Registration number:

Date of Last Refreshed on:

Date of Registration:

Registration Status:

Public title:

English Acronym:

Scientific title:

Scientific title acronym:

Study subject ID:

The registration number of the Partner Registry or other register:

Applicant:

Study leader:

Applicant telephone:

Study leader's telephone:

Applicant Fax:

Study leader's fax:

Applicant E-mail:

Study leader's E-mail:

Study leader's website(voluntary supply):

Study leader's website
(voluntary supply):

Applicant address:

Study leader's address:

Applicant postcode:

Study leader's postcode:

Applicant's institution:

Approved by ethic committee:

Approved No. of ethic committee:

Approved file of Ethical Committee:

Name of the ethic committee:

Date of approved by ethic committee:

Contact Name of the ethic committee:

Contact Address of the ethic committee:

Contact phone of the ethic committee:

Contact email of the ethic committee:

Primary sponsor:

Primary sponsor's address:

Secondary sponsor:

Source(s) of funding:

Target disease:

Target disease code:

Study type:

Study design:

Study phase:

Objectives of Study:

Description for medicine or protocol of treatment in detail:

Inclusion criteria

Exclusion criteria:

Study execute time:

From

To     

Recruiting time:

From

To     

Interventions:

Total sample size

Countries of recruitment
and research settings:

Outcomes:

Collecting sample(s)
from participants:

Min age years
Max age years

Recruiting status:

Participant age:

Gender:

Randomization Procedure (please state who generates the random number sequence and by what method):

Blinding:

IPD sharing:

The way of sharing IPD”(include metadata and protocol, If use web-based public database, please provide the url):

Data collection and Management (A standard data collection and management system include a CRF and an electronic data capture:

Data Managemen Committee:

Publication information of the protocol/research results report
(name of the journal, volume, issue, pages, time; or website):

ITMCTR BJ-ICP:07032215-5 Tip: IE8 is recommended Use the system with widescreen display resolution above