Please understand that this item has been cleanly cut at the binding using a cutting machine and is in a loose-leaf state before purchasing. Basically, there are no writings or markings, but there may be faint roller marks from scanning. ・Although it has been cut, it is generally clean, so please rest assured. ・Packaging will be in an OPP bag or vinyl bag, etc., and will be shipped with waterproof measures. Please purchase only if you understand the meaning of "cut". ※Depending on the book, we may remove the unprinted colored paper. ※We check for writings and markings, but we cannot guarantee that we haven't missed anything. Please forgive us if there are any, as they will be less than 1% of the total pages. ※Even if accessories, DVDs, CDs, serial codes, etc. were included when new, they are not included unless there is additional explanation in the product description. ※Bulk purchases are also welcome. Please proceed with the purchase. ※To prevent trouble, we cannot accommodate holds or exclusive listings other than bulk purchases. ※You can purchase even while we are exchanging questions. First-come, first-served basis. ※Due to the cutting, the condition of the product is listed as "with scratches and dirt" even if it was cut from a new purchase. ※We do not have any pets. ※We cannot accept returns to prevent swapping. In the unlikely event that a problem occurs during the transaction, we will respond sincerely, so please rest assured. A practical reference book on emergency surgery. - Title: The ESTES/AAST Emergency Surgery Course Handbook - Author: Koji Morishita - Contents: A Practical Reference in Expecting the Unexpected - Price: 19,800 yen (tax included) Thank you for viewing.