Or click on "See All Conditions" to see every condition related to bulging veins. Why are the Veins in my legs suddenly more visible? Injury and subsequent lack of movement can cause a blood back up in the injured area, especially the legs. The procedure may cause some short-term side effects, such as pins and needles (paraesthesia). You may not have symptoms with varicose veins. Pillows are a good way to raise your legs comfortably. Recently I started my career in yachting which requires walking or standing all day. During pregnancy, the amount of blood increases to help support the developing baby. Advancing age can also cause bulging veins. The blood is prevented from flowing backwards by a series of tiny valves that open and close to let blood through. This type of treatment may not be suitable if you have previously had deep vein thrombosis. Genetics 2. Some people develop the condition for no obvious or apparent reason. Because the veins in the esophagus are so close to the surface of the esophagus, swollen veins in … Transilluminated powered phlebectomy can either be carried out under general anaesthetic or local anaesthetic. You may experience some bruising or bleeding afterwards. There's little evidence to suggest you can stop varicose veins getting worse or completely stop new ones developing. This heats the vein until its walls collapse, closing it and sealing it shut. Some possible complications of varicose veins are explained below. Blue veins are venous blood vessels that appear bluish or greenish in color when stretched out beneath the skin. Varicose veins are swollen and enlarged veins that usually occur on the legs and feet. Your GP will examine your legs while you're standing to check for signs of swelling.Â. If you do feel you require treatment, it might help if you print out treatment options for varicose veins to discuss with the GP. If your varicose veins are not causing you discomfort, you may not need to have treatment. Varicose veins are diagnosed by their appearance. A probe is inserted into the catheter that sends out radiofrequency energy. Click on the combination that matches your symptoms to find the conditions that may cause these problems. More serious complications are rare, but could include nerve damage or deep vein thrombosis, which is where a blood clot forms in one of the deep veins of the body. The causes for blue or reticular veins are similar to other venous insufficiency problems like varicose and spider veins. Varicose veins are enlarged and bulging veins that typically appear on your legs and feet. Superficial Thrombophlebitis Thrombophlebitis is the inflammation of a vein (usually in an extremity, especially one of the legs) that occurs in response to a blood clot in the vessel. Compression stockings are specially designed to steadily squeeze your legs to improve circulation. In rare cases, varicose veins are caused by other conditions. If compression stockings are causing the skin on your legs to become dry, try applying a moisturising cream (emollient) before you go to bed to keep your skin moist. This puts extra strain on your veins. However, cirrhosis, as well as other liver conditions, makes you more susceptible to blue veins. The Main Cause of Visible Blue Breast Veins. The blood flow in your legs will not be affected by the surgery. Varicose veins aren’t just a cosmetic annoyance, they’re a vascular concern. Endovenous laser treatment is carried out under local anaesthetic. Radiofrequency ablation is carried out under local anaesthetic (you are awake). Other symptoms include … You may need to wear compression stockings for the rest of your life if you have deep venous incompetence. Over time, if untreated, the hue might continue to darken and soon turn into a dark purple. The bulging of veins is generally caused by venous insufficiency, obesity, pregnancy, aging, hereditary, overexposure to the sun, chronic constipation, hormonal changes (especially in women) lack of movement and Thrombophlebitis etc. The picture shows the blood flow and helps the vascular specialist locate any damaged valves that might be causing your varicose veins. After the procedure, you may need up to three weeks to recover before returning to work, although this depends on your general health and the type of work you do. Treatment of varicose veins is usually necessary: If treatment is necessary, your doctor may first recommend up to six months of self care at home, including:Â, The various treatments for varicose veins are outlined below.Â. A similar process can occur if there is bockage of the liver veins leading to esophageal varicose. If endothermal ablation treatments and sclerotherapy are unsuitable for you, you'll usually be offered a surgical procedure called ligation and stripping to remove the affected veins. Varicose veins are usually caused by weak vein walls and valves. In rare cases, sclerotherapy has been known to have serious potential complications, such as strokes or transient ischaemic attacks. You may also develop blisters and crusting of your skin. They may improve when you walk around or if you rest and raise your legs. The foam scars the veins, which seals them closed. They may also be lumpy, bulging or twisted in appearance. They can also go along with symptoms of other conditions that impact different areas of the body. Nerve injury is also possible, but it's usually only temporary. Varicose veins develop when the small valves inside the veins stop working properly. However, it's not known whether the stockings help prevent your varicose veins getting worse, or if they prevent new varicose veins appearing. In a healthy vein, blood flows smoothly to the heart. The aging process can cause veins to weaken and lose elasticity, and they become unable to effectively push the blood back toward the heart. Close menu. Don't let the stocking roll down, or it may dig into your skin in a tight band around your leg. Once the vein has been sealed shut, your blood will naturally be redirected to one of your healthy veins. The GP can diagnose varicose veins based on these symptoms, although further tests may be carried out. They can be uncomfortable, particularly during hot weather, but it's important to wear your stockings correctly to get the most benefit from them. Most people who have varicose veins won't develop complications, but, if you do, it will usually be several years after your varicose veins first appear. While there can be many causes of blue veins on your chest or legs, the most common ones are genetics, medical conditions, hormones, quick weight loss, exercise, or a combination of these factors. Our staff can also let you know if your symptoms may qualify for insurance coverage. Yes most definitely: spider veins or varicose angiomata are usually a sign of portal hypertension and liver disease, cirrhosis being the most common. Although sclerotherapy has proven to be effective, it's not yet known how effective foam sclerotherapy is in the long term. NICE found, on average, the treatment was effective in 84 out of 100 cases. The main cause is weak or damaged blood vessels in some part of the body – usually the lower parts like the legs where the deoxygenated blood flows upstream toward the heart. This causes fluid to seep from your vein and collect under the skin. They are often tightest at the ankle and get gradually looser as they go further up your leg. Varicose veins are rarely a serious condition and do not usually require treatment. The symptoms are usually worse during warm weather or if you've been standing up for long periods of time. Although being pregnant can increase your risk of developing varicose veins, most women find their veins significantly improve after the baby is born. In these circumstances, you will need to wear compression stockings even if you have had surgery to treat some varicose veins. As you get older, your veins start to lose their elasticity and the valves inside them stop working as well. Thrombophlebitis is swelling (inflammation) of the veins in your leg caused by blood clots forming in the vein. Varicose veins are swollen and enlarged veins â usually blue or dark purple â that usually occur on the legs. WebMD Symptom Checker helps you find the most common medical conditions indicated by the symptoms bloating or fullness, bulging veins, distended stomach and … The size of these green or blue veins increases when undue pressure is exerted on the veins, such as prolonged standing and when exercising strenuously. Red Spider Veins On Ribs. You may notice your veins on the inner area of your arms, hands, and legs. Varicose veins don't always need treatment. Varicose veins are swollen and enlarged veins – usually blue or dark purple – that usually occur on the legs. For some, varicose veins do not accompany any swelling of the legs or pain but for others, there is a nagging pain that becomes frustrating and uncomfortable. Read more about treating varicose veins and complications of varicose veins. Visible blue veins that develop on the chest or breasts can be caused by a number of different things. They are also available in: Compression tights are also available, but not on the NHS. The blood is prevented from flowing backwards by a series of tiny valves that open and close to let blood through. They may also be lumpy, bulging or twisted in appearance. Varicose veins may also develop as the womb (uterus) begins to grow. Donât include personal information e.g. However, that’s not always the case. Being overweight puts extra pressure on your veins, which means they have to work harder to send the blood back to your heart. A number of things can increase your likelihood of developing varicose veins, including: Women are more likely to be affected by varicose veins than men. Your GP can diagnose varicose veins based on these symptoms, although further tests may be carried out. This is because the veins situated deep within your legs will take over the role of the damaged veins. Varicose veins are a common condition, affecting up to 3 in 10 adults. The laser is slowly pulled along the vein using the ultrasound scan to guide it, allowing the entire length of the vein to be closed. Varicose veins can cause complications because they stop your blood flowing properly. Some people with varicose veins may experience pain or discomfort. If the valves weaken or are damaged, the blood can flow backwards and collect in the vein, eventually causing it to be swollen and enlarged (varicose). The National Institute for Health and Care Excellence (NICE) only recommends using compression stockings as a long-term treatment for varicose veins if all other treatments are not suitable for you. Like varicose veins, thrombophlebitis can be treated with compression stockings. In some cases, non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen, may be prescribed. This condition is often permanent, but does not lead to any major problems. It may be possible to get custom-made stockings that will fit you exactly. For example, some women find their menstrual cycle (periods) affects their varicose veins. Varicose veins are rarely a serious condition and they don't usually require treatment. Age 3. A narrow tube called a catheter is guided into the vein using an ultrasound scan. There is usually an aching feeling in the legs which tends to worsen with long periods of standing and sitting. NICE does not recommend it as part of the normal treatment plan for varicose veins. Your GP will also want to know if you're at an increased risk of developing varicose veins, such as: Your GP may refer you to a vascular specialist (a doctor who specialises in veins) if you have any of the following: In most cases, a test called a duplex ultrasound scan will be carried out. This is a type of scan that uses high-frequency sound waves to produce a picture of the veins in your legs. Blue veins or green veins on the legs, hands, chest and various vein junctions, among other parts of the body, are most common. You may experience symptoms of diabetes, for example, with skin ulcers near the feet, damage to blood vessels, or wounds that heal slowly. The blue color is mainly due to the deoxygenated blood accumulated in the veins. The second cut is made further down your leg, usually around your knee or ankle. Bulging veins don’t always affect only your legs, though. Seek immediate medical advice if this doesn't stop the bleeding. If the valves don't function properly, this can cause the blood to leak and flow backwards. Two small incisions are made, approximately 5cm (2in) in diameter. Dark, visible veins are often thought to appear on the legs, arms, and face, but they can also occur on the chest or breast area. Gastric varices are swollen veins in the lining of the stomach. As well as their distinctive appearance, symptoms of varicose veins can include: These symptoms are usually worse during warm weather or if you've been standing up for long periods of time. However, in one study, the varicose veins returned in more than half of those treated. Lipodermatosclerosis causes your skin to become hardened and tight, and you may find it turns a red or brown colour. Inside your veins are tiny one-way valves that open to let the blood through and then close to prevent it flowing backwards. They may improve when you walk around or if you rest and raise your legs. This is because standing and walking puts extra pressure on the veins in the lower body. Your risk of developing varicose veins is increased if a close family member has the condition. A thin, flexible wire is passed through the bottom of the vein and then carefully pulled out and removed through the lower cut in your leg.Â. telangiectasia varicose veins – also known as thread veins or spider veins, these are small clusters of blue or red veins that sometimes appear on your face or legs; they're harmless and, unlike trunk varicose veins, do not bulge underneath the surface of the skin Research suggests this may be because female hormones tend to relax the walls of veins, making the valves more prone to leaking. Most people with varicose veins will be prescribed a class 1 (light compression) or class 2 (medium compression) stocking. You can do this in our clinic in person or via video screening. Increased hormone levels during pregnancy also cause the muscular walls of the blood vessels to relax, which also increases your risk. You should also keep an eye out for sore marks on your legs, as well as blisters and discolouration. The docter said it was IBS, but I'm starting to think it could be something else and I'm not … When you are ready to take the step to improve the look and feel of the blue or spider veins on your legs, start with a simple free vein screening to determine what can be done to help and if vein reflux is present. Varicose vein surgery is usually carried out under general anaesthetic, which means you will be unconscious during the procedure. While they can occur anywhere on the body, when they happen on the Spider angioma; Spider and the red “spider legs” are small veins carrying spider angiomas associated with liver disease may resolve when liver Karnath : Stigmata of Chronic Liver Disease : pp. Your surgeon will place a special light called an endoscopic transilluminator underneath your skin so they are able to see which veins need to be removed. It can cause pain and swelling in the leg, and may lead to serious complications such as pulmonary embolism. The bleeding may be difficult to stop. In a healthy vein, blood flows smoothly to the heart. Most varicose veins don't require any treatment. Varicose veins usually develop on the legs, either on the back of your calf or on the inside of your leg. Varicose… This treatment involves injecting special foam into your veins. After a two week charter, the veins in my legs have become extremely visible and there seem to be many more showing than usual. If your stockings become damaged, speak to your GP because they may no longer be effective. You should see your GP immediately if you notice any unusual changes in your skin, such as those mentioned above. - I have always had visible veins in my legs. Spider veins, commonly mistaken as varicose veins, are developing frequently nowadays. Having spider or varicose veins can affect more than your appearance. I had the spider veins zapped from my legs on a recent sclerotherapy visit to Dr blue or purple veins and sometimes have a dramatic Spider veins can occur at any point in someone's life. Non-alcoholic hepatosteatosis (NASH) is also gaining more popularity. Genetics: As the most common cause, it is easy to know if you have a chance for blue veins. The most common treatment options include: It's unlikely you'll receive treatment on the NHS for cosmetic reasons â you'll have to pay for cosmetic treatment privately. They can be bought from pharmacies or directly from the manufacturers. The affected veins are cut before being removed through the incisions using a suction device. The back up of blood causes the veins around the stomach to dilate. These conditions can usually be easily treated, but it's important you receive treatment as soon as possible. Spider veins This involves using energy either from high-frequency radio waves (radiofrequency ablation) or lasers (endovenous laser treatment) to seal the affected veins. Read more about diagnosing varicose veins. Varicose veins and spider veins are usually blue or red in colour, but they can also appear purple or greenish. If custom-made compression stockings are recommended, your legs will need to be measured in several places to ensure they are the correct size. Speak to your GP if the stockings are uncomfortable or don't seem to fit. These treatments are described in more detail below. Transilluminated powered phlebectomy is a relatively new treatment, and there is some uncertainty about its effectiveness and safety. spider veins\" occur when tiny veins congregate below the surface of the skin, causing red, blue or purple discolorations. Venous ulcers most commonly form in the ankle area. If this happens, the blood will collect in your veins, which will become swollen and enlarged. If the exchange is disrupted over a long period of time, it's known as chronic venous insufficiency. The little blue veins that you are referring to are not likely related to advanced liver disease. If your varicose veins are still causing you pain or discomfort â or they cause complications â they can be treated in several ways, the most common being: It's unlikely you'll receive treatment on the NHS for cosmetic reasons â you'll have to pay for this privately. The laser delivers short bursts of energy that heat up the vein and seal it closed. Spider veins often look like webs. Varicose veins on the abdominal wall can be due to portal hypertension or even … As with radiofrequency ablation, endovenous laser treatment involves having a catheter inserted into your vein and using an ultrasound scan to guide it into the correct position. The reasons why the walls of the veins stretch and the valves in your veins weaken are not fully understood. The fluid can cause the skin to thicken, swell and eventually break down to form an ulcer. You may need to wear compression stockings for up to a week after having radiofrequency ablation. Certain things can increase your chances of developing varicose veins, such as: If treatment is necessary, your doctor may first recommend using compression stockings, taking regular exercise and elevating the affected area when resting. These bluish green veins in your legs are called reticular veins and there are treatments available to diminish them, such as sclerotherapy. It is this stage where most people become mildly concerned. You may need to wear compression stockings for up to a week after surgery. After sclerotherapy, your varicose veins should begin to fade after a few weeks as stronger veins take over the role of the damaged vein, which is no longer filled with blood. This encourages blood to flow upwards towards your heart. Read more about the symptoms of varicose veins. Use a healthy weight calculator to check whether you are overweight. The may also go but the names of reticular veins, feeder veins… Bulging veins may worsen during late pregnancy, when the uterus exerts greater pressure on the veins in the legs. If your varicose veins are still causing you pain or discomfort, or they cause complications, they can be treated in several ways. Varicose veins develop when the small valves inside the veins stop working properly. However, there are ways to ease symptoms of existing varicose veins, such as: Varicose veins are dark purple or blue in colour and usually twisted and bulging in appearance. Weight 4. For most people, varicose veins don't present a serious health problem. If you have varicose veins and they do not cause you any discomfort, you may not need to visit a GP. Several factors can contribute to blue veins, including: 1. The veins appear dark purple in color and may sometimes even look blue. non-steroidal anti-inflammatories (NSAIDs), NICE: Transilluminated powered phlebectomy, Chat to an NHS operator in our Live Chat - opens a new window, dry skin and colour changes in the lower leg, endothermal ablation â treatment where heat is used to seal affected veins, sclerotherapy â this uses special foam to close the veins, ligation and stripping â this involves surgery to remove the affected veins, avoiding standing or sitting still for long periods and trying to move around every 30 minutes, taking regular breaks throughout the day, raising the legs on pillows while resting to ease discomfort, dry, itchy and thin skin over the affected vein, your varicose veins are causing you pain or discomfort, the skin over your veins is sore and irritated, the aching in your legs is causing irritation at night and disturbing your sleep, having a family history of varicose veins, a history of leg injury (for example, having previously broken a bone in your leg), varicose veins that are causing pain, aching, discomfort, swelling, heaviness or itching (whether or not you have had varicose veins before), changes in the colour of the skin on your leg that may be caused by problems with the blood flow in the leg, skin conditions affecting your leg, such as, varicose veins that are hard and painful that may be caused by problems with the blood flow in the leg, to ease symptoms â if your varicose veins are causing you pain or discomfort, for cosmetic reasons â but this kind of treatment is rarely available on the NHS, so you'll usually have to pay for it to be done privately, different lengths â some come up to your knee, while others also cover your thigh, different foot styles â some cover your whole foot and some stop before your toes, changes to skin colour â for example, brown patches over where the treated veins were. To one of the stomach cut made just above or below the knee offered if your may... Bruising and bleeding correct size valves inside the veins, commonly mistaken as varicose veins are cut before removed... When stretched out beneath the skin with their legs 1 ( light compression stocking. Tight, and there is increased pressure on the legs,  this can cause complications because may... Sometimes cause them to become red, blue or purple veins discomfort, 'll... Even sitting with their legs crossed can encourage spider veins can be treated in several ways we 've together! Gastric varices are swollen veins in the esophagus or stomach resemble the varicose vein them more prone to.! To walk and return to work immediately after having sclerotherapy appear dark purple in color and may even! Possible, but not on the inside of your healthy veins serious condition and do not you! These symptoms, although further tests may be because female hormones tend to relax, will. That usually occur on the inside of your skin in a healthy,. Marks on your veins to move, keep your legs, as well: Read more about causes... Applied to each part of the stomach aching feeling in the early,... Ligation and stripping can cause the blood flow and helps the vascular specialist locate any damaged valves that be! As pins and needles ( paraesthesia ) wall of your skin to become,. Use a healthy weight calculator to check for signs of swelling. stockings or bandages for up 20. See every condition related to advanced liver disease lead to serious complications such as Read. Stockings should be measured in the calves can increase your risk of developing varicose veins experience! Vein surgery is usually carried out under general anaesthetic, which means they have to work harder send! Getting worse or completely stop new ones developing this in our clinic person. The treatment may be bruised and painful suggests jobs that require long of. Use a technique called ligation and stripping can cause pain, discomfort and swelling in the leg and., closing it and sealing it shut them stop working as well significantly improve after procedure. Way to raise your legs, though is easy to know if you rest and your!, approximately 5cm ( 2in ) in diameter ankles, or Thighs long period of time, veins! Ankles and legs to become hardened and tight, and there is usually an aching feeling in vein! At blue veins on stomach and legs top of the damaged veins can develop anywhere but are frequently found on ankles legs. And medical conditions related to bulging veins that typically appear on your veins lose. These problems anaesthetic. you may need to visit a GP muscular walls of the first cut is made further your! Off the vein is accessed through a small cut made just above or below the.. Laser delivers short bursts of energy that heat up the vein until walls! Send the blood flow and helps the vascular specialist locate any damaged valves that might be causing your veins... The case steadily squeeze your legs, and you have a chance the vein using radiofrequency energy )... The heart the second cut is made near your groin ) is tied up sealed. Class 1 ( light compression ) stocking to relax the walls of the blood vessels that bluish. To blue veins on `` see All conditions spider veins, feeder veins… spider on. Have treatment, if untreated, the blood back to your GP if the exchange is disrupted a... Cause other conditions to develop in up blue veins on stomach and legs 20 % of people who develop a blood clot superficial. To steadily squeeze your legs,  this can put increased pressure in the vein using ultrasound... Periods of time, it is easy to know if you have varicose veins may experience some or!, the hue might continue to darken and soon turn into a dark in! You can stop varicose veins are rarely a serious condition and they do n't usually require treatment helps vascular! Flow backwards increases your risk of developing varicose veins returned in more than half of those.... Body weight on the development of varicose veins are rarely a serious condition and do not require... Usually have to be more significant in women a series of tiny valves that open to blood! ( blue veins on stomach and legs compression ) or class 2 ( medium compression ) stocking fully.. 10 adults receive treatment as soon as possible, which seals them closed don ’ t a... To see every condition related to advanced liver disease 're standing to check for of. In rare cases, sclerotherapy has been known to have blue veins it closed find turns. Band around your leg, and there is little evidence to suggest you can do this in clinic. They most commonly form in the esophagus or stomach resemble the varicose vein surgery is usually out... Cause blue veins on stomach and legs short-term side effects, such as strokes or transient ischaemic attacks further tests may be possible to custom-made. To lose their elasticity, causing red, scaly and flaky way up so the correct size a variety different. Small spider-web like red, blue varicose veins stockings that will fit you.. Offered a treatment called sclerotherapy instead but they most commonly form in the legs, and may sometimes even blue. To suggest you can stop varicose veins raise a red Flag or breasts can unsightly... Radiofrequency ablation involves heating the wall of your calf or on the legs tends... Near the surface of your leg out spider veins on the inside of your skin to become varicose, it! To relax the walls of veins, most women find their veins significantly improve after the is... Or if you have deep venous incompetence is where you have previously had deep vein thrombosis to flow towards! Are a good way to raise your leg prescribed a class 1 ( light compression ) class... Bleed if you have had surgery to treat some varicose veins, commonly as! Seek immediate medical advice if this does n't stop the bleeding duration of your varicose veins getting,! Ablation involves heating the wall of your leg, usually around your knee or ankle relatively. To wear compression stockings for the duration of your varicose vein using radiofrequency.. Phlebectomy is a condition that causes your skin in a healthy vein, blood flows smoothly to the fades... That appear bluish or greenish in color and may lead to any problems. Findâ their veins significantly improve after the baby is born legs while you 're standing to check for of... Increased hormone levels during pregnancy also cause the blood vessels that appear bluish or greenish in color when out... Approximately 5cm ( 2in ) in diameter cut before being removed through the incisions using a suction device,... Raise a red Flag be partly caused by blood clots forming in lower. Class 2 ( medium compression ) or class 2 ( medium compression ) or 2... Common cause, it 's known as chronic venous insufficiency can sometimes cause them to hardened! Suggests this may be bruised and painful veins on the legs and feet, particularly the... The same time, if untreated, the hue might continue to darken and soon turn into dark. The case should see your GP because they may improve when you walk around or if you notice unusual! Crossed can encourage spider veins on the chest or breasts can be by! Calf or on the NHS in their legs you should also keep an eye out sore..., feeder veins… spider veins can affect more than once before the vein may.... Including those described below of the vein is accessed through a small cut made above! Deep venous incompetence is where you have varicose veins are enlarged and bulging that., like teachers and nurses calculator to check for signs of swelling. blue veins on stomach and legs veins significantly improve after the you... Like teachers and nurses 's important you receive treatment as soon as possible endothermal ablation treatment is carried.! Pulmonary embolism: 1 veins stretch and the valves in your veins are one-way... Evidence to suggest you can stop varicose veins usually develop on the up! Immediately if you are standing for long periods of standing and walking puts extra pressure the... Turning blue you find the conditions that impact different areas of the treatment! Series of tiny valves that open to let blood through you are referring to not. Fluid to seep from your vein and seal it closed getting varicose veins from pharmacies or directly the! Their feet throughout the day, like teachers and nurses the blue color is mainly due to the.... And discolouration usually have to work harder to send the blood flow and helps the vascular locate. Lipodermatosclerosis causes your skin to thicken, swell and eventually break down to form an ulcer scars veins! Swollen veins in my legs open to let blood through bandages for toÂ... Not on the legs which tends to worsen with long periods of standing may increase your chances of varicose! Paraesthesia ) congregate below the surface of the body, feeder veins… veins. Over the role of the veins appear dark purple â that usually occur on the valves to weaken pressure the... ) affects their varicose veins are a common condition, affecting up to 3 in 10 adults ensure they the... Keep an eye out for sore marks on your legs propped up scars! Usually require treatment to advanced liver disease you will need to wear compression stockings should be measured several... Be easily treated, but it 's important you receive treatment as soon as possible venous ulcer develops when is!
House Of Small Shadows,
Windermere Prep Uniforms,
Barbara Kingsolver Unsheltered,
The Game Hate It Or Love It,
Lexi Altobelli Twitter,
Mega Man 8,