Chronic kidney disease (CKD) is common in the German adult population, with a prevalence of 10%. This guideline, updated on the basis of current scientific evidence, contains recommendations for the management of CKD in general practice. The updated guideline is based on a review and assessment of source guidelines and systematic reviews concerning individual questions. The recommendations were agreed upon in a moderated two-stage nominal group process by the mandate holders of the participating specialist societies, along with patient representatives. The risk of progression to renal failure requiring renal replacement therapy should be assessed with a risk score. Assessing this risk and determining the indication for treatment with SGLT2 inhibitors both require measurement of the urinary albumin-to-creatinine ratio. Pharmacotherapy is not recommended for asymptomatic hyperuricemia. An initial ultrasonographic examination of the kidneys and urogenital system is now recommended for all patients. The vaccination recommendations that differ for people with CKD have been integrated into the guideline. The risk assessment of CKD and the treatment options have been expanded. The updated guideline can improve primary care for patients with CKD and the selection of patients for interdisciplinary care.

The hypothesis that lunar cycles influence human behaviour, particularly incidents recorded by police or coroners, has been a topic of public and media interest around the world for decades. While connections between lunar cycles and numerous cultural practices are well-documented, claims that lunar cycles influence crime or suicide statistics have not been consistently supported. There have been recent media claims that suicide rates in New Zealand follow a lunar cycle, correlating with the Māori Maramataka lunar calendar. Building on prior research, this study scrutinises the postulated association between lunar phases and suicide rates, for general and Māori populations. Utilising 2 decades (2000–2022) of data from the National Coronial Information System (NCIS) and the New Zealand Ministry of Health – Manatū Hauora, the study employs Poisson regression models and cosine curve analyses. Results reveal no significant correlation between lunar phases and suicide rates for the overall population or the Māori sub-group. The absence of a lunar effect persists across univariate and multivariate analyses, incorporating annual, seasonal and day-of-the-week variations. Contrary to claims linking lunar phases to Māori suicide rates, this study provides a robust analysis of comprehensive suicide data. While acknowledging potential limitations, such as the diversity among Maramataka systems and unaccounted external factors, this study emphasises the need for evidence-based practices in mental health interventions. Further research is warranted to explore potential lunar influences on less severe mental health indicators and to substantiate claims supporting traditional Māori Maramataka-based treatments.

aim: There are limited data on the prevalence of calcific aortic valve disease (CAVD) in Māori and known inequities in outcomes after aortic valve intervention. Our study aimed to investigate the prevalence of CAVD in Māori. methods: Data from initial clinically indicated echocardiograms performed between 2010 to 2018 in patients aged ≥18 years were linked to nationally collected outcome data. Ethnicity was defined using protocols from the Ministry of Health. results: Of the 23,635 patients, 1,312 (5.6%) identified as Māori, and 22,323 (94.4%) as European. Prevalence of aortic stenosis was 5.3% in Māori and 9.9% in Europeans. Age-specific prevalence did not differ between the two groups. Māori with CAVD were more than twice as likely to have advanced cardiac impairment (right ventricular dysfunction) than Europeans (10.1% vs 4.6, p<0.001). conclusions: Age-specific CAVD rates did not differ between Māori and Europeans, though Māori had a higher proportion of advanced cardiac impairment, which is likely unrelated to CAVD. Differences in population structure likely explain the difference in overall prevalence of CAVD. The improving life expectancy in Māori may lead to increasing incidence of CAVD, thus strategies to improve detection and medical management of CAVD should begin as soon as possible.

Objective: To investigate the current status of life stress and hypertension among couples of childbearing age across diverse economic regions in China, and to explore relevant influencing factors. Methods: This study was a cross-sectional study, with subjects from the "Research on the standardized system of comprehensive prevention and control of birth defects based on preconception-prenatal-postnatal whole chain". From February to May 2021, urban and rural couples of childbearing age (18-49 years old) from Beijing, Henan, and Gansu provinces were enrolled, representing the eastern, central, and western regions of China, respectively. The detection rate, cognition and control of hypertension in the general population, as well as the detection rate of hypertension in different genders and regions were analyzed. Subjects were divided into hypertensive group and non-hypertensive group based on whether their blood pressure was≥140/90 mmHg (1 mmHg=0.133 kPa), and the general clinical data of the two groups were compared. Subjects were also divided into prehypertension and hypertension group and normal blood pressure group based on whether their blood pressure was≥130/80 mmHg, and the general clinical data of the two groups were compared, with subgroup analyses conducted by gender. Multifactorial logistic regression model was applied to identify factors associated with prehypertension and hypertension in both males and females. Results: A total of 1 942 couples of childbearing age, comprising 3 884 individuals, aged (29.8±5.2) years were enrolled, with 1 942 males (50.0%). The overall hypertension detection rate was 6.3% (246/3 884), with a detection rate of 10.5% (203/1 942) in males and 2.2% (43/1 942) in females. The hypertension detection rates in Beijing, Henan, and Gansu were 6.2% (92/1 482), 11.6% (139/1 200), and 1.2% (15/1 202), respectively. The overall detection rate of prehypertension and hypertension was 40.5% (1 574/3 884). Multifactorial logistic regression analysis showed that life pressure factors had no effect on female blood pressure levels (P>0.05), while a significant or high level of life/work pressure was a risk factor for prehypertension and hypertension in males (OR=2.30, 95%CI 1.06-4.99, P<0.05). Conclusion: The detection rate of prehypertension and hypertension among young couples of childbearing age in China is high, with poor awareness and control of hypertension. There are sex differences in the relationship between life pressure and blood pressure levels. Comprehensive consideration of individual living environments and mental health factors is crucial in blood pressure management. Measures to reduce life stress and enhance mental resilience should be implemented to address this public health issue.

Objective: To compare the impact of manual right arm blood pressure measurement with computer-controlled blood pressure meter (CCBPM) on the detection rate of hypertension among elderly individuals. Method: This was a cross-sectional study. Elderly residents undergoing routine health check-up in a village in Jiangxi Province from April to June 2024 were enrolled. Manual blood pressure measurements were performed on the right arm using an electronic sphygmomanometer, while standardized dual-arm synchronized blood pressure assessments were conducted using the CCBPM. Blood pressure data were recorded from three sources: manual measurement on the right arm; the first CCBPM measurement on the arm with higher systolic blood pressure (CCBPM single); and the mean blood pressure of the arm with higher systolic blood pressure from two (if the difference between the first two measurements was less than 5 mmHg, 1 mmHg=0.133 kPa) or three (if the difference exceeded 5 mmHg) CCBPM measurements (CCBPM mean). Hypertension detection rates from these three datasets were compared. Subgroup analysis was performed according to age (60-74 years old as the elderly group,≥75 years old as the senior group) and gender. Intra-group correlation coefficient (ICC) was analyzed to evaluate the consistency of blood pressure data of different blood pressure measurement methods, and Kappa value was analyzed to evaluate the consistency of hypertension classification determined by different blood pressure measurement methods. Results: A total of 1 498 participants were enrolled, aged (71.30±6.83) years old, including 678 males (45.26%). The blood pressure and heart rate measured by the artificial right arm blood pressure measurement were higher than those measured by CCBPM single (blood pressure: (140.09±17.19)/(82.40±10.93) mmHg vs. (135.31±18.98)/(81.23±10.51) mmHg; heart rate: (75.76±11.72) beats/min vs.(72.94±11.21) beats/min) and CCBPM mean (blood pressure: (140.09±17.19)/(82.40±10.93) mmHg vs. (134.64±18.39)/(80.28±9.78) mmHg; heart rate: (75.76±11.72) beats/min vs. (72.87±10.70) beats/min, all P<0.05). The detection rate of hypertension determined by CCBPM mean was significantly lower than that of artificial right arm (40.25% (603/1 498) vs.54.34% (814/1 498)) and CCBPM single (40.25% (603/1 498) vs. 44.79% (671/1 498), all P<0.05). Subgroup analysis showed that that the detection rate of hypertension determined by CCBPM mean was lower than that measured by artificial right arm regardless of gender and age (all P<0.05). The consistency of blood pressure data between artificial right arm and the CCBPM mean was moderate (systolic blood pressure: ICC=0.70; diastolic blood pressure: ICC=0.62), with less consistent classification (Kappa=0.37). The consistency of blood pressure data between CCBPM single and CCBPM mean is extremely high (systolic blood pressure: ICC=0.94; diastolic blood pressure: ICC=0.91), with highly consistent classification (Kappa=0.74). Conclusions: Artificial right arm blood pressure measurement in physical examinations may overestimate the hypertension detection rate, and the standardized dual-arm synchronized blood pressure measurement using CCBPM can reduce irregular blood pressure measurement.

BACKGROUND Patients with BRAF V600E mutant metastatic colorectal cancer (mCRC) have a low incidence rate, poor biological activity, suboptimal response to conventional treatments, and a poor prognosis. In the previous cohort study on mCRC conducted by our team, it was observed that integrated Chinese and Western medicine treatment could significantly prolong the overall survival (OS) of patients with colorectal cancer. Therefore, we further explored the survival benefits in the population with BRAF V600E mutant mCRC. AIM To evaluate the efficacy of integrated Chinese and Western medicine in the treatment of BRAF V600E mutant metastatic colorectal cancer. METHODS A cohort study was conducted on patients with BRAF V600E mutant metastatic colorectal cancer admitted to Xiyuan Hospital of China Academy of Chinese Medical Sciences and Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region from January 2016 to December 2022. The patients were divided into two cohorts. RESULTS A total of 34 cases were included, with 23 in Chinese-Western medicine cohort (cohort A) and 11 in Western medicine cohort (cohort B). The median overall survival was 19.9 months in cohort A and 14.2 months in cohort B, with a statistically significant difference (P = 0.038, hazard ratio = 0.46). The 1-3-year survival rates were 95.65% (22/23), 39.13% (9/23), and 26.09% (6/23) in cohort A, and 63.64% (7/11), 18.18% (2/11), and 9.09% (1/11) in cohort B, respectively. Subgroup analysis showed statistically significant differences in median OS between the two cohorts in the right colon, liver metastasis, chemotherapy, and first-line treatment subgroups (P &lt; 0.05). CONCLUSION Integrated Chinese and Western medicine can prolong the survival and reduce the risk of death in patients with BRAF V600E mutant metastatic colorectal cancer, with more pronounced benefits observed in patients with right colon involvement, liver metastasis, combined chemotherapy, and first-line treatment.