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Vaz-Guimaraes F, Sarteschi C, Roesler EH, Cartaxo HQ, da Fonte JE, da Silva Caldas Neto S, Valença MM. Morphometric Analysis of the Retrolabyrinthine Approach to the Posterior Fossa. World Neurosurg 2024; 188:e441-e451. [PMID: 38810870 DOI: 10.1016/j.wneu.2024.05.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION The retrolabyrinthine approach provides shorter working distance and less cerebellar retraction compared with the retrosigmoid approach to the internal acoustic canal (IAC) and cerebellopontine angle cistern. However, exposure of the ventral surface of the brainstem and petroclival region may be restricted. Trautmann's triangle (TT), an area intimately related to this region, demonstrates significant anatomical variability, which may adversely affect the ease of the approach. The aim of this study is to evaluate anatomic parameters of the posterior fossa that may anticipate a challenging situation in approaching the IAC and the petroclival region through the retrolabyrinthine approach. METHODS It was performed a radioanatomic analysis of 75 cerebral angiotomography exams to identify parameters that could potentially reduce areas of surgical exposure. RESULTS Large variations were observed in the area of exposure of the TT (553%) and the height of the jugular bulb (234%). Shorter distances from the sigmoid sinus to the posterior semicircular canal and high-riding jugular bulb were associated with smaller areas of exposure. Dominant and laterally positioned sigmoid sinuses and less pneumatized mastoids were associated with potentially unfavorable conditions, including a narrower angle of attack to the IAC. Increased petrous slopes and petroclival angles were associated with smaller petroclival areas and shallower clival depths. CONCLUSIONS This study of the posterior fossa reveals remarkable anatomic variation in the region. These findings should be taken into consideration during the preoperative planning of retrolabyrinthine approaches in order to offer safer and more effective surgical procedures.
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Greening VA, Hernandez E, Mongle CS, Billings BK, Mngomezulu V, Wallace IJ, Grine FE. Variation, sexual dimorphism, and enlargement of the frontal sinus with age in adult South Africans. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2024; 183:e24899. [PMID: 38269496 DOI: 10.1002/ajpa.24899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/03/2023] [Accepted: 12/14/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVES To document frontal sinus volume (FSV) in a sample of sub-Saharan Africans with a view to evaluating claims that such populations exhibit comparatively small sinuses. This study also addresses questions related to sexual dimorphism, incidence of sinus aplasia, and the possibility that FSV continues to increase through adulthood. MATERIALS AND METHODS FSV was measured from CT scans of adult crania from the Dart Collection. Sex and age were known for each individual. Linear cranial dimensions were used to compute a geometric mean from which a scaled FSV was computed for each cranium. RESULTS FSV does not differ significantly between sexes, but females exhibit a higher incidence of aplasia. There is considerable variation in FSV in this sample, with the average ranking among the higher means reported for other population samples. The incidence of FS aplasia falls within the range of values recorded for other population samples. Although our study is cross-sectional rather than longitudinal, there is strong evidence that FSV continues to increase with age throughout adulthood. DISCUSSION The FSV mean of our sample contradicts the notion that sub-Saharan Africans possess small sinuses. In a global context, geography (climate and altitude) does not appear to be related to FSV. The absence of sexual dimorphism in our sample is unexpected, as significant dimorphism has been reported for most other population samples. Our results support other indications that the frontal sinus continues to expand throughout adulthood, especially in females, and that it is likely due to bone resorption.
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Affiliation(s)
- Victoria A Greening
- Department of Anthropology, Stony Brook University, Stony Brook, New York, USA
| | - Emily Hernandez
- Department of Anthropology, Stony Brook University, Stony Brook, New York, USA
| | - Carrie S Mongle
- Department of Anthropology, Stony Brook University, Stony Brook, New York, USA
- Turkana Basin Institute, Stony Brook University, Stony Brook, New York, USA
| | - Brendon K Billings
- Human Variation and Identification Research Unit, School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Victor Mngomezulu
- Department of Diagnostic Radiology, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Ian J Wallace
- Department of Anthropology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Frederick E Grine
- Department of Anthropology, Stony Brook University, Stony Brook, New York, USA
- Department of Anatomical Sciences, School of Medicine, Stony Brook University, Stony Brook, New York, USA
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Man C, Gilissen E, Michaud M. Sexual dimorphism in the cranium and endocast of the eastern lowland gorillas (Gorilla beringei graueri). J Hum Evol 2023; 184:103439. [PMID: 37804559 DOI: 10.1016/j.jhevol.2023.103439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 10/09/2023]
Abstract
Sexual dimorphism of the nervous system has been reported for a wide range of vertebrates. However, understanding of sexual dimorphism in primate cranial structures and soft tissues, and more particularly the brain, remains limited. In this study, we aimed to investigate the external and internal (i.e., endocast) cranial differences between male and female eastern lowland gorillas (Gorilla beringei graueri). We examined the differences in the size, shape, and disparity with the aim to compare how sexual dimorphism can impact these two structures distinctively, with a particular focus on the endocranium. To do so, we reconstructed gorilla external crania and endocasts from CT scans and used 3D geometric morphometric techniques combined with multivariate analyses to assess the cranial and endocranial differences between the sexes. Our results highlighted sexual dimorphism for the external cranium and endocast with regard to both size and shape. In particular, males display an elongated face accompanied by a pronounced sagittal crest and an elongated endocast along the rostroposterior axis, in contrast to females who are identified by a more rounded brain case and endocast. Males also show a significantly larger external cranium and endocast size than females. In addition, we described important differences for the posterior cranial fossae (i.e., the position of the cerebellum within the brain case) and olfactory bulb between the two sexes. Particularly, our results highlighted that, relatively to males, females have larger posterior cranial fossae, whereas males have been characterized by a larger and rostrally oriented olfactory bulb.
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Affiliation(s)
- Caitlin Man
- Laboratory of Ecology, Evolution and Biodiversity Conservation, Katholieke Universiteit Leuven, Charles Deberiotstraat 32 Bus 2439, 3000 Leuven, Belgium; Department of African Zoology, Royal Museum for Central Africa, Leuvensesteenweg 13, 3080 Tervuren, Belgium.
| | - Emmanuel Gilissen
- Department of African Zoology, Royal Museum for Central Africa, Leuvensesteenweg 13, 3080 Tervuren, Belgium; Laboratory of Histology and Neuropathology, Université Libre de Bruxelles, CP620 - Route de Lennik 808, 1070 Brussels, Belgium
| | - Margot Michaud
- Department of African Zoology, Royal Museum for Central Africa, Leuvensesteenweg 13, 3080 Tervuren, Belgium
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Del Bove A, Menéndez L, Manzi G, Moggi-Cecchi J, Lorenzo C, Profico A. Mapping sexual dimorphism signal in the human cranium. Sci Rep 2023; 13:16847. [PMID: 37803023 PMCID: PMC10558540 DOI: 10.1038/s41598-023-43007-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/18/2023] [Indexed: 10/08/2023] Open
Abstract
The study of sexual dimorphism in human crania has important applications in the fields of human evolution and human osteology. Current, the identification of sex from cranial morphology relies on manual visual inspection of identifiable anatomical features, which can lead to bias due to user's expertise. We developed a landmark-based approach to automatically map the sexual dimorphism signal on the human cranium. We used a sex-known sample of 228 individuals from different geographical locations to identify which cranial regions are most sexually dimorphic taking into account shape, form and size. Our results, which align with standard protocols, show that glabellar and supraciliary regions, the mastoid process and the nasal region are the most sexually dimorphic traits (with an accuracy of 73%). The accuracy increased to 77% if they were considered together. Surprisingly the occipital external protuberance resulted to be not sexually dimorphic but mainly related to variations in size. Our approach here applied could be expanded to map other variable signals on skeletal morphology.
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Affiliation(s)
- Antonietta Del Bove
- Department of History and History of Arts, University Rovira i Virgli, Avinguda de Catalunya 35, 43002, Tarragona, Spain.
- Catalan Institute of Human Paleoecology and Social Evolution (IPHES-CERCA), Zona Educacional 4, Campus Sescelades URV (Edifici W3), 43007, Tarragona, Spain.
| | - Lumila Menéndez
- Department of Anthropology of the Americas, University of Bonn, Oxfordstraße 15, 53111, Bonn, Germany
- Department of Evolutionary Biology, University of Vienna, Djerassiplatz 1, 1030, Vienna, Austria
| | - Giorgio Manzi
- Department of Environmental Biology, Sapienza University of Rome, 00185, Rome, Italy
| | - Jacopo Moggi-Cecchi
- Department of Biology, University of Florence, Via del Proconsolo, 12, 50122, Florence, Italy
| | - Carlos Lorenzo
- Department of History and History of Arts, University Rovira i Virgli, Avinguda de Catalunya 35, 43002, Tarragona, Spain
- Catalan Institute of Human Paleoecology and Social Evolution (IPHES-CERCA), Zona Educacional 4, Campus Sescelades URV (Edifici W3), 43007, Tarragona, Spain
| | - Antonio Profico
- Department of Biology, University of Pisa, Via Luca Ghini, 13, 56126, Pisa, Italy
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Matthews HS, Mahdi S, Penington AJ, Marazita ML, Shaffer JR, Walsh S, Shriver MD, Claes P, Weinberg SM. Using data-driven phenotyping to investigate the impact of sex on 3D human facial surface morphology. J Anat 2023. [PMID: 36943032 DOI: 10.1111/joa.13866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/23/2023] Open
Abstract
The effects of sex on human facial morphology have been widely documented. Because sexual dimorphism is relevant to a variety of scientific and applied disciplines, it is imperative to have a complete and accurate account of how and where male and female faces differ. We apply a comprehensive facial phenotyping strategy to a large set of existing 3D facial surface images. We investigate facial sexual dimorphism in terms of size, shape, and shape variance. We also assess the ability to correctly assign sex based on shape, both for the whole face and for subregions. We applied a predefined data-driven segmentation to partition the 3D facial surfaces of 2446 adults into 63 hierarchically linked regions, ranging from global (whole face) to highly localized subparts. Each facial region was then analyzed with spatially dense geometric morphometrics. To describe the major modes of shape variation, principal components analysis was applied to the Procrustes aligned 3D points comprising each of the 63 facial regions. Both nonparametric and permutation-based statistics were then used to quantify the facial size and shape differences and visualizations were generated. Males were significantly larger than females for all 63 facial regions. Statistically significant sex differences in shape were also seen in all regions and the effects tended to be more pronounced for the upper lip and forehead, with more subtle changes emerging as the facial regions became more granular. Males also showed greater levels of shape variance, with the largest effect observed for the central forehead. Classification accuracy was highest for the full face (97%), while most facial regions showed an accuracy of 75% or greater. In summary, sex differences in both size and shape were present across every part of the face. By breaking the face into subparts, some shape differences emerged that were not apparent when analyzing the face as a whole. The increase in facial shape variance suggests possible evolutionary origins and may offer insights for understanding congenital facial malformations. Our classification results indicate that a high degree of accuracy is possible with only parts of the face, which may have implications for biometrics applications.
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Affiliation(s)
- Harold S Matthews
- Department of Human Genetics, KU Leuven, 3000, Leuven, Belgium
- Medical Imaging Research Center, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Soha Mahdi
- Medical Imaging Research Center, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Anthony J Penington
- Facial Sciences Research Group, Murdoch Children's Research Institute, Parkville, 3052, Australia
- Department of Plastic and Maxillofacial Surgery, Royal Children's Hospital, Melbourne, 3052, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, 3052, Australia
| | - Mary L Marazita
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, 15219, USA
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, 15261, USA
| | - John R Shaffer
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, 15219, USA
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, 15261, USA
| | - Susan Walsh
- Department of Biology, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, 46202, USA
| | - Mark D Shriver
- Department of Anthropology, Pennsylvania State University, State College, Pennsylvania, 16802, USA
| | - Peter Claes
- Department of Human Genetics, KU Leuven, 3000, Leuven, Belgium
- Medical Imaging Research Center, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium
- Facial Sciences Research Group, Murdoch Children's Research Institute, Parkville, 3052, Australia
- Department of Electrical Engineering, ESAT/PSI, KU Leuven, 3000, Leuven, Belgium
| | - Seth M Weinberg
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, 15219, USA
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, 15261, USA
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A Geometric Morphometric Study on Sexual Dimorphism in Viscerocranium. BIOLOGY 2022; 11:biology11091333. [PMID: 36138812 PMCID: PMC9495862 DOI: 10.3390/biology11091333] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022]
Abstract
The level of sexual dimorphism manifested by human bones is an important factor for development of effective sex estimation methods. The aim of the study was to investigate the sexual dimorphism in the size and shape of the viscerocranium using geometric morphometric techniques. It also aimed to explore the sex differences in distinct viscerocranial regions and to establish the most dimorphic region with regard to size and shape. Computed tomography images of 156 males and 184 females were used in the study. Three-dimensional coordinates of 31 landmarks were acquired. Five landmark configurations were constructed from the viscerocranium and its orbital, nasal, maxillary, and zygomatic region. Generalized Procrustes superimposition, principal component analysis, and discriminant analysis were applied to each configuration. The significance of the sex differences in size and shape was assessed and significant differences were found in all configurations. The highest accuracy was obtained from both shape and size of the whole viscerocranium. Based on size only, the highest accuracy was achieved by the nasal region. The accuracy based on shape was generally low for all configurations, but the highest result was attained by the orbital region. Hence, size is a better sex discriminator than shape.
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Sexual Dimorphism of Cranial Morphological Traits in an Italian Sample: A Population-Specific Logistic Regression Model for Predicting Sex. BIOLOGY 2022; 11:biology11081202. [PMID: 36009828 PMCID: PMC9405280 DOI: 10.3390/biology11081202] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/21/2022]
Abstract
Simple Summary Despite the fact that sex estimation methods from crania are very popular in forensic anthropology, few validation studies have verified their accuracy and reliability in different populations. Different from craniometrics, for which validation studies have remarkably increased lately, the methods based on cranial morphology still need to be thoroughly investigated, even if a large consensus exists on the effects of population variability on sexual cranial dimorphism. When dealing with forensic contexts, appropriately-validated methods should be applied for building accurate biological profiles. Since the possible sexual dimorphism variation of cranial morphological traits needs to be evaluated properly in various populations, in this study, we analyzed the accuracy of existing regression models for predicting sex from cranial morphological traits in an Italian contemporary/modern population. In addition, we propose new logistic regression models that are more accurate and specific for our sample. The results also update the reference standards for populations of this geographical area and provide an additional important warning on sexual dimorphism to anthropologists working in forensic contexts. Abstract Although not without subjectivity, the cranial trait scoring method is an easy visual method routinely used by forensic anthropologists in sex estimation. The revision presented by Walker in 2008 has introduced predictive models with good accuracies in the original populations. However, such models may lead to unsatisfactory performances when applied to populations that are different from the original. Therefore, this study aimed to test the sex predictive equations reported by Walker on a contemporary Italian population (177 individuals) in order to evaluate the reliability of the method and to identify potential sexual dimorphic differences between American and Italian individuals. In order to provide new reference data to be used by forensic experts dealing with human remains of modern/contemporary individuals from this geographical area, we designed logistic regression models specific to our population, whose accuracy was evaluated on a validation sample from the same population. In particular, we fitted logistic regression models for all possible combinations of the five cranial morphological traits (i.e., nuchal crest, mastoid process, orbital margin, glabella, and mental eminence). This approach provided a comprehensive set of population-specific equations that can be used in forensic contexts where crania might be retrieved with severe taphonomic damages, thus limiting the application of the method only to a few morphological features. The results proved once again that the effects of secular changes and biogeographic ancestry on sexual dimorphism of cranial morphological traits are remarkable, as highlighted by the low accuracy (from 56% to 78%) of the six Walker’s equations when applied to our female sample. Among our fitted models, the one including the glabella and mastoid process was the most accurate since these features are more sexually dimorphic in our population. Finally, our models proved to have high predictive performances in both training and validation samples, with accuracy percentages up to 91.7% for Italian females, which represents a significant success in minimizing the potential misclassifications in real forensic scenarios.
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Toneva DH, Nikolova SY, Tasheva-Terzieva ED, Zlatareva DK, Lazarov NE. Sexual dimorphism in shape and size of the neurocranium. Int J Legal Med 2022; 136:1851-1863. [PMID: 35945460 DOI: 10.1007/s00414-022-02876-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022]
Abstract
Sex identification is a primary step in forensic analysis of skeletal remains. The accuracy of sex estimation methods greatly depends on the sexual dimorphism manifested by the target anatomical region. The study aims to evaluate the sexual dimorphism in shape and size of the neurocranium and to compare the potential of shape and size of different cranial regions to classify correctly the male and female crania. The study was carried out on computed tomography images of 373 Bulgarian adults (161 males and 212 females). Three-dimensional coordinates of 32 landmarks were acquired. The landmarks were arranged in 4 configurations: neurocranium, frontal bone, parietotemporal region, and occipital bone. For each configuration, the presence of significant sex differences in shape and size was tested. Principal component analysis (PCA) was applied to explore the shape variation. The classification power of size and shape was tested using discriminant analysis and k-means clustering. The neurocranium shows significant sex differences in shape and size. The parietotemporal region is the most dimorphic neurocranial part in size and the frontal bone is the most differing one in shape. The size of the parietotemporal region and frontal bone classifies correctly more than 80% of the crania. The discrimination ability based on shape is rather low as the highest values of about 70% are obtained for the frontal and occipital bone. The PCA plots show large overlapping of the male and female crania. It can be inferred that the sex-specific size differences in the neurocranium are more important than the shape differences.
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Affiliation(s)
- Diana H Toneva
- Department of Anthropology and Anatomy, Institute of Experimental Morphology, Pathology and Anthropology with Museum, Bulgarian Academy of Sciences, Acad. G. Bonchev Str., Bl. 25, 1113, Sofia, Bulgaria.
| | - Silviya Y Nikolova
- Department of Anthropology and Anatomy, Institute of Experimental Morphology, Pathology and Anthropology with Museum, Bulgarian Academy of Sciences, Acad. G. Bonchev Str., Bl. 25, 1113, Sofia, Bulgaria
| | - Elena D Tasheva-Terzieva
- Department of Zoology and Anthropology, Faculty of Biology, Sofia University, 1164, Sofia, Bulgaria
| | - Dora K Zlatareva
- Department of Diagnostic Imaging, Faculty of Medicine, Medical University of Sofia, 1431, Sofia, Bulgaria
| | - Nikolai E Lazarov
- Department of Anatomy, Histology and Embryology, Faculty of Medicine, Medical University of Sofia, 1431, Sofia, Bulgaria
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Andrea C. As fast as a hare: did intraspecific morphological change bring the Hallands Väderö Island population of Lepus timidus close to interspecific differences in less than 150 years? ZOOLOGY 2022; 152:126014. [DOI: 10.1016/j.zool.2022.126014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 11/28/2022]
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Jeffery NS, Humphreys C, Manson A. A human craniofacial life-course: Cross-sectional morphological covariations during postnatal growth, adolescence, and aging. Anat Rec (Hoboken) 2021; 305:81-99. [PMID: 34369671 DOI: 10.1002/ar.24736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/19/2021] [Accepted: 06/30/2021] [Indexed: 01/22/2023]
Abstract
Covariations between anatomical structures are fundamental to craniofacial ontogeny, maturation, and aging and yet are rarely studied in such a cognate fashion. Here, we offer a comprehensive investigation of the human craniofacial complex using freely available software and MRI datasets representing 575 individuals from 0 to 79 years old. We employ both standard craniometrics methods as well as Procrustes-based analyses to capture and document cross-sectional trends. Findings suggest that anatomical structures behave primarily as modules, and manifest integrated patterns of shape change as they compete for space, particularly with relative expansions of the brain during early postnatal life and of the face during puberty. Sexual dimorphism was detected in infancy and intensified during adolescence with gender differences in the magnitude and pattern of morphological covariation as well as of aging. These findings partly support the spatial-packing hypothesis and reveal important insights into phenotypic adjustments to deep-rooted, and presumably genetically defined, trajectories of morphological size and shape change that characterize the normal human craniofacial life-course.
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Affiliation(s)
- Nathan S Jeffery
- Human Anatomy Resource Centre & Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Craig Humphreys
- Human Anatomy Resource Centre & Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Amy Manson
- Human Anatomy Resource Centre & Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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