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1.
H. D. Tagare K. W. Elder D. M. Stoner R. M. Patterson C. L. Nicodemus S. F. Viegas Dr. G. R. Hillman 《Annals of biomedical engineering》1993,21(6):715-726
The carpal regions of ten cadaver extremities were imaged by CT. The images were combined into a 3-dimensional model of the
carpus using a technique based on a dynamic programming algorithm to find an optimal estimate of the location of the bone
boundaries in the CT images. The resulting set of surface points on each bone was used to compute volumes and principal and
antipodal axes for the bones. A spatial coordinate system was established based on the positions of the centroids of three
bones in the distal carpal row. The angular orientations of all carpal bones were determined with respect to this system.
The principal axes for the same bone among ten wrist specimens proved to be more widely dispersed than the antipodal axes
for the same bones. The antipodal axes also correspond more closely to an intuitive notion of the “longest axis” of the bones.
We conclude that the antipodal axis is a more reliable and useful measure of bone orientation than the principal axis. 相似文献
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Non-operative management of malignant intestinal obstruction 总被引:1,自引:0,他引:1
W H Isbister P Elder L Symons 《Journal of the Royal College of Surgeons of Edinburgh》1990,35(6):369-372
Intestinal obstruction is a relatively common clinical problem in patients with advanced cancer, particularly those with colorectal and ovarian tumours. A proportion of patients have a non-malignant cause for their obstruction, but in the remaining patients obstruction will be caused by advanced malignancy itself. In the past, most patients were either managed surgically or by nasogastric intestinal decompression and intravenous hydration. Surgery in patients with advanced cancer is associated with high mortality and morbidity. Effective surgical decompression is difficult. We have managed 24 patients with advanced abdominal malignancy and previous operative or radiological evidence of intestinal obstruction without operation. The technique is only appropriate for patients in whom a solitary or correctable obstructing lesion can be excluded. The patient is encouraged to take free fluid and a diet low in fibre. Intestinal colic is managed with morphine, the dose required being titrated for each individual patient against background pain and colic. Vomiting is controlled by the parenteral administration of antiemetic drugs. To simplify drug administration, morphine and metoclopramide are mixed in the same syringe and infused subcutaneously simultaneously. In our 24 patients the mean survival rate after the onset of complete obstruction was 29.2 days. The mean dose of morphine infused was 9.2 mg/h, and the mean dose of metoclopramide was 6.9 mg/h. The case of an 82-year-old male patient is presented. We commend the technique to surgeons contemplating surgery in these very difficult patients. It is simple, relatively non-invasive and saves the patients the pain, discomfort and complications of unproductive surgery. 相似文献
4.
S R Dager A Khan D Cowley D H Avery J Elder P Roy-Byrne D L Dunner 《Psychopharmacology bulletin》1990,26(3):273-278
Mixed-panic disorder patients (16/60, 27%) randomly assigned to receive blind placebo during a 40-week treatment study were defined as placebo responders based on combined criteria of Hamilton Anxiety Scale score percentage decreases below the median point (-42%), moderate to marked improvement on both clinician and patient Clinical Global Impressions scores, and panic-free at final treatment visit. These criteria applied separately also resulted in a similar clinical grouping and pattern of response. Differential patterns of response between responders and nonresponders occurred across most clinical measures of panic/anxiety. Responders experienced early improvement within the first week of double-blind treatment. This response progressed during treatment and tended to persist during taper and at followup 1 month later. Post-hoc analysis of demographic and clinical features at entrance into the study failed to characterize this stringently defined group of placebo responders. 相似文献
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Mitral balloon valvuloplasty for patients aged over 70 years: an alternative to surgical treatment 总被引:1,自引:0,他引:1
We report the results and one-year follow-up of 20 elderly patients (age range 70-82 years) with severe rheumatic mitral stenosis treated by mitral balloon valvuloplasty (MBV). All 20 were breathless at rest despite treatment with diuretics and digoxin. At cardiac catheterization, successful dilatation was achieved in 17 patients: mean transvalvular mitral gradient fell by 45%, mean cardiac output rose by 24% and mean valve area increased by 76%. There was no procedure-related mortality. At one month, 15 patients had experienced an improvement in symptoms of at least one New York Heart Association class and, at one year, ten had maintained this improvement. Three patients proceeded to mitral valve replacement because of a suboptimal symptomatic result. Mitral balloon valvuloplasty can be successfully performed with significant symptomatic benefit in frail elderly patients unfit for surgery and may also be offered to other selected elderly patients as an alternative to surgical treatment. 相似文献
7.
J R Elder 《Australian and New Zealand journal of ophthalmology》1987,15(4):325-328
Office-based intraocular surgery has been carried out for three years and over 1400 procedures have been performed. There have been no systemic complications or infections. The establishment of an office-based facility is a complex venture. Apart from medicolegal, ethical and financial considerations there are regulations relating to structural requirements, sterilisation of instruments, air-conditioning, electrical hazards and other technical matters. Office-based surgery is convenient for both the patient and the surgeon. The patient remains calm and relaxed from the time of initial counselling to the end of postoperative convalescence. We have borrowed systems used in the United States for management of ambulatory surgical patients, in particular the counselling techniques. This, in our opinion, has been a significant factor for calm relaxed surgery. Patient acceptance and preference for ambulatory surgery will ensure that it is here to stay. A case can be made out for an economic and ethical obligation for this form of surgery to be implemented on a more widespread basis. It is not, however, the universal solution to ocular surgery. There are still specific indications and contraindications, in terms of both the doctor and the patient. At a time when government involvement is being felt more and more in the practice of medicine, any proven alternative method of health care delivery, provided entirely by the private sector, must be worthy of serious consideration. 相似文献
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9.
Extrapulmonary tuberculosis. A review. 总被引:2,自引:0,他引:2
N C Elder 《Archives of family medicine》1992,1(1):91-98
The increase in cases of tuberculosis that has occurred with the increasing number of individuals infected with the human immunodeficiency virus (HIV) has focused attention on the problems in diagnosing and treating tuberculosis. While it is primarily considered a pulmonary disease, tuberculosis has the potential to infect almost every organ system via lymphohematogenous dissemination during the initial pulmonary infection. Since 1984 the incidence of extrapulmonary tuberculosis has increased at an even faster rate than that of pulmonary tuberculosis. Extrapulmonary tuberculosis is considered a diagnostic criterion in the case definition of the acquired immunodeficiency syndrome. Immunocompromised individuals, such as patients with HIV, are at increased risk for extrapulmonary tuberculosis. The clinical manifestations are often nonspecific and insidious, and diagnosis may be delayed for years. Cases of miliary and meningeal tuberculosis are an exception, and they often constitute medical emergencies. Tuberculosis skin tests should be performed on all individuals suspected of having tuberculosis, but a negative test result does not exclude the diagnosis. Chest roentgenograms will often show signs of old or active pulmonary tuberculosis. Microscopic examination and culture of infected body fluids and/or tissue are necessary for definitive diagnosis. Treatment is with standard antituberculous medications. Short-course therapy (6 or 9 months) is probably adequate in most patients with extrapulmonary tuberculosis, but patients with human immunodeficiency viral infection need longer treatment. Extrapulmonary tuberculosis is a persistent problem in the United States and will become more prevalent as the number of patients with HIV increases. A high index of suspicion is needed to diagnose and treat extrapulmonary tuberculosis in a timely and health-preserving manner. 相似文献
10.