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1.Screening
1.1.Inclusion Criteria

Inclusion criteria

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1.2.Exclusion Criteria

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刘义彬

Date

2018-6-12 yyyy-mm-dd

2.Baseline
2.1.Medical History

48 小时

Average times of menstrual onset a year

13 次/年

Average menstrual cycle

28 天(days)

Menarche time

13 岁(years)

The time of last Menstruation

2018-6-8 年、月、日(yyyy-mm-dd)

The time of menstrual onset before the last one

不详 年、月、日(yyyy-mm-dd)

Disease or surgery name

慢性乙肝小三阳

Date of the confirmation or the surgery

5+年前诊断 年/月/日(yyyy-mm-dd)

Date

2018-6-12 yyyy-mm-dd

2.2.General information

Date of signing the informed consent

2018-6-12

Date of birth

1992-12-14 yyyy-mm-dd

Age

25 Years

Education background

Middle school

Occupation

Famer

Other (Description)

--

2.3.Physical examination

Vulva

Normal

Description in detail for abnormal

--

Vagina

Normal

Description in detail for abnormal

--

Uterine neck

Normal

Description in detail for abnormal

--

Corpus uteri

Normal

Description in detail for abnormal

--

Adnexa uteri

Left side

Normal

Description in detail for abnormal

--

Right side

Abnormal

Description in detail for abnormal

可触及20cm包块

Weight

62 kg

Hight

1600 mm

Systolic pressure (SP)

113 mmHg

Diastolic pressure

82 mmHg

Temperature

37.1 degree Celsius

Pulse rate

109 次/分

Breath frequency

23 次/分

Doctor signature

刘义彬

Date

2018-6-12 yyyy-mm-dd

2.4.Blood Routine Tests

WBC

7.30 ×109 /L

NEUT%

63.10 %

LY%

26.60 %

MONO%

8.60

RBC

4.22 ×10^12 /L

HGB

132 g/L

PLT

276 ×10^9 /L

Researcher signature

刘义彬

Date

2018-6-11 yyyy-mm-dd

2.5.Urine Routine Test

Acidity and allkalinity

Acidity

pH value

5.5

Urine protein

Negative

Urine red cell

Negative

Urine WBC

Negative

Urine glucos

Negative

Urine Bilirubin

Negative

Urine HCG

Negative

KET

Negative

SG

1.019

UBG

Negative

NIT

Negative

Date of test

2016-11 yyyy-mm-dd

2.6.Blood Biochemical items Tests

ALT

14.4 U/L

AST

15.5 U/L

GGT/γ-GT

12.0 U/L

ALP

53.0 U/L

TBIL

9.30 μmol/L

DBIL

3.00 μmol/L

IBIL

6.30 μmol/L

ALB

44.9 g/L

UA

378.0 umol/L

UREA

3.20 mmol/L

TC

4.42 mmol/L

Cr

53.0 umol/L

TG

0.80 mmol/L

HDL

1.73 mmol/L

LDL

2.66 mmol/L

CK

46.0 U/L

CK-MB

18.0 U/L

LDH

173.0 U/L

K

4.17 mmol/L

Na

143.3 mmol/L

Cl

103.4 mmol/L

Ca

2.34 mmol/L

Glu

4.20 mmol/L

Date

2018-6-11 yyyy-mm-dd

2.7.Coagulation Function Tests

Prothrombin time

12.1

Thrombin time (TT)

15.3

Activated partial thromboplastin time (APTT)

27.9

Fibrinogen (FIB)

2.19 g/L

Date of examination

20018-6-11 yyyy-mm-dd

2.8.HBV/HCV/HIV/Syphilis Markers Test

HBV

Positive

HCV

Negative

Negtive

Negative

Date of test

2018-6-11 yyyy-mm-dd

2.9.Blood Gas Analysis

Date of examination

2018-6-11 (yyyy-mm-dd)

LAC

1.78 mmol/L

SBE

-- mmol/l

HCO3

-- mmol/l

SO2

--

P02

130.5 mmHg

PCO2

45.3 mmHg

PH

7.336

2.10.D-dimer Test

0.05

2.11.HCG Test

-- mIU/mL

Urine HCG

Not detected

2.12.Visual Analogue Scale

Pain Visual Analogue Score

2.13.Image Examinations

4

-- cm*cm*cm

--

-- cm

-- cm

Date of examination

-- yyyy-mm-dd

Abdomen CT examination

Abnormal with clinical significance

Description in detail for abnormal

盆腔混杂性占位,考虑畸胎瘤可能性大

Date of examination

2-18-6-10 yyyy-mm-dd

--

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

右卵巢

15*10*8 cm

顺时针2圈 °

excision

刘义彬

2018-6-13

4.Follow-up
4.1.Physical examination

BG Puncture site

No

Temperature

37.2

Systolic pressure (SP)

115 mmHg

Diastolic pressure (DP)

72 mmHg

Heart Rate, HR

84 次/分

Blood pressure

115/72 mmHg

4.2.Blood Routine Test

WBC

-- ×109 /L

NEUT%

-- %

LY%

--- %

MONO%

--

RBC

-- ×10^12 /L

HGB

-- g/L

PLT

-- ×10^9 /L

Date

-- yyyy-mm-dd

4.3.D-dimer test

D-dimer

D-dimer

--

Date of test

-- yyyy-mm-dd

4.4.Visual Analogue Scale

Pain Visual Analogue Score

Occasionally very slight pain
/
Occasionally very slight pain

5.Management system of participants

sample collection

Collected

Volume

1 ml

Time of collection

2018-6-13 yyyy-mm-dd-hh-min.

Label Number of the sample

--

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)