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Dr. Joseph A. Kuhn MD Lawrence D. Wagman MD John A. Lorant MD Fredrick W. Grannis MD Mordecai Dunst MD William R. Dougherty MD Daniel I. Jacobs MD 《Annals of surgical oncology》1994,1(4):353-359
Background: A radical forequarter amputation with partial chest wall resection (one to four ribs) has been reported for benign and malignant
lesions involving the shoulder and chest wall region. Concerns about reconstruction and postoperative pulmonary function have
previously limited more extensive chest wall resections. The current report describes the first case in which a complete unilateral
anterior and posterior chest wall resection and pneumonectomy (hemithoracectomy) accompany a forequarter amputation. A novel
reconstructive technique used the full circumference of the forearm tissue with an intact ulna as a free osseomyocutaneous
flap.
Methods: In this case, a 21-year-old patient presented with an extensive recurrent desmoid tumor that involved the shoulder, brachial
plexus, subclavian vein, and chest wall from the lateral sternal border to the midportion of the scapula and down to the eighth
rib. The operative technique involved removal of the entire right hemithorax from the midline sternum to the transverse process
posteriorly, down to the ninth rib inferiorly. Due to the absence of a rigid hemithorax, the uninvolved ipsilateral lung was
also removed. The forearm flap was prepared before final separation of the specimen and division of the subclavian vessels.
Results: Postoperatively, the patient maintained excellent oxygenation without atelectasis or fever and was extubated on the 15th
postoperative day. As expected after pneumonectomy, significant decreases from preoperative to immediate postoperative values
were noted for the vital capacity (VC) (from 4.87 L to 1.29 L), forced 1-s expiratory volume (FEV1) (from 3.77 L to 1.02 L),
and inspiratory capacity (IC) (3.33 1 to 0.99 1). Rehabilitation included a specially designed external prosthesis to provide
cosmesis and prevent scoliosis. By the 15th postoperative week the patient had returned to normal social and physical activities,
with a gradual improvement in all respiratory parameters: VC 1.52 L, FEV1 1.29 L, IC 1.04 L. There has been no evidence of
tumor recurrence at 1 year.
Conclusions: This report provides evidence that a complete hemithoracectomy, pneumonectomy, and forequarter amputation can be safely performed
for selective tumors involving the shoulder region with extensive chest wall invasion. Reconstruction may be achieved with
an extended forearm osseomyocutaneous free flap with an excellent functional outcome.
Presented at the 46th Annual Cancer Symposium of The Society of Surgical Oncology, Los Angeles, California, March 18–21, 1993. 相似文献
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Gold RS Azem F Yovel I Wagman I Amit A Lessing JB 《Human reproduction (Oxford, England)》2000,15(6):1221-1224
This study was conducted to compare early serum human chorionic gonadotrophin (HCG) concentrations in singleton pregnancies achieved after intracytoplasmic sperm injection (ICSI), with those achieved after conventional in-vitro fertilization (IVF). Early serum HCG, 14-16 days after embryo transfer, was analysed in 99 IVF pregnancies achieved after ICSI (group A), and compared to 105 conventional IVF pregnancies (group B). All women were treated at the IVF Unit, Lis Maternity Hospital. Records were studied retrospectively. The mean +/- SE serum HCG concentration on day 14 after embryo transfer in group A was 190.5 +/- 17.4 mIU/ml, compared to 195.7 +/- 14.03 mIU/ml in group B. HCG concentration 14 days after embryo transfer in both groups A and B was higher in women with mechanical factor than in couples with male factor infertility or unexplained infertility (246 +/- 31.4, 183.3 +/- 16.4, 177.98 +/- 14.3 mIU/ml respectively). On the 16th day after embryo transfer, the HCG concentration increased, and the difference between the groups was maintained. Only in the subgroup of unexplained infertility did we find a difference in concentrations of HCG between ICSI and conventional IVF: on the 16th day following embryo transfer in this group there was a significant difference in HCG concentrations (395. 8 +/- 21 and 545.6 +/- 45.7 respectively; P = 0.04). HCG concentrations did not differ overall in the conventional IVF pregnancies compared with those achieved by ICSI. However, a statistical difference in early serum HCG concentrations was found in relation to the aetiology of infertility. 相似文献
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Jolinda LD Schram Joost Oude Groeniger Merel Schuring Karin I Proper Sandra H van Oostrom Suzan JW Robroek Alex Burdorf 《Scandinavian journal of work, environment & health》2021,47(2):127
Objective:Using a novel mediation method that presents unbiased results even in the presence of exposure–mediator interactions, this study estimated the extent to which working conditions and health behaviors contribute to educational inequalities in self-rated health in the workforce.Methods:Respondents of the longitudinal Survey of Health, Ageing, and Retirement in Europe (SHARE) in 16 countries were selected, aged 50–64 years, in paid employment at baseline and with information on education and self-rated health (N=15 028). Education, health behaviors [including body mass index (BMI)] and working conditions were measured at baseline and self-rated health at baseline and two-year follow-up. Causal mediation analysis with inverse odds weighting was used to estimate the total effect of education on self-rated health, decomposed into a natural direct effect (NDE) and natural indirect effect (NIE).Results:Lower educated workers were more likely to perceive their health as poor than higher educated workers [relative risk (RR) 1.48, 95% confidence interval (CI) 1.37–1.60]. They were also more likely to have unfavorable working conditions and unhealthy behaviors, except for alcohol consumption. When all working conditions were included, the remaining NDE was RR 1.30 (95% CI 1.15–1.44). When BMI and health behaviors were included, the remaining NDE was RR 1.40 (95% CI 1.27–1.54). Working conditions explained 38% and health behaviors and BMI explained 16% of educational inequalities in health. Including all mediators explained 64% of educational inequalities in self-rated health.Conclusions:Working conditions and health behaviors explain over half of the educational inequalities in self-rated health. To reduce health inequalities, improving working conditions seems to be more important than introducing health promotion programs in the workforce. 相似文献
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Biological Activity of Sch 14342, an Aminoglycoside Antibiotic Coproduced in the Gentamicin Fermentation 总被引:3,自引:2,他引:1
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J. A. Waitz E. L. Moss Jr. E. M. Oden G. H. Wagman M. J. Weinstein 《Antimicrobial agents and chemotherapy》1972,2(6):464-469
Sch 14342 is an aminoglycoside antibiotic coproduced as a minor component in the gentamicin fermentation. Sch 14342 was found to have the same antibacterial spectrum as gentamicin in vitro and in vivo, and was approximately one-third as active in mouse protection tests. Sch 14342 relative to gentamicin was one-third as toxic in acute tests in mice, one-eighth as toxic in renal toxicity tests in dogs, and an estimated one-tenth as toxic in cat ataxia tests. Sch 14342 possesses a significantly improved therapeutic index relative to gentamicin with reference to ataxia potential and renal toxicity. 相似文献
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Characterization of xenobiotic-metabolizing enzymes and nitrosamine metabolism in the human esophagus 总被引:5,自引:2,他引:5
Smith TJ; Liao A; Wang LD; Yang GY; Starcic S; Philbert MA; Yang CS 《Carcinogenesis》1998,19(4):667-672
Esophageal cancer has been associated with tobacco smoking, and
nitrosamines are possible causative agents for this cancer. The present
study investigated the metabolism of the tobacco carcinogens N'-
nitrosonornicotine (NNN), 4-(methylnitrosamino)-1-(3-pyridyl)-1- butanone
(NNK), and N-nitrosodimethylamine (NDMA), as well as the presence of
xenobiotic-metabolizing enzymes in human esophageal tissues from
individuals in the United States and Huixian, Henan Province, China (a
high-risk area for esophageal cancer). All esophageal microsomal samples
activated NNN and the metabolic rate was 2-fold higher in the esophageal
samples from China than the USA. All microsomal samples activated NDMA.
However, most of the microsomal samples did not activate NNK.
Troleandomycin (an inhibitor of cytochrome P450 3A) decreased the formation
of NNN-derived keto acid by 20-26% in the esophageal microsomes. The
activities for NADPH: cytochrome c reductase, ethoxycoumarin O-deethylase,
NAD(P)H: quinone oxidoreductase and glutathione S-transferase were present
in the esophageal samples. Coumarin 7-hydroxylase (a representative
activity for P450 2A6) activity was not detected in the esophageal
microsomal samples. The activities for nitrosamine metabolism and
xenobiotic- metabolizing enzymes were decreased (by 30-50%) in the squamous
cell carcinomas compared with their corresponding non-cancerous mucosa. The
presence of activation and detoxification enzymes in the esophagus may play
an important role in determining the susceptibility of the esophagus to the
carcinogenic effect of nitrosamines. Our results suggest that P450s 3A4 and
2E1 are involved in the activation of NNN and NDMA, respectively, in the
human esophagus.
相似文献