Seroma formation is a common complication after mastectomy and is associated with delayed wound healing, infection, skin flap necrosis, patient discomfort and repeated visits to the out patient ...clinic to deal with seroma and its sequelae. Closing the dead space after mastectomy seems to be key in reducing seroma and its complications. Various methods have been described to reduce the dead space after mastectomy: closed suction drainage, quilting of the skin flaps and application of adhesive tissue glues. The aim of this trial is to compare seroma formation and its sequelae in the various methods of flap fixation.
This is a multicenter, double-blind, randomized controlled trial in female breast cancer patients undergoing mastectomy, with or without axillary clearance. Exclusion criteria consist of breast conserving therapy, direct breast reconstruction and incapacity to comprehend implications and extent of study and unable to sign for informed consent. A total of 336 patients will be randomized. Patients will be randomly allocated to one of three treatment arms consisting of flap fixation using ARTISS tissue glue with a low suction drain, flap fixation using sutures and a low suction drain or conventional wound closure (without flap fixation) and low suction drainage. Follow up will be conducted up to twelve months post surgery. The primary outcome is the number of seroma aspirations and secondary outcomes consist of number of out patient clinic visits, surgical skin infection rate, shoulder function, cosmesis, health-related quality of life and costs and cost-effectiveness (cost/QALY).
This is the first study of its kind to evaluate the effect of flap fixation and its sequelae (ie seroma aspirations, number of out patient clinic visits, infection, shoulder function, patient assessed cosmesis, quality of life and cost-effectiveness) in a double blind randomized controlled trial.
This trial was approved by the hospitals' joint medical ethical committee (14-T-21, 2 June 2014). The SAM Trial is registered in ClinicalTrials.gov since October 2017, Identifier: NCT03305757 .
•Effect of quilting structure and down mass density on the clothing surface temperature distribution, heat transmission and thermal insulation was analyzed.•Temperature distribution along the down ...lattice was investigated by using an infrared thermography and thermal manikin.•Surface convective and radiative heat exchange of down clothing were clarified.•The lowest comfort temperature for down clothing under different activity levels was estimated.
Down clothing is commonly adopted as cold protective clothing to maintain human thermal comfort. However, its surface temperature distribution, heat transmission and thermal insulation are still not fully understood due to the complex heat and mass transfer caused by the quilting structure and varying mass density. In this work, we comprehensively explored the thermal behavior of down clothing with quilting structures. Objective tests were carried out by the thermal manikin and infrared thermal imager in a climate room at a fixed temperature of 10 ± 1 °C and relative humidity of 40 ± 5%. Four different down clothing were examined to investigate the effect of down lattice structure and mass density on heat flux, surface temperature distribution and thermal resistance. The results revealed a distinct valley in the surface temperature along the down lattice due to the quilting structure. A space-averaged method to estimate the thermal insulation of down clothing would neglect variation among different local positions. Besides, the thermal insulation performance significantly improved with the higher down mass density. Because the average clothing thickness as well as the thickness near quilting position both increased, resulting in an additional reduction of heat dissipation. Furthermore, the surface convective and radiative heat exchange decreased with the higher down mass density as a result of lower surface temperature. The lowest comfort temperature for clothing with various down mass density under activity level 2 met and 4 met was also estimated. The results can help to improve the design of down clothing's thermal performance and enhance human comfort in cold environments.
This paper reports on the findings of a diachronic investigation into ideological patterns of representation around the master signifier Muslim (and its lexical variants) during 70 years of TIME ...Magazine journalism. Manual analysis, of 1,573 concordance lines, showed that across the twentieth century the dominant master signifier transmuted, in both content and form. Three signifiers were used across the twentieth century to refer to Muslims. The signifier Mohammedan/Muhammadan was used in neutral constructions to reference religious and cultural themes. The signifier Moslem was predominantly used in neutral constructions but displayed a greater propensity to reference negatively constructed political. The signifier Muslim was largely used to negatively reference the narrow issue of conflict. We conclude by suggesting directions for future research.
•We analysed representations of Muslims in the TIME Magazine Corpus across the 20th Century.•We used the concepts of ideological quilting and news values to analyse the data.•The master signifiers of Mohammedan, Moslem, and Muslim quilted with different themes.•Representations of Muslims shifted from a neutral focus on religio-cultural issues to a negative focus on political issues.•We frequently found (neo)orientalist representations throughout the data.
In this narrative account of sleeplessness, I draw on Ball’s (2002, 2012) poststructural conceptualization of quilts as social texts to explore the practice of quilting as a method of arts-based ...storytelling. Through the process of quilting, I story my experience of resisting the Sleep Industrial Complex. I explore the biocultural arena of sleep and critique the biomedical construction of sleeplessness as insomnia. I argue that the medicalization of sleeplessness works to support multi-billion-dollar industries that purport to cure insomnia through consumerism (Barbee et al., 2018; Williams, 2008). I describe how radically accepting sleeplessness as a facet of my existence, and not a medicalized disorder, is an expression of self-acceptance and an act of self-care. In this arts-based narrative account of sleeplessness, I mark the transition from viewing sleeplessness as a medical disorder to radically accepting sleeplessness as a natural facet of our complex being-in-the-world.
Background
Total mastectomy and axillary dissection is a common procedure for breast cancer patients in our institution. Seroma is common. This study aimed to compare the quilting suture and ...conventional closure in prevention of seroma after total mastectomy and axillary dissection.
Methods
This randomized comparative study was carried out from January 2018 to June 2019 in Yangon General Hospital. One hundred and forty patients (70 conventional and 70 quilting) were included. For quilting group, customized strategically placed interrupted alternate sutures were placed 2–3 cm apart with 3/0 vicryl sutures between skin flap and pectoral muscle.
Results
Age, body mass index and tumour diameter were comparable between the groups. The mean duration of operation was 111.44 ± 7.045 min in conventional and 124.5 ± 6.39 min in quilting (P = 0.0001). The mean drain output for conventional group was not significantly different from quilting group. In quilting, some area developed dimpling which resolved within a week. A total of 21 (30%) patients in the conventional group and 10 patients (14.3%) in the quilting group developed seroma (P = 0.041). The mean frequency and amount of seroma aspiration were significantly lower in the quilting group. Shoulder movement limitation and analgesia use showed no significant difference.
Conclusion
Although total amount of drain output, duration of drain, hospital stay and post‐operative complications were not different, the incidence of seroma was significantly lower in quilting group. Seroma is treated with more ease in the quilting group as the frequency and amount of aspiration were lower and less frequent follow‐up visits were required. Quilting can reduce the seroma incidence in total mastectomy and axillary dissection for breast cancer patients.
This randomized control study compares quilting suture and conventional closure to prevent seroma after total mastectomy and level 2 axillary dissection for breast cancer. The incidence of seroma is higher in conventional group. Seroma is treated with more ease in the quilting group as the frequency and amount of aspiration are lower and less frequent follow‐up visits are required.
This article explores an analytical, reflexive, epistemological, and liberatory research approach I call senseMaking. This article draws upon data from a larger narrative study of participants who ...work(ed) and/or learn(ed) in self-contained special educational environments in New York City. I use creative writing and quilting as examples of senseMaking tools to complicate and question the deficit-laden narratives and research that currently inform decision making about special education and traditional methods of educational research.
Seroma is the most common complication following mastectomy and can require several days of drainage and lead to delayed wound healing, longer hospital stays, and an increased financial and emotional ...burden. Seroma formation is not well understood and but there is good evidence that closing the dead space via quilting can help reduce seroma formation. This study assessed randomized controlled trials and reviewed current literature to elucidate if there is a strong association between quilting sutures and seroma formation.
A systematic search of 5 databases using search terms similar to “seroma”, “quilting”, “flap fixation”, “random”, and “mastectomy”. Data was extracted and Medcalc software used to perform a meta-analysis of the primary outcome: incidence of seroma formation, as well as secondary outcomes: volume and duration of drainage.
Eleven randomized controlled trials with 2009 patients were included. Quilting with sutures greatly reduced the incidence of seroma formation compared with conventional closure (p < 0.001, RR 0.367 95% CI 0.25, 0.539; I2 = 63.56%) as well as duration of drainage (p = 0.015, SMD -1.657, SE 0.680 95% CI -2.991, −0.324; 8 studies, n = 1578; I2 = 98.98%). Quilting did not significantly affect volume of drainage.
Quilting was found to be associated with lower seroma rates. Future studies should investigate the use of quilting in combination with other preventative techniques to search for a synergistic method that will further improve patient care.
•Seromas are the most common complication following mastectomies.•Seromas require drainage, delay wound healing, cause infection and skin necrosis.•Closing dead space via quilting sutures decreases seroma formation.
By focusing on Xunzi’s concept of the sage-king and the sage-king naming theory, a new interpretive perspective can be applied to Xunzi’s doctrine of the rectification of names. During the Warring ...States period, mainstream views among Confucian and Daoist scholars tended to interpret the sage-king as the bearer of Heaven or Dao. However, Xunzi follows the principle of the division between Heaven and humanity, asserting that the sage-king is entirely subordinate to the realm of humans, embodying the ideal order of Confucian community. In light of this concept of the sage-king, this paper aims to address two questions: first, where the legitimacy of the sage-king naming prerogative comes from, and second, how the sage-king, as the master-signifier, quilts all floating signifiers to ensure the publicity and normativity of names. Moral norms emerge from the sage-king’s projection of intentions and emotions onto external objects. Sage-king naming theory provides the prerequisite for the superassertibility of moral norms, limiting the potential arbitrariness and private interpretations of names and norms, which ensures the public and authoritative nature of the social discourse system, thereby endowing the sage-kings with legitimacy. As the quilting point and stopping point, the sage-king performs the totalization and prohibition by means of which the floating names and norms are fixed and become parts of the structured Confucian discourse of meaning.
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