The Office of Japanese Society for Lymphoreticular Tissue Research
Department of Pathology and Laboratory Medicine,
Nagoya University Graduate School of Medicine,
65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
FAX: 052-744-2897
Submission Form
Manuscript-ID: JCEH
All authors are required to sign this form upon submission and again upon acceptance.
Submission and conflict of interest are defined according to Parts IIA, D, E and F of the Uniform
Requirements for Manuscripts Submitted to Journal of Clinical and Experimental
Hematopathology (JCEH) as per JCEH author instructions.1 If you have a conflict of interest
to disclose, please submit our ″Conflict of Interest″ form. This conflict of interest should also be
reported in the Acknowledgments section of the paper.
Title of Paper: ____________________________________________________________________
________________________________________________________________________________
Corresponding Author: ____________________________________________________________
Acknowledgment of Authors:
Signature: We agree to the submission of our manuscript to JCEH and affirm
knowledge and agreement with its content and presentation. We also agree with the
authorship as listed on the manuscript.
Checkbox: Please check the appropriate box below.
NO: I have no personal or financial conflict of interest and have not entered into any
agreement that could interfere with our access to the data on the research, or upon
our ability to analyze the data independently, to prepare manuscripts, and to publish
them.
YES: I have a potential conflict of interest to report and have enclosed the conflict of interest
form.
Date:
Name:
Signature
Potential
Conflict of
interest
No
Yes
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Reference:
1. International Committee of Medical Journal Editors. Uniform requirements for manuscripts submitted to
biomedical journals. http://www.ICMJE.org, 2005.
The Office of Japanese Society for Lymphoreticular Tissue Research
Department of Pathology and Laboratory Medicine,
Nagoya University Graduate School of Medicine,
65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
FAX: 052-744-2897
Conflict of Interest Form
Manuscript-ID: JCEH
Title of Paper: ____________________________________________________________________
________________________________________________________________________________
Author: ___________________________________________________________________________
JCEH Policy Statement:
The Journal of Clinical and Experimental Hematopathology subscribes to the guidelines published by Davidoff et
2
al. in the New England Journal of Medicine and to the ICMJE “Uniform Requirements for
Manuscripts Submitted to Biomedical Journals”(http://www.ICMJE.org).2 Authors must state
all their sources of funding and any other financial and personal relationships that might bias
their work. If the research reported in the manuscript has received partial or complete funding
from commercial sponsors, the authors must also include a statement to that effect. The Editors
reserve the right not to consider a manuscript if a sponsor has asserted control over the authors'
right to publish their research results.
Author Statement:
I have a potential personal conflict of interest as follows:
_____________________________________________________________________________________________________
___________ __________________________________________________________________________________________
I have a potential financial conflict of interest as follows:
_____________________________________________________________________________________________________
___________ __________________________________________________________________________________________
Date: ______________________ Signature: ______________________________________________________________
References:
1. Davidoff F, DeAngelis CD, Drazen JM, Nicholls MG, Hoey J, Hojgaard L, Horton R, Kotzin S, Nylenna M, Overbeke AJ, Sox HC,
Van Der Weyden MB, Wilkes MS. Sponsorship, authorship, and accountability. N Engl J Med 2001;345:825-6.
2. International Committee of Medical Journal Editors. Uniform requirements for manuscripts submitted to biomedical journals.
http://www.ICMJE.org. 2005.