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Background Human papillomavirus (HPV)-associated oropharyngeal cancer (OPC) is increasing in prevalence, but the drivers of metastasis remain poorly understood, which impacts the ability to personalise management decisions. Much of the genomic research to date focuses on the HPV-negative population. Here, we utilise single-cell and spatial single-cell techniques to understand the drivers of metastasis. Methods Patients with HPV-positive OPC and cervical lymph node metastases treated with curative surgery had matched samples from the primary and lymph nodes collected for research. Single-cell RNA sequencing, single-cell spatial sequencing (Visium) and in-situ spatial platforms were performed. Cancer clones were delineated using inferred copy number variation. Expression phenotypes and interactions with the tumour microenvironment were compared between the metastasising and non-metastasising cancer clones. Results Individual cancer clones have varied abilities to metastasise and undergo clonal expansion in the lymph node, with only a subset of clones present in the primary expanding in the lymph node. Four mechanisms were identified as defining the metastatic phenotype, including protein translation adaptation, immunoproteasome dysfunction and immune evasion, suppression of the IFN immune response and cap-independent protein translation. Conclusions This research elucidates multiple mechanisms driving the expansion of cancer clones in HPV-positive oropharyngeal cancer. By detailing the roles of translational adaptation, immunoproteasome dysfunction, suppression of the interferon immune response and cap-independent protein translation, we provide insights into how these processes contribute to immune evasion and tumour survival.

Head and neck surgery for benign and malignant disease is undergoing a groundbreaking transformation. Robot-assisted surgery is quickly being recognized as a significant innovation, demonstrating the potential to change treatment paradigms for head and neck disease. State-of-the-art robotics enables surgeons to access complex anatomy using a more minimally invasive approach, with the potential to improve patient outcome and reduce surgical morbidity. Learn from international clinicians who have pioneered new paths in the application of robotic-assisted surgery. Throughout the 16 chapters of this book, the authors provide comprehensive discussion of robotic surgical procedures for diseases affecting the oropharynx, larynx, hypopharynx, parapharyngeal space, thyroid, neck, and skull base. Key Features: * Fundamental training and education-from ethical considerations and room set-up-to avoiding complications and clinical pearls * Ten videos on the treatment of squamous and spindle cell carcinomas * 150 superb illustrations enhance the didactic text Although further innovations and refinement of this technology will be forthcoming, the current state of robotic surgery encompassed in these pages lays a foundation for today and inspiration for tomorrow's advancements. The book is an invaluable resource for surgeons and residents interested in learning about and incorporating surgical robotics into otolaryngology practice, and will also benefit medical and radiation oncologists.

The incidence of perioperative complications is well known to be greater in patients with OSA than in the baseline population. This has led to the American Society of Anesthesiologists and the American Academy of Sleep Medicine developing clinical practice guidelines for the perioperative management of patients with OSA. Post OSA surgery patients will have not only more difficult airway management but also altered drug sensitivity, a higher risk of undiagnosed comorbid disease, and the potential for operative site bleeding complicating an already difficult airway.

In 2010 approximately 4.7 % of the Australian population overall were affected by OSA; 6.4 % of males and 3.6 % of females. The importance of sleep health is gaining increased recognition as both the personal and societal costs are better understood. Sleep disorders cost the hospital system around $96.2 million but imposes a burden that extends far beyond the diagnosis and treatment of the disorders themselves.

The truth of the above lines, was forcibly impressed on my mind recently, on hearing of the death of a much loved friend. Maria O'Brien died in Detroit, Mich., Feb. 4, aged 28 years and 7 months. Sister O'Brien experienced religion three years since, and joined the M. E. Church in Calais, Maine, where she resided until a few months previous to her death.