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1.
Transplanting the Highly Sensitized Patient: The Emory Algorithm 总被引:4,自引:0,他引:4
R. A. Bray J. D. L. Nolen C. Larsen T. Pearson K. A. Newell K. Kokko A. Guasch P. Tso J. B. Mendel H. M. Gebel 《American journal of transplantation》2006,6(10):2307-2315
Renal transplant patients sensitized to HLA antigens comprise nearly one-third of the UNOS wait-list and receive 14% of deceased donor (DD) transplants, a rate half that of unsensitized patients. Between 1999 and 2003, we performed 492 adult renal transplants from DD; 120 patients (approximately 25%) had a panel reactive antibody (PRA) of >30%, with nearly half (n = 58) having a PRA of >80%. Our approach is based upon high-resolution solid-phase HLA antibody analysis to identify class I/II antibodies and a 'virtual crossmatch' to predict compatible donor/recipient combinations. Recipients are excluded from the United Network for Organ Sharing match run if donors possess unacceptable antigens. Thus, when sensitized patients appear on the match run, they have a high probability of a negative final crossmatch. Here, we describe our 5-year experience with this approach. Five-year graft survival ranged from 66% to 70% among unsensitized (n = 272), moderately sensitized (PRA < 30%, n = 100) and highly sensitized (>30% PRA; n = 120) patients, equal to the average national graft survival (65.7%). The application of this approach (the Emory Algorithm) provides a logical and systematic approach to improve the access of sensitized patients to DD organs and promote more equitable allocation to a highly disadvantaged group of patients awaiting renal transplantation. 相似文献
2.
Ohne Zusammenfassung 相似文献
3.
Eduard Láng 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》1872,1(5):425-431
Ohne Zusammenfassung
(Hierzu Tafel VIII.) 相似文献
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Ohne ZusammenfassungMit einer Tafel. 相似文献
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7.
Ventilation imaging of the lung: Comparison of hyperpolarized helium-3 MR imaging with Xe-133 scintigraphy 总被引:1,自引:0,他引:1
Talissa A. Altes MD Patrice K. Rehm MD Frank Harrell PhD Michael Salerno PhD Thomas M. Daniel MD Eduard E. de Lange MD 《Academic radiology》2004,11(7):729-734
RATIONALE AND OBJECTIVES: To compare hyperpolarized helium-3 (HHe) magnetic resonance imaging (MRI) of the lung with standard Xe-133 lung ventilation scintigraphy. MATERIALS AND METHODS: We performed a retrospective review of 15 subjects who underwent HHe MRI and Xe-133 lung ventilation imaging. Coronal MRI sections were acquired after a single inhalation of HHe gas, and standard posterior planar lung ventilation scintigraphy was performed during continuous breathing of Xe-133 gas. The first breath scintigram of each patient was compared with a composite MR image composed of the sum of the individual MR images and with the individual helium-3 MR images. Ventilation defects on the two imaging modalities were compared for size, conspicuity, and concordance in presence and location. Assessment was done separately for each of four lung quadrants. RESULTS: Comparing the composite HHe MR images with Xe-133 scintigraphy, ventilation defect size, conspicuity and concordance were the same in 67% (40/60), 63% (38/60), and 62% (37/60) quadrants, respectively. Comparing the individual HHe MR image sections with the Xe-133 ventilation scan, there was concordance between the ventilation defects in 27% (16/60) of quadrants. More defects were identified on the individual HHe MR images in 62% (37/60) of quadrants. CONCLUSION: There was good agreement between composite HHe MR image and first breath Xe-133 scintigraphic images, supporting the widely held assumption that HHe MRI likely depicts first breath lung ventilation. 相似文献
8.
The 3-methoxy-4-hydroxyphenylglycol (MHPG) flow, the creatinine flow in 24 h urine and the plasma creatinine level were determined in 42 psychiatric control patients. The creatinine clearance was calculated. The relationship between MHPG flow in 24 h urine and creatinine clearance, creatinine flow, 24 h urinary output, age, sex and weight of the patient were studied by means of single and multiple regression methods. The MHPG flow was significantly correlated with creatinine clearance (r= 0.597), creatinine flow (r = 0.646) and sex of the patient (rpb = 0.434). The variance of the MHPG flow can be explained by the regression with creatinine flow, age and urinary output for at maximum 51.5%. These variables have to be taken into account for the interpretation of data concerning the MHPG flow in subsequent experimental designs. The results of the measurements of the MHPG flow can best be expressed as the residual values obtained after partialling out the predictable component calculated by multiple regression with creatinine flow, age and 24 h urine output. 相似文献
9.
Rene C. Bakker Eduard M. Scholten Johan W. de Fijter Leendert C. Paul 《Transplantation reviews (Orlando, Fla.)》2004,18(1):54-64
Although extensively studied, the pathophysiologic characteristics of chronic cyclosporine (CsA) nephrotoxicity are still far from being completely understood. The recognition of chronic CsA nephrotoxicity in allografted kidneys is hampered by a lack of easily assessable sensitive and specific markers. Long-term results of CsA withdrawal trials and trials that evaluated CsA sparing or withdrawal after the diagnosis of chronic allograft nephropathy (CAN) have shown that chronic CsA nephrotoxicity has a more important role in the etiology of late transplant dysfunction than appreciated before. Various hypotheses have explained the renal structural changes of chronic CsA nephrotoxicity including ischemia, cellular toxicity, and the stimulation of renal fibrosis by growth factors or cytokines. Possible ways to prevent chronic CsA nephrotoxicity include improved therapeutic drug monitoring and CsA withdrawal or avoidance. Patients with aspecific CAN in late biopsy may benefit from withdrawal of CsA or a reduction of its dose. Current knowledge is being discussed. It is concluded that in the near future more strategies are likely to be used to prevent loss of allograft function as a result of drug toxicity. 相似文献
10.
Peter Knesewitsch Sigrid Fritsch Eduard Kleinhans Udalrich Büll 《European journal of nuclear medicine and molecular imaging》1987,12(12):598-601
Results of 203 patients who underwent first pass radionuclide angiography (FP) and quantitative equilibrium radionuclide ventriculography (qERNV) were stored in a data base system and evaluated statistically. Eighty eight of these patients also underwent exercise equilibrium radionuclide ventriculography (E-qERNV). In patients with coronary artery disease (CAD) without previous myocardial infarction (MI), evaluation of global and regional ejection fraction (gEF, rEF) at rest revealed a poor sensitivity of 64%, the specificity was about 71% (qERNV). FP at rest revealed similar values of sensitivity (69%) and specificity (83%). Additional assessment of stress induced changes of gEF, significantly (P<0.05) improved sensitivity of qERNV in CAD patients without a history of previous MI to 84% (specificity 86%). In patients with one previous MI, however, similar values of sensitivity were found (RFP: 87%, R-qERNV: 84%, E-qERNV: 93%). In patients with several MI's, sensitivity was above 90% at rest and during exercise (R-FP: 96%, R-qERNV: 93%, E-qERNV: 100%). 相似文献