scholarly journals PCSK9 in African Americans and Caucasians in Relation to Lp(a) Level, Apo(a) Size and Heritability

2020 ◽  
Vol 4 (7) ◽  
Author(s):  
Byambaa Enkhmaa ◽  
Kyoungmi Kim ◽  
Wei Zhang ◽  
Nishant Prakash ◽  
Kevin Truax ◽  
...  
Keyword(s):  
African Americans ◽  
Outcome Measure ◽  
Total Plasma ◽  
Cross Sectional ◽  
Main Outcome Measure ◽  
Apolipoprotein A ◽  
Significant Heritability ◽  
Age Range ◽  
Relationship Of ◽  
The Relationship

Abstract Context Inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9) reduces lipoprotein(a) [Lp(a)] levels, but the association of PCSK9 with Lp(a) level and its major determinant, apolipoprotein(a) [apo(a)] size, is not fully understood. Objective To assess the relationship between PCSK9, Lp(a) level, apo(a) size, age, and ethnicity/race. Design Cross-sectional Setting General population Participants Healthy African Americans and Caucasians (n = 267); age range: 6 to 74 years. Interventions None. Main outcome measure(s) PCSK9 levels, apo(a) isoform and LPA allele sizes, and isoform-specific Lp(a) levels. Results Plasma PCSK9 levels were significantly higher in African Americans vs Caucasians, in females vs males, and in adults vs children. PCSK9 levels were not associated with total plasma Lp(a) levels either in all participants or in ethnicity-specific analyses. However, PCSK9 levels were significantly positively associated with isoform-specific Lp(a) levels carried by the larger apo(a) size in all participants (r = 0.139, P = 0.0361). In ethnicity/race analyses, a significant association was seen for African Americans (r = 0.268, P = 0.0199), but not for Caucasians. In contrast, there were no significant associations of PCSK9 with isoform-specific Lp(a) levels for the smaller apo(a) sizes in all participants nor in ethnic-specific analyses. Furthermore, heritability (h2) analyses revealed a significant heritability for PCSK9 level in both ethnic groups, with a higher estimate in Caucasians than in African Americans (47% vs 22%, respectively). Conclusions Among African Americans, but not Caucasians, PCSK9 levels were associated with isoform-specific Lp(a) levels carried on larger, but not smaller, apo(a) sizes. The findings illustrate a diverging relationship of PCSK9 with isoform-specific Lp(a) levels across ethnicity.

scholarly journals SUN-580 PCSK9 and Lp(a): Association Between PCSK9 Level and Larger Apo(a) Isoform Size in African-Americans and Caucasians

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Enkhmaa Byambaa ◽  
Kyoungmi Kim ◽  
Wei Zhang ◽  
Kevin Truax ◽  
Anuurad Erdembileg ◽  
...  
Keyword(s):  
African Americans ◽  
Genetic Factors ◽  
African American Families ◽  
Apolipoprotein A ◽  
Causal Risk Factor ◽  
The Mean ◽  
Race Ethnicity ◽  
Age Range ◽  
Relationship Of ◽  
The Relationship

Abstract Introduction: An elevated level of lipoprotein(a) [Lp(a)] is an independent causal risk factor for cardiovascular disease. Non-genetic factors do not appreciably influence Lp(a) levels due to a strong genetic control. However, inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9) has been shown to reduce Lp(a) levels. The association of PCSK9 with Lp(a) level and its major genetic determinant—apolipoprotein(a) [apo(a)] size—is not fully understood. In this study, we assessed the relationship between PCSK9, Lp(a) level, apo(a) size, age, and race/ethnicity. Methods: Healthy Caucasian and African-American families were recruited from the general population (age range: 6–74 years, N=267). PCSK9 and Lp(a) levels were assayed enzymatically; apo(a) isoform and LPA allele sizes and isoform-specific Lp(a) levels were determined. Results: In all participants, PCSK9 levels differed significantly by race/ethnicity, age, and sex. Thus, the mean PCSK9 levels were significantly higher in African-Americans vs. Caucasians (104 ± 29 vs. 95 ± 30 ng/mL, respectively, p=0.020), in adults vs. children (102 ± 29 vs. 92 ± 31 ng/mL, respectively, p=0.001) and in females vs. males (103 ± 30 vs. 94 ± 29 ng/mL, respectively, p=0.007). PCSK9 levels were not associated with total plasma Lp(a) levels neither in all participants nor in ethnicity-specific analyses. However, PCSK9 levels were significantly and positively associated with isoform-specific Lp(a) levels carried by the larger apo(a) size in all subjects (r=0.139, p=0.0361). In race/ethnicity analyses, a significant association was seen for African-Americans (r=0.268, p=0.0199), but not for Caucasians. In contrast, there were no significant associations of PCSK9 with isoform-specific Lp(a) levels for the smaller apo(a) sizes in all participants nor in ethnic-specific analyses. Of note, PCSK9 levels were significantly negatively associated with the larger apo(a) isoform sizes in all participants (r=-0.139, p=0.0366). Although significant in both groups, heritability of PCSK9 level was higher in Caucasians than in African-Americans (47% vs. 22%, respectively). Conclusions: Among African-Americans, but not Caucasians, PCSK9 levels were associated with isoform-specific Lp(a) levels carried on larger, but not smaller, apo(a) sizes. The findings illustrate a diverging relationship of PCSK9 with isoform-specific Lp(a) levels.

scholarly journals STATUS GIZI KURANG BERESIKO TERHADAP USIA MENARCHE PADA SISWI KELAS VI DI SDN 007 RAMBAH KABUPATEN ROKAN HULU

2021 ◽  
Vol 10 (1) ◽  
pp. 8-13
Author(s):  
Rahmi Fitria
Keyword(s):  
Nutritional Status ◽  
Reproductive Organs ◽  
Cross Sectional ◽  
A Value ◽  
Age Range ◽  
Relationship Of ◽  
The Relationship ◽  
Age Of Menarche ◽  
Regression Tests ◽  
Menarche Age

Menarche is a sign of the proper functioning of a woman's reproductive organs when having her first menstruation and is common in the age range of 10-16 years. Menarche is influenced by several factors, one of which is nutritional status. According to Noviyanti research (2016) nutrition affects a girl's sexual maturity so that it affects the slowness of menarche. Similarly, research conducted by Munda (2016) that students with overweight nutritional status faster experienced menarche compared to students who have normal nutritional status and underweight. This study aims to find out the relationship of nutritional status to the age of menarche grade VII students in Pesantren Bahrul Ulum. This research method uses descriptive method with cross sectional research design. This research was conducted in SDN 007 Rambah. The sample of this study amounted to 45 respondents. Data collection uses simple correlation and linear regression tests. The results of this study stated that the average nutritional status of grade VII students is 21.60Kg /m2, and the nutritional status of students is at least 16.90 Kg / m2 and the highest nutritional status is 27.60 Kg / m2 with an average age of menarche 12.11 years. The conclusion of this study is that there is no relationship of nutritional status with menarche age in grade VII students in Pesantren Bahrul Ulum with a value of p= 0.036.

scholarly journals HUBUNGAN ANTARA STATUS PEKERJAAN DENGAN KEMAMPUAN IBU DALAM MENSTIMULASI PERKEMBANGAN PSIKOSOSIAL OTONOMI PADA TODDLER

2019 ◽  
Vol 14 (3) ◽  
pp. 113
Author(s):  
Esti Widiani
Keyword(s):  
Psychosocial Development ◽  
Total Sample ◽  
Chi Square ◽  
Cross Sectional ◽  
Second Stage ◽  
A Value ◽  
Observational Design ◽  
Age Range ◽  
Relationship Of ◽  
The Relationship

Toddlers are the second stage of psychosocial development after the baby is in the age range of 18 months to 36 months. Failure to skip psychosocial autonomy versus hesitation or shame can be prevented by providing good stimulation. The purpose of this study was to determine the relationship of work with the ability of the mother to stimulate psychosocial development of autonomy in infants. This study used an observational design using cross sectional. The research was conducted in Kemantren Village, Jabung District, Malang Regency. The technique used to take samples in this study was accidental sampling with a total sample of 168 respondents. The instrument used to measure the ability of the mother is a modification of the Care of Babies. HOME Inventory. The data analysis used was chi-square with no statistical results that correlated the employment status with the ability of the mother to stimulate psychosocial development of autonomy in infants with a value of p = 0.106 (p> 0.005). The recommended BKB (Toddler Family Development) group needs to be held in each Posyandu as a service center and learning center for mothers about early detection and stimulation of development

scholarly journals RELATIONSHIP OF XEROSIS CUTIS WITH PROTEINURIA DEGREES IN CHILDREN WITH NEPHROTIC SYNDROME AT THE HAJI ADAM MALIK HOSPITAL

2020 ◽  
Vol 7 (8) ◽  
pp. 23-27
Keyword(s):  
Nephrotic Syndrome ◽  
Skin Surface ◽  
Skin Layer ◽  
Research Subjects ◽  
Dipstick Test ◽  
Cross Sectional ◽  
Urine Dipstick Test ◽  
Age Range ◽  
Relationship Of ◽  
The Relationship

Introduction: xerosis cutis is a disorder of the skin surface due to reduced fluid or oil content in the skin that moisture on the surface of the skin layer decreases. Proteinuria is a risk factor for the progression of nephrotic syndrome. Nephrotic syndrome if there is proteinuria (≥40 mg / m2 / hour or protein / creatinine ratio ≥ 200 mg / mL or protein + 3 on urine dipstick test), hypoalbuminemia (<25 g / L) and edema. Objective: To determine the relationship between xerosis cutis and the degree of proteinuria in children with nephrotic syndrome. Subject and Method: This is is a cross-sectional analytic study, involving 50 subject xerosis cutis with nephrotic syndrome patients. Kruskal Wallis test is used to determine the relationship xerosis cutis with proteinuria degree in children with nephrotic syndrome. This study has been approved by the Health Research Ethics Commission of the Faculty of Medicine, Universitas Sumatera Utara/ H. Adam Malik General Hospital Medan. Result: Based on the characteristics of 50 research subjects, the age of all research subjects has a median value of 8 (3-16) years with the most age range at the age of 6-10 years, as many as 26 subjects (52%), male subjects as many as 34 subjects (68 %) and women as many as 16 subjects (32%). The duration of nephrotic syndrome has a median value of 2 (1-7) years. There was a significant skin dryness relationship based on the degree of proteinuria (p = 0.002). Thus it can be concluded that the higher the degree of proteinuria, the higher the level of dryness of the skin and the greater the degree of proteinuria in children with nephrotic syndrome, then indirectly describe the more protein that is wasted through urine. Conclusion: There is a significant xerosis cutis relationship based on the degree of proteinuria (p= 0,002).

STRATEGI KOPING ORANG TUA TERHADAP ANAK AUTIS DAN POLA ASUH ORANG TUA

2018 ◽  
Vol 11 (2) ◽  
pp. 196-204
Author(s):  
Asirotul Ma’rifah ◽  
Naning Puji Suryantini Suryantini ◽  
Rina Mardiyana
Keyword(s):  
Coping Strategies ◽  
Sampling Technique ◽  
Children With Autism ◽  
Adaptive Coping ◽  
Autistic Children ◽  
Cross Sectional ◽  
Authoritarian Parenting ◽  
Cross Tabulation ◽  
Relationship Of ◽  
The Relationship

Autism is still a nightmare for most parents. Parents with autism can be very stressful when dealing with a hyperactive child's behavior, aggressive and passive. Stress experienced by parents of children with autism will affect the ability of parents in the parenting role, especially in relation to coping strategies have in dealing with problems of children. The participation of parents is crucial the success of socializing with children with autism in the general population. This study aims to determine the relationship of coping strategies parents of autistic children and parenting parents. This type of research is an analytic correlation with cross sectional approach. The population in this study were all parents of autistic children in SLB Muhammadiyah Mojokerto numbering 15 people. Samples in this study were all parents of autistic children in SLB Muhammadiyah Mojokerto which totaled 15 people by using total sampling technique. Collecting data using questionnaires. Data analized use cross tabulation, presented in a frequency distribution. On cross-tabulation obtained results tend to use maladaptive coping strategies permissive parenting that is 8 (53.3%), there are also respondents who use adaptive coping strategies using authoritarian parenting as much as one person (16.7%), and adaptive coping strategies tend using democratic parenting style as much as 5 people (33.3%). Expected parents still seeking information to broaden their parents on coping strategies of parents of autistic children and parenting parents as well as parents to give special attention for children with autism to the development and advancement of their lives because they have the same rights as any other normal child.

Hubungan Motivasi dan Minat Masuk Program Studi DIII Kebidanan Dengan Prestasi Belajar Mahasiswa STIKES ICSADA Bojonegoro

2015 ◽  
Vol 1 (1) ◽  
Author(s):  
Cholida Khusnul Chotimah
Keyword(s):  
Student Achievement ◽  
Learning Outcomes ◽  
Behavior Changes ◽  
Study Program ◽  
Cross Sectional ◽  
Learning Achievement ◽  
Increase Student Achievement ◽  
Learning Conditions ◽  
Relationship Of ◽  
The Relationship

ABSTRAKHasil belajar (prestasi belajar) merupakan perubahan perilaku yang diperoleh seseorang setelah mengalami aktivitas belajar. Perolehan aspek-aspek perubahan perilaku tersebut tergantung pada apa yang dipelajari oleh seseorang. Berhasil atau tidaknya seseorang untuk belajar disebabkan beberapa faktor yang mempengaruhi dalam pencapaian hasil belajar (prestasi belajar) yaitu berasal dari dalam diri orang yang belajar dan ada pula yang dari luar dirinya. Banyak faktor yang mempengaruhinya, diantaranya adalah motivasi dan minat. Tujuan dari penelitian ini adalah untuk mengetahui hubungan motivasi dan minat masuk Program Studi D  III Kebidanan dengan prestasi belajar mahasiswa  STIKES Insan Cendekia Husada Bojonegoro. Jenis penelitian ini adalah analitik korelasi. Penelitian ini menggunakan pendekatan cross sectional. Populasi dalam penelitian ini adalah semua mahasiswa Program Studi D III Kebidanan STIKES Insan Cendekia Husada Bojonegoro sebanyak 39 mahasiswa dengan  teknik total sampling dengan jumlah sampel 39. Penelitian ini menggunakan instrumen berupa kuesioner. Analisis hubungan variabel dilakukan dengan menggunakan Yates Correction. Hasil penelitian ini menunjukkan bahwa ada hubungan antara motivasi masuk Program Studi D III Kebidanan dengan prestasi belajar mahasiswa           (ρ =0,027) dan ada hubungan antara minat masuk Program Studi D III Kebidanan dengan prestasi belajar mahasiswa (ρ =0,044). Saran untuk Program Studi D III Kebidanan STIKES Insan Cendekia Husada Bojonegoro agar meningkatkan prestasi belajar mahasiswa Prodi D III kebidanan STIKES Insan Cendekia Husada Bojonegoro dengan cara dosen atau pembimbing akademik menciptakan kondisi pembelajaran yang menarik, sarana prasarana yang menunjang, hubungan antara dosen dan mahasiswa yang baik, sehingga mahasiswa terdorong untuk butuh dan terus belajar dan melakukan pemantauan dan pendekatan lebih dalam terhadap mahasiswa tentang tujuan mereka untuk masuk di Program Studi D III Kebidanan. Kata Kunci : Motivasi, minat, prestasi belajar  ABSTRACT      Results of learning (learning achievement) is obtained by a person's behavior changes after experiencing learning activities. Acquisition aspects of the behavior change depending on what is learned by someone. Success or failure of someone to learn due to several factors that affect the achievement of learning outcomes (learning achievement) that comes from within the person who studied and some are from outside himself. Many factors influence it, such as motivation and interest. The purpose of this study was to determine the relationship of motivation and interest in D III Midwifery Studies Program with student achievement STIKES Insan Scholar Husada Bojonegoro. This type of research is analytic correlation. This study used cross sectional approach. The population in this study were all students of the D III Midwifery STIKES Insan Husada Bojonegoro Scholar at least 39 students with a total sampling with a sample of 39. This study used a questionnaire instrument. Variable correlation analysis done using Yates Correction. Results of this study indicate that there is a relationship between motivation incoming D III Midwifery Studies Program with student achievement (ρ = 0.027) and there is a correlation between interest in D III Midwifery Studies Program with student achievement (ρ = 0.044). Suggestions for Study Program D III Midwifery STIKES Insan Scholar Husada Bojonegoro in order to increase student achievement Prodi DIII midwifery personnel STIKES Scholar Husada Bojonegoro by way of a professor or academic supervisor creates an attractive learning conditions, infrastructure that support, the relationship between faculty and students good , so that students are encouraged to take and continue to learn and perform monitoring and deeper approach to the students about their goals for entry in the D III Midwifery Studies Program. Key Words : Motivation, interests, academic achievement

Hubungan Pengetahuan Dan Sikap Ibu Dengan Keputusan Waktu Penyapihan

2018 ◽  
Vol 3 (3) ◽  
pp. 500
Author(s):  
Desmariyenti Desmariyenti ◽  
Nelfi Sarlis ◽  
Rima Fitriani
Keyword(s):  
Random Sampling ◽  
Sampling Technique ◽  
P Value ◽  
Stratified Random Sampling ◽  
Significant Relation ◽  
Cross Sectional ◽  
Work Area ◽  
Knowledge And Attitude ◽  
Relationship Of ◽  
The Relationship

<p><em>Good weaning time is done at the age of the child reaches 2 years. Weaning at less</em><em> </em><em>than 2 years of age can cause problems in children such as incidence of infectious diseases, especially increased diarrhea, nutritional effects that lead to malnutrition in children and cause the relationship of children and mothers is reduced </em><em>closeness </em><em>because bounding attachment process is disrupted. This study aims to determine the relationship between knowledge  and  attitude  of  the  mother  with  the  decision  of  weaning  time  in</em><em> </em><em>Tangkerang Timur Work Area Puskesmas Tenayan Raya. This research was conducted in </em><em>Mei</em><em>-</em><em>J</em><em>uni 2017 and this research using research type is quantitative data with research design  using  cross  sectional.  Sampling  technique  using  Stratified  random  sampling, population in this study amounted to 368 people and samples 18</em><em>4</em><em> p</em><em>e</em><em>ople in East Tangkerang Village. The analysis used is univariate and bivariate. The result of this research is can be concluded that there is significant relation between knowledge with time weaning (p-value 0,000 &lt;0,05), there is significant relation between attitude with time weaning (p-value 0,000 &lt;0,05). Mothers exclusively breastfeed to their babies until 6 months of age and and continue with breastfeeding until 24 months of age.</em><em></em></p><p> </p><p>Waktu penyapihan yang baik dilakukan pada usia anak mencapai 2 tahun. Penyapihan yang dilakukan pada usia kurang dari 2 tahun dapat menyebabkan masalah pada anak seperti insiden penyakit infeksi terutama diare meningkat, pengaruh gizi yang mengakibatkan malnutrisi  pada  anak  dan  menyebabkan  hubungan  anak  dan  ibu  berkurang  keeratannya karena proses bounding attachment terganggu. Penelitian ini bertujuan untuk mengetahui hubungan antara pengetahuan dan sikap ibu dengan keputusan waktu penyapihan di Keluraan Tangkerang Timur Wilayah Kerja Puskesmas Tenayan Raya. Penelitian ini dilakukan pada bulan Mei-Juni tahum 2017 dan penelitian ini menggunakan jenis penelitian adalah data kuantitatif dengan  desain penelitian menggunakan  cross sectional. Teknik sampling menggunakan Stratified random sampling, Populasi dalam penelitian ini berjumlah 368 orang dan sampel 184 orang di Kelurahan Tangkerang Timur. Analisa yang diunakan adalah univariat dan bivariat. Hasil penelitian didapatkan bahwa ada hubungan bermakna antara pengetahuan dengan waktu penyapihan (p-value 0,000&lt; 0,05), ada   hubungan   bermakna   antara   sikap   dengan   waktu   penyapihan   (p-value   0,000   &lt;0,05). Diharapkan ibu memberikan ASI eksklusif pada bayinya sampai usia 6 bulan dan dan dilanjutkan dengan MPASI sampai usia 24 bulan.</p>

scholarly journals Cross-Sectional Associations between Mothers and Children’s Breakfast Routine—The Feel4Diabetes-Study

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 720
Author(s):  
Natalia Giménez-Legarre ◽  
Alba M. Santaliestra-Pasías ◽  
Greet Cardon ◽  
Rurik Imre ◽  
Violeta Iotova ◽  
...  
Keyword(s):  
Dairy Products ◽  
Analysis Of Covariance ◽  
Food Groups ◽  
Whole Grain ◽  
Cross Sectional ◽  
Cereal Products ◽  
Breakfast Consumption ◽  
Mothers And Children ◽  
Relationship Of ◽  
The Relationship

Positive influences of family members have been associated with a high probability of children’s daily breakfast consumption. Therefore, the aim of this study was to scrutinize the association of breakfast routines between mothers and their children. The baseline data of the Feel4Diabetes-study was obtained in 9760 children (49.05% boys)–mother pairs in six European countries. A parental self-reported questionnaire gauging the frequency of breakfast consumption and of breakfast´ foods and beverages consumption was used. Agreement in routines of mothers and their children’s breakfast consumption was analyzed in sex-specific crosstabs. The relationship of breakfast routine and food groups’ consumption between mothers and their children was assessed with analysis of covariance. The highest proportion of children who always consumed breakfast were those whose mothers always consumed it. Children consuming breakfast regularly had a higher intake of milk or unsweetened dairy products and all kind of cereal products (low fiber and whole-grain) than occasional breakfast consumers (p < 0.05). The strong similarity between mothers and children suggests a transfer of breakfast routine from mothers to their children, as a high proportion of children who usually consume breakfast were from mothers also consuming breakfast. All breakfast foods and beverages consumption frequencies were similar between children and their mothers.

Mediation of Coping Strategies among Patients with Advanced Cancer

2021 ◽  
pp. 105477382110032
Author(s):  
Nurul Huda ◽  
Yun-Yen ◽  
Hellena Deli ◽  
Malissa Kay Shaw ◽  
Tsai-Wei Huang ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Coping Strategies ◽  
Advanced Cancer ◽  
Well Being ◽  
Cross Sectional ◽  
Correlational Research ◽  
Resampling Procedure ◽  
Relationship Of ◽  
Anxiety Depression ◽  
The Relationship

The purpose of this study was to test the mediating effects of coping on relationships of psychological distress and stress with anxiety, depression, and quality of life. A cross-sectional and correlational research study was used to recruit a sample of 440 patients with advanced cancer in Indonesia. A bootstrap resampling procedure was used to test the significance of the total and specific indirect effects of coping. Data analysis showed that problem-focused coping (PFC) mediated relationships of psychological distress and stress on depression, anxiety and functional well-being. PFC also mediated the relationship between stress and social well-being. Emotional-focused coping (EFC) mediated the relationship of stress with physical and emotional well-being. EFC also mediated the relationships between psychological distress and physical well-being. Thus, proper assessments and interventions should be tailored and implemented for patients in order to facilitate their use of coping strategies when needed in stressful situations.

The relationship of self-acceptance with decision making duration in cancer patient to perform mastectomy

2021 ◽  
pp. 1-5
Author(s):  
Ayu Ratuati Setiawan ◽  
Feny Tunjungsari ◽  
Mochamad Aleq Sander
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Cancer Patients ◽  
Breast Cancer Patients ◽  
Cross Sectional ◽  
Abnormal Growth ◽  
Self Acceptance ◽  
Observation Method ◽  
Relationship Of ◽  
The Relationship

BACKGROUND: Cancer is a disease caused by abnormal growth of body cells that turn malignant and continue to grow uncontrollably. One of the treatments for breast cancer is mastectomy. The quickness of decision-making determines the survival rate of prognosis patients. OBJECTIVE: This study aimed to determine the relationship of self-acceptance with decision-making duration in cancer patients to perform a mastectomy. METHODS: An analytic observation method with cross-sectional design. The samples were taken by purposive sampling method with 50 samples of breast cancer patients. Data collected include age, last level of education, marital status, profession, stage of cancer during mastectomy, self-acceptance score, and decision-making duration to perform a mastectomy. RESULTS: The data analyzed with the Kruskal–Wallis test. The test showed the relationship of self-acceptance (p = 0.027) with decision-making duration in breast cancer patients to perform a mastectomy. CONCLUSION: In Conclusion, there is a relationship of self-acceptance with decision-making duration in breast cancer patients to perform a mastectomy.

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