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Author: Sima

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Published on 1 Comment on Physical Therapy Best For Carpal Tunnel Syndrome?

So many people I know complain of carpal tunnel syndrome, especially those who spend hours every day at a computer keyboard. Carpal tunnel syndrome is a hand and arm condition of numbness, pain, tingling, etc. caused by a pinched nerve in your wrist (pressure or compression of the median nerve). Treatments vary from physical therapy to steroids to surgery, with surgery being the recommended option by many doctors. So what is best?

A study with women randomly assigned to manual (physical) therapy or surgery suggests that from months one to 3 physical therapy was better and more effective, especially in pain relief. At the 6 months and one year follow-up, both groups were similar in outcome - in improvements in pain, symptoms, and functioning of the hands. What was nice in this study was that all assessments, baseline and follow-ups, were done by a blinded assessor - that is, a person who did not know what treatment was used on the patient.  Bottom line: a major intervention (surgery) may be unnecessary. From Medical Xpress:

PT beats surgery for quick relief of carpal tunnel pain

For women with carpal tunnel syndrome (CTS), physical manual therapies are similarly effective to surgery in the medium and long term, and may be more effective in the short term, according to a study published in the November issue of The Journal of Pain.

César Fernández-de-las Peñas, P.T., Ph.D., from the Universidad Rey Juan Carlos in Madrid, and colleagues compared the effectiveness of surgery versus physical therapy consisting of manual therapies, including desensitization maneuvers, in CTS. The interventions were either three sessions of manual therapy (physical therapy group; 60 patients) or decompression/release of the carpal tunnel (surgical group; 60 patients).

The researchers found that 55 women in the physical therapy group and 56 in the surgery group completed follow-up at 12 months. In adjusted analyses there was an advantage for the physical therapy group at one and three months in mean pain, the worst pain, and function. At six and 12 months, the changes in pain and function were similar between the groups. At all follow-ups the two groups had similar improvements in the symptoms severity subscale of the Boston Carpal Tunnel Questionnaire.

"This study found that surgery and physical manual therapies, including desensitization maneuvers of the central nervous system, were similarly effective at medium-term and long-term follow-ups for improving pain and function, but that physical therapy led to better outcomes in the short term," the authors write.

Published on Leave a comment on Could Apigenin Be Considered a Brain Food?

The important thing learned from this study (though it was done in the laboratory and not directly on humans) is that it supports that apigenin (in the same chemical group as flavonoids) is important for neuron formation and for strengthening connections between brain cells. Flavonoids are known to positively affect memory and learning, and to preserve and enhance brain function. Apigenin is found in many fruits and vegetables, but common sources are parsley, celery, celeriac, thyme, chamomile, grapefruit, onions, oranges, red wine, and spices such as rosemary, oregano, thyme, basil, and coriander. Another good reason to eat a variety of fruits and vegetables. From Medical Xpress:

Plant compound found in spices and herbs increases brain connections

Brazilian researchers from D'Or Institute for Research and Education (IDOR), Federal University of Rio de Janeiro (UFRJ) and Federal University of Bahia (UFBA) have demonstrated in laboratory that apigenin, a substance found in parsley, thyme, chamomile and red pepper, improves neuron formation and strengthens the connections between brain cells.

Previous experiments with animals had already shown that substances from the same chemical group as the apigenin, known as flavonoids, positively affect memory and learning. Many studies highlight the potential of flavonoids to preserve and enhance brain function. While the effectiveness of flavonoids for brain health is not an entirely new concept, this research is the first to show the positive effects of apigegin directly on human cells and the first to unraveling its mechanism.

The scientists observed that just by applying apigenin to human stem cells in a dish they become neurons after 25 days - an effect they would not see without the substance. Moreover, the neurons that were formed made stronger and sophisticated connections among themselves after being treated with this natural compound."Strong connections between neurons are crucial for good brain function, memory consolidation and learning", says neuroscientist from IDOR and UFRJ Stevens Rehen, leader author of the paper published today atAdvances in Regenerative Biology.

The research team conducted by Rehen demonstrated that apigenin works by binding to estrogen receptors, which affect the development, maturation, function, and plasticity of the nervous system. This group of hormones is known to delay the onset of psychiatric and neurodegenerative disorders such as schizophrenia, depression, Alzheimer's and Parkinson's disease. However, the use of estrogen-based therapies is limited by the increased risk of estrogen-dependent tumors and cardiovascular problems.

Researchers believe apigenin can be used as an alternative approach on future treatments for neurodegenerative diseases as well as in neuronal differentiation strategies in laboratory. "We show a new path for new studies with this substance", points out Rehen. "Moreover, flavonoids are present at high amounts in some foods and we can speculate that a diet rich in flavonoids may influence the formation of neurons and the way they communicate within the brain."

Published on Leave a comment on Appendicitis in Children Can Be Treated With Antibiotics
Drawing of colon seen from front (appendix is colored red). Credit: Wikipedia

This is the second time I've seen research finding that antibiotics  alone could be used (instead of surgery) for the treatment of uncomplicated appendicitis (June 17, 2015 post), but this time in children. Appendicitis is inflammation of the appendix.  At the one year follow-up the researchers found that 75.7% of patients with uncomplicated appendicitis had been successfully treated with antibiotics alone and had not had any recurrences of appendicitis.

This is a major finding because for years the gold standard for appendicitis treatment has been an appendectomy. The times are a changing.

From Science Daily: Antibiotics alone can be a safe, effective treatment for children with appendicitis

Using antibiotics alone to treat children with uncomplicated acute appendicitis is a reasonable alternative to surgery when chosen by the family. A study led by researchers at Nationwide Children's Hospital found that three out of four children with uncomplicated appendicitis have been successfully treated with antibiotics alone at one year follow-up. Compared to urgent appendectomy, non-operative management was associated with less recovery time, lower health costs and no difference in the rate of complications at one year.

"Surgery has long been the 'gold standard' of care for treating appendicitis because by removing the appendix we eliminate the chance that the appendicitis will ever come back," said Dr. Deans. "However, early in our careers we noticed that patients with appendicitis who were placed on antibiotics overnight until their surgery the following morning felt better the next day. So, Pete and I asked ourselves: do they really need to have surgery?"

In the first study conducted and published in the United States examining non-operative management for appendicitis, they enrolled 102 patients age 7 to 17 who were diagnosed with uncomplicated acute appendicitis at Nationwide Children's between October 2012 and October 2013. Participants had early/mild appendicitis, meaning that they experienced abdominal pain for no more than 48 hours; had a white blood cell count below 18,000; underwent an ultrasound or CT scan to rule out rupture and to verify that their appendix was 1.1 centimeter thick or smaller; and had no evidence of an abscess or fecalith, which is hard stone-like piece of stool.

Thirty-seven families chose antibiotics alone and 65 opted for surgery. Those patients in the non-operative group were admitted to the hospital and received IV antibiotics for at least 24 hours, followed by oral antibiotics after discharge for a total of 10 days. Among those patients, 95% showed improvement within 24 hours and were discharged without undergoing surgery. Rates of appendicitis-related medical care within 30 days were similar between the groups with two patients in the non-operative group readmitted within 30 days for an appendectomy. At one year after discharge, three out of four patients in the non-operative group did not have appendicitis again and have not undergone surgery.

Appendicitis, caused by a bacterial infection in the appendix, is the most common reason for emergency abdominal surgery in children, sending more than 70,000 young people to the operating room each year. Although many of these cases are severe and require surgery, there are a good number that would be candidates for treatment with antibiotics alone, Dr. Minneci said.

According to the study results, patients who were transferred to Nationwide Children's from other institutions expressed concerns about the distance and time necessary to come back if the appendicitis recurred. These families opted for surgery more often. Patients whose families spoke primary languages other than English were more likely to choose antibiotics as a course of treatment due to cultural values to avoid surgery if at all possible.

Published on Leave a comment on Taking Antidepressants During Pregnancy and Autism

A large study found that using antidepressants during the second or third trimester of pregnancy increases the risk that the child will have autism by 87%,  especially if the mother takes selective serotonin reuptake inhibitors (SSRIs). A drawback was that the study looked at associations rather than actual cause (which would have meant randomly assigning women to either treatment or no treatment - which is unethical). From Medical Xpress:

Taking antidepressants during pregnancy increases risk of autism by 87 percent

Using antidepressants during pregnancy greatly increases the risk of autism, Professor Anick Bérard of the University of Montreal and its affiliated CHU Sainte-Justine children's hospital revealed today. Prof. Bérard, an internationally renowned expert in the fields of pharmaceutical safety during pregnancy, came to her conclusions after reviewing data covering 145,456 pregnancies.

"The variety of causes of autism remain unclear, but studies have shown that both genetics and environment can play a role," she explained. "Our study has established that taking antidepressants during the second or third trimester of pregnancy almost doubles the risk that the child will be diagnosed with autism by age 7, especially if the mother takes selective serotonin reuptake inhibitors, often known by its acronym SSRIs." Her findings were published today in JAMA Pediatrics.

Bérard and her colleagues worked with data from the Quebec Pregnancy Cohort and studied 145,456 children between the time of their conception up to age ten. In addition to information about the mother's use of antidepressants and the child's eventual diagnosis of autism, the data included a wealth of details that enabled the team to tease out the specific impact of the antidepressant drugs. 

"We defined exposure to antidepressants as the mother having had one or more prescription for antidepressants filled during the second or third trimester of the pregnancy. This period was chosen as the infant's critical brain development occurs during this time," Prof. Bérard said. "Amongst all the children in the study, we then identified which children had been diagnosed with a form of autism by looking at hospital records indicating diagnosed childhood autism, atypical autism, Asperger's syndrome, or a pervasive developmental disorder. Finally, we looked for a statistical association between the two groups, and found a very significant one: an 87% increased risk." 

The findings are hugely important as six to ten percent of pregnant women are currently being treated for depression with antidepressants. In the current study, 1,054 children were diagnosed with autism (0.72% of the children in the study), on average at 4.5 years of age. Moreover, the prevalence of autism amongst children has increased from 4 in 10,000 children in 1966 to 100 in 10,000 today. While that increase can be attributed to both better detection and widening criteria for diagnosis, researchers believe that environmental factors are also playing a part.

"It is biologically plausible that anti-depressants are causing autism if used at the time of brain development in the womb, as serotonin is involved in numerous pre- and postnatal developmental processes, including cell division, the migration of neuros, cell differentiation and synaptogenesis - the creation of links between brain cells," Prof. Bérard explained. "Some classes of anti-depressants work by inhibiting serotonin (SSRIs and some other antidepressant classes), which will have a negative impact on the ability of the brain to fully develop and adapt in-utero".

Published on Leave a comment on Endocrine Disrupting Chemicals and Male Infertility

Recent research looked at environmental causes of male infertility, specifically endocrine-disrupting chemicals. Poor semen quality contributes to increases in infertility and the use of assisted reproductive technology.The researchers also discuss the higher incidence of testicular cancer worldwide, lower levels of testosterone in men, and poor semen quality among men aged 20 to 25 (with the average man having up to 90% abnormal sperm). From Science Daily:

Endocrine-disrupting chemicals may be threatening fertility in industrialized countries

The birth rate is declining in all industrialised countries, and socioeconomic factors and women's age are not solely to blame. Male reproductive health and environmental factors are also significant, as concluded in a new scientific review article. ...Behind the article are fertility researchers from Denmark, the US and Finland. The researchers studied a number of factors related to fertility, and one of the main conclusions of their study was that poor semen quality contributed to increases in infertility and the use of assisted reproductive technology.

The study also revealed higher incidence of testicular cancer worldwide, with the greatest frequency among Caucasian populations. Moreover, the researchers also observed lower levels of testosterone in average men. "I was surprised that we found such poor semen quality among young men aged 20 to 25. The average man had up to 90% of abnormal sperm. Normally, there would be so many sperms that a few abnormal ones would not affect fertility. However, it appears that we are at a tipping point in industrialised countries where poor semen quality is so widespread that we must suspect that it results in low pregnancy rates," said first author of the article, Professor Niels E. Skakkebaek from the Department of Growth and Reproduction (EDMaRC) at Rigshospitalet and the University of Copenhagen.

"The article also demonstrates the impact of the increasing number of male reproductive problems on low birth rates. There is no doubt that environmental factors are playing a role. These are the correlations we are researching at the new research centre EDMaRC at Rigshospitalet," added Professor Anders Juul, who is the last author of the article.

Many of the male reproductive problems could be due to damage to the testes during embryonic development. While the reproductive problems could arise from genetic changes, "recent evidence suggests that most often they are related to environmental exposures of the fetal testes," the researcher team wrote."Since the disorders in male genitals have increased over a relatively short period of time, genetics alone cannot explain this development. There is no doubt that environmental factors are playing a role and that endocrine-disrupting chemicals, which have the same effect on animals, are under great suspicion. The exposure that young people are subjected to today can determine not only their own, but also their children's, ability to procreate," explained Professor Skakkebaek.

Published on Leave a comment on Male Infertility Linked to Other Chronic Medical Conditions

A recent study found that men with infertility have a much higher risk for a variety of other chronic medical conditions, including diabetes, heart disease, renal disease, alcohol abuse, and drug abuse. Thus, it appears that male infertility may be a symptom or a clue that there may be other health problems. One example is that male infertility is linked to an 81% greater risk of diabetes, and the greatest risk for renal disease occurred among men with azoospermia (zero sperm counts, the most severe form of male infertility). From Medscape:

Infertility in Men Tied to Heart Disease, Chronic Conditions

Men with infertility have a higher risk for a variety of other chronic medical conditions, including diabetes, heart disease, alcohol abuse, and drug abuse, according to a retrospective cohort study published online December 7 in Fertility and Sterility."The results suggest that male factor infertility has more than just reproductive implications," write Michael Eisenberg, MD, assistant professor of urology and director of male reproductive medicine and surgery at Stanford University School of Medicine in California, and colleagues.

The researchers used insurance claims data from 2001 to 2008 from the Truven Health MarketScan to identify more than 115,000 patients for the study population. They compared outcomes among 13,027 men diagnosed with male factor infertility (average age, 33 years), with outcomes among 23,860 men (average age, 33 years) who received semen or infertility testing and with outcomes among 79,099 men who had received vasectomies.

The authors looked for 16 conditions: hypertension, diabetes, hyperlipidemia, renal disease, chronic pulmonary disease, liver disease, depression, peripheral vascular disease, cerebrovascular disease, ischemic heart disease, other heart disease, injury, alcohol abuse, drug abuse, anxiety disorders, and bipolar disorder.

The men with infertility had higher rates of obesity and smoking, but even after adjustment for these covariates and for age, follow-up time, and healthcare use, men with infertility had a higher risk for multiple conditions compared with vasectomized men or those receiving only fertility testing. Specifically, compared with the men who received fertility testing, men with infertility had a 30% increased risk for diabetes (hazard ratio [HR], 1.30; 95% confidence interval [CI], 1.10 - 1.53), a 48% increased risk for ischemic heart disease (HR, 1.48; 95% CI, 1.19 - 1.84) and for alcohol abuse (95% CI, 1.07 - 2.05), a 67% increased risk for drug abuse (HR, 1.67; 95% CI, 1.06 - 2.63), and a 19% increased risk for depression (HR, 1.19; 95% CI, 1.04 - 1.36).

Compared with men who received vasectomies, those with infertility had a 9% higher risk for hypertension (HR, 1.09; 95% CI, 1.02 - 1.17), a 14% greater risk for hyperlipidemia (HR, 1.14; 95% CI, 1.07 - 1.22), a 41% greater risk for ischemic heart disease (HR, 1.41; 95% CI, 1.19-1.67), and a 16% greater risk for other heart disease (HR, 1.16; 95% CI, 1.04 - 1.29). Further, men with infertility, compared with vasectomized men, had an 81% greater risk for diabetes (HR, 1.81; 95% CI, 1.57 - 2.08), a 60% greater risk for renal disease (HR, 1.60; 95% CI, 1.14 - 2.24), a 53% greater risk for liver disease (HR, 1.53; 95% CI, 1.31 - 1.80), and a 52% greater risk for peripheral vascular disorders (HR, 1.52; 95% CI, 1.12 - 2.07).

Published on Leave a comment on Sense of Purpose In Life May Be Good For Health

Of course! Makes sense that people who have a higher sense of purpose in life are at lower risk of death and cardiovascular disease!. From Science Daily:

Sense of purpose in life linked to lower mortality and cardiovascular risk

People who have a higher sense of purpose in life are at lower risk of death and cardiovascular disease, reports a pooled data analysis."Possessing a high sense of purpose in life is associated with a reduced risk for mortality and cardiovascular events," according to the study by Drs. Randy Cohen and Alan Rozanski and colleagues at Mt. Sinai St. Luke's-Roosevelt Hospital, New York. While the mechanisms behind the association remain unclear, the findings suggest that approaches to strengthening a sense of purpose might lead to improved health outcomes.

Using a technique called meta-analysis, the researchers pooled data from previous studies evaluating the relationship between purpose in life and the risk of death or cardiovascular disease. The analysis included data on more than 136,000 participants from ten studies -- mainly from the United States or Japan. The US studies evaluated a sense of purpose or meaning in life, or "usefulness to others." The Japanese studies assessed the concept of ikigai, translated as "a life worth living."

The study participants, average age 67 years, were followed up for an average of seven years. During this time, more than 14,500 participants died from any cause while more than 4,000 suffered cardiovascular events (heart attack, stroke, etc).

The analysis showed a lower risk of death for participants with a high sense of purpose in life. After adjusting for other factors, mortality was about one-fifth lower for participants reporting a strong sense of purpose, or ikigai. A high sense of purpose in life was also related to a lower risk of cardiovascular events. Both associations remained significant on analysis of various subgroups, including country, how purpose in life was measured, and whether the studies included participants with pre-existing cardiovascular disease..

There is a well-documented link between "negative psychosocial risk factors" and adverse health outcomes, including heart attack, stroke, and overall mortality. "Conversely, more recent study provides evidence that positive psychosocial factors can promote healthy physiological functioning and greater longevity," according to the authors.

While further studies are needed to determine how purpose in life might promote health and deter disease, preliminary data suggest a few basic mechanisms. The association might be explained physiologically, such as by buffering of bodily responses to stress; or behaviorally, such as by a healthier lifestyle.

Published on Leave a comment on Amazing Paper Sculptures of Microbes

Just saw some of  Rogan Brown's amazing paper sculptures of microbes. He designs, then cuts by hand or laser thousands of paper microorganisms, including tree moss, cell structures, bacteria, coral, and diatoms. Absolutely gorgeous! From :

Paper Life – The artist Rogan Brown cuts thousands of microorganisms in paper

The following article was from April 2015, and it described the work of various artists contributing to a permanent exhibit of the human microbiome. Go to the article and check out the various fascinating artworks. From Wired (UK edition): Eden Project's 'Human Biome' is a gross, musical microbe showcase

The great domed biomes of the Eden Project are to play host to a new permanent exhibition that will focus on one of nature's most important and complex ecosystems: the human body. Invisible You: The Human Biome will explore the community of microbes that live in and on each and every one of us. Artistic and interactive displays will show bacteria, fungi and viruses, with 11 artists commissioned to create works for the exhibition.

"These trillions of microbes outnumber our cells ten to one and, in the main, work together to keep us healthy -- whether it’s the bacteria in the gut helping to digest our food or the microbes on our skin working to keep it soft. This fascinating new exhibition is one of the most compelling and important we have ever staged," said Jo Elsworthy, the Eden Project's interpretation director. Among the artists commissioned to create work for the exhibition is Rogan Brown, who creates beautifully intricate, hand-cut paper artworks, including microbes. 

Published on Leave a comment on Beneficial Foods: Blackberries, Red Raspberries, and Black Raspberries

It seems that a lot has been written about the health benefits of some berries, such as blueberries, while other berries have been neglected. This study focused on red raspberries, black raspberries, and blackberries. While the study was done in Poland, it was pointed out that these berries are also commonly grown in the USA. Red raspberry, black raspberry, and blackberry fruits are abundant in dietary phytochemicals such as flavonols, phenolic acids, ellagitannins, vitamins C and E, folic acid, and β-sitosterol. Many of these bioactive compounds exhibit antioxidant activity. Anthocyanins and other phenolic compounds such as ellagitannins and ellagic acid, which distinguish raspberry from other berries, occur in high levels and are mainly responsible for their broad beneficial health properties (including anti-inflammatory, antimicrobial, and antiviral activities).

For these reasons, the researchers said that "raspberry and blackberry fruits can be regarded as natural functional foods". Another term for functional foods is nutraceutical, which is a food containing health-giving additives and having medicinal benefit. From Science Daily:

Looking for the best antioxidant fruit? Search no further than black raspberries

As far as healthy foods go, berries make the top of the list. They contain potent antioxidants, which decrease or reverse the effects of free radicals -- natural byproducts of energy production that can play havoc on the body and that are closely linked with heart disease, cancer, arthritis, stroke or respiratory diseases.

Unsurprisingly, the benefits of berries are extoled in one study after another....The research published now in Open Chemistry suggests that black raspberries grown in Central Europe show greater health benefits than their better known cousins -- raspberries or blackberries.

A group of researchers led by Anna Małgorzata Kostecka-Gugała measured the content of phenolics and anthocyanins in black raspberries, red raspberries and blackberries, assessing their antioxidant potential and health benefits. They were able to confirm that the antioxidant activity of natural products correlates directly with their health promoting properties.

It turns out that the amount of antioxidants in black raspberries was three times higher than the other fruits under investigation. Remarkably, the number was even higher for phenolics or the amount of anthocyanines -- with black raspberries topping their humble cousins by over 1000%. But most interestingly, black raspberries seem to be characterized by a higher content of secondary metabolites, which have been proved beneficial for human health.

Published on Leave a comment on Can Cruciferous Vegetables Fight Cancer?

Reading this recent study, I was struck by how the results are evidence for eating sulforaphane containing foods, such as kale, cauliflower, brussels sprouts, broccoli, and cabbage for health and preventing cancer (due to anti-tumor activity). It is debatable whether it is support for taking supplements (here a sulforaphane supplement called BSE), even though the researchers were testing the supplement. Seven days of taking a supplement without "serious adverse events" (but they did have minor ones such as "mild abdominal discomfort") is too short a length of time for any support for a product. The real test would be seeing what health effects, both positive and negative, are after a year or two of taking the supplement.

Numerous other studies have found that eating foods are linked to good health, while taking supplements are linked to various health problems. Some scientists speculate that it's because the doses in supplements are too high - that they're much higher than what is found in foods. Also, supplements may be missing important nutrients that are found in foods. Bottom line: eat real foods for health and and cancer prevention, including several servings a week of cruciferous vegetables (cauliflower, cabbage, garden cress,bok choy, broccoli, brussels sprouts and similar green leaf vegetables). From Futurity:

Can A Broccoli Sprout Pill Fight Cancer?

A compound in broccoli sprouts may not only help prevent cancer but also treat it. Sulforaphane is found in vegetables such as kale, cauliflower, and cabbage—and in particularly high concentrations in young broccoli sprouts. Sulforaphane also is available as a dietary supplement called BSE.

Researchers at the Texas A&M Health Science Center Institute of Biosciences and Technology, along with collaborators in Oregon, had previously found that sulforaphane could inhibit colon and prostate cancer cells in the laboratory. They’ve now shown that it seems to help humans as well. A paper published in the journal Clinical Epigenetics hints at the biological pathways involved and suggests BSE is generally safe.

“We have not seen any serious adverse events in healthy volunteers who consumed BSE pills for seven days,” says Praveen Rajendran, an assistant professor at Texas A&M University, although some people did experience mild abdominal discomfort.

In a separate clinical study, 28 human volunteers over the age of 50, who were undergoing routine colonoscopies, were surveyed for their cruciferous vegetable-eating habits. When their colon biopsies were examined, those who ate more servings were found to have higher levels of expression of the tumor suppressor gene p16 than those who ate few or no cruciferous vegetables.

This effect on p16 held even for people who didn’t eat these vegetables every single day, which may seem strange, as a single serving of sulforaphane is generally cleared from the body in less than 24 hours. “This hints at the possibility that epigenetic mechanisms are initially triggered by sulforaphane and its metabolites, and downstream mechanisms could be sustained, at least in the short-term, even after compounds are eliminated from the body.” In other words, eating vegetables containing sulforaphane may change your genes and help your body fight tumor growth.

However, it’s not all good news. In animal models, sulforaphane was shown to generally inhibit the development of colon cancer, but it’s a bit of a two-edged sword. Sulforaphane induces a protein called Nrf2, which has beneficial antioxidant and detoxifying effects—and is obviously good for fighting cancer. Later in the development of cancer, though, Nrf2 can also have a role in tumor growth and can even enhance the buildup of plaque in the arteries.