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21.
《Clinical Lymphoma, Myeloma & Leukemia》2017,17(9):595-603
BackgroundTumor lysis syndrome (TLS) is a life-threatening disorder that occurs mainly in patients with high-tumor burden hemato-oncologic malignancies. It results in metabolic derangements, including hyperuricemia and acute renal failure. The powerful management for TLS is a daily dose of rasburicase for up to 5 days before chemotherapy; however, the optimal dose and duration of rasburicase for TLS prophylaxis have not been standardized for patients at high risk for TLS. Therefore, we evaluated the efficacy of single-dose rasburicase for prophylactic purposes in patients with malignant lymphoma at high risk for TLS.Patients and MaterialsWe retrospectively evaluated patients with malignant lymphoma at high risk for TLS treated with a prophylactic single-dose of rasburicase (0.1-0.2 mg/kg) from March 2012 to March 2016.ResultsA total of 67 patients treated with a single-dose of rasburicase for prophylaxis were analyzed. A relatively large number of patients (n = 23; 34.3%) had the highly proliferative lymphoblastic lymphoma subtype (n = 14) or Burkitt lymphoma (n = 9) and were at the highest risks of tumor lysis. Two patients were newly diagnosed with TLS; the incidence of TLS after single-dose prophylaxis was 3.0%. Multivariate analysis revealed no predictable risk factors for response to prophylactic rasburicase, though increased level of serum creatinine approached statistical significance in reducing the efficacy of single-dose rasburicase to prevent TLS (odds ratio, 3.61; P = .054).ConclusionOur data indicated that single-dose rasburicase effectively prevented progression of TLS, and, regardless of any risk factors, including increased creatinine, single-dose rasburicase for TLS prophylaxis was useful in patients with lymphoma at a high risk for TLS. 相似文献
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目的:初步评估糖皮质激素治疗重/危重型COVID-19患者的有效性及安全性。方法:通过回顾性分析3例重/危重型COVID-19患者激素使用指征、使用时机、用法用量及疗程和不良反应,对比患者使用激素前后症状、体征,炎症因子、血氧饱和度、氧合指数及影像学等变化,分析激素使用的有效性和安全性。结果:有效性方面:3例患者有激素使用指征且使用后症状体征有一定好转,影像学有吸收;患者C病情反复并进行了气管插管。安全性方面:3例患者均出现了血糖升高;患者B的乙肝病毒被激活并继发了糠秕孢子菌毛囊炎;患者C细菌感染加重并出现了异常躁动。3例患者的排毒时间均大于35天,其中患者B排毒时间最长,为44.67天;3例患者住院时间均超过1个月,B患者长达47.46天。结论:激素应用是把双刃剑,应严格掌握使用指征和疗程,权衡利弊,重视激素使用后的不良反应。 相似文献
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Hector S. Izurieta Patrick Zuber Jan Bonhoeffer Robert T. Chen Osman Sankohg Kayla F. Laserson Miriam Sturkenboom Christian Loucq Daniel Weibel Caitlin Dodd Steve Black 《Vaccine》2013
With the advent of new vaccines targeted to highly endemic diseases in low- and middle-income countries (LMIC) and with the expansion of vaccine manufacturing globally, there is an urgent need to establish an infrastructure to evaluate the benefit-risk profiles of vaccines in LMIC. Fortunately the usual decade(s)-long time gap between introduction of new vaccines in high and low income countries is being significantly reduced or eliminated due to initiatives such as the Global Alliance for Vaccines and Immunizations (GAVI) and the Decade of Vaccines for the implementation of the Global Vaccine Action Plan. While hoping for more rapid disease control, this time shift may potentially add risk, unless appropriate capacity for reliable and timely evaluation of vaccine benefit-risk profiles in some LMIC's are developed with external assistance from regional or global level. An ideal vaccine safety and effectiveness monitoring system should be flexible and sustainable, able to quickly detect possible vaccine-associated events, distinguish them from programmatic errors, reliably and quickly evaluate the suspected event and its association with vaccination and, if associated, determine the benefit-risk of vaccines to inform appropriate action. Based upon the demonstrated feasibility of active surveillance in LMIC as shown by the Burkina Faso assessment of meningococcal A conjugate vaccine or that of rotavirus vaccine in Mexico and Brazil, and upon the proof of concept international GBS study, we suggest a sustainable, flexible, affordable and timely international collaborative vaccine safety monitoring approach for vaccines being newly introduced. While this paper discusses only the vaccine component, the same system could also be eventually used for monitoring drug effectiveness (including the use of substandard drugs) and drug safety. 相似文献
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先进的医院文化是医院持续发展的精神支柱和动力源泉,是医院内涵建设的重要组成部分。为创新医院文化建设,形成医院文化建设成果,编辑出版了6册不同的文化建设书籍。通过总结提炼、汇编成册,起到了学习、传播的作用,不失为医院文化建设行之有效的方法。 相似文献
28.
目的通过对老年轻度认知障碍患者综合干预的效果分析,评价综合干预方案的有效性。方法采用随机对照试验方法,将目标社区MCI患者(130例)随机分为干预组(65例)和对照组(65例),对干预组采取认知干预和体力活动相结合的方法进行综合干预。结果干预组和对照组分别在干预前后3个月比较,差别都有统计学意义(各自P〈0.05);两组分别在干预后3个月与6个月比较,差别都有统计学意义(各自P〈0.05)。结论认知干预和体育锻炼有益于维持或改善老年人的认知状况,并能给老年人的生活态度和精神状态产生积极的影响。 相似文献
29.
《Vaccine》2018,36(36):5416-5423
Prophylactic human papillomavirus (HPV) vaccine represents a revolutionary step forward in preventing HPV-related cancers, especially cervical carcinoma. Alongside appropriate screening, it has the potential to dramatically reduce cervical cancer incidence and even eradicate it. Following extensive evaluations in clinical trials, the first decade of routine HPV vaccine use provides overwhelming evidence of the vaccines’ safety and their real-life effectiveness. In 2016, further clinical trials showed high vaccine efficacy in adult women, especially those that were HPV DNA-negative at baseline, and indicated possible protection from HPV-related diseases after treatment of precancerous cervical lesions. The recommendation for a two-dose schedule in individuals under 15 is further supported for all three licensed vaccines by immunogenicity studies that show non-inferior immune responses and similar clinical efficacy compared to the three-dose schedule. So far, natural competition between HPV types has not been confirmed and therefore vaccine-induced clinically significant type replacement is unlikely. The real-world effectiveness data showed cross-sectional reduction in the prevalence/incidence of vaccine-related HPV types, genital warts and precancerous cervical lesions in countries and regions with HPV vaccination coverage. These declines were evident not only in vaccinated females, but also in unvaccinated females and males, strongly suggesting herd protection. Despite an excellent safety profile consistently demonstrated in clinical trials and confirmed in real-life settings, recently invented controversial syndromes allegedly linked to HPV vaccines temporarily compromised some previously very successful vaccination programs and significantly contributed to the failure of HPV vaccine implementation in some countries with the highest prevalence of cervical cancer. However, several safety studies failed to confirm any association of these syndromes with HPV vaccination in various settings and geographic locations. The main challenges remain implementing HPV vaccination in national vaccination programs, especially in low-and middle-income countries with the highest burden of cervical cancer, and achieving and sustaining high vaccine coverage rates. 相似文献
30.
Fernie J A Penning-van Beest Fabian Termorshuizen Wim G Goettsch Olaf H Klungel John J P Kastelein Ron M C Herings 《European heart journal》2007,28(2):154-159
AIMS: To investigate the 'real world' effectiveness of robust statin therapy, focusing on the effect of dose and early treatment discontinuation on the risk of hospitalization for acute myocardial infarction (AMI). METHODS AND RESULTS: In the PHARMO database, including among others drug-dispensing and hospital discharge records for more than two million subjects in the Netherlands, 59,094 new users of statins in the period 1 January 1991 until 31 December 2004, >or=18 years of age were identified. In these patients, exposure to statins, both in terms of persistence and dose, was determined over the first two treatment years. To determine the risk for AMI, patients were followed from this 2-year time point until the first hospital admission for AMI, death, or end of the study period. A total of 31,557 patients (53%) discontinued statin use within 2 years; 20 883 patients (35%) were persistent users with an average equipotent dose>or=4. A 30% reduction in risk of hospitalization for AMI with persistent statin use was observed. The protective effect increased with a higher dose (20 and 40% risk reduction with an equipotent doseor=4, respectively). CONCLUSION: These results show that statins are suboptimally used in real life for having the maximum benefit in terms of preventing AMI. 相似文献