骨髓炎的症状
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz/miaicBZBfRD4EjENoWOyOVlGmGsLUKT2nZC6fJUW8vYVxbdRibo650v0o5MACSROnvHphjXOaBN1r1ao3gHEdZOiaA/640?wx_fmt=gif&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">为一种骨的感染和破坏，由需氧或厌氧菌，分枝杆菌及真菌<span style="color: black;">导致</span>。骨髓炎好发于椎骨；糖尿病<span style="color: black;">病人</span>的<span style="color: black;">脚步</span>或<span style="color: black;">因为</span>外伤或手术<span style="color: black;">导致</span>的穿透性骨<span style="color: black;">损害</span>部位，儿童最<span style="color: black;">平常</span>部位为血供良好的长骨；如胫骨或股骨的干骺端。</span></p>
<h2 style="color: black; text-align: left; margin-bottom: 10px;"><span style="color: black;">症状体征</span></h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">一，症状</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">骨髓炎<span style="color: black;">指的是</span>化脓性细菌感染骨髓，骨皮质和骨膜而<span style="color: black;">导致</span>的炎症性<span style="color: black;">疾患</span>，<span style="color: black;">都数</span>由血源性<span style="color: black;">导致</span>，<span style="color: black;">亦</span>多由外伤或手术感染<span style="color: black;">导致</span>，多由疖痈或其他病灶的化脓菌毒进入血液而达骨组织，四肢骨两端最易受侵，尤以髋关节为最<span style="color: black;">平常</span>，临床上<span style="color: black;">平常</span>有反复<span style="color: black;">爆发</span>，<span style="color: black;">数年</span>不愈的病例，严重影响身心健康和劳动能力，急性骨髓炎起病时高热，局部<span style="color: black;">病痛</span>，若诊断不<span style="color: black;">即时</span>转为慢性骨髓炎时会有溃破，流浓，有死骨或空洞形成，重症<span style="color: black;">病人</span>常危及生命，有时不得不采取截肢保命的应急办法，使<span style="color: black;">病人</span>落下终生残疾。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">二，诊断</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">本病<span style="color: black;">病人</span>常<span style="color: black;">显现</span>局限性骨痛，发热和不适则提示骨髓炎可能，血白细胞计数<span style="color: black;">能够</span>正常，但ESR和C-反应蛋白几乎总是<span style="color: black;">升高</span>，X线变化在感染后3~4周<span style="color: black;">显现</span>，可见骨破坏，软组织肿胀，软骨下骨板侵蚀，椎间盘间隙变窄和骨质破坏伴椎骨变短，若X线表现不<span style="color: black;">知道</span>，可行CT<span style="color: black;">检测</span>以确定病变骨及<span style="color: black;">表示</span>椎旁脓肿的形成，放射骨扫描在病变<span style="color: black;">初期</span>即有反映，但<span style="color: black;">没</span>法区别感染，骨折和肿瘤，<span style="color: black;">经过</span>椎间盘间隙或感染骨的穿刺活检和手术活检，可行细菌培养和药敏<span style="color: black;">实验</span>，从窦道取到的标本培养结果对诊断骨髓炎是不<span style="color: black;">靠谱</span>的。</p>
<h2 style="color: black; text-align: left; margin-bottom: 10px;"><span style="color: black;">治疗<span style="color: black;">办法</span></span></h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">预防 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1、<span style="color: black;">通常</span>感染性<span style="color: black;">疾患</span>的预防：疖疔疮痈以及上<span style="color: black;">呼气</span>道感染都是最<span style="color: black;">平常</span>的感染性<span style="color: black;">疾患</span>，且最易继发感染而致血源性骨髓炎的<span style="color: black;">出现</span>。<span style="color: black;">因此呢</span>预防疖疮痈及上<span style="color: black;">呼气</span>道感染的<span style="color: black;">出现</span>，对预防骨髓炎的<span style="color: black;">出现</span>是<span style="color: black;">非常</span><span style="color: black;">要紧</span>的。其预防的<span style="color: black;">重点</span><span style="color: black;">办法</span>是：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1、保持室内气流通<span style="color: black;">重视</span>环境卫生和个人卫生保持皮肤清洁 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2、青春期应多食蔬采<span style="color: black;">果蔬</span>少用油剂润肤以防止皮脂腺分泌物堆积或腺管阻塞 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3、加强体育<span style="color: black;">熬炼</span><span style="color: black;">加强</span>身体素质防止感冒<span style="color: black;">出现</span> </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4、扁桃体炎反复<span style="color: black;">爆发</span>者应积极预防和治疗，必要时<span style="color: black;">思虑</span>手术摘除</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2、预防外伤感染：外伤感染<span style="color: black;">包含</span>组织<span style="color: black;">损害</span>后感染和骨骼<span style="color: black;">损害</span>后感染，<span style="color: black;">亦</span>是<span style="color: black;">导致</span>骨髓炎的<span style="color: black;">平常</span><span style="color: black;">原由</span>，<span style="color: black;">因此呢</span>在<span style="color: black;">平常</span>生活中<span style="color: black;">亦</span>应<span style="color: black;">重视</span>积极预防。 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3、及早<span style="color: black;">发掘</span>和<span style="color: black;">即时</span>治疗感染：<span style="color: black;">没</span>论何种<span style="color: black;">原由</span><span style="color: black;">导致</span>的感染，其严重程度影响范围的<span style="color: black;">体积</span>与全身和局部的<span style="color: black;">前提</span>都有着密切的关系。<span style="color: black;">况且</span>与<span style="color: black;">发掘</span>的迟早处理的<span style="color: black;">即时</span>与否<span style="color: black;">亦</span>有很的大的关系。<span style="color: black;">因此呢</span><span style="color: black;">针对</span>感染性的<span style="color: black;">疾患</span>，应及早<span style="color: black;">发掘</span>、<span style="color: black;">即时</span>治疗。这<span style="color: black;">针对</span>预防骨髓炎的<span style="color: black;">出现</span>有着积极的<span style="color: black;">功效</span>。浅表的感染，局部表现<span style="color: black;">显著</span>容易<span style="color: black;">发掘</span>。深部感染常难以诊断。除体温和血象<span style="color: black;">反常</span>以及患处<span style="color: black;">病痛</span>较重外，局部皮肤并不<span style="color: black;">必定</span>表现为炎症的浸润,但却有<span style="color: black;">显著</span>肿胀。临床<span style="color: black;">必要</span>认真<span style="color: black;">检测</span>综合分析，以便<span style="color: black;">即时</span><span style="color: black;">发掘</span>和处理。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4、开放性骨折的处理：开放性骨折<span style="color: black;">首要</span>要防止感染。<span style="color: black;">咱们</span><span style="color: black;">通常</span>不主张内固定。因骨折后局部软组织<span style="color: black;">损害</span>，充血水肿若再施内固定所采用的钢针等异物继续刺激，局部可能<span style="color: black;">作为</span>继发感染的<span style="color: black;">要紧</span><span style="color: black;">原因</span>。<span style="color: black;">因此</span><span style="color: black;">咱们</span>常<span style="color: black;">选择</span>止血、清创、整骨，外用自制的止血生肌之类的<span style="color: black;">药品</span>，用小夹板固定以减少感染的机会。已行内固定的开放性骨折，一旦<span style="color: black;">出现</span>感染并蔓延到髓腔后，炎性感染常沿髓内针向两端扩散，在髓内针穿入或穿出部位的皮下<span style="color: black;">亦</span>可能形成感染，一旦<span style="color: black;">出现</span>，应<span style="color: black;">尤其</span><span style="color: black;">重视</span><span style="color: black;">首要</span>取出内固定物以<span style="color: black;">掌控</span>感染。<span style="color: black;">详细</span>的讲，骨髓炎的预防要<span style="color: black;">膳食</span>有节，起居有常，还要适当进地进行体育<span style="color: black;">熬炼</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">尤其</span><span style="color: black;">重视</span>事项： </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1、</span>在感冒发烧<span style="color: black;">时期</span>，体温不可超过38.5度，此时要尽快<span style="color: black;">运用</span>抗菌、消炎、退烧类针剂静脉点滴或肌肉注射，或清热解毒、发汗解表类中成药内服，将有可能感染成骨髓炎的细菌扼杀在萌芽状态中;</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2、</span>在外伤骨折，或跌打<span style="color: black;">损害</span>，或手术后感染中，疮臃肿毒即褥疮等<span style="color: black;">疾患</span>的<span style="color: black;">爆发</span>时，<span style="color: black;">必定</span>要<span style="color: black;">即时</span>准确地对症治疗处理好，<span style="color: black;">掌控</span>住细菌进一步的入侵，此时<span style="color: black;">能够</span><span style="color: black;">运用</span>大剂量的抗感染、抗病毒、消炎类<span style="color: black;">药品</span>静脉点滴(<span style="color: black;">亦</span><span style="color: black;">能够</span>用大剂量的清热解毒，凉血活血，排毒拔毒类中药内服外用)使<span style="color: black;">病人</span><span style="color: black;">身体</span>感染的病毒及早地排出体外或消散。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">3、</span>在<span style="color: black;">平常</span>生活中，<span style="color: black;">亦</span>不可疲劳过度，过于<span style="color: black;">疲劳</span>会<span style="color: black;">导致</span>人体抵抗力下降，免疫功能低下，此时细菌可乘虚而入<span style="color: black;">引起</span>骨髓炎及其他<span style="color: black;">疾患</span>的<span style="color: black;">出现</span>。 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">4、</span><span style="color: black;">平常</span>生活中，如有其他<span style="color: black;">疾患</span>的<span style="color: black;">出现</span>，治疗<span style="color: black;">时期</span>切不可<span style="color: black;">乱用</span>或<span style="color: black;">长时间</span><span style="color: black;">运用</span>激素类化学<span style="color: black;">药品</span>，此类<span style="color: black;">药品</span><span style="color: black;">运用</span><span style="color: black;">欠妥</span>则易加速骨质的硬化，骨髓腔的硬化及阻塞，<span style="color: black;">导致</span>骨细胞正常代谢功能<span style="color: black;">阻碍</span>，<span style="color: black;">乃至</span><span style="color: black;">导致</span>骨坏死。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">骨髓炎中医治疗<span style="color: black;">办法</span> </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">采用扶正祛邪、内外同治的治疗原则。 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1、</span>辨证选方： </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1.血虚寒凝：治法：温经散寒、养血通络。方药：独活寄生汤加减。独活10g，细辛3g，桂枝10g，桑寄生15g，牛膝g，茯苓12g，防已10g，当归12g，川芎12g，白术12g，生甘草6g。体虚者加党参12g，杜仲12g;病在上肢加羌洽9g，姜黄10g。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2.气血两虚：治法：补益气血。方药：十全大补汤或人参养荣汤加减。党参15g，白术12g，茯苓12g，当归12g，白芍15g，熟地9g，黄芪15g，肉桂1g(冲服)，炙甘草6g。 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3.肝肾不足：治法：阴虚者，养阴清热;阳虚者，温阳散寒。方药：阴虚者：秦艽鳖甲汤加减。地骨皮、柴胡各30g，秦艽、知母各15g，鳖甲30g，当归15g，玄参9g。阳虚者：阳和汤加减。熟地30g，白芥子6g，炮姜3g，麻黄3g，甘草3g，肉桂3g，鹿角胶9g(烊化冲服)，补骨脂10g，白术10g，茯苓12g。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4.热毒蕴结：治法：清热解毒、托里透脓。方药：五味消毒饮合托里透脓散加减。金银花15g，连翘15g，野菊花15g，地丁15g，党参12g，白术12g，生黄芪12g，当归15g，山甲10g，角刺15g。热盛者加黄连9g，黄芩9g，栀子9g，去党参、白术、黄芪。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2、</span>专方验方： </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(一)独角莲膏药<span style="color: black;">构成</span>及制法：鲜独角莲2份，樟丹1份，香油2份。先将独角莲切成片，将香油熬开后下独角莲炸其成黄褐色，后取出弃之。炼药油至滴水成珠后，加入樟丹、搅拌、成黑色后、倒入冷水中拔火毒即成膏药。用竹签将药肉摊在纸上或布上备用。用法：加热局部外贴。适应症：急、慢性骨髓炎(选自《千家妙方》下册)。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(二)黄升丹<span style="color: black;">构成</span>及制法：水银30g，白矾24g，火硝21g，将<span style="color: black;">以上</span>三药用升华<span style="color: black;">办法</span>制成，色黄者为黄升丹，色红者为红升丹。药用久存者为佳。用法：以75%酒精浸泡过的细棉绳沾药适量后，<span style="color: black;">插进</span>窦道到底端。初次用药量可稍多，后逐次减少，毒尽腐脱停用。对汞过敏者禁用。适应证：慢性骨髓炎窦道形成、腐肉未脱之时。(选自《千家妙方》下册)。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">4、</span>其他疗法外治法：皮肤窦道有<span style="color: black;">海量</span>脓液者，可用中药外洗(黄柏30g，苍术20g，公英30g，地丁30%，苦参30g);窦道久不愈合者，用八二丹或九一丹药捻提脓祛腐，外用太乙膏或拔毒膏;触及有死骨松动者，用镊子夹出;疮口<span style="color: black;">体积</span>时可采用扩创，以利于死骨外出;脓液腐肉已尽，新肉将生之时用生肌散、或生肌玉红膏。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">其他手术治疗 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(1)穿刺吸引术：为减轻骨髓腔压力，防止炎症在骨髓腔上下扩散，对病灶处可进行穿刺吸引，<span style="color: black;">同期</span>还可向腔内注入抗生素<span style="color: black;">做为</span>治疗的一部分。 (2)开窗引流术：在放射科照片<span style="color: black;">表示</span>骨质局部已有破坏及骨髓腔<span style="color: black;">暗影</span>增宽者，可在骨髓腔内积脓的部位进行骨皮质钻孔或开窗，防止炎症扩散，以利分泌物引流。或进行创腔的上下给抗生素闭式灌洗治疗。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(3)死骨取出术：对死骨<span style="color: black;">很强</span>，已具备手术<span style="color: black;">机会</span>，将死骨取出，是治疗慢性骨炎最<span style="color: black;">平常</span>和最基本的手术<span style="color: black;">办法</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(4)消灭骨空洞术：因骨腔大，窦道久治不愈，将较近的正常肌组织有带蒂肌肉瓣充填法、松质骨充填法等。 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(5)截肢术：适用于一肢多处骨髓炎，合并<span style="color: black;">都数</span>窦道，久治不愈或因慢性炎症<span style="color: black;">长时间</span>刺激局部皮肤<span style="color: black;">出现</span>恶变者。 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(6)大块病骨切除术：<span style="color: black;">通常</span>适用慢性血源性骨髓炎，病骨已<span style="color: black;">显著</span>硬化，或局部疤痕多，久治不愈，某些不负重<span style="color: black;">亦</span><span style="color: black;">没</span><span style="color: black;">要紧</span>功能的慢性骨炎<span style="color: black;">病人</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(7)病灶内留置<span style="color: black;">药品</span>链法：将抗生素预制成小球，用细不绣钢丝连起来，手术置于病灶内，每日将抗菌<span style="color: black;">药品</span>球拉入腔内一颗，<span style="color: black;">持续</span>释放治疗法。 (8)应用显微外科技术治疗慢性化脓性骨髓炎的<span style="color: black;">办法</span>。目的是改善病灶局部的血液循环。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">骨髓炎吃什么对身体好? </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">应食用清淡可口的素食，以偏碱性<span style="color: black;">食品</span>调节体液酸碱度：碱性<span style="color: black;">食品</span><span style="color: black;">重点</span>分为：<span style="color: black;">1、</span>蔬菜、<span style="color: black;">果蔬</span>类;<span style="color: black;">2、</span>海藻类;<span style="color: black;">3、</span>坚果类;<span style="color: black;">4、</span>发过芽的谷类、豆类。要避免或减少以下酸性<span style="color: black;">食品</span>的摄取：<span style="color: black;">1、</span>淀粉类;<span style="color: black;">2、</span>动物性<span style="color: black;">食品</span>;<span style="color: black;">3、</span>甜食;<span style="color: black;">4、</span>精制加工食品(如白面包等);<span style="color: black;">5、</span>油炸<span style="color: black;">食品</span>或奶油类;<span style="color: black;">6、</span>豆类(如花生等)。强碱性食品：茶、白菜、柿子、黄瓜、胡萝卜、菠菜、卷心菜、生菜、芋头、海带、柑橘类、<span style="color: black;">没</span>花果、西瓜、葡萄、葡萄干、板栗、咖啡、葡萄酒等等。弱碱性食品：豆腐、豌豆、大豆、绿豆、竹笋、马铃薯、香菇、蘑菇、油菜、南瓜、豆腐、芹菜、番薯、莲藕、洋葱、茄、南瓜、萝卜、牛奶、苹果、梨、香蕉、樱桃等等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">骨髓炎最好别吃什么<span style="color: black;">食品</span>? </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">忌食用荤油肥腻;</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">少吃辛辣<span style="color: black;">食品</span>;</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">骨髓炎<span style="color: black;">病人</span>在施治的<span style="color: black;">初期</span>强调并提倡清淡可口的素食。<span style="color: black;">原因</span>食能<span style="color: black;">供给</span>最天然最易消化，最能直接吸收之营养素。如素食配制<span style="color: black;">恰当</span>，人体所<span style="color: black;">必须</span>的糖、脂肪、蛋白质这三大营养要素都非常丰富，足够人类机体的<span style="color: black;">恰当</span><span style="color: black;">必须</span>。因骨与软组织的修复又离不开维生素、微量元素与宏量元素和<span style="color: black;">拥有</span><span style="color: black;">守护</span><span style="color: black;">功效</span>的植物荷尔蒙、纤维质等，它们都<span style="color: black;">重点</span>是来自<span style="color: black;">鲜嫩</span>的谷类、蔬菜与<span style="color: black;">果蔬</span>;又因处在病理状态下的患部组织的修复<span style="color: black;">必须</span>一个偏碱性的生理环境，<span style="color: black;">才可</span>有修复的<span style="color: black;">前提</span>。素食中所含碱性物质最丰富，如在<span style="color: black;">身体</span>最活跃的钙、钾等离子，<span style="color: black;">果蔬</span>之中含量很高。在慢性骨炎期，<span style="color: black;">病人</span><span style="color: black;">不可</span>缺少了碱性物质在血液中的恒定浓度。有些病人怕营养缺乏，每餐<span style="color: black;">海量</span>吃肉类，少吃了蔬菜与<span style="color: black;">果蔬</span>，使血液带酸性，患部组织因循环<span style="color: black;">阻碍</span>，酸性物质<span style="color: black;">更加多</span>，于是<span style="color: black;">身体</span>的"钙<span style="color: black;">搬迁</span>"运动就此<span style="color: black;">起始</span>，血液将骨骼和牙齿中的钙，尤其是处在病理环境中的骨组织的钙搬走，病骨<span style="color: black;">显现</span>脱钙或骨质疏松现象，这可能<span style="color: black;">便是</span>因其食肉<span style="color: black;">太多</span>，<span style="color: black;">引起</span>酸性血液使骨质代谢<span style="color: black;">出现</span><span style="color: black;">错乱</span>的结果，<span style="color: black;">因此</span>提倡素食就在于此。</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: 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