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Mosquito salivary proteins play a crucial role in regulating hemostatic responses at the bite site during blood feeding. In this study, we investigate the function of Anopheles gambiae salivary apyrase (AgApyrase) in Plasmodium transmission. Our results demonstrate that salivary apyrase interacts with and activates tissue plasminogen activator, facilitating the conversion of plasminogen to plasmin, a human protein previously shown to be required for Plasmodium transmission. Microscopy imaging shows that mosquitoes ingest a substantial amount of apyrase during blood feeding which reduces coagulation in the blood meal by enhancing fibrin degradation and inhibiting platelet aggregation. Supplementation of Plasmodium infected blood with apyrase significantly enhanced Plasmodium infection in the mosquito midgut. In contrast, AgApyrase immunization inhibited Plasmodium mosquito infection and sporozoite transmission. This study highlights a pivotal role for mosquito salivary apyrase for regulation of hemostasis in the mosquito blood meal and for Plasmodium transmission to mosquitoes and to the mammal host, underscoring the potential for new strategies to prevent malaria transmission.
RESUMO
Introduction With the development of laparoscopic simulation, medical students are motivated to expand their knowledge and proficiency in basic surgical skills. This study aims to demonstrate their capability and readiness for surgical clerkships and, ultimately, surgical residency. This study's primary objective is to ascertain academic surgeons' perspectives regarding laparoscopic simulation in undergraduate medical education and to determine if early exposure may afford medical students additional opportunities during their surgical clerkships. Methods A survey was created to ascertain surgeon perspectives on medical students' early exposure to laparoscopic simulation. Five-point Likert scales were used to indicate surgeon perspectives. The survey was conducted over the two days of the meeting; all attendees' meeting inclusion criteria were encouraged to participate. Surgeons practicing within the state of Alabama, with prior experience overseeing the development and training of medical students before June 1, 2022, and attending the AL Chapter American College of Surgeons 2022 Annual Meeting were eligible to complete the survey. Only completed surveys were included for analysis. Statement 1: "Pre-clinical exposure to laparoscopic simulators is beneficial to the training and development of medical students pursuing a surgical career." Statement 2: "I am more likely to allow medical students to participate in laparoscopic surgery cases if they have had prior exposure to, and training with, laparoscopic simulators." Results An on-site survey was conducted among 18 surgeons consisting of 14 full-time faculty attendings, two post-graduate year-five residents, and two post-graduate year-three residents, all practicing in academic medicine with experience overseeing the training of medical students. In response to Statement 1, 33.3% of respondents strongly agree and 66.6% agree. In response to Statement 2, 61.1% of respondents strongly agree, 33.3% agree, and 5.6% were undecided. Discussion Our study provides evidence to support the inclusion of laparoscopic simulation training in undergraduate medical education to enhance medical students' basic surgical skills and improve their clinical experience. Further research could inform the development of effective laparoscopic simulation training programs that prepare medical students transitioning to surgical residency.
