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Abdominoplasty provides a reconstructive but rarely aesthetic cosmetic solution after major weight loss. Few articles document quality of life (QOL) issues and the psychological impact of abdominoplasty on obese patients. We report a retrospective study of 41 abdominoplasties performed after an average weight loss of 40.2 kg. Data were obtained through review of patient medical files, double-blind surgical and psychological examinations, and two specifically designated questionnaires used to assess pre-abdominoplasty body perception and QOL, post-body contouring perception of improvement, and psychological status. To date, 14 patients have regained >10 kg; 84.6% have improved QOL; 86.5% have improved psychological status; 74% have better sexual relations; 53.9% admit liking their body; 76.9% are satisfied with the results of abdominoplasty; and 96.1% would be willing to undergo abdominoplasty again. Anterior dermolipectomy improves both QOL and psychological status. Provision of patient education, multidisciplinary management, and long-term follow up are necessary to obtain satisfactory results.

Le tabac est un facteur de risque majeur du cancer des voies aérodigestives supérieures. Le sevrage tabagique permet d’améliorer l’état de santé du patient, son taux de survie, et de diminuer les comorbidités et le risque d’autres cancers. La recommandation du sevrage tabagique est donc importante. Cependant, le taux d’arrêt du tabac après l’annonce de ce cancer reste faible. Il est donc nécessaire de comprendre les raisons d’une poursuite ou de l’arrêt de la pratique tabagique après l’annonce de la maladie. Dans cet objectif nous avons réalisé une enquête qualitative au sein d’un centre de lutte contre le cancer. Après des observations de consultation, nous avons rencontré des patients afin de recueillir leur expérience, leurs usages et pratiques, et ainsi leurs représentations du tabac malgré la maladie. Ces données qualitatives nous ont permis de mieux comprendre les différentes raisons qui permettent à certains patients d’envisager ou bien de débuter un processus de sevrage, et ceux pour qui l’arrêt définitif du tabac est difficile à envisager même à la suite de l’annonce du cancer. Tobacco is a major risk factor for patients with head and neck cancer. Smoking cessation improves a patient’s health, his survival, and reduces co-morbidities and the risk of other cancers. The recommendation of smoking cessation is therefore important. However, the rate of smoking cessation after the announcement of this cancer remains low. It is therefore necessary to understand the reasons for continuing or quitting smoking after the announcement of the disease. To this end, we conducted a qualitative survey at a Cancer Control Centre (CLCC). After consultation observations, we met patients in order to collect their experience, uses and practices, and thus their representations of smoking despite the disease. The qualitative data allowed us to better understand the different reasons why some patients consider or begin a withdrawal process, and those for whom permanent cessation of smoking cannot be considered even after the cancer announcement.

Background In cases of prevalent lymphadenopathy in the head and neck cancer region, identifying the primary tumor site allows for more precise radiotherapy targeting. This improves treatment by reducing the volumes of mucosal irradiation and potentially lowering morbidity. An extensive diagnostic workup, including FDG PET-CT imaging and bilateral tonsillectomy, has been shown to identify the primary cancer in 60% of cases. Mucosectomy of the tongue base holds promise for detecting additional primary sites. When performed using minimally invasive endoscopic techniques such as transoral robotic surgery (TORS) or transoral laser microsurgery (TLM), mucosectomy results in minimal morbidity. However, the effectiveness of tongue base mucosectomy in detecting primary tumors has yet to be evaluated in a randomized trial involving patients with lymphadenopathy of unknown primary. Methods The RoboCUP trial is a multicentre, open-label, randomized, non-comparative phase 2 trial aiming to evaluate the benefit of bilateral TORS or TLM-assisted tongue base mucosectomy in association to tonsillectomy in the assessment of prevalent cervical lymphadenopathy with a negative exhaustive diagnostic workup. The main endpoint is the proportion of patients with detection of a primary cancer. Surgery will consist in tongue base mucosectomy plus tonsillectomy in the experimental arm, and the standard of care, i.e. tonsillectomy alone in the control arm. Patients will then be treated by intensity modulated radiotherapy, possibly with chemotherapy as radiosensitizer, per current guidelines. Using a single-stage Fleming design, 36 patients will be enrolled in the experimental arm, and 36 patients in the control arm. Discussion This trial aims to improve the diagnostic performances, i.e. detection of primary tumor, in patients with head and neck carcinoma of unknown primary. It is expected that the subsequent therapeutic changes could enhance radiotherapy accuracy, and could improve the prognosis, toxicity profiles and quality-of-life of patients. Trial registration NCT04767048, registered February, 19, 2021.

Background First-year medical candidates encounter steep learning demands when transitioning from high school to university. Spaced repetition– a method of distributing review sessions over time– improves long-term memory retention. This study assessed its effectiveness alongside lifestyle and academic factors in students preparing for the medical school entrance examination. Methods In 2023, all 618 candidates at the University of Rouen were invited to complete a post-exam, self-administered questionnaire; 523 responded (84.6%). We collected data on revision methods (e.g., spaced repetition, reviewing archives of previous exams), participation in private preparatory classes and summer courses, lifestyle behaviors (e.g., sleep duration, physical activity or smoking), and secondary-school grades. Predictors of success were identified through univariate analyses. A multivariate logistic regression was then conducted to determine independent predictors of success. Results Of 523 respondents, 134 (25.6%) passed the entrance exam. In univariate analysis, successful candidates significantly more often used spaced repetition (44.8% vs. 20.3%; p  < 0.001), reviewed archives of previous exams, attended private preparatory classes or summer courses, and had higher secondary-school grades. In multivariate logistic regression, independent predictors of success included spaced repetition (aOR 2.09; 95% CI, 1.16–3.48), secondary-school grades (aOR 3.19; 95% CI, 2.33–4.37), private preparatory class attendance (aOR 2.02; 95% CI, 1.11–3.66), sleep duration (aOR 1.49; 95% CI, 1.12–1.99), and regular sport practice (aOR 1.81; 95% CI, 1.13–2.93). Conclusions Admission success in the medical school entrance examination appeared to be influenced by multiple factors: while spaced repetition significantly enhanced performance, academic background, private preparatory classes, and healthy lifestyle habits also contributed. These findings support integrating validated study techniques and wellness strategies into university support programs for entrance examinations. Practice points Students frequently feel underprepared for the transition from small-group secondary-school instruction to large-lecture university formats. Structured study strategies– such as spaced repetition– are associated with higher success rates in medical school entrance examinations. Additional factors– including sleep duration, regular physical activity, attendance at private preparatory classes, and strong secondary school performance– also correlate with admission success.

PurposeThis study aimed to assess the prevalence of chronic low back pain (CLBP) and related biopsychosocial factors in urban and rural communities in Benin. MethodsThis is a population-based observational cross-sectional survey. An interviewer-administered electronic questionnaire was used to collect information on demographic, socio-economic, behavioral, and psychological factors relating to CLBP risk factors and medical history of participants. The numeric pain rating scale and the Beck Depression Inventory were used to assess pain intensity and the level of depression, respectively. Bivariate analyses were performed to investigate the association between sociodemographic, behavioral, and psychological factors and CLBP. Sequential multiple regression analyses were subsequently performed to predict the occurrence of CLBP.ResultsA total of 4320 participants, with a mean age ± SD of 32.9 ± 13.1 years, of which 40.7% were females and 50.1% from an urban area, were enrolled in the study. We found a global prevalence rate of CLBP of 35.5% [95% CI 34.1–36.9%]. The prevalence in urban areas was 30.68% [95% CI 28.9–32.8%]) while 40.2% was found in rural areas [95% CI 38.1–42.2%]). Age (p < 0.001), level of education (p = 0.046), marital status (p < 0.001), working status (p < 0.003), tobacco use (p < 0.016) and regular physical activity (p < 0.011) were associated with CLBP. In urban areas, only the level of education was able to predict the prevalence of CLBP (R2 = 61%). In rural areas, CLBP was predicted by age, marital and working status (R2 = 89%).ConclusionsThis study showed a high prevalence of CLBP among urban and rural communities in Benin. Age, level of education, marital status, and working status were significantly associated with CLBP in Benin.

My dissertation consists of three essays reported in three different Chapters, each related to a different research question about the Key Audit Matters (KAM) section in audit reports. KAM disclosures have been implemented to enhance the communicative value of audit reports and to increase users’ confidence in the audit process and the companies’ financial statements (EY Reporting, 2015). KAMs reflect the greatest risks of material misstatements encountered during the audit process based on auditors’ professional judgment (FRC, 2020). Their implementation represents the most significant change in the audit report for the past 70 years.KAMs have first been implemented in the United Kingdom (UK) in 2013. To get the largest sample period possible, I use hand-collected data from premium-listed non-financial firms on the London Stock Exchange (LSE). KAMs represent additional qualitative disclosures in the audit report, where auditors report one KAM per risk encountered during the audit process. Each KAM is related to a significant matter and is composed of two parts. Auditors first describe the risk encountered and then explain the audit procedures performed to address the risk identified. I define these two parts as the following two KAM components: the risk description and the auditors’ response and observation. Although auditors are encouraged to write KAMs in their own words (FRC, 2013b), critics of this new disclosure requirement fear that KAMs would be boilerplate and standardized (Citi Research, 2014; Gray, Turner, Coram, & Mock, 2011; Mock et al., 2013).Although several researchers examine the consequences of the KAM regulation worldwide, I believe that examining the content of KAMs provides more granular insights into the audit process. I develop measures of dissimilarity to capture specific information in KAMs. These measures reflect differences in words written by auditors for the same type of KAM. My Thesis contributes to the KAM literature by providing a granular analysis of the content of KAM disclosures and by complementing studies examining textual features of KAMs (e.g., Burke, Hoitash, Hoitash, & Xiao, 2022; Chen, Nelson, Wang, & Yu, 2020; Gutierrez, Minutti-Meza, Tatum, & Vulcheva, 2018; Lennox, Schmidt, & Thompson, 2022).Although textual analysis is gaining increased interest in accounting research, it is still sparse in auditing research. In the first Chapter of my Thesis entitled “Key Audit Matters Dissimilarity: Determinants and Consequences”, we detail client and audit firm characteristics associated with client-specific (dissimilar) information in KAMs. Our findings suggest that the two KAM components, namely the risk description and the auditors’ response and observation, are different, as the client-specific information they contain is driven by different factors. Our results indicate that the main characteristics explaining client-specific (dissimilar) KAMs are client-firm and audit partners' unobservable factors. We also show that controlling for similar risks (by grouping KAMs per topic) and the length of the KAM when computing the dissimilarity scores is important as it provides different results regarding KAM determinants. We find some evidence that KAM dissimilarity is associated with audit quality, and we also find that more dissimilar KAMs are associated with longer audit delays. We contribute to the literature by explaining differences among metrics capturing client-specific information in KAMs used in the literature (e.g., Chen, Nelson, et al., 2020; Zeng, Zhang, Zhang, & Zhang, 2021). We also complement the KAM literature that examines the content of KAMs by analyzing the determinants of KAM dissimilarity based on client and audit firm characteristics as well as some of its consequences.In the second Chapter entitled “Client-Specific Information in Key Audit Matters and Audit Risks”, we link the KAM and audit risks components. This association enables us to better understand the audit risk model, a foundation of the auditing literature. We find that clientspecific information in the risk description of the KAM is associated with higher audit risks, reflecting inherent and control risks. We also find that client-specific information in the auditors’ response and observation is associated with lower audit risks, reflecting detection risks. Overall, auditors’ disclosure of client-specific information in KAMs is associated with lower audit risks. We further show that client-specific information in the entire KAM and the auditors’ response and observation are associated with higher audit quality and greater audit effort. This result suggests that auditors reduce detection risks and the overall level of audit risks without compromising audit quality or audit effort. Additional tests show that our results are stronger when KAM topics are new or infrequent, when auditors face lower industry litigation risks, when managers’ compensation is linked to firm performance and firms are more profitable, and when auditors are industry experts and have a short tenure. By linking the textual content of KAMs with the audit risks components, we contribute to the audit risk literature and highlight the importance to examine the two KAM components separately, as they provide complementary insights about audit risks (e.g., Felix, Gramling, & Maletta, 2001; Hackenbrack & Knechel, 1997; Hogan & Wilkins, 2008; Mock & Wright, 1999).In the third Chapter entitled “Is Specific Information in Key Audit Matters Informative? The Role of Risk Disclosures”, I focus on the informativeness of auditors’ risk disclosures. KAMs provide unique opportunities to examine auditors’ risk disclosures. I thus complement the literature focusing on managerial risk disclosures (Beatty, Cheng, & Zhang, 2019; Elzahar & Hussainey, 2012; Tan, Zeng, & Elshandidy, 2017) by providing insights from auditors’ risk disclosures. While risk disclosures represent a fundamental source of information for market participants, they become less informative as managers disclose fewer risks of material misstatements (Beatty et al., 2019). I find that auditors’ risk disclosures are informative if they provide dissimilar information in two dimensions simultaneously: compared to (a) the previous year and (b) industry peers. My results are stronger when investors face greater information asymmetries, and when all the audit committee members are independent. This study contributes to prior literature that examines the informativeness of the implementation of KAMs (e.g., Burke et al., 2022; Gutierrez et al., 2018; Lennox et al., 2022) and KAM features (e.g., Abbott & Buslepp, 2022; Chang, Chi, & Stone, 2022; Seebeck & Kaya, 2022) by providing granular analyses into the content of KAMs. This study is the first to examine two dimensions of KAM dissimilarity encompassing both temporal and cross-sectional variations.

Background Radiotherapy for head and neck squamous cell carcinomas (HNSCC) is associated with a substantial morbidity and inconsistent efficacy. Human papillomavirus (HPV)-positive status is recognized as a marker of increased radiosensitivity. Our goal was to identify molecular markers associated with benefit to radiotherapy in patients with HPV-negative disease. Methods Gene expression profiles from public repositories were downloaded for data mining. Training sets included 421 HPV-negative HNSCC tumors from The Cancer Genome Atlas (TCGA) and 32 HNSCC cell lines with available radiosensitivity data (GSE79368). A radioresistance (RadR) score was computed using the single sample Gene Set Enrichment Analysis tool. The validation sets included two panels of cell lines (NCI-60 and GSE21644) and HPV-negative HNSCC tumor datasets, including 44 (GSE6631), 82 (GSE39366), and 179 (GSE65858) patients, respectively. We finally performed an integrated analysis of the RadR score with known recurrent genomic alterations in HNSCC, patterns of protein expression, biological hallmarks, and patterns of drug sensitivity using TCGA and the E-MTAB-3610 dataset (659 pancancer cell lines, 140 drugs). Results We identified 13 genes differentially expressed between tumor and normal head and neck mucosa that were associated with radioresistance in vitro and in patients. The 13-gene expression-based RadR score was associated with recurrence in patients treated with surgery and adjuvant radiotherapy but not with surgery alone. It was significantly different among different molecular subtypes of HPV-negative HNSCC and was significantly lower in the “atypical” molecular subtype. An integrated analysis of RadR score with genomic alterations, protein expression, biological hallmarks and patterns of drug sensitivity showed a significant association with CCND1 amplification, fibronectin expression, seven hallmarks (including epithelial-to-mesenchymal transition and unfolded protein response), and increased sensitivity to elesclomol, an HSP90 inhibitor. Conclusions Our study highlights the clinical relevance of the molecular classification of HNSCC and the RadR score to refine radiation strategies in HPV-negative disease.

Head and neck (HN) squamous cell carcinomas (SCCs) originate from the epithelial cells of the mucosal linings of the upper aerodigestive tract, which includes the oral cavity, the pharynx, the larynx, and the sinonasal cavities. There are many associated risk factors, including alcohol drinking coupled with tobacco use, which accounts for 70% to 80% of HNSCCs. Human papilloma virus (HPV) is another independent risk factor for oropharyngeal SCC, but it is only a minor contributor to oral cavity SCC (OSCC). Betel quid chewing is also an established risk factor in southeast Asian countries. However, OSCC, and especially oral tongue cancer, incidence has been reported to be increasing in several countries, suggesting risk factors that have not been identified yet. This review summarizes the established risk factors for oral cavity squamous cell carcinomas and examines other undemonstrated risk factors for HNSCC.