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Immune checkpoint inhibitors(ICIs) have improved survival and are increasingly used for cancer. However, ICIs use may be limited by immune-related adverse events (irAEs), such as ICI-induced diabetes mellitus(ICI-DM). The objective of the present study was to characterize ICI-DM patients and real-world adherence to guidelines.
The present study was a retrospective review of electronic records of ICI-DM patients at the First Affiliated Hospital of Nanjing Medical University between July 2018 and October 2022.
34.8% (8/23)patients monitored blood glucose in every treatment cycle. The proportion of patients with severe diabetic ketoacidosis(DKA) was lower in the tight glycemic monitoring group than the non-tight glycemic monitoring group (16.7% vs. 55.6%, p = 0.049). 78.3%(18/23) patients with hyperglycemia visited a non-endocrinologist first, but 95.7% of patients were then referred to an endocrinologist. Twenty patients were tested for distinguishing the etiology of hyperglycemia and 20% patients with positive glutamic acid decarboxylase antibody(GADA), 55% with C-peptide <3.33pmol/L. High screening rates for other ICI-induced endocrinopathies were observed and half of the patients with ICI-DM developed other endocrine gland irAEs, with the most common being thyroiditis. Moreover, five patients developed non-endocrine serious adverse events(SAEs). Twelve (52.2%) patients were withdrawn from ICI due to ICI-DM. The time to progression of tumor in ICI-DM patients in the continue and interruption group was longer than in the withdrawal group (333.5 ± 82.5 days vs. 183.1 ± 62.4 days, p = 0.161). Only 17.4% of ICI-DM patients were completely managed according to guidelines. Thus, the present study proposed a screening, diagnosis, and management algorithm for ICI-DM in real-world practice.
The present study reported the largest number of ICI-DM cases described in a single institute, providing insight into real-world ICI-DM management guideline adherence and highlighting the clinical challenges in ICI-DM management.

When there is no immediate response after a proposal and normally the silence is longer than 0.2 s, the proposer would take subsequent actions to pursue a preferred response or mobilize at least an articulated one from the recipient. These actions modulate the prior deontic stance embedded in the original proposal into four trends as follows: (1) maintaining the prior deontic stance with a self-repair or by seeking confirmation; (2) making the prior deontic stance more tentative by making a revised other-attentiveness proposal, providing an account, pursuing with a tag question, or requesting with an intimate address term; (3) making the prior deontic stance more decisive by making a further arrangement (for the original proposal), closing the local sequence, or providing a candidate unwillingness account (for the recipient\'s potential rejection); and (4) canceling the prior deontic stance by doing a counter-like action. Additionally, these trends inherently embody a decisive-to-tentative gradient. This study would penetrate into the phenomena occurring in Mandarin mundane talk with the methodology of Conversation Analysis to uncover the underflow of deontic stance.

China\'s participation in global governance, inspired by the 17 United Nations Sustainable Development Goals, is driven by the guiding principle of \"building a community of shared future for mankind\". China has been promoting the Belt and Road Initiative and South-South Cooperation and has made significant contributions to the prosperity of human beings. Along with the opportunities that globalization brought about such as the World Health Organization and the boom in the economy, global health challenges also emerged. This resulted in certain obstacles for China when it sought to advocate the Belt and Road Initiative and when it attempted to carry out its strategy to address global health issues. What are the emerging challenges for global health? What can China do for global health? Why does global health need China? We tried to address these questions as China\'s global engagement continues to expand in the new era. This article makes the case for Chinese approaches, including getting involved in public health, being consistent in addressing local conditions, sharing China\'s experience with handling health services, and strengthening government-led action while being guided by relative policies. China has a lot to offer in the promotion of global health and in overcoming the challenges and risks that this goal currently faces. Thus, China should be considered an inseparable part of global health governance and bilateral health development cooperation.

China\'s government is considering legalization of online prescription drugs to increase the pharmaceutical market and enhance access to necessary medicines. However, challenges such as a shortage of licensed pharmacists and drug quality issues have raised concerns and delayed consensus on the proposal. China\'s government must address the most pressing issues so it can render a decision on online prescription sales.