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排序方式: 共有491条查询结果,搜索用时 15 毫秒
1.
Caroline A. Bulstra Jan A. C. Hontelez Moritz Otto Anna Stepanova Erik Lamontagne Anna Yakusik Wafaa M. El-Sadr Tsitsi Apollo Miriam Rabkin UNAIDS Expert Group on Integration Rifat Atun Till Brnighausen 《PLoS medicine》2021,18(11)
BackgroundIntegration of HIV services with other health services has been proposed as an important strategy to boost the sustainability of the global HIV response. We conducted a systematic and comprehensive synthesis of the existing scientific evidence on the impact of service integration on the HIV care cascade, health outcomes, and cost-effectiveness.Methods and findingsWe reviewed the global quantitative empirical evidence on integration published between 1 January 2010 and 10 September 2021. We included experimental and observational studies that featured both an integration intervention and a comparator in our review. Of the 7,118 unique peer-reviewed English-language studies that our search algorithm identified, 114 met all of our selection criteria for data extraction. Most of the studies (90) were conducted in sub-Saharan Africa, primarily in East Africa (55) and Southern Africa (24). The most common forms of integration were (i) HIV testing and counselling added to non-HIV services and (ii) non-HIV services added to antiretroviral therapy (ART). The most commonly integrated non-HIV services were maternal and child healthcare, tuberculosis testing and treatment, primary healthcare, family planning, and sexual and reproductive health services. Values for HIV care cascade outcomes tended to be better in integrated services: uptake of HIV testing and counselling (pooled risk ratio [RR] across 37 studies: 1.67 [95% CI 1.41–1.99], p < 0.001), ART initiation coverage (pooled RR across 19 studies: 1.42 [95% CI 1.16–1.75], p = 0.002), time until ART initiation (pooled RR across 5 studies: 0.45 [95% CI 0.20–1.00], p = 0.050), retention in HIV care (pooled RR across 19 studies: 1.68 [95% CI 1.05–2.69], p = 0.031), and viral suppression (pooled RR across 9 studies: 1.19 [95% CI 1.03–1.37], p = 0.025). Also, treatment success for non-HIV-related diseases and conditions and the uptake of non-HIV services were commonly higher in integrated services. We did not find any significant differences for the following outcomes in our meta-analyses: HIV testing yield, ART adherence, HIV-free survival among infants, and HIV and non-HIV mortality. We could not conduct meta-analyses for several outcomes (HIV infections averted, costs, and cost-effectiveness), because our systematic review did not identify sufficient poolable studies. Study limitations included possible publication bias of studies with significant or favourable findings and comparatively weak evidence from some world regions and on integration of services for key populations in the HIV response.ConclusionsIntegration of HIV services and other health services tends to improve health and health systems outcomes. Despite some scientific limitations, the global evidence shows that service integration can be a valuable strategy to boost the sustainability of the HIV response and contribute to the goal of ‘ending AIDS by 2030’, while simultaneously supporting progress towards universal health coverage.Caroline Bulstra and co-workers assess evidence on the benefits of service integration in the HIV care cascade. 相似文献
2.
I P Ashchmarin T A Goilo V P Goncharova G A Nechaeva I S Stepanova 《Biokhimii?a (Moscow, Russia)》1975,40(2):331-338
Cationic proteins of brain lysosomes (LCP), myelin (MCP) and nuclear histone fractions from calf thymus (T) and rat brain (B) are shown to increase at different degree the permeability of brain lysosomes and neutrophiles for acid RNAase, acid phosphatase, catepsin D and beta-galactosidase. According to the effectivity, basic proteins can be listed in the following order: for lysosomes-f2aT, F3B, f3T greater than total histones B, f2bT greater than f2B greater than LCP, MCP greater than flT, flB; for neutriphiles-f3T larger than or equal to total histones B larger than or equal to f3b MCP larger than or equal to f2aT, f2bT greater than f2B greater than LCP greater than flB greater than flT. Fractions f2a and f3 considerably increased the release of acid RNAase from lysosomes in very low concentrations beginning from 0,2 mug/ml, while the release of catepsine and acid phosphatase took place beginning from 5-10 mug/ml. The effect of lysosome and myelin cationic proteins on the release of hydrolases occurred at concentrations ten to hundred times higher. 相似文献
3.
A. A. Stepanova Ya. D. Karpova G. A. Bozhok V. D. Ustichenko Yu. V. Lyupina E. I. Legach M. S. Vagida D. B. Kazansky T. P. Bondarenko N. P. Sharova 《Russian Journal of Bioorganic Chemistry》2014,40(1):36-47
Proteasomes in the liver of August rats (RT1c) were investigated 30 days after allotransplantation of Wistar rat (RT1u) thyroid tissue under renal capsule with/without induction of donor-specific tolerance by donor splenocyte intraportal administration. The levels of total proteasome pool, immune proteasomes containing subunits LMP2 and/or LMP7, and proteasome regulators 19S and 11S were defined. Intact and sham-operated August rats were used as control groups. The level of all immune proteasome forms and 11S regulator increased while the level of the total proteasome pool and 19S regulator decreased in the liver of experimental animals compared to the control groups, which indicated changes of liver functional state after transplantation. The 19S/11S ratio increased in the liver of nontolerant rats compared to tolerant animals. In the liver of tolerant rats with accepted grafts, the number of mononuclear cells expressing the immune subunit LMP2 greatly increased in comparison with control and nontolerant animals. Study of accepted grafts showed an increase in the ratio of LMP2/LMP7 immune subunits and 19S/11S regulators in them, compared to the tissue replacing the rejected grafts. Immune proteasomes were almost completely absent from the control intact thyroid tissue, while 19S/11S ratio was maximal in it. Thus, the development of the immune reaction or its suppression are accompanied by a change in the balance between different proteasome forms. Immune subunit LMP7 and 11S regulator are associated with the response against donor tissue. On the contrary, immune subunit LMP2 and 19S regulator are likely to be important for the development of immune tolerance and surviving tissue functioning. Immunofluorescence assay revealed a low content of the immune proteasomes in the follicle cells. Probably, formation of antigens for the major histocompatibility complex class I molecules was impaired by the low content of immune proteasomes, which led to immunological tolerance of hormone-producing follicle cells. 相似文献
4.
A. R. Kotovskaya M. I. Koloteva V. Yu. Luk’yanuk G. P. Stepanova L. M. Filatova S. P. Builov A. F. Zhernavkov L. L. Kondratuk 《Human physiology》2010,36(7):871-876
Analysis of alterations in the cardiac activity on the basis of electrocardiographic (ECG) findings in 29 cosmonauts of flight
and ground professions aged from 29 to 61 years after 34 short (8–30 days) space flights (SFs) between 1982 and 2006 has been
carried out. The ECG data at the stage of clinical selection, clinical-physiological examination (CPE) before a SF, at the
stage of the launch of a spacecraft (SC) into orbit and its landing on Earth and at the stage of postflight CPE have been
analyzed. The analysis of cardiac activity parameters on the basis of ECG data at different stages of observations has led
to the identification of three groups of cosmonauts. There were no significant changes or negative tendencies in the alteration
of ECG data in the first group (55.2% of the total number of cosmonauts) during the observation period from selection to the
end of the SF. The changes that later became more pronounced during the landing on Earth and were retained during postflight
CPE have been found in the second group of cosmonauts (in 34.5% cases) at the time of selection and preflight CPE. Considerable
disturbances in cardiac activity that are dangerous for human health have been found in ECGs in the third group (10.3%) during
the descent from orbit. The data from the study are the first step in the investigation of possible medical risks for the
development and improvement of requirements for the medical selection of crews and the admission of subjects with partial
health insufficiency on SFs. 相似文献
5.
A. T. Eprintsev M. I. Falaleeva I. Yu. Stepanova N.V. Parfenova M. Zuzu 《Biology Bulletin》2003,30(3):243-247
Malate dehydrogenase (E.C. 1.1.1.37) from the bacterium Beggiatoa leptomitiformis was isolated and purified 123-fold using a five-step purification procedure including the enzyme extraction, ammonium sulfate protein fractionation, gel filtration, ion exchange chromatography, and gel chromatography. The enzyme was homogenous according to the electrophoresis data; its activity was 20.43 U/mg protein. This malate dehydrogenase is a homotetramer (Mr = 172 kDa). The catalytic and thermodynamic properties, as well as the analysis of the published data suggest that the tetrameric structure of the enzyme allows it to participate in constructive metabolism supplying the cell with organic acids as a source of carbon. 相似文献
6.
O. N. Stepanova 《Entomological Review》2016,96(7):848-852
Data on the fauna, abundance and prevalence of chewing lice collected from 360 specimens of 13 sedentary species of passerine birds in Yakutia are given. A total of 3206 specimens of chewing lice belonging to 27 species of 6 genera were collected. Most of the studied bird species were infested with several chewing lice species. Exchange of parasites may take place between some bird species in the study region. 相似文献
7.
Khyzhniak SV Prokhorova AO Hryshchenko VA Stepanova LI Sorokina LV Tomchuk VA 《Ukrainski? biokhimicheski? zhurnal》2010,82(4):105-111
Lipid peroxidation (LPO) and antioxidant system functioning in the blood, liver and small intestine mucosal cells of rats under cadmium chloride intake and administration of the liposomal form of the biologically active supplement (BAS FLP-MD) have been studied. It is shown that cadmium chloride administration (1 mg/kg, 14 days) leads to the activation of the oxidative processes in the cells and decrease of the antioxidant enzyme activities including mitochondrial enzymes. The revealed inhibition of the hepatic superoxide dismutase (SOD) activity considerably determined by the effect on mitochondrial Cu, Zn-SOD. The effect of one-shot and long-term cadmium intake on the conjugation system and decrease of the tissue glutathione level were shown. BAS FLP-MD intake normalizes the oxidative processes possibly due to stabilization of the cellular components. 相似文献
8.
Stepanova E. V. Koroleva O. V. Gavrilova V. P. Landesman E. O. Makower A. Papkovsky D. B. 《Applied Biochemistry and Microbiology》2003,39(5):482-487
Stability characteristics of the laccases of the basidiomycetes Coriolus hirsutus and Coriolus zonatus were measured comparatively at temperatures of 25 and 40°C in the presence of various effectors (proteins, salts, polyalcohols, polyacids, and polyelectrolytes). Stabilization effects of cations on the laccases from C. hirsutus and C. zonatus decreased in the descending series Cu2+ > Mg2+ > Ca2+ and Ca2+ > Mg2+ > Mn2+, respectively. Tween 20 caused insignificant stabilization of the two enzymes. The C. zonatus laccase was also insignificantly stabilized as a result of treatment with bovine serum albumin. The enzymatic activity of the laccase preparations from C. hirsutus and C. zonatus was conserved virtually completely after vacuum drying (84 and 93%, respectively). The most effective stabilizer of the C. hirsutus laccase was found to be dextran (17 kDa). Dry preparations treated with this agent conserved up to 95% of the enzymatic activity. The most effective stabilizer of the C. zonatus laccase was polyacrylic acid (102% of the initial activity). 相似文献
9.
The main idea of the authors' paper is to propose the most reasonable way of actively introducing the digital principle into the traditional roentgenological section of radiation diagnosis. For this, a luminophore digital radiography system has been chosen. The authors of the paper give a full-scale assessment and appropriate recommendations for its use. The paper essentially discusses the entire complex of matters that permit assessment whether its sound use is possible in regional and municipal health care systems. This is both a section devoted to a dose load, by making a comparative assessment of luminophore radiography and the green system and a study of different clinical diseases (456 cases). In their study, the authors have applied an original principle in the formation of an image obtained and some other approaches in order to make a comprehensive assessment of this method. In the authors' opinion, luminophore radiography has a variety of advantages. Firstly, this technique can be simultaneously applied to several nondigital apparatuses, including those available in the ward and it shows a rather diagnostic effectiveness and economic profitability, yields a qualitative image of varying density tissues upon single exposure, and has some other capacities of the CR system as a digital technique. All this things considered, the authors consider that luminophore radiography may be one of the main ways of introducing a digital technique into the conventional roentgenological section of radiation diagnosis at the level of regional and municipal heath care systems. 相似文献
10.
Bryushkova EA Vladychenskaya EA Stepanova MS Boldyrev AA 《Biochemistry. Biokhimii?a》2011,76(4):467-472
We have found that neutrophils begin to express NMDA receptors on their membranes after in vivo activation. These receptors are the target for action of homocysteine (HC). After incubation of activated neutrophils with
HC, the degranulation process is stimulated and generation of reactive oxygen species is increased. We conclude that expression
of NMDA receptors on neutrophil membrane makes neutrophils sensitive to HC. Thus, hyperhomocysteinemia may induce additional
stimulation of immune competent cells. 相似文献