ࡱ>  g2ɀ\pNR Ba==+\%8X@"1 -3 000001 -3 000001 -3 000001 -3 000001Verdana1-3 fg1Verdana1 x-3 000001 -3 000001Verdana1-3 fg1Verdana1 -3 000001Verdana1Verdana1-3 fg1Verdana1-3 fg1 x-3 000001Verdana1 -3 000001 -3 000001 -3 000001 -3 000001-3 fg1Verdana1Verdana1 -3 000001-3 0fg1-3 0fg1 -3 000001@Verdana1Verdana1@Verdana1 -3 000001 -3 000001 h8-3 000001  -3 000001 <-3 000001 4-3 000001 -3 000001 4-3 000001 -3 000001 ,8-3 000001 8-3 000001 8-3 000001 -3 000001 ?-3 000001 -3 000001 >-3 000001 -3 000001Verdana1Verdana1Verdana1Verdana1 -3 000001-3 fg1Verdana1-3 fg1Verdana1.Times New Roman1 -3 000001@Verdana""#,##0;""\-#,##0""#,##0;[Red]""\-#,##0""#,##0.00;""\-#,##0.00#""#,##0.00;[Red]""\-#,##0.007*2_ ""* #,##0_ ;_ ""* \-#,##0_ ;_ ""* "-"_ ;_ @_ .))_ * #,##0_ ;_ * \-#,##0_ ;_ * "-"_ ;_ @_ ?,:_ ""* #,##0.00_ ;_ ""* \-#,##0.00_ ;_ ""* "-"??_ ;_ @_ 6+1_ * #,##0.00_ ;_ * \-#,##0.00_ ;_ * "-"??_ ;_ @_ \$#,##0_);\(\$#,##0\)\$#,##0_);[Red]\(\$#,##0\) \$#,##0.00_);\(\$#,##0.00\)% \$#,##0.00_);[Red]\(\$#,##0.00\)"Yes";"Yes";"No""True";"True";"False""On";"On";"Off"],[$ -2]\ #,##0.00_);[Red]\([$ -2]\ #,##0.00\) # # # # # # # # # # # # # #  # # # # # # # # # # # # $ $ $ $ $ $ $ $ $ $ $ $ % &ff ' #  #   (` ) *  + #& #( ,P -P .  . /a> 0 1 # # 2  3 4 5 48@  68@  78@@ 4<@  48@ @  48@@  4<@ 4<@  88@ 98@@  68 @  4<  68@ @  4<@  4<@  : 48@@ 48@ @ 48@  48@  ; 98  : :8  @ :8  0  :8"@  < : :8""  :8 "@ = 0"@ @ 0  @ :8" @  0"@  48@ 48@@ 48@  48@ 48@  98@@  >  0  ? 4<@  48  48  8@ 48@  48 @  48 48  88 48@ 48@  48 @ 48  48@ 4<  48@@ 48@ 48 @ 48@ @ 48@  48@@ 48@  98!@ @  98"@ @  98@ @  98!@ @  98"@ @  98@ @  :8 48@ 48 48  48@  48  48  98@@  98@  98 @  :8"@ @ :8"@  :8" @  < :8 @  :8  :8  :8 :8 :8  :8@ :8 :8  :8"@ :8 "  :8" :8" :8 " :8"  :8 "   :8"@  :8"  :8 "  ||>}-} 00_)}-} 00_)}-} 00_)}-} 00_)}-} 00_)}-} 00_)}-} 00_)}-} 00_)}-} 00_)}-}  00_)}-}  00_)}-}  00_)}-}  00_)}-}  00_)}-} 00_)}-} 00_)}A} 00_)ef[$ -}A} 00_)ef[$ -}A} 00_)ef[$ -}A} 00_)ef[$ -}A} 00_)ef[$ -}A} 00_)ef [$ -}A} 00_)L[$ -}A} 00_)L[$ -}A} 00_)L[$ -}A} 00_)L[$ -}A} 00_)L[$ -}A} 00_)L [$ -}A} 00_)23[$ -}A} 00_)23[$ -}A} 00_)23[$ -}A} 00_)23[$ -}A}  00_)23[$ -}A}! 00_)23 [$ -}A}" 00_)[$ -}A}# 00_)[$ -}A}$ 00_)[$ -}A}% 00_)[$ -}A}& 00_)[$ -}A}' 00_) [$ -}-}( 00_)}}) 00_)[$ -???##0.??? ??? ???}A}* e00_)[$ -}-}+ 00_)}}, 00_)[$ -##0.  }A}- }00_)[$ -}A}. 00_)[$ -}}/ }00_)[$ -##0.  }-}0 00_)}-}1 00_)}-}2 00_)}A}3 00_)[$ -}A}4 00_)?[$ -}A}5 00_)23[$ -}-}6 00_)}U}7 00_)[$ -##0.}}8 ???00_)[$ -???##0.??? ??? ???}-}9 00_)}-}: 00_)}-}; 00_)}}< ??v00_)̙[$ -##0.  }A}= a00_)[$ -}(}> 00_)}(}? 00_)}(}@ 00_)}(}A 00_)}(}B 00_)}(}C 00_)}(}D 00_)}(}E 00_)}(}F 00_)}(}G 00_)}(}H 00_)}(}I 00_)}(}J 00_)}(}K 00_)}(}L 00_)}(}M 00_)}(}N 00_)}(}O 00_)}(}P 00_)}(}Q 00_)}(}R 00_)}(}S 00_)}(}T 00_)}(}U 00_)}(}V 00_)}(}W 00_)}(}X 00_)}-}Y 00_)}(}Z 00_)}(}[ 00_)}(}\ 00_)}d}] 00_)[$##  }P}^ 00_)[$ ##}(}_ 00_)}-}` 00_)}-}a 00_)}(}b 00_)}-}c 00_)}(}d 00_)}(}e 00_)}(}f 00_)}(}g 00_)}(}h 00_)}(}i 00_)}(}j 00_)}-}l 00_)}(}m 00_)}(}n 00_)}(}o 00_)}(}p 00_)}(}r 00_)}(}s 00_)}(}t 00_)}(}u 00_)}(}v 00_)}(}w 00_)}(}x 00_)}(}y 00_)}(}z 00_)}(}{ 00_)}(}| 00_)}(}} 00_)}(}~ 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}(} 00_)}<} 00_) [$}(} 00_)}<} 00_) [$}(} 00_)}(} 00_)}(} 00_)}P} 00_)[$##}P} 00_)[$##}d} 00_)[$##  }P} 00_)[$##}d} 00_)[$##  }P} 00_)[$ ##}<} 00_)[$}<} 00_)[$}<} 00_)[$}P} 00_)[$ ## 20% - 00000 1M 20% - 00000 1 ef % 20% - 00000 2M" 20% - 00000 2 ef % 20% - 00000 3M& 20% - 00000 3 ef % 20% - 00000 4M* 20% - 00000 4 ef % 20% - 00000 5M. 20% - 00000 5 ef % 20% - 00000 6M2 20% - 00000 6  ef % 40% - 00000 1M 40% - 00000 1 L % 40% - 00000 2M# 40% - 00000 2 L渷 % 40% - 00000 3M' 40% - 00000 3 L % 40% - 00000 4M+ 40% - 00000 4 L % 40% - 00000 5M/ 40% - 00000 5 L % 40% - 00000 6M3 40% - 00000 6  Lմ % 60% - 00000 1M 60% - 00000 1 23 % 60% - 00000 2M$ 60% - 00000 2 23ږ % 60% - 00000 3M( 60% - 00000 3 23כ % 60% - 00000 4M, 60% - 00000 4 23 % 60% - 00000 5M0 60% - 00000 5 23 %! 60% - 00000 6M4 60% - 00000 6  23 %"00000 1A00000 1 O %#00000 2A!00000 2 PM %$00000 3A%00000 3 Y %%00000 4A)00000 4 d %&00000 5A-00000 5 K %'00000 6A100000 6  F % (0000/0000 I}%)0000 00y0000 00  %????????? ???*i0a00g00j0D0Ai0a00g00j0D0  e%+ 00000 ,00^ 00  -000 00A000 00 }% .`D07`D0  % /{o{  }%  0fJTe- fJTe %1Ah:SR02, Ah:SR0 [0.00]3QW0 1?QW0 1 I}%O4QW0 2?QW0 2 I}%?5QW0 3?QW0 3 I}%236QW0 41QW0 4 I}% 7ƖGƖ %OO 8QRoQR  ???%????????? ??? 9fe-5fe %:;(  [0.00] <eQRoeQR ̙ ??v% +jn % =oD07oD0  a%XTableStyleMedium2PivotStyleLight16` S}Form1}Form2-1Form2-2eOForm2-3QQ  ;   ;   ;8@-S AA@A@   ^J7 TEL: E-mail:Day ofSurgeryRecordDiseaseNameRole in the surgery% Operating Surgeon, Instructor, etc. $ (Form 2-2) 5No*: (Form 2-3) 5=Ten Major Cases of Surgical Performances as Operating Surgeon 5(Listed in Form 2-2) 5  (Form 1) 5 Curriculum Vitae0e\tkf500000 (Kana)(K0j0)  5 (000000000000)  5 0Seal or Signature000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000pS0So00r T ,500000000 Name in Full0l T 5000  Sex0'`%R 50000 (Date of Birth0ut^ge $50000000 ,(Year/Month/Day)(t^/g/e)   (5000000 "Present Address0sOO@b 50000000 (zip code00: )  5 Current Affiliation0@b^\ 50000 Position0sw 500000  Affiliation Address0@b(W0W 5000000 >Affiliated Academic 0Society, Position0@b^\f[O0 y_w T & :5000000000000000')-> Date(Year/Month/Day)000000000000000000000000000000000eN(t^/g/e) 7 89 :; <= 50005O "0Education0*Name of University, Faculty, Department, Laboratory00f[tk0*'Yf[0f[0xvz[ T  ?@DE50000ABQ &0Academic Degree0 *Title, Major Field, Conferring University000f[MO0* Ty0\;eRΑ0cNW0_0'Yf[  <>BC"5000000@CA N0Licensure and Certification0*Title, License Number00MQ10* Ty0MQ1~v2(5 000000000 (Name)l T %%%%  5000No. 5 0Books0*Authors or translators (all in order), Title, pp., Publisher, Year (e.g. 1. Hiroshima T: Epidemiologic aspects of eeee. Comprehensive Handbook of eeee: pp 100-150, Elsevier, 2005)00Wf0*W T0f T0Rbv T0R^B}0zvL@b0t^0 T _z ~    5d 40Reviews0*Authors (all in order), Title, Name of Journal, vol, pp., Year00}0*W T0Lv0 T0]0R^B}0t^0  H IMN 05 0000000000JNP Impact Factor 5 Times Cited 5 20Original Papers (refereed)0*Authors (all in order), Title, Name of Journal, vol, pp., Year (e.g. 1.* Hiroshima T, Suzuki I, Tanaka H: The relationship between eeee. Scientific Reports, 15: 200-215, 2007)00SWg g 0*W T0Lv0 T0]0R^B}0t^0 g r   .5 000000000 0Original Papers (non-refereed)0*Authors (all in order), Title, Name of Journal, vol, pp., Year00SWg!q 0*W T0Lv0 T0]0R^B}0t^0  _ `ij 500f @0Teaching Experience (Undergraduate Course)0*Target Schools, Period, Subject Name (e.g. 1. School of Pharmaceutical Sciences, 2010-2015, Practice of Pharmaceutics)00c\L}f[X z 0*[af[!h0g0yv T0 +,  <5 0000000000000  (0Research Supervision on Dissertation (Master s or Doctoral Course)0*Dissertation Name, Period, Part which you supervised00֊en0xvzvcwOXSo0ZSX z 0*֊e T0g0vOW0_0R0 CDy $50000000~ *0Social Contributions00>yOk0J0Q00;mR0&500000000 0Acquisition of Research Funds0*Name of Fund, Distinction of Role (Representative or Collaborator), Allotted Amount of Money, Period (e.g. 1. KAKENHI Scientific Research(C), representative, 2000000yen, 2013-2015)0xvznjёn0rs_0*xvzn0 Ty Nh0Rbn0%R S_Nn0bS_Y00ёM g  5< D0Awards0*Award Name, Date(Year/Month/Day)0Sތ0*Sތ T, eN(t^/g/e))-. 13 56 78 9: ;@5000000000000000*. 0 3 00Patents0*Distinction of applying or registered, Invention Name, Investor s Name, Summary of the Patent, Patent Number00yr10*QXSo0{v2n0:S%R0zvf T0bnj T0yr1n0}0yr1juS0 v w{| ,500000000x~m @0Conference Presentations0*Presenters (all in order), Title, Conference Name ,Year00f[Ozvh0*zvh N T 0000 Op T t^R SYZ <50000000000000000TV ZMedical 5gяt^n0KbSuO0000000000 5 (Name)(l T)00000000000000  5000&KbSe"5000000No. 5 No.00000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000<0000000000000000juS50000 Age00t^b50000 Sex000000'`%R50000 u T500000 Operative Method000000S_500000KbSk0J0Q00y_rR WR c\j0i0  5 Diagnosis0:e T:   5 Age t^b:0 50000 8 Sex'`%R: M7u'` / FsY'`  45 000000000000  Surgery Name0KbS T:  5& Surgery Date0KbSe: / /  5 Clinical Outcome000^: 5 Institution Name0KbS[ee- T: 5C Treatment or surgical content and the disease course0lBvj0D0W0KbSQ[Ss0L}N:4B 5= * Fill in the number listed in form 2-2.0i_ n0W0juS0eQW0f0O0`0U0D00( 5 i_0 n0F0a0Nhv10uOn0KbS[>~  5 60Overseas Training,etc.00wmYxOI{0  25 00000000000 Y L0Certified Physician or Specialist,etc.0*Title, Qualified Society00[;S \;S c\;SI{0* Ty [f[O T "!' (ABPQH50000000000000000CEG KN6 Records of Surgical Operations In the Last Three Years"  5  (Form 2-1) 5RU UPWX["V`^ equw*|ccB g2ɀ B  dMbP?_*+%& `?' `?(i4F?)i4F?M KONICA MINOLTA C754SeriesPCL8 4XXA4Courier NewTimes New Roman ++++  XX8SPLX8C754_6PCLXL< 4 ++++4 L -e4 4 L -dInTray1InTray2InTray3InTray4InTrayLCTInTrayManuald}WM_101%`%`-3 00000H<b-3 00000ddXXP_ArialCourier NewTimes New RomanSymbolWingdingslr SVbNlr oSVbNlr lr o  ArialCourierTimes New RomanSymbolWingdingsHGGothic-BoldHGPGothic-BoldHGMincho-LightHGPMincho-Light #ivgXKkasumi-jinji4 EXCEL.EXEՇAa(" UXX BP(? BP(?&\(U} U} #}  } #Bh@@@@w@w@@h@@ w@ w@  h@ @*@@@ O j B e y f hz {{ @| {{ A|  } ~{wtu x op { w  u {wu  } ~ {wtu x op f xop D r rsCttuCttuCvtuCvtuCvtuCvtuCttuCttu D r rsCttuCttuCttuCttu>X040&*&0*&** !"#$@%&'()*+,-@./0123456@789:;<=>@? Cttu!Cttu"Cttu#Cttu $D $r $rs%Cttu&Cttu'Cttu(Cttu)Cttu*Cttu+Cttu,Cttu -D -r -rs.Cttu/Cttu0Cttu1Cttu2Cttu3Cttu4Cttu5Cttu 6D 6rG 6rs7Cttu8Cttu9Cttu:Cttu;Cttu<Cttu=Cttu >D >qF >rs?CttuD l****@A@CttuAnoopLPH0(  >@ddB        !!""##$$%%&&((==77))**++,,--..88991122334455<<::;;AA>>@@66''00??//5ggD g2ɀ F%a    dMbP?_*+%& `?' `?(i4F?)i4F?M KONICA MINOLTA C754SeriesPCL8 4XXA4Courier NewTimes New Roman ++++  XX8SPLX8C754_6PCLXL$# 4 ++++4 L -e4 4 L -dInTray1InTray2InTray3InTray4InTrayLCTInTrayManuald}WM_101%`%`-3 00000H<b-3 00000ddXXP_ArialCourier NewTimes New RomanSymbolWingdingslr SVbNlr oSVbNlr lr o  ArialCourierTimes New RomanSymbolWingdingsHGGothic-BoldHGPGothic-BoldHGMincho-LightHGPMincho-Light #ivgXKkasumi-jinji4 EXCEL.EXEe'a(" KXX BP(? BP(?&\(U} } q} Fh@@I@     @g@@ OI >> ?! ?? "  E# $ FFFFF E# i% L& J' FPQQ FgRR FgRR FgRRFhSS E# I( L& J'FHMKFdMKFdMKFHMKFdMKFdNK E# ) FFFFF E# * FFFDtl*88** !"@#$%&'()*+,-.@/0123456789:@;<=>? F!F "E# "+ "#F$F%F&F'F (E# (, ()F*F+F,F-F .E# .- ./F0F1F2F3F 4E# 4. 45F6F7F8F9G :E# :/ :;F<F=F>F?FD8l*****@@ABCDE @E# @0 @AFBFCFDFEGd* ,(  ~2 , Dpg ?Oval 1_],`>@dd7$$%%&&'' !!##,,--//..))**++001122335544DDEE@@::>>??AA;;<<==((""BBCC667788995ggD g2ɀ  uKiN  dMbP?_*+%&ffffff?'ffffff?(?)?M KONICA MINOLTA C754SeriesPCL8 4XXA4Courier NewTimes New Roman ++++  XX8SPLX8C754_6PCLXL  4 ++++4 L -e4 4 L -dInTray1InTray2InTray3InTray4InTrayLCTInTrayManuald}WM_101%`%`-3 00000H<b-3 00000ddXXP_ArialCourier NewTimes New RomanSymbolWingdingslr SVbNlr oSVbNlr lr o  ArialCourierTimes New RomanSymbolWingdingsHGGothic-BoldHGPGothic-BoldHGMincho-LightHGPMincho-Light #ivgXKkasumi-jinji4 EXCEL.EXENa(" dXX333333?333333?&<3U}  }  } * } *} U @ @ A @Q @ @  @ V mH T2 k3 5 W W1 7 8 W : W X X  X U l4 X6  l9 l;Z`WWWaWaZcXXXYXYZcXXXYXY bbbbbbbbpZZPH00(  >@dd"5ggD g2ɀ    dMbP?_*+%&ffffff?'ffffff?(?)?M KONICA MINOLTA C754SeriesPCL8 4XXA4Courier NewTimes New Roman ++++  XX8SPLX8C754_6PCLXLJ  4 ++++4 L -e4 4 L -dInTray1InTray2InTray3InTray4InTrayLCTInTrayManuald}WM_101%`%`-3 00000H<b-3 00000ddXXP_ArialCourier NewTimes New RomanSymbolWingdingslr SVbNlr oSVbNlr lr o  ArialCourierTimes New RomanSymbolWingdingsHGGothic-BoldHGPGothic-BoldHGMincho-LightHGPMincho-Light #ivgXK4 EXCEL.EXELa(" dXX333333?333333?&<3U} U} } *} *}  ,,,, , :@ :@  Z@ @    V [[ [ [ [ E\ k3 ] < ^= ^> ?  @ A B  C   _____ VD B44 PH@0(  >@ddJ   5ggD Oh+'0HP`p Microsoft Excel@m@D@ |՜.+,0@HP X`hp x  Form1Form2-1Form2-2Form2-3'Form2-2'!Print_Area'Form2-3'!Print_Area'Form2-1'!Print_Titles  [NV[g Otꗗ  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry FؔWorkbook)SummaryInformation(DocumentSummaryInformation8