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1.
E.Paul Kirk MB BS J. Santa MD T. Heckler MBA M. Collins MD 《American journal of obstetrics and gynecology》1998,178(6):1222-1228
OBJECTIVE: Our purpose was to assess whether legislative action influenced the role of obstetrician-gynecologists as primary care physicians. STUDY DESIGN: An observational study was performed on the basis of a questionnaire sent to 410 obstetrician-gynecologists and 27 medical directors of managed-care organizations. RESULTS: Of 67% of obstetrician-gynecologists and 96% of medical directors who responded, there was agreement as to the content of primary care, but a minority (38%) of obstetrician-gynecologists identified themselves as primary care providers. A minority of medical directors (35%) felt that obstetrician-gynecologists should serve in that role. Both obstetrician-gynecologists and medical directors felt that legislation had little impact. CONCLUSION: The reticence of obstetrician-gynecologists to assume a major role in primary care appears to be the result of an uneasiness with accepting a more comprehensive role in patient management and gatekeeping. They appear comfortable with the more traditional roles but feel that training and experience has not prepared them well for the management of more complex medical problems. (Am J Obstet Gynecol 1998;178:1222-8.) 相似文献
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Fernanda Coutinho Luiz Claudio de Santa Maria 《Macromolecular chemistry and physics.》1992,193(7):1739-1744
The effect of ethyl benzoate (EB), diisobutyl phthalate (DIBP), dibutyl ether (DBE) and triethoxy(phenyl)silane (EPS) as third components on the propene polymerization with the catalyst systems δ-TiCl3/AlCl(C2H5)2 and δ-TiCl3/Al(C2H5)3 was investigated. The influence of external donors on the isotacticity, catalyst activity and average molecular weight (M v) was tested. If external donors are employed, M v decreases, the insoluble fraction in boiling isooctane increases and the catalyst activity is strongly influenced by the mole ratio external donor/TiCl3. The results indicate that all external donors employed have the same qualitative effect on catalytic active centers. 相似文献
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Histologic Classification of Endoscopically Removed Flat Colorectal Polyps: A Multicentric Study 总被引:1,自引:0,他引:1
A total of 594 flat colorectal polyps, removed at endoscopy, were histologically classified into non-neoplastic (n=49) and neoplastic (n=545) polyps. Non-neoplastic polyps were subdivided into metaplastic (n=45) and hyperplastic (n=4), whereas neoplastic polyps were subdivided into adenomas (n=481), intramucosal carcinomas (n=28) and invasive adenocarcinomas (n=36). Several adenoma phenotypes were discerned: tubular (n=375), serrated (n=59), villous (n=39), mixed (n=7) and fenestrated (n=1). Intramucosal carcinomas were subdivided into tubular (n=26) and serrated (n=2), and invasive adenocarcinomas into tubular (n=32), serrated (n=3) and fenestrated (n=1). The microscopic characteristics of each histologic phenotype described in this communication are defined and illustrated. 相似文献
6.
From 1969 through 1977, 210 patients with Stage IB carcinoma of the uterine cervix were treated at University of Maryland Hospital. Fifty-six patients were treated by radical hysterectomy (S), 136 patients were treated by a full course of radiation therapy (RT) only and 18 patients received radiation treatment following radical surgery (S + RT). The 5-year determinate survival rates were almost the same in the S group and RT alone group (79% and 77%, respectively). The 5-year determinate survival rate in the S + RT group was 50%, which was statistical significantly lower than S alone or RT alone groups (P less than 0.05). Several prognostic factors were analyzed in the radiated patients: the size of the primary lesion, location of the lesion within the cervix, tumor grade, age of the patients at the time of diagnosis, and complete blood count nadir during the course of radiation treatment. The only factor found to influence the prognosis was the size of the primary tumor. The patients with smaller tumors had a better prognosis; the absolute and determinate 5-year survival rates were 80% and 82%, while the absolute and determinate survival rates in the large, fungating tumor replacing the entire cervix were 56% and 60%, respectively (P less than 0.001). The complication rate was 22% in the RT alone, 22% in the S + RT, and 25% in the S alone groups. 相似文献
7.
Kerry E. Goetz Melissa J. Reeves Shaina Gagadam Delphine Blain Chelsea Bender Cara Lwin Amelia Naik Santa J. Tumminia Robert B. Hufnagel 《American journal of medical genetics. Part C, Seminars in medical genetics》2020,184(3):828-837
Genetic testing in a multisite clinical trial network for inherited eye conditions is described in this retrospective review of data collected through eyeGENE®, the National Ophthalmic Disease Genotyping and Phenotyping Network. Participants in eyeGENE were enrolled through a network of clinical providers throughout the United States and Canada. Blood samples and clinical data were collected to establish a phenotype:genotype database, biorepository, and patient registry. Data and samples are available for research use, and participants are provided results of clinical genetic testing. eyeGENE utilized a unique, distributed clinical trial design to enroll 6,403 participants from 5,385 families diagnosed with over 30 different inherited eye conditions. The most common diagnoses given for participants were retinitis pigmentosa (RP), Stargardt disease, and choroideremia. Pathogenic variants were most frequently reported in ABCA4 (37%), USH2A (7%), RPGR (6%), CHM (5%), and PRPH2 (3%). Among the 5,552 participants with genetic testing, at least one pathogenic or likely pathogenic variant was observed in 3,448 participants (62.1%), and variants of uncertain significance in 1,712 participants (30.8%). Ten genes represent 68% of all pathogenic and likely pathogenic variants in eyeGENE. Cross‐referencing current gene therapy clinical trials, over a thousand participants may be eligible, based on pathogenic variants in genes targeted by those therapies. This article is the first summary of genetic testing from thousands of participants tested through eyeGENE, including reports from 5,552 individuals. eyeGENE provides a launching point for inherited eye research, connects researchers with potential future study participants, and provides a valuable resource to the vision community. 相似文献
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9.
Kenichi Ohashi Yo Kato Jun Kanno Tsutomu Kasuga 《Virchows Archiv : an international journal of pathology》1990,417(2):137-143
Summary Normal oesophagus specimens taken from 65 autopsy cases and surgical specimens from 127 oesophageal carcinoma cases were examined
histopathologically to determine melanocyte incidence and distribution. Melanocytes were found in the epithelio-stromal junction
in 7.7% of normal oesophagus specimens examined at autopsy, and in 29.9% of surgical cases with oesophageal carcinoma. Positive
specimens in the latter groups, especially from pre-operatively irradiated individuals, showed a more remarkable increase
of melanocytes than was evident in any of the normal oesophageal samples. There were no significant differences in incidence
between males and females, or between age groups. In cases where the cancer invaded into deeper stroma, the melanocytes were
mainly observed in the normal epithelium around the carcinomas. Epithelial and stromal elements of the melanotic mucosa commonly
showed hyperplastic changes such as acanthosis or basal cell hyperplasia, and chronic oesophagitis. Melanocytes were observed
most commonly in the lower part of the oesophagus, the site where malignant melanoma of the oesophagus, most often originates.
These results strongly suggest that the melanocyte increase observed in areas of hyperplastic epithelium and chronic oesophagitis
may play an important role as a precursor lesion for malignant melanoma in the oesophagus. 相似文献
10.
Laura McGillis Nimish Mittal Daniel Santa Mina Joyce So Medha Soowamber Aliza Weinrib Leslie Soever Dmitry Rozenberg Louis Liu Yvonne Tse Joel Katz George S Charames Kieran Murphy Peter Vadas Maxwell P Slepian Scott Walsh Lindsay Wilson Arnon Adler Alyssa Franzese Laura Hussey Dayna‐Lynn Nevay Juan Guzman Hance Clarke 《American journal of medical genetics. Part A》2020,182(3):484-492
The new 2017 diagnostic criteria for hypermobile Ehlers–Danlos Syndrome (hEDS) provide a framework for diagnosing hEDS but are more stringent than the previous Villefranche criteria. Our clinical experience at the GoodHope EDS clinic was that the 2017 criteria left many highly symptomatic patients without a diagnosis of hEDS. We conducted a retrospective cohort study to confirm our clinic experience and assess the accuracy of the 2017 diagnostic criteria for hEDS in patients who had a previous hEDS diagnosis based on the Villefranche criteria. Our study found that 15% (n = 20 of 131) of patients with a prior diagnosis of hEDS met the 2017 diagnostic criteria, and many of the traits used to distinguish hEDS were not significantly more frequent in patients who met 2017 criteria versus those who did not. In both groups objective systemic manifestations were found less frequently than subjective systemic manifestations. Beighton score (BS) as assessed by primary care practitioner was found to be higher than assessment by EDS practitioner in 81% (n = 74 of 91) of cases. Generalized joint hypermobility was confirmed in only 46% (n = 51 of 111) of patients who had a previous diagnosis of hEDS. Higher BS did not correlate with increased number of systemic manifestations in our cohort. Common comorbidities of hEDS were found with similar frequency in those who met 2017 criteria and those who did not. Based on our cohort, the 2017 hEDS diagnostic criteria require refinement to improve its diagnostic accuracy. 相似文献