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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

2018-11-24 yyyy-mm-dd

2.Baseline
2.1.Medical History

12 小时

Average times of menstrual onset a year

13 次/年

Menarche time

-- 岁(years)

Average menstrual cycle

未来潮 天(days)

The time of last Menstruation

-- 年、月、日(yyyy-mm-dd)

The time of menstrual onset before the last one

-- 年、月、日(yyyy-mm-dd)

Disease or surgery name

--

Date of the confirmation or the surgery

-- 年/月/日(yyyy-mm-dd)

Date

2018-11-24 yyyy-mm-dd

2.2.General information

Date of signing the informed consent

2018-11-24

Date of birth

2006-11-01 yyyy-mm-dd

Age

12 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

58 kg

Hight

1600 mm

Systolic pressure (SP)

102 mmHg

Diastolic pressure

64 mmHg

Temperature

36.5 degree Celsius

Pulse rate

92 次/分

Breath frequency

23 次/分

Doctor signature

刘义彬

Date

2018-11-24 yyyy-mm-dd

2.4.Blood Routine Tests

WBC

8.50 ×109 /L

NEUT%

61.90 %

LY%

29.60 %

MONO%

6.80

RBC

4.51 ×10^12 /L

HGB

132 g/L

PLT

244 ×10^9 /L

Researcher signature

刘义彬

Date

2018-11-24 yyyy-mm-dd

2.5.Urine Routine Test

Acidity and allkalinity

Acidity

pH value

6.0

Urine protein

Negative

Urine red cell

Negative

Urine WBC

Negative

Urine glucos

Negative

Urine Bilirubin

Negative

Urine HCG

Negative

KET

Negative

SG

1.020

UBG

Negative

NIT

Negative

Date of test

2018-11-25 yyyy-mm-dd

2.6.Blood Biochemical items Tests

ALT

8.3 U/L

AST

13.7 U/L

GGT/γ-GT

8.3 U/L

ALP

213 U/L

TBIL

8.7 μmol/L

DBIL

3.6 μmol/L

IBIL

5.10 μmol/L

ALB

47.9 g/L

UA

329 umol/L

UREA

4.90 mmol/L

TC

3.67 mmol/L

Cr

53.0 umol/L

TG

0.76 mmol/L

HDL

1.06 mmol/L

LDL

2.60 mmol/L

CK

69.0 U/L

CK-MB

18.0 U/L

LDH

160.0 U/L

K

4.06 mmol/L

Na

142.1 mmol/L

Cl

104.0 mmol/L

Ca

2.44 mmol/L

Glu

5.20 mmol/L

Date

2018-11-25 yyyy-mm-dd

2.7.Coagulation Function Tests

Prothrombin time

12.0

Thrombin time (TT)

14.9

Activated partial thromboplastin time (APTT)

31.1

Fibrinogen (FIB)

2.91 g/L

Date of examination

2018-12-25 yyyy-mm-dd

2.8.HBV/HCV/HIV/Syphilis Markers Test

HBV

Negative

HCV

Negative

Negtive

Negative

Date of test

2018-11-25 yyyy-mm-dd

2.9.Blood Gas Analysis

Date of examination

2018-11-25 (yyyy-mm-dd)

SBE

-3.0 mmol/l

LAC

0.98 mmol/L

HCO3

21.9 mmol/l

SO2

91.4

P02

56.1 mmHg

PCO2

38.6 mmHg

PH

7.369

2.10.D-dimer Test

0.25

2.11.HCG Test

未查 mIU/mL

Urine HCG

Not detected

2.12.Visual Analogue Scale

Pain Visual Analogue Score

Very pain

2.13.Image Examinations

--

2.5*2.47*1.83 cm*cm*cm

--

2.77cm cm

左侧1.70*1.59 右侧3.6*3.13*2.96 cm

Date of examination

2018-11-24 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

右卵巢

5cm cm

°

decollement

刘义彬

2018-11-25

4.Follow-up
4.1.Physical examination

BG Puncture site

No

Temperature

36.5

Systolic pressure (SP)

102 mmHg

Diastolic pressure (DP)

64 mmHg

Heart Rate, HR

88 次/分

Blood pressure

102/64 mmHg

4.2.Blood Routine Test

WBC

6.50 ×109 /L

NEUT%

56.40 %

LY%

31.10 %

MONO%

9.30

RBC

4.38 ×10^12 /L

HGB

131 g/L

PLT

220 ×10^9 /L

Date

2018-11-27 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
/
Occasionally very slight pain

5.Management system of participants

sample collection

Collected

Volume

1 ml

Time of collection

2018-11-25 yyyy-mm-dd-hh-min.

Label Number of the sample

2100619

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)