
Antonio Grande-Trillo Carmen Baliellas Laura Lladó Carlos Casasnovas Joaquín V. Franco-Baux Laura Gracia-Sánchez Miguel Á. Gómez-Bravo Emma González-Vilatarsana Luis Caballero-Gullón Eduardo Echeverri José González-Costello 《American journal of transplantation》2021,21(1):372-381
Domino liver transplantation (DLT) has been used widely in patients with hereditary amyloid transthyretin (ATTR) amyloidosis. New-onset polyneuropathy in recipients of DLT has been reported, but there are few cases of cardiac involvement reported. We aimed to perform a cross-sectional study for ATTR amyloidosis with cardiomyopathy (ATTR-CM) in DLT recipients. We evaluated 23 living DLT recipients a median of 9 years since DLT at 2 referral centers with a systematic cardiac evaluation, including bone scintigraphy. Median age was 72 years, 91% had hypertension, 35% had diabetes mellitus, 67% had chronic renal failure, and 8 patients (35%) developed new-onset polyneuropathy. Only 13% had a normal electrocardiogram and a normal echocardiography, and most of them showed some conduction disturbance or increase in left ventricular wall thickness, but only 1 patient with a Glu89Lys mutation developed ATTR-CM diagnosed by bone scintigraphy and endomyocardial biopsy. None of the recipients of a DLT with Val30Met mutation showed cardiac involvement by bone scintigraphy. In conclusion, DLT from Val30Met donors seems to be safe regarding the development of ATTR-CM. Evaluation of cardiomyopathy in DLT recipients is challenging due to concomitant comorbidities and in this context, bone scintigraphy can be helpful to evaluate ATTR-CM. 相似文献
115.
Sudeshna Paul Taylor Melanson Sumit Mohan Katherine Ross-Driscoll Laura McPherson Raymond Lynch Denise Lo Stephen O. Pastan Rachel E. Patzer 《American journal of transplantation》2021,21(1):314-321
Kidney transplant program performance in the United States is commonly measured by posttransplant outcomes. Inclusion of pretransplant measures could provide a more comprehensive assessment of transplant program performance and necessary information for patient decision-making. In this study, we propose a new metric, the waitlisting rate, defined as the ratio of patients who are waitlisted in a center relative to the person-years referred for evaluation to a program. Furthermore, we standardize the waitlisting rate relative to the state average in Georgia, North Carolina, and South Carolina. The new metric was used as a proof-of-concept to assess transplant-program access compared to the existing transplant rate metric. The study cohorts were defined by linking 2017 United States Renal Data System (USRDS) data with transplant-program referral data from the Southeastern United States between January 1, 2012 and December 31, 2016. Waitlisting rate varied across the 9 Southeastern transplant programs, ranging from 10 to 22 events per 100 patient-years, whereas the program-specific waitlisting rate ratio ranged between 0.76 and 1.33. Program-specific waitlisting rate ratio was uncorrelated with the transplant rate ratio (r = −.15, 95% CI, −0.83 to 0.57). Findings warrant collection of national data on early transplant steps, such as referral, for a more comprehensive assessment of transplant program performance and pretransplant access. 相似文献
116.
Robert Pearson John Asher Andrew Jackson Patrick B. Mark Vlad Shumeyko Marc J. Clancy 《American journal of transplantation》2021,21(3):1317-1321
The role of ex vivo normothermic perfusion (EVNP) in both organ viability assessment and reconditioning is increasingly being demonstrated. We report the use of this emerging technology to facilitate the transplantation of a pair of donor kidneys with severe acute kidney injury (AKI) secondary to rhabdomyolysis. Donor creatinine was 10.18 mg/dl with protein (30 mg/dl) present in urinalysis. Both kidneys were declined by all other transplantation units and subsequently accepted by our unit. The first kidney was perfused with red cell-based perfusate at 37°C for 75 min, mean renal blood flow was 110 ml/min/100 g and produced 85 ml of urine. Having demonstrated favorable macroscopic appearance and urine output, the kidney was transplanted into a 61-year-old peritoneal dialysis dependent without complication. Given the reassuring information from the first kidney provided by EVNP, the second kidney was not perfused with EVNP and was directly implanted to a 64-year-old patient. The first kidney achieved primary function and the second functioned well after delayed graft function. Recipient eGFR have stabilized at 88.5 and 55.3, respectively (ml/min/1.73 m2), at 2 months posttransplant. 相似文献
117.
Tom D. Blydt-Hansen Atul Sharma Ian W. Gibson Chris Wiebe Ajay P. Sharma Valerie Langlois Chia W. Teoh David Rush Peter Nickerson David Wishart Julie Ho 《American journal of transplantation》2021,21(4):1545-1555
Individualized posttransplant immunosuppression is hampered by suboptimal monitoring strategies. To validate the utility of urinary CXCL10/Cr immune monitoring in children, we conducted a multicenter prospective observational study in children <21 years with serial and biopsy-associated urine samples (n = 97). Biopsies (n = 240) were categorized as normal (NOR), rejection (>i1t1; REJ), indeterminate (IND), BKV infection, and leukocyturia (LEU). An independent pediatric cohort of 180 urines was used for external validation. Ninety-seven patients aged 11.4 ± 5.5 years showed elevated urinary CXCL10/Cr in REJ (3.1, IQR 1.1, 16.4; P < .001) and BKV nephropathy (median = 5.6, IQR 1.3, 26.9; P < .001) vs. NOR (0.8, IQR 0.4, 1.5). The AUC for REJ vs. NOR was 0.76 (95% CI 0.66–0.86). Low (0.63) and high (4.08) CXCL10/Cr levels defined high sensitivity and specificity thresholds, respectively; validated against an independent sample set (AUC = 0.76, 95% CI 0.66–0.86). Serial urines anticipated REJ up to 4 weeks prior to biopsy and declined within 1 month following treatment. Elevated mean CXCL10/Cr was correlated with first-year eGFR decline (ρ = −0.37, P ≤ .001), particularly when persistently exceeding ≥4.08 (ratio = 0.81; P < .04). Useful thresholds for urinary CXCL10/Cr levels reproducibly define the risk of rejection, immune quiescence, and decline in allograft function for use in real-time clinical monitoring in children. 相似文献
118.
Robin K. Avery Jennifer D. Motter Kyle R. Jackson Robert A. Montgomery Allan B. Massie Edward S. Kraus Kieren A. Marr Bonnie E. Lonze Nada Alachkar Mary J. Holechek Darin Ostrander Niraj Desai Madeleine M. Waldram Shmuel Shoham Seema Mehta Steinke Aruna Subramanian Janet M. Hiller Julie Langlee Sheila Young Dorry L. Segev Jacqueline M. Garonzik Wang 《American journal of transplantation》2021,21(4):1564-1575
Desensitization has enabled incompatible living donor kidney transplantation (ILDKT) across HLA/ABO barriers, but added immunomodulation might put patients at increased risk of infections. We studied 475 recipients from our center from 2010 to 2015, categorized by desensitization intensity: none/compatible (n = 260), low (0-4 plasmaphereses, n = 47), moderate (5-9, n = 74), and high (≥10, n = 94). The 1-year cumulative incidence of infection was 50.1%, 49.8%, 66.0%, and 73.5% for recipients who received none, low, moderate, and high-intensity desensitization (P < .001). The most common infections were UTI (33.5% of ILDKT vs. 21.5% compatible), opportunistic (21.9% vs. 10.8%), and bloodstream (19.1% vs. 5.4%) (P < .001). In weighted models, a trend toward increased risk was seen in low (wIRR = 0.771.402.56,P = .3) and moderately (wIRR = 0.881.352.06,P = .2) desensitized recipients, with a statistically significant 2.22-fold (wIRR = 1.332.223.72,P = .002) increased risk in highly desensitized recipients. Recipients with ≥4 infections were at higher risk of prolonged hospitalization (wIRR = 2.623.574.88, P < .001) and death-censored graft loss (wHR = 1.154.0113.95,P = .03). Post–KT infections are more common in desensitized ILDKT recipients. A subset of highly desensitized patients is at ultra-high risk for infections. Strategies should be designed to protect patients from the morbidity of recurrent infections, and to extend the survival benefit of ILDKT across the spectrum of recipients. 相似文献
119.
Christina D. Mejia Adam M. Frank Pooja Singh Anju Yadav 《American journal of transplantation》2021,21(3):1322-1325
Immune checkpoint inhibitors (ICPIs) are monoclonal antibodies against inhibitory receptors on T cells resulting in anticancer activity. In kidney transplant (KT) recipients, ICPI use has been associated with acute allograft rejection. In failed allografts, however, the effects of ICPIs are unknown. We present a case of a 66-year-old man with a history of diabetes, renal cell cancer, left native nephrectomy, and end-stage kidney disease. He received a deceased donor KT which failed after 6 years due to biopsy-proven recurrent diabetic nephrosclerosis. He was started on hemodialysis and his immunosuppression was gradually weaned off. A year later, he was diagnosed with renal cell cancer in his right native kidney requiring nephrectomy. He later developed metastasis and was started on combination ICPIs. He developed hematuria, allograft pain, and malaise consistent with graft intolerance syndrome 28 days after starting ICPIs. Urine culture and cystoscopy were normal. A computed tomography scan of his abdomen revealed an enlarged allograft with patchy enhancement. After a multidisciplinary discussion, he underwent transplant nephrectomy. Histopathology showed chronic active T cell–mediated rejection. As ICPI use becomes prevalent, practitioners need to be aware of its potential complications among KT recipients both with functioning and failed allografts. 相似文献
120.
Kai Nishime Chika Miyagi-Shiohira Kazuho Kuwae Yoshihito Tamaki Tasuku Yonaha Mayuko Sakai-Yonaha Issei Saitoh Masami Watanabe Hirofumi Noguchi 《American journal of transplantation》2021,21(8):2698-2708
Ischemia-reperfusion injury (IRI) results in increased rates of delayed graft function and early graft loss. It has recently been reported that hydrogen sulfide (H2S) protects organ grafts against prolonged IRI. Here, we investigated whether the preservation of pancreas in University of Wisconsin (UW) solution supplemented with AP39, which is a mitochondrial-targeted H2S donor, protected pancreatic islets against IRI and improved islet function. Porcine pancreata were preserved in the UW solution with AP39 (UW + AP39) or the vehicle (UW) for 18 h, followed by islet isolation. The islet yields before and after purification were significantly higher in the UW + AP39 group than in the UW group. The islets isolated from the pancreas preserved in UW + AP39 exhibited significantly decreased levels of reactive oxygen species (ROS) production and a significantly increased mitochondrial membrane potential as compared to the islets isolated from the pancreas preserved in the vehicle. We found that the pancreas preserved in UW + AP39 improved the outcome of islet transplantation in streptozotocin-induced diabetic mice. These results suggest that the preservation of pancreas in UW + AP39 protects the islet grafts against IRI and could thus serve as a novel clinical strategy for improving islet transplantation outcomes. 相似文献