Conference Abstracts: Winter Meeting of the Anatomical Society, Lancaster 2019

S1

Do bone marrow adipocytes in human bone contribute to abnormal bone formation in osteoarthritis?

Rebecca Shepherd¹; Kathryn Allison²; Bryan Rhodes²; Jemma G. Kerns¹; Adam M. Taylor¹

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

Trabecular excrescences are novel bone structures identified in osteoarthritic (OA) patients that are often found associated with bone marrow adipocytes (BMAds). We hypothesise that these adipocytes contribute to the formation of bone like structures. This study aimed to identify the types BMAds present in OA joint samples and clarify their contributions to the formation of trabecular excrescences.

Joint samples were obtained from 20 patients with OA (mean age = 75.3) and 20 patients without OA (mean age = 78.5). North of Scotland NHS Research Ethics Committee approved this research. Flow cytometry was performed on adipocytes from the BMAT of 28 samples. Flow cytometric analysis identified adipocytes using markers for adiponectin (Acrp30), uncoupling protein 1 (UCP1) and myogenic factor 5 (Myf5). The remaining joint tissue was decalcified and processed for histology. Immunohistochemistry stained for collagen I, collagen VI, osteocalcin, Acrp30, UCP1 and Myf5.

The flow cytometry result found a population of beige adipocytes in the BMAT of both patient groups. Statistical analysis to account for disease, age and biological sex demonstrated no significant difference in the proportions of adipocytes found in the two patient groups. The presence of beige adipocytes was confirmed by immunohistochemistry, which showed the presence of collagen VI within the extracellular matrix of the newly formed excrescences, which were in turn lined by beige adipocytes. Histology showed excrescences present in both OA and non‐OA samples.

This study has shown that trabecular excrescences are initially formed by the deposition of collagen VI by beige adipocytes. However, the presence of osteocalcin suggests that excrescences have the potential to be remodelled. Understanding changes in the anatomical composition of BMAT and the role of adipocytes in skeletal health may prove important in understanding of bone pathology.

S2

The effect of ageing on human skeletal muscle as assessed by quantitative MR imaging: an association with frailty and muscle strength

Matt Farrow; John Biglands; Steven F. Tanner; Elizabeth Hensor; Philip O'Connor; Paul Emery; Ai Lyn Tan

University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom and Leeds Biomedical Research Centre, Leeds, United Kingdom

The proportion of older people in the population is increasing, from 461 million people older than 65 years in 2004 to an estimated 2 billion people by 2050. Skeletal muscles undergo changes with ageing, including myosteatosis, fatty infiltration, atrophy and changes in muscle microstructure, which can result in an increased risk of serious injury from sudden falls and sudden fracture. In the search for interventions to reduce frailty, the identification of sub‐clinical muscular features using quantitative MRI has the potential to enable better targeting of interventions based on well‐defined quantitative measures that are associated with frailty.

18 ‘young’, 18 ‘middle‐aged’ and 18 ‘older’ participants were recruited. It was approved by the ethics committee. Participants had knee extension and flexion power measured using an isokinetic (concentric‐concentric) dynamometer. Statistical analyses were performed using SPSS. One‐Way ANOVA with Bonferroni post hoc analysis was used to test for significant differences. Spearman's rank correlation was used to measure correlation.

Fat fraction, mean diffusivity and T2 values were significantly higher in the older age group compared to the young group. In the quadriceps, there were differences of 4% (p < 0.001) in fat fraction, of 0.11 x10‐3mm2s (p = 0.002) in mean diffusivity and of 4.3 ms (p < 0.001) in T2. Muscle volume was significant decreased with a difference of 397 cm3 (p = 0.006) between the old and young groups. T2 correlated with frailty index (rs = 0.8; p < 0.001) and muscle power extension (rs = 0.6; p < 0.001). Fat fraction correlated with frailty index (rs = 0.7; p < 0.001), muscle power extension (rs = 0.7; p < 0.001) and gait speed (rs = 0.6; p = 0.001). Muscle volume of the thigh correlated with frailty index (rs = 0.6; p < 0.001), muscle power flexion (rs = 0.6; p < 0.001), muscle power extension (rs = 0.6; p < 0.001) and gait speed (rs = 0.6; p = 0.01).

We have identified that quantitative MR measurements can detect differences between young, middle‐aged and older participants. Older participants had significantly higher T2, FF and mean diffusivity and significantly lower muscle volume. This study has shown for the first time a correlation between quantitative MRI measurement for T2, FF and muscle volume with frailty. This demonstrates that quantitative MRI is a useful marker of frailty and could be used as a diagnostic and management tool in ageing muscle.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Experiments were performed with the understanding and signed consent was obtained from all individual participants included in the study.

S3

The Segond fracture occurs at the site of the lowest entheseal trabecular bone volume fraction across the human tibial plateau

Will Mullins¹; Daniel Oluboyede¹; Gavin Jarvis¹; Jai Chitnavis^1,3; Linda Skingle⁴; Ken Poole⁴; Tom Turmezei²; Cecilia Brassett¹

¹Human Anatomy Teaching Group, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom; ²Consultant Musculoskeletal Radiologist, Norfolk and Norwich University Hospitals NHS Trust, Norfolk, United Kingdom; ³Consultant Orthopaedic Surgeon, The Cambridge Knee Clinic, University of Cambridge, Cambridge, United Kingdom; ⁴Department of Medicine, Cambridge NIHR Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom

The Segond fracture is an avulsion of part of the anterolateral tibial plateau which occurs following knee trauma in which the anterior cruciate ligament is often also damaged. It may result from torsional forces generated during tibial internal rotation due to the attachment of the anterolateral ligament (ALL) to the site of the Segond fragment. However, the existence of the ALL is controversial. While the avulsion is an important marker of traumatic internal knee derangement, its underlying mechanisms are poorly understood. We hypothesised that trabecular bone volume fraction (BV/TV) at the Segond site was lower than other entheseal sites across the plateau, explaining the propensity for avulsion.

Twenty tibial plateaus from 15 female (age range, 72‐99) and 5 male (age range, 82‐93) human cadavers were imaged in a Nikon‐XTH225‐μCT scanner at < 80 μm resolution. All donors had provided written consent before decease for their bodies to be used for anatomical research, in compliance with the Human Tissue Act 2004. After 3D reconstruction with MicroView software, 5 mm3 regions‐of‐interest (ROI) were positioned at 10 pre‐selected entheseal sites. BV/TV was calculated at each ROI and means were compared using repeated‐measures ANOVA (with Greenhouse‐Geisser correction for sphericity) and post‐hoc Dunnett's test.

Comparison of mean BV/TV at each ROI demonstrated substantial inter‐ and intra‐subject variation. Analysis confirmed that BV/TV at the Segond site was significantly lower than any other ROI across the 20 specimens.

Since BV/TV correlates with tensile and torsional strength, its regional reduction might represent an area of local weakness in certain individuals which predisposes them to an avulsion injury following the application of excessive torsional force. The distribution of entheseal BV/TV values in our results agrees with the reported incidence of tibial plateau avulsion fractures at the respective insertions. A higher entheseal BV/TV may, therefore, indicate that the weakest link lies in the substance of the ligament, meaning a mid‐substance tear is more likely to occur than an avulsion fracture. The lower BV/TV also suggests that the Segond site is unlikely to be a discrete enthesis, but instead part of a broader insertion (the ‘anterolateral complex’) in line with Frost's Mechanostat hypothesis.

S4

Prevalence of the Linburg‐Comstock variation in a cohort of human cadavers of Irish descent

Martyna Stasiewicz; Harumi Ramanayake; Rafie Ebrahimi Ghaei; Cara Connolly

Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin 2, Ireland

Flexor digitorum profundus (FDP) and flexor pollicis longus (FPL) are two deep muscles of the anterior forearm originating from the ulna and radius, respectively. FDP tendons insert into digits 2‐5, whereas FPL controls the flexion of the thumb interphalangeal joint (IPJ). These muscles are positioned adjacent to each other at their origin points in the proximal forearm and diverge distally. The Linburg‐Comstock variation (LCV) is characterised clinically by simultaneous flexion of the IPJ of the thumb and distal interphalangeal joint of the index and/or middle finger. This variant occurs as a result of tendinous connections between the two forearm muscles. However, muscular, tendinous and dense connective tissue connections have been previously described in cadaveric specimens and in imaging studies. Patients are often unaware of the presence of the variation as it is generally asymptomatic. A previous study has shown that inflammation of the connection post‐trauma caused chronic pain in the forearm, which was relieved by surgical disconnection.

In a cadaveric dissection study, in an Irish cohort, we examined a series of anterior forearms and hands for the presence of the variant. The aim was to establish the prevalence and morphology of connections between the FPL and FDP muscles and tendons. Cadaveric specimens used were part of the body donation programme in the Royal College of Surgeons Ireland. Ethical approval was obtained at the time of body donation as part of the Anatomy Gift Programme in the Royal College of Surgeons in Ireland. The donation of remains to medical science is governed by the Anatomy Act 1832.

A total of 42 forearms and hands were dissected in 15 females and 9 males. The average age at the time of death was 75 (53‐103). In 55% (20/36) of the bilaterally dissected forearms, and in 67% (4/6) of unilaterally dissected forearms connections were identified. Right side prevalence was seen in paired specimens (65%).

Variations beyond the Linburg‐Comstock anomaly were identified: tendinous and muscular connections were found, as well as separate muscle tendon units and Y‐shaped connections. Connections were also found between FPL and flexor digitorum superficialis.

We identified a range of morphologically diverse variants beyond that described in the LCV. There was bilateral prevalence. Most commonly encountered connections were muscular and musculo‐tendinous, contrary to the findings in current literature. The anomaly may contribute to more clinical scenarios than currently appreciated. Ethical approval was obtained at the time of body donation as part of the Anatomy Gift Programme in the Royal College of Surgeons in Ireland. The donation of remains to medical science is governed by the Anatomy Act 1832.

S5

A human cadaveric study on lung fissure variations

Conor Sheahan; Gerges Abdelsayed; Harumi Ramanayake; Cara Connolly

Department of Anatomy and Regenerative medicine, The Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland

The purpose of this study was to observe variances in lung fissures within an Irish Cohort. In adult cadavers, paired lungs were examined: Anterior thoracotomies were performed and the lungs were removed at the hilae. A general inspection of the lungs was performed: Lung fissures were measured and aberrant (additional) fissures recorded. Fissures were graded by the ‘Craig Walker’ classification (CWC) whereby Grade 1 is a complete fissure, Grade 2 is complete in length with parenchymal fusion at the lung base, grade 3 is incomplete by length and grade 4 is a total fusion (absent fissure). Grade 1 & 2 were grouped together and grade 3 and 4 grouped separately. Exclusion criteria included the presence of lung malignancy, localized fibrosis, or previous lobectomy.

28 lungs (14 pairs) were examined in 5 males and 9 females with a mean age of 82. Results are given as Mean ± S.D in males and females respectively: Grade 1 & 2 right oblique fissures (ROF) were 33.00 cm ± S.D 4.3 and 29.3 cm ± S.D 6.8 cm. Grade 1 & 2 Right Transverse Fissures (RTT) were 20.6 cm ± S.D 3.5 cm and 18.3 cm ± S.D 1.6. The grade 1 & 2 left oblique fissures (LOF) were 32.3 cm ± S.D 6.2 cm and 33.7 cm ± S.D 5.01. There was no statistical difference between male and female findings (Students TTest).

Of the 14 pairs of lungs examined, incomplete fissures (Grade 3) were identified in 1 ROF, 1 LOF and 6 RTF. Only one fissure was completely absent (grade 4); a LOF. Aberrant fissures were identified on 2 right lungs and 4 left.

In these findings variable lung fissure morphology was more typical than standard lung fissures descriptions but we will continue to increase the size of this study. We believe that these findings are clinically and anatomically significant as they can inform both surgical techniques and the interpretation of radiological images. All donors provided full consent as part of the RCSI body donation program. Local institutional permission was also obtained for the project.

S6

The influence of species specialization on anatomy use in first opinion clinical veterinary practice

Alison Attwood; Ben Homfray; Sarah Channon*

The Royal Veterinary College, London, United Kingdom

Veterinary graduates, on entering primary care practice, typically specialize by species. The majority enter small animal practice, however a minority work in mixed, farm animal, or equine only specialties. In contrast, the Royal College of Veterinary Surgeons in the UK require graduating vets to be omnicompetent across species. As a result, determining veterinary anatomy curricula can be challenging: faculty must balance the need for broad coverage across multiple species, with the need to achieve sufficient depth of understanding and practical application to allow surgical competence.

Previous studies of anatomy use in small animal practice have indicated several important outcomes for undergraduate veterinary anatomy teaching. These include the need to develop information literacy, psychomotor and professional skills in an anatomical context to ensure graduates are suitably equipped to transfer their anatomical knowledge to the clinical environment. The current study aimed to further this work by qualifying how vets working in first‐opinion farm animal and equine specialisms use anatomy knowledge in clinical practice. Ethical approval was obtained from the Royal Veterinary College's Social Sciences Research Ethical Review Board, URN: SR2019‐0244. Observations and semi‐structured interviews were undertaken of 11 vets working in equine (N = 7) practice and large animal (N = 4) practice over four weeks in summer 2019. A thematic analysis of the qualitative dataset was undertaken with subthemes and themes identified via a grounded theory approach. Both farm animal and equine vets were clear that anatomy was important for all aspects of their daily work. However vets in both specialties emphasized species‐specific challenges they faced with using anatomy in practice. Farm animal vets felt that undergraduate anatomy teaching was not always relevant to their current role, and whilst useful, was often overly detailed, or omitted key aspects of anatomy that they now use frequently in practice. Equine vets spoke of reliance on learning opportunities out with their university learning, particularly in the areas of musculoskeletal anatomy and diagnostic imaging. Our results highlight that developing an anatomy curriculum to support the learning needs for all graduate destinations in veterinary medicine is still a challenge and pertinent aspiration.

*Presenting Author

S7

From body donation to rare disease therapy” ‐ Alkaptonuria research in Liverpool

Jim Gallagher; Lakshminarayan Ranganath

University of Liverpool, Liverpool, United Kingdom

Alkaptonuria (AKU) is an iconic rare disease caused by genetic deficiency of an enzyme in tyrosine metabolism, leading to failure to breakdown homogentisic acid (HGA). It was the first human disease shown to follow Mendelian inheritance by Sir Archibald Garrod over a century ago. In AKU, circulating and urinary HGA are massively elevated and although most HGA is excreted, over the years some is deposited as a pigmented polymer in connective tissues, a process known as ochronosis. Articular cartilages are a favoured site for ochronosis, causing severe, early onset arthritis beginning in the third decade. Spinal and joint disease has a devastating effect on AKU patients, leading to severe disability, chronic pain and multiple surgical procedures. The first research on AKU undertaken in Liverpool was a post‐mortem investigation of a 74‐year old female with AKU who donated her body to the University. The results of this investigation inspired a new chapter in AKU research in which we elucidated the mechanism of joint destruction in the disorder. This included the identification of four novel pathoanatomical structures, initially recognised in AKU joints but later shown to be present in common osteoarthritis, where they may also play a central role in joint destruction. Subsequently, we developed a mouse model of ochronosis and identified an effective therapeutic agent, nitisinone, which completely blocked deposition of ochronotic pigment. The efficacy of nitisinone in the mouse model led to a pan‐European clinical programme “DevelopAKUre” which comprised a cross‐sectional study (SOFIA) and two clinical trials on nitisinone, a phase 2 dose‐ranging study called (SONIA 1) and a phase 3 efficacy study (SONIA 2). Nitisinone has also been used in the National Alkaptonuria Centre in Liverpool, and shown to arrest the progression of AKU.

S8

The circle of willis – more C than circle: Study of the circle of willis in an irish cohort, a human cadaveric dissection study

Rafie Ebrahimi Ghaei; Martyna Stasiewicz; Harumi Ramanayake; Amir Hameed; Cara Connolly

Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Republic of Ireland

The aim of this study was to carry out a general inspection of the Circle of Willis, for symmetry, presence of variations (such as aneurysm) and to measure cross sectional diameter for each vessel.

Via craniotomy, brains were removed with the circle of Willis blood vessels (CoW) intact and inspected. The optic chiasm, basilar arteries and medulla oblongata were transected to facilitate the dissection. Cross‐sectional vessel diameters were measured at 14 points, on the right and left sides. To perform measurements in situ on the brain, a mathematical compass was used under magnification and the reading made with a micrometer screw gauge.

In 6 females and 3 males, with an average age of 75, 123 measurements were made. No aneurysms were identified but three of the left posterior communicating arteries (PCoA) were over 80% greater than the average size for this vessel (3.4 mm ‐ 3.9 mm versus 1.8 mm). In 1 left posterior cerebral artery the proximal segment P1 was narrow as compared to the adjacent segment (P2); 1.6 mm versus 2.8 mm.

The only significant asymmetry for left and right vessels, Genderor anterior versus posterior CoW was for the origin of the right and left anterior cerebral arteries, P < .047, students TTest.

The PCoA was the vessel most likely to have duplications and to exhibit tortuosity. In one case the PCoA terminated in the brain parenchyma only. Both the PCoA and anterior communicating were the smallest vessels measured. An aberrant anterior cerebral vessel was also identified

The cadavers in this study were gratefully utilized as part of the RCSI body donation program.

Previous studies have documented vessel sizes in the CoW, but this has not been determined in an Irish cohort. The absence of aneurysmal findings reflect the greater age of this group as compared to the typical age of presentation in cerebral bleeds (of which aneurysms are a leading cause). The small size, tortuosity and duplications found in the PCoA supports the dogma that the circle is only complete in a minority of cases.

S9

Development of a massive open online course (MOOC) for enhancing spatial and social anatomy learning

Jeremy Cheong Jie En¹; Farzaan Bhandari¹; Suzanne Hardy²; Leonard Shapiro³; Iain D Keenan¹

¹School of Medical Education, Newcastle University, United Kingdom; ²Learning and Teaching Development Service, Newcastle University, United Kingdom; ³Department of Human Biology, University of Cape Town, South Africa

We have previously described the design and evaluation of a novel Observe‐Reflect‐Draw‐Edit‐Repeat (ORDER) learning approach as a step‐by‐step process of collaborative observation, reflection, drawing and modification. The cyclical structure of ORDER has provided a framework around which we have constructed our distinct Haptico‐visual observation and drawing (HVOD) process. In doing so, we have collaboratively created an innovative, optimised and enhanced art‐based learning approach named ‘ORDER Touch’. While ORDER is currently delivered in anatomy practical classes at Newcastle University, and HVOD has been delivered as face‐to‐face workshops in South Africa and the U.K, ORDER Touch will be delivered as an interactive massive open online course (MOOC).

Our course will provide a free platform for the accessible and remote delivery of ORDER Touch to a global audience of anatomy educators and students when it launches in October 2020. Each cycle of the MOOC will run over a 4 week period, comprising around 4 hours per week of video and text‐based instruction, anatomy observation and drawing, educator‐led group discussions and peer‐peer feedback activities. There will be multiple releases of the MOOC throughout the academic year 2020/21 and beyond, with each iteration expected to achieve a cohort of up to 1000 participants.

Here we present the theoretical and evidence‐based design of ORDER Touch, and a descriptive account of the development of our MOOC. We also describe a planned research study, which we have designed in order to identify the value of the MOOC for enhancing the haptico‐visual observation skills, spatial understanding and anatomy knowledge of medical students at Newcastle University. Ethical approval will be sought prior to research commencing.

Successful development and evaluation of our ORDER Touch MOOC will have implications for modern anatomy education in terms of the valuable pedagogic outcomes of art‐based and technology‐enhanced learning, which can be achieved with flexible delivery, enhanced availability and global reach.

S10

Visualizing the Mammalian inner ear from low to high resolution

Anna Lysakowski

Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, IL, United States

The mammalian inner ear has been difficult to visualize, but new technologies are on the horizon that will make imaging the inner ear more precise, with the ultimate goal of visualizing the human inner ear in living patients. Almost 1% of the human genome codes for deafness genes (160/20,000 genes), making the inner ear a very complex mixture of proteins with a myriad of functions. By means of animal studies, we have determined the level of visualization that is necessary to assess the morphological structure of deafness and dizziness disorders. Building on early studies utilising camera lucida and light microscopy, investigators are now using cutting‐edge imaging techniques, such as optical coherence tomography, focused ion‐beam scanning electron microscopy, serial block face EM, electron microscopic tomography, to visualize structures within the temporal bone. These structures range from the gross structures, such as the semi‐circular canals and middle ear ossicles, to the otoconia and sensory epithelia, down to cellular and subcellular structures, such as hair cells, stereocilia, mitochondria, synaptic ribbons and ion channels and co‐transporters. Images from these studies are being used to generate functional models that are helping inform our thinking about how the inner ear works.

All animal studies were carried out with the approval of the University of Illinois at Chicago Institutional Animal Care and Use Committee and according to NIH guidelines. We gratefully acknowledge funding support from NIH R01‐012347.

S11

Anatomical clutter in medical image perception

Tim Donovan

Medical Sciences, Institute of Health, University of Cumbria, Lancaster, United Kingdom

Medical image perception is a difficult task, and despite advances in imaging technology error rates of up to 30% still persist. The medical image interpretation task requires cognitive processes such as perception, comprehension, reasoning, decision‐making and problem solving, all of which are affected by knowledge, memory and reasoning strategies as well as their biases. Understanding the processes that underlie expert performance in the detection of pathology has not yet been fully achieved.

A conventional medical image, such as a chest x‐ray, is a 2D representation of the 3D anatomy. Fully understanding the image means having a 3D mental representation of the anatomy or template to which the image can be compared. One also needs accurate anatomic‐pathologic schemas leading to perceptual differentiation of abnormalities. Experts generally detect pathology within 1 or 2 seconds of viewing an image, as they are sensitive to pathology and can attenuate or nullify all the anatomical detail in an image. This is analogous to mentally applying a pre‐whitening filter to the image data, and removing anatomical clutter. The greatest motivation for the development of 3D radiographic imaging is that it removes anatomical background clutter that may decrease the conspicuity of pathology.

Currently most radiology trainees are instructed on how to classify abnormalities, whereas it would probably be better to initially instruct them on how to gather the holistic impression of the image such as normal anatomy (and variants) so that they can then fine‐tune the perception of pathology. There is no short cut; this requires a great deal of practice and feedback.

S12

Ageing of craniofacial form among adult modern humans

Craig Humphreys; Nathan Jeffrey

Human Anatomy Resource Centre & Institute of Ageing and Chronic Disease University of Liverpool, Liverpool, United Kingdom

Craniofacial form (shape and size) changes significantly during the modern human lifespan. Most ontogenetic changes are documented with a paucity of research focused on form changes later in life. We aim to resolve ageing related changes in adults using different methodological and analytical approaches. Twenty‐three landmarks were placed on T1‐weighted scans using 3DSlicer (v4.8.1) to capture changes in the face and cranial base of 143 individuals, from the IXI MRI datasets (20‐79 years). Landmark co‐ordinates were analysed with geometric morphometric (GMM) analysis (MorphoJ 1.06d) and to calculate standard measurements such as length. Volumetric techniques were used to measure endocranial volumes on T2‐weighted scans using Volumest for ImageJ (v1.51k). Data were subdivided into three groups; young adults (20‐30 years, n = 39), established adults (30‐50 years, n = 52) and old adults (50‐80 years, n = 52). Grouped gender t‐tests showed differences between young and established adults in facial length, cranial base angle and index of relative encephalisation (IRE). Separate t‐tests for each gender revealed endocranial size differences between young and established adult females. Males displayed differences in facial length and IRE between young adults and both older groups. Differences in basicranial length were also found between young and established adults as well as centroid size between young and old adults. Additionally, old adult males appear to have slightly flatter basicrania than established adults (83.8° vs 86.9°; p = 0.01). Non‐euclidean GMM analysis demonstrated similar patterns of difference. Canonical variate analysis showed that young adults differ from established and old adults, but the latter two groups do not differ from each other. Shape changes across CV1 from young adult to old adult included dorsal deflection of the palate, orbital tipping and coronally rotated petrous ridges. Form changes were more prominent in males than females. Evidence for craniofacial ageing was found with reference to the youngest adults. However, it is worth noting that this may be due to residual ontogeny (e.g. suture fusion) in the youngest group as well as ageing. Comparisons between the two oldest groups suggest that unlike other musculoskeletal systems, the craniofacial complex is relatively spared in the ageing process. No specific ethical approval was required (http://brain‐development.org/ixi-dataset/).

S13

Morphological associations between the major duodenal papilla and the safety and efficacy of endoscopic sphincterotomy in humans

Shaan Patel^1,*; Mythiri Sutharson^1,*; Jonathan Brown^1,2; Cecilia Brassett¹

¹Human Anatomy Teaching Group, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom; ²Gloucestershire Hospitals NHS Foundations Trust, Gloucester, United Kingdom

Biliary calculi can be extracted from the common bile duct (CBD) during endoscopic retrograde cholangio‐pancreatography (ERCP) with a balloon catheter following division of the sphincter of Oddi (sphincterotomy). Retroperitoneal perforation is a recognised complication of this procedure. Predictive associations between the major duodenal papilla (MDP) morphology, the intramural bile duct length and the maximum safe extent of sphincterotomy were sought in 56 cadaveric specimens using a previously described classification system: I (flat), II (prominent), III (infundibular), IV (dependent). The prominence of the classified papillae was measured with digital callipers as the distance between the duodenal wall and their maximal endoluminal extent. The length of the intramural CBD was measured by drawing a marked endoscopic guidewire through the papilla from the retroperitoneal side at the choledochal window. The maximum length of sphincterotomy was determined by cutting away from the ampullary orifice towards the hooding fold in the 11‐12 o'clock direction until a retroperitoneal perforation was observed by transillumination. The length of this incision was measured with digital callipers.

The mean prominence for each papilla type was: 0.42 mm (±0.58) for type I, 2.74 mm (±1.27) for type II, 3.46 mm (±1.42) for type III and 5.44 mm (±0.68) for type IV, highlighting the progressive nature of the classification scheme. The mean intramural CBD lengths for each papilla type was 5.53 mm (±3.07) for type I, 7.50 mm (±2.73) for type II, 9.79 mm (±1.58) for type III and 11.19 mm (±2.56) for type IV. The results demonstrated that the length of sphincterotomy incision differed between MDP types; 9.148 mm (±3.17) for type I, 10.785 mm (±2.29) for type II, 12.89 mm (±1.67) for type III and 12.152 mm (±2.53) for type IV. Type III MDPs had a significantly larger length of sphincterotomy incision compared to type I (P = 0.0067).

The results show that MDP morphology can be used by endoscopists to determine the maximum safe extent of sphincterotomy. The precise values should be interpreted with caution as the data derive from cadaveric specimens. The observation that type III papillae allow for a longer cut is in keeping with empiric experience and can be explained by the prominent infundibulum underpinning the type definition.

Specimens used in this study were from donors who had consented before decease to the use of their bodies for anatomical research in compliance with the Human Tissue Act 2004.

*Joint first authors.

S14

A novel method for mapping the location of the digital branches of the ulnar nerve in human cadaveric hands

Shahzaib Ahmed¹; Ákos Marton¹; Gavin Jarvis¹; Cecilia Brassett¹; Ian Grant²

¹Human Anatomy Centre, Anatomy Building, Department of Physiology, Development and Neuroscience, University of Cambridge, United Kingdom; ²Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom

Better understanding of the location and variations of the digital branches of the ulnar nerve in the palm can reduce the risk of iatrogenic injury during surgery. This may occur during the Huber opposition transfer procedure, where the abductor digiti minimi muscle is transposed across the palm for correction of thumb hypoplasia. We could also improve the safety of endoscopic or short scar procedures such as trigger finger release or division of the A1 pulley ‐ the first annular pulley near the head of the metacarpal.

This study develops and uses a novel method to map the course of the sensory digital branches of the ulnar nerve in the palm, with reference to specific landmarks. 10 cadaveric palms were dissected and analysed with ImageJ software and converted into a coordinate map using Microsoft Excel. All donors had provided written consent before decease for the use of their bodies for anatomical research under the Human Tissue Act 2004. The “ulnar digital nerve map” from the 10 palms were averaged to present the “average” ulnar nerve course in the hand.

Results showed that the position of the 5th digital nerve (5DN) to the ulnar border of the small finger was 2.65 ± 0.96 mm (SD) away from the midline of the 5th digit at the level of the first finger crease (FFC) in the supine hand. A one‐way ANOVA determined whether there was a significant difference in the position of the 5DN at three points along the A1 pulley – the proximal (a) and distal borders (b) and the midpoint (c). There is a significant difference in 5DN position at a vs. b (p = 0.0002), and a vs. c (p = 0.0121) but not between b and c (p = 0.4118). The average angle of 5DN at the FFC is 8.77 ± 1.29o. The results may be used to construct a safe zone for surgery to the A1 pulley, or others where the ulnar nerve may be involved.

This method could be employed to record the variations in the anatomy of other peripheral nerves, enabling surgeons to plan safer procedures while obviating the need for long incisions to achieve exposure of relevant structures.

S15

Human semicircular canal shape changes in ageing

Marcela Cardenas‐Serna; Nathan Jeffery

Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom

Semicircular canal form has been evaluated across intraspecific, interspecific (extant and fossil) as well as prenatal ontogenetic samples. These studies used a range of conventional morphometrics and more complex mathematical analyses such as geometric morphometrics to assess the shape and correlate it with function and in particular agility and locomotor capabilities. However, form changes have yet to be evaluated later in life and during the ageing process.

Previous work has shown that the semicircular canals reach adult size in utero and that bone remodelling is tightly regulated throughout ontogeny through osteocyte‐mediated bone remodelling inhibition. Additionally, a loss in osteocyte count associated with ageing has been found in perilabyrinthine bone which is indicative of a disinhibition of remodelling. The purpose of this study is to assess potential shape changes in the shape of the semicircular canals due to the ageing process in humans and its implications for vestibular function.

To carry out this work, 65 petrous temporal bones were imaged using microCT at a resolution of 13 microns. Of those, 49 were 9‐month‐old perinatal specimens and 16 were adults. A geometric morphometric analysis was performed by placing 12 landmarks and 6 semi‐landmarks on the centrelines of the semicircular canals. We hypothesised that due to the loss of osteocyte mediation, adult specimens would have a more variable shape than young specimens.

Preliminary data suggest that the size of the canals, as assessed by centroid size, is the same in both age groups, in line with previous studies proposing that adult size is reached in utero. However, young semicircular canal shape is subtly different from that in adults. These findings, albeit tentative, indicate that there are postnatal changes of canal shape but not size. The next stage is to increase the adult samples to confirm this and then explore possible functional implications using computational models of fluid models within the canals. This study was approved by the Health and Life Sciences Research Ethics Committee (Approval no. 5504).

S16

Primordial signalling in prehistoric cancer

Alison Gartland

The Mellanby Centre For Bone Research, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, United Kingdom

Adenosine 5′‐triphosphate (ATP) is well known and accepted as the fundamental energy of life – a molecule without which life as we know it would simply not exist! Very early on in evolution ATP became the dominant energy substrate, this stimulated the evolution of enzymes for which ATP (and other adenine nucleotides) began to be used in various intracellular signalling cascades. At the same time due to the shear amount and availability of ATP in cells, an extracellular role for ATP was established. We now know that virtually every known cell or single‐cell organism has a form of ATP sensitivity, and purinergic signalling represents the primordial form of chemical intercellular signalling. The field of purinergic signalling itself has fast evolved since the initial suggestion in the 1970s and the advent of cloning in the mid‐90s identifying numerous purinergic receptor subtypes. Today purinergic signalling is known to control most of the fundamental processes for life – from early development, proliferation and differentiation of cells to cell death and involvement in many disease states including various cancers.

The primary bone cancer Osteosarcoma is one of the earliest cancers with fossil evidence of cases in prehistoric man and other living things from as far back as the Triassic period. Osteosarcoma is a rare and orphan tumour of mesenchymal origin with highly heterogeneous subtypes. Osteosarcoma in humans mainly affects children and adolescences and has two peak incident ages at 18 and 60 years of age with males affected more than females. In 80% of the cases Osteosarcoma affects the limbs, in particular the long bones, which can be attributed to rapid bone growth and turnover during adolescence. Worldwide incidence occurs at a rate of 4 or 5 cases per million people per year, the overall 5‐year survival rate is ˜55% and the treatment options for Osteosarcoma haven't changed since the 1970s. New evidence from our laboratory and others suggest that the most primordial of signalling cascades may play an important role in one of the most ancient cancers.

S17

The Anatomical Society's core anatomy syllabus for dental undergraduates

Joanna Matthan¹; Mark Cobb²; Stephen McHanwell³; Bernard J. Moxham⁴; Gabrielle M. Finn⁵

¹School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle, United Kingdom; ²Sunderland Royal Hospital, Kayll Road, Sunderland, United Kingdom; ³School of Medical Education, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle, United Kingdom; ⁴Cardiff School of Biosciences, Cardiff University, Cardiff, Wales, United Kingdom; ⁵Hull York Medical School, University of York, Heslington, York, United Kingdom

The role of the dentist – and, consequently, dental education – is ever‐evolving. Numerous changes relating to dental education reflect this, with an increasing push towards integrated curricula. Given the surgical nature of the role of the dental practitioner, human morphology including gross anatomy provide a strong focus throughout a dental degree, necessitating them to be woven seamlessly both horizontally and vertically throughout, particularly as dental students within two years from starting their course often undertake irreversible surgical procedures on patients. Thus, the need to ensure students are equipped with sufficient anatomy to become safe, and effective, practitioners is vital. What then are the limits of anatomical knowledge needed for safe practice? The Anatomical Society has developed a series of learning outcomes in consultation with dentists, dental educators and anatomists delivering anatomical content to undergraduate dental students. The modified Delphi methodology adopted was utilised through a body of experts within the field who recommended core anatomical content in undergraduate dental programmes throughout the UK. Two comprehensive sets of learning outcomes from two UK‐based Dental Schools were combined, and the final learning outcomes list was scrutinised through a modified Delphi technique to develop dental anatomical learning outcomes relevant to dental graduates. The Delphi panel consisted of 66 individuals from a wide pool of educators associated with the 14 undergraduate dental schools in the UK. The final output was 147 anatomical learning outcomes deemed applicable to dental undergraduate programmes in the UK. The new recommended core anatomy syllabus for dental undergraduates offers a comprehensive anatomical framework with which to scaffold clinical practice. The syllabus, presented as a set of learning outcomes, may be used in a variety of pedagogic situations, including where anatomy teaching exists within an integrated dental curriculum (both horizontally in the basic sciences part of the curriculum and vertically within the clinical years). This recommended core syllabus provides the minimum level of knowledge expected of a recently‐qualified graduate in dentistry in order to carry out clinical procedures safely and effectively.

Full ethical approval for this work was granted by the Hull York Medical School Ethics Committee (reference 17 08).

S18

Dissection or prosection in anatomy education? A systematic review

Timothy Shun Man Chu¹; Aye Moh Moh Oo¹; Iain D. Keenan¹

¹School of Medical Education, Newcastle University, Newcastle, United Kingdom

Human cadavers are widely considered to be the ‘gold standard’ learning resource in anatomy education. Conventional cadaveric dissection is being gradually replaced by prosection in UK medical schools, while physical and technology‐enhanced learning (TEL) activities are being integrated to supplement traditional approaches. While logistical and financial constraints, the growing popularity of TEL, and increased curricular focus on self‐directed learning may be responsible for such changes, there is substantial evidence supporting preservation of cadaveric resources as valuable means of enhancing student learning. Consequently, we aimed to investigate the relative pedagogic value of dissection and prosection to determine their respective advantages and limitations, and to identify factors influencing their successful delivery within the context of modern anatomy education.

Our systematic review concerned searching Medline, Embase and PubMed for the terms Prosection + Dissection + Medical Education, yielding 131 articles. Implementation of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) resulted in 23 articles being included in our qualitative synthesis, having been screened against our eligibility and exclusion criteria. Predominantly, we determined that dissection is characterised as providing tactile and emotional learning experiences and supports development of important transferable practical skills. Prosection is described as efficient, cost‐effective and possessing the capacity to clearly demonstrate complex anatomical structures. However, we identified considerable variabilities in methodological design, inconsistencies in supplementary learning resources, and an absence of universal parameters for identifying effectiveness. These factors constitute barriers to the formulation of meaningful comparisons and conclusions from published studies.

In summary, our findings have not identified convincing data that supports implementation of one approach over the other, and we propose that prosection is unlikely to completely replace dissection. Rather, we recommend that planned research seeking to determine the value of cadaveric approaches should address limitations in the current literature by adopting rigorous methodologies with standardised designs and outcome measures. We aim to address these aspects in our future work by seeking to identify the relative value of dissection and prosection through generating rich qualitative data from focus group studies.

Ethical approval has been granted for our planned research and was not required for our systematic review.

S19

Turning points: cochlear development in the human embryo

Claudia Santoni; Matthew Mason

Department of Physiology, Development & Neuroscience, Downing Street, Cambridge, United Kingdom

The spiral shape of the mammalian cochlea is one of the most iconic in nature. The reason for its coiling has long been debated, but determining the influencing factors has potential clinical application both in understanding basic hearing mechanisms and in improving cochlear implants, which must fit an individual's curvature.

It has recently been suggested that cochlear coiling may be the result of spatial constraints during development, in which case surrounding structures such as the facial nerve, internal carotid artery and tensor tympani muscle could be important. This hypothesis has not been directly investigated, however. The primary aim of this study was to assess the plausibility of this idea through observation of human embryonic material from the Boyd Collection belonging to the University of Cambridge.

Photomicrographs were made of histological sections of 11 embryos from 7.5‐170 mm crown‐rump length (CRL), which represents a span of 6‐18 weeks’ gestation. 3D reconstruction software was then used to produce fully rotatable models of the inner ear and surrounding structures at different points in development. The reconstructions suggest that the facial nerve and developing veins are the structures most likely to have a role in promoting coiling because they appear before, and in close proximity to, the cochlea. Although the facial nerve was known to develop precociously and had been implicated as a factor which might affect cochlear coiling, the potential involvement of veins had not previously been suggested.

Using 3D reconstructions improves our understanding of the relative positions of the developing structures of the ear region, compared with traditional microscopy. We believe that this is the first study of this nature to look specifically at which structures might be close enough, at the right time, to influence human cochlear coiling. Whilst anatomical proximity alone cannot prove a constraining effect or provide mechanistic insight, we hope that this work will help to frame future experimental investigations.

No ethical approval was required due to use of archival material.

S20

Form changes of the human postnatal skull

Amy Manson^1,2; Graham Kemp^2,3; Nathan Jeffery^1,2

¹Human Anatomy Resource Centre, University of Liverpool, Liverpool, United Kingdom; ²Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, United Kingdom; ³Liverpool Magnetic Resonance Imaging Centre (LiMRIC), University of Liverpool, United Kingdom

Tracking changes in form (shape and size) during ontogeny is key to understanding the structural and functional trade‐offs that combine with phylogeny in determining adult intraspecific and interspecific differences of the skull. This study examines form changes of the modern human basicranium, face and brain in neonates (0‐1 years). We applied both geometric morphometric analyses and standard cephalometrics to 64 MRI datasets. Measurements included cranial base angle (CBA), endocranial volume, cranial base and face lengths, as well as derived indices of relative encephalisation (IRE). Landmarks were also taken and analysed.

In the first postnatal year, there were increases in endocranial volume as well as base and face lengths which were strongly related to growth (size) and development (age). According to the spatial packing hypothesis, an increase in relative brain size should be accompanied by a decrease in CBA in order to accommodate the growing brain. Whilst IRE showed a modest increase (rs = 0.42, p = 0.0205) with age, the predicted decrease of CBA was not evident in relation to age nor any other variable. Regressions against the symmetric component of the corresponding form space revealed that centroid size and age both predict about 12% of the form variation. Associated form variations included a relative anterior shift of the posterior cranial base and ventral rotation of the midface as well as relative deepening of the posterior cranial fossa. Regression of IRE against shape revealed that IRE predicted about 6% of the form variation. Shape changes associated with the increased IRE included an anterior shift of the posterior cranial base, ventral deflection of the anterior cranial base, as well as an anteroventral displacement of sella turcica, and relative anteroposterior lengthening of the posterior cranial fossa.

In conclusion, the brain grows dramatically in the first postnatal year, while the basicranium lengthens at a slower pace. Rather than the expected decrease in CBA, brain expansion was instead found to be occurring alongside complex shape change of the entire cranial base, which could not be readily captured using standard cephalometrics.

No specific ethical approval was required for this study (NIMH Data Repositories: PedsMRI; NDAR).

S21

Understanding heterogeneity of bone matrix synthesis of osteoblast‐like cells stimulated with interleukin 1 beta cytokine, compared to primary osteoblasts with Raman spectroscopy

Nur Adeelah Che Ahmad Tantowi¹; Ailsa Watt²; George Mclaughlan²; Jemma G. Kerns¹

¹Lancaster Medical School, Lancaster University, Lancaster, United Kingdom; ²Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom

Understanding the phenotype of osteoblasts is crucial to understand the changes that happen during skeletal development and disease progression. Interleukin 1 beta (IL‐1β) cytokine has emerged as the primary therapeutic target for bone‐related diseases. Osteoarthritis, for example, has been implicated with IL‐1β cytokine, and demonstrated heterogeneity of bone, where it exhibits an increase in the remodelling rate at early stage, with the bone thickening at later stage. Raman spectroscopy, a light scattering technique, can sensitively provide information on the molecular composition of osteoblasts. This study aims to measure the heterogeneity of bone matrix produced by osteoblast‐like cells (MG63) compared to primary osteoarthritic osteoblasts following exposure to IL‐1β cytokine at different time points.

This study utilised MG63 osteoblast‐like cells and grown in osteogenic media. At confluence, the cells were stimulated with a low (1 ng/ml) or high (10 ng/ml) dose of recombinant IL‐1β cytokine at several incubation times; 1, 3 and 5 hours. Non‐stimulated MG63 cells were grown as control. Cell viability and bone matrix properties were analysed. In a separate experiment, a tibial plateau subchondral bone specimen was obtained from total knee replacement surgery with patients’ understanding and consent (REC: 18/LO/1129), and osteoblasts isolated. Raman spectroscopy was used to observe the changes of osteoblast‐like cells at different time point and compare the changes with isolated osteoarthritic osteoblasts.

Stimulation with IL‐1β cytokine at one‐hour exposure resulted in increased collagen type I and osteocalcin production. Alizarin red staining detected no difference in mineral production. Meanwhile, Raman spectroscopy demonstrated sensitive detection of different mineral species. We demonstrated for the first time, the heterogeneous phenotype of osteoblast‐like cells following one‐hour exposure of IL‐1β cytokine has a similar bone matrix phenotype to primary osteoarthritic osteoblast, which increased in mineral production and reduced in substituted carbonate into hydroxyapatite via univariate analysis from Raman spectra.

In summary, osteoblast‐like cells showed a heterogeneous phenotype at one‐hour exposure to IL‐1β cytokine similar to osteoarthritic osteoblasts. Raman spectroscopy is capable of recognising subtle changes in bone matrix and may represent a promising non‐invasive tool to study chemical changes in the bone extracellular matrix.

S22

Learning Human Cardiac Embryology – which resources do students use, and why?

Jane C. Holland¹; Teresa Pawlikowska²

¹Department of Anatomy, RCSI, Dublin, Ireland; ²Ireland Health Professions Education Centre, RCSI, Dublin, Ireland

While embryology has always been considered a conceptually challenging component of medical curricula, the time and opportunities for small group teaching in this area are present in few institutions, often as a result of increasing class sizes. How then do students supplement their lectures in order to ask and answer questions, or delve into concepts in detail? Arguably animations and videos are ideal for visualizing 4‐dimensional anatomy, but how do students find and filter these?

First‐year medical students were surveyed with respect to the cardiac embryology component of their course, and asked their opinions regarding the clinical relevance of this content, and the resources they used to enhance learning.

The majority of students held a positive view of the relevance of embryology both within medical education and for their future clinical practice, suggesting they are motivated to engage with this content, and indicated that videos were a useful resource in helping them to learn this material. However, when seeking videos or resources, it emerged that students tended to Google information in preference to accessing online resources (or textbooks) specifically recommended by their instructor, despite students’ recognition that “accuracy of information” was paramount when choosing what resource to use. While all students seemed reluctant to contact a staff member with questions, those with less proficiency in English were less likely to approach faculty for assistance.

Whilst acknowledging students as adult learners, self‐regulated learning skills do not develop automatically and the development of these skills should be viewed as a “shared responsibility” between students and staff. Likewise, students also need to be taught critical appraisal of learning resources, especially in the complex online environment, with design of their bespoke institutional virtual learning environment should ensure that recommended materials are easy to identify, and access.

No conflict of interests to declare. Ethical approval was granted by RCSIs Ethics committee in May 2018 – REC 1478.

S23

Decreased human bone mineralisation at the joint: is it a marker of early OA?

Jemma G. Kerns¹; Nur Adeelah Che Ahmad Tantowi¹; George McLauchlan²; David Cheneler³

¹Lancaster Medical School, Lancaster University, Lancaster, United Kingdom; ²Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, United Kingdom; ³Engineering Department, Lancaster University, Lancaster, United Kingdom

The chemical and mechanical properties of bone are vital for function, and to some extent are interdependent. There is a strong relationship between mineralisation of bone and mechanical properties. Bone is heterogeneous, and it is important to understand how this natural, healthy, heterogeneity relates to function, fracture resistance, changes with different bone diseases, and associated treatments. Osteoarthritis (OA) is a debilitating disease, with treatment options limited to pain management and joint replacement. OA of the knee commonly affects the medial aspect first, and characteristic clinical signs, visible on a radiograph, include osteophytes and subchondral sclerosis. However, many clinical and laboratory techniques, including X‐ray based ones, cannot measure the collagen component of bone, or are destructive.

Raman spectroscopy provides a measure of the overall chemistry of a given sample and it is particularly useful for studying bone as it can provide information on the organic components simultaneously to the inorganic component of bone. Furthermore, as it is non‐destructive and requires no sample preparation, it can be used ex vivo and in vivo. Previous research has shown that both the medial and lateral aspects of the tibial plateau are chemically different to non‐OA samples.

The aim of this study was to compare the mechanical properties of OA bone to the chemistry, as measured with Raman spectroscopy.

Raman spectroscopic analysis revealed that a lower mineral to collagen ratio correlated with lower elastic modulus, which may lead to less capacity for weight bearing and deformation. This provides further evidence that Raman spectroscopy can identify changes in the chemistry of subchondral OA bone, which are related to the mechanical properties. If we can detect a decrease in the mineralisation of bone using Raman spectroscopy, this could contribute to the non‐invasive diagnosis of early OA in sub‐clinical patients.

S24

Exploring how medical students develop social media professionalism

Catherine M. Hennessy¹; Claire F. Smith¹; Sue Greener²; Gordon Ferns¹

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

Medical students must develop social media professionalism due to the serious implications of inappropriate use of social media, including doctors losing their medical registration. How to best help students develop social media professionalism so that they can actively use social media as future doctors is still being understood by educators. This project explored what factors contribute towards students developing social media professionalism during medical school?

Individual interviews were conducted on Year 1 (n = 12) and Year 3 (n = 9) students at Brighton Sussex Medical School (BSMS). Ethical approval was granted and informed consent was received from all participants. Thematic analysis was carried out on interview data, facilitated by NVIVO software.

Before starting medical school medical students are highly aware of their social media behaviour and online footprint due to factors including: online safety talks received at school; being friends with family members on social media and warnings from parents about behaviour; rumours that medical schools search their social media presence during selection; and press reports of medical students getting expelled due to social media misconduct. Professionalism talks given at medical school cause students to become highly aware of the high standards of professionalism expected of them and that their social media (mis)behaviour can affect the reputation of the medical profession. These factors result in students using social media conservatively.

Facebook is used at BSMS for year group chats and students report feeling that they need Facebook in order to stay updated and included with medical school activities. In Year 3 students become part of further group chats with doctors to arrange and participate in extracurricular teaching opportunities. Students report observing how their peers and seniors use and behave on social media as a gauge for professionalism, including using WhatsApp to communicate about patients with colleagues.

Warnings about misconduct results in students using social media conservatively, however at BSMS Facebook and WhatsApp are widely used for communicating and networking about medical school activities. Students use observations, particularly of senior colleagues, as a gauge for social media professionalism but often find themselves in an ethical dilemma when they observe seniors using social media inappropriately.

S25

Real‐time visualization: early ultrasound exposure in undergraduate medical students

Zygmunt Domagala¹; Jakub Klekowski²; Jurand Domanski²; Victoria Tarkowski³; Slawomir Wozniak¹

¹Division of Anatomy, Wrocław Medical University, Wrocław Chałubinskiego 6a street, Poland; ²Clinical and Dissecting Anatomy Students Scientific Club, Wrocław Medical University, Wyb Pasteura 1, Poland; ³Student, Medical Faculty, Wrocław Medical University, Mikulicza‐Radeckiego 5, Wrocław

Ultrasonography is a basic diagnostic tool used for tissue imaging in clinical practice. Its universality makes it necessary to familiarize students with this technique at the earliest possible moment. Undergraduate anatomy classes provide an ideal moment for medical students to consolidate their learning with medical imaging in real‐time.

The aim of this paper is to share our own experiences related to the implementation of this teaching method in the anatomy curriculum.

Our department uses high‐quality ultrasound machines from leading manufacturers. The devices are used to visualize tissues and organs of student volunteers. The evaluation of experiences related to the introduction of ultrasonography as a teaching tool was conducted on the basis of semester student questionnaires, as well as on the basis of direct conversations with the instructors and advanced students in the anatomy course.

The Wrocław Ultrasound Anatomy Laboratory is the first such unit in Poland. In order to implement ultrasonography into the anatomy curriculum, we have modified the class schedule.

Our experience shows the usefulness of ultrasonography at two stages of teaching; (i) in vivo visualization of the organs discussed simultaneously on the dissecting material, and (ii) learning the standard of examination and diagnosis of important anatomical pathologies in the field of quickly accessible organs for examination..

From the students’ perspective, an important element highlighted in the questionnaires distributed after classes is to increase motivation to learn the subject, facilitate three‐dimensional visualization of the depicted tissues and visualize the relationship between the structure and function of anatomy, and understand the importance of interrelating structures and organs. The most important limitations are group size, the employment of appropriate teachers, the risk of damaging the transducers, and the need to constantly invest in new equipment.

Our experience shows the sense of implementing ultrasound methods to teach anatomy to medical students. Due to rapid technical progress, we believe that modern, high‐end ultrasound devices should be used to teach the basics of ultrasound. Students are usually very interested in enriching their classes with visualizations of organs with the use of clinical ultrasound devices.

The work has approval of the local bioethics committee No. 745/2017.

S26

Green‐silver nanoparticles synthesis using Cinnamomum Cassia: an experimental animal model using Sprague‐Dawley rats

Koffi Kouame¹; Ugochukwu Offor¹; Roshila Moodley²; Edwin Coleridge Naidu¹; Onyemaechi Okpara Azu^1,3

¹Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, University of KwaZulu‐Natal, Durban, South Africa; ²School of Chemistry and Physics, University of KwaZulu‐Natal, Durban, South Africa; ³Department of Anatomy, School of Medicine, University of Namibia, Windhoek, Namibia

Improving targeted treatment for diabetic nephropathy associated with antiretroviral treatment (HAART) remains an unmet medical need due to the long term consequences associated with HAART on the kidneys. We investigated renal microstructure following 56 days of treatment with Cinnamon Cassia nanoparticles (CcAgNPs). 24 Sprague‐Dawley rats (250 ± 20 g) were randomly assigned to four groups (A–D) and treated following ethical approval AREC/074/016D from the University of KwaZulu‐Natal Animal Research Ethics Committee; Group A ‐ 200 mg/kg of Cinnamon Cassia extract, group B 5 mg/kg of CcAgNPs, group C 10 mg/kg of CcAgNPs, and group D normal saline. After 56 days, animals were euthanized (inhalation of excess halothane), kidneys harvested and processed for light and electron microscopy and stereological evaluations. Spectroscopic characterisation of the biosynthesised CcAgNPs using UV TEM, Scanning Electron Microscopy and X‐ray (D) analysis were done.

FTIR results showed predominance of flavonoids, alkaloids and sugars in CcAgNPs with particle size of 4.28 nm – 30 nm. Qualitative histological assessment showed that glomerular and tubulo‐interstitial changes were much more pronounced in the diabetic control group compared to the treated group with CcAgNPs. Other ultrastructural perturbations including basement membrane changes, podocyte processes as well as mesangial matrix presence were noted in the various groups compared to control. These results suggests that CcAgNPs at high dose could be a candidate for studying structural nephropathy in diabetic Sprague‐Dawley rats.

S27

The emergence and history of medicine and anatomy in Lancaster

Quenton Wessels

Department of Anatomy, School of Medicine, University of Namibia, Windhoek, Namibia

Lancaster's economic growth during the nineteenth century was driven by the opening of the town's rail systems, its oilcloth industry and the establishment of the Lune Mills Factory. Urbanisation, occupational diseases and poor sanitation followed as a result. This paper explores the influence of the scientific advances of the nineteenth century on the emergence of medicine and anatomy in Lancaster. Modern medicine emerged due to the rapid growth of industries and the scientific developments of the period. These advances included the evolution of dispensaries into infirmaries, improved sanitation, the acceptance of the germ theory of disease and the dawn of painless and routine surgical procedures. The provision of medical and social services in Lancaster progressed in a similar fashion. The town's first Dispensary was established by David Campbell (1749‐1832) in 1781. The growing population in Lancaster justified the establishment of a House of Recovery in 1815, initiated by Christopher Johnson (1782‐1866), and would later evolve into the Royal Lancaster Infirmary. Johnson and his sons are believed to have sparked the scientific interests of the well known anatomist, Sir William Turner (1832‐1916). Infectious diseases were rife within the mill towns and were considered an indicator of poor social and environmental conditions. The healthcare needs of the town were further driven by the outbreak of cholera in 1832. Sir Richard Owen (1804‐1892) and Edmund Sharpe (1809‐1877) subsequently reformed the provision of clean water and sanitation within Lancaster. It is against the backdrop of these events that Samuel Gaskell (1807‐1886) and Edward Denis de Vitré (1806‐1878) pursued the humane treatment of the mentally ill in Lancaster's Asylums. Both men not only served the asylums but also the general public. Gaskell would later, in 1847, attend the first successful use of ether as anaesthetic in Lancaster by Thomas Howitt (jr) (c1800‐1887). The organisation of Lancaster's public authorities and social actions gradually transformed the wellbeing of the town and its people. This was largely mediated by a close‐knit community of visionaries. The surgeons and physicians of the town formed a community of practice and together they brought about change for the greater good.

S28

Common variants of anatomy in general surgical practice

Joe McAleer

North West School of Surgery, Health Education North West

The study of anatomy in undergraduate and postgraduate medicine forms a substantial part of the curriculum in early years, and in higher radiological and surgical training respectively. Though learning and assessment is focused on anatomical ‘norms’, there is a clinical relevance to learning common anatomical variants. Misdiagnosis, operative confusion, and unnecessary risk can be introduced to patients when there is failure to recognise anatomical variants when faced with them in the clinical setting.

To highlight the importance of anatomical variants facing a clinician in practice, a series of case reports featuring incidents of variation encountered by a Higher Surgical Trainee (Speciality Registrar) in General Surgery in the North West over a five‐year period will be presented. The cases will be focused on four of the core operations which trainees must undertake in high volumes to complete training and be eligible for appointment as a Consultant General Surgeon.

This will highlight the potential frequency in which significant anatomical variations may be encountered, and how these can be clinically significant. The hope is to present an opportunity to discuss the value of teaching on variant anatomy, and the possible benefits of this in both undergraduate and postgraduate curriculums.

S29

Science has a communication problem – together anatomists can solve it

Jason M. Organ¹; Krista Hoffmann‐Longtin²

¹Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine; ²Department of Communication Studies, Indiana University Purdue University Indianapolis

As scientific fields have become more complex in the 21st century, some Americans have given up trying to understand what we do, leading to science illiteracy. Although scientists have reached consensus on many issues, such as climate change accelerated by humans, and evolution, the public and (American) elected officials have not always accepted this consensus. According to the Pew Center, there is a wide gap between scientists’ and the public's perception of how science is used to inform government policy. Without expert voices communicating science to the public and policy‐makers, fields like healthcare, climate science, and evolutionary biology—all fields that are inextricably linked to anatomy—have been overrun with conspiracy theories and misinformation.

The timing is right to make science communication a fundamental part of doing science. And to do that, we must train our students/faculty in the skills necessary to be effective communicators. Over the last several years, the American Association for Anatomy (AAA) has prioritized professional development in science communication for researchers, educators, and practitioners at its annual meeting. Furthermore, AAA recently adopted a new strategic plan which brings science communication front and center, where the public is engaged through the promotion of anatomical sciences. To support this new science communication initiative, AAA hosted its inaugural Science Communication Boot Camp (SCBC) on the campus of Indiana University School of Medicine in Indianapolis in July 2019. This three‐day program brought participants together to learn effective communication skills from the faculty of the Alan Alda Center for Communicating Science and from representatives of the Federation of American Societies for Experimental Biology science policy staff. This talk reports on the SCBC program and demonstrates some of the hands‐on activities employed. This study was granted exempt status by the Institutional Review Board of Indiana University School of Medicine.

S30

Respiratory turbinate morphology in seals (Carnivora; Phocidae)

Matthew J. Mason^1,4,*; Léa M.D. Wenger¹; Øyvind Hammer²; Arnoldus S. Blix^3,4

¹Department of Physiology, Development & Neuroscience, University of Cambridge, Cambridge, United Kingdom; ²Natural History Museum, University of Oslo, Norway; ³Department of Arctic and Marine Biology, University of Tromsø, Tromsø, Norway; ⁴St. Catharine's College, Cambridge, United Kingdom

The respiratory turbinate bones in the nasal cavities of mammals help to conserve heat and water. Inspired air passing over the surfaces of these bones cools them when breathing in; on exhalation the warm, moist gas passes over these cooled surfaces and is reduced in temperature, leading to condensation and hence recapture of some of the water vapour before it leaves the body. Although poorly developed in humans, the respiratory turbinate system can be very elaborate in other mammals, including seals (Carnivora; Phocidae). If the reduction of respiratory water loss is the dominant requirement, all marine seals might be expected to have a similarly dense turbinate morphology. If heat conservation is important, there might be a difference between polar species and the monk seals which come from lower latitudes. In this study, we used micro‐computed tomography to examine and reconstruct the maxilloturbinate structures of eight species of seals from around the world. The maxilloturbinates of Arctic and Antarctic seal species are considerably more elaborate than those of monk seals, featuring a greatly increased surface area and narrower channels between adjacent surfaces. Heat conservation therefore seems to exert a strong influence on respiratory turbinate morphology in these marine mammals.

This study was based on CT scans of prepared skulls obtained from existing collections. No animal was harmed as part of this project and so no ethical approval was required.

S31

The anatomical drawings: the intersection of anatomy and art

Veronica Papa^1,2,*; Elena Varotto^2,3; Mauro Vaccarezza⁴; Francesco M. Galassi^2,5

¹Department of Motor Sciences and Wellness, University of Naples “Parthenope”, 80132, Napoli (NA), Italy; ²FAPAB Research Center, Avola (SR), Italy; ³Department of Humanities, University of Catania, Piazza Dante 32, 95124 Catania, Italy; ⁴School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA, 6102 Australia; ⁵Archaeology, College of Humanities, Arts and Social Sciences, Flinders University, Adelaide 5001, SA, Australia

Towards the end of the 15th century, the science of anatomy was becoming more and more popular. However, it still lacked visual canons that were appropriate to its nature as a descriptive science.

The systematic use of anatomical drawings was introduced by da Vigevano (1280 ‐1349), one of Mondino de Liuzzi's student, who can therefore be considered the first anatomical illustrator. Although based on empirical and observational concepts, his work represented a milestone for the further development of anatomy, especially during the Renaissance. During that time anatomy was not confined to physicians or medical students but also involved coeval artists: Italian Renaissance artists started to perform their own dissections, tightly binding the science of anatomy and the artworks in a crescendo that reached its peak in the work of Leonardo da Vinci (1452‐ 1519) and Andreas Vesalius (1514‐1564).

Vesalius's work De Humani Corporis Fabrica engaged and educated scholars and students setting the standard for subsequent generations of anatomical publications, research and training.

At the beginnings, the artist did not approach anatomy with the purpose to achieve any knowledge per se but regarded the subject ancillary to the art itself. Leonardo da Vinci was the exception: even though some would not define him an anatomist, his approach to anatomy was more scientific than artistic and his achievements ranked as some of the highest for decades to come.

Da Vinci showed the human body in more than 750 anatomical illustrations that included sketches of muscles, bones, the brain, blood vessels and viscera. He discovered the frontal and maxillary sinuses and described in detail the structure and function of heart valves. Although the anatomical accuracy of the drawings can be discussed, undoubtedly the methods and the techniques Leonardo used are impressive and truly pioneering, e.g. the cross‐sectional technique, injection of wax into the ventricles of the brain.

500 years after Leonardo's death, the purpose of this study is to offer a review on the medical literature both on the history of anatomical illustration as well as Leonardo's anatomical drawings.

Poster 1

Ultrasonographic assessment of palmaris longus tendon in gulf arab population

Bhagath Kumar Potu¹; Ahmad Abdullah Alnaggar^2,3; Ayesha Fatima¹; Abdel Halim Deifalla¹; Raouf Abdulrahman Fadel¹

¹Department of Anatomy, College of Medicine & Medical Sciences, Arabian Gulf University, Kingdom of Bahrain; ²Consultant in Radiology, Zagazig University, Egypt; ³Consultant in Radiology, American Mission Hospital, Kingdom of Bahrain

Most of the studies published on the palmaris longus (PL) prevalence is by physical examination methods. Although few studies done in the past on Arab population using physical testing methods, none of them have studied the prevalence of PL using Ultrasonography; hence we have undertaken this study. Study was performed on 61 medical students (male: 24; female: 37) of aged 19‐24 years at Arabian Gulf University. This study was approved by Institutional Research & Ethics Committee (Project number G‐E011‐PI‐11/18) and written informed consent was obtained from all the students before conducting the studies. Occurrence of the PL was recorded by Schaeffer test and the vertical, transverse (diameters) and circumference of the PL tendon at wrist and the distance of PL tendon with median nerve at wrist were measured with the help of SIEMENS ACUSON P 500 Ultrasound System located in anatomy lab. Ultrasonography was performed by an experienced radiologist with a linear array probe (6– 15 MHz), with settings of depth and focal zones appropriate for a superficial structure. Of 122 limbs examined by Schaeffer test, only 106 PL tendons were detected (43 in male & 63 in female), while the Ultrasound examination revealed 46 (male) & 68 (female) limbs had the PL tendon. The vertical, transverse (diameters) and circumference of the PL tendon at wrist and the distance of PL tendon from median nerve at wrist measured by ultrasound were 1.10 ± 0.48; 3.85 ± 1.36; 8.88 ± 3.07; 1.16 ± 0.52 mm respectively. This study has documented both topographical and ultrasonographic studies of the PL tendon in gulf Arab population and proved that the Ultrasonography is more accurate for detecting the PL tendon than any other physical testing methods. This data will give accurate information for surgeons in the region for its potential use in orthopaedic and reconstructive surgeries.

Poster 3

Human endometrial organoid responses to pregnancy hormones

Amy L Wilkinson¹; Graham J Burton²; Tereza Cindrova‐Davies²

¹St. Catharine's College, Cambridge, United Kingdom; ²Centre for Trophoblast Research, Downing Street, Cambridge, United Kingdom

Maternal blood supply to the placenta is not fully established until the end of the first trimester of pregnancy. During the critical period of organogenesis, the conceptus is supported by endometrial gland secretions, referred to as histotroph or uterine milk. The secretions contain an array of molecules including glycodelin, a glycoprotein with immunomodulatory effects at the maternal‐fetal interface, and epidermal growth factor (EGF) that is known to stimulate trophoblast proliferation. In domestic species (such as sheep, pig, horse and rabbit), paracrine signalling between the placenta and uterus constitutes a servomechanism whereby secretions from the endometrial gland increase to meet the needs of the conceptus. The aim of this project was to determine if a similar mechanism operates during human pregnancy, and to identify the signalling pathways involved.

Organoid cultures were derived from endometrial scratch biopsies of 5 patients undergoing IVF treatment at the Bourn Hall Clinic and grown with ethical permission (NHRA 17/EE/0151). Organoids were grown for 3 days, stimulated with 10 nM estrogen for 3 days, and subsequently treated with either i) estrogen (E2), ii) estrogen and 1 μM progesterone (EP), or iii) EP and other hormones (20 ng/ml prolactin, 20 ng/ml human placental lactogen and 100 ng/ml hCG (All)) for 6‐48 hours. Protein and mRNA expression of glycodelin, EGF, and phospho‐STAT3 were examined using Western blotting, immunohistochemistry or RT‐qPCR analysis. The treatment with all hormones significantly increased glycodelin and EGF mRNA and protein levels, and phosphorylation of STAT3, compared to E2 and EP treatments. Addition of a P‐STAT3 inhibitor, S31‐201 (50 μM), significantly reduced glycodelin mRNA and protein levels in hormone‐treated samples. Organoid receptor profile was also altered with different treatments. Addition of progesterone (EP and All treatments) downregulated the progesterone receptor, compared to E2 alone, whilst the prolactin receptor expression was upregulated by the hormonal treatment (All).

Together these data provide evidence in support of a servomechanism operating in the human, and provide pilot mechanistic insights. The results suggest that early pregnancy hormones lead to the activation of STAT3, which mediates an increase in glycodelin production. These findings may be translatable to pregnancy complications, such as miscarriage, where endometrial function is compromised and placental development post‐implantation is deficient.

Poster 4

Quantitative MRI of muscles is different in rheumatoid arthritis patients compared to healthy controls

Matt Farrow; John Biglands; Steven F Tanner; Elizabeth Hensor; Philip O'Connor; Paul Emery; Ai Lyn Tan

University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds Biomedical Research Centre, Leeds, United Kingdom

Rheumatoid arthritis (RA) can present with the loss of muscle mass and a decrease in strength and functional capability. Quantitative MRI offers a non‐invasive measurement of muscle status which could improve the understanding of muscle pathology in RA. The purpose of this study was to assess whether MRI‐based measurements of T2, fat fraction (FF), diffusion tensor imaging and muscle volume can detect differences between the muscles of RA patients and healthy controls in the thigh.

39 RA patients were recruited, comprised of 3 groups: 13 newly diagnosed treatment naïve, 13 in clinical remission DAS28 < 2.6 for at least 1 year, 13 RA with at least 1‐year diagnosis, DAS28 > 3.2 ± raised CRP/ESR ± DMARD/targeted therapy escalation ± requiring steroid therapy. 13 healthy controls were also recruited. All four groups were age and gender matched. MRI of the dominant thigh was performed using a STEAM‐EPI imaging sequence to assess diffusion: mean diffusivity (MD) and fractional anisotropy (FA), 2‐point Dixon imaging to assess FF and a fat‐suppressed turbo‐spin echo sequence to measure T2. All participants had knee extension/flexion measured using isokinetic dynamometer.

A one‐way ANOVA analysis demonstrated significant differences in T2, FF and muscle volume between RA patients and healthy controls, but no difference in MD or FA. There was no significant difference between the RA groups. T2 and FF were higher in RA patients, whilst muscle volume was lower. Muscle volume was significantly correlated with early morning stiffness (rs = 0.4, p = 0.001), DAS28 (rs = 0.4, p = 0.001) and grip strength (rs = 0.5, p < 0.001). All RA patients showed weaker strength compared to the healthy controls.

Quantitative MRI can detect changes in the muscles of RA patients, whether they are newly diagnosed, in remission or with persistently active disease. Difference in T2, FF and muscle volume were apparent even at diagnosis, suggesting muscle changes in RA occur early. Despite effective RA therapy, patients in remission show worse MRI parameters and strength compared to healthy individuals. These warrant attention in improving the muscle strength and quality throughout the spectrum of the RA continuum.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Poster 5

Muscles humans in Myositis with Normal MRI appearance have higher quantitative T2 compared to those in healthy controls

Matt Farrow; John Biglands; Steven F Tanner; Elizabeth Hensor; Philip O'Connor; Paul Emery; Ai Lyn Tan

University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds Biomedical Research Centre, Leeds, United Kingdom

Myositis is an autoimmune disease which can cause a decrease in quality of life and increased mortality, presenting with muscle weakness, raised muscle enzymes and myalgia. Diagnosis is reliant on subjective clinical examinations, blood tests, conventional MRI and invasive muscle biopsies. Quantitative T2 MRI offers a non‐invasive measurement of muscle oedema which could help improve the understanding of muscle pathology and potentially inform diagnosis. The aim is to evaluate whether quantitative T2 MRI of muscles is sensitive enough to detect differences in myositis patients compared to healthy controls, and how it compares with current radiologist scoring methods.

16 myositis patients were recruited, and 16 age and gender matched healthy controls had an MRI of their dominant thigh. Imaging was performed using a fat‐suppressed turbo‐spin echo sequence. Quantitative T2 measurements were obtained from regions of interest (ROI) drawn within the individual muscles of the quadriceps and hamstrings. Two radiologists blinded to the diagnosis, semi‐quantitatively scored by consensus the muscles on a 4‐point visual scale as either no oedema (0), mild oedema (1), moderate oedema (2) or severe oedema (3).

T2 values were significantly higher in myositis patients compared to healthy controls (p < 0.001). Patients who had been classified as normal (unaffected muscles) by the radiologists were compared with matched healthy controls (n = 8), T2 values for patients with ‘normal muscle’ were still significantly higher than those for healthy controls: mean T2 in the hamstrings (myositis 42.2 ms, healthy controls 38.7 ms, p = 0.004); mean T2 in the quadriceps (myositis 43.9 ms, healthy controls 40.1 ms, p = 0.001).

Quantitative T2 measurements can detect muscle differences between myositis patients and healthy control groups, which suggests that this measurement could be used as an objective method to monitor muscles. They are also sensitive to differences that may not be detected by radiologists. This suggests that subtle systemic changes in muscle in myositis patients, which go undetected in semi‐quantitative visual scoring, can be detected using quantitative T2 measurements. This shows the potential for T2 measurements to be a diagnostic measure in the diagnosis and management of myositis.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Experiments were performed with the understanding and signed consent was obtained from all individual participants included in the study.

Poster 6

The anatomical distribution of ochronotic pigment in alkaptonuric mice reveals that ageing and mechanical loading make collagen susceptible to chemical attack

Juliette H. Hughes¹; Craig M Keenan¹; Hazel Sutherland¹; Henry R Edwards¹; Lakshminarayan R. Ranganath^1,2; George Bou‐Gharios¹; James A Gallagher¹

¹Institute of Ageing and Chronic disease, University of Liverpool, Liverpool, United Kingdom; ²Liverpool Clinical Laboratories, Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, United Kingdom

Musculoskeletal disease is often related to tissue damage from mechanical loading or “wear and tear”. Currently there are no good experimental models predicting early tissues changes in response to mechanical damage. Alkaptonuria (AKU) is an ultra‐rare disease where there is failure to metabolise homogentisic acid (HGA), which is characteristically elevated in the blood, despite urinary excretion. Over time HGA is deposited as ochronotic pigment in connective tissues leading to musculoskeletal disorders including tendon ruptures, heart valve stenosis and severe osteoarthritis. Here, the anatomical distribution of ochronotic pigment was investigated in AKU mice to determine potential factors initiating ochronosis. Formalin‐fixed, paraffin sections from AKU mice (Hgd tm1a ‐/‐) were stained with Schmorl's stain to detect ochronotic pigmentation. Within large weight bearing joints (knee, hip, shoulder, elbow), pigmentation was identified within the calcified articular cartilage (CAC). In the knee joint, pigmentation was also observed in the fibrocartilaginous calcified meniscus. Quantification of pigmented chondrons in the CAC in representative knee joint sections of mice aged 7‐52 weeks shows that pigmentation initiates at 9 weeks and progresses linearly with age. In the vertebral column, pigmentation was found in the calcified vertebral endplates, but not in bone nor disc (non‐calcified fibrocartilage). A striking observation was the significantly greater number (mean ±SEM; n = 5 sections) of pigmented chondrons in the endplates of the L2 intervertebral disc (IVD)(48.4 ± 4.5) compared with an IVD from the base of the tail (2.2 ± 0.6)(p = 0.002), reflecting greater loading in the lumbar region. In addition, clusters of pigmented chondrons were observed in areas of greater tensile stress, such as the insertions of tendons and ligaments, including the Achilles tendon on the calcaneus and the cruciates on the tibia/femur. No pigmentation was observed in the eye, ear, liver, kidney nor notably the heart valves. Anatomically, the initial sites of ochronosis are in tissues subjected to the most mechanical loading, such as CAC in weight‐bearing joints. Interestingly, calcified tissue appears more susceptible to early pigmentation. In addition, greater stress appears to lead to increased pigmentation; in effect HGA behaves like an endogenous marker of repetitive load‐induced matrix damage. Ethics statement: All animals were house and maintained under UK Home Office guidelines.

Poster 7

Investigating the role of Dishevelled Associated Activator of Morphogenesis 2 (Daam2) in mouse lung development

Ambreen Muhammed

Imperial College London, London, United Kingdom

Dishevelled Associated Activator of Morphogenesis 2 (Daam2) is a gene that plays an essential role in the planar cell polarity pathway (PCP), which is required for normal lung embryogenesis and repair. Emphysema is a disease characterised by the breakdown and stretching of the alveoli in the lung that cannot repair itself. Manipulation of genes that are critical for lung development may provide a way of inducing repair in lung diseases such as emphysema. We wished to understand the role of Daam2, in lung development.

The aim of this study was to determine whether there were any differences in lung architecture of heterozygous and homozygous Daam2 mutant mice compared to wildtype littermates at embryonic days 14.5 and 18.5. The localisation of platelet cell adhesion molecule, surfactant‐protein C and smooth muscle actin were also investigated by immunohistochemistry to determine whether there was any effect on these key proteins in Daam2 mutant lungs.

Results showed at E18.5, the airspaces are significantly wider in Daam2 homozygous lungs, indicating that lung development is abnormal in Daam2 mutant mice. Immunohistochemical staining showed that SMA localisation was unchanged in the mutant lungs however, fewer SPC stained cells were present in Daam2 homozygous lungs. SP‐C is a marker of alveolar type II epithelial cells and therefore the reduced number of these cells in Daam2 homozygotes also indicates that development is abnormal.

All mouse maintenance and procedures were carried out according to the requirements of the animals (scientific procedures) act 1986. Animal work was approved by the South Kensington and St Mary's AWERB committee at Imperial College,

Poster 9

Social media use by anatomy educators and the implications for professionalism

Catherine M. Hennessy¹; Kirsten Brown²; Mike Pascoe³; Jane Holland⁴; Iain Keenan⁵; Amanda Meyer⁶; Danielle Royer³

¹Brighton Sussex Medical School, Brighton, United Kingdom; ²The George Washington University School of Medicine and Health Sciences, Washington DC, United States; ³University of Colorado, United States; ⁴RCSI Dublin, Ireland; ⁵Newcastle University, Newcastle, United Kingdom; ⁶The University of Western Australia, Australia

Anatomy educators are increasingly using social media to disseminate educational content with their students and wider online audience. Anatomy educators and associations are also using social media to network with colleagues internationally. It is becoming increasingly common for anatomists to see cadaveric material on their social media newsfeeds, whether or not they like or expect it. This project aims to gather experiences from anatomists on how they use social and their opinions on cadaveric material being publicly posted on social media, including implications for professionalism. Anatomy educators who attended the social media workshop at the Congress of the International Federation of Association of Anatomists 2019 were invited to complete a questionnaire. Ethical approval was granted and informed consent was received from participants to use their responses as research data. Thirty‐nine completed questionnaires were returned. A minority of respondents reported that cadaveric images appear on their social media occasionally (33.3%) or frequently (2.6%) and most were in favour of cadaveric material being posted on social media (61.5%), although most have never posted such content themselves (79.5%). A majority (71%) felt that specific consent needs to be received from donors to share cadaveric images on social media and 82% of respondents thought that donors would not expect that images of their body would be posted on social media. Only 30.8% of respondents reported that donor forms at their institutions specifically ask donors for consent to take images and no respondents could confirm that specific consent to share such images on social media was included on donor forms. Most respondents (74.4%) believed that social media posts containing cadaveric material could affect the number of people donating their bodies to anatomy departments. A large majority (89.7%) agreed that more guidance on posting cadaveric material on social media is needed from anatomy associations. Anatomy educators see the benefits of using social media to share educational content including images and videos containing cadaveric material, however the majority of anatomists believe more needs to be done to ensure informed consent is received from donors, such as international anatomy associations providing guidelines on this topic.

Poster 10

Drawing brains, golgi stains: A public engagement workshop

Pavlos Theodorou

Imperial College Healthcare NHS Trust, London, United Kingdom

As part of the Great Exhibition Road Festival 2019, a workshop entitled ‘Tracing the Mind’ was carried out. Children and adults were invited to explore the drawings of Santiago Ramon y Cajal, as well as some contemporary microscopic images of neurons. They had the opportunity to look down the microscope at some Golgi stained mouse neurons and learn about the significance of this staining method, as well as the importance of this work to the development of neuroscience as a discipline. They were then invited to create their own images inspired by what they had learnt and seen, using a selection of materials including inks, watercolours and waxes. This poster details the way in which the workshop was structured and suggests a model for future public engagement workshops. No ethical approval was required.

Poster 11

Unusual innervation of cattle horns in geographically isolated location of St Kitts; implications for cornual nerve block

Roger Hancock; Lang Jason; Milan Nancy; Busanelli Lohit; Sofia Simone; Glenn Wakley

Department of Biosciences, Division of Anatomy, Ross School of Veterinary Medicine, Basseterre, St Kitts & Nevis, West Indies

Horns of mature cattle are often removed surgically in dehorning as animals may become entrapped by their horns in wire fencing. Horns also bruise other livestock lowering herd economic value and horns pose hazards to farm personnel and premises. Even when performed under local anesthesia, dehorning is painful and stressful, with avoidance behaviours and significant weight loss that may take months to recover, at economic cost to the farmer. Usually, prior to dehorning, the cornual nerve (zygomaticotemporal branch of trigeminal) is ‘blocked’ in the temporal fossa ventral to the temporal crest. However, variations in the patterns of innervation of the horn have been described in some cattle making the block ineffective. In this study on the in‐bred cattle population of St Kitts island (West Indies), heads from nine horned cattle and one polled cow were removed after commercial slaughter and dissected to determine the paths of nerves to the horn. Animals included were crossbreeds 2 each of Holstein and Senepol, 5 Brahma and 1 Zebu. In the hornless animal and in eight of nine horned animals the cornual nerve followed the ‘textbook’ path across the temporal fossa but, in one horned animal, did not reach the horn. Instead, infratrochlear and supraorbital nerves extended to the horn base. Additionally in the hornless head and two with horns a branch of the cornual nerve extended dorsally over the temporal crest to the horn base, connecting the supraorbital nerve. In three, the supraorbital nerve extended to the horn. In summary, in addition to the cornual nerve there was a significant and frequent involvement of the supraorbital nerve in horn innervation, more so than described in larger populations in mainland locations elsewhere, and a cornual branch may be absent. This is possibly due to inbreeding of cattle of a limited population on a small island. We conclude by recommending that cornual nerve block in preparation for dehorning on St Kitts be accompanied by ‘ring’ infiltration of anesthetic around the horn base for potential involvement of supraorbital and other nerves in horn innervation. Similar considerations may apply when dehorning cattle in other geographically isolated areas. No ethical approval was required for this study as per the institutional animal care and use committee (IACUC).

Poster 12

Massive open online courses (MOOCs) in anatomical and medical education: A systematic review

Jeremy Cheong Jie En; Iain D. Keenan

School of Medical Education, Newcastle University, United Kingdom

Massive open online courses (MOOCs) have become increasingly popular as approaches for remotely delivering education to global audiences via technology‐enhanced means. MOOCs can provide platforms for the collective engagement of participants from a variety of professional backgrounds and international locations via online communication. Our systematic review has investigated the current literature surrounding MOOCs, and has identified the value of such courses with respect to anatomical and medical education. We present the design and outcomes of our systematic review as an accessible and informative guide for anatomy educators.

Our literature search strategy involved exploring the PubMed database for the terms ‘MOOC +Anatomy’ and ‘MOOC + Medical Education’. This approach identified a total of 290 articles. Following implementation of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) criteria, this total was reduced to 24 articles for inclusion in our systematic review. Our inclusion criteria permitted articles that were published in English; concerned MOOCs that had involved the delivery of anatomical or medical education; and contained either qualitative or quantitative data obtained from experimental, survey or interview‐based research studies.

Our review has identified that participants completing MOOCs in anatomical and medical education have in general shown increases in their knowledge and skills. We have also found that MOOC discussion forums can encourage development of a community of social learning among participants. Moreover, MOOCs have been shown to address the needs and expectations of participants and to supplement traditional learning approaches in anatomical and medical education. However, the majority of experimental research studies that have investigated the value of anatomical and medical education MOOCs did not include pre‐post testing or appropriate controls. Furthermore, high levels of participant attrition, the inability to address all learning approaches and lower discussion forum participation rates have all been identified as limitations.

Findings from our systematic review will serve to inform anatomy educators intending to develop and implement their own MOOCs. This work may therefore have implications for the technology‐enhanced delivery and global reach of modern anatomy education.

Ethical approval was not required for this study.

Poster 13

Multisensory observation and drawing enhances social and spatial anatomy learning

Iain D Keenan¹; Leonard Shapiro²; Kathryn Bell^1,3; Kallpana Dhas¹; Toby Branson⁴; Graham Louw²

¹School of Medical Education, Newcastle University, United Kingdom; ²Department of Human Biology, University of Cape Town, South Africa; ³Acute Medical Unit, James Cook University Hospital, Middlesbrough, United Kingdom; ⁴Department of Health and Medical Sciences, University of Adelaide, Adelaide, Australia

Educational research and theories of drawing provide support for the concept that multisensory observation and drawing can be effective for enhancing anatomy learning. To support student understanding of 3D anatomical form, we have previously introduced a multisensory learning process which concerns the haptic and visual exploration of 3D anatomy. A combination of touch and sight are utilised by students in order to simultaneously make graphite marks on paper that correspond to the observed anatomy. Findings from our previous study of this Haptico‐visual observation and drawing (HVOD) approach indicate that HVOD can enhance memorisation and perceptual understanding of the 3D form of observed structures. Consequently, we have produced a comprehensive and detailed HVOD guide for anatomy instructors.

Additionally, we have explored the pedagogic and cognitive underpinnings of multisensory observation and drawing in order to further identify the specific value of HVOD for anatomy learning, and here we present our findings from a phenomenological study of educator experiences. Themes arising from our research indicate that the supportive social context of HVOD can provide an engaging learning environment for the spatial exploration of anatomy. However, participating educators also identified the importance of modifying HVOD in order for the process to be effectively integrated into anatomy curricula. Consequently, we present our strategy of utilising the evidence‐based framework provided by our Observe‐reflect‐draw‐edit‐repeat (ORDER) art‐based learning approach to support our optimisation of HVOD through creation of a novel ‘ORDER Touch’ anatomy observation and drawing process.

We will provide ORDER Touch to a global audience of anatomy educators and students, with the aim of supporting social learning, 3D spatial understanding and specific anatomical knowledge, through delivery as a massive open online course. Our work will have implications for the flexible and widely accessible delivery of technology‐enhanced and art‐based anatomy learning resources

Ethical approval for this study was granted by Newcastle University.

Poster 14

Student perceptions on the value of anatomical dissection

Himanshi Choudhary; Shiby Stephens

Cardiff School of Biosciences, Cardiff University, Sir Martin Evans Building, Museum Avenue, Cardiff, United Kingdom

Recent developments in medical curricula worldwide have led to marked changes in the teaching of the basic biomedical sciences. These changes include reducing the hours students spend dissecting. In this study, we hypothesize that students who are exposed to traditional cadaveric dissection would have a better perception to anatomy. Following ethical approval from Cardiff School of Biosciences, questionnaire was distributed amongst Second year Biomedical (Anatomy) students at Cardiff University. Out of 60 students, 55 responded thus attaining a 92% response rate. The questionnaire consisted of a series of 21 brief positive and negative perception statements that students had to grade on a Likert scale between 0‐5 (0 being strongly disagree and 5 being strongly agree). For calculating the significance between perceptions, the data was grouped into positive and negative statements. Following ANOVA one‐way, f ratio value of 48.4 and a p value of < 0.0001 was calculated. Therefore, the data was significant between the negative and positive perception. Following the analysis, in accordance with our hypothesis, it was concluded that students who undertake human cadaveric dissection to learn anatomy had a positive perception to dissection. The students may have developed better understanding of human anatomy and may have developed skills to appreciate anatomical variations, pathologies and relations better thus aiding to the development of a positive perception.

Poster 15

Student‐led development of medical school 3D printing technology for enhancing delivery and accessibility of anatomy learning resources

Harry Carr^1,2; Christopher Kui^1,2; Sze Yi Beh^1,2; Mark Neszmelyi^1,2; Elgin Kah Meng Lee^1,2; Christien Ka Hou Li^1,2; Iain D. Keenan¹

¹School of Medical Education, Newcastle University, United Kingdom; ²M3dicube 3D‐Printing Student Interest Group, Newcastle upon Tyne, United Kingdom

Three‐dimensional printing (3DP) is an exciting and rapidly developing technology with widespread clinical applications. In anatomy education, accurate and affordable 3DP models can deliver enhanced practical and self‐directed visuospatial and haptic learning as a powerful supplement to technology‐enhanced and cadaveric learning approaches.

Despite such advantages, development of UK medical school 3DP facilities has not always kept pace with institutions in the USA and Australia. Consequently, we have founded M3dicube, a student‐led interest group aiming to promote 3DP awareness through development and sharing of 3DP models and provision of educational events and 3DP expertise. Furthermore, undergraduate Newcastle University medical education projects were undertaken by M3dicube founders with the aim of creating resources for enhancing 3DP accessibility.

Project outputs have generated a modified protocol based on previous work, and demonstrative step‐by‐step tutorials for creating 3DP anatomical models with open‐source software: Structures were visualised using volumetric data from diagnostic images using 3D Slicer software; digital painting tools in 3D Slicer were used to reconstruct target structures into 3D stereolithography (STL) files; Blender graphical software was used to refine STL models; Finally, Raise3D ideaMaker software was used to prepare digital models as printable GCode files for production of 3DP models on a Raise3D Pro2 printer.

We subsequently implemented our protocol to produce 3DP models for a student‐led Tanzanian Surgical Skills Project (TSSP) in collaboration with Kilimanjaro Christian Medical University College. The aim of TSSP is to evaluate 3DP for anatomy learning when the availability of cadaveric material is limited. Ethical approval was granted by Newcastle University and a pilot study was recently completed. A dual‐site study in the UK and Tanzania is planned for academic year 2020/21.

Furthermore, development of interactive workshops though our partnerships with Newcastle University undergraduate societies is ongoing. These events will deliver training on fracture repair using 3DP femurs, and cortical anatomy through physical painting of 3DP brains. In the future, M3dicube aims to produce high‐quality outputs in order to yield significant impacts on the enhancement of anatomical education and clinical medicine.

Poster 16

3D digital visualisation technologies in anatomy education: A systematic review

Daphne Liew Yi Juin¹; Iain D Keenan²

¹Newcastle University Medicine Malaysia (NuMed), Johor, Malaysia; ²School of Medical Education, Newcastle University, Newcastle, United Kingdom

The human body is three‐dimensional and the modality appropriateness model therefore determines that 3D learning resources should be used to deliver anatomy education. Traditionally, cadaveric material has been the primary anatomy learning resource for imparting visual and haptic 3D experiences. However, cultural, ethical and financial considerations can limit the availability of human donors in some countries and institutions. Furthermore, it is important to provide a variety of resources to support 3D anatomical understanding from multiple perspectives. Consequently, non‐cadaveric alternatives have been sought to supplement anatomy learning, such as 3D digital visualisation resources including augmented reality (AR), virtual reality (VR), stereoscopy and autostereoscopy. We aimed to investigate the value of these 3D visualisation technologies and their impact on enhancing student learning and experience. A PubMed search of the terms ‘virtual reality; ‘augmented reality’; autostereoscopy’: ‘stereoscopy’ and ‘anatomical education’ yielded 389 articles. Following implementation of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) criteria, this was reduced to 31 eligible studies. Our inclusion criteria permitted relevant articles that were published in English and excluded those primarily concerning technical development or protocols and clinical applications. Accordingly, 14 articles met the criteria for inclusion in our qualitative synthesis. Our review identified only a small number of research studies that have robustly addressed the value of AR, VR, autostereoscopy or stereoscopy in anatomy education. In some cases, student understanding and engagement in anatomy appeared to be enhanced by 3D visualisation technologies, while advantages of AR over VR concerned simultaneous observation of virtual and real world environments and fewer physical side effects. We conclude that 3D visualisation technologies may be valuable supplementary resources in anatomy education, but further research is required to identify the specific nature and extent to which such approaches can enhance student learning and experience both in the presence and absence of cadaveric material. Consequently, we have developed our own 3D digital and physical models using autostereoscopy and 3D printing technology to support multimodal and cadaveric anatomy learning. We plan to investigate the value of implementing these learning activities in our future research. Ethical approval was not required for this project.

Poster 17

Spatiotemporal expression pattern of the ZIC4 transcription factor in the developing human thalamus

Niveditha Sankar¹; Janet Kerwin¹; Ayman Alzu'bi^1,2; Maznah Alhesain¹; Gavin Clowry¹

¹Institute of Biosciences, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, United Kingdom; ²Department of Basic Medical Sciences, Yarmouk University, Irbid, Jordan

Development of the human thalamic nuclei, dysfunction of which have been implicated in several neurodevelopmental disorders, is potentially guided by the interplay of several transcription factors including ZIC4 which belongs to a family of proteins whose function is well‐studied in cerebellar formation. Although the zinc‐finger domain in ZICs shares structural similarity with GLI transcription factors involved in hedgehog signalling in development, molecular differences among the ZIC proteins indicate that differential roles are played by each. Zic4, which is still understudied compared to other ZIC factors, had been found to be expressed in the thalamus of the developing mouse and in neonatal marmoset and play a role in visual‐thalamic nuclei differentiation. However, nothing is known about its role in human thalamic development. Here we characterise the spatial and temporal expression of ZIC4 in fetal human thalamus between 8‐21 post‐conception weeks (pcw). Sagittal and coronal sections of human brain at different fetal stages were provided by Human Developmental Biology Resource (HDBR) all tissue collected with appropriate maternal consent and approval from the Newcastle and North Tyneside NHS Health Authority Joint Ethics Committee. ZIC4 expression was revealed by RNAscope in‐situ hybridisation and compared with immunofluorescence labelling of forkhead transcription factor, FOXP2, a known marker of thalamus development.

At 8‐10pcw, ZIC4 gene was expressed throughout prosomere 2 including thalamus and epithalamus. In the thalamus it exhibited a high ventrolateral to low dorsomedial gradient. FOXP2 exhibited an opposing high dorsomedial to low ventrolateral gradient in the thalamus and was also expressed in other forebrain nuclei. Expression of ZIC4 became more regionalised in later fetal stages being restricted to the dorsolateral region of the mid‐thalamus at 19pcw. It was highly expressed in ventral, but not dorsal, lateral geniculate nucleus 21pcw. Similar to the perinatal marmoset, ZIC4 was expressed moderately in lateral regions of the pulvinar, demonstrating the subdivisions of this large nucleus at this stage. The results established a spatiotemporal map of ZIC4 expression potentially regulating the development of human thalamic nuclei. At early stages it may interact with other transcription factors in counter gradients prior to establishment of discrete thalamic nuclei at later stages.

Poster 18

Anatomical variation within teaching skeletons: An appraisal of the university of glasgow skeletal collection

Morven Burton; Carrah McConnell; David Russell; Eilidh Ferguson

Anatomy Facility, School of Life Sciences, College of Medicine Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom

Anatomical collections are an invaluable resource for teaching. Anatomy specimens facilitate practical approaches to learning human anatomy, such as increasing spatial awareness and exposing students to real‐life anatomical variation. Anatomical variation in the human skeleton is relatively common, although not always well classified, as many anomalies are asymptomatic and therefore go unnoticed during an individual's lifetime. This project aimed to analyse teaching skeletons within the University of Glasgow's Anatomy Facility, to quantify the presence of anatomical variation and bone pathologies, with a view to informing future teaching and research. Anecdotal evidence from previous cataloguing of the collection, supported by published literature, has led to a hypothesis that the lumbosacral region will display high levels of anatomical variability within this skeletal assemblage. Skeletal elements were identified and recorded both digitally and via physical inventory forms. Each element was visually assessed, and the presence of anatomical variations and/or pathology was verified and documented based on comparison with standard reference texts. Sixty boxes containing a total of 5149 skeletal elements/fragments were analysed (range 11 – 188 elements per box; mean = 85.82; SD = 35.99). Overall, 138 instances of anatomical variation and 190 examples of pathology were identified. As hypothesised, the lumbosacral region was highly variable, with large numbers of transitional vertebrae (present in 33% of vertebral columns) and unfused/cleft neural arches (19%) identified. Insight into the frequency of variations and pathologies in this sample has enhanced understanding of skeletal variation and disease within this osteology teaching collection. By cataloguing and assessing the skeletal remains, through the creation of a new searchable database, this project has taken the first step to ensuring that this invaluable collection continues to play an integral role in future anatomy teaching and research. Analysis of skeletal specimens was conducted within a licenced anatomy facility and in accordance with the Anatomy Act 1984 and the Human Tissue (Scotland) Act 2006. There is no personally identifiable information related to the use of these remains and no additional ethical approval was required.

Poster 19

The supraserratus bursa and accessory muscle from serratus anterior to the second rib: potential sites for scapular pain

Katie James; Tabitha Brough; Gavin Jarvis; Cecilia Brassett; John Jenner

Human Anatomy Teaching Group, Department of Physiology, Development & Neuroscience, University of Cambridge, Cambridge, United Kingdom

Scapular pain is a common presenting complaint, often presumed to be referred from the spine, whereas structures related to the scapula itself are rarely considered as a cause. This may in part be due to difficulties in examining the subscapular structures which are obscured by the scapula, making imaging challenging, as well as the paucity of detailed anatomical descriptions of this area. However, the anatomical space between the subscapularis (SS) and serratus anterior (SA) muscles, known as the supraserratus bursa, is a potential site of pathology which may lead to scapular pain.

In this study, the posterior thoracic regions of 15 human cadavers were dissected, and a distinct supraserratus bursa (SB) was found between SS and SA in all cases. The area of the bursa was measured using two methods: (1) the surface area of the imprint of the bursa was measured following latex injection, giving a Mean±SD of 110.0 ± 23.1 cm2 (n = 5); (2) the outline of the smooth, shiny area of the bursa was measured, giving a value of 98.9 ± 8.5 cm2(n = 4). Technical difficulties precluded measurement in 6 cases.

In addition, a muscle slip was found connecting SA to the posterior aspect of the second rib in 3 cases. The mean width and length found was 1.3 cm and 4.9 cm respectively.

This study has shown the presence of a sizeable SB in all cadavers where measurements could be made. Its area is larger than what has previously been described in the literature (28.1 cm2). The presence of a muscle slip between the SA and second rib is also a novel finding.

It is postulated that the SB may act synergistically with the physiological (subserratus bursa) articulation between SA and the posterior thoracic wall, thus contributing to scapulothoracic mobility.

Moreover, the SB, along with this accessory muscle slip, should be considered when treating scapular pain, particularly in overhead athletes in whom these structures are subjected to repetitive tension.

All donors had provided written consent before decease for their bodies to be used for anatomical research under the Human Tissue Act 2004.

Poster 20

Human placenta in Movat staining – the pilot study

Zygmunt Domagała¹; Nathalie Smyczek²; Bożena Przygodzka³; Sławomir Woźniak²; Piotr Dzięgiel³

¹Division of Anatomy, Wroclaw Medical University, Wrocław, Poland; ²Clinical and Dissecting Anatomy Students Scientific Club, Wroclaw Medical University, Wroclaw Poland; ³Division of Histology and Embryology, Wroclaw Medical University, Wrocław, Poland

A placenta is a structure whose primary purpose is the exchange between the foetus and the mother. The most important part of it is the vascular system, which is responsible for the effective exchange of metabolites and gases between the mother and the foetus. This determines the proper, dynamic development of the new organism. Any disturbances in the functioning of this exchange are responsible for the development of diseases of the pregnant mother and foetus.

Movat pentachrome (MOVAT) is a staining that allows to make all elements of connective tissue visible in one slide in contrasting colours. It is a dye that enables a particularly good assessment of the structure of vessels, perfectly colours elastin and smooth muscle components and thereby greatly enhances the detection of easily overlooked vascular pathology.

In the available literature there are no studies evaluating the image of placental tissues stained with this technique. Therefore, the aim of this pilot study is to evaluate the visualisation of the placenta tissue in the pentachrome staining.

The study was carried out on 7 normal placenta (elective caesarean sections, 39‐41 weeks of pregnancy). Slides were taken from several placenta sites according to the standard procedure. The HE and Movat staining were performed. The study was made according to the Declaration of Helsinki and approved by the Local Bioethics Committee.

The pilot study showed paraffin slides stained with MOVAT intensive black coloration of villous and extravillous trophoblasts, red coloration of tissue surrounding villous villi and beige‐yellow coloration of tissues in the stroma.

In limited localisation, the bluish staining was also found. That corresponds to tissues containing large amounts of collagen and reticular fibers

MOVAT is an interesting addition to the standard techniques for staining placenta tissue. Further comparative work is planned to evaluate the intensity and location of the staining of the specimen depending on the clinical condition of the mother and foetus.

Poster 21

Topography of muscular branches of the superficial fibular nerve in human foetuses

Aleksandra Karykowska¹; Anna Rohan‐Fugiel²; Grzegorz Mączka³; Joanna Grzelak⁴; Sławomir Wozniak²; Bohdan Gworys^2,5; Zygmunt Domagała²

¹Department of Anthropology, Wroclaw University of Environmental and Life Sciences Wrocław, Poland; ²Division of Anatomy, Department of Human Morphology and Embryology, Wroclaw Medical University, Wroclaw, Poland; ³Non‐public health care institution “Doktor”, Boleslawiec, Poland; ⁴Division of Oral Anatomy, Wroclaw Medical University, Wroclaw, Poland; ⁵Faculty of Health Science and Physical Education, The Witelon State University Of Applied Sciences In Legnica

The aim of the study was to determine the position of motor branches of the nervus fibularis superficialis (NFS) in relation to the main axis of the trunk of this nerve in human foetuses. The possible occurrence of sexual dimorphism and symmetry in the course of NFS branches was also determined.

The study was performed according to the Declaration of Helsinki and approved by the Local Bioethics Committee. The standard preparatory analysis was performed on 207 human foetuses (101 females) aged from 113th day (5th month of foetal life) to 222nd day (8th month of foetal life)

Based on the performed analysis, four basic types of arrangement of muscle branches derived from NPS were proposed: bipinnate type ‐ at least 3 motor branches located on both sides of the nerve trunk, unipinnate type ‐ at least 2 branches located on one side of the trunk, the pitchfork type ‐ one motor branch on both sides and other type. In each types the lower branches were responsible for innervation of fibularis brevis muscle. An analysis of the frequency of occurrence of particular types of muscle branch positions showed that the most frequent is the bipinnate type. The unipinnate type is almost half as common and the pitchfork type is the least common. Individual types were symmetrical in both extremities in most cases. There were no statistically significant gender differences both in the right (χ=0.877, p = 0.645) and left (χ=1.263, p = 0.738) limbs.

An important novelty of this paper is the presentation of the typology of NPS based on broad fetal material. The cognitive significance of this study is therefore important and allows to directly determine the course and division of NPS in the perspective of prenatal development and perinatal surgery.

Poster 22

Are locomotive styles in primates a driving force behind intra‐ and interspecies variation in the vertebral column?

Michelle Payne; John Mulley; Isabelle Catherine Winder

School of Natural Sciences, Bangor University, Memorial Building, Bangor, United Kingdom

The vertebral column stabilises the body, facilitates flexion/extension of the back and serves as the axis of a basic tetrapodal body plan that can be adapted to various forms of locomotion. It comprises five regions, each containing vertebrae of different shapes and sizes. In primates, there are almost always seven cervical vertebrae, with this number very stable except in rare (usually pathological) instances. In the other regions, however, the number of vertebrae varies more freely. Vertebral shape also varies within and between regions, from head to tail‐tip. Knowing more about why and how vertebral variation develops in primates, and how these patterns of variation have evolved, would dramatically enhance our understanding of the complex structure and function of primate (including human) spines.

One potential cause of variation in primate vertebral columns is locomotion. Primates display several distinctive locomotive styles and can be arboreal or terrestrial. There has been recent debate as to how much locomotor styles and flexibility might drive functional variation in primate skeletons, but this mostly focuses on limb bones. As of yet, we remain uncertain even of how much variation there actually is in the primate vertebral column. Even less has been done on the potential role of locomotion as a driver of specifically intraspecific anatomical variation, although we know there is substantial within‐species variation in locomotor behaviour. This project will quantify vertebral number variation across primate species and use digital photography to capture size and shape variation through all five regions. We will analyse vertebral morphometrics within individuals and within and between species. Ethical approval is not required for this data collection, as we will use only existing skeletons housed in major museums.

Our analyses will focus particularly on transitional vertebrae and the possibility that developmental constraints and histories might affect vertebral numbers, shapes and patterns in species with different locomotor preferences. We aim ultimately to deepen understandings of how and why variation occurs within a species, how the primate vertebral column has evolved, and how much variation there is within non‐pathological primate populations.

Poster 23

Identifying mammoth ivory with Raman spectroscopy

Rebecca F. Shepherd¹; Adrian. M. Lister²; Alice M. Roberts³; Adam M. Taylor¹; Jemma G. Kerns¹

¹Lancaster Medical School, Lancaster University, Lancaster, United Kingdom; ²Earth Sciences Vertebrates and Anthropology Palaeobiology, The Natural History Museum, London, United Kingdom; ³School of Biosciences, University of Birmingham, Birmingham, United Kingdom

Mammoth ivory is comprised of an inner mineralised protein matrix of dentine, with an outer layer of cementum. Enamel is present on the tips of the tusks of young mammoths, but is not present in older mammoths. To determine the species from which ivory originated, often destructive methods are used. Raman spectroscopy is a non‐invasive laser based method that has applications in the study of bone chemistry. Given the similarities between ivory and bone, the objective of this study was to test the hypothesis that mammoth ivory can be identified using Raman spectroscopy.

Mammoth tusks were obtained from the Natural History Museum. The ivory was scanned with an inVia Raman micro spectrometer (Renishaw Ltd) equipped with a x50 objective lens and a 785 nm laser. Spectra were acquired using line maps on cross sections of two samples, and individual spectral points were acquired independently at random or at points of interest on all samples. Data was analysed with principal component analysis (PCA) using an in‐house Matlab script.

The results so far demonstrate the ability to characterise well preserved mammoth ivory through the comparison of peak intensity ratios between organic v(CH) collagen peaks and inorganic v(PO) hydroxyapatite peaks.

Further work in this study aims to compare the Raman spectra between mammoth and elephant ivory. This information will be valuable for assessing ivory from an unknown origin and add to the archaeological knowledge from excavated materials. Furthermore, it will provide evidence for archaeologists by using a non‐destructive methodology to explore well‐preserved specimens without the need for removing ivory samples for testing, which is necessary with more traditional laboratory techniques. It may also be applicable to the illegal ivory trade today, if specimens can be readily identified. No ethical approval was required.

Poster 24

A cadaveric study of the intra‐fascicular anatomy of the ulnar nerve in the palm and forearm

Shahzaib Ahmed¹; Ákos Marton¹; Gavin Jarvis¹; Cecilia Brassett¹; Ian Grant²

¹Human Anatomy Centre, Anatomy Building, Department of Physiology, Development and Neuroscience, University of Cambridge, United Kingdom; ²Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom

The intra‐fascicular anatomy of the ulnar nerve in the forearm has not been previously well described. In patients with a high median nerve palsy, the motor branch of the ulnar Nerve to the Abductor Digiti Minimi (ADMN) muscle has been suggested as a potential source of nerve transfer to the Recurrent motor Branch of the Median Nerve (RBMN). This requires intra‐fascicular dissection to achieve tension‐free anastomosis. A better understanding of intra‐fascicular anatomy of the ulnar nerve in the forearm will also improve the accuracy of fascicular repair of distal ulnar nerve injuries.

This study involved dissection of 10 cadaveric forearms, with intra‐fascicular dissection of the ulnar nerve. We have documented the length of ulnar nerve branch ADMN available for the above nerve transfer procedure, the necessary retrograde dissection of the RBMN, and the location of fascicular interconnections of the ulnar nerve in the forearm.

Our results show the maximum length of ulnar nerve branch ADMN available for nerve transfer to be 50.9 ± 13.7 mm (SD), and confirm that this is positively correlated with forearm length (Pearson Correlation r=+0.68, p = 0.03). This branch is also significantly longer in males than females (p = 0.015; males (n = 4) = 61.3 ± 4.9 mm, females (n = 6) = 44.0 ± 13.5 mm). The necessary retrograde dissection of RBMN (8.4 ± 4.3 mm) is independent of forearm length, sex and side of the body.

Three interconnections were found between the fascicles to the 5th digit and 4th webspace at 13.9 ± 3.3%, 19.7 ± 2.7% and 23.7 ± 11.5% of the distance between the distal pisiform and proximal olecranon in our “average” forearm of length 257.7 ± 17.7 mm.

Two interconnections were identified between the 4th webspace and motor branch fascicles at 17.6 ± 3.0% and 20.0 ± 2.6% in 6 out of 7 specimens, with only 1 in 1 specimen.

Data collected from this study will be useful in pre‐operative planning and informing safe surgical practise in nerve transfer surgery, fascicular repairs and nerve grafts involving the ulnar nerve and its branches. Recognition of the fascicular interconnections may explain reports of sensibility maintained in the digits despite more proximal nerve injury.

All donors had provided written consent before decease for their bodies to be used for anatomical research, in compliance with the Human Tissue Act 2004.

Poster 25

Using lasers to investigate the chemistry of archaeological human bones

Sheona I. Shankland¹; Hugh Willmott²; Emma Hook²; Adam M Taylor¹; Jemma G. Kerns¹

¹Lancaster Medical School, Lancaster University, Lancaster, United Kingdom; ²Department of Archaeology, University of Sheffield, Sheffield, United Kingdom

Excavated human burials from archaeological sites could hold information that is important both historically and medically, but limited analyses can be conducted without damaging the remains. CT scans and X‐rays are used to gather macroscopic data but, whilst non‐destructive, offer no insight into the skeleton's chemical composition. Raman spectroscopy could potentially be used to analyse such remains by gathering chemical data without detriment to the bones.

Raman spectroscopy measures the exchange in energy between a set wavelength, infrared laser and the molecular bonds in a sample. These energy changes are indicative of the chemical make‐up of the sample; allowing a bone's biochemical fingerprint to be established. This study aims to ascertain if chemical differences present in bone can be linked to medical conditions, such as osteoarthritis (OA).

The L3‐L5 lumbar vertebrae were chosen for analysis due to their role in load bearing and support; making them a prime site for OA related pathologies. These vertebrae were acquired from the remains of individuals from ‘The Thornton Abbey Project’, two of which have so far been analysed from both ends of the age range available to the study: 18‐25 years and 45 + years.

The initial results indicated a marked difference in the chemical signature of the older L3 vertebrae compared to their L4 and L5. This could be related to the increased biomechanical stress lower in the spine. The analysis also indicated that the data from the younger adult were distinctly grouped from the older adult. This suggests that the changes during ageing, and the development of OA, create a more heterogeneous chemical composition in the lower lumbar vertebrae, but a composition distinctly different from the more homogeneous younger adult. These data could indicate that during ageing and OA the composition of the superior vertebrae shifts to offset the degradation of the inferior vertebrae.

More data is being gathered to assess these changes further, but it is hypothesised that the differences in the older adult are associated with chemical modifications from OA and, if proven, we could develop Raman spectroscopy to detect pathology in archaeological human bone.

Poster 26

Do the skeletally conservative Cercopithecus monkeys (guenons) show morphological differences in their feet in accordance with locomotor style?

Angharad Elizabeth Thom; Vivien Shaw; Isabelle Winder

School of Natural Sciences, Bangor University, Bangor, Gwynedd, United Kingdom

Many studies have explored the transitions between arboreality and terrestriality in monkeys. These focus on the differences such changes may have made to specific species’ anatomies. This type of research has obvious relevance both for comparative anatomy and for understanding our own locomotor transition. The question of how humans got from the trees onto the ground is a contentious one. Understanding how similar changes have occurred in other primate species may be key to resolving it.

However, existing investigations into genus Cercopithecus (the guenon monkeys) are either no longer relevant because the species classification has changed, or very limited, despite this genus’ relevance as a seemingly highly flexible taxon within our own parvorder, the Catarrhini. Studies have shown how general positional behaviour affects several areas such as the intertuberosity angle, neck and epiphysis of the humerus and femur in this taxon, and, in more recent studies, metacarpals. There has, however, been little or no work on guenon foot structure, and very little data exists on morphological variation between species in this group or other primate taxa.

The foot has been described as morphologically redundant, because a change in function will not necessarily be related to a change in structure. If that is the case then significant differences could be good indicators of relatedness between species, rather than function. Foot structure is also interesting as guenons are known to be conservative for both their cranial and post‐cranial skeleton; they may represent something like our last common ancestor with other Catarrhine primates. Further study of guenon foot anatomy could thus help us unpick structure and function and reconstruct some of the early evolutionary history of primate locomotion, particularly with regards to variation within and between species and how this relates to locomotion.

Such a study will be important in understanding the guenons as a whole and building an ecological, morphological and phylogenetic profile of the genus.

Poster 27

Cerebral torque in nonhuman primates ‐ implications for psychosis development

Ella Ronan; Isabelle Winder; Vivien Shaw

Bangor University, Bangor, Gwynedd, North Wales, United Kingdom

Cerebral torque has been described as a right‐left asymmetry of the frontal and parieto‐occipital regions of the brain. It is associated with an increase in inter‐hemispheric connectivity and the subsequent development of language. T.J. Crow has postulated links between cerebral torque and functional psychoses; with a focus on schizophrenia. Connections between psychotic disorders and language have been made where disordered speech, auditory hallucinations, and functional or structural deficits in language areas of the brain are seen in diagnosed individuals.

T.J. Crow hypothesises that cerebral torque arose after a genetic speciation event occurring 5‐6 MYA – around the same time Homo sapiens diverged from the Pan lineage. This is thought to have triggered a chain of events mitigating the formation of the Xq21.2/Yp11.2 homology block, where a paracentric inversion occurred on the Y chromosome 160 KYA and cerebral torque is hypothesised to have formed. It is this timeline of genetic events that initially implies that torque is specific to Homo sapiens, as they only occur after the Homo‐Pan split. However, contrary to Crow's theory, asymmetries of the brain have been documented in nonhuman primates since the 1970's as new technologies such as functional magnetic resonance imaging (fMRI) and computed tomography (CT) came into use for imaging the brain. Neurological asymmetries have been found in ape species Gorilla, Pan and Pongo, as well as monkey species Macaca mulatta; Macaca fascicularis; Saguinus oedipus, and Callithrix jacchus.

If theorised correlations between hemispheric asymmetries and psychosis are to be believed, evidence for such asymmetry in nonhuman primates could point towards their possession of an anatomical foundation for developing psychotic‐type behaviours.

This research examines the genetic and anatomical precursors of psychosis through a meta‐analysis of existing literature, genome comparison studies and examination of CT scans of human and primate brains. It further investigates the hypothesis that African great apes (Gorilla spp., Pan troglodytes, Pan paniscus) possess the neuroanatomical prerequisites for developing psychosis, and explores the question as to whether or not ancient human species (Neanderthals and Denisovans) also possessed them.

Poster 28

Micro‐CT assessment of bone microstructure in baboon mandibles

Alessandro A Felder¹; Emmy Bocaege²; Jessica Joganic³

¹Royal Veterinary College, London, United Kingdom; ²University of Kent, Canterbury, United Kingdom; ³University of Missouri, St. Louis, United States

Osteocyte density and vascular porosity (proportion of bone volume comprised of blood vessels) have been used as bone formation proxies, with larger measures correlated with increased growth rates. Here, we report on three‐dimensional osteocyte density and vascular porosity in 5 baboon mandibles (1‐3 years of age, 3 female/2 male) and their relationship to life‐history variables (age at death, body weight at birth and growth rate).

The mandibular inferior margin (below the first molar) was scanned using x‐ray micro‐computed tomography (0.74 μm voxel size). Reconstructed image stacks were segmented into bone, pores and background using a region‐growing algorithm followed by a thresholding step in Avizo. The classification of osteocytes (pore volume/osteocyte < 8000 voxels) and vessels (larger pores), allowed osteocyte density (N osteocytes/bone volume) and vascular porosity (volume of large pores/total volume) measurements. Micro‐anatomical variables were compared to life‐history variables.

Osteocyte density (OD) ranged between 19400/cm3–83800/cm3 and vascular pores (VP) constituted 1.3%–3.4% of the volume measured. Neither measure was sexually dimorphic (OD: t = 1.26, P = 0.32; VP: t = ‐0.96, P = 0.41) or significantly correlated (Spearman rank correlation) with age at death (OD: r = ‐0.67, P = 0.22; VP: r = 0.0, P ≅ 1.0), birth weight (OD: r = ‐0.82, P = 0.09; VP: r = ‐0.20, P = 0.78), or growth rate (OD: r = 0.05, P = 0.93; VP: r = 0.60, P = 0.35).

This study confirms that micro‐CT methods can complement and extend traditional histological methods. Future work will divide vascular porosity into primary vessels and cutting cones and compare μCT observations with physical analyses.

No ethical approval was required for this work.

Poster 30

Integrating remote digital visualisation technologies for enhancing self‐directed learning of 3D and cross‐sectional anatomy

Abdullah Ben Awadh¹; Jill Clark²; Gavin Clowry¹; Iain D Keenan³

¹Institute of Neuroscience, Newcastle University, United Kingdom; ²School of Education, Communication and Language Sciences, Newcastle University, United Kingdom; ³School of Medical Education, Newcastle University, United Kingdom

Integrating gross anatomy and radiology within medical curricula is known to enhance student learning. Our previous findings have identified that the interpretation of anatomical features in cross‐sectional clinical images is a challenging concept for novice medical students. However, reductions in the contact time available to deliver anatomy and radiology content have increased demand for the provision of effective self‐directed anatomy learning approaches. Consequently, we describe our implementation of a remote digital resource, which aims to simultaneously support medical student understanding of both 2D cross‐sections and 3D anatomy.

Sectra Education Portal (SEP) is an interactive cloud‐based sharing platform that provides access to a wide variety of diagnostic images for visualisation, manipulation and modification. We currently use SEP to deliver taught content on the Sectra Visualisation Table (SVT) during practical anatomy classes. Our previous work has identified that SVT can significantly improve clinical image interpretation when compared to standard approaches. We have therefore provided access to Year 1 medical students for the remote usage of SEP on their own devices during self‐directed study. Furthermore, we have implemented specific SEP learning resources in order to support delivery of curricular learning outcomes, initially with respect to the structure and relations of anatomical structures. Initially, we provided students with an introductory guide to using SEP which also included activities concerning the identification of abdominal viscera in digital 3D images and cross‐sectional computed tomography scans.

We propose that SEP will enhance the gross anatomy and radiology learning of medical students and will support their understanding of these challenging areas through the provision of flexible and remote access to this effective learning resource. In order to address this hypothesis, we plan to implement research studies to identify the extent of student learning and experience using SEP. Ethical approval has been obtained.

Outcomes of our investigations will be described in future work and will inform our subsequent usage of SEP. We anticipate that our findings will have wide‐ranging implications for the provision and integration of remotely‐accessible learning and teaching resources for anatomy educators and their students.

Poster 31

New anatomy‐related ratios describing the risk of incomplete colonoscopy in human patients

Slawomir Wozniak¹; Radoslaw Kempinski^2,3; Tomasz Pytrus⁴; Maria Zazga⁵; Marcin Szymocha⁵; Zygmunt Domagala¹; D. Ceri Davies⁶; Friedrich Paulsen⁷

¹Department of Human Morphology and Embryology, Division of Anatomy, Wroclaw Medical University, Wroclaw, Poland; ²Department and Clinic of Gastroentrology and Hepatology, Wroclaw Medical University, Wroclaw, Poland; ³Medical Centre Endomed, Wroclaw, Poland and 2nd Department and Clinic of Paediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Wroclaw, Poland; ⁴2nd Department and Clinic of Paediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Wroclaw, Poland; ⁵SKN (Students Scientific Society) ANATOMIA‐KLINIKA‐NAUKA, Wroclaw Medical University; Department of Human Morphology and Embryology; Division of Anatomy, Wroclaw, Poland; ⁶Department of Surgery and Cancer, Imperial College London, Human Anatomy Unit, London, United Kingdom; ⁷Friedrich Alexander University Erlangen‐Nürnberg (FAU), Institute of Functional and Clinical Anatomy, Erlangen, Germany

Some colonoscopies cannot be completed because of anatomical features of the individual's colon, e.g. tortuosity or elongation. To investigate and describe the risk of incomplete colonoscopy, 403 children (192 girls and 211 boys aged 3‐18) and 500 adults (252 female and 248 male aged 40‐65 years) underwent colonoscopy. New anatomy‐related ratios: Incomplete Colonoscopy Anatomy‐Related (ICAR) and Modified Incomplete Colonoscopy Anatomy‐Related (MICAR) were calculated according to the formulas: ICAR=IAC÷CC and MICARcp=IACcp÷CC. (IAC, number of incomplete anatomy‐related colonoscopies; CC, complete colonoscopies; IACcp, incomplete anatomy‐related colonoscopies halted at critical points). The ICAR describes the colonoscopy incompleteness risk without indicating the site of failure, whereas a MICAR reflects the colonoscopy incompleteness risk at a given anatomical critical point.

There were significantly more incomplete colonoscopies in children weighing less (N = 109) compared to more than 30 kg (p = 0.0006, chi2 test). In children under 30 kg, 10 colonoscopies failed at the left colic flexure (LCF), 3 at the transverse colon and 4 at the right colic flexure (RCF). There were no failures after passing the RCF). The initial MICAR=ICAR = 0.19, while MICAR decreased from 0.19 to 0.08 (at the transverse colon) and to 0.04 at the RCF. The ICAR/ initial MICAR value of 0.19 indicates that every 5.26 (100÷19) colonoscopies will fail overall, while the MICAR of 0.04 indicates that every 25th colonoscopy will fail at the RCF. In children weighing more than 30 kg, the MICAR decreased from an initial 0.05 to 0.04 at the RCF.

There were significantly more incomplete colonoscopies in adult females than males (p = 0.03, chi2 test). In females 3 colonoscopies failed at the sigmoid colon (SC), 1 at the descending‐sigmoid flexure, 3 at the descending colon and 1 at the LCF. There were no failures after passing the LCF. The ICAR and initial MICAR were 0.06. The MICAR decreased from 0.06 at the SC to 0.04 at the descending‐sigmoid flexure and to 0.001 at the LCF and finally to 0.0 after passing it. In males the MICAR reduced from 0.02 at the SC to 0.004 at the LCF.

This study was approved by the Wroclaw Medical University Local Bioethics Co

Poster 32

Diameters of umbilical and portal veins and ductus venosus in the human foetuses after 20 weeks of gestation in an ultrasound examination

Slawomir Wozniak¹; Jerzy Florjanski²; Aleksandra Piatek²; Marek Tomialowicz²; Maria Zazga³; Marcin Szymocha³; Zygmunt Domagala¹; Bozena Kurc‐Darak¹; D. Ceri Davies⁴; Friedrich Paulse⁵

¹Department of Human Morphology and Embryology, Division of Anatomy, Wroclaw Medical University, Wroclaw, Poland; ²2nd Department and Clinic of Gynaecology and Obstetrics, Wroclaw Medical University, Wroclaw, Poland; ³STN (Students Scientific Society) ANATOMIA‐KLINIKA‐NAUKA, Wroclaw Medical University; Department of Human Morphology and Embryology; Division of Anatomy, Wroclaw, Poland; ⁴Department of Surgery and Cancer, Imperial College London, Human Anatomy Unit, Charing Cross Campus, St Dunstan's Road, London, United Kingdom; ⁵Friedrich Alexander University Erlangen‐Nürnberg (FAU), Institute of Functional and Clinical Anatomy, Erlangen, Germany

Early detection of fetal hypoxemia risk is a principal aim in obstetrics and blood vessel diameter may be an important marker of this risk. Therefore, in order to gain baseline data, the diameters of human fetal portal vein umbilical vein and ductus venosus were investigated in 63 fetuses (27 females and 36 males) aged 21‐40 weeks of gestation. Measurements were performed during routine ultrasound examinations using a General Electric E8 ultrasound machine with a volumetric, transabdominal transducer.

The diameters of the vessels were analyzed according to the following: weight centiles below or over 10 (diameters in mm+sd: PV 4.02 ± 1.40 and 4.12 ± 1.53; UV 5.32 ± 1.23 and 5,51 ± 1.19; DV 3.0 ± 1.05 and 2,62 ± 0.59, respectively), weight below 1000 g, between 1001‐2000, and greater than 2000 g (diameters in mm+sd: PV 3.55 ± 0.89 and 4.35 ± 1.56 and 3.85 ± 1.29; DV 3.03 ± 0.97 and 2.80 ± 0.83 and 2.68 ± 0.63; UV 4.51 ± 1.12* and 5.57 ± 1.13 and 6.26 ± 0.98**, respectively; p = 0,007*; **p = 0,007*) and gestational age ‐ 20‐30 or 31‐40 weeks (diameters in mm+sd: PV 3.68 ± 1.02 and 4.1 ± 1.4; DV 2.79 ± 0.91 and 2.70 ± 074; UV 4.71 ± 1.2** and 6.06 ± 0.95***, respectively; p = 0,0002**, p = 0,0002**). PV, portal vein; UV, umbilical vein; DV, ductus venosus; Anova test or Student's t‐test. There were no statistically significant sex differences in the diameters of the vessels investigated (Student's t‐test).

The umbilical vein diameter was found to be consistently larger than that of the portal vein, which was in turn always larger than the ductus venosus diameter. The umbilical vein/ductus venosus ratio was always greater than both the umbilical vein/portal vein or portal vein/ductus venosus ratios. Thus, the data obtained in the current study may provide a normal baseline for assessing the likelihood of hypoxia in at risk fetuses.

This study was approved by the Wroclaw Medical University Local Bioethics Committee.

Poster 33

Human wrist anatomy: anatomical features important for treatment of palmar dislocation of the lunate bone

Slawomir Wozniak¹; Grzegorz Szpotowicz^1,2; Mariusz Bienias³; Bartlomiej Kedzierski³; Dorota Sosnowska⁴; Marcin Szymocha⁵; Elena Wasilewska⁵; Maria Zazga⁵; Zygmunt Domagala¹; D. Ceri Davies⁶; Friedrich Paulsen⁷

¹Department of Human Morphology and Embryology, Division of Anatomy, Wroclaw Medical University, Wroclaw, Poland; ²Department of Orthopedics and Trauma Surgery, T. Marciniak Lower Silesian Specialist Hospital ‐ Emergency Medicine Centre, Wroclaw, Poland; ³Radiology Department, 4th Military Hospital, Wroclaw, Poland; ⁴RadiologyDepartment, T. Marciniak Lower Silesian Specialist Hospital ‐ Emergency Medicine Centre, Wroclaw, Poland; ⁵SKN (Students Scientific Society) ANATOMIA‐KLINIKA‐NAUKA. Wroclaw Medical University; Department of Human Morphology and Embryology; Division of Anatomy, Wroclaw, Poland; ⁶Department of Surgery and Cancer, Imperial College London, Human Anatomy Unit, Charing Cross Campus, St Dunstan's Road, London, United Kingdom; ⁷Friedrich Alexander University Erlangen‐Nürnberg (FAU), Institute of Functional and Clinical Anatomy, Erlangen, Germany

A 36‐year old male suffered a rare acute volar dislocation of the lunate carpal bone with displacement into the distal forearm after being hit by a motor car. Radiological examination revealed that the lunate was completely displaced (stage IV wrist injury according the Mayfield classification). The lunate underwent palmar and axial displacement and rotation by approximately 90 degrees. The scaphoid underwent slight palmar rotation. Triquetralohamate and triquetralopisiform ligaments, which are components of the palmar, dorsal and interosseous carpal ligaments were ruptured. Other minor fractures were also found; a small part of the ulnar styloid process was avulsed by its ligamentous attachments.

The scapholunate and lunatotriquetral intercarpal ligaments have the greatest influence on stabilization of the proximal row of carpal bones and their rupture in the patient described above, indicates high energy trauma. The most common types of wrist dislocation are: scapholunate dislocation (with rupture of neighbouring ligaments including the radioscaphoid, palmar radiocapitate and scapholunate), perilunate dislocations (with radiocapitate ligament injury), intercarpal dislocation (with injuries of the palmar and dorsal radio‐triquetral ligaments and ulnotriquetral ligaments) and lunate dislocation with damage to the radiolunate fascicle, the dorsal radiocarpal and the volar ligaments. The case reported here is one of the rarest of wrist injuries; its treatment was by open reduction of the lunate dislocation with K wire stabilization and reconstruction of the ruptured ligaments. The K wires were removed during the 6th week post operation and the recovery period was without complication. X‐ray examination during the 1st week and 3rd month after treatment confirmed effective treatment and normal wrist biomechanics were restored. No ethical approval was required.

Poster 35

Morphometric measurement of the human median nerve: an ultrasonographic study

Jyoti Chopra¹; Vandana Lakra²; Garima Sehgal¹; Anita Rani¹; RK Diwan¹

¹Department of Anatomy, King George's Medical University, Lucknow, UP, India; ²Orchid Medical Centre, Ranchi, India

Ultrasound, also known as modern stethoscope, is now widely used for multidimensional evaluation of peripheral nerves in cases of compressive neuropathies, traumatic injuries and tumours. The knowledge of normal reference range of cross sectional area (CSA) of nerve becomes crucial to avoid diagnostic pitfall in such cases. In most of the Indian studies the dimensions of median nerve have been observed mainly at carpal tunnel, the commonest site of its entrapment. In few studies only dimension of median nerve is observed at other ultrasonographically approachable sites. The objective of the present study was to provide ultrasonographic reference value of CSA of median nerve at six predetermined sites along its anatomical course in the adult population of Uttar Pradesh. The study was approved by the ethical review board of the university. The cross sectional area of median nerve was measured by ellipse method using linear probe of 6‐13 MHz in both upper limbs of 100 volunteer students (68 males, 32 females) after obtaining informed consent. The mean CSA of median nerve at axilla was 7.99 ± 1.76 mm2, midarm 8.22 ± 1.83 mm2, cubital fossa 8.73 ± 2.12 mm², mid‐forearm 6.07 ± 1.53 mm², distal wrist crease 7.79 ± 1.78 mm² and at carpal tunnel 7.11 ± 1.51 mm². There was statistically insignificant difference between the mean CSA of median nerve of right and left side whereas the nerve was significantly larger in males as compared to females at all sites except at carpal tunnel.