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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

2018-11-10 yyyy-mm-dd

2.Baseline
2.1.Medical History

12 小时

Average times of menstrual onset a year

13 次/年

Menarche time

13 岁(years)

Average menstrual cycle

5.5 天(days)

The time of last Menstruation

2018-11-03 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

Date of the confirmation or the surgery

-- 年/月/日(yyyy-mm-dd)

Date

2018-11-10 yyyy-mm-dd

2.2.General information

Date of signing the informed consent

2018-11-10

Date of birth

2002-01-24 yyyy-mm-dd

Age

16 Years

Education background

Middle school

Occupation

Other

Other (Description)

学生

2.3.Physical examination

Vulva

Normal

Description in detail for abnormal

Vagina

Not examined

Description in detail for abnormal

Uterine neck

Not examined

Description in detail for abnormal

Corpus uteri

Not examined

Description in detail for abnormal

Adnexa uteri

Left side

Not examined

Description in detail for abnormal

Right side

Not examined

Description in detail for abnormal

Weight

66 kg

Hight

1720 mm

Systolic pressure (SP)

119 mmHg

Diastolic pressure

64 mmHg

Temperature

36 degree Celsius

Pulse rate

68 次/分

Breath frequency

17 次/分

Doctor signature

刘义彬

Date

2018-11-10 yyyy-mm-dd

2.4.Blood Routine Tests

WBC

9.20 ×109 /L

NEUT%

85.10 %

LY%

9.40 %

MONO%

5.10

RBC

3.90 ×10^12 /L

HGB

113 g/L

PLT

212 ×10^9 /L

Researcher signature

刘义彬

Date

2018-11-09 yyyy-mm-dd

2.5.Urine Routine Test

Acidity and allkalinity

pH value

未查

Urine protein

Urine red cell

Urine WBC

Urine glucos

Urine Bilirubin

Urine HCG

KET

SG

未查

UBG

NIT

Date of test

未查 yyyy-mm-dd

2.6.Blood Biochemical items Tests

ALT

6.3 U/L

AST

16.4 U/L

GGT/γ-GT

9.0 U/L

ALP

65.0 U/L

TBIL

11.10 μmol/L

DBIL

5.30 μmol/L

IBIL

5.80 μmol/L

ALB

1.62 g/L

UA

207.0 umol/L

UREA

2.40 mmol/L

TC

2.56 mmol/L

Cr

54.0 umol/L

TG

0.29 mmol/L

HDL

1.60 mmol/L

LDL

0.95 mmol/L

CK

111.0 U/L

CK-MB

14.0 U/L

LDH

175.0 U/L

K

4.16 mmol/L

Na

137.4 mmol/L

Cl

100.3 mmol/L

Ca

2.41 mmol/L

Glu

6.21 mmol/L

Date

2018-11-09 yyyy-mm-dd

2.7.Coagulation Function Tests

Prothrombin time

13.1

Thrombin time (TT)

14.2

Activated partial thromboplastin time (APTT)

34.1

Fibrinogen (FIB)

2.97 g/L

Date of examination

2018-11-09 yyyy-mm-dd

2.8.HBV/HCV/HIV/Syphilis Markers Test

HBV

Negative

HCV

Negative

Negtive

Negative

Date of test

2018-11-09 yyyy-mm-dd

2.9.Blood Gas Analysis

Date of examination

2018-11-10 (yyyy-mm-dd)

SBE

-2.2 mmol/l

LAC

0.59 mmol/L

HCO3

21.9 mmol/l

SO2

97.7

P02

97.3 mmHg

PCO2

35.1 mmHg

PH

7.413

2.10.D-dimer Test

未查

2.11.HCG Test

-- mIU/mL

Urine HCG

Not detected

2.12.Visual Analogue Scale

Pain Visual Analogue Score

Very pain

2.13.Image Examinations

7

3.79*4.36*4.05 cm*cm*cm

未报告

子宫前方12.1*9.27*9.21cm混合包块,子宫左侧4.75*3.34*3.45混合包块。 cm

右侧3.51*2.02 cm

Date of examination

2018-11-09 yyyy-mm-dd

Abdomen CT examination

Not tested

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

左侧输卵管系膜

15*13*12 cm

逆时针720度 °

decollement

刘义彬

2018-11-10

4.Follow-up
4.1.Physical examination

BG Puncture site

No

Temperature

37.7

Systolic pressure (SP)

未查 mmHg

Diastolic pressure (DP)

未查 mmHg

Heart Rate, HR

未查 次/分

Blood pressure

未查 mmHg

4.2.Blood Routine Test

WBC

6.50 ×109 /L

NEUT%

61.10 %

LY%

22.60 %

MONO%

12.90

RBC

3.40 ×10^12 /L

HGB

96 g/L

PLT

176 ×10^9 /L

Date

2018-11-12 yyyy-mm-dd

4.3.D-dimer test

D-dimer

D-dimer

未查

Date of test

-- yyyy-mm-dd

4.4.Visual Analogue Scale

Pain Visual Analogue Score

Occasionally very slight pain
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Occasionally very slight pain

5.Management system of participants

sample collection

Collected

Volume

1 ml

Time of collection

2018-11-10 yyyy-mm-dd-hh-min.

Label Number of the sample

2095715

6.ADR/ADE management system

Is there any adverse event?

No

No

No

Severity

Within 30 minites or not?

No

Begin time at

-- 年/月/日(yyyy-mm-dd)

Time of stop

-- 年/月/日(yyyy-mm-dd)