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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 | 2024-1-28 |
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Date of birth | 1992-10-20 yyyy-mm-dd |
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Age | 31 Years |
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Education background | Middle school
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Occupation | Famer
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Other (Description) | -- |
间断2年 小时 |
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无 |
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Number of pregnancy | 2 次 |
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Number of delivery | 1 次 |
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If has delivery history, select following items | |
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partus maturus | 1 次 |
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premature delivery | 0 次 |
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abortion | 1 次 |
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Last pregnancy | 2015-？-？ yyyy-mm-dd |
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Average times of menstrual onset a year | 12 次/年 |
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Average menstrual cycle | 30 天(days) |
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Menarche time | 12 岁(years) |
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The time of last Menstruation | 2024-1-26 年、月、日(yyyy-mm-dd) |
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The time of menstrual onset before the last one | 不详 年、月、日(yyyy-mm-dd) |
剖宫产 |
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2014 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 | 轻度糜烂样改变 |
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Corpus uteri | Normal
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Description in detail for abnormal | -- |
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Adnexa uteri | |
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Left side | Abnormal
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Description in detail for abnormal | 可触及直径6cm包块。轻压痛活动可。 |
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Right side | Normal
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Description in detail for abnormal | -- |
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Weight | 51 kg |
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Hight | 1620 mm |
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Systolic pressure (SP) | 118 mmHg |
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Diastolic pressure | 80 mmHg |
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Temperature | 36.6 degree Celsius |
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Pulse rate | 80 次/分 |
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Breath frequency | 20 次/分 |
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Doctor signature | 刘义彬 |
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Date | 2024-1-28 yyyy-mm-dd |
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WBC | 3.22 ×109 /L |
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NEUT% | 50.70 % |
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LY% | 41.60 % |
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MONO％ | 4.00 ％ |
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RBC | 4.29 ×10^12 /L |
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HGB | 129 g/L |
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PLT | 261 ×10^9 /L |
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Researcher signature | 刘义彬 |
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Date | 2024-1-29 yyyy-mm-dd |
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Acidity and allkalinity | Acidity
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pH value | 6.0 |
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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 | Negative
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KET | Negative
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SG | 1.025 |
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UBG | Negative
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NIT | Negative
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Date of test | 2024-1-29 yyyy-mm-dd |
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Date of test | 2024-1-29 yyyy-mm-dd |
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K | 3.87 mmol/L |
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Na | 141.2 mmol/L |
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Cl | 106.3 mmol/L |
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Ca | 2.27 mmol/L |
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P | 0.93 mmol/L |
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Date of examination | 2024-1-29 yyyy-mm-dd |
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Prothrombin time | 12.9 秒 |
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Thrombin time (TT) | 16.6 秒 |
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Activated partial thromboplastin time (APTT) | 29.9 秒 |
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Fibrinogen (FIB) | 1.69 g/L |
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ALT | 9.0 IU/L |
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AST | 12.0 IU/L |
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GGT | 11.0 U/L |
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Serum bilirubin | 10.13 μmol/L |
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Indirect bilirubin | 6.64 umol/L |
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Direct bilirubin | 3.49 umol/L |
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Serum albumin | 41.3 g/L |
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Serum globulin | 1.68 g/L |
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Serum total protein | 65.9 g/L |
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Date of test | 2024-1-29 yyyy-mm-dd |
Negative
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Date of test | 2024-1-29 yyyy-mm-dd |
Negative
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Date of test | 2024-1-29 yyyy-mm-dd |
Negative
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Date of test | 2024-1-29 yyyy-mm-dd |
Negative
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Date of test | 2024-1-29 yyyy-mm-dd |
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SCr | 54.0 μmol/L |
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Blood urea | 5.13 mmol/L |
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Blood uric acid | 254.0 μmol/L |
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Date of test | 2024-1-29 yyyy-mm-dd |
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D-dimer value | 0.10 ug/mL |
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Date of test | 2024-1-29 |
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Urine pregnancy test | Not tested
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Blood HCG concentration | -- mIU/mL |
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Date of test | -- yyyy-mm-dd |
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Size of the ulcer | 5.94*5.77*5.19 cm*cm |
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Uterine echo distribution | Even
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Endometrial thickness | 0.87 mm |
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Left ovary size | 4.57*2.67 cm ×cm |
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Shape of Left ovary | Ovarian cyst
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Size of the Ovarian cyst | 左卵巢旁探及7.43*5.96*5.20cm液性包块 |
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Right ovary size | 2.38*2.04 cm ×cm |
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Shape of right ovary | Ovarian cyst
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Size of Ovarian cyst | 3.55cm，内见弱网格状强回声 |
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Description of other abnormal findings | -- |
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Diagnosis of the Ultrasound B | 左侧输卵管系膜囊肿 |
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Doctor signature | 刘义彬 |
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Date of examination | 2024-1-28 yyyy-mm-dd |
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Pain Visual Analogue Score | Occasionally very slight pain
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PH | 7.435 |
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PCO2 | 35.2 mmHg |
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P02 | 395.3 mmHg |
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SO2 | 98.6 ％ |
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HCO3 | 23.1 mmol/l |
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SBE | -0.6 mmol/l |
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LAC | 0.84 mmol/L |
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Date of examination | 2024-1-30 (yyyy-mm-dd) |
左侧输卵管系膜 |
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10*10*8 cm |
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-- ° |
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刘义彬 |
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2024-1-30 |
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D-dimer value | 0.14 ug/mL |
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Date of test | 2024-2-1 |
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Body temperature | 36.3 ℃ |
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Systolic pressure (SP) | 104 mmHg |
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Diastolic pressure (DP) | 81 mmHg |
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Heart Rate, HR | 80 次/分 |
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Pulse | 80 次/秒 |
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WBC | 7.10 ×109 /L |
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NEUT% | 70.53 % |
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LY% | 23.69 % |
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MONO％ | 5.29 ％ |
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RBC | 4.07 ×10^12 /L |
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HGB | 124 g/L |
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PLT | 244 ×10^9 /L |
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Date | 2024-1-31 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 | 2024-1-29 2024-2-1 yyyy-mm-dd-hh-min. |
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Label Number of the sample | 2561076 |
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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 | 刘义彬 |
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Data | 2024-2-1 yyyymmdd |
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Site Investigator’s signature | 刘义彬 |
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Data | 2024-2-1 yyyymmdd |