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1.Screening
1.1.Inclusion Criteria

Inclusion criteria

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1.2.Exclusion Criteria

刘义彬

Date

2022-08-28 yyyy-mm-dd

2.Baseline
2.1.Medical History

小时

Average times of menstrual onset a year

次/年

Menarche time

岁(years)

Average menstrual cycle

天(days)

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

yyyy-mm-dd

2.2.General information

Date of signing the informed consent

Date of birth

yyyy-mm-dd

Age

Years

Education background

Occupation

Other (Description)

2.3.Physical examination

Vulva

Description in detail for abnormal

Vagina

Description in detail for abnormal

Uterine neck

Description in detail for abnormal

Corpus uteri

Description in detail for abnormal

Adnexa uteri

Left side

Description in detail for abnormal

Right side

Description in detail for abnormal

Weight

kg

Hight

mm

Systolic pressure (SP)

mmHg

Diastolic pressure

mmHg

Temperature

degree Celsius

Pulse rate

次/分

Breath frequency

次/分

Doctor signature

Date

yyyy-mm-dd

2.4.Blood Routine Tests

WBC

×109 /L

NEUT%

%

LY%

%

MONO%

RBC

×10^12 /L

HGB

g/L

PLT

×10^9 /L

Researcher signature

Date

yyyy-mm-dd

2.5.Urine Routine Test

Acidity and allkalinity

pH value

Urine protein

Urine red cell

Urine WBC

Urine glucos

Urine Bilirubin

Urine HCG

KET

SG

UBG

NIT

Date of test

yyyy-mm-dd

2.6.Blood Biochemical items Tests

ALT

U/L

AST

U/L

GGT/γ-GT

U/L

ALP

U/L

TBIL

μmol/L

DBIL

μmol/L

IBIL

μmol/L

ALB

g/L

UA

umol/L

UREA

mmol/L

TC

mmol/L

Cr

umol/L

TG

mmol/L

HDL

mmol/L

LDL

mmol/L

CK

U/L

CK-MB

U/L

LDH

U/L

K

mmol/L

Na

mmol/L

Cl

mmol/L

Ca

mmol/L

Glu

mmol/L

Date

yyyy-mm-dd

2.7.Coagulation Function Tests

Prothrombin time

Thrombin time (TT)

Activated partial thromboplastin time (APTT)

Fibrinogen (FIB)

g/L

Date of examination

yyyy-mm-dd

2.8.HBV/HCV/HIV/Syphilis Markers Test

HBV

HCV

Date of test

yyyy-mm-dd

2.9.Blood Gas Analysis

Date of examination

(yyyy-mm-dd)

SO2

HCO3

mmol/l

LAC

mmol/L

SBE

mmol/l

P02

mmHg

PCO2

mmHg

PH

2.10.D-dimer Test

2.11.HCG Test

mIU/mL

Urine HCG

2.12.Visual Analogue Scale

Pain Visual Analogue Score

2.13.Image Examinations

cm*cm*cm

cm

cm

Date of examination

yyyy-mm-dd

Abdomen CT examination

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

右附件

8*7*7 cm

逆时针扭转720 °

Detwist

张明乐

2022-08-29

4.Follow-up
4.1.Physical examination

BG Puncture site

No

Temperature

37

Systolic pressure (SP)

117 mmHg

Diastolic pressure (DP)

74 mmHg

Heart Rate, HR

80 次/分

Blood pressure

117/74 mmHg

4.2.Blood Routine Test

WBC

6.4 ×109 /L

NEUT%

59.20 %

LY%

32.0 %

MONO%

7.80

RBC

4.11 ×10^12 /L

HGB

90 g/L

PLT

294 ×10^9 /L

Date

2022-8-30 yyyy-mm-dd

4.3.D-dimer test

D-dimer

D-dimer

0.21

Date of test

2022-8-30 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

2 ml

Time of collection

2022-8-30 yyyy-mm-dd-hh-min.

Label Number of the sample

2437937

6.ADR/ADE management system

Is there any adverse event?

No

No

No

Severity

Within 30 minites or not?

Begin time at

-- 年/月/日(yyyy-mm-dd)

Time of stop

-- 年/月/日(yyyy-mm-dd)