Exploring clinical applications and long-term effectiveness of benzodiazepines: An integrated perspective on mechanisms, imaging, and personalized medicine.

Benzodiazepines have been long-established treatments for various conditions, including anxiety disorders and insomnia. Recent FDA warnings emphasize the risks of misuse and dependence associated with benzodiazepines. This article highlights their benefits and potential drawbacks from various perspectives. It achieves this by explaining how benzodiazepines work in terms of neuroendocrinology, immunomodulation, sleep, anxiety, cognition, and addiction, ultimately improving their clinical effectiveness. Benzodiazepines play a regulatory role in the HPA axis and impact various systems, including neuropeptide Y and cholecystokinin. Benzodiazepines can facilitate sleep-dependent memory consolidation by promoting spindle wave activity, but they can also lead to memory deficits in older individuals due to reduced slow-wave sleep. The cognitive effects of chronic benzodiazepines use remain uncertain; however, no adverse findings have been reported in clinical imaging studies. This article aims to comprehensively review the evidence on benzodiazepines therapy, emphasizing the need for more clinical studies, especially regarding long-term benzodiazepines use.

Response of a submerged macrophyte (Vallisneria natans) to water depth gradients and sediment nutrient concentrations.

Submerged plants constitute a vital component of shallow lake ecosystems, where water depth and sediment nitrogen­phosphorus content are two key factors influencing their growth. This study focuses on Vallisneria natans and investigates the morphological and physiological changes of V. natans under the interaction of three water depth gradients and two different sediment nutrient levels. It explores the mechanisms through which varying sediment nutrient conditions under different water depths affect the growth of V. natans. The results indicate that both independent and interactive effects of water depth and sediment nutrient status significantly impact the morphology, antioxidant enzyme activity, and photosynthetic pigment content of V. natans, with water depth having a greater influence. To adapt to increased water depth-induced light stress, V. natans responds morphologically by increasing leaf length, leaf width, and decreasing maximum root length. Physiologically, it enhances its antioxidant regulation capacity and photosynthetic efficiency by increasing antioxidant enzyme activity, root vitality, and photosynthetic pigment content to counter weak light stress. However, these adaptations are insufficient to cope with excessively deep waters (200 cm). Sediment nutrient levels primarily control the growth of V. natans by affecting its root system. When sediment nitrogen and phosphorus content is lower, V. natans exhibits greater total root volume and surface area to enhance nutrient absorption efficiency. Water depth not only directly influences the growth of submerged plants but may also impact the migration and transformation of phosphorus in sediments, further exacerbating its effects on the growth of these plants, thus accelerating the regime shift of shallow lakes. Therefore, this study reveals V. natans' response strategies to varying water depths and sediment nutrient levels, determining suitable water levels and sediment nutrient conditions for its growth. These research findings provide a scientific basis for water level management and ecological restoration of submerged aquatic plants in shallow lakes.

A Decade of Changes in Preferences for Life-Sustaining Treatments Among Terminally Ill Patients With Cancer.

BACKGROUND: Changes over time in preferences for life-sustaining treatments (LSTs) at end of life (EOL) in different patient cohorts are not well established, nor is the concept that LST preferences represent more than 2 groups (uniformly prefer/not prefer). PURPOSE: The purpose of this study was to explore heterogeneity and changes in patterns of LST preferences among 2 independent cohorts of terminally ill patients with cancer recruited a decade apart. METHODS: Preferences for cardiopulmonary resuscitation, intensive care unit care, cardiac massage, intubation with mechanical ventilation, intravenous nutritional support, nasogastric tube feeding, and dialysis were surveyed among 2,187 and 2,166 patients in 2003-2004 and 2011-2012, respectively. Patterns and changes in LST preferences were examined by multigroup latent class analysis. RESULTS: We identified 7 preference classes: uniformly preferring, uniformly rejecting, uniformly uncertain, favoring nutritional support but rejecting other treatments, favoring nutritional support but uncertain about other treatments, favoring intravenous nutritional support with mixed rejection of or uncertainty about other treatments, and preferring LSTs except intubation with mechanical ventilation. Probability of class membership decreased significantly over time for the uniformly preferring class (15.26%-8.71%); remained largely unchanged for the classes of uniformly rejecting (41.71%-40.54%) and uniformly uncertain (9.10%-10.47%), and favoring nutritional support but rejecting (20.68%-21.91%) or uncertain about (7.02%-5.47%) other treatments, and increased significantly for the other 2 classes. The LST preferences of Taiwanese terminally ill patients with cancer are not a homogeneous construct and shifted toward less-aggressive treatments over the past decade. CONCLUSIONS: Identifying LST preference patterns and tailoring interventions to the unique needs of patients in each LST preference class may lead to the provision of less-aggressive EOL care.