James R. Doty

THE CYBERKNIFE : A FRAMELESS ROBOTIC SYSTEM FOR RADIOSURGERY

The Cyberknife is a unique instrument for performing frameless stereotactic radiosurgery. Rather than using rigid immobilization, the Cyberknife relies on an image-to-image correlation algorithm for target localization. Furthermore, the system utilizes a novel, light-weight, high-energy radiation source. The authors describe the technical specifications of the Cyberknife and summarize the initial clinical experience.

A wandering mind is a less caring mind: Daily experience sampling during compassion meditation training

Mind wandering, or the tendency for attention to drift to task-irrelevant thoughts, has been associated with worse intra- and inter-personal functioning. Utilizing daily experience sampling with 51 adults during 9-weeks of a compassion meditation program, we examined effects on mind wandering (to neutral, pleasant, and unpleasant topics) and caring behaviors for oneself and others. Results indicated that compassion meditation decreased mind wandering to neutral topics and increased caring behaviors towards oneself. When collapsing across topics, mind wandering did not serve as an intermediary between the frequency of compassion meditation practice and caring behaviors, though mind wandering to pleasant and unpleasant topics was linked to both variables. A path analysis revealed that greater frequency of compassion meditation practice was related to reductions in mind wandering to unpleasant topics and increases in mind wandering to pleasant topics, both of which were related to increases in caring behaviors for oneself and others.

The current and future role of heart rate variability for assessing and training compassion

The evolution of mammalian caregiving involving hormones, such as oxytocin, vasopressin, and the myelinated vagal nerve as part of the ventral parasympathetic system, enables humans to connect, co-regulate each other’s emotions and create prosociality. Compassion-based interventions draw upon a number of specific exercises and strategies to stimulate these physiological processes and create conditions of “interpersonal safeness,” thereby helping people engage with, alleviate, and prevent suffering. Hence, compassion-based approaches are connected with our evolved caring motivation and attachment and our general affiliative systems that help regulate distress. Physiologically, they are connected to activity of the vagus nerve and corresponding adaptive heart rate variability (HRV). HRV is an important physiological marker for overall health, and the body–mind connection. Therefore, there is significant value of training compassion to increase HRV and training HRV to facilitate compassion. Despite the significance of compassion in alleviating and preventing suffering, there remain difficulties in its precise assessment. HRV offers a useful form of measurement to assess and train compassion. Specific examples of what exercises can facilitate HRV and how to measure HRV will be described. This paper argues that the field of compassion science needs to move toward including HRV as a primary outcome measure in its future assessment and training, due to its connection to vagal regulatory activity, and its link to overall health and well-being.

Pilot study of a compassion meditation intervention in chronic pain

BackgroundThe emergence of anger as an important predictor of chronic pain outcomes suggests that treatments that target anger may be particularly useful within the context of chronic pain. Eastern traditions prescribe compassion cultivation to treat persistent anger. Compassion cultivation has been shown to influence emotional processing and reduce negativity bias in the contexts of emotional and physical discomfort, thus suggesting it may be beneficial as a dual treatment for pain and anger. Our objective was to conduct a pilot study of a 9-week group compassion cultivation intervention in chronic pain to examine its effect on pain severity, anger, pain acceptance and pain-related interference. We also aimed to describe observer ratings provided by patients’ significant others and secondary effects of the intervention.MethodsPilot clinical trial with repeated measures design that included a within-subjects wait-list control period. Twelve chronic pain patients completed the intervention (F = 10). Data were collected from patients at enrollment, treatment baseline and post-treatment; participant significant others contributed data at the enrollment and post-treatment time points.ResultsIn this predominantly female sample, patients had significantly reduced pain severity and anger and increased pain acceptance at post-treatment compared to treatment baseline. Significant other qualitative data corroborated patient reports for reductions in pain severity and anger.ConclusionsCompassion meditation may be a useful adjunctive treatment for reducing pain severity and anger, and for increasing chronic pain acceptance. Patient reported reductions in anger were corroborated by their significant others. The significant other corroborations offer a novel contribution to the literature and highlight the observable emotional and behavioral changes in the patient participants that occurred following the compassion intervention. Future studies may further examine how anger reductions impact relationships with self and others within the context of chronic pain.

Intramedullary spinal cord metastasis from prostate carcinoma: a case report

IntroductionAlthough vertebral and epidural metastases are common, intradural metastases and intramedullary spinal cord metastases are rare. The indications for the treatment of intramedullary spinal cord metastases remain controversial. We present the first biopsy-proven case of an intramedullary spinal cord metastasis from adenocarcinoma of the prostate.Case presentationOur patient was a 68-year-old right-handed Caucasian man with a Gleason grade 4 + 3 prostate adenocarcinoma who had previously undergone a prostatectomy, androgen blockade and transurethral debulking. He presented with new-onset saddle anesthesia and fecal incontinence. Magnetic resonance imaging demonstrated a spindle-shaped intramedullary lesion of the conus medullaris. Our patient underwent decompression and an excisional biopsy; the lesion’s pathology was consistent with metastatic adenocarcinoma of the prostate. Postoperatively, our patient received CyberKnife® radiosurgery to the resection cavity at a marginal dose of 27Gy to the 85% isodose line. At three months follow-up, our patient remains neurologically stable with no new deficits or lesions.ConclusionsWe review the literature and discuss the indications for surgery and radiosurgery for intramedullary spinal cord metastases. We also report the novel use of stereotactic radiosurgery to sterilize the resection cavity following an excisional biopsy of the metastasis.

Compassion as the Highest Ethic

Ethics are governing principles that help guide people or groups when making moral decisions, judgments, or when engaging in actions. We draw upon our ethical principles when attempting to address some of the most complicated decisions in our lives, for example in health care when dealing with difficult matters such as assisted suicide or with terminally ill patients. Indeed, many modern professions (e.g., doctors, psychologists) have ethical codes to ensure that members engage in behaviors, which are seen as being the human ideal that recognizes the integrity, dignity, and the justice of the individuals and the situation. In this chapter, we posit that compassion might be the foundation principal necessary in making ethically wise decisions. To support this premise, we will first define compassion, and how it can be understood in terms of evolutionary function, physiological processes, and brain functioning. We will then examine the benefits of compassion and how this links with ethics. Finally, we will discuss specific interventions that aim to cultivate compassion and how these might offer hope for individuals and society in making ethically wise decisions.