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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 | 2024-1-31 |
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Date of birth | 2005-04-08 yyyy-mm-dd |
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Age | 18 Years |
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Education background | Middle school
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Occupation | Other
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Other (Description) | 学生 |
1年前间断腰痛，1月前骶髂关节疼痛。 小时 |
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久坐后 |
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Number of pregnancy | 0 次 |
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Number of delivery | 0 次 |
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If has delivery history, select following items | |
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partus maturus | -- 次 |
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premature delivery | -- 次 |
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abortion | -- 次 |
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Last pregnancy | -- yyyy-mm-dd |
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Average times of menstrual onset a year | 11 次/年 |
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Average menstrual cycle | 31.5 天(days) |
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Menarche time | 11 岁(years) |
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The time of last Menstruation | 2024-01-21 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) |
斜视手术 |
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2018 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 | Not examined
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Description in detail for abnormal | -- |
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Uterine neck | Not examined
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Description in detail for abnormal | -- |
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Corpus uteri | Not examined
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Description in detail for abnormal | --- |
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Adnexa uteri | |
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Left side | Normal
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Description in detail for abnormal | -- |
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Right side | Abnormal
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Description in detail for abnormal | 7*8*8cm包块 |
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Weight | 72 kg |
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Hight | 1670 mm |
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Systolic pressure (SP) | 129 mmHg |
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Diastolic pressure | 87 mmHg |
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Temperature | 36.2 degree Celsius |
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Pulse rate | 100 次/分 |
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Breath frequency | 23 次/分 |
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Doctor signature | 刘义彬 |
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Date | 2024-1-31 yyyy-mm-dd |
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WBC | 6.80 ×109 /L |
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NEUT% | 52.40 % |
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LY% | 37.00 % |
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MONO％ | 5.46 ％ |
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RBC | 3.90 ×10^12 /L |
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HGB | 116 g/L |
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PLT | 291 ×10^9 /L |
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Researcher signature | 刘义彬 |
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Date | 2024-2-1 yyyy-mm-dd |
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Acidity and allkalinity | Acidity
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pH value | 6.5 |
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Urine protein | |
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Urine red cell | Negative
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Urine WBC | Positive+++
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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 | |
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SG | 1.017 |
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UBG | Negative
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NIT | Negative
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Date of test | 2024-2-1 yyyy-mm-dd |
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Date of test | 2024-2-1 yyyy-mm-dd |
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K | 4.39 mmol/L |
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Na | 141.8 mmol/L |
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Cl | 105.5 mmol/L |
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Ca | 2.23 mmol/L |
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P | 1.35 mmol/L |
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Date of examination | 2024-2-1 yyyy-mm-dd |
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Prothrombin time | 12.5 秒 |
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Thrombin time (TT) | 15.9 秒 |
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Activated partial thromboplastin time (APTT) | 32.5 秒 |
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Fibrinogen (FIB) | 2.27 g/L |
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ALT | 11.9 IU/L |
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AST | 16.2 IU/L |
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GGT | 12.0 U/L |
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Serum bilirubin | 12.40 μmol/L |
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Indirect bilirubin | 8.70 umol/L |
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Direct bilirubin | 3.70 umol/L |
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Serum albumin | 41.5 g/L |
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Serum globulin | 20.9 g/L |
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Serum total protein | 62.4 g/L |
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Date of test | 2024-2-1 yyyy-mm-dd |
Negative
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Date of test | 2024-2-1 yyyy-mm-dd |
Negative
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Date of test | 2024-2-1 yyyy-mm-dd |
Negative
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Date of test | 2024-2-1 yyyy-mm-dd |
Negative
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Date of test | 2024-2-1 yyyy-mm-dd |
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SCr | 46.0 μmol/L |
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Blood urea | 3.60 mmol/L |
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Blood uric acid | 260.0 μmol/L |
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Date of test | 2024-2-1 yyyy-mm-dd |
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D-dimer value | 0.05 ug/mL |
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Date of test | 2024-2-1 |
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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 | 5.66*4.75*4.41 cm*cm |
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Uterine echo distribution | Not even
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Endometrial thickness | 1.16 mm |
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Left ovary size | 2.68*2.21 cm ×cm |
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Shape of Left ovary | Normal
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Size of the Ovarian cyst | -- |
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Right ovary size | 7.73*6.02 cm ×cm |
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Shape of right ovary | Ovarian cyst
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Size of Ovarian cyst | 7.30 |
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Description of other abnormal findings | -- |
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Diagnosis of the Ultrasound B | 右卵巢囊肿 |
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Doctor signature | 刘义彬 |
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Date of examination | 2024-1-20 yyyy-mm-dd |
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Pain Visual Analogue Score | Occasionally very slight pain
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PH | 7.413 |
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PCO2 | 39.9 mmHg |
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P02 | 327.5 mmHg |
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SO2 | 98.4 ％ |
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HCO3 | 24.9 mmol/l |
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SBE | 0.3 mmol/l |
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LAC | 0.88 mmol/L |
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Date of examination | 2024-2-2 (yyyy-mm-dd) |
右卵巢 |
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7cm cm |
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-- ° |
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| / | |
刘义彬 |
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2024-2-2 |
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D-dimer value | 0.13 ug/mL |
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Date of test | 2024-2-3 |
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Body temperature | 37.2 ℃ |
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Systolic pressure (SP) | 109 mmHg |
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Diastolic pressure (DP) | 67 mmHg |
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Heart Rate, HR | 100 次/分 |
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Pulse | 100 次/秒 |
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WBC | 11.20 ×109 /L |
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NEUT% | 77.11 % |
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LY% | 14.85 % |
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MONO％ | 7.71 ％ |
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RBC | 3.68 ×10^12 /L |
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HGB | 109 g/L |
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PLT | 276 ×10^9 /L |
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Date | 2024-2-3 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 | 2024-2-1 2024-2-3 yyyy-mm-dd-hh-min. |
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Label Number of the sample | 2562016 |
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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 |