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J R A Duckett S Jain A Tamilselvi P A Moran D Richmond 《Journal of obstetrics and gynaecology》2004,24(7):785-793
The aim of the study was to describe the experience, current trends and management of incontinence surgery for urodynamic stress incontinence (USI) in the United Kingdom. The study was a postal questionnaire survey that was sent to a cohort of surgeons known to be performing continence surgery. The subjects addressed included the considered role of the surgeon, the total number and type of operations performed in the last year, urodynamics and physiotherapy prior to incontinence surgery, operative complications, postoperative advice and follow-up (lengths and methods). The response rate was 54%. Large variations were found in all areas. The survey provides evidence of the number of incontinence operations performed, potentially important trends and differences in the practice and management of incontinence in the United Kingdom. This survey may be helpful in making guidelines and standards for audit at regional, local and individual levels as well as recommendations for strategies to enhance professional expertise in urogynaecology in the United Kingdom. 相似文献
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Survivorship of cemented knee replacements 总被引:9,自引:0,他引:9
G R Scuderi J N Insall R E Windsor M C Moran 《The Journal of bone and joint surgery. British volume》1989,71(5):798-803
The survivorship method of analysis has been used to compare the failure rate and overall success of 1,430 cemented primary total knee arthroplasties performed at The Hospital for Special Surgery over a 15-year period. There were 224 total condylar prostheses with a polyethylene tibia, 289 of the posterior stabilised type with an all polyethylene tibia, and 917 posterior stabilised with a metal-backed tibial component. There were 12 failures in the total condylar series, giving an average annual failure rate of 0.65% and a 15-year success rate of 90.56%. The posterior stabilised prosthesis with a polyethylene tibia showed an average annual failure rate of 0.27% and a 10-year success rate of 97.34%, and this prosthesis with a metal-backed tibial component gave an annual failure rate of 0.19% and a seven-year success rate of 98.75%. The overall survival rate was not influenced by sex or age, diagnosis or the percentage of ideal body weight. No metal-backed tibial components have yet needed revision for loosening. It seems that infection will be the major cause of failure. 相似文献
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Melanoma of the upper aerodigestive tract: a review of 21 cases 总被引:1,自引:0,他引:1
In this report 21 cases of primary malignant melanoma arising from the mucosa of the upper aerodigestive tract are reviewed. The patients ranged in age from 30 to 86; mean age was 67 years. There were 10 men and 11 women. All but one patient were white. Sites of involvement were: nose and paranasal sinuses, oral cavity and labial mucosa, parotid duct, and larynx. Surgery was the primary method of treatment. The 2-year survival rate was 44% (7/16) and the 5-year survival rate was 13% (2/15). Regional metastases were seen in 19% (4/21) while distant metastases was seen in 55% (11/21). The local recurrence rate was 69% (11/16). Distant metastases were usually associated with uncontrolled disease at the primary site. This fact as well as the low incidence of regional metastases lead us to conclude that better local control rather than regional lymphatic control is necessary if decreased distant metastases and increased survival are to be achieved. 相似文献
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The subthalamic nucleus (STN) is a major target for treatment of advanced Parkinson's disease patients undergoing deep brain stimulation surgery. Microelectrode recording (MER) is used in many cases to identify the target nucleus. A real-time procedure for identifying the entry and exit points of the STN would improve the outcome of this targeting procedure. We used the normalized root mean square (NRMS) of a short (5 seconds) MER sampled signal and the estimated anatomical distance to target (EDT) as the basis for this procedure. Electrode tip location was defined intraoperatively by an expert neurophysiologist to be before, within, or after the STN. Data from 46 trajectories of 27 patients were used to calculate the Bayesian posterior probability of being in each of these locations, given RMS-EDT pair values. We tested our predictions on each trajectory using a bootstrapping technique, with the rest of the trajectories serving as a training set and found the error in predicting the STN entry to be (mean +/- SD) 0.18 +/- 0.84, and 0.50 +/- 0.59 mm for STN exit point, which yields a 0.30 +/- 0.28 mm deviation from the expert's target center. The simplicity and computational ease of RMS calculation, its spike sorting-independent nature and tolerance to electrode parameters of this Bayesian predictor, can lead directly to the development of a fully automated intraoperative physiological procedure for the refinement of imaging estimates of STN borders. 相似文献
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Focal glomerulosclerosis in the remnant kidney model--an inflammatory disease mediated by cytokines 总被引:7,自引:0,他引:7
BACKGROUND: The mechanism of progression of established renal disease
remains unclear. While a low protein diet slows this progression, the role
of cytokines in this process has been little investigated. METHODS: We
investigated cytokine expression by Northern blot and immunohistochemistry
in two groups of 5/6 nephrectomized rats (5/6 Nx) fed a normal (24%) or low
(6%) protein diet and compared them with sham operated controls. RESULTS:
The rats on 6% protein diet had significantly less focal glomerulosclerosis
(FGS) (17.4 +/- 4.4 vs 27.4 +/- 8.8%, P < 0.05) and global sclerosis
(GGS) after 7 weeks (0.4 +/- 0.8 vs 3.5 +/- 2.1% of glomeruli P < 0.05).
Both experimental groups showed three times control levels of MCP-I
expression after 2 weeks. However in the 5/6 Nx 6% protein group the
expression decreased at 4 weeks (1.5 times controls) and reached control
levels after 7 weeks. In contrast, the 5/6 Nx 24% protein group exhibited a
further marked increase after 4 weeks (5.6 times controls) and was still
two-fold higher after 7 weeks. TGF-beta expression was modestly but
consistently increased at all time points (120-160% of controls), with no
difference between the two study groups. Neither IL-1 beta or TNF-alpha was
detectable at any time. Immunohistochemistry demonstrated TGF-beta
intracellularly in distal tubular cells in both experimental and control
animals, while MCP-1 protein was found in the area of FGS and in the apical
pole of distal tubular cells in both experimental groups. Glomerular and
interstitial ED1 positive cells were significantly increased after four
weeks in the 5/6 Nx 24% protein group (P < 0.05). CONCLUSIONS: A
'mechanical' injury to the kidney clearly results in an inflammatory
response associated with the upregulation of MCP-1. A low protein diet
modulates the expression of MCP-1 and improves the morphological sequelae
seen after renal ablation.
相似文献
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Digital radiography of subtle pulmonary abnormalities: an ROC study of the effect of pixel size on observer performance 总被引:3,自引:0,他引:3
Forty conventional radiographs with examples of mild interstitial infiltrates and subtle pneumothoraces and 40 normal studies of the chest were selected and digitized, with pixel sizes of 1.0, 0.5, 0.2, and 0.1 mm. Observer performance tests were carried out using receiver operating characteristic analysis. Conventional radiographs and digitized images were compared. The results indicate that, in such cases, diagnostic accuracy increases significantly as the pixel size is reduced, at least to the 0.1-mm level. We conclude that, for digital systems using screen-film or similar image receptors, use of a pixel size substantially larger than 0.1 mm may result in some loss of diagnostic accuracy. 相似文献