Summary Background Vitamin D deficiency is highly prevalent among patients with IBD, however, data on its association with clinical outcomes are conflicting. Aim To perform a systematic review and meta‐analysis to explore the association of low vitamin D status with clinical outcomes in patients with IBD. Methods We searched PubMed, Embase, Scopus and Web of Science from inception to February 2018 for observational studies evaluating the association of low 25(OH)D status on IBD disease activity, mucosal inflammation, clinical relapse and quality of life. Odds ratios (ORs) were pooled and analysed using a random effects model. Results Twenty‐seven studies were eligible for inclusion comprising 8316 IBD patients (3115 ulcerative colitis, 5201 Crohn's disease). Among IBD patients, low 25(OH)D status was associated with increased odds of disease activity (OR 1.53, 95% CI 1.32‐1.77, I2 = 0%), mucosal inflammation (OR 1.25, 95% CI 1.06‐1.47, I2 = 0%), low quality of life (QOL) scores (OR 1.30, 95% CI 1.06‐1.60, I2 = 0%) and future clinical relapse (OR 1.23, 95% CI 1.03‐1.47, I2 = 0%). In subgroup analysis, low vitamin D status was associated with Crohn's disease activity (OR 1.66, 95% CI 1.36‐2.03, I2 = 0%), mucosal inflammation (OR 1.39, 95% CI 1.03‐1.85, I2 = 0%), clinical relapse (OR 1.35, 95% CI 1.14‐1.59, I2 = 0%), and low QOL scores (OR 1.25, 95% CI 1.04‐1.50, I2 = 0%) and ulcerative colitis disease activity (OR 1.47, 95% CI 1.03‐2.09, I2 = 0%) and clinical relapse (OR 1.20, 95% 1.01‐1.43, I2 = 0%). Conclusions Low 25(OH)D status is a biomarker for disease activity and predictor of poor clinical outcomes in IBD patients.

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Chronic injury to the brain from seizure activity is associated with decreased language skills in pediatric patients, as measured on neuropsychological tests for language function and academic achievement. This makes the study of language in patients with epilepsy clinically necessary. Functional magnetic resonance imaging and direct electrical cortical stimulation have been used to evaluate aspects of cortical language processing in healthy adults and in adults with epilepsy or other neurological insults. Results of these studies help to locate cortical language areas that are involved with modality-specific language processing (visual naming, auditory naming, sentence-completion, and repetition) and the neuroplasticity of language areas in the setting of neurological injury and reorganization. A better understanding of language processing contributes to a more efficient and efficacious electrical cortical stimulation mapping of language areas for patients with intractable epilepsy who are undergoing preresection evaluation. Most of the current literature on localization and reorganization of cortical language areas in the setting of epilepsy concerns the adult patient population, whereas the literature on pediatric patients is substantially lacking in comparison. This article reviews the conclusions drawn thus far from Wada, magnetoencephalography, functional magnetic resonance imaging, and electrical cortical stimulation language studies on types of language reorganization seen in pediatric patients with intractable temporal lobe epilepsy and the clinical factors associated with reorganization, and proposes future directions of research to further the academic and clinical understanding of language processing in pediatric patients.

O r i g i n a l A r tic le 332 I NTRO D U C TIO NSubarachnoid haemorrhage (SAH) secondary to intracranial aneurysm rupture remains one of the most serious neurosurgical emergencies today. Intracranial aneurysms are acquired cerebrovascular anomalies that develop throughout a patient's lifetime.(1) They are arterial lesions defined by thinned and dilated regions of the cerebrovascular wall that exhibit loss of the internal elastic lamina, thinning of the tunica media, and subsequent remodelling and degradation of extracellular matrix proteins throughout the vessel wall. Most aneurysms occur at bifurcation sites along the Circle of Willis, as these areas are prone to haemodynamic patterns that potentiate aneurysm development.( 2) The key to minimising the risk of rebleeding following aneurysmal rupture is to isolate the aneurysm from its cerebral circulation. In this regard, surgical clipping and endovascular coiling are both effective, although there has been much debate on the merits of each intervention. there has been much criticism of the trial, as was eloquently highlighted by the BRAT study. For example, it has been cited that in the ISAT, almost 80% of aneurysms were excluded, the proficiencies between the different interventionists and neurosurgeons were varied, and the types of recruiting centres as well as type and location of aneurysms between groups had wide differences. (3,4) Furthermore, the subsequent five-year follow-up data of the ISAT suggest that the benefit in outcome seen at six months had vanished over the ensuing years.However, the current results of the ongoing BRAT study haveshown that a policy of intent to treat by endovascular coiling results in a reduction of poor clinical outcome at one-year of follow-up.Our study was a retrospective audit of our institution's experience in the management of ruptured intracranial aneurysms. We assessed the overall outcomes of patients admitted for SAH secondary to aneurysmal bleeding, and