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I want to go back to this vitamin D threshold issue
下面回到维生素D临界值问题
because as I said this morning the illustration of the enabling effect of vitamin D
早上我讲过维生素D的积极效果
Physiological regulation is no longer limited by vitamin D availability but the regulation is still there
生理调节不再受可用维生素D的限制不过调节仍然在
and I'm going to go back to revisit this scheme
我要回头讲这个体系
This is the old scheme and this is a new one that we need to be thinking about
这是老的体系，这是需要考虑的新体系
where the action in the periphery is where the action really is
外围的活动才是真正活动所在
Now we know that our colleagues in the physiology recognized that
我们知道生理学的学者们认为
when your kidneys are damaged or they've been removed
患者如果肾脏受损或被去除
and you're dependent upon dialysis, you can't make 1,25D
依赖透析将无法生成1,25D
and so they did the logical thing and they gave their patients 1,25D
于是他们理所当然地给患者1,25D
By doing that allowed them completely to ignore the autocrine pathway
这让他们完全忽略了自分泌方式
because this was what's needed to be optimized not simply supplying this that was missing
这才是需要优化的，而不只是供应失去的
They thought that you could get there this way but in fact that's not what the tissues are looking for
他们曾认为可以这样来，这不是组织想要的
and the concentrations you're gonna achieve don't work
想获得的浓度也达不到
which is why there's such a terrible vitamin D deficiency in patients who have renal disease
这就是肾病患者维生素D缺陷严重的原因
because the focus is not being on this
因为关注不在这里
That's changing today. I'm happy to say that
这现在有所改变，我很高兴
but for years, I mean even the renal literature uses this in keywords, says it's vitamin D.
但很多年来，肾病文献中甚至使用关键字"维生素D"
This is not vitamin D
这不是维生素D
This is a derivative of vitamin D. It's not vitamin D
这是维生素D衍生物，不是维生素D
Now, I'm going to show you a couple of examples
下面来看几个例子
One of you today asked me about adjuvant therapy
有人今天问我辅助疗法
Here's a perfect example of adjuvant therapy
这是辅助疗法的完美例子
This was a study that was published the same year as the Liu study was published, just four years ago
该研究的发布同Liu的研究一样，都是四年前
