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Eligible participant has to fullfill all of the following items | / / / / |
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Anyone with one of following items or more should be excluded: | / / / / / / / / |
- General information
- Medical history
- Physical examination
- Blood Routine Tests
- Urine Routine Test
- Blood Electrolytes Tests
- Coagulation Function Tests
- Serum Liver Function Tests
- HBV/HCV/HIV/Syphilis Markers Test
- Renel Function Test
- D-dimer
- hCG Test
- Image Examinations
- Visual Analogue Scale
- Blood Gas Analysis
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Date of signing the informed consent | 2024-1-16 |
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Date of birth | 1975-07-19 yyyy-mm-dd |
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Age | 48 Years |
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Education background | Middle school
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Occupation | Famer
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Other (Description) | 子宫切除前腹痛腹胀，子宫切除后腹痛消失，腹胀存在。 |
2+月 小时 |
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无 |
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Number of pregnancy | 4 次 |
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Number of delivery | 3 次 |
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If has delivery history, select following items | |
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partus maturus | 3 次 |
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premature delivery | 0 次 |
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abortion | 1 次 |
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Last pregnancy | 20年前具体不详 yyyy-mm-dd |
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Average times of menstrual onset a year | 12 次/年 |
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Average menstrual cycle | 27 天(days) |
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Menarche time | 14 岁(years) |
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The time of last Menstruation | 4个月前子宫切除 年、月、日(yyyy-mm-dd) |
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The time of menstrual onset before the last one | 6年前子宫内膜消融医源性绝经 年、月、日(yyyy-mm-dd) |
子宫内膜消融 子宫切除 |
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6年前 4个月前 年/月/日（yyyy-mm-dd） |
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Namy of the drug to be allergied | 无 |
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Vulva | Normal
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Description in detail for abnormal | - |
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Vagina | Normal
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Description in detail for abnormal | - |
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Uterine neck | Abnormal
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Description in detail for abnormal | 确如 |
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Corpus uteri | Abnormal
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Description in detail for abnormal | 缺如 |
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Adnexa uteri | |
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Left side | Abnormal
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Description in detail for abnormal | 5cm囊性包块 |
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Right side | Abnormal
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Description in detail for abnormal | 5cm囊性包块 |
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Weight | 65 kg |
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Hight | 1500 mm |
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Systolic pressure (SP) | 114 mmHg |
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Diastolic pressure | 72 mmHg |
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Temperature | 36.1 degree Celsius |
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Pulse rate | 96 次/分 |
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Breath frequency | 22 次/分 |
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Doctor signature | 刘义彬 |
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Date | 2024-1-17 yyyy-mm-dd |
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WBC | 8.60 ×109 /L |
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NEUT% | 60.53 % |
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LY% | 30.08 % |
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MONO％ | 6.59 ％ |
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RBC | 4.74 ×10^12 /L |
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HGB | 139 g/L |
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PLT | 310 ×10^9 /L |
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Researcher signature | 刘义彬 |
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Date | 2024-1-17 yyyy-mm-dd |
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Acidity and allkalinity | Acidity
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pH value | 5.5 |
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Urine protein | Negative
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Urine red cell | Negative
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Urine WBC | Negative
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Urine glucos | Negative
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Urine Bilirubin | Negative
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Urine HCG | |
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KET | Negative
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SG | 1.019 |
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UBG | Negative
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NIT | Negative
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Date of test | 2024-1-17 yyyy-mm-dd |
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Date of test | 2024-1-17 yyyy-mm-dd |
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K | 4.12 mmol/L |
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Na | 141.6 mmol/L |
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Cl | 103.2 mmol/L |
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Ca | 2.37 mmol/L |
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P | 1.18 mmol/L |
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Date of examination | 2024-1-17 yyyy-mm-dd |
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Prothrombin time | 11.1 秒 |
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Thrombin time (TT) | 13.4 秒 |
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Activated partial thromboplastin time (APTT) | 30.8 秒 |
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Fibrinogen (FIB) | 3.03 g/L |
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ALT | 9.8 IU/L |
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AST | 14.8 IU/L |
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GGT | 26.0 U/L |
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Serum bilirubin | 18.50 μmol/L |
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Indirect bilirubin | 14.00 umol/L |
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Direct bilirubin | 4.50 umol/L |
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Serum albumin | 43.0 g/L |
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Serum globulin | 23.4 g/L |
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Serum total protein | 66.4 g/L |
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Date of test | 2024-1-17 yyyy-mm-dd |
Negative
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Date of test | 2024-1-17 yyyy-mm-dd |
Negative
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Date of test | 2024-1-17 yyyy-mm-dd |
Negative
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Date of test | 2024-1-17 yyyy-mm-dd |
Negative
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Date of test | 2024-1-17 yyyy-mm-dd |
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SCr | 54.0 μmol/L |
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Blood urea | 4.50 mmol/L |
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Blood uric acid | 266.0 μmol/L |
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Date of test | 2024-1-17 yyyy-mm-dd |
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D-dimer value | 0.06 ug/mL |
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Date of test | 2024-1-17 |
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Urine pregnancy test | Not tested
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Blood HCG concentration | 未查 mIU/mL |
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Date of test | -- yyyy-mm-dd |
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Size of the ulcer | 缺如 cm*cm |
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Uterine echo distribution | |
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Endometrial thickness | -- mm |
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Left ovary size | cm ×cm |
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Shape of Left ovary | Ovarian cyst
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Size of the Ovarian cyst | 5cm |
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Right ovary size | -- cm ×cm |
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Shape of right ovary | Ovarian cyst
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Size of Ovarian cyst | 5cm |
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Description of other abnormal findings | -- |
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Diagnosis of the Ultrasound B | 双卵巢囊肿 |
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Doctor signature | 刘义彬 |
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Date of examination | 2024-1-16 yyyy-mm-dd |
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Pain Visual Analogue Score | very slight pain
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PH | -- |
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PCO2 | -- mmHg |
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P02 | -- mmHg |
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SO2 | -- ％ |
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HCO3 | -- mmol/l |
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SBE | -- mmol/l |
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LAC | -- mmol/L |
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Date of examination | -- (yyyy-mm-dd) |
双侧附件 |
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双侧均5cm cm |
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无 ° |
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刘义彬 |
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2024-1-20 |
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D-dimer value | 0.11 ug/mL |
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Date of test | 2024-1-20 |
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Body temperature | 36.2 ℃ |
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Systolic pressure (SP) | 103 mmHg |
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Diastolic pressure (DP) | 70 mmHg |
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Heart Rate, HR | 76 次/分 |
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Pulse | 90 次/秒 |
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WBC | 15.8 ×109 /L |
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NEUT% | 82.17 % |
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LY% | 10.69 % |
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MONO％ | 6.49 ％ |
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RBC | 4.44 ×10^12 /L |
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HGB | 129 g/L |
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PLT | 283 ×10^9 /L |
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Date | 2024-1-19 yyyy-mm-dd |
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Pain Visual Analogue Score | Occasionally very slight pain
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sample collection | Collected
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Volume | 1 ml |
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Time of collection | 2024-1-19 yyyy-mm-dd-hh-min. |
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Label Number of the sample | 2557774 |
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Date received at DCC | -- yyyymmdd |
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Report type | |
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Name of this event | -- |
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SAE start date | -- yyyymmdd |
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SAE stop date | -- yyyymmdd |
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Was this an unanticipated adverse event | |
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Attribution to Study Drug | |
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Outcome Type(check all that apply) | |
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Recovery Description: (check only one) | |
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Please provide a brief narrative of the SAE occurrence below | -- |
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Name of the recorder | -- |
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Data | -- yyyymmdd |
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Site Investigator’s signature | - |
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Data | -- yyyymmdd |