第81回日本大腸肛門病学会学術集会

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First Author Information

Name*
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1.Affiliation*
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Affiliation Information

2.Affiliation
Please enter the official name.
e.g. Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Japan
3.Affiliation
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Co-author InformationUp to 20people can be registered.

Co-author Name　2
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Co-author Name　12
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Co-author Name　13
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Co-author Name　14
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Co-author Name　15
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Co-author Name　16
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Co-author Name　17
Name
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The first author’s affiliation will be assigned as No. 1.
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Co-author Name　18
Name
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The first author’s affiliation will be assigned as No. 1.
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Co-author Name　19
Name
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Affiliation Number
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Please check the box for your affiliated institutions.
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If you belong to multiple organizations, check all that apply.
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The first author’s affiliation will be assigned as No. 1.
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Co-author Name　20
Name
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Affiliation Number
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The first author’s affiliation will be assigned as No. 1.
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Presentation Information

Category*
(Ⅰ)Category A*
(Ⅱ)Category B*
(Ⅲ)Medical Department*
(Ⅳ)Subcategory*
Abstract Title*
Limit: 200 characters. Entries over this limit cannot be registered.
Abstract Body*
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If your abstract is not accepted for the symposium, would you like to apply for the International Session (an oral session with approximately 6 minutes per presentation)?*

Conflict of Interest Disclosure by the Lead Presenter

For the lead author and all co-authors, please disclose any COI (Conflict of Interest) status related to companies, organizations, or entities associated with the presentation topic within the past three years from the time of submission, by self-declaration for each author.
Inquiry
Status
If yes, provide the name of the company and/or organization
①
Honoraria
($10,000 or more per year from one company or organization）
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②
Stock or stock options
（$10,000 or more per year or holding 5% or more of shares in one private company）
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③
Royalties or licenses
（$5,000 or more per year for one patent）
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④
Lecture fees
($5,000 or more per year from one company or organization）
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⑤
Manuscript fees
($5,000 or more per year from one company or organization）
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⑥
Research funding
($10,000 or more per year of research funding including funding for collaborative research, funded research, and drug trials paid by one company or organization）
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⑦
Scholarship fund
($10,000 or more per year provided by one company or organization to a disclosing party, his/her course/class, or laboratory）
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⑧
Belonging to endowed chair by business
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⑨
Travel fees, gifts, and others
($500 or more per year from one company or organization）
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NOTE:
Any conflicts of interest that require disclosure should cover the three years prior to abstract submission and should be disclosed at the beginning of the presentation slides or at the end of the poster.

Application for Ethics Review

Q1. Select one from the following study contents.*

Q2. Studies that checked B1, B2, C, D1, D2, and E in Question 1 require a committee review based on the regulations that apply to each study.*

IRB number
Name：
IRB number：
*
If unapproved or off-label medical treatment is performed as a medical treatment rather than as research, each institution must perform the procedure per the Medical Care Act.
*
The above ethical information may be revised per changes in national laws, regulations, and guidelines in the future (as of June 2022).
*
This guideline is based on the ethical guidelines prepared by the Japanese Society for Abdominal Emergency Medicine and the Organization of Japan Digestive Disease Week (JDDW).