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Objective: The microbiome contributes to the pathogenesis of inflammatory bowel disease (IBD) but the relative contribution of different lifestyle and environmental factors to the compositional variability of the gut microbiota is unclear., Design: Here, we rank the size effect of disease activity, medications, diet and geographic location of the faecal microbiota composition (16S rRNA gene sequencing) in patients with Crohn's disease (CD; n=303), ulcerative colitis (UC; n = 228) and controls (n=161), followed longitudinally (at three time points with 16 weeks intervals)., Results: Reduced microbiota diversity but increased variability was confirmed in CD and UC compared with controls. Significant compositional differences between diseases, particularly CD, and controls were evident. Longitudinal analyses revealed reduced temporal microbiota stability in IBD, particularly in patients with changes in disease activity. Machine learning separated disease from controls, and active from inactive disease, when consecutive time points were modelled. Geographic location accounted for most of the microbiota variance, second to the presence or absence of CD, followed by history of surgical resection, alcohol consumption and UC diagnosis, medications and diet with most (90.3%) of the compositional variance stochastic or unexplained., Conclusion: The popular concept of precision medicine and rational design of any therapeutic manipulation of the microbiota will have to contend not only with the heterogeneity of the host response, but also with widely differing lifestyles and with much variance still unaccounted for., Competing Interests: Competing interests: MTB reports grants and personal fees from AbbVie Canada, grants and personal fees from Janssen Canada, grants and personal fees from Pfizer Canada, grants from Shire Canada, grants and personal fees from Takeda Canada, personal fees from Mylan Pharmaceuticals, other from AbbVie, Janssen, Pfizer, Boerhinger Ingelheim, Celgene, outside the submitted work; FS reports other from Alimentary Health/Precision Biotics, other from 4D pharma, Cork, other from Atlantia Food Clinical Trials, personal fees from Kaleido Biosciences, outside the submitted work; MJC reports personal fees from Mars PetCare, other from Second Genome, outside the submitted work., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To present our institution's experience in the management of childhood craniopharyngioma since 1982., Methods: We retrospectively reviewed the records of all children diagnosed with craniopharyngioma at our children's hospital from its opening in 1982 through to 2003. One neuroradiologist systematically reviewed the neuroimaging. Kaplan-Meier curves were used to analyze the progression-free survival and the overall survival from the time of the first definitive intervention., Conclusions: Most children diagnosed with craniopharyngioma are long-term survivors. Survivors suffer from multiple deficits in the long term. A conservative surgical and radiotherapeutic approach and avoiding interventions that are known to cause severe morbidity may minimize these. The use of intracystic bleomycin is a strategy that allows the delay of more aggressive therapies in select patients.