Selective laser trabeculoplasty as adjunctive treatment for open-angle glaucoma vs following incisional glaucoma surgery in Chinese eyes

BACKGROUND Selective laser trabeculoplasty(SLT)is a relatively safe and effective therapy in lowering intraocular pressures(IOP)for glaucoma.AIM To study the long-term effects of SLT on IOP and number of glaucoma medications used in Chinese eyes.METHODS This is a retrospective study in which 75 eyes of 70 patients with open-angle glaucoma(OAG,n=36)and eyes with prior glaucoma surgery(PGS,n=39)were included.Changes in mean IOP and number of glaucoma medications used evaluated at 1 d,1 wk,1 mo,3 mo,6 mo,12 mo,and 36 mo after laser treatment.RESULTS All patients(33 male,37 female)were Chinese.The mean age was 44.34±16.14years.Mean pre-SLT IOP was 22.75±2.08 mmHg in OAG and 22.52±2.62 mmHg in PGS.Mean IOP was significantly reduced 1 d,1 wk,1 mo and 3 mo after laser treatment(P<0.05,respectively).Whereas,there were no significant differences between baseline and SLT treated groups at the 6th month both in OAG(P=0.347,P>0.05)and in PGS(P=0.309,P>0.05).Six months after SLT treatment,some patients received retreatment of SLT or were given more topical IOP-lowering medication to control the IOP.By the end of our study,the average IOP decreased to 20.73±1.82 mmHg in OAG and 20.49±1.53 mmHg in PGS groups.The number of glaucoma medications used was significantly reduced until the end of 3 years compared to baseline.CONCLUSION SLT could reduce IOP as adjunctive treatment both in OAG and PGS groups.SLT significantly reduced the number of glaucoma medications used 3-years following treatment in glaucoma patients.

Role of adjunctive nonpharmacological strategies for treatment of rapid-cycling bipolar disorder

Rapid-cycling bipolar disorder(RCBD)is a phase of bipolar disorder defined by the presence of≥4 mood episodes in a year.It is a common phenomenon characterized by greater severity,a predominance of depression,higher levels of disability,and poorer overall outcomes.It is resistant to treatment by conventional pharmacotherapy.The existing literature underlines the scarcity of evidence and the gaps in knowledge about the optimal treatment strategies for RCBD.However,most reviews have considered only pharmacological treatment options for RCBD.Given the treatment-refractory nature of RCBD,nonpharmacological interventions could augment medications but have not been adequately examined.This review carried out an updated and comprehensive search for evidence regarding the role of nonpharmacological therapies as adjuncts to medications in RCBD.We identified 83 reviews and meta-analyses concerning the treatment of RCBD.Additionally,we found 42 reports on adjunctive nonpharmacological treatments in RCBD.Most of the evidence favoured concomitant electroconvulsive therapy as an acute and maintenance treatment.There was preliminary evidence to suggest that chronotherapeutic treatments can provide better outcomes when combined with medications.The research on adjunctive psychotherapy was particularly scarce but suggested that psychoeducation,cognitive behavioural therapy,family interventions,and supportive psychotherapy may be helpful.The overall quality of evidence was poor and suffered from several methodological shortcomings.There is a need for more methodologically sound research in this area,although clinicians can use the existing evidence to select and individualize nonpharmacological treatment options for better management of RCBD.Patient summaries are included to highlight some of the issues concerning the implementation of adjunctive nonpharmacological treatments.

Adjuncts to colonic cleansing before colonoscopy

Pre-procedural cleansing of the bowel can maximize the effectiveness and efficiency of colonoscopy.Yet,efficacy of the current gold standard colonic preparation method-high-volume oral administration of purgative agents 12-24 h prior to the procedure-is limited by several factors,such as patient compliance(due to poor palatability and inconvenience of the dosing regimen)and risks of complications(due to drug interactions or intolerance).Attempts to resolve these limitations have included providing adjunctive agents and methods to promote the colonic cleansing ability of the principal purgative agent,with the aim of lessening unpleasant side effects(such as bloating)and reducing the large ingested volume requirement.Several promising adjunctive agents are bisacodyl,magnesium citrate,senna,simethicone,metoclopramide,and prokinetics,and each are being investigated for their potential.This review provides an up to date summary of the reported investigations into the potencies and weaknesses of the key adjuncts currently being applied in clinic as supplements to the traditional bowel preparation agents.While the comparative analysis ofthese adjuncts showed that no single agent or method has yet achieved the goal of completely overcoming the limitations of the current gold standard preparation method,they at least provide endoscopists with an array of alternatives to help improve the suboptimal efficacy of the main cleansing solutions when used alone.To aid in this clinical endeavor,a subjective grade was assigned to each adjunct to indicate its practical value.In addition,the systematic review of the currently available agents and methods provides insight into the features of each that may be overcome or exploited to create novel drugs and strategies that may become adopted as effective bowel cleansing adjuncts or alternatives.

英语状语(adjunct)的多功能性质研究

从功能语法的角度,英语状语的分类:环境状语,情态状语,连接状语,分别体现语言的三大元功能:概念功能,人际功能,语篇功能。状语与补语有着功能性差别。上述三类状语在句中的位置不同,它们实现的功能不同;并且某一状语在句中的位置不同,其意义或功能亦不同。上述三类状语在分类上存在级差问题。在讨论分类级差问题的过程中分析了某一类状语,在实际语篇中可以同时实现两种或三种元功能的性质,即,多功能性质。

Adjunctive Peony-Glycyrrhiza decoction for antipsychotic-induced hyperprolactinaemia:a meta-analysis of randomised controlled trials

Background Hyperprolactinaemia is a common adverse effect of antipsychotics(APs). The results of PeonyGlycyrrhiza decoction(PGD) as a potentially useful adjunctive treatment for hyperprolactinaemia are inconsistent.Aim This meta-analysis of randomised controlled trials(RCTs) examined the efficacy and safety of adjunctive PGD therapy for AP-induced hyperprolactinaemia.Methods English(PubMed, Embase, Cochrane Library,PsycINFO) and Chinese(Chinese National Knowledge Infrastructure, Wanfang Data) databases were systematically searched up to 10 June 2018. The inclusion criteria were based on PIC0 S一/^rticipants: adult patients with schizophrenia; Aitervention: PGD plus APs; Cbmparison: APs plus placebo or AP monotherapy;(Xjtcomes: efficacy and safety; Study design: RCTs. The weighted mean difference(WMD) and risk ratio(RR) along with their 95% CIs were calculated using Review Manager(RevMan) V.5.3 software.Results Five RCTs(n=450) were included and analysed.Two RCTs(n=140) were double-blind and four RCTs(n=409) reported ‘random' assignment with specific description. The PGD group showed a significantly lower serum prolactin level at endpoint than the control group(n=380, WMD:-32.69 ng/mL(95% Cl-41.66 to 23.72),/X0.00001, ^=97%). Similarly, the superiority of PGD over the control groups was also found in the improvement of hyperprolactinaemia-related symptoms. No difference was found in the improvement of psychiatric symptoms assessed by the Positive and Negative Syndrome Scale(n=403,WMD:-0.62(95% Cl-2.38 to 1.15), p=0.49, ^=0%). There were similar rates of all-cause discontinuation(n=330, RR0.93(95% Ci 0.63 to 1.37),/t=0.71, ^=0%) and adverse drug reactions between the two groups. According to the Grading of Recommendations Assessment, Development and Evaluation approach, the level of evidence of primary and secondary outcomes ranged from ‘very low'(14.3%),‘low'(42.8%),‘moderate'(14.3%),to ‘high,(28.6%>.Conclusions Current evidence supports the adjunctive use of PGD to suppress elevated prolactin and improve prolactininduced symptoms without significant adverse events in adult patients with AP-induced hyperprolactinaemia. Highquality RCTs with longer duration are needed to confirm these findings.Trial registration number 42016037017.

Pharmacologic adjunctive to insulin therapies in type 1 diabetes:The journey has just begun

Treatment of type 1 diabetes(T1 D) is currently based exclusively on insulin replacement therapy. However, there is a need for better glycemic control, lower hypoglycemia rates, more effective weight management, and further reduction of cardiovascular risk in people with T1 D. In this context, agents from the pharmaceutical quiver of type 2 diabetes are being tested in clinical trials, as adjunctive to insulin therapies for T1 D patients. Despite the limited amount of relevant evidence and the inter-class variability, it can be said that these agents have a role in optimizing metabolic control, assisting weight management and reducing glycemic variability in people with T1 D. Specific safety issues, including the increased risk of hypoglycemia and diabetic ketoacidosis, as well as the effects of these treatments on major cardiovascular outcomes should be further assessed by future studies, before these therapeutic choices become widely available for T1 D management.

Role of adjunctive treatment strategies in COVID-19 and a review of international and national clinical guidelines

The coronavirus disease(COVID-19)pandemic has led to a global struggle to cope with the sheer numbers of infected persons,many of whom require intensive care support or eventually succumb to the illness.The outbreak is managed by a combination of disease containment via public health measures and supportive care for those who are affected.To date,there is no specific anti-COVID-19 treatment.However,the urgency to identify treatments that could turn the tide has led to the emergence of several investigational drugs as potential candidates to improve outcome,especially in the severe to critically ill.While many of these adjunctive drugs are being investigated in clinical trials,professional bodies have attempted to clarify the setting where the use of these drugs may be considered as off-label or compassionate use.This review summarizes the clinical evidence of investigational adjunctive treatments used in COVID-19 patients as well as the recommendations of their use from guidelines issued by international and national organizations in healthcare.

The efficacy and tolerability of lamotrigine adjunctive/monotherapy in patients with partial seizures refractory to poly-AEDs

Objective： This study was designed as an open-label trial to assess the effects of changing the antiepileptic drugs （AEDs） regimen to lamotrigine （LTG） as adjunctive/monotherapy in patients with partial seizures who were dissatisfied with their drug regimen because of intractable seizures. Methods： The patients were recruited from mulficenters using the following criteria： age≥ 18 years; at least 3 seizures per month during the last 16 weeks; previous use of at least 3 AEDs. The study involved a baseline phase and 2 experimental phases： LTG was first added to the regimen, and then patients could gradually change to LTG monotherapy if their seizures were reduced by at least 50 percent/month. Tolerability, the primary end point, was assessed using the Liverpool Adverse Experience Profile （LAEP）. Secondary end points included quality of life, as measured with the Quality of Life in Epilepsy-31 inventory. Reductions in seizures from baseline throughout each phase were also analyzed. Results： One hundred and fourteen patients aged between 18 and 52 years （age 27.8___ 13.2 years; 71 men and 43 women） were enrolled. After adding LTG, 105 patients （92.11%） Completed adjunctive therapy. Upon completion of the adjunctive phase, mean improvement from baseline was 2.6 points on the LAEP （p=0.037）. The overall score on the QOLIE-31 improved by 8.49 points from baseline （p=0.023）. At the end of the trial, 26 （22.81%） of patients completed LTG monotherapy, and 65 patients （57.02%） experienced at least 50% reduction in seizure frequency compared to baseline, The mean improvement from baseline was 5.1 points on the LAEP （p=0.0059）, and the overall score on the QOLIE-31 score improved by 12,72 points from baseline（p=0,0071）. Twenty-two （19.30%） patients reported adverse effects and 9 patients discontinued participation in the trial because of adverse effects. Conclusion： For patients with partial seizures who were dissatisfied with their AED regimen because of intractable seizures, adding LTG to the drug regimen was well tolerated and effective in improving the quality of life and controlling seizures. Furthermore, switching to LTG monotherapy was associated with further improvement.

Evaluation of the Protégé^(TM) stent in the treatment of carotid artery stenosis with adjunctive use of a filter Embolic Protection Device (PROCAR)-one-month follow-up data on 77 patients

Objective The trial was designed to evaluate the safety and performance of the ev3 Protégé TM stent in the treatment of de novo or re-stenotic common and/or internal carotid artery stenoses with adjunctive use of a CE-marked filter embolic protection device.Methods This study was a prospective multi-center, single-arm trial. Between June and October 2003, 77 patients were enrolled in 8 investigational centers throughout Europe. The primary endpoint was the incidence of Major Neurological Events (MANE) through one month. Other endpoints were the ability to properly place the stent, and primary patency and MANE after six months. Eligible for the study were patients with a de novo or restenotic target lesion located in the common and/or internal carotid artery (>70% stenosis for asymptomatic and >50% stenosis for symptomatic patients). The ev3 Spider (Embolic Protection Filter was used in 75 of 77 cases. Results In 76 out of the 77 patients (99%), the stent could be successfully implanted with a residual stenosis ≤30% as criterion. Of the 74 patients that had a carotid ultrasound at one month follow-up, none had a re-stenosis of the target lesion. There were three MANEs during or immediately after the procedure (3.9%), two were major and one was a minor stroke. There were eight severe complications (9.1%); six of these happened during or immediately after the procedure and were related to the procedure, none was related to the device. They are resolved without sequelae. No deaths have occurred.Conclusions The Protégé stent is safe and performs well in the treatment of carotid artery stenosis. The technical success rate for placement of the Protégé stent as assessed by the residual stenosis post implant was very high and all stents were successfully deployed. The incidence of MANE was comparable with that in other recent carotid stent studies and still lower than standard CEA.

The Syntactic Position of Adverbial Adjuncts in Chinese

In modern Chinese,adjuncts can be classified into adjective adjuncts(also attributes)and adverbial adjuncts(also adverbials).This paper firstly attempts for a reasonable definition and classification of adjunct in modern Chinese,then analyzes the syntactic position of adverbial adjunct,and finally tries to find a general mechanism for the position of adverbial adjunct in the phrase level and the sentence level.

Granulocyte colony-stimulating factor as a novel adjunct to improve hepatitis B vaccination

Hepatitis B vaccination is successful in 95% of individuals. In the remainder, despite repeated attempts, immunization often remains unsuccessful. 'Non-response' leaves the individual susceptible to infection. Various strategies have been employed to overcome this. These include the use of adjuncts alongside conventional vaccines which activate immune responses. In this case report we demonstrate the successful use of the hematopoietic growth factor Granulocyte colonystimulating factor (G-CSF) as a vaccine adjunct in an individual who had previously failed conventional vaccination three times. The patient tolerated the regimen without any side effects and achieved a hepatitis B surface antibody titer greater than 100 IU/L. Use of G-CSF as a vaccine adjunct for hepatitis B has not previously been reported and the outcome in this case suggests that the use of G-CSF in this context warrants further exploration.

Experimental Study on Extruded Beer Adjunct Used for Brewing Beer

The properties of saccharified and boiled worts between extruded and traditional non-extruded beer adjuncts were studied at the laboratory and a small beer brewing equipment(100 L) in this paper. Test results indicate that the main saccharification indices and filtration speeds of worts between extruded and traditional non-extruded beer adjuncts are similar basically. The collected rate of extracted material of worts of extruded beer adjuncts is 8% more than that of traditional non-extruded beer adjuncts. Fermentation time of worts of extruded beer adjuncts is 10 % less than that of traditional non-extruded beer adjuncts. The energy consumption of extruded beer adjuncts in saccharification process is 13 % less than that of traditional non-extruded beer adjuncts.

Adjunctive pharmacotherapy and treatment patterns among initiators of SSRI therapy for major depressive disorder: A cohort study using a primary care database

Objective: Adjunctive therapy is often used for treatment of major depressive disorder (MDD) following an inadequate response to an antidepressant. However, there is little information regarding its practice within primary care in the United Kingdom (UK). Objectives of the study were to examine incidence and predictors of adjunctive pharmacotherapy among patients with MDD treated with selective serotonin reuptake inhibitors (SSRIs) by UK general practitioners (GPs). Methods: The General Practice Research Database was used to identify 15,274 MDD patients prescribed first-line treatment with SSRIs from 2006-2008 (latest patient follow-up towards end of 2010). Treatment trajectories were identified and classified as adjunctive therapy, combination therapy, drug switches, dose increases, and restart of therapy. Incidence and predictors of adjunctive therapy were assessed, and healthcare resource utilization was evaluated. Results: Overall incidence of adjunctive therapy was 3.07/100 person years (95% CI 2.90-3.25). Patients prescribed adjunctive therapy were more likely to be female (IRR 1.15, p = 0.03), of higher age (IRRs 1.51-2.60, p ≤ 0.001), and had a greater depression severity score (IRR 1.02, p = 0.003). Presence of irritable bowel syndrome (IRR 1.53, p = 0.001), and an increasing Charlson Comorbidity Index (IRR 1.15, p = 0.01) were associated with a higher incidence of adjunctive therapy. MDD-related general practitioner consultations among patients who received adjunctive therapy was lower compared with patients receiving other treatment interventions (IRRs 0.79 - 0.87, p ≤ 0.001). Conclusions: Adjunctive therapy is infrequently utilized relative to other treatment options for management of MDD among patients who are inadequate responders to their SSRI treatments in UK primary care;however some groups are more likely to receive adjunctive therapy than others.

Long-Term, Open-Label, Safety Study of Edivoxetine as Adjunctive Treatment for Adult Patients with Major Depressive Disorder Who Were Partial Responders to Selective Serotonin Reuptake Inhibitor Treatment in Japan

Edivoxetine is a highly selective norepinephrine reuptake inhibitor (NRI) that has been investigated in short-term studies as adjunctive therapy to?selective serotonin reuptake inhibitor antidepressants (SSRIs) in patients with major depressive disorder (MDD) who were partial responders to their SSRIs. This 52-week open-label study investigated the safety and tolerability of longer-term treatment with adjunctive edivoxetine in patients with MDD in Japan, who had completed one of two placebo-controlled acute studies of edivoxetine as adjunctive therapy to SSRIs. All patients continued on their stable dose of SSRI. Two hundred eighty-eight patients were enrolled and assessed for up to 1 year using standard safety and tolerability measures. Of these, 195 patients previously received only placebo in the parent study and, therefore, were first exposed to edivoxetine in this study. Approximately 46% of patients completed the study. The most frequently cited (>5%) reasons for discontinuation were sponsor decision (19.4%, which included patients discontinued due to early study termination), adverse event (17.4%) and subject decision (8.7%). Adverse events leading to discontinuation in more than 2 patients (>1%) were palpitations, vomiting, hepatic function abnormal, hypertension, nausea, and tachycardia. Treatment-emergent elevations in diastolic blood pressure and pulse were at least twice that reported in the literature for non-Asian patients. Twenty percent of patients had sustained elevations in pulse. Treatment-emergent changes in laboratory measures were small and not clinically meaningful. Assessment across all safety measures in this study indicated that the safety profile of edivoxetine was consistent with that expected for a selective NRI.

Alpha-Dihydroergocryptine vs. Pramipexole as Adjunct Symptomatic Treatment of Idiopathic Parkinson’s

A randomized, double blind, and active reference-controlled study was carried out among 116 patients suffering from idiopathic Parkinson’s disease (PD). The aim of the study was to compare the safety and efficacy of alpha-dihydroergocryptine (DHEC) vs. pramipexole (PRAM) as an adjunct symptomatic therapy to levodopa in PD patients. The motor symptoms, assessed by the Unified Parkinson’s Disease Rating Scale (UPDRS) III subscale, was identified as efficacy target. Fifty-six patients were randomized to DHEC and 60 to PRAM. Patients included were under constant levodopa dose for at least 3 months before entering the study, with baseline UPDRS III ≥14. They underwent a 16-week treatment. Out of the 116 included patients, 85 (39 in DHEC group and 46 in PRAM group, respectively) completed the study protocol. In DHEC group, UPDRS III decreased by 24.2% from baseline at week 10 and by 28.1% at week 16. In PRAM group, UPDRS III decreased by 27.1% from baseline at week 10 and by 29.2% at week 16. The data were highly significant

Cardiotoxicity of current antipsychotics:Newer antipsychotics or adjunct therapy?

Use of newer antipsychotics for substitution of current antipsychotics might be one way awaiting to be clinically verified to address antipsychotic cardiotoxic effects.Alternatively,the combination of existing antipsychotics with cardioprotective agents is also beneficial for patients with mental disorders for avoiding cardiotoxicity to the maximum.

Topical Application of Ascorbic Acid Solution as an Adjunctive Method of Periodontal Therapy among Wet Snuff Users after Prosthodontics Therapy

Background: During several years, ascorbic acid (vitamin C) played a significant role in the health of periodontal tissues. The goals of prosthodontics management are to restore the missing teeth, provide the loss of teeth functions, and establish acceptable dental esthetics, and there are some evidences revealing the passive effects of snuff on the results of prosthodontics and periodontal treatment, so the present study is performed to evaluate the outcomes of topical application of ascorbic acid solution as an adjunctive method of periodontal therapy among wet sniff users after prosthodontics therapy. Methods: The clinical situation was evaluated in 150 moderate periodontitis patients after conventional periodontal and prosthodontics therapy. They were selected from outpatient clinics, college of dentistry, King Khalid University, and from some hospitals Ministry of Health in Tabuk, Jazan and Aseer regions. The study was conducted from September 2020 to December 2020. The time of post-treatment assessment was one year. The study was included 50 patients who don’t use wet snuff as a group I (GI) (control group), 50 patients wet snuff users as group II (GII), and 50 patients wet snuff users were treated with topical application of ascorbic acid solution as group III (GIII). The participants were aged over 20 years, with a mean age of 35 years. The duration of using wet snuff was at least one year. Plaque index (PLI), gingival index (GI), clinical attachment loss (CAL) were recorded at baseline (first visit), then after 4 weeks (second visit) and after 6 weeks (third visit) of conventional periodontal therapy and topical application of ascorbic acid solution. Statistical analysis was done using ANOVA test and paired t-test. Results: According to statistical analysis, there was the inclination of decrease in the mean and standard deviation of plaque index (PLI) from 2.8 ± 1.4 to 2.5 ± 0.51, and 2.7 ± 0.33 in group II, and decrease from 2.7 ± 0.34 to 2.5 ± 0.23 and 2.6 ± 0.65 in group III. Similarly in the gingival index (GI), there was a decrease in the mean and standard deviation from 2.8 ± 0.52 to 2.3 ± 0.62 and 2.5 ± 0.51 in group II and a decrease from 2.5 ± 0.8 to 2.3 ± 0.58 and 2.4 ± 0.47 in group III. Moreover, there was a decrease in the mean and standard deviation of clinical attachment loss (CAL) from 4.5 ± 0.26 to 3.9 ± 0.83 and 4.2 ± 0.83 in group II and from 4.2 ± 0.31 to 3.8 ± 0.46 and 3.8 ± 0.31 in group III;less than group I without significance differences (p > 0. 05) in all study groups at baseline and after 4 weeks, and 6 weeks of follow up except CAL. Conclusion: The results of our study displayed that periodontal parameters vary among wet snuff users after topical application of ascorbic acid solution as an adjunctive method of periodontal therapy

抗IgE单克隆抗体联合变应原特异性免疫治疗的应用进展

抗IgE单克隆抗体目前已被批准用于治疗哮喘和慢性荨麻疹,同时抗IgE单克隆抗体联合变应原特异性免疫治疗(AIT)作为过敏性疾病的辅助治疗已引起普遍关注。研究表明,在AIT治疗中或治疗前添加抗IgE单克隆抗体可显著减少AIT不良反应的发生频率和严重程度,明显改善症状评分,缩短达到维持剂量所需的时间。目前仍需要更大规模的高质量对照试验更好地识别抗IgE单克隆抗体联合AIT的获益人群,以及治疗最佳剂量和持续时间,并评估长期效益、进行成本-效益分析。本文就抗IgE单克隆抗体在AIT中作为辅助治疗的应用进展进行综述。

Research progress in spasmodic torticollis rehabilitation treatment

Spasmodic torticollis(ST)is a focal dystonia that affects adults,causing limited muscle control and impacting daily activities and quality of life.The etiology and curative methods for ST remain unclear.Botulinum toxin is widely used as a firstline treatment,but long-term usage can result in reduced tolerance and adverse effects.Rehabilitation therapy,with its minimal side effects and low potential for harm,holds significant clinical value.This article explores the effectiveness of adjunctive therapies,including exercise therapy,transcranial magnetic stimulation,shockwave therapy,neuromuscular electrical stimulation,vibration therapy,electromyographic biofeedback,and acupuncture,in the treatment of ST.The aim is to provide clinicians with additional treatment options and to discuss the efficacy of rehabilitation therapy for ST.

汉语“的”字短语关系小句的句法分析

语言类型学认为汉语是唯一一个关系小句前置于名词的SVO语言,然而有些学者发现汉语似乎也存在“的”字短语后置关系小句。虽然嫁接法和提升法是生成语法中关系小句的主流分析法,但是“的”字短语前置关系小句的嫁接分析存在嫁接方向性与任意性问题,“的”字短语后置关系小句的提升分析会违反“主语孤岛限制”。标签理论视阈下的汉语“的”字短语关系小句研究表明:汉语仅存在“的”字短语前置关系小句,所谓的“的”字短语后置关系小句实为主谓谓语句。