Anatomical Society Winter Meeting

S01

From the physical to the virtual and back again: how modelling is informing our understanding of primate dietary adaptations

L. C. Fitton,¹ E. Hunter² and E. Dickinson^3,4

¹Department of Archaeology and Hull York Medical School, Centre for Anatomical and Human Sciences, University of York, York, UK; ²Centre for Anatomical and Human Sciences, Hull York Medical School, University of York, York, UK; ³Max Planck Weizmann Center for Integrative Archaeology and Anthropology, Leipzig; ⁴Max Planck Institute for Evolutionary Anthropology, Leipzig

Advances in imaging and computing have led to exciting advances in the field of anatomy. Creating virtual copies of specimens allows for internal and external anatomy to be dissected, reconstructed, quantified and studied in ways that are often impossible in reality. Now recent advances in 3D printing, in particular, the types of materials that can be printed, are allowing the virtual to return back to the physical and may further enhance the possibilities for anatomical research and modelling.

This paper uses and reviews a variety of modelling techniques including virtual anatomy, finite element analysis (FEA), multibody dynamic analysis (MDA), 3D printing and physical materials testing to investigate the functional significance of morphological differences between the masticatory anatomy of primates. Special focus is paid to Macaca fascicularis and Cercocebus atys. These species both belong to the same tribe of Old World monkeys but have different diets. C. atys is a hard object feeding specialist compared with the more frugivorous M. fascicularis. Overall results indicate that both species possess morphological features which are functionally significant, being advantageous for feeding and or certain social behaviours. Developmental changes in hard tissue anatomy also appear to play a vital role in the masticatory performance of these species during ontogeny.

This work also demonstrates that by taking advantage of these technological innovations there is the possibility for a deeper insight into the relation between anatomical form and function than ever before. By combining virtual anatomy with biomechanical studies the functional anatomy of a species can now be examined non‐invasively and anatomical data digitally manipulated to create hypothetical specimens, both of a virtual and physical nature, capable of testing various form‐function hypotheses.

No ethical approval was required to carry out this study. All specimens used were sourced from osteological or 40‐year‐old cadaveric collections housed at Hull York Medical School as part of their teaching and museum collection; no experiments were carried out on living primates.

S02

A novel neuroanatomically driven method of virtualising the stria terminalis in humans using diffusion imaging

C. Kennedy,¹ A. Nasa,² C. Gaughan,² R. King,² E. Roman,² K. Levins,³ B. Adegbemi,² D. Barry,⁴ E. O'Hanlon,² V. O'Keane² and D. Roddy^1,2

¹Department of Physiology, School of Medicine, University College Dublin, Dublin, UK; ²Trinity College Institute of Neuroscience, Lloyd Building, Trinity College Dublin, Dublin, UK; ³Department of Anaesthetics and Pain Medicine, St. Vincent's University Hospital, Dublin, Dublin, UK; ⁴Department of Anatomy, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, UK

The stria terminalis is the main output tract from the amygdala to the hypothalamus. Changes in this tract have been found in animal models of neuropsychiatric disease. In humans, the stria terminalis follows a course similar to and tightly aligned with the fornix. This close anatomical arrangement can cause difficulty in separating these tracts when using diffusion weighted magnetic resonance imaging (DW‐MRI). Here we present a novel and anatomically driven protocol for accurately separating the smaller stria terminalis from the larger fornix.

Ninety subjects underwent DW‐MRI using high angular resolution diffusion imaging (HARDI) and high resolution T1 (1 mm isotropic) MR imaging at Trinity College Dublin (Phillips Intega 3T). Ethics approval was granted by the St James/Tallaght joint REC. The fornix‐stria combination was isolated using a previously presented technique. Amygdala volumes were generated using the automated segmentation module of FreeSurfer 6.0. Digital amygdalar analogues were generated from these volumes, which could then be used, in conjunction with Boolean logic, to extract the stria terminalis from the fornix‐stria combination.

Using this technique we were able reliably to visualise and quantify the stria terminalis. This is the first time the stria terminalis has been visualised in humans with this level of precision and it demonstrates how neuroanatomy can inform new imaging techniques. As this white matter tract provides the majority of the amygdalar drive to the hypothalamus, this protocol could be used to study amygdalar/hypothalamic connections in neuropsychiatric diseases. It could have particular use in investigations of illness that involve amygdalar, neuroendocrine and autonomic pathology such as depression, anxiety, post‐traumatic stress disorder and schizophrenia.

S03

Unpacking the human amygdala: neuroanatomical findings in depression

R. King,¹ E. Roman,¹ B. Adegbemi,¹ C. Barry,² D. Barry,² E. O'Hanlon,¹ V. O'Keane¹ and D. Roddy^1,3

¹Trinity College Institute of Neuroscience, Lloyd Building, Trinity College Dublin, Dublin, UK; ²Department of Anatomy, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, UK; ³Department of Physiology, School of Medicine, University College Dublin, Dublin, UK

The amygdala is a key structure involved in emotional processing and the response to stress. Amygdala volume changes have been observed in depression; however, previous studies have been inconclusive. This may be due to changes in depression occurring at a subnuclear level, rather than being reflected in the amygdala as a whole.

Magnetic resonance imaging (MRI) was employed to compare the amygdalae of 80 secondary care patients meeting diagnostic criteria for major depressive disorder with 83 healthy controls. High resolution T1 and T2‐FLAIR‐weighted MRI brain scans were examined using the automated amygdalar substructure volumetric module in FreeSurfer version 6.0. Between‐group volumetric assessment of nuclei was performed. Ethics approval was granted by the St James/Tallaght joint REC.

Nine nuclei were identified in each amygdala hemisphere. These were divided into three composite groups, based on functional, hodological and embryological similarities. We found that the output centromedial group of nuclei was larger on the right side in depression. We also found that the left–right asymmetry of the whole amygdala was increased in depression (with the left amygdala slightly decreasing and the right amygdala slightly increasing). This asymmetry was driven by differences in the centromedial nuclei on both sides.

This study identified the right‐sided centromedial nuclei as important in depression. These nuclei send amygdala output directly to the hypothalamus, allowing the amygdala to influence emotional states through autonomic and HPA axis changes. Both these changes are known to occur in depression and can manifest as anxiety, stress, agitation and vegetative disturbance. Interestingly, it is known from animal and human studies that the right amygdala is particularly involved in the generation of negative emotions. This study shows how neuroanatomical expertise may lead to improved interpretation of clinical research.

S04

Rat inner ear mitochondria characterised by EM tomography into distinct subpopulations

A. Lysakowski,¹ J. Lesus,¹ K. Arias,² V. Babu,³ S. Sobkiv,² M. Patel,² F. Padron,² J. Kulaga,⁴ A. Kambalyal,⁴ P. Mozafarri,⁴ L. Ghatala,² A. Jayakumar,² R. Bahari,² B. Desai,² N. Laban,² S.D. Price,¹ M. Ellisman⁵ and G. Perkins⁵

¹Department of Anatomy and Cell Biology, University of Illinois at Chicago (UIC), Chicago, IL, USA; ²Department of Biological Sciences, UIC, Chicago, IL, USA; ³Illinois Math and Science Academy, UIC, Chicago, IL, USA; ⁴Department of Economics, UIC, Chicago, IL, USA; ⁵National Center for Microscopy and Imaging Research (NCMIR), University of California at San Diego, San Diego, CA, USA

Our central hypothesis is that mitochondria in hair cells and inner ear sensory epithelia are non‐homogeneous and that structural and molecular differences they exhibit are related to their differential responses to ototoxic insults, such as aminoglycoside toxicity and noise. Due to variations in physical structure and corresponding molecular composition, the various sub‐populations of hair‐cell (HC) mitochondria are likely differentially affected by ototoxic insults, such as aminoglycoside antibiotics and chemotherapeutics. EM tomography and graphical reconstruction methods were used. Our results indicate there are three different‐sized populations of mitochondria in vestibular sensory epithelia (based upon volume and surface area measurements): large (found in the subcuticular region of central type I vestibular HCs); medium (in all HCs and afferents); and small (in efferent boutons). By reconstructing several examples of each type, we are determining average volume and surface area of each type, and the number and type of cristae (tubular, lamellar or tubulo‐lamellar). In addition, we are investigating the number, size, and locations of crista junctions (CJs, intersections of the cristae with the inner mitochondrial membrane) in relation to other structures in the cell. As one example of our structural findings, we found that in many HCs, lamellar mitochondrial cristae adjacent to the cuticular plate (CP) are perpendicular to and polarised towards it. This means that these cristae align end‐on with the cuticular plate and that more CJs open towards the CP on that side of the mitochondrion. Short videos help us to determine asymmetry in the distribution of CJs. Finally, we are also attempting to characterise the three size sub‐populations in vestibular HCs by Seahorse Bioanalyzer analysis of oxygen consumption rates and electron flow assays, with the goal of determining which sub‐population is most sensitive to ototoxic antibiotics. We conclude that there are significant differences in morphology among these three mitochondrial sub‐populations. All experiments were approved by the University of Illinois at Chicago IACUC. Funding source: NIH R21‐DC013181.

S05

Multi‐dimensional anatomy teaching

S. McAtamney, C.J. Thornton, M. O'Donnell and E. Sweeney

Centre for Biomedical Sciences Education, Queen's University Belfast, Belfast, UK

Anatomy is the study of 3D structures and their relations and behaviours in time and space, but in many cases the didactic lecture is a mostly 2D, static affair. This work aims to detail techniques that may be employed to confer a better spatial understanding to students. We demonstrate how digital animations may be easily created and incorporated into lectures to demonstrate shape and movement of structures. We also detail how multiple photos of a specimen may be processed by photogrammetry software (AgiSoftPhotoScan/Metashape) to create 3D virtual images of cadaveric specimens. These ‘virtual prosections’ may be introduced into teaching and ‘virtual spot tests’. Once created, these images and other freely available 3D images may be viewed in virtual reality (VR) cheaply and easily using devices such as the UK£3 Google Cardboard®. Physical 3D models also have a place in modern anatomy education, virtual files can be 3D printed to replicate anatomical structures that may be used outside of designated gross anatomy areas. Other physical models that will be demonstrated include mannequin heads for easy ‘body painting’ and an ‘opthalmotrope’, a simply constructed dynamic model of the extraocular muscles. We present the feedback received from students and expert focus groups regarding these teaching methods; this was entirely positive and indicates that these techniques are a worthwhile endeavour.

No institutional ethical approval was necessary for the generation of the data contained in this presentation.

S06

The human mammillothalamic tract: a virtual game of hide‐and‐seek

R. King,¹ E. Roman,¹ B. Adegbemi,¹ C. Barry,² D. Barry,² E. O'Hanlon,¹ K. Levins,³ V. O'Keane¹ and D. Roddy^1,4

¹Trinity College Institute of Neuroscience, Lloyd Building, Trinity College Dublin, College Green, Dublin, UK; ²Department of Anatomy, Trinity Biomedical Sciences Institute, Trinity College Dublin, College Green, Dublin, UK; ³Department of Anaesthesia, Intensive Care and Pain Medicine, St. Vincent's University Hospital, Dublin, UK; ⁴Department of Physiology, School of Medicine, University College Dublin, Dublin, UK

The human mammillothalamic tract (MTT) is the somewhat elusive pathway projecting bilaterally from the mammillary bodies, passing posteriorly and then superolaterally to insert into the anterior thalamic nuclei. We discovered a need to refine protocols for dissecting out the MTT in the virtual realm, due to inconsistencies and difficulties in isolating the tract.

We used the MRI scans of 52 individuals with major depressive disorder and 94 healthy controls to design a method that would enable us to study the depression‐related changes that may occur in the MTT. Using high‐resolution T1 scans and EPI trafo files to generate tracts for each subject, we worked on virtual dissection to carve out the MTT. Two regions of interest (ROIs) were identified in the axial plane, and the ‘AND’ operation was performed to exclude fibres not passing through these ROIs. These ROIs enabled us to identify the MTT accurately. Ethics approval was granted by the St James/Tallaght joint REC.

To our knowledge, this is the first study to conduct a large‐scale investigation into the methods of isolating this sequestered tract using MRI T1 imaging and EPI trafo files. Reliability was shown by using two raters applying the method to each scan. Furthermore, the tracts we generated match our research into its cadaveric appearance, and we are going to use cadaver measurements to verify this. It was found that this method was effective in carving out and identifying the MTT in both depressed and control subjects.

Following the development of this protocol, we have overcome the initial obstacles in virtually dissecting the MTT, and can proceed with our investigations into what/any changes occur in this pathway in the pathogenesis of depression. Moreover, we have been considering the possibility of using this innovative method in the teaching of Neuroanatomy to medical students.

S07

The microstructural anatomy of hard tissues as a signature of human experience: from australopithecines to astronauts

K.R. Brown

University of Bristol, Bristol, UK

A long‐standing focus of biological anthropology has been the study of human skeletal diversity that we can easily observe and quantify: macroscopic anatomy. In more recent years, we have also been agile in our take up of the opportunities presented by biomolecular characteristics and markers that can be used to estimate relatedness or differences between people and populations. The study of microstructural anatomy has, in contrast, received much less attention within biological anthropology. In this presentation, I will review the opportunities and challenges of working at the microscale and explore whether the hard tissues of the body hold a structural signature of human growth, physical activity, life history events, and even the extreme environment of space.

S08

Primate seed predators and masticatory anatomy: is there more than one way to be a nut‐cracker?

E.M. Hunter,¹ P.G. Cox² and L.C. Fitton²

¹Centre for Anatomical and Human Sciences, Hull York Medical School, University of York, York, UK; ²Centre for Anatomical and Human Sciences, Department of Archaeology and Hull York Medical School, University of York, York, UK

Primates that specialise in hard, stress‐limited objects are often considered functionally extreme due to the mechanical challenges presented by their diet. Numerous primates spanning a diverse phylogeny feed extensively on such objects; however, whether morphological convergence has occurred is unknown.

This study compares the masticatory anatomy of hard and non‐hard object feeding primates belonging to the families Atelidae, Cebidae, Pitheciidae, Cercopithecidae and Hominidae. Ninety landmarks (3D) representing key masticatory features were taken on a sample of 101 primate specimens spanning 11 species. Landmarks placed on occluded crania and mandibles captured masticatory form. The analysis was carried out using geometrical morphometrics and a distance‐based test of convergence was carried out on representative males.

It was predicted that the masticatory form of the specialist hard object feeding Cercocebus atys would converge with the Pitheciidae, relative to its non‐hard object feeding relatives. Preliminary results suggest that hard object feeding primates do not converge in the way that was predicted. The tougher feeding Sapajus apella showed significant convergence with the hard object feeding Pitheciidae; however, C. atys did not converge with the other hard object feeding primates.

Results suggest many‐to‐one‐mapping of masticatory form in order to process hard objects, but could reflect differences in food processing behaviour. Tough and hard foods also appear to place similar demands on the masticatory form. Further analyses will explore the functional differences between these masticatory forms to establish if there are many ways to crack a nut.

No ethical approval was required to carry out this study as all specimens used were sourced from museum collections.

S09

Are finite element models of primate crania valid?

P. O'Higgins

Department of Archaeology and Centre for Anatomical and Human Sciences, Hull York Medical School, University of York, York, UK

With the ready availability of computed tomorgraphy (CT) scanning, software and increased computing power, virtual simulations of how primate and hominin crania bear the loads of mastication have become increasingly common. Finite element analysis (FEA), a tool from engineering, is often used to simulate biting loads and to predict the resulting deformations of the craniofacial skeleton. Typically, the ability of the cranium to resist these loads is of interest and may be compared among individuals or within the same model with varying loads, constraints or geometry. But how valid are the results of such studies?

Validity depends on how models are made and loaded, and many factors can impact model behaviour under simulated loads. To these ends, this presentation reviews a series of ongoing studies in primates and hominins, undertaken with ethical approval where required. They aim to detail the impact of variations in model geometry, material properties, loads and constraints on subsequent predictions of cranial deformations. A novel morphometric approach to comparing deformations is applied to assess the relative impact of variations in modelling parameters. The studies find that, on the whole, predicted deformations are sensitive to all of these parameters and that errors will impact validity to greater or lesser extent. Practical limitations in estimating parameters mean that it is unlikely that with current technology, cranial FE models will reliably predict strains, especially when detailed experimental data are not available to refine modelling.

These studies lead to the conclusion that, at present, FEA is best applied to understanding the consequences of variations in anatomy and loading, through experimental manipulation of single models. Where differences in performance among individuals are of interest, modelling should be undertaken in as controlled a manner as possible and the results interpreted cautiously, with appropriate acknowledgement of the effects of modelling simplifications and errors.

Ethical statement

Some of the presented studies were carried out on human cadaveric remains obtained under the HYMS anatomy donor programme. The donor gave consent during life and the studies were approved by the HYMS ethics committee. Other human material used in these studies was ancient and CT scans of all primate skeletal material were obtained from museum collections and so are excluded from HTA oversight and the need for ethical approval.

S10

The hidden curriculum

F.W. Hafferty

The Mayo Clinic, Rochester, Minnesota, MN, USA

When the hidden curriculum (HC) as a conceptual and analytic lens first appeared within medical education (Hafferty & Frank 1994) it was tied to the topics of medical ethics and professional identity formation. Nevertheless, its origins actually can be traced to earlier work in the fields of sociology and of education in general, and, more specifically, to the world of anatomy education in the 1970s. Earlier work by Hafferty (1976, 1988, 1991) was heavily dependent upon his fieldwork experiences in anatomy and anatomy lab. Although he did not explicitly deploy a HC framework at that time, the conclusions he drew from those fieldwork experiences were very ‘HC’ in nature. In this presentation, we will explore this history, more firmly anchor the HC within its anatomy roots, and trace the evolution of anatomy education over the past 40 years through a HC lens.

S11

Early perceptions of social media professionalism amongst medical students

C.M. Hennessy,¹ C.F. Smith¹ S. Greener² and G. Ferns¹

¹Brighton and Sussex Medical School, Falmer, Brighton, UK; ²School of Business, University of Brighton, Brighton, UK

Communication norms in today's society including patients are changing and many patients are eager to interact with doctors on social media. Some doctors also advocate the advantages of using social media for communicating with patients and improving healthcare outcomes. Medical students must develop social media professionalism due to the serious implications of inappropriate use of social media which has previously resulted in doctors losing their medical registration. Some believe that simply applying the usual principles of professionalism to social media communication is enough, but the public nature of social media adds a new dimension to professionalism. This project aimed to explore the early perceptions of social media professionalism amongst Year 1 medical students at Brighton Sussex Medical School. Approval was granted by the ethics committee. A questionnaire was completed by 147/161 students. Although 89% felt confident that they understood how to use social media professionally; only 23% reported having read the guidelines provided by the General Medical Council. In all, 87% agreed that their social media behaviour could affect the medical profession, which students were asked to explain in an open‐ended question. Thematic analysis of explanations revealed four main themes – students perceived:

1 themselves representatives of the medical profession;

2 the high standards of professionalism the public expect of this trusted profession;

3 that social media can be used by the public to form first impressions

4 and consequences of inappropriate use of social media can reduce public trust in the profession.

Conclusion

Medical students perceive themselves to be representing the medical profession from an early stage and have a high awareness of how their behaviour on social media can affect the reputation of the medical profession. Early medical students appear to adopt conservative use of social media to avoid damaging the reputation of the medical profession.

S12

Traditional lecture or problem based learning? Exploring the impact on knowledge gain and student perceptions within a neuroanatomy near‐peer teaching programme

D. Anbu,¹ D. Payne,¹ C.H. Harrison,¹ M.A. Myers,¹ A. Elmansouri,² S. Hall,² W. Parton,² E. Nagy,¹ K. Geoghegan,¹ R. Parker,¹ S. Morton¹ and S. Border¹

¹Faculty of Medicine, University of Southampton, Southampton, UK; ²University Hospital Southampton, NHS Foundation Trust, Southampton, UK

Near peer teaching (NPT) is an educational approach where teachers are several years senior in the same educational path as the learners. Although the positive impacts of this approach are widely established, there are various teaching methods that may be employed within NPT. Traditional lecture style (TLS) teaching has been shown to be beneficial in ‘science’ heavy aspects of medicine, whereas problem based learning (PBL) has been found to increase knowledge retention. Although evidence exists to support these teaching styles, no such studies compare these methods within NPT. The purpose of this study was to compare TLS and PBL methods of teaching head, neck and neuroanatomy in NPT.

In 2017, all 2^nd year students (n = 215) at Southampton Medical School attended an NPT session by 3^rd year students (n = 16). Six cranial nerves were taught in a lecture style and six were taught using PBL in week 2 of an 8‐week module, which was their first exposure to this topic. Learners were blinded to the purpose of the study and experienced both teaching styles, providing matched samples. The students completed a pre‐teaching test, post‐teaching test and a perception survey (response rate 88.4%).

Analysis showed a non‐significant increase of 0.001 (P = 0.54) in mean normalised knowledge gain when using PBL vs. TLS. Furthermore, there were no significant differences between student perceptions of the two approaches across criteria such as Delivery and Enjoyment. However, students demonstrated a significant improvement in learning with both TLS (P < 0.0001) and PBL (P < 0.0001).

This cohort study demonstrates no differences in the student experience or in academic achievement when using PBL and TLS approaches within an NPT programme. This would suggest that both options are viable strategies in NPT delivery irrespective of session timing in the curriculum.

This study was approved by the Faculty of Medicine Ethics Committee.

S13

Can we do better? Challenges for 21^st century anatomy education for allied health professionals

S.A. Connolly,¹ T.H. Gillingwater,¹ C. Chandler² and G.M. Finn³

¹School of Biomedical Science, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK; ²School of Health & Social Science, College of Humanities and Social Sciences, University of Edinburgh, Edinburgh, UK; ³Hull York Medical School, University of York, York, UK

The 2013 Francis report and the more recent Gosport report (2018) detail poor care and standards and inability to challenge medical decisions that have led to sustained patient morbidity and exponential mortality. This is compounded by an extensively documented anatomy and bioscience deficit in nursing, leading to urgent reform within nursing education. Despite this, the guidance on the level and depth of anatomy required remains generic, outlined as a ‘sufficient knowledge of anatomy’ creating widespread variability that lacked an objective criterion. In response, anatomists posed the question: ‘What is meant by sufficient anatomical knowledge? to provide clarity on the level and depth of anatomical knowledge required, creating a national core anatomy syllabus for undergraduate nurses. Barriers to the uptake of the syllabus became apparent when the data showed that 80% of nursing schools had no affiliation with anatomy departments, raising questions on nurse's ability to access expertise and resources. After surveying nursing and anatomy departments across 69 higher education institutions and receiving 101 responses throughout the UK and Ireland, we found that nursing faculties were unaware of what anatomy departments have to offer, despite 65% of nursing educators believing that collaboration is important. Nursing faculties also reported that when they had approached anatomy departments they were ‘stretched’ and unable to accommodate them, leading some respondents to believe that they were closed off from establishing partnerships, despite 85% of anatomists believing access and collaboration is vital not just with nurses, but with all allied health professions. Anatomists evocatively revealed a medical monopoly on teaching time and resources. Disturbingly, this historically mediated monopoly has led to severe staffing and space constraints as medical schools reduced funding and teaching hours to meet the needs of the medical curriculum, while attempting to accommodate growing student numbers, making it near impossible to provide educational support to allied health professionals. The findings show there is a medical monopoly on anatomical resources that necessitates a multidisciplinary dialogue between anatomists, medical and nursing faculties, as insufficient anatomy knowledge compromises quality healthcare and makes both medical and nursing practitioners vulnerable to medico‐legal and fitness to practice proceedings in the age of team‐based healthcare delivery.

This project has obtained full ethical approval from the University of Edinburgh School of Health & Social Science.

S14

Taking osteology from the Stone age to the Space age

T. Thompson¹ and D. Errickson²

¹Tessside University, Middlesbrough, UK; ²Cranfield University, Bedford, UK

Osteology has a long academic history and with it a very traditional approach to teaching the subject. Over recent years, increasing interest in, and access to, methods of digitisation have had an impact on the learning and teaching of human skeletal studies within higher education. This talk will explore how traditional models of teaching are being evolved to incorporate these new approaches and how this can have significant wider participation benefits, but also raises a number of ethical challenges.

S16

The morphology of the human prefemoral fat pad suggests that it aids patellar stabilisation in knee extension.

P. Warren,¹ M. Fortune,² D.C. Davies,³ C. Brassett¹ and J. Chitnavis^1,4

¹Human Anatomy Teaching Group, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK; ²MRC Biostatistics Unit, University of Cambridge, Cambridge Institute of Public Health, Cambridge, UK; ³Human Anatomy Unit, Department of Surgery & Cancer, Imperial College London, London, UK; ; ⁴Cambridge Knee Clinic, Cambridge, UK

The prefemoral fat pad (PFP), also known as the posterior suprapatellar or supratrochlear fat pad, is one of three anterior fat pads of the knee joint. The PFP adheres to the anteroinferior surface of the femur and separates it from the patella in full extension of the knee. While pathological changes in the PFP have been implicated in anterior knee pain, little research has been conducted into its morphology. Therefore, the anatomy of the PFP and its role in shaping the peripatellar environment in full extension were investigated. In all, 36 cadaveric knees from 26 donors (12 male, 14 female, mean age ± SEM 85 ± 1.5 years) were dissected in compliance with the UK Human Tissue Act (2004). Measurements were taken of the PFPs to determine whether they were of uniform thickness. The depth of the ‘prefemoral sulcus’ (a visible central sulcus) in the PFP was measured prior to PFP resection and then the depth of the underlying femoral (supratrochlear) groove was measured at the same level. The mean thickness (± SEM) of the PFP was significantly less centrally at the level of the prefemoral sulcus (2.86 ± 0.24 mm) than at its medial (6.92 ± 0.42 mm) and lateral (4.99 ± 0.43 mm) prominences overlying the respective femoral condyles (P ≤ 0.0001 for both comparisons). The mean depth (± SEM) of the ‘prefemoral sulcus’ in the PFP (4.41 ± 0.19 mm) was significantly greater (P ≤ 0.001) than that of the underlying femoral groove (2.88 ± 0.25 mm). These results suggest that the PFP acts to deepen the groove in which the patella rests, increasing its stability in full knee extension. Thus, the PFP may play a significant role in shaping the peripatellar environment and PFP pathology could alter this environment and result in anterior knee pain. This possibility warrants further investigation using in vivo imaging.

No specific ethical approval was required for this research, as consent for anatomical research is specifically included in the donor's consent statement for all cadavers included in this work.

S17

Virtual microanatomy

S.I. Anderson

Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham School of Medicine, Royal Derby Hospital Centre, Nottingham, UK

Medical education in the early years’ curricula is increasingly congested, with the addition of valuable skills and subjects squeezing the time available for more traditional basic sciences. This includes microanatomy, which is taught in a variety of ways, including traditional microscopy labs and virtual microscopes (VM). Some Schools do neither, instead using histological images or diagrammes as part of a lecture series. This talk aims to give an overview of two different approaches to the microanatomy curriculum at the University of Nottingham for medical students and BSc students, and at Hull York Medical School for intercalating MSc students. The approaches used have been twofold: (1) integration of microanatomy with physiology, such that normal structure equates to normal function and is then linked to pathology as an alteration of normal structure, with predictable effects on function; (2) use of immersive exposure using virtual microscopy techniques.

The preferred approach for (1) has been to use the VM dynamically and interactively during lectures. This has increased engagement and provided more clarity regarding tissue structure and how this relates to function and dysfunction. For (2), a longitudinal theme has been developed, where lectures have been followed by VM sessions for every body system in health and disease, while students build their own e‐resource over a 2‐year period. Students also use VM to carry out group projects across the international campuses. Students can choose an optional histopathology module in their final year using VM for diagnoses, case studies and coursework. Where it has been possible to evaluate exam performance, this has improved. Significantly, students frequently report that their understanding of anatomy, physiology and pathology had come together in an integrated way as a result of immersive VM learning.

Staff and students reported that VM stimulated engaged and active learning with increased knowledge and skills. Perhaps surprisingly, it has fostered an enthusiasm for microanatomy and a career path for several students. Considering these benefits, consensus on curricular content and the importance of microanatomy in integrating the essential knowledge required for successful medics and scientists would be beneficial.

S18

Physician Associate student perceptions of 3D digital visualisation technologies for enhancing their learning of anatomy

A.B. Awadh,¹ J. Clark,² S. Lindsay,³ G. Clowry¹ and I.D. Keenan⁴

¹Institute of Neuroscience, Newcastle University, Newcastle, UK; ²School of Education, Communication and Language Sciences, Newcastle University, Newcastle, UK; ³Institute of Genetic Medicine, Newcastle University, Newcastle, UK; ⁴School of Medical Education, Newcastle University, Newcastle, UK

Early in their training, Physician Associate (PA) students at Newcastle University are exposed to gross anatomy, surface anatomy and clinical imaging in order to provide them with an overview of the anatomical basis of clinical examination. PA students typically have limited prior knowledge of anatomy when commencing their studies and we propose that they have particular difficulties in understanding specific anatomical topics and concepts. We have introduced the use of 3D visualisation technologies comprising a Sectra visualisation table and 3D printed (3DP) models to support their learning.

We sought to identify PA student perceptions of the value of these 3D resources and how they may impact upon the most challenging areas of anatomy learning. The 2018/2019 cohort of PA students at Newcastle University (n = 17) participated in our study. A validated questionnaire with Likert‐type items (1 = strongly disagree/not at all challenging, 7 = strongly agree/extremely challenging) was analysed statistically and by one‐way ANOVA.

PA students had positive perceptions of the Sectra (mean = 5.94, SD ± 1.09) and 3DP models (4.59 ± 1.62). They reported that understanding 3D features (3.18 ± 1.47) and 3D spatial relationships (3.12 ± 1.65) was less challenging than other anatomical concepts. Clinical image interpretation (4.41 ± 1.33) was significantly (P < 0.05) more challenging for PA students than surface anatomy (3.35 ± 0.79). Understanding the anatomy of the limbs (4.88 ± 1.45) was significantly more challenging (P < 0.05) than understanding the thorax (3.29 ± 1.40) or abdomen (3.35 ± 1.58). This was likely due to concepts concerning the innervation and cross‐sectional arrangement of muscle compartments (4.53 ± 1.62), which PA students considered to be significantly (P < 0.05) more challenging to interpret than other cross‐sections (2.88 ± 1.32).

We aim to continue this work to identify the perceptions of future PA cohorts. Our findings will have implications for how anatomy content is delivered within PA programmes, and furthermore how digital visualisation technologies are implemented within anatomy curricula more widely.

Ethical approval was obtained for conducting research with consenting human participants.

S19

Final year medical student reflections on ultrasound use in anatomy

N.C. Monteoliva, K. Pearce, A. Dilley and C.F. Smith

Brighton & Sussex Medical School, University of Sussex, Brighton, UK

Undergraduate exposure to ultrasound is variable across institutions but has been suggested as a useful teaching adjunct in medical education, particularly for learning basic anatomy. The aim of the study was to evaluate final year medical student attitudes towards the use of ultrasound imaging in undergraduate teaching. Ethical approval was obtained for this study. At Brighton and Sussex Medical School, ultrasound has been fully integrated into year 1 and 2 of the MBBS medical curriculum in small group teaching sessions (n = 15) totalling 12 h. Final year students were asked to complete a 20‐point retrospective rating‐scale questionnaire. Responses (n = 22) were analysed: 77% indicated that ultrasound helped them comprehend the three‐dimensional nature of anatomical structures and 59% indicated that ultrasound alone helped them develop an understanding of anatomy. Furthermore, 91% of students strongly agreed that learning anatomy through ultrasound was very relevant to clinical practice. However, 86% remained underconfident about using ultrasound in their clinical practice; for instance, 45% suggested difficulty in recognising vessels. Only 50% had received further bedside teaching in ultrasound since living anatomy sessions. All students wanted more formal training in ultrasound use during the clinical years of study and 82% wanted more supplementary information about its clinical applications. Conclusively, the majority of students appreciate the formal ultrasound teaching they received, its benefits for learning anatomy and related clinical applications. Further opportunities to develop ultrasound skills and learn about clinical applications of the modality should be provided to students in a blended learning environment throughout the course.

S20

The spectacle of dissection: investigating the visuospatial features of anatomical teaching in UK medical schools

A. Neumann,¹ M. Qureshi² and C. Brassett³

¹Research Associate & Affiliated Lecturer in German, School of Medieval and Modern Languages, University of Cambridge, Cambridge, UK; ²University of Cambridge School of Clinical Medicine, Cambridge, UK; ³Human Anatomy Teaching Group, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK

This study examines how the visuospatial features of dissection facilities have shaped anatomy teaching in Cambridge and other UK medical schools. Just as medical topography surveys a region to uncover physical features influencing health and disease, an investigation of anatomical teaching spaces should reveal recurrent themes. Anatomical theatres are modelled on an amphitheatre which elevates the observer to a position with a virtual bird's‐eye view of the unfolding drama. The analogy of theatrical performance can thus be used to uncover the relationships between the topography of a room and methods of anatomical teaching, highlighting the similarities between a dramatic play and dissection lesson. Our research methods were drawn from the critical medical humanities, cultural anthropology and sociology. The performative structure of a dissection lesson was analysed through participant observation, semi‐structured interviews with students and demonstrators, and qualitative thematic content analysis. Fully informed consent was obtained from all interviewees for this study. Participant observation was informed by seeing anatomy ‘acted out’ first‐hand during teaching sessions in Cambridge, University College London, Imperial College London, King's College London and Manchester University. Guided interviews with different ‘actors’ provided an in‐depth understanding of their experience, opinions and feelings. Care was taken to disentangle the interaction between demonstrators, students, donors, props and ‘matters of care’. Our findings showed that the conceptual design of visuospatial features in dissection rooms is key to maximising student engagement with dissection. Although the clinical anatomist, the ‘director’, plays a leading role in shaping the screenplay, the donor is retained as the centre of attention. The spatial proximity between different ‘characters’ and ‘props’ through designated teaching zones allows for multiple role changes but concentrates the focus on the donor. The use of digital devices with 3D‐rendered images created new teaching ‘scenes’ which juxtapose bodies in the analogue and virtual realms. These were employed especially effectively in teaching sessions involving clinical and applied anatomy.

S21

Imaging morphological integration in mutts, mice and monkeys

N. Jeffery

Human Anatomy Resource Centre, University of Liverpool, Sherrington Building, Ashton Street, Liverpool, UK

Phenotypic plasticity can pervade the skull by integration and potentially prejudice the interpretation of morphological traits used for taxonomic, ecological, functional and behavioural reconstructions of extinct taxa. In recent decades, techniques based on computed‐tomography (CT) and magnetic resonance imaging (MRI) have vastly enhanced our understanding of these co‐ordinated variations. Here we survey a range of imaging strategies used to study the interplay among the brain, masticatory muscles and skull. We follow the use of preclinical and clinical MRI to detect patterns of correlation between relative brain size and cranial base flexion during primate ontogeny. We also consider the co‐registration of CT and MRI to investigate ornamentations of the canid skull and the allometric dilemma of fitting larger masticatory muscles around a relatively smaller neurocranium. Then, we scrutinise the craniofacial complex in hyper‐muscular mice on the basis of micro‐CT and I2KI contrast enhance micro‐CT. Finally, we briefly explore current work in the virtual realm, bringing together advances of imaging and computational analyses to simulate spatial‐packing under various theoretical conditions and compare predicted outcomes against real world data.

Ethics statement

Aspects of this work were approved by the University of Liverpool (RETH000553) and the University of Michigan (PRO00003566).

S22

Midfacial and maxillary sinus anatomy and development in Neanderthals and H. sapiens

F. Landi,¹ A. Profico² and P. O'Higgins¹

¹Department of Archaeology and Centre for Anatomical and Human Sciences, Hull York Medical School, CAHS, University of York, York, UK; ²Department of Environmental Biology, Sapienza, University of Rome, Rome, Italy

Maxillary sinus anatomy and function have long been investigated by morphologists and clinicians, with conflicting conclusions being reached concerning their biological significance. The very large maxillary sinuses of Neanderthals compared with those of H. sapiens have been hypothesised as adaptations to extreme cold or as consequences of the presence of large prognathous midfaces. Few studies have related adult differences in maxillary sinus form to differences in mid‐facial ontogeny and developmental interactions.

Geometric morphometric methods were applied to an ontogenetic sample of modern human crania and Neanderthals from museum collections (ethical approval not required). Two sets of landmarks were acquired on 3D segmented surfaces of CT‐scans of skulls and sinuses of H. sapiens and Neanderthals (H. sapiens n = 60, Neanderthals n = 6). Partial least squares analyses (PLS) were used to investigate covariations, modularity and integration among anatomical features. Growth trajectories were modelled using regression and principal components analyses and used to test the null hypothesis that maxillary sinus anatomy is independent of that of the rest of the skull.

PLS shows that, in modern humans, mid‐facial size changes are the main factor driving the development of sinuses. The associations among sinuses and cranial regions are significantly reduced from infants to adults. This may be linked to differences in growth rates and structural constraints acting over time. The large interindividual variation observed in the PCA suggests that maxillary sinuses act as a buffer, allowing some degree of autonomy among developing cranial regions.

Neanderthal maxillary sinuses achieve larger sizes; however, sinus shape overlaps that of H. sapiens. PLS suggests developmental interactions and sinus form are similar in both groups despite the heavily built midface of Neanderthals. These studies suggest that differences among H. sapiens and Neanderthals arise, to some considerable degree but not completely, through extension/truncation of common ontogenetic patterns.

S23

Make no bones about it; adipocytes template microanatomical structures in human trabecular bone

R. Shepherd,¹ K. Allison,² B. Rhodes,² J.G. Kerns¹ and A.M. Taylor¹

¹Lancaster Medical School, Lancaster University, Lancaster, UK; ²University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK

The presence of novel bone structures, termed trabecular excrescences, has previously been found in surgical waste tissue samples from patients with osteoarthritis (OA), alkaptonuria and from aged bone samples. A particular form of trabecular excrescence is found associated with bone marrow adipocytes and the absence of bone‐lining cells, and we hypothesise that the adipocytes are contributing to bone formation. This is inconsistent with the current paradigm of osteoclast–osteoblast coupled remodelling. We aimed to determine the topographical distribution of trabecular excrescences throughout the trabecular bone in human femoral heads and to identify whether they are associated with the onset of osteoarthritis.

Femoral heads were obtained as surgical waste, with informed patient consent, from three patients with OA (mean age = 71.3, two male and one female patient) and three control patients with no clinical history of OA (mean age = 73.0, three female patients). Each femoral head was sliced into sagittal sections and decalcified. A central sagittal slice from each of the six samples was taken and divided into six regions – superior, central and inferior from the anterior and posterior halves of the section – and processed for histology. Sections were stained with haematoxylin and eosin and examined using bright field microscopy. The slides were imaged and the anatomical location of excrescences was documented. This study was approved by North of Scotland NHS Research Ethics Committee.

Excrescences were found in all six anatomical regions of all six samples from both control and osteoarthritic groups. When found, the excrescences were often clustered, with several protrusions shown along a region of trabeculae. These results demonstrate that trabecular excrescences are globally distributed throughout the femoral head, and not specific to areas of pathological change. This suggests the formation of these structures may be linked to the ageing process rather than to disease progression.

S24

Insular gigantism in Mediterranean dormice

J.J. Hennekam,¹ N. Jeffery,² V.L. Herridge³ and P.G. Cox¹

¹Hull York Medical School, University of York, York, UK; ²Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK; ³Natural History Museum, London, UK

During the Pleistocene, the rodent fauna of Sicily was characterised by the presence of Leithia melitensis, a gigantic dormouse species around the size of a domestic cat. Even though the enlargement of dormice on islands is a common phenomenon in the Mediterranean area, the exceptionally large size of L. melitensis is unique within Gliridae. A second species, Leithia cartei, was also present on Sicily. This species was less extremely enlarged, being comparable in size to the extant species of Eliomys on Formentera. Here, changes in shape associated with body size increases were analysed by comparing the morphology of Leithia with that of extant glirids. Cranio‐mandibular shape of individuals from one extinct and six extant genera of dormice were quantified using landmark‐based techniques. Procrustes superimposition was performed to correct for size changes within the sample data. Principal component analyses showed distinct clustering of certain genera, with the mandibular shape of L. melitensis clearly separated from that of extant dormice. As Eliomys and Leithia are considered to share a common ancestor, this distinction suggests that shape changes within this giant were allometric. The less extremely enlarged species, L. cartei, clusters in the same region as the Eliomys species, implying a relatively isometric size increase in comparison with that of L. melitensis. Geometric morphometrics indicate intergeneric segregation of dormice based on shape, as well as a clear separation of species influenced by insular gigantism within the Gliridae.

The osteological material of dormice used in this research originates from European museum collections. Therefore, no ethics approval was required for this study.

S25

Balloon dilatation of the human frontal sinus – why and when?

N. Jayakody,^* D. Ioannidis and S. Dennis

ENT department, Salisbury NHS Foundation Trust, Salisbury, UK

Purpose of the study

Chronic rhino‐sinusitis (CRS) related frontal sinus headache (FSH) is one of the most prevalent secondary headaches. Due to complexity of the anatomy of frontal sinus and complications from conventional surgery, newer techniques such as balloon sinuplasty (BS) are now used for management of this condition. The purpose of our study was to assess the effectiveness and limitations of balloon sinuplasty in its management.

Methods

30 patients, aged 14–80, with CRS‐related FSH were treated with BS as a day case under a general anaesthetic. SNOT 22 and a VAS pain scores were collected pre‐operatively and at 6‐month follow‐up and used as an outcome measure. Patients were subsequently monitored with patient‐initiated follow‐up for 7–42 months (mean 27).

Results

Although external approach fronto‐ethmoidectomies are sometimes used, the most common surgical modality used for management of FSH currently is functional endoscopic nasal surgery (FESS), which has serious complications such as orbital damage (due to proximity to the orbit through lamina papyracea) and cerebrospinal fluid leak (due to proximity to cribriform plate).

A series of studies have reported similar patency of the frontal sinus ostium at follow‐up between surgery which includes BS as part of its procedure and FESS approach, with improvement of SNOT 22 scores and fewer major adverse events.

In this study, patient SNOT 22 scores improved from 33–93 (mean 57) pre‐operatively to 0–61 (mean 21) postoperatively at 6 months. In a small number of cases, lack of post op clinical improvement leads to follow‐up CT scans that reveal persistent frontal recess obstruction, highlighting the limitations of the technique especially in cases with complex frontal recess anatomy.

Conclusion

BS is an effective technique in the vast majority of patients with CRS‐related FSH. However, further research is required to define clear universally agreed indications and potential limitations.

No ethical approval was required for this study.

S26

Aging of the skeletal muscle extracellular matrix drives a stem cell fibrogenic conversion

K.M. Stearns‐Reider,^1,2 A. D'Amore,³ K. Beezhold,⁴ B. Rothrauff,⁵ L. Cavalli,¹ W.R. Wagner,^2,3,6 D.A. Vorp,^2,3,6,7 A. Tsamis,⁸ S. Shinde,¹ C. Zhang,¹ A. Barchowsky,⁴ T.A. Rando,^9,10 R.S. Tuan^2,5 and F. Ambrosio^1,2,7

¹Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; ²McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA, USA; ³Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA; ⁴Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA, USA; ⁵Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; ⁶Center for Vascular Remodeling and Regeneration, Center for Bioengineering (CNBIO), University of Pittsburgh, Pittsburgh, PA, USA; ⁷Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; ⁸Department of Engineering, University of Leicester, Leicester, UK; ⁹Glenn Center for the Biology of Aging and Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA; ¹⁰RR&D Center, VA Palo Alto Health Care System, Palo Alto, CA, USA

Age‐related declines in skeletal muscle regeneration have been attributed to muscle stem cell (MuSC) dysfunction. Aged MuSCs display a fibrogenic conversion, leading to fibrosis and impaired recovery after injury. Although studies have demonstrated the influence of in vitro substrate characteristics on stem cell fate, whether and how aging of the extracellular matrix (ECM) affects stem cell behavior has not been investigated. Here, we investigated the direct effect of the aged muscle ECM on MuSC lineage specification. Quantification of ECM topology and muscle mechanical properties reveals decreased collagen tortuosity and muscle stiffening with increasing age. Age‐related ECM alterations directly disrupt MuSC responses, and MuSCs seeded ex vivo onto decellularised ECM constructs derived from aged muscle display increased expression of fibrogenic markers and decreased myogenicity compared with MuSCs seeded onto young ECM. This fibrogenic conversion is recapitulated in vitro when MuSCs are seeded directly onto matrices elaborated by aged fibroblasts. When compared with young fibroblasts, fibroblasts isolated from aged muscle display increased nuclear levels of the mechanosensors, Yes‐associated protein (YAP)/transcriptional coactivator with PDZ‐binding motif (TAZ), consistent with exposure to a stiff microenvironment in vivo. Accordingly, preconditioning of young fibroblasts by seeding them onto a substrate engineered to mimic the stiffness of aged muscle increases YAP/TAZ nuclear translocation and promotes secretion of a matrix that favors MuSCfibrogenesis. The findings here suggest that an age‐related increase in muscle stiffness drives YAP/TAZ‐mediated pathogenic expression of matricellular proteins by fibroblasts, ultimately disrupting MuSC fate.

S27

The effect of surgery for basal thumb osteoarthritis on range of dart thrower's motion at the wrist: human cadaveric study

M. Elajnaf,¹ P. Rust² and R. Wallace³

¹Anatomy, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, Edinburgh, UK; ²Hand Surgery Unit, St John's Hospital, Livingston, UK; ³Department of Biomechanical Engineering, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK

Dart thrower's motion (DTM) is the functional oblique plane of motion at the wrist, from radial extension to ulnar flexion, used in most activities of daily living. It occurs at the midcarpal joint, specifically at the scaphotrapeziotrapezoid (STT) joint, guided by an oblique ridge on the distal scaphoid. The articular surfaces of the scaphoid, trapezium and trapezoid allow for this characteristic oblique motion. Surgical treatments of basal thumb osteoarthritis are commonly performed, but their effect on DTM is not documented in the literature. Therefore, it is important to assess how this plane of motion is affected by surgery, to provide better patient outcomes. The aim of this study was to identify the range of DTM and compare it with the effects of simulated basal thumb osteoarthritis surgeries. Cadaveric specimens were obtained with ethical approval from Anatomy, University of Edinburgh, regulated by Human Tissue (Scotland) Act 2006. Thirteen fresh‐frozen cadaveric wrists (seven paired upper limbs of five females and two males, average age 83 years) were dissected and placed in a specially designed jig. DTM was produced and control measurements were recorded using a goniometer. Simulated STT fusion was performed on all specimens and DTM measured. Distal pole of scaphoid excision was performed on left‐side specimens and trapeziectomy performed on right‐side specimens with measurements taken for each. Arc of dart thrower's motion averaged 117° in intact wrists. Simulated STT fusion reduced the range of DTM significantly to an average of 104° (87% of control, P = 0.00004). Neither distal pole of scaphoid excision (average 117°) nor trapeziectomy (average 121°) significantly altered DTM range. Theories on DTM suggest free movement occurs between the STT joint and our results are consistent with this theory. However, DTM may not be affected by distal pole of scaphoid excision or trapeziectomy, which may inform pre‐operative decision making.

S28

Predicting the ease of selective common bile duct cannulation and extent of sphincterotomy during ERCP using a novel endoscopic classification of human major duodenal papilla morphology

A. Sinha, D. Thiaya, J. Brown and C. Brassett

Human Anatomy Teaching Group, Department of PDN, University of Cambridge, Cambridge, UK

*Joint first authors.

During ERCP (endoscopic retrograde cholangiopancreatography), endoscopists make an initial assessment of major duodenal papilla (MDP) morphology to determine the optimal approach for common bile duct (CBD) cannulation and a safe limit for sphincterotomy. In the absence of recognised descriptors for papillary morphology, a novel progressive classification system based on increasing prominence of the MDP was devised following analysis of 100 videos of successful cannulation in patients who had provided consent for research. Four types were defined: I – flat (biliary epithelium in continuity with duodenal wall); II – prominent (an elevated papilla with an anulus of papillary epithelium); III – infundibular (an infundibulum present with its lateral edges tethered to the duodenal wall); IV – dependent (distended infundibulum and mobile papilla). This system was assessed in a preliminary validation exercise with 40 University of Cambridge medical students. The sensitivities of their responses demonstrated the reproducibility of the system and suggested a requirement to refine the definition for Type III. During ERCP, selective CBD cannulation requires initial engagement followed by an angular adjustment (step angle) to attain deep cannulation, a prerequisite for sphincterotomy. Dissection of 27 cadaveric specimens, in compliance with the Human Tissue Act 2004, showed an increasing mean step angle from Types I to IV, with this adjustment being significant in Types II and III (P < 0.05). Prediction of the angular adjustment required using MDP morphology could therefore facilitate deep cannulation and sphincterotomy. Additionally, the intramural CBD length was shown to increase with type: Type I (3.7 ± 1.9 mm), Type II (6.6 ± 2.7 mm), Type III (9.8 ± 1.9 mm) and Type IV (12.5 ± 1.7 mm). The above findings corroborate the progressive nature of the novel classification system, while also demonstrating the differing limits to which sphincterotomy can be safely extended. Our results support a need for further study to explore the relationship between MDP morphology and efficacy of endoscopic biliary intervention.

S29

Variation in the site of emergence of the median nerve in the human forearm and its clinical significance

S. Bostock, O. Siaw, L. Sun, N. Glibbery and C. Brassett

Human Anatomy Teaching Group, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK

Accurate knowledge of the neurovascular anatomy of the forearm and its relationship to surface anatomy is vital when assessing traumatic injuries and performing surgical procedures safely. In the forearm, the median nerve is typically described as emerging from the radial aspect of the flexor digitorum superficialis (FDS) 5 cm proximal to entering the carpal tunnel; at this point becoming more superficial and exposed. However, observations made during dissection have indicated this may not always be the case. In this study, 39 cadaveric forearms (23 male, 16 female) were dissected and the site of emergence of the median nerve was recorded with reference to surface landmarks. Measurements were taken from the medial humeral epicondyle (ME) to the distal wrist crease (DWC) and from the point of emergence of the median nerve beneath the FDS to the DWC. The median nerve ran deep to FDS and emerged from its radial aspect in all specimens. While the mean distance from the point of emergence of the median nerve to the DWC was confirmed to be 5.01 cm, the range was 2.01–8.73 cm with an SD of ± 1.67 cm. In 19/39 specimens the median nerve emerged > 5 cm from the DWC and, of these, 2/39 specimens emerged at > 8 cm. Statistical analysis showed that the relationship between the distance from ME to DWC and ME to the emergence of median nerve demonstrated a strong positive correlation (R = 0.76, P < 0.00001). These findings confirm significant variation in the location at which the median nerve emerges from beneath FDS in the forearm. We hypothesise that cases of proximal emergence leave the median nerve more vulnerable to injury in the distal forearm and that awareness of the degree of anatomical variation is key to safe clinical practice. Donors provided consent before decease for anatomical research in compliance with HTA 2004.

S30

Sexual dimorphism and ethnic variation in the location of the mental foramen in humans

S. Moore,^1,2 J. Chu,^1,2 R. Shah,^1,2 S. El‐Basyuni,^1,2 V. Santhanam^1,3 and C. Brassett¹

¹Human Anatomy Teaching Group, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK; ²University of Cambridge School of Clinical Medicine, Cambridge, UK; ³Consultant in Oral and Maxillofacial Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

Located on the anterolateral aspect of the mandible, the mental foramen (MF) transmits the mental nerve, a terminal branch of the inferior alveolar nerve, which innervates the lower lip and chin. Knowledge of its site is clinically important, as paraesthesia or neuralgia may result from injury during mandibular operations. This study investigates sexual dimorphism and ethnic variation of MF location and morphology in 239 dry human mandibles from seven ethnic groups in Europe, Africa, India, North America, South America, Australia and New Zealand. The 3D coordinates of 18 mandibular landmarks were scanned using the MicroScribe G2X digitiser. MF location was plotted relative to the mandibular teeth, alveolar crest, inferior border of the mandibular body, pogonion and gonion, and morphological features were recorded using objective criteria. Our findings showed that the MF had a greater horizontal (4.50 ± 0.925 mm) than vertical (3.60 ± 0.736 mm) diameter (P < 0.0001), was mostly situated below the second premolar (53.5%) and displayed a posterosuperior emergence pattern for the nerve (57.3%). Along the vertical axis, the superior and inferior borders of the MF lay within the middle third of the mandibular body in 96.9% and 99.6% of cases, respectively, regardless of mandibular size. Significant ethnic variation was found for all the above features (P < 0.0001). Within the European cohort, the MF was closer to the alveolar crest in females (11.4 ± 1.76 mm) than in males (14.1 ± 2.21 mm; P < 0.0001). Accounting for size, the relative MF location was closer to the alveolar crest in females (0.430 ± 0.0527) than in males (0.467 ± 0.0372; P = 0.0034). This is the first study of ethnic variation in both MF location and morphology, comparing across more populations than previously studied, with significant differences reported. Although surgeons typically consider the MF to be inferior to the second premolar, our data indicate that it may be situated more posteriorly in particular ethnic groups, even to the first molar.

No ethical approval was required for this study.

S31

Why anatomists should know more about glycans and lectins

J.C. Manning,¹ G.G. Caballero,¹ C. Knospe,² H. Kaltner¹ and H.J. Gabius¹

¹Institute of Physiological Chemistry, Faculty of Veterinary Medicine, Ludwig‐Maximilians‐University Munich, Munich, Germany; ²Institute of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, Ludwig‐Maximilians‐University Munich, Munich, Germany

Although terms such as glycocalyx and glycoconjugates are commonly in use, they are still mostly phenomenologically understood. Looking closely at the chemical properties of carbohydrates reveals an often overlooked property, i.e. their capacity to generate molecular messages of unsurpassed high density. This is the chemical basis of the concept of the sugar code. These code words are ‘read’ and ‘translated’ into effects by sugar receptors (lectins). Apparently, a wide range of (patho)physiological processes depends on the interplay of distinct glycan determinants presented by a certain counter‐receptor (glycoprotein or glycolipid) with cognate tissue lectins so that lectin histochemical sugar profiling is receiving an exciting functional dimension. These receptors occur in families in animals and man, matching the diversity of glycan structures, and functional assays are currently providing first insights into their teamwork. The recent completion of the characterisation of all members of the family of adhesion/growth‐regulatory galectins enabled the first comprehensive histochemical monitoring for a class of endogenous lectins. The talk will lead from the concept of the sugar code to the emerging functional relevance of glycan‐lectin recognition in situ and the perspectives opened by the galectin fingerprinting in avian retina documented recently.

P01

Model of an innovative interdisciplinary programme promoting integrative STEM education

M.G. Sagoo

School of Centre for Education, King's College London, UK

The bioscience‐bioengineering module introduced at King's College London in January 2017 explores the model of innovative pedagogy within anatomy which sits at the heart of STEM‐inspired learning and strives to shift the teaching paradigm beyond school‐based curricula towards translational value of the subject, team‐working skills, and critical and technical reflection.

The teaching on the module is a blend of formal introductions and seminar‐style workshops facilitated by artists, radiologists and anatomists to encourage students to think ‘outside the box’ and reflect on their journey throughout the module. The assessment combined a variety of novel elements that draw on contemporary approaches to assessment in higher education developed and tested by the Eberly Centre for Teaching Excellence at Carnegie Mellon University, the Higher Education Academy, UK. Individuals’ e‐portfolio submission and groups’ table display of 3D printed project work were the core assessment tools. The culture to engage and reflect on the journey rather than only focusing on the end product, and to feel confident to take risks, be ambitious and celebrate failure was encouraged.

Ethical approval was gained to collate data from observations, reviewing e‐portfolios, interviews with the teaching staff and focus group discussions with the students.

One cycle of the module has been successfully completed with positive and constructive feedback and we are keen to share some of our findings with the community. Beyond the module requirements, we have recently secured a place in the Science Gallery London for our students to 3D print and gain exposure of working outside the classroom. Moreover, selected students are given the opportunity to present their displays of projects in outreach awareness and widening participation programmes.

P02

To what extent do previous qualifications predict student approach to learning anatomy?

S.J. Taylor,¹ S. Miller² and K. Lloyd²

¹School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK; ²School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK

Human anatomy is one of the subjects under‐pinning medical degree programmes and is highly relevant to all clinical specialties. During their study of anatomy, medical students may choose to engage in a deep, strategic or surface approach when learning the subject. What is clear from the literature is that few studies have investigated the specific approaches that are adopted by medical students when studying anatomy. In recent years, the number of graduates entering medicine has increased; despite this rise, few studies have looked at learning approaches that are adopted by this particular student group when learning anatomy. Consequently, this gap in the literature indicates a need to understand the learning approaches that are used by this particular group of students when learning anatomy. For the purposes of this quantitative cross‐sectional study, 2^nd year medical students (n = 238) completed a study questionnaire containing the Approaches to Study Skills in Students Inventory (ASSIST). Ethical approval for this study was granted by the School of Social Sciences, Education and Social Work at Queen's University Belfast. Multiple regression analysis was carried out to establish whether graduate status is a predictor of approach to learning anatomy. The results of this analysis have shown that graduate students are more likely to study anatomy using a deep approach to learning than are non‐graduate students (students who have entered medicine without a degree). Having a previous degree did make a statistically significant contribution to the multiple regression model, t (232) = 2.0, P = 0.047 and the study results have therefore increased our understanding of how graduate students approach the study of anatomy.

P03

Retrograde venous air embolism following upper gastrointestinal endoscopy: a case study.

U. Hasaam,¹ A. Shabana² and O. Raslan³

¹Good Hope Hospital, University Hospitals Birmingham, Birmingham, UK; ²New Cross Hospital, Wolverhampton, UK; ³University of California – Davis Medical Center, San Francisco, CA, USA

Cerebral infarction is a known complication of upper gastrointestinal endoscopic procedures. Although it is well‐described in the existing literature, most proposed mechanisms are based around arterial travel of the embolus. Travel of air embolism through the venous system to cause cerebral infarction is relatively poorly documented.

A 72‐year‐old man with eosinophilic oesophagitis underwent nasoendoscopy for retrieval of a food bolus obstruction. This was successful but was complicated by submucosal perforation of the oesophagus. The patient developed profound weakness in his right arm within 2 h of the procedure. Head imaging showed intracranial gas within the cavernous sinus together with multiple acute cortical infarcts. Arterial routes of embolism travel were excluded through echocardiography and radiography.

This case describes an exceptional case of cerebral infarction attributable to upper gastrointestinal endoscopy which can only be explained by the retrograde travel of an air embolus within the cerebral venous system rather than the arterial routes previously described in the literature. We describe in detail the process by which air would have entered into the oesophageal veins and then drained through the systemic venous system into the internal jugular vein, then proceeding into the cavernous and sagittal venous sinuses to cause cerebral infarction.

Ethics approval

Patient consent was obtained for this report.

P04

Determining sexual dimorphism by measuring the distance between teeth among adult human subjects

E. Rehab, C. Lamb and C. Rynn

Center of Anatomy and Human Identification, Dundee University, Dundee, UK

Many studies have reported that sex can be verified from different parts of the human skeleton, one of which is the skull. This project aimed to determine sexual dimorphism by dentation analysis through measuring the distance between teeth and to suggest a discriminant function for sex determination. A total of 114 multinational participants were recruited (78 females, 36 males, mean age 27.74 years ± 9.43 SD). Vernier calipers were used to measure the length of the upper and lower central incisors (from the incisal edge to the gingival line) and the distance between contact point of the maxillary incisors, canines, first premolar, mandibular incisors and canines. The study was approved by the research ethics committee of the University of Dundee. A discriminant function was obtained by applying the distance between contact point of the maxillary incisors, canines, first premolar, mandibular and canines, with a confidence level of 72.8%. A blind test on caucasian and sub‐Saharan African skulls showed a discriminant function to be more reliable on the caucasian group. In conclusion, except for the difference between the length of the upper and lower central incisors, all of the landmarks that were examined were sexually dimorphic. The discriminant function used was found to be a reliable determinant of sex for forensic identification in a caucasian group.

P05

Science education at scale: MCQ quality in MOOCs

E. Costello,¹ C. Kirwan¹ and J. Holland²

¹National Institute for Digital Learning, Dublin City University, Dublin, UK; ²Department of Anatomy, RCSI Dublin, Dublin, UK

If massive open online courses (MOOCs) are to play a role in the future of higher education, we must carefully examine how they are currently functioning. As the focus turns from informal and free to formal, accredited and paid, the quality of the courses and their assessments is critical. Multiple choice questions (MCQs) have a long history, particularly in medical education, and a large body of research exists which suggests that flawed MCQ items may compromise assessment reliability and validity. While MCQs are a key component of MOOC assessments and testing, a gap exists in that prior research has not examined the quality of MCQs in this context.

Eighteen MOOCs were sampled, across health sciences, social sciences and computing domains; 204 MCQs were retrieved and their correct answers determined by content experts. These MCQs were reviewed by two evaluators, independently and then with comparison of evaluations, using a 19‐item evaluation matrix, incorporating a priori themes drawn from extant research.

Over 50% of MCQs (n = 112) violated item‐writing guidelines and contained at least one item flaw; 57 MCQs contained multiple flaws. These findings are comparable with prior studies examining the prevalence of flaws in assessments in more traditional contexts, such as medical education.

The problem of low quality MCQs can be ameliorated by reference to existing guidelines and research in this area, by appropriate faculty training in item‐writing, and by conducting appropriate pre‐ and post‐test quality checks, such as item analysis. These activities are essential if MOOCs are to enable enhanced and improved pedagogies in higher education, instead of simply replicating poor practices at scale.

No human or animal subjects were part of this study, which simply reviewed openly available online activities, and thus permission not required according to the Institutional Review Board guidelines of the National Institute of Digital Learning.

P06

Morphometric analysis of human foramen transversarium variation in cervical vertebrae In KwaZulu Natal, South Africa

A.K. Zaw,¹ U. Offor,¹ ECS Naidu¹ and O.O. Azu^1,2

¹Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of KwaZulu‐Natal, Durban, South Africa; ²Department of Anatomy, School of Medicine, University of Namibia, Windhoek, Namibia

Cervical vertebrae are recognised by presence of foramen transversarium (FT), which is traversed by vertebral artery, vein and sympathetic fibers.

Aim

To observe anatomical variations in FT, anatomical knowledge of these variations is helpful for surgeons to prevent injuries to vertebral vessels and sympathetic nerves while operating on cervical spines.

Materials and methods

A total of 104 typical cervical vertebrae were analysed macroscopically after ethics approval (BREC BCA356/14), examining diameter and presence of FT as well as presence of accessory FT (AFT).

Results

All cervical vertebrae presented FT, with mean diameter of 7.24  x 6.31 mm on the right, 7.38 mm x 6.31 mm on the left. AFT were found in 37 vertebrae (35.58%). AFT were unilateral in 18 vertebrae (17.31%) and bilateral in 19 vertebrae (18.27%). AFT were either bilateral complete (4; 3.85%) or incomplete (8; 7.69%) or unilateral complete (7; 6.73%) and unilateral incomplete (11; 10.58%). Seven (6.73%) vertebrae showed the presence of complete AFT on one side and incomplete AFT on other side in same vertebra. Bilateral AFT were more common than unilateral. Left and right occurrences of unilateral AFT were same in our study. AFT were smaller and posteriorly placed compared with regular FT.

Conclusions

Knowledge of variations of the presence of AFT in typical cervical vertebrae is important not only to the anatomist but also to the radiologist in identifying the presence of duplicate vertebral artery and hence helping neurosurgeons in preventing accidental bleeding from vertebral artery while performing surgeries on cervical spines.

P07

Differentiating healthy and malignant tissue in human pancreatic tissue resections using Raman spectroscopy

H.A. Bham,¹ G. Sgourakis² and J.G. Kerns¹

¹Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK; ²University Hospitals of Morecambe Bay NHS Trust, Lancaster, UK

Pancreatic cancer is often diagnosed at a late stage of the disease, often due to non‐specific symptoms, and has high associated mortality. The main challenge is the ability accurately to identify tumour margins, both histologically and during surgery, leading to a high rate of recurrence after resection.

Raman spectroscopy facilitates the acquisition of a biochemical fingerprint and is a strong research tool for laboratory investigations of cancers such as skin, cervical and colorectal. However, it is rarely applied to pancreatic cancer. We hypothesise that Raman spectroscopy is able to differentiate between healthy and cancerous tissue in the exocrine pancreas with differences seen in peaks related to DNA and protein.

In this study, we aim to address the hypothesis by collecting Raman spectra from pancreatic cancer resections and specifically measuring across the tumour margin to try to identify the progression of chemical changes between healthy and cancerous tissue, which could be used in developing diagnostic or surgical techniques.

Tissue from human pancreatic cancer tumour resections was taken (n = 4), with ethical approval from Greece (St Savvas Cancer Hospital, Red Cross Hospital, Athens) and the UK (REC approval: 17/YH/0283), after surgery from patients diagnosed with pancreatic cancer. Spectra were acquired across the tissue margin of fixed and unfixed tissue, using a Renishaw Raman microspectrometer (Renishaw plc, UK) with a 785‐nm laser. A minimum of 15 spectra were acquired per sample with at least 250 mm between spectra, totalling 158 spectra.

Differences between healthy and malignant tissue were seen due to proline and nucleic acids in fresh tissue and collagen in fixed tissue. Findings suggest there is potential to use Raman spectroscopy in a clinical setting to identify tumour margins, potentially aiding diagnosis or helping to prevent recurrence. Improved understanding of tumour progression using spectroscopy may also provide scope for further research to improve patient outcomes in the future.

P08

Relationship between morphological variability of the human first metacarpal and trapezium quantified using statistical shape modelling

WMR Rusli and A.E. Kedgley

Department of Bioengineering, Imperial College London, London, UK

The first metacarpal and trapezium form the first carpometacarpal (CMC) joint. Due to its biconcave‐convex articulating surfaces, this joint lacks bony stability. Morphological variations in the articulating surfaces individually can further compromise the stability; however, it is also important to look at variations in the overall structure of the joint. Thus, the objectives were to quantify the morphological variability in the first metacarpal and trapezium and to determine the relationship between the variations in the shape of these two bones.

CT images of 50 human cadaveric specimens were used in this study, with approval from the Imperial College Healthcare Tissue Bank. The specimens were provided by a licensed human tissue facility and the tissue donors had consented to their use for scientific research.

Morphological variations of the first metacarpal and trapezium were determined based on the principal components obtained from multi‐object statistical shape modelling. Three morphological parameters were measured from the first two principal components: the volar tilt and torsion angles of the first metacarpal and the trapezium length. Correlation between the morphological variations of the first metacarpal and trapezium were quantified using Pearson correlation coefficients, with significance defined as P < 0.05.

The first principal component showed that the metacarpal volar tilt angle and trapezium length varied between −6.25° and 12.3° and 2University Hospitals of Morecambe Bay NHS Trust ween b14.6 and 16.48 mm, respectively. Variation between these two morphological parameters showed strong and positive correlation (r = 0.893, P = 0.007). In the second principal component, the torsion and volar tilt angles of the metacarpal varied within the range of 90.23°–104.2° and 0.96°–6.4°, respectively. The trapezium length varied between 12.25 and 17.33 mm. There was strong correlation between the variability of the trapezium length and the torsion (r = −0.922, P = 0.003) and volar tilt angles (r = 0.944, P = 0.001).

The strong correlation observed between the morphological variability of the first metacarpal and trapezium provides an insight into how morphological variability can affect the stability of the first CMC joint. This has implications for the development of joint pathologies such as osteoarthritis.

P09

Cadaveric training must be incorporated into postgraduate surgical training curricula: an orthopaedic trainee's perspective

I. Crowther¹ and J. Matthan²

¹Department of Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK; ²Anatomy and Clinical Skills Centre, School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK

Access to opportunities to learn surgically‐relevant anatomy from cadavers in the UK are increasingly more challenging with the manifold Human Tissue Authority (HTA) regulations institutions are required to comply with. For postgraduate surgical trainees, cadaveric training provides a safe environment in which to practise procedures without putting patients at risk, allowing ‘real’ operating experience without the time pressures or consequences prevalent in a clinical environment. It facilitates a meditative approach to revisiting gross anatomy, without fear of irreversibly damaging structures or incurring adverse clinical outcomes.

The Newcastle Surgical Training Centre (NSTC) provides trainees with a unique, intensive and individualised cadaveric training programme that complements clinical work. Orthopaedic Core Trainees receive eight full‐day sessions, including cadaver‐based days revisiting gross anatomy and approaches to the wrist, hip, knee and ankle. Teaching is consultant‐delivered and predominantly hands‐on, with an average of two trainees per cadaver. Feedback is unanimously positive and the confidence of attending trainees with specific procedures is greatly boosted by these sessions. Cadaveric training is, however, not the norm across UK postgraduate deaneries, and trainees continue to lose out on valuable opportunities to gain an appreciation of anatomical relations that may improve future operating performance and the ability to adapt to unforeseen circumstances.

No ethical approval was required for this work.

P10

Intra‐temporal facial nerve dehiscence of the human middle ear: a systematic review of methods of investigation

A. Alomiery^1,2 and C. Thompson¹

¹Anatomy, College of Medicine and Veterinary Medicine, Deanery of Biomedical Sciences, University of Edinburgh, Edinburgh, UK; ²Prince Sultan College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia

The facial nerve (FN) runs in a protective bony canal from the internal auditory meatus until it exits from the temporal bone at the stylomastoid foramen. Iatrogenic FN injury is a significant event increased by the presence of FN canal dehiscence (FND). FND represents a breach in the bony canal due to abnormal development, pathologies or trauma. The incidence of FND is highly variable across different methods of investigation, none of which has been determined to be reliable. Surgical books do not seem to acknowledge clearly the potential effect caused by the limitations of each methodology on the reported results. We hypothesise that the causes of variability are due to the underlying limitation of each method rather than to causes related to randomised sampling. This research aimed to investigate causes of variability in reported FND incidences, utilising systematic review and meta‐analysis techniques. We aimed to provide an evaluation of the heterogeneity of results, investigate the underlying limitations of each methodology and review/summarise the previous studies investigating FND incidence, by type. A systematic review of FND incidences was conducted in accordance with (PRISMA) guidelines. Studies were classified into four groups based on methods of investigation utilised in studying FND. Heterogeneity was investigated among all methods of investigation and across studies of the same method. Twenty‐two studies were systematically reviewed with a combined sample size of 6049. A significant heterogeneity among studies was found: I² test = 98.84%, P < 0.0001; 95% CI for I² = 98.63–99.01), with the least heterogeneity in the gross dissection studies. The significant heterogeneity among studies in addition to the underlying limitations found in each method suggest that the high variability of incidences reported was due to the different investigation methods utilised. With its limitations in mind, we believe that gross anatomy showed superiority in yielding more homogeneous, surgically relevant data.

No ethical approval was required.

P11

Modelling the development of human tissues in vitro using advanced cell technologies and mammalian stem cells

L.A. Smith,¹ D. Owens¹ and S.A. Przyborski^1,2

¹Durham University, Durham, UK; ²Reprocell Europe, Sedgefield, UK

Human tissue development is a complex, time‐dependent process involving morphogen influence on stem cell populations in the developing embryo, and resulting in mature tissue formation. This process remains poorly understood, and current studies utilise pluripotent stem cells (PSCs) to model the events which take place. Specifically, embryoid body (EB) formation is employed, as these multicellular structures are controllable, and recapitulate events of early embryogenesis through their ability to self‐organise. However, increasing EB size leads to issues with viability and structure; an increasing diffusion distance limits oxygen and nutrient diffusion, and prevents EB use in long‐term studies. Time is crucial to the tissue development process. The teratoma assay is another approach used successfully to study complex cellular differentiation; putative PSCs are xenografted into an immunodeficient mouse host and allowed to form a tumour. The presence of structures from three germ layers is indicative of pluripotency, but assay variation brings into question its use and ‘gold standard’ status. In this study, we extend EB viability by reducing diffusion distances to allow for better nutritional/oxygen support. This enables long‐term in vitro culture and complex tissue structure formation. Initial investigations showed that EB‐derived tissues can be maintained for 35 days, and further work involved incorporating properties such as perfusion and co‐culture, to better mimic the teratoma microenvironment. Model validation through direct comparison to the teratoma assay has shown production of tissues as complex as the in vivo sample. Current focuses on differentiating the model towards specific germ layers to better investigate developmental events, as well as using other PSC populations to validate fully the model and explore its capabilities. The model has potential to be used to study the stages of early tissue development as well as a novel, standardised in vitro alternative to the teratoma assay.

The teratoma assay and associated procedures were completed with permission and according to the guidelines of Newcastle University and the Home Office, UK.

P12

Anatomical variation of the innervation of triceps brachii in humans and the clinical importance of these variations

P. Simpson¹ and S. Strauther²

¹University of Leeds Medical School, Leeds, UK; ²Leeds Institute of Medical Education, School of Medicine, University of Leeds, Leeds, UK

The aim of this study was to ascertain the incidence and significance of the known anatomical variations of triceps brachii innervation. A literature review of available studies regarding the variant innervation of the medial head of triceps (MHT) and long heads of triceps (LHT) by the ulnar and axillary nerves, respectively, was carried out. In addition, single cadaveric dissection was undertaken to demonstrate the anatomy and attempt to identify variation. Due to the small cadaveric sample, the focus of this study lay with the review of the literature.

There is mixed evidence supporting the existence of these branches, with prevalence in studies ranging from 0 to 100%. This review found figures of 16.5% prevalence for the LHT variant and 11% for the MHT variant. No variation was found on dissection.

Their existence could have a significant impact on diagnosing, preventing and predicting the outcomes of nerve injury. There has been evidence of triceps involvement in axillary nerve damage and the presence of an ulnar nerve branch in the arm could also raise queries around the safety of surgical approaches to the posterior elbow.

There is also the potential to use redundant variant nerve fascicles for restorative nerve transfer surgery in brachial plexus injury. On the contrary, the existence of variation presents potential intraoperative hurdles within current techniques such as misidentification and unexpected denervation of donor nerves.

This review presents the first known analysis of the literature regarding the prevalence of the ulnar nerve MHT variation; no analysis exists in any published reviews. It has also presented evidence to support existing published studies regarding the prevalence of the axillary innervation of the LHT. Through the analysis of the literature, a greater understanding of the topic is hopefully now available; however, much more study is necessary.

There was no requirement for ethical approval.

P13

Using YouTube for learning cardiac embryology – what quality of videos are there to view?

R. Matthew,¹ N. Ramakrishnan,¹ T. Pawlikowska² and J. Holland³

¹Direct Entry Medical Students RCSI, Dublin, UK; ²Director Health Professions Education Centre RCSI, Dublin, UK; ³Senior Lecturer (Anatomy) RCSI, Dublin, UK

Embryology is an integral part of medical curricula, typically taught through lectures, with additional links to web‐based resources or videos. 3D animations enable students to visualise this anatomy and how it changes in the fourth dimension – time. Where do students generally find them?

A systematic literature review regarding YouTube in teaching or learning cardiac embryology was carried out. Abstracts of 287 references were screened, and 59 full‐text publications reviewed, but no papers examined this question specifically, and only one semi‐related study was identified (congenital gastrointestinal neonatology). YouTube was next searched for cardiac embryology videos using 12 specific search terms and a total of 1200 videos were retrieved; 370 video URLs were retrieved under two or more search terms and so excluded. A further 456 videos were excluded under criteria of language, non‐human or non‐cardiac embryology. The remaining 374 videos were qualitatively evaluated using criteria developed by Azer et al. and Chan et al. Although the qualitative evaluation is still ongoing, initial observations may be reported.

Content control on YouTube is still imperfect. Five videos identified in initial searches (June 2018) were subsequently removed from YouTube for issues including content infringement, and we also identified and excluded 26 videos as being duplicates of other videos. In all 49 videos showed operations or human material, but none contained an ethical statement regarding these images, and only 10 videos included an age‐restriction or graphical advice.

Although there are useful videos for medical students studying cardiac embryology on YouTube, intuitive search strategies will also identify many videos with irrelevant content and variable quality. Some, which claim to be educational, may score low on rating scales, whereas some which have been very simply shot and edited, with minimal resources, are outstanding.

No human or animal subjects were part of this study, which simply reviewed openly available online resources.

P14

Iliac artery morphology; an anatomical study of iliac tortuosity in human cadavers

J. Green, P. Vickerton and C. Molyneux

Barts and the London, School of Medicine and Dentistry, Queen Mary, University of London, London, UK

The external and common iliac arteries have great importance for gaining access to the aorta for a wide range of medical procedures, such as cardiac interventions, endovascular aneurism repair (EVAR) and resuscitative endovascular balloon occlusion of the aorta (REBOA). The tortuosity of these vessels can have a direct impact on the success of such interventions.

The aim of the study was to determine whether age and sex can be a predictor of common and external iliac artery tortuosity. Embalmed cadavers (n = 47, 28 male, 19 female) with various causes of death and ages ranging from 54 to 100 were studied. All donors gave written consent for anatomical examination prior to their death. External and common iliac arteries were measured for tortuosity and a tortuosity index calculated.

A positive correlation for tortuosity index against age was clearly seen (r = 0.538) with every increasing year of age. TI increased by 0.006, which correlates to a percentage increase of 0.6% every year. The difference between left and right vessel TI compared with age was found to be non‐significant (P = 0.2667). These data indicate that the process is more likely to be a systemic one rather than focal disease.

Our study provides new evidence of the link between external and common iliac artery tortuosity with age, which could in turn be used to predict patients who would have access difficulties in a pre‐hospital setting during REBOA where extensive vascular imaging is not available.

Ethical approval was not required. All donors gave written consent for anatomical examination prior to their death.

P15

Localisation of parvalbumin and perineuronal nets in the prefrontal cortex of an aged mouse model of Lewy body dementia

N. Ajmera, F. LeBeau and G. Clowry

Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK

Thy1‐A30P mice express a mutant human alpha‐synuclein in neurons, a protein‐implicated Lewy body dementia in humans. Previous work showed behavioural changes and alterations in interneuron function in the hippocampus of these mice with age. Here we studied markers for interneurons in the prefrontal cortex, also important to cognition and memory, in aged control and transgenic mice. The A30P (homozygous) and control age‐matched C57BL6 mice were aged (2–16 months) in the animal facility according to ARRIVE guidelines. Hippocampal slices were prepared for electrophysiology in accordance with the UK Animals (Scientific Procedures) Act 1986 and European Union directive 2010/63EU. The frontal cortex tissue taken and immersion‐fixed in buffered 4% paraformaldehyde, then cryoprotected and sectioned for histology. Sections were stained free‐floating for parvalbumin (PV) by immunofluorescence and for perineuronal nets (PNN) with labelled lectin, wisteria floribunda, which binds N‐acetylgalactosamine. We observed strong, co‐localised staining for both markers in sensorimotor and orbitofrontal regions, particularly in cortical layers III and V. There was also strong labelling with lectin only in the taenia tectum. However, within the infralimbic, prelimbic and anterior cingulate cortex, we observed low levels of expression of PV and PNN. In anterior sections, PV⁺/PNN⁺ neurons were seen in deep cortical layer VI and few labelled cells were seen superficially. In posterior sections, mostly PNN⁺‐only neurons were observed in superficial layers II/III and PV⁺‐only cells were seen in layer V, with double‐labelled cells a rarity. This pattern was observed in both wild type and transgenic mice. PV⁺/PNN cells are believed to be required for generation of gamma oscillatory activity underpinning cognition and have been recorded from these prefrontal regions in rodents. The question remains whether this lack of PV neurons is a feature of old mice or gamma oscillations in frontal cortex rely on other mechanisms.

P16

Anatomical variations in the arterial branching of the canine pudendoepigastric trunk

C. Barron

Ross University, St. Kitts, Dominica

The pudendoepigastric trunk in the dog has been described as a branch from the deep femoral artery that will then terminate as the caudal epigastric artery and the external pudendal artery. In Miller's Guide to the Dog, it is described as rarely absent. The specimens that were used in this study are canine cadavers that were utilised by the students in the first and second semester Gross Anatomy course at Ross University, School of Veterinary Medicine (RUSVM); 125 of those canine specimens were evaluated for their pudendoepigastric trunk (all canine lupus familiaris). The typical pattern (type A) is the pudendoepigastric trunk arising from the deep femoral artery and terminating as the caudal epigastric artery and the external pudendal artery. Any clear deviations from this described pattern are described as an atypical type C. An ambiguous type B pattern was determined as an intermediate between type where the branching of the caudal epigastric artery and the external pudendal artery showed no clear trunk and there appeared as a trifurcation. Of the canine specimens dissected and observed, 45% showed the type A branching, and 23% the type C branching where a single case showed the external pudendal as a branch of the femoral artery. The remaining 32% were determined to have the type B pattern, where there was no discernible pudendoepigastric trunk and the termination of the deep femoral artery appeared to end as a trifurcation of the caudal epigastric artery, external pudendal artery and the medial circumflex femoral artery. A side comparison of right vs. left was difficult in most cases, as the arteries are transected during the dissection of one side. In all, 22 specimens were dissected and observed on the right side, and 17 on the left. There does not appear to be a variation that is dependent on side. In conclusion, the terminal pattern of the deep femoral into the pudendoepigastric trunk and the medial circumflex femoral is highly variable and should be noted when teaching and performing surgery within the inguinal region.

P17

Development of a student‐led anatomy eLearning tool

M. Cupper and K. Richardson

School of Biosciences, Cardiff University, Cardiff, UK

Anatomy is renowned as a difficult subject for students to learn. The vast level of detail needed often leads students to resort to rote‐learning methods that result in difficulties in applying knowledge to functional or clinical‐related scenarios. To aid student learning and preparation for assessments, an online learning tool was developed.

The learning tool was created using Xerte software, which allows the user to create text slides, annotated images, videos and testing features, enabling the production of an interactive application. The learning tool was created by a final year anatomy student who designed and distributed questionnaires to anatomy peers. Questionnaires gauged student opinion of learning resources, preferences for preparation material and methods and information needed in such a resource.

The questionnaire used Likert scales, ranking of criteria and free comments. Of the 70 students who completed the questionnaire, 67% were in the second year of their studies, with a large proportion of students (56%) hoping to study medicine following graduation. The majority of students (66%) indicated that they enjoyed anatomy, although 64% of respondents found the subject difficult. Of the students who completed the questionnaire, 99% used online resources for preparation, with the majority of students (57%) ranking online resources and the use of videos in the top three methods used and 69% of students preferring these methods for revision.

The resource was designed from the results of the questionnaire and is based on the anatomy of the trunk. The resource has been divided into five small learning resources that each comprise information relating to dissection sessions. The resource consists of annotated diagrammes/photos, interactive 3D images, videos and quiz questions. The resource is available to students via the University's Virtual Learning Environment. This resource will be evaluated and further developed by students to facilitate their learning and understanding of anatomy.

No ethical approval was needed for this study.

P18

Dermatoglyphics study of patients with schizophrenia in Western Indian Population

H. Choudhary and S. Stephens

Cardiff School of Biosciences, Cardiff University, Cardiff, UK

The word ‘dermatoglyphics’ comes from Greek (derma means skin, glyphe means carve) and refers to the ‘friction ridge’ formations which appear on the palms of the hand and soles of the foot. These ridges are linear thickenings both within and on the surface of epidermis. The ridges on finger tips are called finger tip ridge pattern (FTRP) and have an arch, whorls and loops (depending on the side they open, loops are classified as radial and ulnar loops). Similarly, the creases on the palm are proximal transverse crease (PCT)/line of head and distal transverse crease (DCT)/line of heart. The Simian line is formed when the heart line and head line are fused together and only one major line is present, which extends from the ulnar to the radial border of palm. The Sydney line is formed when the head line extends across palm while line of heart appears normal. The fingerprints are static and do not change with age. Thus, the results of dermatoglyphics are used widely in criminology, forensic, clinical medicine and anthropology to find relations between various human ethnicities.

Following ethical approval from the Dr S N Medical College, India, the study compared palms and fingerprints of 100 schizophrenic patients with a control group of 100, employing the Cummins ink method.

To establish significance between the control and the schizophrenic FTRP, a t‐test for unequal variance was performed on the raw data: for thumb, index, middle and ring fingers, P = 0.5, and for little finger P = 0.9. Thus, it was concluded that the findings were not significant. To reaffirm the above findings, two‐factor ANOVA without replication was conducted on the same raw data. For all the fingers, an F‐value was less than the F critical value. This confirms that there is no relation between FTRP and the schizophrenic disorder.

Although, schizophrenia is quite prevalent in western Rajasthan, in our study we did not observe an association between frequency of certain dermal traits (FTRP, Simian and Sydney line) and schizophrenia.

P19

The anatomists: an endangered species?

F. AFakoya

Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria

Anatomy is the study of structure of living beings, animal and plants. Even though the term is used mostly in association with the study of human beings, the structure of animals and plants in other forms/composition have also been studied. Those who engage in this discipline are called Anatomists. Of critical note is their involvement in the training of a wide category of healthcare providers, who are in direct contact with patients, including doctors, nurses, dentists, physiotherapists and pharmacists. Anatomists are often the first teachers that students encounter when they enter medical schools, utilising reality anatomical tools such as dissection to demonstrate the cadaver in the evaluation of the structure of the human body, as the foundation upon which the students will build their studies of medicine and understand the basis of clinical diagnosis and patient treatment. Yet this category of teachers has thinned out globally, with many medical schools having mostly ‘non‐Anatomists’ teaching Anatomy to students. This report considered the fate of this discipline and those who practise it through a combination of extensive literature search and focus group interview of six eminent senior Anatomists (20–40 years’ experience in the field) following informed consent, to determine factors responsible for the observed decline of Anatomists in medical schools globally, current interventions to resuscitate the profession, discipline and practitioners, where such exists, and the potential consequences and implications of an extinction of Anatomists as they are known today. The paper recommends a re‐visitation to the nomenclature, training and practice of Morphological Sciences in the light of current technological advancements offering better understanding of the structure of the human body and those of other living things, and concludes that the Anatomist, after all, might not be ‘the dying breed’ as has been currently suggested.

P20

Azygos system of veins in relation to posterior thoracic surgery – a study on human cadavers

A. Patel and J. Pickering

University of Leeds, Leeds, UK

The most troublesome intra‐operative hazard during thoracic surgery is haemorrhage, with a majority of cases being of venous origin. The azygos venous system is a collective term given to describe the ‘H‐shaped’ configuration of veins in the posterior mediastinum that provides a drainage route for most of the posterior thoracic wall as well as some mediastinal structures. It is a highly variable network of veins and is positioned within the posterior mediastinum, putting it at considerable risk in several surgical procedures that require access to structures in the region such as splanchnic neurotomy, oesophagectomy, extra‐pleural pneumonectomy and repair of idiopathic scoliosis.

The aim of this study was carefully to dissect thoraces from human cadavers and observe the venous pattern and relationship with surrounding structures in the posterior mediastinum. All findings were then compared with previous research papers and relevant anatomical literature.

Three thoraces (two females and one male) were taken from three cadavers that were fixed in a solution of industrial meths (75.6%), phenol (12.5%), formaldehyde (4%), glycerol (2.2%) and water (5.7%). An anterior approach to the chest wall was used for two thoraces and a lateral approach was used for the third to ensure that the heart could be kept in situ to further appreciate structural relationships with the venous system.

The first two dissections revealed a predictable ascent of the hemi‐azygos and azygos veins through the thoracic cavity. The third dissection, however, showed a unique variation that included the presence of an accessory hemi‐azygos vein draining the left superior posterior hemi‐thorax. Numerous surrounding structural differences were also noted.

Congenital and acquired abnormalities of the azygos venous system increase the risk of complications during surgery. Knowledge of these variations and relationships with surrounding structures is essential for surgeons operating within the posterior mediastinum.

Ethical approval was obtained prior to commencement of the study.

P21

Student‐led development of a histology e‐resource

D. Pinto, T. Burgher, H.M. Shaw and J. Muensoongnoen

Cardiff University School of Biosciences, Cardiff, UK

Modern curricula are increasingly allocating less time to the study of histology, limiting the time students have with specimen slides. E‐resources provide a useful alternative to increase accessibility and aid the student's learning. Most available e‐resources have been created by lecturers based on their perception that the most logical progression through the content to them is the most effective for student learning. The assumptions made when designing these e‐resources may not necessarily match the student's requirement to learn effectively. The aim of this project was to explore the creation of an e‐resource for histology that not only utilised feedback from student focus groups but also the student perspective to shape content delivery. It was anticipated that this approach would balance the quality of information filtered through an experienced academic to meet desired learning outcomes with a format the target audience would find engaging and digestible. Using Xerte, an online software which enabled the use of interactive interfaces supported by Cardiff University, two histology e‐resources created by a lecturer and by students, respectively, were compared. A survey created using an online form was used to collate feedback anonymously from a focus group comprised of MEDIC, DENTAL and BIOSI students in years 1 and 2 (pre‐changes n = 24, post‐changes n = 17). Comparison of the feedback for the two e‐resources demonstrated that both resources are comparable with nuanced differences. In conclusion, we suggest that students can have an essential role in shaping effective learning resources for themselves and their peers. Although content must be quality controlled through the guidance of experienced academics so that it meets learning outcomes, student contribution to content delivery can improve engagement and user experience.

As an evaluation of e‐resource, an ethical approval was not required.

P22

Developing a protocol to investigate the association between the Segond fracture and anterior cruciate ligament injury in cadaveric human tibiae

D. Oluboyede,^1,2 T. Turmezei,³ G.E. Jarvis,² J. Chitnavis⁴ and C. Brassett²

¹Downing College, University of Cambridge, Cambridge, UK; ²Human Anatomy Teaching Group, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK; ³Consultant Musculoskeletal Radiologist, Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK; ⁴Consultant Orthopaedic Surgeon, Cambridge Knee Clinic, Cambridge, UK

The Segond fracture, an avulsion fracture at the anterolateral proximal tibia, is associated with anterior cruciate ligament injury in 75–100% of cases. This study aimed to develop a protocol for investigating this association by observing differences in morphometric parameters between entheseal and non‐entheseal bone at different sites on cadaveric tibiae. The proximal tibiae of five female donors (aged 74‐98) with no macroscopic evidence of knee trauma, surgery or degenerative disease were used, in compliance with the Human Tissue Act 2004. The soft tissue was dissected down to the ligamentous and tendinous insertions only. Each specimen was scanned in a Nikon XTH225 microCT scanner with ca. 80 μm pixel spacing. The images were processed with the MicroView 3D image viewer and analysis tool, which allowed virtual bone biopsy to be performed. For each specimen, bone volume over total volume (BV/TV) was measured at several entheseal and non‐entheseal sites using a 5‐mm diameter spherical volume of interest for each site. These sites were: the ‘Segond’ site (ALL, ALLβ, ALLγ); anterior cruciate ligament (ACL); posterior cruciate ligament (PCL); patellar tendon (PT); iliotibial band (ITB); lateral collateral ligament (LCL); lateral tibial condyle (LC); and medial tibial condyle (MC). One‐way repeated measurements ANOVA on logged values (to eliminate heteroscedasticity) indicated a difference in BV/TV between these 10 regions (P = 0.0005). BV/TV for ALL was 0.17 ± 0.03 (mean ± SD), identical to ALLβ and less than all other regions. A Dunnett's post‐hoc comparison of ALL with the other nine regions gave adjusted P‐values as follows: ALLβ = 1.00; ALLγ = 0.15; LCL = 0.45; ACL = 0.055; PCL = 0.0036; PT = 0.031; LC = 0.032; ITB = 0.021; MC = 0.018. These results suggest that ALL has smaller BV/TV than other areas. Larger studies are needed to confirm whether the differences for sites such as the ACL and PCL are real, to assist in elucidating the pathogenesis of Segond fracture and informing the management of ACL injury.

P23

Junior doctors’ knowledge of applied clinical anatomy

A. Bircher, R. Shah, S. Chadha and H. Ellis

Department of Anatomy, King's College University, London, UK

The modern undergraduate medical curriculum regularly undergoes adaptation to keep up with the ever expanding field of medicine. The first publication of Tomorrow's Doctors in 1993 by the General Medical Council initiated a significant change in the delivery of medical education to undergraduates, with emphasis moving from purely gaining knowledge to encouraging a learning process including developing the ability to evaluate data as well as skills to interact with patients and colleagues. Secondary to these changes, it has been suggested that the teaching of human anatomy has declined in recent years. Undeniably, anatomy forms a foundation for clinical medicine and a sound knowledge is vital for doctors of any discipline to practise safe medicine. Examples of applied anatomy in practice include locating the femoral artery in the emergency setting and auscultating heart sounds accurately.

This study aims to examine knowledge of applied clinical anatomy among junior doctors of varying levels of seniority.

A multiple‐choice questionnaire was designed containing 20 questions covering several aspects of applied clinical anatomy. Results were obtained from junior doctors ranging from foundation year 1 to senior registrar level across both medical and surgical specialties, as well as from junior doctors currently working as Anatomy Demonstrators at King's College University. A total of 46 participants completed the questionnaire. The general trend shows that more experienced junior doctors score better overall when compared with other junior doctors, with registrars scoring an average of 60% compared with FY1s scoring an average of 49%. However, at pre‐registrar level, Anatomy Demonstrators scored highest overall, with an average of 82%. This suggests that a more traditional style of dissection‐based anatomy teaching is the most effective method for learning human anatomy.

P24

Anatomy of a 3D print: morphologic constraints of polygon mesh from theory into practice

K. Kirkness and G. Finn

Health Professions Education Unit, Hull York Medical School (HYMS), York, UK

3D printing is prominent in the research around clinical and educational applications in medical education and has a strong presence in the literature around regenerative medicine. But what is a 3D print? This poster illustrates the concepts underlying ‘polygonal mesh’ that apply to 3D visualisations come to life through polygonal anatomy and into practical applications in medical education and clinical practice.

This poster starts with the triangle as the basic morphological unit of a 3D print. Meshwork based on triangulation is built up in subsequent stages in rendering software. The nature of this ‘polygon mesh’ gives movement and stability to the living body, and in the world of model‐making it allows the computer to arrive at simulations of forms anatomical and otherwise. We look at how this polygonal nature is interpreted by the 3D printing process, culminating in photos of actual 3D printed anatomy parts and body painted temporary tattoos derived from the datasets and applied to a living body.

The morphological aspect of 3D printed models is interesting in comparison with the morphology of living organisms. Is there a polygonal aspect to living tissue? This poster addresses the basics of polygonal mesh to illustrate how triangulation and closed kinematic chain dynamics arise from such a morphological arrangement, characteristics that are emerging as hallmarks of tissue in the fascia literature. We hope that our poster will shed a new angle of light on the research around polygonal mesh as a basis for frameworks in model and living tissue. No ethics approvals are applicable for this poster as it is a theoretical construct only.

P25

Comparing dissection and prosection in anatomy education in the undergraduate medical curriculum: a review of the literature

TSM Chu and A.M.M. Oo

Newcastle University, Newcastle upon Tyne, UK

Dissection has traditionally been the main instructional tool for anatomy education. However, it is replaced by prosection in a significant number of medical schools in the UK. There is an ongoing debate regarding approaches in delivering anatomy teaching in the undergraduate medical curriculum. This study aims to evaluate and compare the two methods using existing literature to aid in refining the current anatomical curriculum.

We searched through three databases for studies that looked at the two approaches. In all, 72 articles were identified, and their titles and abstracts were screened. Sixteen papers were included in this study. Both quantitative and qualitative data from these records were extracted for analysis.

Studies analysed included different student groups and there was marked variability between the study designs. From our review, a significant number of studies reported no difference in the effectiveness of the two approaches. However, due to the limitations of the reviewed studies, it is difficult to interpret and generalise from the results.

Advantages and disadvantages of the two methods were highlighted through qualitative analysis. Prosection is an efficient and cost‐effective learning tool which can demonstrate anatomical variations in different individuals. Dissection, on the other hand, provides a tactile and emotional learning experience while giving students valuable practical skills that are useful for their future careers.

Although the current literature presents no convincing data in favour of one method over the other, there is growing evidence on the complementary effects of combining multiple learning pedagogical resources, including dissection, prosection and other multimedia modalities, to enhance the effectiveness of anatomy teaching. Moving forward, future research should address limitations of the current literature and adopt a well‐developed methodology with standardised course design and outcome measures.This study requires no ethical approval.

P26

Testicular morphometric and hormonal changes following administration of vancomycin linoleic acid nanoparticles in Sprague‐Dawley rats

ECS Naidu,¹ A.I. Peter,¹ E.N. Akang,¹ R. Kalhapure,² T. Govender² and O.O. Azu^1,3

¹Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of KwaZulu‐Natal, Durban, South Africa; ²Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu‐Natal, Durban, South Africa; ³Department of Anatomy, School of Medicine, University of Namibia, Windhoek, Namibia

Aim

Nano‐drugs are novel innovations in the management of methicillin‐resistant Staphylococcus aureus (MRSA) infections seen in both community and healthcare settings. The aim of the present study was to investigate the potential of linoleic vancomycin nanoparticles produced by the University of KwaZulu‐Natal (UKZN) nano‐team on testicular tissue in an experimental model.

Materials and methods

Twenty‐five adult male Sprague‐Dawley (SD) rats maintained at the Animal House of the Biomedical Resources Unit, UKZN, were weighed and divided into five groups. Control animals (A) were administered normal saline. Therapeutic doses of SLNNV, VSLN, LN and VLA were administered to treatment groups B–E, respectively. At the end of 4 weeks, animals were sacrificed and epididymal tissue removed for sperm analysis using a standard protocol. Testicular tissues were processed for light microscopy, histochemical stains (H/E, PAS and MT stains) and morphometry. Hormonal assay was done using ELISA kits. Data were analysed using Graph Pad version 6. Ethical approval from Animal Ethics Committee of the University (AREC/010/016PP) was granted.

Results

We report significant depletion in testosterone (P < 0.05) and elevation in FSH/LH (P < 0.05) in treated groups compared with controls. This corresponded with reduction in sperm count in the VSLN group and LA group when compared with controls, but sperm motility and morphology were not significantly different when compared with controls. Histological testicular perturbations were observed with epithelial sloughing, shrinkage, as well as atrophied tubules, reduction in Sertoli cells and loss of cellular components in treated groups compared with controls. These mirrored the morphometric evaluations with a significant reduction in seminiferous tubular diameter, seminiferous tubular area and a significant increase in basement membrane thickness in all treatment groups.

Conclusion

VSLN as well as its constituents SLN and LA lead to negative disruptions in testicular morphometry and hormonal milieu capable of inducing altered reproductive function in this model. (South African NRF grant U99053 to O.O.A. is acknowledged; UKZN postgraduate fund to E.C.S.N.; postdoc funding to A.I. & A.E.N.; Nano‐mobility grant to G.T., O.O.A., K.R.).

P27

Discovery of human anatomical variants during routine dissection is an integral part of developing surgically relevant anatomical knowledge: implications of finding a musculocutaneous nerve variant

R. Strong, H. Chaggar, P. Prabahar and J. Matthan

School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle, UK

A reduction in opportunities for medical students to undertake cadaveric dissection is prevalent across UK medical institutions, impacting on an understanding of the variations often discovered during routine dissection and potentially impacting on patient safety. Variations of the brachial plexus are surgically relevant during procedures on the upper arm; awareness of variations can prevent iatrogenic injury to the nerves, and are especially relevant during flap repair, post‐traumatic evaluations of the arm and peripheral nerve repair. Routine tissue‐based dissection on a male cadaver by two fourth‐year medical students revealed an unusual MCN variant.

Eight variations of the MCN are known. The norm is for MCN to emerge as a terminal branch of the lateral cord (LC) of the brachial plexus. It branches off LC before piercing and innervating coracobrachialis muscle (CB), after which it supplies branches to two other elbow flexors and continues as the lateral cutaneous nerve of the forearm. In the variation observed, in the left upper limb, CB was supplied by a branch directly from the LC, 24.3 mm from the coracoid process. A further 106 mm along its course, a second branch originated from the LC and supplied the biceps brachii muscle. Two normal terminal branches of the LC were present, one of which was the MCN. A branch from the MCN innervated the brachialis muscle. The terminal branch of the LC was the lateral root of the median nerve. This merged with the medial root of the median nerve, forming the median nerve. The finding was unilateral. Less than 5% of cadavers are thought to exhibit this MCN variation, although MCN variations are more common than previously thought. Discovery of the MCN variation illustrated the importance of dissection for raising awareness of the anatomical variations, as well as the need for vigilance during surgical procedures to avoid iatrogenic damage.

This work falls within the remit of the Human Tissue Act and no further ethical approval was required.

P28

Increasing 3D visualisation skills in veterinary students by using a virtual reality (VR) canine model

X. Xu,¹ D. Kilroy,² E. Mangina,¹ A. Kumar² and A G Campbell¹

¹School of Computer Science, UCD, Belfield, Dublin, UK; ²School of Veterinary Medicine, UCD, Belfield, Dublin, UK

A good working knowledge of regional anatomy is essential for correctly interpreting radiographs. Other diagnostic imaging modalities (CT, MRI and ultrasonography) require the additional skill of 3D visualisation of the area being studied. In the first two years of the veterinary course, dissection classes help students develop these skills. When clinical students start their diagnostic imaging (DI) modules, much of their anatomy knowledge is dormant and a clinically directed refresher course would greatly improve their learning experience. Virtual reality (VR) is an impressive addition to the list of computer‐aided methods of teaching. Although there are several medical anatomy VR applications (Oculus, Anatomyou), there are few equivalents for comparative animal anatomy. Consequently, a collaboration began between UCD Veterinary Anatomy and the School of Computer Science, where faculty members have expertise in VR programming and have access to an immersive VR facility (a 3D environment that surrounds the user). Suitable CT scans of canine heads were selected and the DICOM images were transferred to computer science staff who used gaming software (Unity) along with a modelling program (MeshLab) to develop a VR dog head. This work was conducted in a specialised VR facility. The final version of the model was reviewed by anatomy staff who added 20 MCQs to the application prior to its use by students. Year 2 and final year students (n = 15) were asked to review the application within the immersive environment. Each student wore a VR headset and used hand controls to study the model. All took part in the MCQ portion, which were delivered by VR. Students completed a survey after completion of the review. Responses (on a Likert scale) were very positive on the reality of the application, its utility in developing 3D anatomy knowledge and its ease of use. Ethical approval was granted for this work.

P29

Biomechanical properties of intrasutural (Wormian) bone in the equine calvaria

L.Z. Martinez,¹ AHS Kumar² and D. Kilroy²

¹UCD Engineering and Materials Science Centre, University College Dublin, Belfield, Dublin, UK; ²Veterinary Anatomy, School of Veterinary Medicine, UCD, Belfield, Dublin, UK

Wormian (intrasutural) bones are small, irregular bones, which are found in the cranial sutures of the skull, typically those sutures associated with the parietal bone, which forms part of the dorsal braincase (calvaria). Although the presence of higher numbers of Wormian bones in patients is linked to bone pathology, studies on its biomechanical significance in healthy individuals are rare. With the aim of assembling a comprehensive set of biomechanical data on intrasutural bone, this study used microCT imaging of the equine parietal bone to determine bone characteristics such as stiffness, strain rate, bone mineral density (BMD) and maximum displacement. All collected data were statistically analysed to determine whether the presence of Wormian bone affected these parameters. Our findings on 54 specimens taken from 10 horses (age range 4–29 years) showed that BMD was unaffected by the presence of Wormian bone. However, the presence of Wormian bone influenced the strain rate and its effects on elasticity suggests that it renders bone less prone to the impact of a fracture, resulting in an incomplete break in the osseous tissue rather than a total separation of the bone fragments. We consequently conclude that the presence of these intrasutural bones, which are confined to the calvaria, act as a protective mechanism to shield the brain from damage when skull fractures occur. As all skull samples were collected from a local abattoir, ethical approval was not required for this work.

P30

Variation in lumbosacral anatomy: a radiographic and dissection study of large breed and giant breed dogs

N. Rosenberger,¹ E De Capitani,¹ S. Hoey,¹ A. Kumar² and D. Kilroy²

¹UCD Veterinary Hospital, School of Veterinary Medicine, UCD, Belfield, Dublin, UK; ²Veterinary Anatomy, School of Veterinary Medicine, UCD, Belfield, Dublin, UK

Several breeds of large (25–50 kg bodyweight) and giant (>50 kg bodyweight) dogs are prone to serious skeletal conditions affecting the lumbosacral region (hip dysplasia in Labrador Retrievers, Golden Retrievers and German Shepherds; cauda equina syndrome in German Shepherds, Great Danes and Airedale terriers). There have been several studies on the occurrence of transitional vertebrae in dogs and their relationship to sacroiliac morphology, but little research on the potential link between lumbosacral anatomy and pathologies of the pelvic region. This study aimed to evaluate this link by examination of radiographs and CT images from both large and giant breed dogs (n = 80), all of which were obtained from UCD Veterinary Hospital. In addition, the pelvic region of four Greyhound cadavers, used for undergraduate teaching, was thoroughly dissected and digital images were obtained. All data were analysed using ImageJ software (NIH) to determine the height and the length of lumbar vertebra 7 (L7) and the height and length of the sacrum, measured as a composite of three vertebrae (S1–S3) and for the presence of transitional vertebrae. Images were categorised based on the animal's breed, age, sex, and the presence or absence of significant pathology, as assessed by an experienced radiographer.

In contrast to the German Shepherds and Retriever breeds, Greyhounds were under‐represented in the dogs with pathological problems of the pelvis and hip. Given their athletic nature, it is unusual that the lumbosacral skeleton of Greyhounds shows so little pathology. A larger sample size, especially of younger dogs, would better determine the relative importance of lumbosacral anatomy in the onset of pathology in this region.

Ethical approval was granted for this work by the university's research ethics committee (AREC‐E‐15‐08‐Kilroy).

P31

Defining branching morphogenesis in murine salivary glands using a computational approach

Z. Waheed, L. Chatzeli and B.D. Simons

The Wellcome Trust/Medical Research Council Stem Cell Institute, University of Cambridge, Cambridge, UK

The mammalian salivary gland is a saliva‐producing and ‐secreting exocrine organ. The important physiological functions of saliva are well known. The salivary gland itself is a paired structure and there are three main types: the parotid, the submandibular (SMG) and sublingual (SL). The latter two are closely associated with each other and the SMG is one of the most commonly studied salivary glands in culture. Extensive branching morphogenesis is required to establish the highly branched ductal network of this epithelial organ, but despite the molecular mechanisms being widely characterised, very little is known about the precise arrangement and pattern of branching. Here we establish a 3D model of the mouse SMG and SL of E15.5, E16.5 and E18.5 embryos in order to investigate the branching pattern within these glands. To achieve this, we first identified effective immunofluorescent markers to track the ductal and the salivary gland epithelium (K14). We then reconstructed the branching tree using ImageJ before developing an image analysis protocol for 3D reconstruction. Comparisons of the submandibular 3D renderings suggested an increase in complexity with increasing developmental stage, which mainly occurs between E15.5 and E16.5. Further work on this project will enable a greater insight into the branch decisions of the submandibular gland and reveal more about salivary gland development. Overall this project has helped successfully to establish an essential research tool that can be used to aid these future studies.

All experiments were performed according to Home Office guidelines using schedule 1 approved culling methods.