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1.Screening
1.1.Inclusion Criteria

Inclusion criteria

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1.2.Exclusion Criteria

刘义彬

Date

2022-2-9 yyyy-mm-dd

2.Baseline
2.1.Medical History

24 小时

Average times of menstrual onset a year

-- 次/年

Average menstrual cycle

-- 天(days)

Menarche time

-- 岁(years)

The time of last Menstruation

-- 年、月、日(yyyy-mm-dd)

The time of menstrual onset before the last one

-- 年、月、日(yyyy-mm-dd)

Disease or surgery name

--

Date of the confirmation or the surgery

-- 年/月/日(yyyy-mm-dd)

Date

2022-2-9 yyyy-mm-dd

2.2.General information

Date of signing the informed consent

2022-2-9

Date of birth

2011-7-8 yyyy-mm-dd

Age

10 Years

Education background

Primary school

Occupation

Other

Other (Description)

学生

2.3.Physical examination

Vulva

Not examined

Description in detail for abnormal

--

Vagina

Not examined

Description in detail for abnormal

--

Uterine neck

Not examined

Description in detail for abnormal

--

Corpus uteri

Not examined

Description in detail for abnormal

--

Adnexa uteri

Left side

Not examined

Description in detail for abnormal

--

Right side

Not examined

Description in detail for abnormal

--

Weight

39 kg

Hight

1400 mm

Systolic pressure (SP)

104 mmHg

Diastolic pressure

59 mmHg

Temperature

36.7 degree Celsius

Pulse rate

104 次/分

Breath frequency

24 次/分

Doctor signature

刘义彬

Date

2022-2-9 yyyy-mm-dd

2.4.Blood Routine Tests

WBC

8.1 ×109 /L

NEUT%

70.6 %

LY%

20.2 %

RBC

4.66 ×10^12 /L

MONO%

4.8

HGB

140 g/L

PLT

304 ×10^9 /L

Researcher signature

刘义彬

Date

2022-2-9 yyyy-mm-dd

2.5.Urine Routine Test

Acidity and allkalinity

pH value

未查

Urine protein

Urine red cell

Urine WBC

Urine glucos

Urine Bilirubin

Urine HCG

KET

SG

未查

UBG

NIT

Date of test

未查 yyyy-mm-dd

2.6.Blood Biochemical items Tests

ALT

8.4 U/L

AST

14.4 U/L

GGT/γ-GT

10 U/L

ALP

348 U/L

TBIL

6.1 μmol/L

DBIL

2.8 μmol/L

IBIL

3.3 μmol/L

ALB

49.7 g/L

UA

368 umol/L

UREA

2.6 mmol/L

TC

未查 mmol/L

Cr

44 umol/L

TG

未查 mmol/L

HDL

未查 mmol/L

LDL

未查 mmol/L

CK

未查 U/L

CK-MB

未查 U/L

LDH

未查 U/L

K

4.05 mmol/L

Na

139.7 mmol/L

Cl

104.7 mmol/L

Ca

2.41 mmol/L

Glu

4.89 mmol/L

Date

2022-2-9 yyyy-mm-dd

2.7.Coagulation Function Tests

Prothrombin time

12

Thrombin time (TT)

14.6

Activated partial thromboplastin time (APTT)

31.6

Fibrinogen (FIB)

2.42 g/L

Date of examination

2022-2-9 yyyy-mm-dd

2.8.HBV/HCV/HIV/Syphilis Markers Test

HBV

Negative

HCV

Negative

Negtive

Negative

Date of test

2022-2-9 yyyy-mm-dd

2.9.Blood Gas Analysis

Date of examination

2022-2-9 (yyyy-mm-dd)

LAC

1.5 mmol/L

SBE

-5.6 mmol/l

HCO3

18.8 mmol/l

SO2

99.6

PCO2

33.3 mmHg

P02

105 mmHg

PH

7.369

2.10.D-dimer Test

0.08

2.11.HCG Test

未查 mIU/mL

Urine HCG

Not detected

2.12.Visual Analogue Scale

Pain Visual Analogue Score

Quit pain barely tolerable

2.13.Image Examinations

--

未描述 cm*cm*cm

未记录

10 cm

未描述 cm

Date of examination

20222-2-9 yyyy-mm-dd

Abdomen CT examination

Not tested

Description in detail for abnormal

--

Date of examination

-- yyyy-mm-dd

--

2.14.Other Tests
3.In the process of the treatment
3.1.Treatment Record

左卵巢

10*9*10cm cm

顺时针720 °

decollement

亓文博

2022-2-9

4.Follow-up
4.1.Physical examination

BG Puncture site

No

Temperature

37

Systolic pressure (SP)

91 mmHg

Diastolic pressure (DP)

55 mmHg

Heart Rate, HR

96 次/分

Blood pressure

91/55 mmHg

4.2.Blood Routine Test

WBC

8.5 ×109 /L

NEUT%

69.3 %

LY%

18.1 %

MONO%

8.7

RBC

4.02 ×10^12 /L

HGB

122 g/L

PLT

263 ×10^9 /L

Date

2022-2-10 yyyy-mm-dd

4.3.D-dimer test

D-dimer

D-dimer

未查

Date of test

yyyy-mm-dd

4.4.Visual Analogue Scale

Pain Visual Analogue Score

very slight pain
/
very slight pain

5.Management system of participants

sample collection

Collected

Volume

1 ml

Time of collection

2022-2-9 yyyy-mm-dd-hh-min.

Label Number of the sample

57106

6.ADR/ADE management system

Is there any adverse event?

No

No

No

Severity

Within 30 minites or not?

No

Begin time at

--- 年/月/日(yyyy-mm-dd)

Time of stop

-- 年/月/日(yyyy-mm-dd)