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1.
2.
Die 5-Jahres-überlebensrate von differenzierten Schilddrüsenkarzinomen ist generell sehr gut und betr?gt 80 – 95%. Hierbei
bestehen Abh?ngigkeiten zum Alter des Patienten [15], zum prim?ren Tumorstadium, zur histologischen Differenzierung und zum
Ausma? der region?ren und Fernmetastasierung [6]. Patienten mit Tumorfreiheit haben ebenfalls eine bessere Prognose gegenüber
denen mit einem Resttumor. Dies spricht für ein konsequentes Vorgehen beim Prim?reingriff mit Thyreoidektomie und Entfernung
der Lymphknoten des zentralen Kompartments. Stadienadaptiert schlie?t sich eine Radiojodtherapie oder die Kombination mit
einer externen Radiatio an.
Bei der Reoperation differenzierter Schilddrüsenkarzinome mu? zwischen der individuellen Prognose des Patienten, dem Ziel
der Operation und der postoperativen Morbidit?t/Mortalit?t entschieden werden. Aufgrund des hohen Risikos sollten diese Operationen
in Zentren durchgeführt werden, so da? postoperative Komplikationen (permanente Recurrensparese/Hypoparathyreoidismus) vertretbar
gering gehalten werden k?nnen (Tabelle 11).
Dennoch sollte nicht au?er Acht gelassen werden, da? individuell bei differenzierten Schilddrüsenkarzinomen im Stadium pT1
auch ein eingeschr?nkt radikales Vorgehen (Hemithyreoidektomie) ohne Verschlechterung der Prognose m?glich scheint. Strenge
Nachuntersuchungsergebnisse und Ergebnisse weiterer klinischer Studien müssen hierzu abgewartet werden. 相似文献
3.
Despite a wide array of mechanisms implicated in esophagogastric varix hemorrhage, predicting the onset of bleeding or even identifying the dominant factor in its causation has proved elusive. In this article we re-examine variceal pathophysiology and hypothesize that bleeding is rooted in turbulent portal system flow, a phenomenon embodied in the 'new' science of chaos and the principles of non-linear, rhythmic fluid dynamics. Analogous to forecasting the weather, predicting turbulent flow hinges on defining the initial physical conditions, and, like the field theory of quantum physics, depends on probabilities and instabilities rather than direct proportional analysis. Based on the complex regional and systemic hemodynamic forces and local physical properties underlying formation and perpetuation of esophagogastric varices, we propose, as with climatologic events, that a relatively minor or remote physiologic adjustment may set into motion a sequence of destabilizing splanchnic blood flow kinetics that ultimately causes a varix to erupt. In other words, the onset of varix bleeding derives from a sudden, erratic switch from disorganized but stable to disruptive turbulent variceal blood flow, and as a 'chaotic' phenomenon, is likely to remain for the foreseeable future highly unpredictable. 相似文献
4.
5.
Twenty-four-hour ambulatory blood pressure profiles in pediatric patients after renal transplantation 总被引:2,自引:2,他引:0
Nicolaus Lingens Eva Dobos Klaus Witte Christopher Busch Björn Lemmer Günther Klaus Karl Schärer 《Pediatric nephrology (Berlin, Germany)》1997,11(1):23-26
Ambulatory blood pressure monitoring was applied in 27 pediatric patients aged 6.3 – 24.3 (median 15.0) years who had been
transplanted 1.5 – 8.4 years previously. Daytime values were compared with the mean of 10 concomitant casual blood pressure
recordings. At the time of the study, antihypertensive drugs were given to 17 patients. Inulin clearance ranged from 18 to
116 (median 66) ml/min per 1.73 m2. Ambulatory blood pressure monitoring confirmed hypertension or normotension determined by casual blood pressure measurements
in 63% of patients. The physiological nocturnal dip in blood pressure was attenuated or reversed in 8 of 27 patients. It was
reduced in all 3 patients with renal artery stenosis of the graft, in 3 of 4 patients with chronic rejection, in the only
patient with recurrent focal segmental glomerulosclerosis, and in 1 of 6 patients with past acute rejection. The dipping was
not related to inulin clearance. In conclusion, casual blood pressure measurements do not accurately reflect blood pressure
in pediatric patients transplanted more than 1.5 years previously. A reduced nocturnal dip in blood pressure may indicate
an underlying renovascular or renoparenchymal pathology. Ambulatory blood pressure monitoring should regularly be applied
in patients with renal transplants.
Received May 23, 1995; received in revised form June 18, 1996; accepted June 20, 1996 相似文献
6.
M Oosterveld S Suciu G Verhoef B Labar A Belhabri C Aul D Selleslag A Ferrant P Wijermans F Mandelli S Amadori U Jehn P Muus R Zittoun U Hess O Anak F Beeldens R Willemze T de Witte 《Leukemia》2003,17(5):859-868
This report used the framework of a large European study to investigate the outcome of patients with and without an HLA-identical sibling donor on an intention-to-treat basis. After a common remission-induction and consolidation course, patients with an HLA-identical sibling donor were scheduled for allogeneic transplantation and patients lacking a donor for autologous transplantation. In all, 159 patients alive at 8 weeks from the start of treatment were included in the present analysis. In total, 52 patients had a donor, 65 patients did not have a donor and in 42 patients the availability of a donor was not assessed. Out of 52 patients, 36 (69%) with a donor underwent allogeneic transplantation (28 in CR1). Out of 65 patients, 33 (49%) received an autograft (27 in CR1). The actuarial survival rates at 4 years were 33.3% (s.e. = 6.7%) for patients with a donor and 39.0% (s.e. = 6.5%) for patients without a donor (P = 0.18). Event-free survival rates were 23.1% (s.e. = 6.2%) and 21.5% (s.e. = 5.3%), respectively (P = 0.66). Correction for alternative donor transplants did not substantially alter the survival of the group without a donor. Also, the survival in the various cytogenetic risk groups was not significantly different when comparing the donor vs the no-donor group. This analysis shows that patients with high-risk myelodysplastic syndrome and secondary acute myeloid leukemia may benefit from both allogeneic and autologous transplantation. We were unable to demonstrate a survival advantage for patients with a donor compared to patients without a donor. 相似文献
7.
BACKGROUND: The Study Centre of the German Surgical Society (SDGC) designs, conducts, and analyses multicentre randomised controlled surgical trials. The aim of this paper is to present the decision-making process and responsibilities of the SDGC from submission of a study idea to full protocol development in order to achieve transparency in trial selection. METHODS: The process is divided into four steps. Study ideas can be submitted electronically by members of the German Surgical Society using a form via the homepage of the institution. Firstly, ideas are screened by staff members within 4 weeks for methodological and clinical relevance. Feasible and novel ideas are then converted to trial outlines in cooperation with the submitting surgeon. As a third step, the Steering Committee of the SDGC decides whether to accept the project using a list of defined criteria. Finally, the SDGC draws up a full protocol together with the submitting surgeon. All ideas and decisions are accessible via the SDGC homepage. CONCLUSIONS: The process described should help in the selection of relevant projects, acquisition of grants, and maintenance of transparency in trial selection and the protocol development process. 相似文献
8.
Summary Fourteen patients with Ph'-chromosome positive chronic myelogenous leukemia (CML) in first chronic phase were treated with recombinant interferon-2c. Interferon-2c 5 to 10×106 units s.c. was given for 12 weeks as an induction therapy. Maintenance treatment consisted of interferon-2c 5 × 106 units twice weekly s.c.. Two patients (14%) attained a complete clinical remission and 6 (43%) a partial remission, 3 of whom developed progressive disease during maintenance therapy. A complete disappearance of Ph'-chromosome was achieved in 1 patient. All patients had a more than 45% initial decline of the leukocyte count. Four out of ten patients with an initially enlarged spleen demonstrated reduction in spleen size. Influenza-like symptoms, anorexia, nausea, weight loss and fatigue were common side effects. Interferon-alpha is active in CML but additional clinical investigations are warranted to assess more precisely the therapeutic value of the interferons in this disease. 相似文献
9.
10.
New methods for the detection of ECG and EOG artefacts in the EEG are introduced, which can also be used for the evaluation
of the quality of the elimination procedure. These algorithms are based on the estimation of the power or coherence spectrum
by means of FFT. The advantage of this method is that the EEG spectrum is monitored by the test algorithm. The spectrum will
be plotted if no influence of the ECG and EOG can be found. On the other hand, if artefacts are detected the correction of
the EEG time series will be carried out and the spectrum of the corrected EEG time series will be plotted after repeated monitoring
by the test algorithm. 相似文献