Anatomist Hermann Stieve used Nazi victims for his research on the menstrual cycle, but did he also fabricate facts?

PURPOSE: Hermann Stieve (1886-1952), director of the Berlin Anatomical Institute from 1935, benefited from the rise of execution numbers during the "Third Reich". He used organs and tissues from executed women for his histological research on the reproductive organs and investigated the influence of "nervous agitation" on the cyclical changes of endometrium and ovary. It is still controversial how he was able to acquire intimate data on the executed women and it was therefore suggested that some of his data may have been "invented". METHODS: Newly emerged dissection protocols and histological drawings from Stieve's research, together with archived court records, enable a more detailed analysis of Stieve's published data. RESULTS: We extracted 304 case descriptions from Stieve's publications. Of these, 88 could be linked with 33 identifiable women and related historical records. Nearly all reported causes of death and/or verdicts of executed women were false. Reported clinical data, particularly the day of the menstrual cycle and uterine bleeding shortly before death, are more difficult to verify. We found non-standardised documentation and possible confusions of cases, which may in part be attributable to war effects. CONCLUSION: Stieve actively concealed the fate of the executed women, mostly by inventing imaginary stories. This followed a request by the German and Soviet authorities after 1945 not to publish results from cases of political victims, but only from "dangerous criminals". Scientifically relevant clinical data were not always reported correctly, but are not necessarily fraudulent as different interpretations of this finding can be suggested.

Pain is not the major determinant of quality of life in fibromyalgia: results from a retrospective "real world" data analysis of fibromyalgia patients.

OBJECTIVE: To identify correlates of quality of life (QoL) measured with the Quality of Life Scale (QOLS) in participants of a multidisciplinary day hospital treatment program for fibromyalgia (FM). METHODS: In this cross-sectional, observational study, "real world" data from 480 FM patients including socio-demographics, pain variables and questionnaires such as the SF-36, Beck Depression Inventory (BDI), Multiphasic Pain Inventory (MPI), SCL-90-R and others were categorized according to the components (body structure and function, activities and participation, personal factors, environmental factors) of the International Classification of Functioning (ICF). For every ICF component, a linear regression analysis with QOLS as the dependent variable was computed. A final comprehensive model was calculated on the basis of the results of the five independent analyses. RESULTS: The following variables could be identified as main correlates for QoL in FM, explaining 56% of the variance of the QOLS (subscale/questionnaire and standardized beta in parenthesis): depression (- 0.22), pain-related interference with everyday life (- 0.19), general activity (0.13), general health perception (0.11), punishing response from others (- 0.11), work status (- 0.10), vitality (- 0.11) and cognitive difficulties (- 0.12). Pain intensity or frequency was not an independent correlate. CONCLUSIONS: More than 50% of QoL variance could be explained by distinct self-reported variables with neither pain intensity nor pain frequency playing a major role. Therefore, FM treatment should not primarily concentrate on pain but should address multiple factors within multidisciplinary therapy.

[Undetected coccyx fracture in a woman with fibromyalgia]. / Unentdeckte Os-coccygis-Fraktur bei Patientin mit Fibromyalgiesyndrom.

This article presents the case of a 46-year-old woman with fibromyalgia with an undetected fracture of the coccyx. The heterogeneity of the symptoms of patients suffering from fibromyalgia including chronic widespread pain, vegetative and functional disorders, mental and physical exhaustion as well as sleep disorders can cause accidentally undetected comorbidities, especially if these are rare and predominantly present with pain as the main symptom. In the present case the reason for symptoms was detected only after 14 months of ineffective therapies and diagnostic procedures. The coccygeal pain was eliminated through a coccygectomy as ultima ratio. It should be nevertheless emphasized that patients with fibromyalgia suffer from a central pain-processing disorder. Indications for operative treatment must be very carefully considered. Surgery should only be considered in consultation with the patient and after failed conservative therapy.

Consent and consensus-ethical perspectives on obtaining bodies for anatomical dissection.

Biomedical research and education benefit from the use of human cadavers. These are usually acquired from donors who have willed their body to science during their lifetime. This concept of donation through "informed consent" respects the personal autonomy of the donor and the dignity of the dead body (extended from the dignity of the living person). The concept of informed consent is taken from research on living human subjects regulated in the Helsinki Declaration. This transfer to the domain of anatomical donation, however, has several problems. For example, the dead cannot speak for themselves and the ethical status of the human cadaver remains ambiguous. It is therefore suggested that an element of consensus is added to the concept of consent, a consensus between donors, relatives, anatomists, and the wider community. A consensus can give difficult decisions surrounding body donation and dissection a broader basis and can help bridge the gap between donors and families on the one side and anatomists, researchers and students on the other side. This approach can help to establish relationships of trust with local communities, on which body donation programs depend.

Acknowledging tissue donation: Human cadaveric specimens in musculoskeletal research.

Human cadaveric specimens are an important resource for research, particularly in biomechanical studies, but their use also raises ethical questions and cannot simply be taken for granted. It was asked how much information authors publishing musculoskeletal research actually give about such specimens and about how they were acquired. The aim was to formulate recommendations on how this reporting might be improved. Relevant articles published between 2009 and 2012 in four North American or European journals were scanned for information regarding the characteristics of the human specimens used, their institutional source and the ethical or legal context of their acquisition. While the majority of articles report biological characteristics of specimens (sex, age at death, preservation method), only 40% of articles refer to body donation, only 23% report the institution that provided specimens, and only 17% refer to some kind of formalized approval of their research. There were regional and journal-to-journal differences. No standard for reporting studies involving human specimens could be detected. It is suggested that such a standard be developed by researchers and editors. Information on the source of specimens and on the ethical or legal basis should be regularly reported to acknowledge this unique research resource and to preserve the good relationship between researchers and the communities, that provide the required specimens by body donation and upon which researchers depend.

Attentional bias toward negative information in patients with fibromyalgia syndrome.

OBJECTIVE: In addition to central nervous sensitization, affect dysregulation constitutes an important factor in the pathogenesis of fibromyalgia syndrome (FMS). The present study is concerned with emotional influences on information processing in FMS. The hypothesis of attentional bias, i.e., selective processing of negatively connoted stimuli, was tested. METHODS: Twenty-seven female FMS patients and 34 healthy women undertook an emotional modification of the Stroop task. Subjects had to decide whether the colors of positive, negative, and neutral adjectives accorded with color words presented in black. Attentional bias was defined as delay in color naming of emotional words relative to neutral words. Affective and anxiety disorders, pain severity, as well as medication were considered as possible factors mediating the expected interference. RESULTS: Patients showed marked attentional bias, manifested in a greater response delay due to negative words compared with the control group. Among the clinical features, pain severity was most closely associated with the extent of the interference. While depression played only a subordinate role, anxiety and medication were without effect. CONCLUSIONS: The study provides evidence of emotionally driven selective attention in FMS. Attentional bias to negative information may play an important role in the vicious circle between negative affective state and pain augmentation. In the management of FMS pain, strategies aiming at conscious direction of attention may be helpful, e.g., imagery techniques or mindfulness training.

Wilhelm Waldeyer as an object - Anatomists as body donors.

INTRODUCTION: Berlin anatomist Wilhelm von Waldeyer-Hartz (1836-1921) donated his skull, brain, and hands to his institute. Only the skull survives in the present-day collection. This study investigates the skull itself as much as the historical context of Waldeyer's donation. METHODS: Physical-anthropological investigation of the remains and historical research. RESULTS: Waldeyer's main motivation was the donation of his brain to science. While this was the first ever recorded body donation in Berlin, it was not unusual for scientists of his time to donate their brains and/or to investigate brains of fellow scientists to correlate brain morphology to individual traits. Nevertheless, Waldeyer's pupil Hans Virchow expressed reservations dissecting his former boss, reservations that were unknown to him when dissecting others. Waldeyer's brain was never investigated and not preserved, likely due to damage by stroke and poor anatomical fixation. Waldeyer's skull shows the common features of a male European of senile age with some notable anatomical variation including a "trigeminus bridge". DISCUSSION: Waldeyer's donation is embedded in a tradition of research looking, if in vain, for traceable signs of intelligence or geniality in brains of well-known individuals. Reservations of anatomists to dissect other anatomists and to donate their own bodies persist until today.

American Association for Anatomy recommendations for the management of legacy anatomical collections.

Collections of human remains in scientific and private institutions have a long tradition, though throughout history there has often been variable regard for the respect and dignity that these tissues demand. Recent public scandals around the use of human remains, coupled with an increasing community awareness around accountability in such instances, forces scholars to confront the ethical and moral concerns associated with these collections. This includes specific focus on the acquisition, storage, use, and disposition of these remains, which were often collected with no consent and with little knowledge, or concern, about the individual or their respective culture and practices surrounding death and postmortem treatment. As a response, the American Association for Anatomy convened a Legacy Anatomical Collections Task Force to consider these issues and to develop recommendations to assist those working with these tissues in education, research, and museum collections. This has culminated with the development of Recommendations for the Management of Legacy Anatomical Collections. The recommendations provide both an ethical foundation and practical considerations for the use, storage, and disposition of legacy collections of human tissues, and deliver guidance for establishing appropriate management and oversight, investigating provenance, and engaging with communities of care. While these Recommendations are considered a living document which will change over time as ethical principles concerning human tissue evolve, they currently represent 'best practice' recommendations that can guide researchers, teachers, and museum associates as they consider the future of legacy anatomical collections in their care.

Patient-related predictors of treatment satisfaction of patients with fibromyalgia syndrome: results of a cross-sectional survey.

OBJECTIVES: This study aimed to determine patient-related predictors of treatment satisfaction in fibromyalgia syndrome (FMS)-patients. METHODS: In a cross-sectional survey, participants with self-reported diagnosis of FMS were recruited by FMS-self help organisations and clinical institutions. The patients answered demographic and medical questionnaires, the Fibromyalgia Survey Questionnaire (FSQ) including the Somatic Severity Score (SSS) and Widespread Pain Index (WPI), the Patient Health Questionnaire (PHQ-4), and rated their treatment satisfaction on an 11-point Likert scale. The impact of patient-related variables (age, gender, partnership, educational level, time since onset of pain, time since FMS-diagnosis, health status since diagnosis, membership in FMS self-help organisations, polysymptomatic distress, anxiety and depression) and types of treatment on treatment satisfaction were tested by a multiple regression analysis. RESULTS: The study sample (n=1651 patients) was composed mainly of middle-aged women with a long disease history, and 83.9% fulfilled the American College of Rheumatology diagnostic criteria of 2010. There was considerate variety regarding treatment satisfaction in FMS-patients, 14.8% reported no, 31.7% low, 40.8% moderate and 12.7% high satisfaction. Higher satisfaction was predicted by longer time since FMS diagnosis (p=0.03), improved health status since FMS-diagnosis (p<0.0001), lower depression score (p=0.005) and higher amount of active therapies (p<0.0001). Other sociodemographic (age, gender etc.) and disease-related variables (polysymptomatic distress intensity) did not influence treatment satisfaction. CONCLUSIONS: The results of the study illustrate the influence of patient-related factors on treatment satisfaction. Treating comorbid depression and enabling patients to actively cope with the disease might prove successful in improving treatment satisfaction of FMS-patients.

Recognition of facially expressed emotions in patients with fibromyalgia syndrome.

The study investigated the ability to identify facially expressed emotions in fibromyalgia syndrome (FMS) and its association with clinical parameters. Thirty-five FMS patients and 35 healthy controls accomplished a face recognition task. Additionally, pain severity, alexithymia, depression, anxiety, psychiatric co-morbidity and medication use were assessed. The patients displayed reduced task performance in terms of more misclassifications of emotional expressions than controls. Pain severity, alexithymia, depression and anxiety were inversely related to recognition performance, with pain severity accounting for the largest portion of test score variance. Psychiatric co-morbidity and medication had no impact on performance. The study documented impaired emotion recognition in FMS, which may contribute to the interpersonal difficulties and reduced social functioning related to this condition. As potential mechanisms mediating the occurrence of the deficits, altered affective processing due to interoceptive impairment as well as interference of central nervous nociceptive activity with cognitive and emotional processing are discussed.

Implicit memory function in fibromyalgia syndrome.

The study investigated implicit memory function in fibromyalgia syndrome (FMS) and its association with clinical parameters. Implicit memory refers to the influence of past experience on current behavior without conscious awareness of these experiences. Eighteen FMS patients and 25 healthy individuals accomplished a word-stem completion task. As possible factors mediating the expected impairment, pain severity, emotional disorders, and medication were taken into account. The patients displayed markedly reduced task performance and higher levels of depression and anxiety. Among the clinical features, pain severity was most closely associated with performance, whereas depression, anxiety, and medication showed only a minor impact. The study documented reduced implicit memory function in FMS. In contrast to former findings on impaired performance of FMS patients on classical memory tests, lower implicit memory function cannot be ascribed to motivational deficits. Instead, the aberrances may relate to functional inference between central nervous nociceptive activity and cognitive processing.

Strong and aversive cold processing and pain facilitation in fibromyalgia patients relates to augmented thermal grill illusion.

The thermal grill illusion (TGI) is assumed to result from crosstalk between the thermoreceptive and nociceptive pathways. To elucidate this further, we compared 40 female fibromyalgia patients to 20 healthy women in an exploratory cross-sectional study. Sensations (cold, warm/heat, unpleasantness, pain and burning) evoked by 20 °C, 40 °C and alternating 20 °C/40 °C (TGI) and somatosensory profiles according to standardized quantitative sensory testing (QST) were assessed on the palm of the dominant hand. Compared to healthy controls, fibromyalgia patients reported stronger thermal grill-evoked cold, warm, unpleasantness and pain as well as stronger and more aversive 20 °C- and 40 °C-evoked sensations. They showed a loss in warm, mechanical and vibration detection, a gain in thermal pain thresholds and higher temporal summation (TS). Among QST parameters higher TS in fibromyalgia patients was most consistently associated with an augmented TGI. Independently, an increased TGI was linked to cold (20 °C) but less to warm (40 °C) perception. In fibromyalgia patients all thermal grill-evoked sensations were positively related to a higher 20 °C-evoked cold sensation and/or 20 °C-evoked unpleasantness. In conclusion, the TGI appears to be driven mainly by the cold-input. Aversive cold processing and central pain facilitation in fibromyalgia patients seem to independently augment the activation of the pain pathway.

Cerebral blood flow dynamics during pain processing in patients with fibromyalgia syndrome.

OBJECTIVES: Increased cerebral blood flow during processing of acute pain has repeatedly been observed in fibromyalgia syndrome. The study investigated the time dynamics of the pain-related hemodynamic response in fibromyalgia using transcranial Doppler sonography. METHODS: In 25 women with fibromyalgia and 25 healthy participants, blood flow velocities in the anterior and middle cerebral arteries of both hemispheres were recorded, while heat stimuli of 45°C were applied to their forearms. Thermal pain threshold and subjective pain experience during stimulation were assessed, and the participants completed the McGill Pain Inventory, Beck Depression Inventory, and State-Trait Anxiety Inventory. RESULTS: The early component of the blood flow response in both anterior cerebral arteries, that is, the steep flow increase during the initial stimulation period, was more pronounced in the patients than in the controls (mean [standard deviation] = 1.28% [1.85%] versus 0.24% [1.58%], p = .04). The patients showed lower pain threshold (p = .018), stronger sensory and affective pain experience (p < .001), and increased values on all questionnaire scales (all p values < .001). Although higher scores on each of the scales were associated with a stronger early blood flow response (r values ranging from 0.17 to 0.36), clinical pain severity proved to be the best predictor (ß = .33, p = .02). CONCLUSIONS: The increased blood flow response in the anterior cerebral arteries reflects hyperactivity of medial structures of the neuromatrix of nociception, structures involved in the processing of affective and cognitive aspects of pain. Aberrances in cerebral blood flow related to fibromyalgia and its clinical characteristics become particularly apparent in the enhancement of the initial component of the hemodynamic response.

The German fibromyalgia consumer reports - a cross-sectional survey.

BACKGROUND: Consumer surveys provide information on effectiveness and side effects of medical interventions in routine clinical care. A report of fibromyalgia syndrome (FMS) consumers has not been carried out in Europe. METHODS: The study was carried out from November 2010 to April 2011. Participants diagnosed with FMS rated the effectiveness and side effects of pharmacological and non-pharmacological FMS interventions on a 0 to 10 scale, with 10 being most efficacious (harmful). The questionnaire was distributed by the German League for people with Arthritis and Rheumatism and the German Fibromyalgia Association to their members and to all consecutive FMS patients of nine clinical centers of different levels of care. RESULTS: 1661 questionnaires (95% women, mean age 54 years, mean duration since FMS diagnosis 6.8 years) were analysed. The most frequently used therapies were self-management strategies, prescription pain medication and aerobic exercise. The highest average effectiveness was attributed to whole body and local warmth therapies, thermal bathes, FMS education and resting. The highest average side effects were attributed to strong opioids, local cold therapy, gamma-amino-butyric acid analogues (pregabalin and gabapentin), tramadol and opioid transdermal systems. CONCLUSION: The German fibromyalgia consumer reports highlight the importance of non-pharmcological therapies in the long-term management of FMS, and challenges the strong recommendations for drug therapies given by FMS-guidelines.

The "economy of truth" - New historical sources allow new insights into Hermann Stieve's use of bodies of execution victims for research.

INTRODUCTION: During the times of National Socialism, Berlin anatomist Hermann Stieve had access to many bodies of executed women for his histological research on reproductive organs. Newly emerged sources add to our knowledge of this research and allow a critical examination of some of Stieve's post-war claims. SOURCES: Descendants of Stieve have preserved more than 200 dissection protocols in Stieve's own hand, which are now held at the archive of Humboldt University in Berlin. In addition, a list of names of execution victims related to this research has been newly identified at the Federal Archive in Berlin. RESULTS: The 207 protocols mostly relate to women executed in Berlin Plötzensee from March 1942 onwards and include two women executed after the war in January 1947. Other sources show that bodies of executed men were delivered to the institute of anatomy until November 1950. The documents confirm that Stieve did not use only the bodies of "Schwerverbrecher [felons]" as he had asserted in 1952. They do verify some of Stieve's post war claims, like that he had access to court records of the victims and likely also to information from attending doctors and family members, if only in rare cases. DISCUSSION: The anatomists' access to bodies of the executed continued after 1945 as this practice was not seen as something Nazi-typical by the allied authorities. Hermann Stieve's post-war defence strategy can be characterised by an "economic" handling of the truth, avoiding outright lies by making true statements on rare cases which, however, were not representative of his general course of actions.

Das Schambein und die Scham.

SHAME ON THE PUBIC BONE: The German term "Schambein" (literally "shame bone") for the pubic bone, the anterior part of the pelvis, takes its name from its proximity to the sexual organs. At least the female external genitalia also carry German names built with the term "Scham" (shame). While the same is true for many Latin terms referring to the female genitalia like pudendum (pudor meaning shame), this is not true for the Os pubis which has a different Latin root that does not carry the negative connotation of shame.It has recently been suggested that the official Latin terms for the anatomy of the female genitalia should be replaced with less derogatory designations. This also applies to the German term "Schambein" - nobody needs to be ashamed of the pubic bone. We therefore suggest that it should be renamed as "Schoßbein" (literally "lap bone"), a term that is neutral and correctly describes its anatomical location.

Traces of Nazi victims in Hermann Stieve's histological collection.

INTRODUCTION: Berlin anatomist Hermann Stieve (1886-1952) had access to many bodies of execution victims during the period of National Socialism and used tissues from these bodies to conduct histological research. Estate material of his eldest son, who died in 2012, included histological specimens related to this research, some of them carrying inscriptions with names. This historical investigation tried to identify the individuals behind these names and their fate. SOURCES AND METHODS: Information was sought in several archives, the data collection of the Gedenkstätte Deutscher Widerstand (German Resistance Memorial Center), Stieve's own publications, and in other estate material. FINDINGS: Thirty-six of the hundreds of histological slides from the estate carried a total of 20 personal names. Fifteen of these could be unequivocally related to individual historical persons, twelve women and three men, all of them executed at Berlin Plötzensee prison between 1937 and 1945. As detailed as the archival sources allowed, the fate of these individuals was reconstructed. They include men and women convicted of alleged political resistance activities, but also of just stealing cigarettes or speaking bad of Hitler. They were all victims of a murderous justice system, and their fate demonstrates the involvement of the anatomist in this system. CONCLUSIONS: The histological slides from Stieve's estate were buried on the Dorotheenstädtischer Friedhof in central Berlin on 13 May 2019. For most execution victims, this place now is the only known burial site of their mortal remains, as they were denied a grave at the time.