Yuan Xiaoli knew that simvastatin was extracted from Aspergillus terreus. It was first developed by Merck pharmaceutical factory and began to enter medical use in 1992.


    The drug is listed in the list of essential drugs of the World Health Organization. As an oral lipid-lowering drug, it is one of the essential drugs in the basic medical system.


    Now, in order to reduce blood lipid and prevent cardiovascular and cerebrovascular diseases, many elderly people take statins orally all year round.


    "Stop the old simvastatin, and you''ll be fine with the muscle pain in a few days." Wu Mian''s voice came, and he was very sure in his words.


    "Mr. Wu, you... OK, I''ll report to the superior doctor. If there is any result, I''ll contact you at any time." the inpatient always wants to ask carefully, but he doesn''t dare to say immediately.


    "It''s hard for you. I''ll hang up if I''m all right." Wu Mian said.


    The sunshine and gentle voice came, and the first snow outside seemed to melt.


    "Mr. Wu, you''re welcome."


    Hang up the phone and the hospitalized general manager looks at Yuan Xiaoli in a daze.


    "No." Yuan Xiaoli said, "Wu Mian, isn''t this bullshit!"


    "Brother yuan, I remember simvastatin does have muscle side effects."


    "Which patient do you see? The clinical pharmacy group suggested this possibility during the consultation a few days ago, but it also said it was quite rare. Do you think the probability of one in ten thousand or one in 100000 is so easy? And how can he be sure that the pain of quadriceps femoris is caused by simvastatin?" Yuan Xiaoli asked.


    "..." was always speechless in hospital.


    Yuan Xiaoli was afraid that he remembered wrong. Even if someone mentioned this in the consultation a few days ago, he had seen it.


    However, Wu Mian suggested that Yuan Xiaoli also involuntarily began to look for the instructions of simvastatin again.


    Really, Wu Mian, a surgeon, is even more skilled in medication than himself! Yuan Xiaoli is a little unconvinced. We must find the problem.


    It is clear from the instructions that simvastatin is generally well tolerated, and most adverse reactions are mild and transient.


    The incidence of adverse reactions (possible, suspicious or certain) related to drugs is greater than or equal to 1%, including abdominal pain, constipation and gastrointestinal flatulence.


    The incidence of adverse reactions ranged from 0.5% to 0.9%, including fatigue, weakness and headache.


    Reports of myopathy are rare.


    There are adverse reactions of myopathy, but Merck pharmaceutical company clearly wrote in the manual - myopathy is very rare!!!


    The instructions of foreign pharmaceutical companies are trustworthy in most cases, and Yuan Xiaoli despises them.


    Myopathy may be extremely rare. Does Wu Mian know what is extremely rare?! The clinical pharmacy group also mentioned simvastatin. Wu Mian''s judgment on this matter is indeed out of standard.


    Isn''t this playing the piano! Yuan Xiaoli has gradually affirmed his ideas.


    Academician Che should be contacted by someone close to him to see if there is any way to give a clear diagnosis.


    As the actual editor of diagnostics, Wu Mian is one of the most qualified doctors to be consulted.


    So he knew that chelao had tinea pedis, and then looked at the medical record and found that chelao usually took simvastatin orally, so it was related to quadriceps femoris pain.


    However, this article has been put forward during the previous discussion, but everyone does not think that the pain of car aging is caused by simvastatin.


    It''s true that the higher the status of a doctor, the bigger the mouth. If you open your mouth, it''s said that simvastatin causes muscle pain.


    Yuan Xiaoli disdained to think of it.


    "Professor Yuan, what should I do?" asked the chief inpatient.


    "Not much to do," Yuan Xiaoli said cheerfully, "wait until the directors of other hospitals come tomorrow."


    "Does simvastatin stop?"


    "There''s nothing to stop." Yuan Xiaoli has begun to be a little impatient. "The day before yesterday, the clinical pharmacy group said during the consultation that the possibility of muscle pain is very low. Now there is no practical evidence that Che Lao''s quadriceps pain is caused by simvastatin."


    The hospital is always silent.


    "I''m going to wash and sleep. Call me if you need anything." Yuan Xiaoli said.


    "OK."


    Back in the duty room, Yuan Xiaoli washed and lay in bed. He didn''t want to think about Wu Mian. But in my mind, Wu Mian always looks like a khaki windbreaker, wearing sunglasses and black sheepskin gloves.


    I didn''t expect that the young man had become a scholar so soon. Yuan Xiaoli sighed and thought. It is estimated that Wu Mian has been separated from clinical practice for too long, and he can''t even give a correct diagnosis.


    But what he said was unreasonable, but it was also wrong.


    The side effects of simvastatin do have muscle pain, but


    High academic level does not mean that the operation is done well, nor does it mean that you will see a doctor. Wu Mian is of this type. What are you looking at! Yuan Xiaoli scolded in his heart.


    Treat Alzheimer''s disease honestly, and don''t go back to DIDU to make a fool of yourself.


    Lying in bed, Yuan Xiaoli repeatedly pondered over academician Che''s condition, but in the end he had no clue.


    ……


    At 14:10 p.m. the next day, two experts from the brother hospital came to the imperial people''s Hospital and began to consult academician Che''s condition.


    Both experts are academician level figures. Yuan Xiaoli should have been off the night shift, but he specially stayed to listen to the opinions of the elderly.


    They were very serious. After listening to the report of their illness, they began to look at the medical records. Academician Guo and academician Lin watched the first trip and then looked at the test sheet and image data.


    After listening to the opinions of the imperial people''s Hospital, they were at a loss.


    After physical examination and chatting with Academician Che, we returned to the office and began to discuss some extremely rare situations.


    Academician Guo leaned back in his chair and stated his views on his condition, while academician Lin frowned and pondered academician Che''s situation, unable to do anything.


    "The examination of systemic lupus erythematosus should be improved. A few patients with lupus erythematosus will have symptoms of muscle pain." academician Guo said his guess, "although it is unlikely, it still needs to be investigated one by one."


    "Mr. Guo, OK, do relevant examinations as soon as possible. Do you want to check other diseases?"


    "Other diseases... Scleromyosis... Unlike." academician Guo said hesitantly, "Lao Lin, what do you think?"


    "No, but there is no more way. Rare diseases such as mitochondrial disease should also be investigated." academician Lin said, "although mitochondrial myopathy usually starts at the age of 20, the clinical feature is that skeletal muscle can''t tolerate fatigue..."


    He was talking incessantly. The doctor sitting next to him gently touched academician Lin with his knee.


    "Hmm?" academician Lin paused.


    "Look at this, teacher," the young doctor said, looking at the computer screen.


    "Where?"


    "There was a special ward round last night, describing a missing past history."