Experience is an important point in the effectiveness of the surgical procedure and in the reduction of complications in pituitary surgery. Endoscopic pituitary surgery differs from microscopic surgery because it requires a steep learning curve for endoscopic skills. In this study, we investigated the learning curve of endoscopic transsphenoidal pituitary surgery in our department. Endoscopic transsphenoidal operations were performed on 80 patients, who were retrospectively examined and grouped as the early and late experience groups to evaluate the learning curve. The patients' characteristics, gross total resection, endocrinological cure, visual field improvement, duration of surgery, postoperative hospital stay, and complications were noted. After examining our patients of the 2 groups of period, our experience showed that as the effectiveness of endoscopic surgery increases, the duration of surgery and postoperative hospital stay decrease. In this study, we identified a learning curve in endoscopic pituitary surgery.

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BackgroundThe efficacy of treatments that lower glucose in reducing the risk of incident stroke remains unclear. We therefore did a systematic review and meta-analysis to evaluate the efficacy of intensive control of glucose in the prevention of stroke.Methodology/Principal FindingsWe systematically searched Medline, EmBase, and the Cochrane Library for trials published between 1950 and June, 2012. We included randomized controlled trials that reported on the effects of intensive control of glucose on incident stroke compared with standard care. Summary estimates of relative risk (RR) reductions were calculated with a random effects model, and the analysis was further stratified by factors that could affect the treatment effects. Of 649 identified studies, we included nine relevant trials, which provided data for 59197 patients and 2037 events of stroke. Overall, intensive control of glucose as compared to standard care had no effect on incident stroke (RR, 0.96; 95%CI 0.88–1.06; P = 0.445). In the stratified analyses, a beneficial effect was seen in those trials when body mass index (BMI) more than 30 (RR, 0.86; 95%CI: 0.75–0.99; P = 0.041). No other significant differences were detected between the effect of intensive control of glucose and standard care when based on other subset factors.Conclusions/SignificanceOur study indicated intensive control of glucose can effectively reduce the risk of incident stroke when patients with BMI more than 30.

BackgroundB vitamins have been extensively used to reduce homocysteine levels; however, it remains uncertain whether B vitamins are associated with a reduced risk of stroke. Our aim was to evaluate the effects of B vitamins on stroke.Methodology and Principal findingsWe systematically searched PubMed, EmBase, and the Cochrane Central Register of Controlled Trials to identify studies for our analysis. Relative risk (RR) was used to measure the effect of B-vitamin supplementation on the risk of stroke. The analysis was further stratified based on factors that could affect the treatment effects. Of the 13,124 identified articles, we included 18 trials reporting data on 57,143 individuals and 2,555 stroke events. B-vitamin supplementation was not associated with a significant reduction in the risk of stroke (RR, 0.91, 95%CI: 0.82–1.01, P = 0.075; RD, -0.003, 95%CI: -0.007–0.001, P = 0.134). Subgroup analyses suggested that B-vitamin supplementation might reduce the risk of stroke if included trials had a man/woman ratio of more than 2 or subjects received dose of folic acid less than 1 mg. Furthermore, in a cumulative meta-analysis for stroke, the originally proposed nonsignificant B-vitamin effect was refuted by the evidence accumulated up to 2006. There is a small effect with borderline statistical significance based on data gathered since 2007.Conclusions/SignificanceOur study indicates that B-vitamin supplementation is not associated with a lower risk of stroke based on relative and absolute measures of association. Subgroup analyses suggested that B-vitamin supplementation can effectively reduce the risk of stroke if included trials had a man/woman ratio of more than 2 or subjects received dose of folic acid less than 1 mg.