| 收费全文 | 26944篇 |
| 免费 | 1931篇 |
| 国内免费 | 74篇 |
| 耳鼻咽喉 | 355篇 |
| 儿科学 | 1069篇 |
| 妇产科学 | 730篇 |
| 基础医学 | 3364篇 |
| 口腔科学 | 535篇 |
| 临床医学 | 2627篇 |
| 内科学 | 5614篇 |
| 皮肤病学 | 613篇 |
| 神经病学 | 2503篇 |
| 特种医学 | 481篇 |
| 外国民族医学 | 1篇 |
| 外科学 | 3311篇 |
| 综合类 | 238篇 |
| 一般理论 | 14篇 |
| 预防医学 | 3061篇 |
| 眼科学 | 498篇 |
| 药学 | 1780篇 |
| 1篇 | |
| 中国医学 | 80篇 |
| 肿瘤学 | 2074篇 |
| 2024年 | 22篇 |
| 2023年 | 232篇 |
| 2022年 | 370篇 |
| 2021年 | 973篇 |
| 2020年 | 575篇 |
| 2019年 | 940篇 |
| 2018年 | 1227篇 |
| 2017年 | 804篇 |
| 2016年 | 768篇 |
| 2015年 | 829篇 |
| 2014年 | 1106篇 |
| 2013年 | 1486篇 |
| 2012年 | 2222篇 |
| 2011年 | 2443篇 |
| 2010年 | 1209篇 |
| 2009年 | 1034篇 |
| 2008年 | 1762篇 |
| 2007年 | 1788篇 |
| 2006年 | 1689篇 |
| 2005年 | 1547篇 |
| 2004年 | 1390篇 |
| 2003年 | 1217篇 |
| 2002年 | 1117篇 |
| 2001年 | 250篇 |
| 2000年 | 232篇 |
| 1999年 | 241篇 |
| 1998年 | 127篇 |
| 1997年 | 113篇 |
| 1996年 | 106篇 |
| 1995年 | 75篇 |
| 1994年 | 72篇 |
| 1993年 | 48篇 |
| 1992年 | 75篇 |
| 1991年 | 65篇 |
| 1990年 | 62篇 |
| 1989年 | 59篇 |
| 1988年 | 48篇 |
| 1987年 | 67篇 |
| 1986年 | 54篇 |
| 1985年 | 46篇 |
| 1984年 | 42篇 |
| 1983年 | 45篇 |
| 1982年 | 37篇 |
| 1981年 | 32篇 |
| 1980年 | 23篇 |
| 1979年 | 32篇 |
| 1978年 | 24篇 |
| 1977年 | 19篇 |
| 1974年 | 33篇 |
| 1973年 | 18篇 |
Background
Multiple myeloma (MM) is a hematologic malignancy of plasma cell origin. MM primarily affects bone marrow, but extramedullary sites can also be involved. Myelomatous pleural effusion (MPE) is an atypical and rare complication of MM. We aimed to systematically study the incidence and clinicopathologic profile of patients with MPE in a real-world setting.Patients and Methods
In this retrospective study, 415 consecutive patients with MM managed at a tertiary care center in North India during a study period of January 1, 2010 to December 31, 2015 were evaluated for MPE. The patients with MPE were analyzed for their clinical profile, diagnosis, treatment, and outcomes.Results
Of these 415 patients, 11 (2.65%) patients had MPE. The median age of the study population was 50 years with male preponderance. The majority of these patients had immunoglobin (Ig)G Kappa disease. All patients had higher than International Staging System stage I disease. MPE was a presenting feature at MM diagnosis in 45.45% (n = 5) of the patients, whereas the rest developed MPE during follow-up. MPE presented predominantly (81.8%) as a unilateral effusion. Concurrent extramedullary involvement at other site was seen in 45.45% (n = 5), with 3 (27%) patients having concurrent myelomatous ascites. Six of these were managed aggressively, whereas 5 patients opted for palliation. The outcomes were dismal (90.9% mortality), with a median survival of 2.47 months.Conclusion
MPE is a rare entity, and positive outcomes of therapy remain low with dismal prognosis. 相似文献Methods: The purpose of this study was to examine the degree to which several personal factors and school characteristics affect and explain students’ self-determination. A total of 232 students with intellectual disability from Spain participated. Their self-determination level was assessed by the ARC-INICO Scale.
Results: Students with moderate levels of intellectual disability obtained significantly lower scores on self-determination than their peers with mild intellectual disability. There were significant differences in relation to the level of support needs and their experience with transition programs. The level of support needs was a significant predictor.
Conclusion: These findings contribute to current research in this field and practical implications were discussed. 相似文献
Background
A history of childhood maltreatment and psychopathology are common in adults with obesity.Objectives
To report childhood maltreatment and to evaluate associations between severity and type of childhood maltreatment and lifetime history of psychopathology among adults with severe obesity awaiting bariatric surgery.Setting
Four clinical centers of the Longitudinal Assessment of Bariatric Surgery Research Consortium.Methods
The Childhood Trauma Questionnaire, which assesses presence/severity (i.e., none, mild, moderate, severe) of physical abuse, mental abuse, physical neglect, mental neglect, and sexual abuse, was completed by 302 female and 66 male bariatric surgery patients. Presurgery lifetime history of psychopathology and suicidal ideation/behavior were assessed with the Structured Clinical Interview for DSM-IV and the Suicidal Behavioral Questionnaire-Revised, respectively. Presurgery lifetime history of antidepressant use was self-reported.Results
Two thirds (66.6%) of females and 47.0% of males reported at least 1 form of childhood trauma; 42.4% and 24.2%, respectively, at greater than or equal to moderate severity. Among women, presence/greater severity of childhood mental or physical abuse or neglect was associated with a higher risk of history of psychopathology (i.e., major depressive disorder, posttraumatic stress disorder, other anxiety disorder, alcohol use disorder, binge eating disorder), suicidal ideation/behavior and antidepressant use (P for all ≤ .02). These associations were independent of age, race, education, body mass index, and childhood sexual abuse. Childhood sexual abuse was independently associated with a history of suicidal ideation/behavior and antidepressant use only (P for both ≤ .05). Statistical power was limited to evaluate these associations among men.Conclusion
Among women with obesity, presence/severity of childhood trauma was positively associated with relatively common psychiatric disorders. 相似文献There is an increasing incidence of elderly patients requiring emergency laparotomy. Our study compares the outcomes of elderly patients undergoing emergency laparotomy against the outcomes of non-elderly patients.
MethodologyPatients who underwent emergency laparotomy between 2015 and 2017 from the National University Hospital, Singapore, were included. Apart from demographic data, indication of surgery and surgical procedure performed were collected. Prospectively collected nutritional scores were evaluated. Outcome measures included duration of surgery, length of ICU and total hospital stay, post-operative complications, and mortality indices. We performed multivariate Cox regression analysis to determine the contribution of various risk factors towards overall survival following emergency laparotomy.
ResultsA total of 170 emergency laparotomies were performed. Compared to non-elderly patients, elderly patients had a significantly longer mean stay in hospital (31.5 vs. 18.6 days, p = 0.006) and mean stay in ICU (13.1 vs. 5.3 days, p = 0.003). More elderly patients suffered from post-laparotomy complications compared with non-elderly patients (65.8% vs. 37.4%, p < 0.001). 30-day mortality (31.5% vs. 8.8%, p = 0.019) and 1-year mortality (27.9% vs. 14.3%, p = 0.023) were higher in elderly patients compared with non-elderly patients. Interestingly, there was no statistically significant difference between elderly and non-elderly groups in both the global 3-MinNS as well as the global SGA nutritional scores. ASA status (HR 2.61, 95% CI 1.05–6.45, p = 0.038) was an independent risk factor for decreased survival following emergency laparotomy. Notably, while age ≥ 65 demonstrated a significant correlation with survival on univariate analysis (HR 1.03 (1.01–1.05), p = 0.003), this effect was lost following multivariate regression (HR 1.01 (0.453–2.23), p = 0.989).
ConclusionElderly patients suffer worse morbidity and mortality following emergency laparotomy. This is likely contributed by comorbidities resulting in higher ASA status.
相似文献