Optional Features Research Articles

Presidents in Parliamentary Democracies

Management and administration of a state are important functions to ensure security, protection, and shape environments where peoples of a country live. Depending on the context, various institutional design options have served as basis for governing a country. In democratic societies, three main institutional design options for a country’s governance are observed. The first institutional design option is Parliamentarism, where main officials mandate originates from an electoral system. The second is Presidentialism, where citizens can select directly by the vote the Parliamentarian/ Congressman and the President through different election processes. The third is Semipresidentialism, where there is more integration of the different branches, and the executive and legislative aren’t so strictly separated. This abstract gives a snapshot in the current year, about the main powers of the Presidents across Europe, by analyzing the exercising of power of the Presidents that is at an extent is influenced by the election procedure, whether the President derives from the election of the members of the Parliament or by electoral vote of the citizens (https://crsreports.congress.gov). This article provides an overview of the features of the key institutional design options in a country’s governance, with a view on the role and merits of Presidents versus types of institutional designs. At the same time, it contributes to raising consciousness about reforms needed in the current governance system, and setting priorities for choosing the institutional rules. The research method used for the purposes of writing of this article, is secondary research. This has involved review of various external sources from a variety of channels. Format sources reviewed have included published datasets, reports, articles, other. The analytical framework covers the following data sets: political systems, regime types, economic freedom, government defense integrity, freedom in the world, corruption perception index. The results indicate for a potential correlational relationship between the governance institutional design and level of development of a country. Data gathered shows that presidentialism and semipresidentialism are prevailing governance systems. But parliamentarians countries, tend to perform better in national sectoral assessments. Presidentialism or semipresidentialism countries, perform lower and, usually poor, in what is assessed as quality governance, and democratic regimes.

Smart Energy Meter using IOT

The wireless monitoring system of energy meter using Blynk application via smart phone. In addition, the over consumption of energy notification as an optional Features embedded in this system. Due to the advance recent technology in tandem with the Internet of Things (IoT) can be also applied in advance as an application of Artificial Intelligence (AI)into a manual device, transitional to an automated device such as smart meter that helps the smart cities to have an efficient energy management system as an ewconcept. This system used ESP32 as a micro- controller board with WiFi module to provide IoT communication with IoT platform such as Blynk application. The prototype designed intends to monitor daily energy consumption in the smart phone application interfaced with Blynk server and also provide awareness to save electricity through notification using Blynk features by the smart phone application. We need to select the current sensor as well as the voltage sensor so that the current & voltage can be measured and thus, we can know about the power consumption & total power consumed.

Option features and price discovery in convertible bonds

AbstractIn this paper, we investigate whether the option features in convertible bonds lead to price discovery. On the basis of minute‐level data from January 2019 to December 2021, we find that the convertible bond market contributes to the price discovery of the stock market by using the thermal optimal path method, and that the option features in convertible bonds are an important factor affecting the price discovery ability. Regression analysis shows that the effect of option features remains significant after controlling for a range of variables, such as the size of the convertible bond, the premium rate, information shock, and volatility. In addition, we further explore the impact of the difference in trading regimes between the convertible bond market and the equity market on price discovery.

Мультимодальный анализ в жанроведении: семиотика туристического буклета

The paper discusses the complex genre of tourist booklet as a fixed type of multimodal text that serves in a communicative situation of promoting a tourist product. This genre is a semiotically complex phenomenon, which conveys information through different semiotic systems. The methodological issues are posed as to a perspective model of genre analysis that would take into account the multimodal nature of genres. The author points to major hindrances that an analyst faces when doing multimodal analysis. The study focuses on discovering mechanisms of the interplay between verbal and visual components on semantic and formal levels, as well as showing how the elements of multimodal analysis can be targeted at various genre parameters. The booklets (85 items) for the study were collected in 2007–2019 in Australia, Great Britain, Germany, Poland, Russia and other countries. Methodologically, the paper draws on speech genre theory, semiotics, critical discourse analysis, and multimodal analysis. The claims are advanced that the tourist booklet has both obligatory and optional features, the visual component being obligatory. It is revealed that the colours of visuals can have factual and modal meanings embedded in them; photos convey precedent meanings; while using different semiotic codes, visual and verbal elements join the convergence relations and, thus, provide for genre coherence. The complex genre includes intertextual links between genres in its structure. These links may be of cross-code nature, since they are established between the elements of different semiotic systems, verbal and non-verbal. The conclusion is drawn that a consistent analytical model for multimodal genres has to be designed.

Research On The Pricing Of Rainbow Option Based On The Geometric Brownian Motion Model: Case Of Pfizer & Walmart

Trading financial derivatives become more and more popular in the modern life. The investor wants to purchase the financial derivative to receive more benefits. However, Option is the important component in the financial derivatives. Compared with Futures, Option can let investor feel more convenance since it acts as the contract. This research analyzes the price of the Rainbow Option in the Stock market. The Stock market includes two companies which are Pfizer and Walmart. The results shows that the Rainbow Option should be priced between max of call options and the sum of the options. It can testify the theory of rainbow Options‘ price successfully. Based on this research, the investor can understand the background and process of the rainbow Options‘ working. Combine with the feature of the rainbow options, the investor can make the proper investment decision in the different situations.

Variation and change in Swiss German agreement morphology: Spatial, social, and attitudinal effects

AbstractThis paper investigates the occurrence of inflected predicative adjectives, an optional yet distinguishing feature of German dialects spoken in southern Switzerland. We provide an in-depth analysis of the patterns of change of this morphosyntactic marker with a particular focus on extralinguistic factors. Historical records from 1950 were compared to contemporary data collected from 192 speakers across 49 localities in 2020–21. Our results corroborate previous reports indicating a substantial, real-time decline in inflected forms. Logistic mixed-effects modeling suggests that the inflection of predicative adjectives occurs more frequently among speakers who report tight social networks, have a strong local dialect identity, and regularly use one or more Romance languages. These findings support the claim that tight social networks and local dialect identity construction may lead to the preservation of conservative grammatical forms. Additionally, the effect of Romance languages highlights the role of transfer phenomena induced by language contact.

Development of Simple and Advanced Adult Proximal Tibia Simulators for a Decentralized Simulation-Based Education Model to Teach Paramedics-in-Training the Intraosseous Infusion Procedure.

Introduction During the COVID-19 pandemic, public health had advised practicing social distancing which led to the temporary shutdown of simulation laboratories or centralized simulation-based education model, shared spaces that healthcare workers such as paramedicsuse to train on important hands-on clinical skills for the job. One such skill is intraosseous (IO) access and infusion, the delivery of fluids and medication through the marrow or medullary cavity of the bone which provides fast and direct entry into the central venous system. This skill is critical in emergencies when peripheral access is not immediately available. To continue the training of paramedics in life-saving skills like IO infusion in the post-pandemic era, a decentralized simulation-based education (De-SBE) model was proposed. The De-SBE relies on the availability of inexpensive and flexible simulators that can be used by learners outside of the simulation laboratory. However, to date, there is a paucity of simulation design methods that stimulate creativity and ideation, and at the same time, provide evidence of validity for these simulators. Our exploratory research aimed to test a novel approach that combines components of development-related constraints, ideation, and consensus(CIC) approachto develop and provide content validity for simulators to be used in a De-SBE model. Materials and methods The development of the IO simulators was constrained to follow a design-to-cost approach. First, a modified design thinking session was conducted with three informants from paramedicine and medicine to gather ideas for the development of two IO simulators (simple and advanced). Next, to sort through, refine, and generate early evidence of the content validity of the simulators, the initial ideas were integrated into a two-round, modified Delphi process driven by seven informants from paramedicine and medicine. In addition, we surveyed the participants on how well they liked the CIC approach. Results The CIC approach generated a list of mandatory and optional features that could be added to the IO simulators. Specifically, six features (one mandatory and four optional) for the existing simple IO simulator and eight (three mandatories and five optional) for the advanced IO simulators were identified. Following a design-to-cost approach, the features classified as mandatory for the simple and advanced IO simulators were integrated into the final designs to maintain the feasibility of production for training purposes. The surveys with the participants showed that the CIC approach worked well in the group setting by allowing for various perspectives to be shared freely and ending with a list of features for IO simulator designs that could be used in the future. Some improvements to the approach included flagging for potential users to determine what works best concerning the mode of delivery (online or in person), and duration of the stages to allow for more idea generation. Conclusion The CIC approach led to the manufacturing of simple and advanced IO simulators that would suit a training plan catered to teach the IO access and infusion procedure decentrally to paramedics-in-training. Specifically, they have been designed in a manner that allows them to be made easily accessible to the trainees i.e., low costs and high mobility, and work cohesively with online learning management systems which further facilitates the use of a De-SBE model.

Physiological features of development and options for technology for obtaining pluripotent stem cells

Topical issues related to the technology of isolation and mechanisms of development of pluripotent stem cells and their application in medicine are considered. The isolation, as well as the subsequent use of stem cells, still remains an unsolved problem both from a scientific point of view and especially in practical health care. There are three ways to produce pluripotent stem cells. First, they can be obtained in vitro from cell culture of the inner layer of early eggs. These are embryonic stem cells. Second, they can be obtained from somatic cells, as a result of the introduction of a group of genes that induce pluripotency. These are induced pluripotent stem cells. Finally, they can be obtained by transplanting the nucleus of somatic cells into an enucleated secondary egg. The microenvironment of the egg contributes to the reprogramming of the nucleus to a state close to the zygote. Mouse embryonic stem cells have many embryonic markers on their surface: carbohydrate receptors CD15, alkaline phosphatase, factor 4 like Kruppel, estrogen-bound receptor, transcription factor CP2 like 1, T-box transcription factor and gastrulation homeobox brain 2. Embryonic mouse stem cells differentiate from the internal mass of cells at the stage of preimplantation, epiblast. This is established by comparing gene expression profiles and directly isolating embryonic stem cells from epiblasts of 4.5-day-old fertilized eggs. Embryonic stem cells derived from mouse embryos of later stages of development lose markers of pluripotency. Approximately 3 days after the elimination of the leukemia inhibition factor, the expression of the Oct4 gene leads to the loss of specificity markers by cells of the early embryo. Currently, the reprogramming of pluripotency is an active area of research in which significant technological progress has been made. So, the original gene cocktail consisting of four genes is used: Oct4, Sox2, Klf4 and cMyc. The obtained types of embryonic stem cells of mouse and human, from fertilized blastocysts, induced pluripotent stem cells undoubtedly exist. However, this does not apply to pluripotent stem cells derived from postnatal animals, humans, or from extraembryonic sources such as amniotic fluid or cord blood. Despite the fact that many laboratories are working to obtain stem cells from these objects, unfortunately, there is little reproducibility in this work, and the properties of the resulting cells and even their existence are still the subject of controversy.

Comparison of Pediatric Dermatology Conditions Across Telehealth and In-Person Visits During the COVID-19 Pandemic.

Understanding the utility of virtual visits in pediatric dermatology practice has become increasingly important in the telehealth era. We compared the conditions diagnosed in pediatric dermatology between traditional in-person visits and virtual telehealth visits during the initial 8-month phase of the COVID-19 pandemic at an urban medical institution. When given the option, pediatric dermatology patients and their families were more likely to choose telehealth visits for the diagnosis and/or management of acne, hemangiomas, and contact dermatitis; however, they were more likely to choose in-person visits for atopic dermatitis, viral warts, and alopecia areata. These differences may be attributed to clinical features of pediatric skin conditions, treatment options, and other factors which may influence patient preference for telehealth or in-person care for their condition. J Drugs Dermatol. 2022;21(11):1260-1263. doi:10.36849/JDD.6843.

Social functions of rural farmers (on the example of the Altai Region)

The article focuses on the social functions of rural farmers. The significance of this perspective is determined by the possibilities of revaluating social processes in the contemporary Russian countryside. Features of rural life predetermine various options for rural farmers to support villagers. The article aims at identifying those social groups and communities that can take an active part in everyday rural life, thus, changing the value system of the village and affecting the consequences of alienation and disunity. The theoretical analysis allowed the author to define rural farmers are a social-professional group with specific value priorities which lead to its active participation in the life of rural society. Such an involvement in solving the problems of rural settlements is of both social-economic and moral nature (help, support, responsibility). The article considers the heuristic potential of the concept ‘social function’ in assessing the role of farmers in the daily life of Russian villages. The author conducted semi-structured interviews with farmers in the Altai Region - to identify the key social functions associated with the activities of the representatives of this social-professional group. The author interviewed 66 male farmers of different age to assess their actions for consolidating the villagers, supporting people in difficult life situations, and expanding cooperation with the local government to solve the most important tasks of rural settlements. Based on the empirical data, the author identifies a number of social functions of farmers, which explain the features and directions of their activities in the development of Russian villages.

A survey of healthcare professionals’ perceptions of the decisional needs of parents with an infant born with a disorder/difference of sex development

Parents of infants born with differences in sex development (DSD) face many difficult decisions. As part of a larger project designed to develop educational interventions to promote shared decision making, this study assessed healthcare professionals' (HCPs) perceptions of parental decision-making needs when an infant is born with a DSD. A cross-sectional web-based survey following the Ottawa Decision Support Framework was conducted in two waves, between October 2020 and June 2022. Survey domains included: common DSD decisions, indicators of parents' decisional needs, and resources and approaches to support parental decision making. Eligible participants were HCPs working within interprofessional pediatric DSD centers in the USA. Up to three reminders were sent. Descriptive analysis was conducted. 71 HCPs participated; most (>90%) reported parents experience signs of decisional conflict including feeling unsure, worrying about what could go wrong, and fear of choosing a "wrong," irreversible option. The majority (90%) reported parents experience strong emotions interfering with their receptivity to information or deliberation. The majority (>70%) identified inadequate parental knowledge of the DSD as a barrier to decision making, coupled with information overload (>90%). HCPs rated several factors as "very" important, including: parents having information on benefits, harms, and other features of options (93%), having information about all the available options (87%), and having access to providers to discuss the options (84%). Providers endorsed using a variety of approaches to support parents' decision making; however, access to decision aids was not universally rated as highly important (very, 44%; somewhat, 46%; a little, 10%). Overall, HCPs expressed favorable attitudes toward supporting active parental participation in medical decision making. Opportunities for enhanced support of shared decision making included: a) recognizing and addressing parental emotional distress and informational overload at a time when parents need to consider complex options for their infant or young child; and b) the need for HCPs to encourage values clarification in decision-making encounters with parents.

CLASSIFICATION OF ROBOTS FOR ECONOMIC RESEARCH

The article proposes criteria for distinguishing between different types of robots (field of application, type of working shell, specificity of replaced functions, level of autonomy and degree of mobility). We developed a classification of robots for the purposes of economic research. The robots used in the modern economy are investigated. The discussion that has developed in the literature regarding the physical embodiment as an (optional) feature of a robot, as well as the relationship between a robot and artificial intelligence, is considered.

Taking hostage a journalist: problems of theory and practice

The provisions of the current Criminal Code of Ukraine, which relate to criminal responsibility for taking journalists as hostages, are analyzed. The factors (circumstances) of the social conditionality of separate, enhanced criminal liability for this kind of criminal act are researched. In particular, public danger; the relative prevalence of this type of criminal offence, such as taking hostage a journalist are analyzed; the traditions of domestic legislative practice, as well as foreign experience of using criminal-legal measures in counter such violations are discussed; the expediency of counteracting these encroachments by criminal-law means are considered. It was concluded that separate (established by a special norm) criminal liability for taking journalists as hostages is not socially conditioned.The position, according to which the privilege of a journalist to be a special victim in criminal law should be combined with the obligation to bear responsibility for conscientious use of opportunities related to the journalist’s professional activities is supported.The criminal law protection of legal professional activity of a journalist, proposed in the Project of the Criminal Code of Ukraine, developed by the Working Group on Law Development of the Legal Reform Commission is researched. Theoretical and applied problems of criminal responsibility for the crime under Article 349-1 of the Criminal Code of Ukraine, as well as the problem of violation of the consistency of the criminal law in the aspect of «reduced» age of criminal liability and are analyzed; the imperfection of the formulation of the optional features of the subjective side of the analyzed composition of the crime (lack of linking this composition of the crime to the legitimate professional activity of a journalist) has been substantiated.As a result of the research, a conclusion was made about the necessity exclusion of Article 349-1 from the Criminal Code of Ukraine.

On the Term Structure of VIX Futures’ Implied Convexity

Before the global equity crash in October 1987, volatility could be reasonably approximated as a constant, consistent with Black-Scholes (1973) dynamics. Thereafter, a stylized feature of equity options markets is that both single-name and index options have exhibited consistent, regular deviations of volatility in both strike and maturity. The resulting volatility surface has been studied extensively (Rubinstein 1994, Jackwerth and Rubinstein 1996, Derman 1999, Cont and da Fonseca 2002, Gatheral 2006). Moreover, reduced-form representations of major equity indices’ volatility surfaces corresponding to “average” volatility (over strikes) accumulated through fixed maturities, for example, Cboe’s (formerly Chicago Board Options Exchange) Volatility Index (VIX), have been popularized as gauges of investor sentiment and risk-aversion. Likewise, there has been considerable interest in quantifying and interpreting the term structure of futures whose payoffs are tied to these indices (Zhu and Zhang 2007; Lu and Zhu 2009; Egloff et al. 2010). In the context of the risk-neutral distribution characterizing asset prices at contract maturity, these studies focus on futures’ expectations—their first moments; higher-order moments are less well-studied. Daigler et al. (2016) introduce <i>implied convexity</i> as a measure of variance, that is, the second moment. However, although many authors have studied the term structure of VIX futures’ expectations, to our knowledge, none has examined the term structure of their variances.This work extends the research of Daigler et al. in two important ways. First, it provides an alternative to their intermediate adjustments of the VIX near-term (VIN) and VIX far-term (VIF) component indices that is consistent with the assumptions underlying the calculation of all Cboe volatility indices. It is likewise consistent with volatility indices in foreign markets, for example, the Euro STOXX 50 Volatility (VSTOXX) index (Deutsche Börse Group 2022). Second, it characterizes the entire term structure of VIX futures’ second moments, rather than that of a single contract with a maturity of approximately one month. Additionally, we quantify the differences arising from various interpolation choices. We find that extrapolation based only on two maturities near thirty calendar days produces estimates of variance that differ considerably from interpolations based on all available expiries. Furthermore, the accuracy of extrapolation degrades as the absolute differences between a contract’s maturity and the maturities of the interpolants increase.

Cheaper by the bundle: The interaction of frictions and option exercise in variable annuities

AbstractTypical Variable Annuity products combine complex baseline contracts at substantial fees with optional guarantees. We argue this product design aligns with the benefits of bundling to the provider, to the extent that the baseline option features can reduce total replication value. This is possible due to market frictions, and particularly taxation rules, affecting policyholder exercise behavior. We demonstrate the relevance of this mechanism in the context of popular withdrawal guarantees, both theoretically and empirically. Specifically, we show that in the presence of personal taxes, adding on a common death benefit at baseline may decrease the total contract value to the provider.

Decomposing preferences into predispositions and evaluations.

When making decisions, people can be influenced by the context (or framing) of the decisions in addition to the features of the choice options. It has recently been argued that people can use context to develop predispositions toward certain categories (or types) of options. This research has shown that predispositions increase the efficiency of the choice process by reducing the need for in-depth evaluation of the features but that they also bias choice. Here, we experimentally studied the dynamics of predispositions and their link to evaluations. In our first experiment, using real choices between healthy and unhealthy foods, we found that predispositions arise whenever one category is made to appear generally better than the other, regardless of the specific features of the options in a given decision. We found that predispositions toward healthy and unhealthy foods can be altered but that people's favorable evaluations of healthy foods persist. In our second experiment, we induced changes in both predispositions and evaluations. We again found that predispositions evolve in response to subjects' choice biases while evaluations do not. These changes occur over very short periods of time, highlighting the malleability of people's predispositions. Our findings provide a framework for understanding the factors that affect preferences and for attributing them to context-dependent predispositions or decision-level evaluations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Benefits of an Open-Science Approach in Student Research Projects

Student projects can sometimes be overlooked when considering open science methods. This is perhaps because of the limited time available to complete the project, a lack of confidence in their open research skills by supervision staff or students, and lower expectations of publications resulting from student project work (particularly at undergraduate level). However, open science methods add value to student projects and provide benefits on several levels.&#x0D; This talk describes from both the student and supervisor perspectives how open science can benefit student projects - from methods to management - using recent undergraduate projects as an example. We give a brief description of the concept of open science as we understand it and discuss the general benefits of an open science approach to research.&#x0D; The Edward Wallace lab (School of Biological Sciences, University of Edinburgh) has run several student projects working with and extending the open source software tool 'riboviz' to process and analyse ribosome profiling sequencing datasets. This collaborative project worked with experts in the UK and USA and aimed to add new features and capabilities to riboviz, thoroughly documenting the software, and successfully using it to analyse a diverse range of datasets from organisms across the tree of life.&#x0D; Student projects recreated existing published results using riboviz, developed new visualisation scripts, and added new optional features to the codebase to address specific research questions.&#x0D; This talk discusses how both the student project and the riboviz project fit into open science research, covering how open science tools were used to plan, manage and carry out an open science project and the challenges these presented. For example, as this was a computer-based project, we discuss the tools and skills needed by the students to successfully complete the project, including programming skills (Unix command-line, R, Python) and version control (using Git and GitHub) and the open resources used to learn and develop these skills.&#x0D; Open software tools such as version control are also explained in the context of student supervision and project management (for example how to use GitHub issue tickets for identifying and quickly solving project problems remotely), and for writing collaborative manuscripts (such as the recently published riboviz 2 paper and open science article).&#x0D; Our experiences provide a strong case study for successful open science approaches in student projects and clear evidence of their long-term benefits to students, supervisors and wider lab groups. We highlight our "top takeaways" aimed at students, day-to-day supervisors, and PIs and demonstrate how others can take the same approach.

PSM-DMO: Power Save Mode and Discontinuous BLE Mesh Operation

The Bluetooth Low Energy (BLE) mesh profile, standardized by the Bluetooth Special Interest Group (SIG), has an increasing interest in IoT solutions. However, the standard assumes that relay and friend nodes should be continuously scanning the channel awaiting any incoming transmissions. This could be very inefficient in terms of energy consumption, particularly in application scenarios where the backbone of the mesh network cannot be powered and traffic is infrequent. Hence, we present a novel strategy, named PSM-DMO, that minimizes the scan periods and thus, significantly reduces the overall energy consumption of the mesh network. PSM-DMO is defined as a new and optional feature for the currently published BLE mesh specifications, coexists with the standard operation, and is implemented without modifying the core of the specification. The proposal, that ensures the reliability of the mesh operation, can be used in BLE sensor networks that can tolerate a certain transmission delay. PSM-DMO replaces the continuous scan by a periodic but asynchronous polling process whereby the relay and sink nodes interrogate their neighbors about the existence of data to receive or to retransmit through the network. Nodes only go into scan mode during the period of time the mesh network will be involved in the transmission and dissemination. This period is estimated by the node which is the source of data, it is announced to its neighbors and it is propagated consecutively by all the relay nodes until the destination. PSM-DMO allows a theoretical reduction in the energy consumption of relay nodes up to 99.24 %.

Secure Real-time Data Transmission for Drone Delivery Services using Forward Prediction Scheduling SCTP

Drone technology is considered the most effective solution for the improvement of various industrial fields. As a delivery service, drones need a secure communication system that is also able to manage all of the information data in real-time. However, because the data transmission process occurs in a wireless network, data will be sent over a channel that is more unstable and vulnerable to attack. Thus, this research, purposes a Forward Prediction Scheduling-based Stream Control Transmission Protocol (FPS-SCTP) scheme that is implemented on drone data transmission system. This scheme supports piggybacking, multi-streaming, and Late Messages Filter (LMF) which will improve the real-time transmission process in IEEE 802.11 wireless network. Meanwhile, on the cybersecurity aspect, this scheme provides the embedded option feature to enable the encryption mechanism using AES and the digital signatures mechanism using ECDSA. The results show that the FPS-SCTP scheme has better network performance than the default SCTP, and provides full security services with low computation time. This research contributes to providing a communication protocol scheme that is suitable for use on the internet of drones’ environment, both in real-time and reliable security levels.

Analysis of 55 patients with multiple endocrine neoplasia type 1-associated insulinoma from a single center in China

ObjectiveTo investigate the clinical characteristics of patients with multiple endocrine neoplasia type 1 (MEN1)-related insulinoma and their relationship with specific biochemical changes and to summarize the features of treatment options for the Chinese population with this disease and the impact on long-term prognosis.Methods“MEN1” and “insulinoma” were used when searching the Peking Union Medical College Hospital (PUMCH) medical record retrieval system to obtain clinical information about patients. We identified patients diagnosed with MEN1-associated insulinoma based on endocrinological, radiological, and pathological examinations, and subsequently analyzed their clinical data.ResultsA total of 55 patients with MEN1-associated insulinoma were included, including 29 (52.7%) men and 26 (47.3%) women. The parathyroid gland was the most commonly affected (78.2%), followed by the pituitary gland (69.1%) and adrenal gland (16.4%). Insulinoma was the first manifestation of MEN1 in at least 23.6% (13/55) of patients. Nineteen (34.5%) patients presented with initial symptoms of hypoglycemia before the age of 22 years. Among the 24 Patients with high serum calcium (Ca) had significantly lower serum insulin levels than those with normal serum Ca levels (p < 0.001) during hypoglycemic episodes. However, serum C-peptide level at 0.5 h and serum insulin level at 1 h was higher in patients with hypercalcemia than in patients with normal serum Ca levels in the oral glucose tolerance test (OGTT), although the differences were not statistically significant. Multifocal pancreatic neuroendocrine tumors (pNETs) were present in 38 (69.1%) patients; most of them (55.6%, 20/36) underwent multiple enucleations, and 45% (9/20) had a postoperative recurrence. Five patients (10%) who underwent distal pancreatectomy developed pancreatic insufficiency after an average of seven years. patients who underwent genetic testing, 23 (95.8%) were positive for MEN1 mutation, with mutations most commonly found in exons 2 (21.7%) and 3 (13%).ConclusionsIn our study, the rates of postoperative recurrence and long-term complications in patients with MEN1 with multifocal pNETs were significantly different from those in other international centers and might be related to the choice of surgical method. In addition, elevated serum Ca levels in patients with primary hyperparathyroidism may affect insulin secretion.