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Background
Intentional carbon monoxide (CO) poisoning is responsible for two-thirds of the deaths from CO poisoning in this country and an estimated 15,000 Emergency Department visits annually.Objectives
In an attempt to optimize medical management of such patients, this study was conducted to examine the frequency and types of toxic co-ingestions that may accompany CO inhalation.Methods
Records of all patients treated with hyperbaric oxygen for acute, intentional CO poisoning at a regional referral center for hyperbaric medicine in Seattle from 1980 to 2005 were reviewed. For those where co-ingestions were identified, information about type of poison(s) and results of toxicology screens was recorded and analyzed.Results
Over the 25-year period examined, 433 patients were treated for intentional CO poisoning and records were available for 426. Of those, 188 (42%) had ingested one or more poisons in addition to CO. Ethanol was most common, but a wide variety of other drug classes were also identified. Toxicology screening studies of some type were performed in 49 patients.Conclusions
Toxic co-ingestions seem to be relatively common in patients treated for intentional CO poisoning. For this reason, providers should be vigilant and open to clinical signs that can’t be explained with CO exposure alone, and ready to treat clinical issues that arise from co-ingestions. 相似文献7.
Linda J. Porrino Robert E. Hampson Ioan Opris Samuel A. Deadwyler 《Psychopharmacology》2013,225(1):105-114
Rationale
Acute and/or chronic exposure to cocaine can affect cognitive performance, which may influence rate of recovery during treatment.Objective
Effects of the GABA-B receptor agonist baclofen were assessed for potency to reverse the negative influence of acute, pre-session, intravenous (IV) injection of cocaine on cognitive performance in Macaca mulatta nonhuman primates.Methods
Animals were trained to perform a modified delayed match to sample (DMS) task incorporating two types of trials with varying degrees of cognitive load that had different decision requirements in order to correctly utilize information retained over the delay interval. The effects of cocaine (0.2, 0.4, and 0.6 mg/kg, IV) alone and in combination with baclofen (0.29 and 0.40 mg/kg, IV) were examined with respect to sustained performance levels. Brain metabolic activity during performance of the task was assessed using PET imaged uptake of [18?F]-fluorodeoxyglucose.Results
Acute cocaine injections produced a dose-dependent decline in DMS performance selective for trials of high cognitive load. The GABA-receptor agonist baclofen, co-administered with cocaine, reversed task performance back to nondrug (saline IV) control levels. Simultaneous assessment of PET-imaged brain metabolic activity in prefrontal cortex (PFC) showed alterations by cocaine compared to PFC metabolic activation in nondrug (saline, IV) control DMS sessions, but like performance, PFC activation was returned to control levels by baclofen (0.40 mg/kg, IV) injected with cocaine.Conclusions
The results show that baclofen, administered at a relatively high dose, reversed the cognitive deficits produced by acute cocaine intoxication that may have implications for use in chronic drug exposure. 相似文献8.
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Marleen?J?NahuisEmail author Nienke?S?Weiss Fulco?van der Veen Ben?Willem?J?Mol Peter?G?Hompes Jur?Oosterhuis Nils?B?Lambalk Jesper?MJ?Smeenk Carolien?AM?Koks Ron?JT?van Golde Joop?SE?Laven Ben?J?Cohlen Kathrin?Fleischer Angelique?J?Goverde Marie?H?Gerards Nicole?F?Klijn Lizka?CM?Nekrui Ilse?AJ?van Rooij Diederik?A?Hoozemans Madelon?van Wely 《BMC women's health》2013,13(1):42
Background
Clomiphene citrate (CC) is first line treatment in women with World Health Organization (WHO) type II anovulation and polycystic ovary syndrome (PCOS). Whereas 60% to 85% of these women will ovulate on CC, only about one half will have conceived after six cycles. If women do not conceive, treatment can be continued with gonadotropins or intra-uterine insemination (IUI). At present, it is unclear for how many cycles ovulation induction with CC should be repeated, and when to switch to ovulation induction with gonadotropins and/or IUI.Methods/Design
We started a multicenter randomised controlled trial in the Netherlands comparing six cycles of CC plus intercourse or six cycles of gonadotrophins plus intercourse or six cycles of CC plus IUI or six cycles of gonadotrophins plus IUI.Women with WHO type II anovulation who ovulate but did not conceive after six ovulatory cycles of CC with a maximum of 150 mg daily for five days will be included.Our primary outcome is birth of a healthy child resulting from a pregnancy that was established in the first eight months after randomisation. Secondary outcomes are clinical pregnancy, miscarriage, multiple pregnancy and treatment costs. The analysis will be performed according to the intention to treat principle. Two comparisons will be made, one in which CC is compared to gonadotrophins and one in which the addition of IUI is compared to ovulation induction only. Assuming a live birth rate of 40% after CC, 55% after addition of IUI and 55% after ovulation induction with gonadotrophins, with an alpha of 5% and a power of 80%, we need to recruit 200 women per arm (800 women in total).An independent Data and Safety Monitoring Committee has criticized the data of the first 150 women and concluded that a sample size re-estimation should be performed after including 320 patients (i.e. 80 per arm).Discussion
The trial will provide evidence on the most effective, safest and most cost effective treatment in women with WHO type II anovulation who do not conceive after six ovulatory cycles with CC with a maximum of 150 mg daily for five days. This evidence could imply the need for changing our guidelines, which may cause a shift in large practice variation to evidence based primary treatment for these women.Trial registration number
Netherlands Trial register NTR144910.