版权说明:本文档由用户提供并上传,收益归属内容提供方,若内容存在侵权,请进行举报或认领
文档简介
PhagocytosisandtheInteractions
ofVariousPhagocytesBIOL533Lecture6MedicalMicrobiologyBIOL5331PhagocytosisandtheInteractiLeukocyteChemotaxinsTypesofchemotaxinsC5aattractsneutrophilsandmonocytesMadebybacteriaPeptideclippedoffN-terminus(beginningwithN-formylmethionine)duringpeptidematurationafterproteinsynthesisMadebybacteriaandnucleatedbloodcellsLeucotrienes—lipidproductsofcellmembranemetabolismBIOL5332LeukocyteChemotaxinsTypesofLeukocyteChemotaxinsFunctionofchemotaxinsEnhanceanddirectmotilityofphagocyticcellsToalimitedextent,oxidativemetabolismofphagocyticcellsBIOL5333LeukocyteChemotaxinsFunctionOpsonizationandOpsoninsGeneralaspectsSubstancesthatenhanceabilityofphagocytestoingestmicrobesDefendagainstpresenceofcapsulesandothermicrobialmechanismsthatinterferewithphagocytosisBIOL5334OpsonizationandOpsoninsGenerOpsonizationandOpsoninsTypesofopsoninsAntibodiesC3bcomponentofcomplementBindscovalentlytobacterialsurfaceandisrecognizedbyreceptorsonneutrophils,monocytes,andmacrophageBacteriabecomeboundtosurfaceofphagocytefacilitatingtheiruptakeBIOL5335OpsonizationandOpsoninsTypesOpsonizationandOpsoninsTypesofopsonins,continuedMechanismWhitebloodcellreceptorsforC3bAtleast3—CR1,CR2,CR3(complementreceptor)ChildrendeficientinCR3veryvulnerabletobacterialinfectionsBIOL5336OpsonizationandOpsoninsTypesPhagocytes—TypesofCellsNeutrophils—celloriginActivelymotilecellsproducedinbonemarrowDifferentiatefromstemcellsoveraboutatwo-weekperiodProductionofgranulesduringthistimeAzurophilProducespecificgranuleslaterBIOL5337Phagocytes—TypesofCellsNeutrPhagocytes—TypesofCellsNeutrophils—cellorigin,continuedUponmaturation(innumbersof1010perday),theymoveintoperipheralbloodandcirculateforabout6.5hoursNextmoveintocapillarybedandmarginateBIOL5338Phagocytes—TypesofCellsNeutrPhagocytes—TypesofCellsNeutrophils—cellorigin,continuedMarginationcausedbystickinessduetointerleukin-1Summonedbychemotaxis,theymovethroughendothelialcelljunctions(diapdesis)intoextravasculartissuespacesBIOL5339Phagocytes—TypesofCellsNeutrPhagocytes—TypesofCellsNeutrophilsaremostactiveingutGuthasenormousmicrobialpopulationlyingjustonecelllayerawayfromaseptictissueFloragenerateslargeamountsofchemotaxinsthatrecruitmostofbody’savailableleukocytesBIOL53310Phagocytes—TypesofCellsNeutrPhagocytes—TypesofCellsAsaresult,submucosaofgutisinaconstantstateofinflammationKeepmicrobialfloradownSynthesisofneutrophilsinhibitedbychemicalsorradiationInfectionsingutregionBIOL53311Phagocytes—TypesofCellsAsaPhagocytes—TypesofCellsMonocytesandmacrophageComparedtoneutrophilsArriveatdamagedtissuelaterininfectionDaysafterneutrophilshavebeenactiveinfightingintrudersEventuallysettleintissuesandbecomeresidentmacrophageBIOL53312Phagocytes—TypesofCellsMonocPhagocytes—TypesofCellsMonocytesandmacrophageShareprogenitorcelltype,butkineticsofmaturation&appearanceareverydifferentMonocytescontinuecelldifferentiationafterleavingbonemarrowMonocytesandmacrophageinvolvedinbothconstititiveandinduciblemechanismsInteractwithTcellsandplayimportantroleincell-mediatedimmunityBIOL53313Phagocytes—TypesofCellsMonocPhagocytes—TypesofCellsTissue(resident)macrophageExistthroughoutbodyDifferentnamesandfunctionsindifferenttissuesKupffercells—liverAlveolarmacrophage—lungsOsteoclasts—boneMicroglia—brainBIOL53314Phagocytes—TypesofCellsTissuPhagocytes—TypesofCellsMonocyteandmacrophagefunctionsPhagocytizeinvadingmicrobesContributegreatlytoinflammatoryresponseReleasesIL-1—enhancesstickingofneutrophiltocapillaryendotheliaTNF—activatesnewlyarrivedneutrophilsBIOL53315Phagocytes—TypesofCellsMonocMechanismofPhagocyteKillingNeutrophilsGeneralstepsAttachtomicrobesIngestmicrobesKillmicrobesGranules—consideredasenlargedlysosomescontaininghydrolyticenzymesBIOL53316MechanismofPhagocyteKillingMechanismofPhagocyteKillingNeutrophilgranuletypesAzurophil(primarygranule)ContainsLysozymeElastaseAchymotryptic-likeproteaseMyeloperoxidaseSeveralantibacterialcationicproteinsBIOL53317MechanismofPhagocyteKillingMechanismofPhagocyteKillingNeutrophilgranuletypesSpecific(secondarygranule)ContainsCytochromeLysozymeLactoferin(iron-bindingprotein)VitaminB12bindingproteinCollagenaseBIOL53318MechanismofPhagocyteKillingMechanismofPhagocyteKillingTheneutrophilmembraneContainsreceptorsforchemotaxinandopsoninsAfterbindingchemotaxins,receptorsareinternalizedandreplacedwithnewonesBIOL53319MechanismofPhagocyteKillingMechanismofPhagocyteKillingEffectivenessofchemotaxis:veryeffectiveNeutrophilsareverymotileMovebyrearrangingcytoplasmicmicrofilamentsandmicrotubulesActinandmyosininmicrofilamentsareaffectedbyproteingelsolinPortionsthatfaceupstreaminchemotacticgradientformstructurecalledlamellipodiumCytoplasmisdenselypackedwithmicrofilamentsPortionsfacedownstreamformknob-likeuropodBIOL53320MechanismofPhagocyteKillingMechanismofPhagocyteKillingProcessofphagocytosisGeneralaspectsDiffersfrompinocytosisinthatparticles,notliquids,takenupBIOL53321MechanismofPhagocyteKillingMechanismofPhagocyteKillingProcessofphagocytosis,continuedReceptorsonphagocytesurfaceprogressivelyattachtoligandsonbacterialsurfaceStimulatesmechanismsofkillingOxidativemetabolismleadingtoproductionofhydrogenperoxideandcompoundslethaltomicrobes(oxygen-dependentkilling)Dischargeoftoxiccompoundsfromgranulesintophagosome(oxygen-independentkilling)BIOL53322MechanismofPhagocyteKillingMechanismofPhagocyteKillingProcessofphagocytosis,continuedFormphagosome—pouch-likestructurethatinvaginates,displacingthenucleusandgranulestowarduropodFormphagolysosome—membraneofgranulesandphagosomefuse,releasingtoxicsubstancesFormsseparatepinched-offorganelleBacteriacoatedwithantibacterialproteinsBIOL53323MechanismofPhagocyteKillingOxygen-DependentKillingFusionofspecificgranuleswithphagosomemembrane(derivedfromplasmamembrane)bringstogether:NADPHoxidase(oxidizesNADPH;foundinneutrophilplasmamembrane)Uniquecytb(granulemembrane)AquinoneBIOL53324Oxygen-DependentKillingFusionOxygen-DependentKillingReactionO2O2— (reducesoxygentosuperoxideradical)2O2—
+H2OH2O2
+O2 (superoxidedismutase)BIOL53325Oxygen-DependentKillingReactiOxygen-DependentKillingPatientslackingcytochromecomponentsChildrenhavingchronicgranulomatousdisease(CGD)FailuretosynthesizesuperoxideradicalandthereforehydrogenperoxideDuetodecreasedamountofcytochromebGeneforlargersubunitismissing(90K,20K)BIOL53326Oxygen-DependentKillingPatienOxygen-DependentKillingChildrenhavingchronicCGD,cont’d.Neutrophilscanphagocytizenormally,butdonotefficientlyoxidizeNADPHandkillviaoxidativepathwayUsuallydon’tsurviveintoadulthoodBIOL53327Oxygen-DependentKillingChildrOxygen-DependentKillingHowdoesoxidativeprocesskill?InteractionwithmyeloperoxidasesuppliedbyfusionwithazurophilCombineschlorideionsandhydrogenperoxidetoformhypochlorousions(analogoustobleach)Bacterialackingcatalaseproducehydrogenperoxide(pneumococci);basicallycommitsuicidePneumococciarenotdangeroustoCGDpatientsBIOL53328Oxygen-DependentKillingHowdoOxygen-IndependentKillingProcessTriggeredbybindingopsonizedbacteriatotheplasmamembraneofneutrophilsSpecificgranulesfusefirstDeliverseveralbacteriodicalproteins,includinglysozymeandlactoferinBIOL53329Oxygen-IndependentKillingProcOxygen-IndependentKillingAzurophilgranulesdischargeantimicrobialcationicproteinsSomeareamphipathicandresembleothercationicsurfaceproteinssuchaspolymyxinBBIOL53330Oxygen-IndependentKillingAzurOxygen-IndependentKillingAzurophilgranules,continuedDisruptoutermembraneofGram—andkillbycausingleakageofvitalcomponentsEachoftheproteinshasuniqueantimicrobialspectrum,buttendtoaffectGram—morethanGram+
ProteinsmayaccountforsurvivalofsomeCGDchildrenBIOL53331Oxygen-IndependentKillingAzurOxygen-IndependentKillingEfficiencyBacterialkillingunderhighlyanaerobicconditionsofdeepabscessesPatientslackinggenesCodingforcationicproteinsNonefound,maybelethalBIOL53332Oxygen-IndependentKillingEffiOxygen-IndependentKillingChediak-Higashisyndrome (geneticdisease)PrematurefusionofneutrophilgranuleswhilecellsinbonemarrowWhenmaturecellsphagocytize,granulesarealreadyspent,substantiallyreducingkillingpowerBIOL53333Oxygen-IndependentKillingChedComparisonofBacterialSensitivityGram—rodsingutkilledbyoxygen-independentGram+bacteriaonskinandupperrespiratoryepitheliaareresistanttooxygen-independentandkilledbyoxygen-dependentBIOL53334ComparisonofBacterialSensitMechanismofPhagocyteKillingEosinophilsMuchlikeneutrophils,butindicativeofparasiticinfectionBIOL53335MechanismofPhagocyteKillingKillingbyMonocytesandMacrophageGeneralaspectsTendtotakecareofwhatisleftafterbattlewithneutrophilsMechanismsofchemotaxis,phagocytosis,andkillingresemblemechanismsofneutrophilsNotstudiedinsamedetailBIOL53336KillingbyMonocytesandMacroKillingbyMonocytesandMacrophageDifferencesContinuetodifferentiateafterleavingbonemarrowandareactivatedCalled“angrymacrophage”PhagocytizemorevigorouslyTakeupmoreoxygenSecretelargequantityofhydrolyticenzymesIngeneral,betterpreparedtokillBIOL53337KillingbyMonocytesandMacroKillingbyMonocytesandMacrophageActivatedbyElicitedbysubstancesmadeinresponsetopresenceofbacteria(C3b)orviruses(interferon)EndotoxinofGram—Tetrapeptidederivedfromimmunoglobulins(tuftsin)BIOL53338KillingbyMonocytesandMacroKillingbyMonocytesandMacrophageMicrobial(bacterial,fungi,protozoa)growthwithinSomecangrowuntilactivated,thenkilledParticipationinimmuneresponseHelpridbodyofnotonlymicrobialinvaders,butalsotumorandforeigncellsBIOL53339KillingbyMonocytesandMacroKillingbyMonocytesandMacrophageImmuneresponseprocessStimulatedevelopmentofTlymphocytesRespondtosignalsfromotherlymphocytesthatstimulatedifferentiationandactivationofmacrophageBIOL53340KillingbyMonocytesandMacroPhagocytoticKillingMacrophages/neutrophils/mastcellsstimulatedbyTNFinterferonProducereactivenitrogenintermediatesNitricoxideNitrite(NO2—)Nitrate(NO3—)BIOL53341PhagocytoticKillingMacrophagePhagocytoticKillingReleasedfromcellsorcontainedwithinvacuolesMacrophagesproduceNOfromargininewhenstimulatedbycytokinesNOcanblockcellularrespirationbycomplexingironinelectrontransportproteinsBIOL53342PhagocytoticKillingReleasedfMacrophageKillingHerpessimplexToxoplasmagondiiLeishmaniamajorCryptococcusneoformansSchistosomamansoniBIOL53343MacrophageKillingHerpessimplLecture6Questions?Comments?Assignments...BIOL53344Lecture6Questions?BIOL53344PhagocytosisandtheInteractions
ofVariousPhagocytesBIOL533Lecture6MedicalMicrobiologyBIOL53345PhagocytosisandtheInteractiLeukocyteChemotaxinsTypesofchemotaxinsC5aattractsneutrophilsandmonocytesMadebybacteriaPeptideclippedoffN-terminus(beginningwithN-formylmethionine)duringpeptidematurationafterproteinsynthesisMadebybacteriaandnucleatedbloodcellsLeucotrienes—lipidproductsofcellmembranemetabolismBIOL53346LeukocyteChemotaxinsTypesofLeukocyteChemotaxinsFunctionofchemotaxinsEnhanceanddirectmotilityofphagocyticcellsToalimitedextent,oxidativemetabolismofphagocyticcellsBIOL53347LeukocyteChemotaxinsFunctionOpsonizationandOpsoninsGeneralaspectsSubstancesthatenhanceabilityofphagocytestoingestmicrobesDefendagainstpresenceofcapsulesandothermicrobialmechanismsthatinterferewithphagocytosisBIOL53348OpsonizationandOpsoninsGenerOpsonizationandOpsoninsTypesofopsoninsAntibodiesC3bcomponentofcomplementBindscovalentlytobacterialsurfaceandisrecognizedbyreceptorsonneutrophils,monocytes,andmacrophageBacteriabecomeboundtosurfaceofphagocytefacilitatingtheiruptakeBIOL53349OpsonizationandOpsoninsTypesOpsonizationandOpsoninsTypesofopsonins,continuedMechanismWhitebloodcellreceptorsforC3bAtleast3—CR1,CR2,CR3(complementreceptor)ChildrendeficientinCR3veryvulnerabletobacterialinfectionsBIOL53350OpsonizationandOpsoninsTypesPhagocytes—TypesofCellsNeutrophils—celloriginActivelymotilecellsproducedinbonemarrowDifferentiatefromstemcellsoveraboutatwo-weekperiodProductionofgranulesduringthistimeAzurophilProducespecificgranuleslaterBIOL53351Phagocytes—TypesofCellsNeutrPhagocytes—TypesofCellsNeutrophils—cellorigin,continuedUponmaturation(innumbersof1010perday),theymoveintoperipheralbloodandcirculateforabout6.5hoursNextmoveintocapillarybedandmarginateBIOL53352Phagocytes—TypesofCellsNeutrPhagocytes—TypesofCellsNeutrophils—cellorigin,continuedMarginationcausedbystickinessduetointerleukin-1Summonedbychemotaxis,theymovethroughendothelialcelljunctions(diapdesis)intoextravasculartissuespacesBIOL53353Phagocytes—TypesofCellsNeutrPhagocytes—TypesofCellsNeutrophilsaremostactiveingutGuthasenormousmicrobialpopulationlyingjustonecelllayerawayfromaseptictissueFloragenerateslargeamountsofchemotaxinsthatrecruitmostofbody’savailableleukocytesBIOL53354Phagocytes—TypesofCellsNeutrPhagocytes—TypesofCellsAsaresult,submucosaofgutisinaconstantstateofinflammationKeepmicrobialfloradownSynthesisofneutrophilsinhibitedbychemicalsorradiationInfectionsingutregionBIOL53355Phagocytes—TypesofCellsAsaPhagocytes—TypesofCellsMonocytesandmacrophageComparedtoneutrophilsArriveatdamagedtissuelaterininfectionDaysafterneutrophilshavebeenactiveinfightingintrudersEventuallysettleintissuesandbecomeresidentmacrophageBIOL53356Phagocytes—TypesofCellsMonocPhagocytes—TypesofCellsMonocytesandmacrophageShareprogenitorcelltype,butkineticsofmaturation&appearanceareverydifferentMonocytescontinuecelldifferentiationafterleavingbonemarrowMonocytesandmacrophageinvolvedinbothconstititiveandinduciblemechanismsInteractwithTcellsandplayimportantroleincell-mediatedimmunityBIOL53357Phagocytes—TypesofCellsMonocPhagocytes—TypesofCellsTissue(resident)macrophageExistthroughoutbodyDifferentnamesandfunctionsindifferenttissuesKupffercells—liverAlveolarmacrophage—lungsOsteoclasts—boneMicroglia—brainBIOL53358Phagocytes—TypesofCellsTissuPhagocytes—TypesofCellsMonocyteandmacrophagefunctionsPhagocytizeinvadingmicrobesContributegreatlytoinflammatoryresponseReleasesIL-1—enhancesstickingofneutrophiltocapillaryendotheliaTNF—activatesnewlyarrivedneutrophilsBIOL53359Phagocytes—TypesofCellsMonocMechanismofPhagocyteKillingNeutrophilsGeneralstepsAttachtomicrobesIngestmicrobesKillmicrobesGranules—consideredasenlargedlysosomescontaininghydrolyticenzymesBIOL53360MechanismofPhagocyteKillingMechanismofPhagocyteKillingNeutrophilgranuletypesAzurophil(primarygranule)ContainsLysozymeElastaseAchymotryptic-likeproteaseMyeloperoxidaseSeveralantibacterialcationicproteinsBIOL53361MechanismofPhagocyteKillingMechanismofPhagocyteKillingNeutrophilgranuletypesSpecific(secondarygranule)ContainsCytochromeLysozymeLactoferin(iron-bindingprotein)VitaminB12bindingproteinCollagenaseBIOL53362MechanismofPhagocyteKillingMechanismofPhagocyteKillingTheneutrophilmembraneContainsreceptorsforchemotaxinandopsoninsAfterbindingchemotaxins,receptorsareinternalizedandreplacedwithnewonesBIOL53363MechanismofPhagocyteKillingMechanismofPhagocyteKillingEffectivenessofchemotaxis:veryeffectiveNeutrophilsareverymotileMovebyrearrangingcytoplasmicmicrofilamentsandmicrotubulesActinandmyosininmicrofilamentsareaffectedbyproteingelsolinPortionsthatfaceupstreaminchemotacticgradientformstructurecalledlamellipodiumCytoplasmisdenselypackedwithmicrofilamentsPortionsfacedownstreamformknob-likeuropodBIOL53364MechanismofPhagocyteKillingMechanismofPhagocyteKillingProcessofphagocytosisGeneralaspectsDiffersfrompinocytosisinthatparticles,notliquids,takenupBIOL53365MechanismofPhagocyteKillingMechanismofPhagocyteKillingProcessofphagocytosis,continuedReceptorsonphagocytesurfaceprogressivelyattachtoligandsonbacterialsurfaceStimulatesmechanismsofkillingOxidativemetabolismleadingtoproductionofhydrogenperoxideandcompoundslethaltomicrobes(oxygen-dependentkilling)Dischargeoftoxiccompoundsfromgranulesintophagosome(oxygen-independentkilling)BIOL53366MechanismofPhagocyteKillingMechanismofPhagocyteKillingProcessofphagocytosis,continuedFormphagosome—pouch-likestructurethatinvaginates,displacingthenucleusandgranulestowarduropodFormphagolysosome—membraneofgranulesandphagosomefuse,releasingtoxicsubstancesFormsseparatepinched-offorganelleBacteriacoatedwithantibacterialproteinsBIOL53367MechanismofPhagocyteKillingOxygen-DependentKillingFusionofspecificgranuleswithphagosomemembrane(derivedfromplasmamembrane)bringstogether:NADPHoxidase(oxidizesNADPH;foundinneutrophilplasmamembrane)Uniquecytb(granulemembrane)AquinoneBIOL53368Oxygen-DependentKillingFusionOxygen-DependentKillingReactionO2O2— (reducesoxygentosuperoxideradical)2O2—
+H2OH2O2
+O2 (superoxidedismutase)BIOL53369Oxygen-DependentKillingReactiOxygen-DependentKillingPatientslackingcytochromecomponentsChildrenhavingchronicgranulomatousdisease(CGD)FailuretosynthesizesuperoxideradicalandthereforehydrogenperoxideDuetodecreasedamountofcytochromebGeneforlargersubunitismissing(90K,20K)BIOL53370Oxygen-DependentKillingPatienOxygen-DependentKillingChildrenhavingchronicCGD,cont’d.Neutrophilscanphagocytizenormally,butdonotefficientlyoxidizeNADPHandkillviaoxidativepathwayUsuallydon’tsurviveintoadulthoodBIOL53371Oxygen-DependentKillingChildrOxygen-DependentKillingHowdoesoxidativeprocesskill?InteractionwithmyeloperoxidasesuppliedbyfusionwithazurophilCombineschlorideionsandhydrogenperoxidetoformhypochlorousions(analogoustobleach)Bacterialackingcatalaseproducehydrogenperoxide(pneumococci);basicallycommitsuicidePneumococciarenotdangeroustoCGDpatientsBIOL53372Oxygen-DependentKillingHowdoOxygen-IndependentKillingProcessTriggeredbybindingopsonizedbacteriatotheplasmamembraneofneutrophilsSpecificgranulesfusefirstDeliverseveralbacteriodicalproteins,includinglysozymeandlactoferinBIOL53373Oxygen-IndependentKillingProcOxygen-IndependentKillingAzurophilgranulesdischargeantimicrobialcationicproteinsSomeareamphipathicandresembleothercationicsurfaceproteinssuchaspolymyxinBBIOL53374Oxygen-IndependentKillingAzurOxygen-IndependentKillingAzurophilgranules,continuedDisruptoutermembraneofGram—andkillbycausingleakageofvitalcomponentsEachoftheproteinshasuniqueantimicrobialspectrum,buttendtoaffectGram—morethanGram+
ProteinsmayaccountforsurvivalofsomeCGDchildrenBIOL53375Oxygen-IndependentKillingAzurOxygen-IndependentKillingEfficiencyBacterialkillingunderhighlyanaerobicconditionsofdeepabscessesPatientslackinggenesCodingforcationicproteinsNonefound,maybelethalBIOL53376Oxygen-IndependentKillingEffiOxygen-IndependentKillingChediak-Higashisyndrome (geneticdisease)PrematurefusionofneutrophilgranuleswhilecellsinbonemarrowWhenmaturecellsphagocytize,granulesarealreadyspent,substantiallyreducingkillingpowerBIOL53377Oxygen-IndependentKillingChedComparisonofBacterialSensitivityGram—rodsingutkilledbyoxygen-independentGram+bacteriaonskinandupperrespiratoryepitheliaareresistantt
温馨提示
- 1. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007和PDF阅读器。图纸软件为CAD,CAXA,PROE,UG,SolidWorks等.压缩文件请下载最新的WinRAR软件解压。
- 2. 本站的文档不包含任何第三方提供的附件图纸等,如果需要附件,请联系上传者。文件的所有权益归上传用户所有。
- 3. 本站RAR压缩包中若带图纸,网页内容里面会有图纸预览,若没有图纸预览就没有图纸。
- 4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
- 5. 人人文库网仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对用户上传分享的文档内容本身不做任何修改或编辑,并不能对任何下载内容负责。
- 6. 下载文件中如有侵权或不适当内容,请与我们联系,我们立即纠正。
- 7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。
最新文档
- 2025年度楼顶景观照明设施安装与维护合同4篇
- 2024版陶瓷产品购销合同范本
- 2025年桶装水销售区域市场调研与分析合同样本3篇
- 二零二五年度果树租赁与果树种植项目投资合同3篇
- 二零二五版仓储搬运操作服务合同2篇
- 二零二五版出租汽车承包合同车辆报废及更新政策3篇
- 二零二五年度担保合同争议解决与会计处理办法合同3篇
- 2025年度机械设备买卖合同范本3篇
- 2025年度漫画连载作品授权手机游戏开发合同4篇
- 二零二五南宁市租赁市场租赁合同押金退还协议
- 临床医学院毕业实习管理-new-new课件
- 阻燃材料的阻燃机理建模
- PLC控制系统合同(2024版)
- CJT 511-2017 铸铁检查井盖
- ISO15189培训测试卷及答案
- JJG(交通) 171-2021 超声式成孔质量检测仪检定规程
- 气象卫星技术在军事中的应用
- 配电工作组配电网集中型馈线自动化技术规范编制说明
- 介入科围手术期护理
- 化验员个人自查自纠报告
- 食品良好操作规范(GMP)和食品卫生标准操作程序(SSOP)课件
评论
0/150
提交评论