# Oral pantothenic acid (vitamin B5) as the sole active ingredient × Reduction of FSS fatigue severity in adults with unexplained/nonspecific persistent fatigue Verdict 3101 · Evidence Check Stored-material review date: 2026-10-05 Original evidence date: 2026-09-15 Review-criteria version: NGM-v3101-SOLE-B5-NONSPECIFIC-PERSISTENT-FATIGUE-FSS-1.0 Public page/material preparation date: 2026-11-02 Clinical papers were not read directly; existing review summaries were checked. No new clinical-literature search was performed. Unverified does not mean that research is absent or that there is no effect. ## Assessment scope - Population: Adults with unexplained/nonspecific persistent fatigue; separate from specific diseases and correction of deficiency - Ingredient, formulation and route: Pantothenic acid (vitamin B5) as the sole active ingredient; exact salt to be verified separately · Oral formulation with a single active ingredient; salt, tablet/capsule, and release type unverified - Dose: Unverified — eligible monotherapy dose and frequency not verified - Comparator: Placebo or usual care on the same background treatment; actual composition and concomitant treatment unverified - Measured outcome: Priority given to the between-group difference in change in FSS; endpoint difference separate; version, scoring method, and time points in an eligible trial unverified - Duration: Unverified — eligible monotherapy treatment duration and assessment time points not verified - Questions outside this scope: Specific diseases/correction of deficiency, B-complex products/pomegranate/multivitamins, other molecules/routes, CIS/Chalder/exercise/metabolomics, diarrhea harms/optimal dose/persistence/all populations, and clinical events are separate. /subclaims=[] ## Checklist items ### N01 · Which fatigue, intervention, and FSS comparison? Verification status: Met Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: The selected question is whether oral treatment with pantothenic acid as the sole active ingredient lowers FSS more than placebo or usual care on the same background treatment in adults with unexplained/nonspecific persistent fatigue. subclaims is an empty list. - Why unverified: This verifies the identity of the question, not an effect or the absence of all human studies. - Reason for missing information: This verifies the identity of the question, not an effect or the absence of all human studies. - Required materials and conditions: Adults with nonspecific persistent fatigue, oral B5 as the sole active ingredient, comparator on the same background treatment, and between-group FSS results - Materials to obtain first: Adults with nonspecific persistent fatigue, oral B5 as the sole active ingredient, comparator on the same background treatment, and between-group FSS results - Further research: Compare differences in population, intervention, and endpoint between the existing question and candidate results for each material. - Conditions for verification: Link the current original effect wording and inclusion/exclusion questions to exact locations. - Why this condition is needed: Needed to avoid combining all vitality claims for the ingredient or fatigue in different diseases into a single question. - Application exceptions: ME/CFS, lupus, correction of confirmed deficiency, treatment-related fatigue, and multicomponent products are separate. - Remaining uncertainty: This verifies the identity of the question, not an effect or the absence of all human studies. - Referenced methods: Question-clarification principles in M03 §3.1, §3.2.1–3.2.4; detailed separation rules are internally designed; M03 §3.2.1; detailed population conditions are internally designed; M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation to tests are internally designed; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations are internally designed - Related sources: S201, S202, S204, S205, S207 ### N02 · How was the population with unexplained persistent fatigue defined? Verification status: Unverified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: The population was fixed to adults with unexplained/nonspecific persistent fatigue, but diagnosis, baseline nutrition/deficiency, and exclusion criteria in eligible monotherapy trials were not verified. - Why unverified: The population specified in the question does not substitute for actual recruitment criteria in an eligible study. - Reason for missing information: The population specified in the question does not substitute for actual recruitment criteria in an eligible study. - Required materials and conditions: Diagnosis, exclusion tests, age, underlying diseases, and selection criteria - Materials to obtain first: Diagnosis, exclusion tests, age, underlying diseases, and selection criteria - Further research: Obtain recruitment and diagnostic tables for the target population and compare applicability boundaries with groups with other causes. - Conditions for verification: Distinguish actual diagnostic/exclusion criteria in the directly eligible population from what remains unverified. - Why this condition is needed: Needed to avoid transferring CFS or lupus data merely because the same word, fatigue, is used. - Application exceptions: Do not fill an unverified value with an assertion that there was no underlying disease. - Remaining uncertainty: The population specified in the question does not substitute for actual recruitment criteria in an eligible study. - Referenced methods: M03 §3.2.1; detailed population conditions are internally designed - Related sources: S201, S205, S207, S213 ### N03 · Are fatigue duration and baseline severity known? Verification status: Unverified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: The fatigue-duration criterion and baseline FSS in a directly relevant monotherapy trial are unverified within the preserved scope. - Why unverified: Do not fill in the duration for the selected question solely from the prolonged fatigue label in a related product trial. - Reason for missing information: Do not fill in the duration for the selected question solely from the prolonged fatigue label in a related product trial. - Required materials and conditions: Fatigue-duration threshold, baseline FSS, and distribution by severity - Materials to obtain first: Fatigue-duration threshold, baseline FSS, and distribution by severity - Further research: Link recruitment criteria and baseline tables to time points/scale versions to review eligibility. - Conditions for verification: Indicate whether actual duration and the baseline scale were verified in an eligible monotherapy trial. - Why this condition is needed: Needed to avoid using the label persistent fatigue as verified duration or severity values. - Application exceptions: Do not transfer disease diagnostic criteria or baseline scores from another trial. - Remaining uncertainty: Do not fill in the duration for the selected question solely from the prolonged fatigue label in a related product trial. - Referenced methods: M03 §3.2.1; detailed population conditions are internally designed; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations are internally designed - Related sources: S201, S202 ### N04 · Were B5 monotherapy and other molecules or multicomponent products distinguished? Verification status: Met Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: The question concerns oral B5 as the sole active ingredient. Pantethine, pantetheine, dexpanthenol/panthenol, B-complex products, multivitamins, and multicomponent energy products were distinguished from the direct intervention. The exact eligible salt is unverified. - Why unverified: This verifies the distinction between boundaries; it does not mean that a specific single-active-ingredient product was acquired. - Reason for missing information: This verifies the distinction between boundaries; it does not mean that a specific single-active-ingredient product was acquired. - Required materials and conditions: Documentation of pantothenic acid, the exact salt, other active ingredients, and route - Materials to obtain first: Documentation of pantothenic acid, the exact salt, other active ingredients, and route - Further research: Compare manufacturing-composition and chemical-form documents for each result to verify sole-active-ingredient status. - Conditions for verification: Link differences in chemical form, combination, and route in the original text with limits on direct attribution. - Why this condition is needed: Needed to avoid converting effects of pantethine or multiple ingredients into effects of B5 alone. - Application exceptions: Verify the salt identity of calcium pantothenate separately and do not import a conversion from another product. - Remaining uncertainty: This verifies the distinction between boundaries; it does not mean that a specific single-active-ingredient product was acquired. - Referenced methods: Question-clarification principles in M03 §3.1, §3.2.1–3.2.4; detailed separation rules are internally designed; M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation to tests are internally designed; M03 §3.2.3, M08 §8.2.2–8.2.3; internal application - Related sources: S06, S201, S205, S207, S213 ### N05 · Are the origin, quality, and formulation of an eligible single-active-ingredient product known? Verification status: Unverified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: Origin, salt, brand, purity, batch, formulation, and release type are unverified in eligible monotherapy trials. - Why unverified: Esserre or Swisse brand information belongs to the respective multicomponent product. - Reason for missing information: Esserre or Swisse brand information belongs to the respective multicomponent product. - Required materials and conditions: Exact salt, origin, purity, batch, brand, release type, and excipients - Materials to obtain first: Exact salt, origin, purity, batch, brand, release type, and excipients - Further research: Verify formulation specifications, active-ingredient analyses, and batch records for the eligible comparison together with the results. - Conditions for verification: Preserve verified values for a directly eligible formulation and unresolved fields separately. - Why this condition is needed: Needed to avoid substituting specifications of a multicomponent product with a different brand for monotherapy specifications. - Application exceptions: Specifying a single-active-ingredient oral product in the question differs from actual product specifications. - Remaining uncertainty: Esserre or Swisse brand information belongs to the respective multicomponent product. - Referenced methods: M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation to tests are internally designed - Related sources: S201, S202, S203, S213 ### N06 · What are the directly eligible B5 dose and actual total exposure? Verification status: Unverified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: The eligible monotherapy dose and frequency are unverified. Calcium pantothenate 10 g/day in the lupus cases and NIH nutritional reference values do not fill in a directly relevant fatigue-treatment dose. - Why unverified: Nominal or actual amounts and salt conversions were not arbitrarily generated. - Reason for missing information: Nominal or actual amounts and salt conversions were not arbitrarily generated. - Required materials and conditions: Single-active-ingredient product dose, frequency, salt mass, dietary/concurrent supplementation, and actual intake - Materials to obtain first: Single-active-ingredient product dose, frequency, salt mass, dietary/concurrent supplementation, and actual intake - Further research: Obtain administration, adherence, and dietary-exposure records from a comparative monotherapy trial to assess actual exposure. - Conditions for verification: Distinguish unverified eligible dose/frequency from related-study and nutritional values. - Why this condition is needed: Needed to avoid using the high dose in a lupus combination regimen as a fatigue-treatment dose. - Application exceptions: Perform no new conversion of calcium pantothenate mass, and do not turn nutritional reference values into treatment doses. - Remaining uncertainty: Nominal or actual amounts and salt conversions were not arbitrarily generated. - Referenced methods: M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation to tests are internally designed; M03 §3.2.3, M08 §8.2.2–8.2.3; internal application; M03 §3.2.1–3.2.4; details of dose, duration, and effect modification are internally designed - Related sources: S06, S207 ### N07 · Have eligible treatment duration and FSS assessment time points been specified? Verification status: Unverified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: Eligible monotherapy treatment duration and assessment time points are unverified. Assessments at 28 days and 56 days and follow-up visits for Ullah's multicomponent product were preserved as distinct. - Why unverified: A different formulation's schedule does not verify duration for the selected question. - Reason for missing information: A different formulation's schedule does not verify duration for the selected question. - Required materials and conditions: Treatment duration, planned endpoint time points, follow-up, and discontinuation time points - Materials to obtain first: Treatment duration, planned endpoint time points, follow-up, and discontinuation time points - Further research: Collect plans, actual administration duration, and each follow-up result separately and compare them with prespecified endpoints. - Conditions for verification: Separate unverified eligible treatment duration/assessment time points from the time points in related reports. - Why this condition is needed: Needed to avoid transferring the 28-day, 56-day, and follow-up visits for a multicomponent product to a monotherapy duration. - Application exceptions: Do not arbitrarily specify a universal minimum duration. - Remaining uncertainty: A different formulation's schedule does not verify duration for the selected question. - Referenced methods: M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation to tests are internally designed; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations are internally designed; M08 Table 8.2.a, M04 §4.6.3; internal application; M03 §3.2.1–3.2.4; details of dose, duration, and effect modification are internally designed - Related sources: S201, S202 ### N08 · Are placebo or usual care and common treatment actually the same? Verification status: Unverified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: Placebo or usual care on identical background treatment is the planned comparison. Placebo composition, common treatment, and rescue medication in eligible monotherapy trials are unverified. - Why unverified: The presence of a control arm in a multicomponent trial alone does not meet the monotherapy comparison conditions. - Reason for missing information: The presence of a control arm in a multicomponent trial alone does not meet the monotherapy comparison conditions. - Required materials and conditions: Placebo composition, background treatment, rescue medication, and arm-specific changes - Materials to obtain first: Placebo composition, background treatment, rescue medication, and arm-specific changes - Further research: Compare arm-specific prescription, placebo, rescue-treatment, and change records for the eligible comparison against the analysis plan. - Conditions for verification: Distinguish the comparator specified in the question from actual common treatment/changes in an eligible trial. - Why this condition is needed: Needed to avoid attributing effects of different background treatments to an additional B5 effect. - Application exceptions: Do not require all changes in both arms to be identical; record the actual effect of interest. - Remaining uncertainty: The presence of a control arm in a multicomponent trial alone does not meet the monotherapy comparison conditions. - Referenced methods: M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation to tests are internally designed; M03 §3.2.3, M08 §8.2.2–8.2.3; internal application; M08 §8.2.2, M15 §15.3.1; internal application - Related sources: S201, S205, S207 ### N09 · Can diet, deficiency, and concurrent supplementation be distinguished? Verification status: Unverified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: Baseline nutrition and deficiency status in eligible monotherapy trials are unverified. Deficiency case reports and the nonspecific-fatigue question are separate. - Why unverified: Do not fill in baseline information with mechanisms or blood markers. - Reason for missing information: Do not fill in baseline information with mechanisms or blood markers. - Required materials and conditions: Baseline nutrition, B5-deficiency testing, diet, and concurrent active ingredients - Materials to obtain first: Baseline nutrition, B5-deficiency testing, diet, and concurrent active ingredients - Further research: Obtain baseline nutrition, deficiency measurements, and concurrent-supplementation information by arm to review applicability. - Conditions for verification: Link differences between the selected population's baseline status and disease/deficiency cases. - Why this condition is needed: Needed to avoid mixing correction of deficiency with additional supplementation for nonspecific fatigue. - Application exceptions: Do not establish that participants are nondeficient if deficiency information is unavailable. - Remaining uncertainty: Do not fill in baseline information with mechanisms or blood markers. - Referenced methods: M03 §3.2.1; detailed population conditions are internally designed; M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation to tests are internally designed; M03 §3.2.3, M08 §8.2.2–8.2.3; internal application - Related sources: S211, S06 ### N10 · Have the actual FSS version, range, and scoring method been verified? Verification status: Unverified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: FSS is the prioritized scale for this question. Its actual version, range, and scoring method in an eligible monotherapy trial are unverified. - Why unverified: An FSS label does not mean that all measurement conditions have been verified. - Reason for missing information: An FSS label does not mean that all measurement conditions have been verified. - Required materials and conditions: Actual FSS version, items/range, aggregation, direction, and measurement procedures - Materials to obtain first: Actual FSS version, items/range, aggregation, direction, and measurement procedures - Further research: Compare the actual scale version and scoring/collection procedures against results tables and blinding information. - Conditions for verification: Distinguish the scale prioritized in the question from the actual scale in an eligible monotherapy trial. - Why this condition is needed: Needed to avoid mistaking the selection of FSS as the prioritized scale for verification of its actual use. - Application exceptions: Do not convert CIS, Chalder, vitality, or mood into FSS. - Remaining uncertainty: An FSS label does not mean that all measurement conditions have been verified. - Referenced methods: M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations are internally designed; M08 Table 8.2.a, M03 §3.2.4; internal application - Related sources: S201, S202, S205, S213 ### N11 · Are FSS, CIS, Chalder, and mechanisms the same outcome? Verification status: Met Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: FSS for Ullah's multicomponent product, CIS for the CFS multicomponent product, the secondary Chalder endpoint in the healthy-women registration, and animal/metabolic and exercise markers were distinguished. - Why unverified: Improvement in related symptoms or mechanistic observations does not substitute for the FSS effect of B5 alone. - Reason for missing information: Improvement in related symptoms or mechanistic observations does not substitute for the FSS effect of B5 alone. - Required materials and conditions: Scale, primary/secondary endpoint, time point, population, and intervention for each material - Materials to obtain first: Scale, primary/secondary endpoint, time point, population, and intervention for each material - Further research: Compare the original definitions of different scales and planned endpoints, and do not merge them into a common effect. - Conditions for verification: Attribute each result's population, scale, and time point to its original location. - Why this condition is needed: Needed to avoid using different symptom scales or physiological markers as the same direct effect. - Application exceptions: Do not delete results on other scales; retain them under their respective questions. - Remaining uncertainty: Improvement in related symptoms or mechanistic observations does not substitute for the FSS effect of B5 alone. - Referenced methods: M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations are internally designed; M04 §4.6.3, M15 §15.3.1–15.3.3; status distinctions are internally designed; M08 Table 8.2.a, M03 §3.2.4; internal application; M03 §3.2.4; internally specified boundary on extensions - Related sources: S201, S202, S204, S205, S210, S213, S216 ### N12 · Were between-group differences in change distinguished from endpoint differences and within-group differences? Verification status: Unverified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: The question was fixed to prioritize the between-group difference in change in FSS, with endpoint differences separate, but monotherapy baseline, change, and endpoint values and the actual analysis are unverified. - Why unverified: Do not estimate a between-group monotherapy effect from improvement with a multicomponent product or subjective lupus narratives. - Reason for missing information: Do not estimate a between-group monotherapy effect from improvement with a multicomponent product or subjective lupus narratives. - Required materials and conditions: Baseline, change, and endpoint values, definition of between-group comparison, and adjustment/analysis methods - Materials to obtain first: Baseline, change, and endpoint values, definition of between-group comparison, and adjustment/analysis methods - Further research: Compare eligible results tables against the analysis plan to verify estimates and denominators for the effect of interest. - Conditions for verification: Indicate the between-group/within-group and change/endpoint definitions of the actual selected results and the gaps. - Why this condition is needed: Needed to avoid turning within-group improvement into an effect superior to placebo. - Application exceptions: Do not fill in an analysis not specified in the original text as ITT or an adjusted effect. - Remaining uncertainty: Do not estimate a between-group monotherapy effect from improvement with a multicomponent product or subjective lupus narratives. - Referenced methods: M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations are internally designed; M08 §8.2.2, M15 §15.3.1; internal application - Related sources: S201, S205, S207 ### N13 · Are the directly relevant FSS effect, CI, and P value known? Verification status: Unverified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: The primary_effect.mean_difference, confidence_interval, p_value, and analysis sample-size records are empty/not_verified. - Why unverified: No graphs, correlations, variances, or effect estimates were newly calculated or reconstructed. - Reason for missing information: No graphs, correlations, variances, or effect estimates were newly calculated or reconstructed. - Required materials and conditions: Eligible between-group effect, uncertainty interval, P value, and units - Materials to obtain first: Eligible between-group effect, uncertainty interval, P value, and units - Further research: Obtain estimates, intervals, variances, and denominators from the original results tables and attribute them to the reported effect definition. - Conditions for verification: Distinguish empty values in primary_effect from the direction of related reports. - Why this condition is needed: Needed to avoid filling in an effect based on significance or the number of related studies. - Application exceptions: Do not turn an unverified result into an effect of 0, nonsignificance, or equivalence. - Remaining uncertainty: No graphs, correlations, variances, or effect estimates were newly calculated or reconstructed. - Referenced methods: M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations are internally designed; M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; design-specific adaptations are internally designed; M15 §15.3.1–15.3.3; internal application - Related sources: S201, S205, S207 ### N14 · How many participants were allocated, analyzed, and completed, respectively? Verification status: Unverified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: Arm-specific allocation, FSS analysis, and completion denominators in directly eligible monotherapy trials are unverified. Known denominators from related trials remain attributed only to each respective study. - Why unverified: No effect or incidence rate was calculated without a denominator. - Reason for missing information: No effect or incidence rate was calculated without a denominator. - Required materials and conditions: Arm-specific allocation, analysis, completion, and missing-data/dropout handling in an eligible monotherapy trial - Materials to obtain first: Arm-specific allocation, analysis, completion, and missing-data/dropout handling in an eligible monotherapy trial - Further research: Compare participant flow, reasons for missing data, and outcome-specific analysis tables to verify denominators. - Conditions for verification: Distinguish eligible outcome-specific denominators from what remains unverified. - Why this condition is needed: Needed to avoid using another trial's total sample size as the directly relevant FSS analysis denominator. - Application exceptions: Do not transfer Ullah 58 or Brouwers 53/48 as monotherapy denominators. - Remaining uncertainty: No effect or incidence rate was calculated without a denominator. - Referenced methods: M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; design-specific adaptations are internally designed; M08 §8.2.2, M15 §15.3.1; internal application; M15 §15.3.1–15.3.3; internal application - Related sources: S201, S202, S204, S205 ### N15 · Are allocation, concealment, and assessment procedures in the direct comparison known? Verification status: Unverified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: The preserved materials include related multicomponent-product RCTs, but allocation, concealment, and blinding in a direct monotherapy FSS comparison are unverified. - Why unverified: Do not label this as formal execution of RoB 2 or absence of bias. - Reason for missing information: Do not label this as formal execution of RoB 2 or absence of bias. - Required materials and conditions: Actual design, allocation/concealment, baseline balance, and assessor/participant blinding - Materials to obtain first: Actual design, allocation/concealment, baseline balance, and assessor/participant blinding - Further research: Review the scope of verification of allocation and outcome measurement using eligible methods, registrations, and baseline/assessment materials. - Conditions for verification: Link actual design/measurement information for the direct results with the missing material. - Why this condition is needed: Needed to avoid using a related RCT label as a bias assessment of an eligible monotherapy trial. - Application exceptions: Do not arbitrarily mark crossover or cluster designs as not applicable when the design is unverified. - Remaining uncertainty: Do not label this as formal execution of RoB 2 or absence of bias. - Referenced methods: M08 §8.1–8.2.3; internal application; M08 Table 8.2.a, M03 §3.2.4; internal application; M03 §3.2.1; detailed population conditions are internally designed - Related sources: S201, S205 ### N16 · Were the effects of ITT/PP, adherence, rescue treatment, and missing data verified? Verification status: Unverified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: Adherence, arm-specific analyses, and handling of missing data/rescue treatment in eligible monotherapy trials are unverified. - Why unverified: The reporting of completers in a related multicomponent-product trial does not verify missing-data handling for monotherapy results. - Reason for missing information: The reporting of completers in a related multicomponent-product trial does not verify missing-data handling for monotherapy results. - Required materials and conditions: Effect of interest, analysis population, adherence, arm-specific changes, and missing-data handling - Materials to obtain first: Effect of interest, analysis population, adherence, arm-specific changes, and missing-data handling - Further research: Match the analysis plan, adherence, and participant flow with results tables to distinguish the actual effect of interest. - Conditions for verification: Indicate the directly eligible analysis and why verification is not possible. - Why this condition is needed: Needed to avoid mixing the effect of assignment with effects among adherent participants or before-and-after results among completers. - Application exceptions: Do not arbitrarily assume ITT if the analysis method is unavailable. - Remaining uncertainty: The reporting of completers in a related multicomponent-product trial does not verify missing-data handling for monotherapy results. - Referenced methods: M03 §3.2.3, M08 §8.2.2–8.2.3; internal application; M08 §8.2.2, M15 §15.3.1; internal application; M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; design-specific adaptations are internally designed - Related sources: S201, S205 ### N17 · What magnitude of fatigue difference does the interval allow? Verification status: Unverified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: The direct between-group FSS CI, variance, and MCID are unverified. The remaining precision axis is also an unscored empty value in the original material. - Why unverified: Do not use an unverified interval as evidence excluding an important effect or establishing an effect of 0. - Reason for missing information: Do not use an unverified interval as evidence excluding an important effect or establishing an effect of 0. - Required materials and conditions: Direct effect/CI, endpoint-specific variance, and the basis for an MCID - Materials to obtain first: Direct effect/CI, endpoint-specific variance, and the basis for an MCID - Further research: Obtain the basis for an important difference appropriate to the endpoint version and the actual result interval separately, and compare them. - Conditions for verification: Explain the reported interval and importance criterion, or why interpretation is not possible. - Why this condition is needed: Needed to avoid declaring sufficiency based only on sample size, statistical significance, or the number of reports. - Application exceptions: Do not arbitrarily adopt an MCID, minimum sample size, or common duration. - Remaining uncertainty: Do not use an unverified interval as evidence excluding an important effect or establishing an effect of 0. - Referenced methods: M15 §15.3.1–15.3.3; internal application; M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; adaptations by study design are this project's own design - Related sources: S201, S205 ### N18 · What produced the FSS improvement in Ullah? Verification status: Partly verified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: Ullah 2023 allocated 58 participants, 29 per arm, to study a product containing pomegranate extract, B-complex vitamins, and vitamin C, and reported FSS improvement. Assessments at 28 days and 56 days were distinguished from follow-up. FSS analysis denominators, completion counts, and the contribution of B5 alone are unverified. - Why unverified: The positive combination-product results were neither deleted nor elevated to a direct single-ingredient effect. - Reason for missing information: The positive combination-product results were neither deleted nor elevated to a direct single-ingredient effect. - Required materials and conditions: Product composition, endpoints, time points, and arm-specific results in the 58-participant trial - Materials to obtain first: Product composition, endpoints, time points, and arm-specific results in the 58-participant trial - Further research: Review the combination trial's original tables, composition, and whether individual factors were compared to verify whether an independent B5 contribution can be estimated. - Conditions for verification: Link the positive results with the actual combination product and denominator limitations. - Why this condition is needed: Needed to limit attribution to a single ingredient while preserving favorable related results. - Application exceptions: Do not isolate a contribution from B5 solely because it was included. - Remaining uncertainty: The positive combination-product results were neither deleted nor elevated to a direct single-ingredient effect. - Referenced methods: M03 §3.2.2–3.2.3; reverse-direction labeling and adaptations for tests are this project's own design; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations are this project's own design; M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; adaptations by study design are this project's own design; M04 §4.6.3, M15 §15.3.1–15.3.3; separation of statuses is this project's own design; M03 §3.2.3, M08 §8.2.2–8.2.3; internal application - Related sources: S201, S202 ### N19 · Are the Ullah full text, abstract, and preliminary evaluation independent replications? Verification status: Partly verified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: S201 and S202 are the full text/abstract of the same Ullah RCT and have the same DOI and PMID. S203 is a citation concerning chemical characterization and preliminary evaluation, and the details of its original text are unverified. - Why unverified: S203 was not added as an independent single-ingredient FSS trial, and its exact cohort relationship was not established. - Reason for missing information: S203 was not added as an independent single-ingredient FSS trial, and its exact cohort relationship was not established. - Required materials and conditions: S201/S202/S203 report identities, DOI/PMID, and cohort linkage - Materials to obtain first: S201/S202/S203 report identities, DOI/PMID, and cohort linkage - Further research: Trace the registration, recruitment, product, and participant relationships for each report to check for overlap. - Conditions for verification: Distinguish the explicit identity of reports of the same trial from the unresolved relationship with the preliminary evaluation. - Why this condition is needed: Needed to avoid counting reports as unique trials. - Application exceptions: Do not establish cohort linkage for the preliminary evaluation solely from similar names. - Remaining uncertainty: S203 was not added as an independent single-ingredient FSS trial, and its exact cohort relationship was not established. - Referenced methods: Distinction between studies and reports in M04 §4.6.1–4.6.2; cohort/outcome linkage is an internal application; data collection/selection principles in M04 §4.5–4.6; separation of access and reading and the hyperlink contract are this project's own design; M04 §4.6.1–4.6.2, M15 §15.3.1; internal application - Related sources: S201, S202, S203 ### N20 · Does nonsignificance in Brouwers mean that B5 alone is ineffective? Verification status: Partly verified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: Brouwers 2002 is a trial of a polynutrient supplement in CFS patients and did not report a significant between-group difference in CIS fatigue or other outcomes. It is directly ineligible for the question of B5 alone and FSS. - Why unverified: The nonreporting wording in the original evidence.result and the explanation of nonsignificance in the main text are preserved at their respective locations, without converting them into an effect of 0 for the single ingredient. - Reason for missing information: The nonreporting wording in the original evidence.result and the explanation of nonsignificance in the main text are preserved at their respective locations, without converting them into an effect of 0 for the single ingredient. - Required materials and conditions: CIS, design, between-group results, and original tables for the CFS combination product - Materials to obtain first: CIS, design, between-group results, and original tables for the CFS combination product - Further research: Check the original CIS results and analysis, composition, and population materials to limit direct attribution to FSS. - Conditions for verification: Link the differences in population, combination product, and CIS with the scope of the nonsignificant findings. - Why this condition is needed: Needed to preserve unfavorable related findings as well and avoid converting them into an effect of 0 for a different question. - Application exceptions: Do not turn nonsignificance into equivalence or ineffectiveness for all fatigue. - Remaining uncertainty: The nonreporting wording in the original evidence.result and the explanation of nonsignificance in the main text are preserved at their respective locations, without converting them into an effect of 0 for the single ingredient. - Referenced methods: M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations are this project's own design; M04 §4.6.3, M15 §15.3.1–15.3.3; separation of statuses is this project's own design; M04 §4.6.1–4.6.2, M15 §15.3.1; internal application - Related sources: S204, S205 ### N21 · What denominators do 53 allocated and 48 completed represent? Verification status: Partly verified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: Brouwers allocated 53 participants (27/26), and 48 completed. These are denominators for the CFS combination product, not FSS analysis denominators for B5 alone. - Why unverified: No new arm-specific completion counts or direct FSS denominators were estimated beyond the preserved values. - Reason for missing information: No new arm-specific completion counts or direct FSS denominators were estimated beyond the preserved values. - Required materials and conditions: Brouwers arm-specific allocation, completion, outcome-specific analyses, and handling of dropouts - Materials to obtain first: Brouwers arm-specific allocation, completion, outcome-specific analyses, and handling of dropouts - Further research: Compare participant flow with the CIS analysis population to verify arm-specific missingness and outcome denominators. - Conditions for verification: Attribute the original 53 (27/26) allocated and 48 completed to the corresponding combination-product trial. - Why this condition is needed: Needed to avoid merging allocation/completion counts from a related trial into the same analysis denominator. - Application exceptions: Do not calculate new dropout counts or arm-specific rates from the difference. - Remaining uncertainty: No new arm-specific completion counts or direct FSS denominators were estimated beyond the preserved values. - Referenced methods: M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; adaptations by study design are this project's own design; M08 §8.2.2, M15 §15.3.1; internal application - Related sources: S204, S205 ### N22 · Is the improvement in 12 people with lupus a single-ingredient comparison? Verification status: Partly verified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: The 2007 lupus report is a case series in which 12 women received calcium pantothenate 10 g/day together with several vitamins and combination tablets. It describes subjective fatigue improvement; a concurrent comparator and validated between-group FSS results were not verified. - Why unverified: The disease, combined exposure, comparison, and scale all differ from the selected direct question. - Reason for missing information: The disease, combined exposure, comparison, and scale all differ from the selected direct question. - Required materials and conditions: Case populations, concomitant prescriptions, comparator, and validated fatigue scale - Materials to obtain first: Case populations, concomitant prescriptions, comparator, and validated fatigue scale - Further research: Check prescriptions, populations, fatigue collection, and the presence of a comparator for each case to examine the limits of causality/direct applicability. - Conditions for verification: Link the original 12 participants, 10 g/day, and concomitant vitamins with the reasons for direct exclusion. - Why this condition is needed: Needed to avoid turning an uncontrolled multiple-vitamin narrative into a between-group result for a single ingredient. - Application exceptions: Do not convert calcium-salt mass or transfer a disease-specific sample to the target population. - Remaining uncertainty: The disease, combined exposure, comparison, and scale all differ from the selected direct question. - Referenced methods: M03 §3.2.1; detailed population conditions are this project's own design; M03 §3.2.2–3.2.3; reverse-direction labeling and adaptations for tests are this project's own design; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations are this project's own design; M08 §8.1–8.2.3; internal application; M03 §3.2.3, M08 §8.2.2–8.2.3; internal application; design considerations in M19 §19.2.2–19.2.4; detailed confounding records are this project's own design - Related sources: S207 ### N23 · Do the cases in the 2004 and 2007 lupus reports overlap? Verification status: Partly verified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: Whether the cases in the 2004 S206 and 2007 S207 lupus reports overlap is unclear. The preserved original text did not add the samples together. - Why unverified: Different journals, years, or URLs are not evidence of independent cases. - Reason for missing information: Different journals, years, or URLs are not evidence of independent cases. - Required materials and conditions: Populations, recruitment, case numbers, periods, and linkage in the two reports - Materials to obtain first: Populations, recruitment, case numbers, periods, and linkage in the two reports - Further research: Compare case tables and periods in the two original reports and record whether they are the same, different, or unresolved. - Conditions for verification: Preserve the original uncertainty about overlap and the principle of not summing the samples. - Why this condition is needed: Needed to avoid counting repeat reports of the same cases as independent replications and additional participants. - Application exceptions: Do not establish that cases differ solely from publication years. - Remaining uncertainty: Different journals, years, or URLs are not evidence of independent cases. - Referenced methods: Distinction between studies and reports in M04 §4.6.1–4.6.2; cohort/outcome linkage is an internal application; M04 §4.6.1–4.6.2, M15 §15.3.1; internal application; M04 §4.6.1–4.6.2; adaptation for harm data is this project's own design - Related sources: S206, S207 ### N24 · Are the rheumatology reviews separate direct trials? Verification status: Partly verified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: S208 and S209 are bibliographic records for reviews concerning rheumatic diseases. Historical review locations identifying the Leung entry, study summaries, and references are preserved. - Why unverified: The two DOIs or review averages were not counted as independent replications of B5 alone for FSS. - Reason for missing information: The two DOIs or review averages were not counted as independent replications of B5 alone for FSS. - Required materials and conditions: Original reports included in S208/S209, linkage to Leung, and overlap - Materials to obtain first: Original reports included in S208/S209, linkage to Leung, and overlap - Further research: Compare family relationships among included-study tables, original reports, and related reviews to link endpoints and repeated citations. - Conditions for verification: Distinguish the bibliographic records and historical locations of the two reviews from direct material from original trials. - Why this condition is needed: Needed to avoid double-counting reviews and their included cases as unique trials. - Application exceptions: An indication of historical full-text access to a review is not direct reading in this review. - Remaining uncertainty: The two DOIs or review averages were not counted as independent replications of B5 alone for FSS. - Referenced methods: Distinction between studies and reports in M04 §4.6.1–4.6.2; cohort/outcome linkage is an internal application; data collection/selection principles in M04 §4.5–4.6; separation of access and reading and the hyperlink contract are this project's own design; M04 §4.6.1–4.6.2, M15 §15.3.1; internal application - Related sources: S208, S209, S206, S207 ### N25 · Is Chalder in BEMS a direct FSS result? Verification status: Partly verified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: ACTRN12613001087741 is a registered trial of a Swisse multicomponent multivitamin in healthy women aged 50~75. Chalder is a different secondary endpoint, and actual randomized counts and results are unverified. - Why unverified: Historical access to the full registration does not mean that the registration was read or direct B5 results were verified in this review. - Reason for missing information: Historical access to the full registration does not mean that the registration was read or direct B5 results were verified in this review. - Required materials and conditions: ACTRN registration, healthy women aged 50~75, multicomponent composition, and endpoint hierarchy/results - Materials to obtain first: ACTRN registration, healthy women aged 50~75, multicomponent composition, and endpoint hierarchy/results - Further research: Link the registration and results report by exact identity to compare the planned Chalder endpoint with the actual results. - Conditions for verification: Link the population, combination intervention, secondary endpoint, and unverified actual results. - Why this condition is needed: Needed to avoid elevating the existence of a registration to a target single-ingredient FSS result. - Application exceptions: Distinguish the planned registered sample from actual allocated/analyzed counts. - Remaining uncertainty: Historical access to the full registration does not mean that the registration was read or direct B5 results were verified in this review. - Referenced methods: M03 §3.2.1; detailed population conditions are this project's own design; M03 §3.2.2–3.2.3; reverse-direction labeling and adaptations for tests are this project's own design; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations are this project's own design; M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; adaptations by study design are this project's own design; M08 Table 8.2.a, M04 §4.6.3; internal application - Related sources: S213 ### N26 · Does a CTG shell mean that results are absent? Verification status: Partly verified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: S214 is a mitochondrial cocktail/Gulf War illness lead, and S215 is an Alii combination-product lead; the direct pages at that time were JavaScript shells. - Why unverified: They were not labeled as verified full texts/results or counted as negative studies. - Reason for missing information: They were not labeled as verified full texts/results or counted as negative studies. - Required materials and conditions: Actual text, interventions/endpoints, and results of NCT02804828 and NCT07271316 - Materials to obtain first: Actual text, interventions/endpoints, and results of NCT02804828 and NCT07271316 - Further research: In an authorized subsequent update, read the registration text and results and compare the exact products and endpoints indicated by the leads. - Conditions for verification: Distinguish historical search leads and shells from unverified plans/results. - Why this condition is needed: Needed to avoid turning access failures or shell pages into negative trials or 0 studies worldwide. - Application exceptions: No current access was attempted, and historical shells are not treated as failures in this review. - Remaining uncertainty: They were not labeled as verified full texts/results or counted as negative studies. - Referenced methods: Data collection/selection principles in M04 §4.5–4.6; separation of access and reading and the hyperlink contract are this project's own design; M04 §4.5, §4.6.3; limitations of the current material conversion follow the user's scope and this project's own design; M08 Table 8.2.a, M04 §4.6.3; internal application - Related sources: S214, S215 ### N27 · Do mouse fatigue and CoA functions constitute an FSS effect in adults? Verification status: Partly verified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: S210 is a bibliographic record of original-paper metadata/abstract concerning physical fatigue/cognitive dysfunction in mice. CoA/metabolic functions are not direct FSS effects in adults. - Why unverified: Only the preserved metadata/abstract was read; external original experimental tables or effects translated to humans were not verified. - Reason for missing information: Only the preserved metadata/abstract was read; external original experimental tables or effects translated to humans were not verified. - Required materials and conditions: Species, experimental intervention, physiological/behavioral endpoints, and limits of human applicability - Materials to obtain first: Species, experimental intervention, physiological/behavioral endpoints, and limits of human applicability - Further research: State the differences between animal/mechanistic observations and the human clinical question, and do not combine them with direct results. - Conditions for verification: Identify nonhuman/mechanistic materials at a separate level, with their original bibliographic locations. - Why this condition is needed: Needed to avoid substituting mechanisms or animal responses for direct human treatment effects. - Application exceptions: Traditional uses or metabolic functions are not eligible between-group effect estimates. - Remaining uncertainty: Only the preserved metadata/abstract was read; external original experimental tables or effects translated to humans were not verified. - Referenced methods: M03 §3.2.1; detailed population conditions are this project's own design; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations are this project's own design; M03 §3.2.4; this project's own boundary on extensions - Related sources: S210, S06 ### N28 · Can B5 deficiency case reports be used for the same fatigue treatment? Verification status: Partly verified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: S211 is a J-STAGE abstract/search-index bibliographic record of pantothenic-acid deficiency cases. It is not a comparative FSS result for a single active ingredient in nonspecific persistent fatigue. - Why unverified: The existence of human deficiency studies is preserved, but comparisons or effect estimates beyond that abstract are not inferred. - Reason for missing information: The existence of human deficiency studies is preserved, but comparisons or effect estimates beyond that abstract are not inferred. - Required materials and conditions: Deficiency diagnosis, correction, population, and assessment endpoints - Materials to obtain first: Deficiency diagnosis, correction, population, and assessment endpoints - Further research: Check the actual populations, endpoints, and exposures in deficiency/correction cases to examine how they differ from the selected question. - Conditions for verification: Indicate the bibliographic/access level of deficiency cases and the boundaries for direct exclusion. - Why this condition is needed: Needed to distinguish correction of a specific deficiency from additional supplementation for nonspecific persistent fatigue. - Application exceptions: Do not reclassify the material as a comparative FSS trial in adults when original details are absent. - Remaining uncertainty: The existence of human deficiency studies is preserved, but comparisons or effect estimates beyond that abstract are not inferred. - Referenced methods: M03 §3.2.1; detailed population conditions are this project's own design; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations are this project's own design; M04 §4.5, §4.6.3; limitations of the current material conversion follow the user's scope and this project's own design - Related sources: S211 ### N29 · Does the older sports-vitamin material answer the FSS question? Verification status: Partly verified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: S212 is at the bibliographic/search-abstract level for the early sports-vitamin study with PMID4238715 and DOI10.1007/BF00695017. - Why unverified: It was not used as a direct FSS result for B5 alone in nonspecific persistent fatigue. - Reason for missing information: It was not used as a direct FSS result for B5 alone in nonspecific persistent fatigue. - Required materials and conditions: Product composition, populations, exercise/fatigue endpoints, and actual analyses - Materials to obtain first: Product composition, populations, exercise/fatigue endpoints, and actual analyses - Further research: Compare the composition, population, and endpoint tables of the original sports trial to record its differences from the direct question. - Conditions for verification: Link the verified level of material with the reasons for not attributing it directly. - Why this condition is needed: Needed to avoid substituting exercise performance or vitality wording for FSS in persistent fatigue. - Application exceptions: Do not establish single-ingredient intervention/scale eligibility from bibliographic records or search abstracts. - Remaining uncertainty: It was not used as a direct FSS result for B5 alone in nonspecific persistent fatigue. - Referenced methods: M03 §3.2.1; detailed population conditions are this project's own design; M03 §3.2.2–3.2.3; reverse-direction labeling and adaptations for tests are this project's own design; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations are this project's own design; M03 §3.2.4; this project's own boundary on extensions - Related sources: S212 ### N30 · Do ME/CFS metabolomic data represent a single-ingredient treatment effect? Verification status: Partly verified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: S216 is a search-index description of ME/CFS metabolomics material, and a CAPTCHA was reported during direct access at that time. - Why unverified: The metabolomic bibliography/association was not used as an FSS treatment effect from administering B5 alone. - Reason for missing information: The metabolomic bibliography/association was not used as an FSS treatment effect from administering B5 alone. - Required materials and conditions: Direction of exposure, disease, metabolomic findings, and whether a direct intervention exists - Materials to obtain first: Direction of exposure, disease, metabolomic findings, and whether a direct intervention exists - Further research: Check the direction and comparative design of observational metabolomic data and separate them from the direct FSS intervention question. - Conditions for verification: Indicate the disease/endpoint level of the search leads and the lack of direct attribution. - Why this condition is needed: Needed to avoid reversing associations or surrogate markers into an effect of administering the ingredient. - Application exceptions: Do not extrapolate metabolomic differences to doses or individual treatment responses. - Remaining uncertainty: The metabolomic bibliography/association was not used as an FSS treatment effect from administering B5 alone. - Referenced methods: M03 §3.2.1; detailed population conditions are this project's own design; M03 §3.2.2–3.2.3; reverse-direction labeling and adaptations for tests are this project's own design; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations are this project's own design; data collection/selection principles in M04 §4.5–4.6; separation of access and reading and the hyperlink contract are this project's own design; M03 §3.2.4; this project's own boundary on extensions - Related sources: S216 ### N31 · Do patent examples constitute clinical comparative evidence? Verification status: Partly verified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: S217 is a search-index bibliographic record of examples in patent US5304574A. - Why unverified: Directly eligible between-group FSS results, samples, and independence were not verified from this bibliographic record. - Reason for missing information: Directly eligible between-group FSS results, samples, and independence were not verified from this bibliographic record. - Required materials and conditions: Populations, experiments, and independent clinical results in the US5304574A examples - Materials to obtain first: Populations, experiments, and independent clinical results in the US5304574A examples - Further research: Compare the relationship between the patent lead and actual clinical reports, including whether they concern the same cases, and verify direct evidence separately. - Conditions for verification: Link the verified patent search-index level to its original location. - Why this condition is needed: Needed to avoid confusing the existence of a patent with eligible trials or demonstrated efficacy. - Application exceptions: Do not label patent rights/cases as independent replications of efficacy. - Remaining uncertainty: Directly eligible between-group FSS results, samples, and independence were not verified from this bibliographic record. - Referenced methods: Distinction between studies and reports in M04 §4.6.1–4.6.2; cohort/outcome linkage is an internal application; data collection/selection principles in M04 §4.5–4.6; separation of access and reading and the hyperlink contract are this project's own design; Chamgap's own conditions for independence and attribution. The official methods sections used in this pilot do not guarantee all of these detailed items; M04 §4.6.1–4.6.2, M15 §15.3.1; internal application - Related sources: S217 ### N32 · Were preserved archived summaries distinguished from historical full-text access? Verification status: Met Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: The complete preserved archived summary for 3101 was actually read in this review. NIH inherited extraction, partial PMC access followed by a CAPTCHA, author uploads, visual PDF inspection, full-text access to reviews/registrations, and search indexes are reports from the manuscript at that time. No external materials were attempted or read in this review. - Why unverified: No report-specific access-date field exists, so it was left empty and distinguished from the original review date of 2026-09-15. - Reason for missing information: No report-specific access-date field exists, so it was left empty and distinguished from the original review date of 2026-09-15. - Required materials and conditions: Identity, current locations/values/SHA read, and historical access/dates for each material - Materials to obtain first: Identity, current locations/values/SHA read, and historical access/dates for each material - Further research: When material acquisition is separately authorized, record access levels, dates, original bytes, and locations read for each report. - Conditions for verification: Indicate the summaries actually read in the current review separately from external materials not attempted/not read, and connect the links. - Why this condition is needed: Needed to avoid turning a URL or historical access into original-paper reading in this review. - Application exceptions: Historical CAPTCHAs, shells, and unacquired material are not current access failures, and access dates are not inferred. - Remaining uncertainty: No report-specific access-date field exists, so it was left empty and distinguished from the original review date of 2026-09-15. - Referenced methods: Data collection/selection principles in M04 §4.5–4.6; separation of access and reading and the hyperlink contract are this project's own design; M04 §4.5, §4.6.3; limitations of the current material conversion follow the user's scope and this project's own design - Related sources: S06, S201, S202, S203, S204, S205, S206, S207, S208, S209, S210, S211, S212, S213, S214, S215, S216, S217 ### N33 · Does no_human_study mean that all human studies are absent? Verification status: Met Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: axes.no_human_study=true and human_study_exists=false apply to the fixed direct single-ingredient FSS comparison. related_human_studies_exist=true and search_exhaustive=false are also explicitly stated in the original text. - Why unverified: Do not delete related human studies of combination products/specific diseases or interpret the record as a worldwide absence of human evidence. - Reason for missing information: Do not delete related human studies of combination products/specific diseases or interpret the record as a worldwide absence of human evidence. - Required materials and conditions: Original flags, scope, directly eligible/related human-study existence, and search limitations - Materials to obtain first: Original flags, scope, directly eligible/related human-study existence, and search limitations - Further research: When updating, review the link between direct eligibility, search scope, and code meaning, and distinguish raw values from the current explanation. - Conditions for verification: Preserve the original flags together with their semantic limitations and the existence of related human studies. - Why this condition is needed: Needed to avoid reading a code flag as 0 studies worldwide or no effect. - Application exceptions: Do not alter the original true/false/empty values to make them identical. - Remaining uncertainty: Do not delete related human studies of combination products/specific diseases or interpret the record as a worldwide absence of human evidence. - Referenced methods: M04 §4.6.3, M15 §15.3.1–15.3.3; separation of statuses is this project's own design; M04 §4.5, §4.6.3; limitations of the current material conversion follow the user's scope and this project's own design; M04 §4.6.1–4.6.2, M15 §15.3.1; internal application - Related sources: S201, S202, S204, S205, S207 ### N34 · What do ?, empty values, and the subsequent 5 axes mean? Verification status: Met Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: The original efficacy grade is ?, the score is empty, and the 7 axes are B/P/empty/empty/empty/empty/empty. The subsequent 5 axes and strength count are unscored, not 0. The document_quality B in the original self-review is also separate. - Why unverified: Condition statuses, report counts, and original document assessments were not turned into new scores or official certification. - Reason for missing information: Condition statuses, report counts, and original document assessments were not turned into new scores or official certification. - Required materials and conditions: Original grade/score, application of each axis, gate rationale, and historical calculation references - Materials to obtain first: Original grade/score, application of each axis, gate rationale, and historical calculation references - Further research: In a future, separately authorized update of the criteria, compare and distinguish the original inputs, rules, actual calculations, and valid judgments. - Conditions for verification: Preserve the applied/unscored meaning of the original B/P/5 null axes, ?, and empty score. - Why this condition is needed: Needed to avoid elevating new verification statuses into efficacy grades or scores. - Application exceptions: Do not merge document quality B with efficacy ?, or rerun the original calculator. - Remaining uncertainty: Condition statuses, report counts, and original document assessments were not turned into new scores or official certification. - Referenced methods: M04 §4.5, §4.6.3; limitations of the current material conversion follow the user's scope and this project's own design; M15 §15.3.1–15.3.3; internal application - Related sources: ### N35 · What is known about products, company-affiliated authors, and funding? Verification status: Partly verified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: For Ullah, the Esserre product and company-employee authorship are reported; for Brouwers, Numico supply/manufacture and author affiliation are reported. Full funding and patent information are unverified. Lupus-study funding is also unverified, and the full Swisse COI information was not reviewed for an efficacy conclusion. - Why unverified: Do not transfer related-product sponsorship information to the independence axis of a single-active-ingredient trial. - Reason for missing information: Do not transfer related-product sponsorship information to the independence axis of a single-active-ingredient trial. - Required materials and conditions: Product provision, manufacture, company affiliations, research funding, patents, and disclosed COI - Materials to obtain first: Product provision, manufacture, company affiliations, research funding, patents, and disclosed COI - Further research: Compare original disclosures, product supply, and funding/employment information by study family, and limit the interpretation of independence. - Conditions for verification: Distinguish the reported Esserre, Numico, and Swisse information from what remains unverified. - Why this condition is needed: Needed to avoid turning partial company information or unverified information into independent funding/independent replication. - Application exceptions: Do not delete results because conflicts of interest exist or treat their absence as absence of bias. - Remaining uncertainty: Do not transfer related-product sponsorship information to the independence axis of a single-active-ingredient trial. - Referenced methods: Chamgap's own conditions for independence and attribution. The official methods sections used in this pilot do not guarantee all of these detailed items; M08 §8.1–8.2.3; internal application - Related sources: S201, S202, S204, S205, S207, S213 ### N36 · Was the target FSS outcome prespecified? Verification status: Unverified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: Preregistration and analysis plans for a direct single-active-ingredient FSS comparison are unverified within the preserved scope. The full related registration and CTG shell are distinct levels of material. - Why unverified: Do not establish that selective reporting occurred or that registration was absent from gaps in direct plans. - Reason for missing information: Do not establish that selective reporting occurred or that registration was absent from gaps in direct plans. - Required materials and conditions: Eligible single-active-ingredient trial registration, protocol, SAP, reasons for changes, and all results - Materials to obtain first: Eligible single-active-ingredient trial registration, protocol, SAP, reasons for changes, and all results - Further research: Compare registration/SAP with the actual FSS version, time points, and analyses, and record the scope of changes and nonreporting. - Conditions for verification: Link the plans compared and the scope of direct material not compared to their locations. - Why this condition is needed: Needed to avoid turning the failure to acquire direct plans into confirmation of nonregistration or selective reporting. - Application exceptions: The related BEMS registration is a plan for a different population, product, and scale. - Remaining uncertainty: Do not establish that selective reporting occurred or that registration was absent from gaps in direct plans. - Referenced methods: M08 Table 8.2.a, M04 §4.6.3; internal application; data collection/selection principles in M04 §4.5–4.6; separation of access from reading and the hyperlink contract are internally designed; M04 §4.5, §4.6.3; the limits of the current material conversion follow the user's scope and the project's own design - Related sources: S213, S214, S215 ### N37 · Are optimal dose, persistence, and efficacy in special populations also required? Verification status: Not applicable Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: The selected question in this review is the between-group FSS effect in the fixed population. Optimal dose, persistence after discontinuation, and efficacy in all special populations are separate extension questions and were not adopted as additional requirements. - Why unverified: Gaps in verification of the duration and population needed for the claim remain unverified under the earlier items. - Reason for missing information: Gaps in verification of the duration and population needed for the claim remain unverified under the earlier items. - Required materials and conditions: Separate direct dose comparisons, follow-up after discontinuation, and prespecified subgroups/interactions - Materials to obtain first: Separate direct dose comparisons, follow-up after discontinuation, and prespecified subgroups/interactions - Further research: If an extension question is separately requested, review direct dose/follow-up/interaction designs against their plans and results. - Conditions for verification: Record separately the nonapplicability boundary for extensions of efficacy beyond the direct question and what remains unverified. - Why this condition is needed: Needed to avoid extending the narrow FSS question to all long-term and optimal-dose claims. - Application exceptions: The actual duration relevant to the assessed claim must be verified, but optimal-dose/all-subgroup trials are not imposed as additional requirements. - Remaining uncertainty: Gaps in verification of the duration and population needed for the claim remain unverified under the earlier items. - Referenced methods: M03 §3.2.1–3.2.4; details of dose, persistence, and effect modification are internally designed; M03 §3.2.4; internally specified boundary on extensions; question-clarification principles in M03 §3.1, §3.2.1–3.2.4; detailed separation rules are internally designed - Related sources: ### N38 · How much is known about diarrhea and discontinuations with the same single-active-ingredient exposure? Verification status: Partly verified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: The original preserved NIH description mentions the possibility of diarrhea and gastrointestinal discomfort with high-dose B5. The 10 g/day example is not a toxicity threshold/dosing recommendation, and the adequate intake of 5 mg/day is a nutritional reference value. Harm collection, arm-specific denominators/discontinuations, and causality for a single active ingredient used for this fatigue purpose are unverified. - Why unverified: The absence of an established upper limit does not mean unlimited safety. Do not transfer combination-product adverse effects or pantethine bleeding cautions to B5 alone. - Reason for missing information: The absence of an established upper limit does not mean unlimited safety. Do not transfer combination-product adverse effects or pantethine bleeding cautions to B5 alone. - Required materials and conditions: Event definitions, collection, exposure, time, denominators, arm-specific discontinuations, and concomitant use/causes - Materials to obtain first: Event definitions, collection, exposure, time, denominators, arm-specific discontinuations, and concomitant use/causes - Further research: Separately review systematic harm/discontinuation, concomitant-use, and follow-up data for the same single-active-ingredient product and population. - Conditions for verification: Distinguish the NIH high-dose GI warning from gaps in denominators/methods for direct target harms. - Why this condition is needed: Needed to avoid converting general safety commentary into incidence rates in the target single-active-ingredient trial or overall safety. - Application exceptions: Do not turn unverified efficacy into safety or copy cautions for combination products/pantethine. - Remaining uncertainty: The absence of an established upper limit does not mean unlimited safety. Do not transfer combination-product adverse effects or pantethine bleeding cautions to B5 alone. - Referenced methods: M19 §19.1.2–19.2.4; internal application; M19 §19.1.2–19.2.4; detailed distinctions are internally designed; design-specific harm questions in M19 §19.2; details of temporal relationships are internally designed; M19 §19.2.2–19.2.4, M03 §3.2.3; internal application; design considerations in M19 §19.2.2–19.2.4; detailed confounding records are internally designed; M19 §19.1.2–19.2.4, M04 §4.6.3; internal application; Chamgap's own interpretive boundary. The principles of M19 are referenced; this is not an application of a formal causality tool - Related sources: S06 ### N39 · Has safety been verified for long-term high-dose use, special populations, and concomitant use? Verification status: Unverified Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: Safety for long-term high-dose use for this fatigue purpose, pregnancy, lactation, children, and liver/kidney disease is unverified. The statement that no important interactions are known is also not proof of safety for all combinations. - Why unverified: Do not turn study doses into personal dosing instructions or calculate incidence rates from general warnings. - Reason for missing information: Do not turn study doses into personal dosing instructions or calculate incidence rates from general warnings. - Required materials and conditions: Data on long-term exposure, rare events, pregnancy/lactation/children, liver/kidney disease, and concomitant use - Materials to obtain first: Data on long-term exposure, rare events, pregnancy/lactation/children, liver/kidney disease, and concomitant use - Further research: Review long-term/vulnerable-population and concomitant-use studies with matching exposure and baseline risk in relation to their separate designs and actual collection methods. - Conditions for verification: Preserve the safety limitations for the selected fatigue purpose and the original Caution label. - Why this condition is needed: Needed to avoid using limited general descriptions as proof of safety for all populations/combinations. - Application exceptions: Do not establish that unverified interactions are absent. - Remaining uncertainty: Do not turn study doses into personal dosing instructions or calculate incidence rates from general warnings. - Referenced methods: M19 §19.1.2–19.2.4; internal application; Chamgap's own interpretive boundary. The principles of M19 are referenced; this is not an application of a formal causality tool - Related sources: S06 ### N40 · What can change, as of which date and within which material scope? Verification status: Met Reading scope: The complete, exactly retained archived summary was actually read; external material and separate earlier original texts were not read in this review - Current findings: The evidence/original review date is 2026-09-15. This conversion of preserved material into a table is not a new search, external full-text reading, calculation, judgment, or deployment. If new single-active-ingredient trials, composition, fatigue tables, registration/SAP, corrections/retractions, or classification/numerical errors are verified, preserve the prior original text and history at the same ID/URL. - Why unverified: The original document_quality B, grade_revalidated, and single-assistant self-review are original reports, not independent clinical certification in this review. - Reason for missing information: The original document_quality B, grade_revalidated, and single-assistant self-review are original reports, not independent clinical certification in this review. - Required materials and conditions: Original review date, scope actually read in the current review, new evidence/corrections, and preservation of versions/original text - Materials to obtain first: Original review date, scope actually read in the current review, new evidence/corrections, and preservation of versions/original text - Further research: In a separately authorized update event, preserve the identity of new material, the full original text, and before/after values, and review linked conditions again. - Conditions for verification: Distinguish the original date and self-review, what has not been newly performed, and the conditions for updates/the same ID. - Why this condition is needed: Needed to avoid overstating the current table conversion as a current comprehensive search, publication, or official certification. - Application exceptions: The original first_published_at is an editorial reference date, not proof of actual server deployment. - Remaining uncertainty: The original document_quality B, grade_revalidated, and single-assistant self-review are original reports, not independent clinical certification in this review. - Referenced methods: M04 §4.5, §4.6.3; the limits of the current material conversion follow the user's scope and the project's own design; data collection/selection principles in M04 §4.5–4.6; separation of access from reading and the hyperlink contract are internally designed; M04 §4.6.3, M15 §15.3.1–15.3.3; status distinctions are internally designed - Related sources: ## Evidence and sources ### S06 NIH Office of Dietary Supplements. Pantothenic Acid — Health Professional Fact Sheet [Source](https://ods.od.nih.gov/factsheets/PantothenicAcid-HealthProfessional/) Materials actually read: The corresponding Korean/English summaries and bibliographic records in the archived manuscript were read. The linked external original materials were not read in this review. Findings recorded in the summary: Description of nutritional reference values, high-dose GI effects, absence of an established upper limit, and interactions; not a direct FSS trial Record level: This is content recorded in the archived manuscript. It is not the result of a fresh comparison against current external original material. Independent replication: 18 bibliographic records ≠ 18 independent trials. The same full text/abstract, potentially overlapping cases/preliminary products, reviews, registration/search/patent/official documents/animal data are distinguished; new participant summations performed: 0 | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Preserved archived-summary bibliography, linked summary/historical access | Locally preserved | Acquired | Summary read | The corresponding bibliography and linked summary in the archived manuscript were read. This does not mean that the full text of the original clinical article, protocol, or official document itself was acquired or read. | | NIH ODS official web document | Unverified (external lookups in this review 0) | Access not attempted | Not read | No attempt was made to access this external original material or read its original text in this review. The address recorded in the bibliography is a route to the source; cases with no address or only a domain landing page were also left unchanged. Historical access level in the bibliography: inherited_full_text_extraction. The actual historical access date for each material is unverified. The archived manuscript's review date of 2026-09-15 is not the access date of the original material. Historical location: Table 1; Health Risks from Excessive Pantothenic Acid; Interactions with Medications | ### S201 Ullah et al. Combination of Chemically Characterized Pomegranate Extract and Hydrophilic Vitamins against Prolonged Fatigue [Source](https://pmc.ncbi.nlm.nih.gov/articles/PMC10343643/) Materials actually read: The corresponding Korean/English summaries and bibliographic records in the archived manuscript were read. The linked external original materials were not read in this review. Findings recorded in the summary: 58 participants, 29 per arm; FSS improvement reported; contribution of B5 alone and FSS analysis denominator unverified Record level: This is content recorded in the archived manuscript. It is not the result of a fresh comparison against current external original material. Independent replication: 18 bibliographic records ≠ 18 independent trials. The same full text/abstract, potentially overlapping cases/preliminary products, reviews, registration/search/patent/official documents/animal data are distinguished; new participant summations performed: 0 | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Preserved archived-summary bibliography, linked summary/historical access | Locally preserved | Acquired | Summary read | The corresponding bibliography and linked summary in the archived manuscript were read. This does not mean that the full text of the original clinical article, protocol, or official document itself was acquired or read. | | PMC full-text page | Unverified (external lookups in this review 0) | Access not attempted | Not read | No attempt was made to access this external original material or read its original text in this review. The address recorded in the bibliography is a route to the source; cases with no address or only a domain landing page were also left unchanged. Historical access level in the bibliography: full_text_partial_retrieval_then_captcha. The actual historical access date for each material is unverified. The archived manuscript's review date of 2026-09-15 is not the access date of the original material. Historical location: Methods, Sections 2.1 and 2.2; abstract; full text initially read, later detailed retrieval blocked | ### S202 Ullah et al. PubMed record and abstract for the same randomized trial [Source](https://pubmed.ncbi.nlm.nih.gov/37447210/) Materials actually read: The corresponding Korean/English summaries and bibliographic records in the archived manuscript were read. The linked external original materials were not read in this review. Findings recorded in the summary: Same DOI/PMID as S201; product/company-affiliated authors; not an independent trial Record level: This is content recorded in the archived manuscript. It is not the result of a fresh comparison against current external original material. Independent replication: 18 bibliographic records ≠ 18 independent trials. The same full text/abstract, potentially overlapping cases/preliminary products, reviews, registration/search/patent/official documents/animal data are distinguished; new participant summations performed: 0 | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Preserved archived-summary bibliography, linked summary/historical access | Locally preserved | Acquired | Summary read | The corresponding bibliography and linked summary in the archived manuscript were read. This does not mean that the full text of the original clinical article, protocol, or official document itself was acquired or read. | | PubMed bibliography/abstract | Unverified (external lookups in this review 0) | Access not attempted | Not read | No attempt was made to access this external original material or read its original text in this review. The address recorded in the bibliography is a route to the source; cases with no address or only a domain landing page were also left unchanged. Historical access level in the bibliography: abstract. The actual historical access date for each material is unverified. The archived manuscript's review date of 2026-09-15 is not the access date of the original material. Historical location: Abstract; conflict-of-interest statement; metadata; reference 5 | ### S203 Esposito et al. Chemical Characterization and Preliminary Evaluation of a Pomegranate Extract, B Vitamins and Vitamin C Supplement [Source](https://www.mdpi.com/2227-9717/10/2/208) Materials actually read: The corresponding Korean/English summaries and bibliographic records in the archived manuscript were read. The linked external original materials were not read in this review. Findings recorded in the summary: S202 reference 5; original-text details/cohort linkage unverified Record level: This is content recorded in the archived manuscript. It is not the result of a fresh comparison against current external original material. Independent replication: 18 bibliographic records ≠ 18 independent trials. The same full text/abstract, potentially overlapping cases/preliminary products, reviews, registration/search/patent/official documents/animal data are distinguished; new participant summations performed: 0 | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Preserved archived-summary bibliography, linked summary/historical access | Locally preserved | Acquired | Summary read | The corresponding bibliography and linked summary in the archived manuscript were read. This does not mean that the full text of the original clinical article, protocol, or official document itself was acquired or read. | | Publisher article page | Unverified (external lookups in this review 0) | Access not attempted | Not read | No attempt was made to access this external original material or read its original text in this review. The address recorded in the bibliography is a route to the source; cases with no address or only a domain landing page were also left unchanged. Historical access level in the bibliography: metadata_and_citing_reference_full_text_failed. The actual historical access date for each material is unverified. The archived manuscript's review date of 2026-09-15 is not the access date of the original material. Historical location: Search-index metadata; cited reference 5 of S202 | ### S204 Brouwers et al. The effect of a polynutrient supplement on fatigue and physical activity of patients with chronic fatigue syndrome [Source](https://pubmed.ncbi.nlm.nih.gov/12324640/) Materials actually read: The corresponding Korean/English summaries and bibliographic records in the archived manuscript were read. The linked external original materials were not read in this review. Findings recorded in the summary: Related report of nonsignificant CIS findings; not a direct single-active-ingredient FSS trial Record level: This is content recorded in the archived manuscript. It is not the result of a fresh comparison against current external original material. Independent replication: 18 bibliographic records ≠ 18 independent trials. The same full text/abstract, potentially overlapping cases/preliminary products, reviews, registration/search/patent/official documents/animal data are distinguished; new participant summations performed: 0 | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Preserved archived-summary bibliography, linked summary/historical access | Locally preserved | Acquired | Summary read | The corresponding bibliography and linked summary in the archived manuscript were read. This does not mean that the full text of the original clinical article, protocol, or official document itself was acquired or read. | | PubMed bibliography/abstract | Unverified (external lookups in this review 0) | Access not attempted | Not read | No attempt was made to access this external original material or read its original text in this review. The address recorded in the bibliography is a route to the source; cases with no address or only a domain landing page were also left unchanged. Historical access level in the bibliography: abstract. The actual historical access date for each material is unverified. The archived manuscript's review date of 2026-09-15 is not the access date of the original material. Historical location: Abstract and bibliographic metadata | ### S205 Brouwers et al. Author-uploaded primary paper, QJM 95:677–683 [Source](https://www.researchgate.net/publication/11115445_The_effect_of_a_polynutrient_supplement_on_fatigue_and_physical_activity_of_patients_with_chronic_fatigue_syndrome_a_double-blind_randomized_controlled_trial) Materials actually read: The corresponding Korean/English summaries and bibliographic records in the archived manuscript were read. The linked external original materials were not read in this review. Findings recorded in the summary: 53 participants, 27/26; 48 completed; no detected CIS difference; not an additional independent trial Record level: This is content recorded in the archived manuscript. It is not the result of a fresh comparison against current external original material. Independent replication: 18 bibliographic records ≠ 18 independent trials. The same full text/abstract, potentially overlapping cases/preliminary products, reviews, registration/search/patent/official documents/animal data are distinguished; new participant summations performed: 0 | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Preserved archived-summary bibliography, linked summary/historical access | Locally preserved | Acquired | Summary read | The corresponding bibliography and linked summary in the archived manuscript were read. This does not mean that the full text of the original clinical article, protocol, or official document itself was acquired or read. | | Author-shared full-text page | Unverified (external lookups in this review 0) | Access not attempted | Not read | No attempt was made to access this external original material or read its original text in this review. The address recorded in the bibliography is a route to the source; cases with no address or only a domain landing page were also left unchanged. Historical access level in the bibliography: full_text_author_upload. The actual historical access date for each material is unverified. The archived manuscript's review date of 2026-09-15 is not the access date of the original material. Historical location: Methods pp.678–679; Results pp.680–681; Tables 1–4 | ### S206 Leung. Systemic lupus erythematosus: a combined deficiency disease. Medical Hypotheses 62:922–924 [Source](https://pubmed.ncbi.nlm.nih.gov/15142649/) Materials actually read: The corresponding Korean/English summaries and bibliographic records in the archived manuscript were read. The linked external original materials were not read in this review. Findings recorded in the summary: Overlap with the 2007 cases unknown; historical metadata and failed full-text access Record level: This is content recorded in the archived manuscript. It is not the result of a fresh comparison against current external original material. Independent replication: 18 bibliographic records ≠ 18 independent trials. The same full text/abstract, potentially overlapping cases/preliminary products, reviews, registration/search/patent/official documents/animal data are distinguished; new participant summations performed: 0 | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Preserved archived-summary bibliography, linked summary/historical access | Locally preserved | Acquired | Summary read | The corresponding bibliography and linked summary in the archived manuscript were read. This does not mean that the full text of the original clinical article, protocol, or official document itself was acquired or read. | | PubMed bibliographic page | Unverified (external lookups in this review 0) | Access not attempted | Not read | No attempt was made to access this external original material or read its original text in this review. The address recorded in the bibliography is a route to the source; cases with no address or only a domain landing page were also left unchanged. Historical access level in the bibliography: metadata_search_index_full_text_failed. The actual historical access date for each material is unverified. The archived manuscript's review date of 2026-09-15 is not the access date of the original material. Historical location: Indexed metadata and DOI; PubMed page CAPTCHA; publisher access failed | ### S207 Leung. Systemic Lupus Erythematosus: A Combined Deficiency Disease. Journal of Orthomolecular Medicine 22(4) [Source](https://isom.ca/wp-content/uploads/2020/02/JOM_2007_22_4_06_Systemic_Lupus_Erythematosus_A_Combined_Deficiency-.pdf) Materials actually read: The corresponding Korean/English summaries and bibliographic records in the archived manuscript were read. The linked external original materials were not read in this review. Findings recorded in the summary: 12 women; calcium pantothenate 10 g/day/concomitant vitamins; control/FSS absent or unverified Record level: This is content recorded in the archived manuscript. It is not the result of a fresh comparison against current external original material. Independent replication: 18 bibliographic records ≠ 18 independent trials. The same full text/abstract, potentially overlapping cases/preliminary products, reviews, registration/search/patent/official documents/animal data are distinguished; new participant summations performed: 0 | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Preserved archived-summary bibliography, linked summary/historical access | Locally preserved | Acquired | Summary read | The corresponding bibliography and linked summary in the archived manuscript were read. This does not mean that the full text of the original clinical article, protocol, or official document itself was acquired or read. | | Publisher PDF link | Unverified (external lookups in this review 0) | Access not attempted | Not read | No attempt was made to access this external original material or read its original text in this review. The address recorded in the bibliography is a route to the source; cases with no address or only a domain landing page were also left unchanged. Historical access level in the bibliography: full_text_pdf_and_visual_page. The actual historical access date for each material is unverified. The archived manuscript's review date of 2026-09-15 is not the access date of the original material. Historical location: Clinical observations, printed p.213, PDF page index 11; observed visually | ### S208 De Carvalho and Martinez. Pantothenic acid (vitamin B5) supplementation in rheumatological diseases: A systematic reviews [Source](https://www.spandidos-publications.com/10.3892/ijfn.2025.53) Materials actually read: The corresponding Korean/English summaries and bibliographic records in the archived manuscript were read. The linked external original materials were not read in this review. Findings recorded in the summary: Leung entry/included studies; no duplicate counting alongside original studies Record level: This is content recorded in the archived manuscript. It is not the result of a fresh comparison against current external original material. Independent replication: 18 bibliographic records ≠ 18 independent trials. The same full text/abstract, potentially overlapping cases/preliminary products, reviews, registration/search/patent/official documents/animal data are distinguished; new participant summations performed: 0 | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Preserved archived-summary bibliography, linked summary/historical access | Locally preserved | Acquired | Summary read | The corresponding bibliography and linked summary in the archived manuscript were read. This does not mean that the full text of the original clinical article, protocol, or official document itself was acquired or read. | | Publisher review full-text page | Unverified (external lookups in this review 0) | Access not attempted | Not read | No attempt was made to access this external original material or read its original text in this review. The address recorded in the bibliography is a route to the source; cases with no address or only a domain landing page were also left unchanged. Historical access level in the bibliography: review_full_text. The actual historical access date for each material is unverified. The archived manuscript's review date of 2026-09-15 is not the access date of the original material. Historical location: Eligibility criteria; Table I; Leung entry; references | ### S209 De Carvalho and Martinez. Pantothenic acid and rheumatological disease review [Source](https://www.sciltp.com/journals/jmai/articles/2512002425) Materials actually read: The corresponding Korean/English summaries and bibliographic records in the archived manuscript were read. The linked external original materials were not read in this review. Findings recorded in the summary: Study summary/references; not an independent single-active-ingredient FSS trial Record level: This is content recorded in the archived manuscript. It is not the result of a fresh comparison against current external original material. Independent replication: 18 bibliographic records ≠ 18 independent trials. The same full text/abstract, potentially overlapping cases/preliminary products, reviews, registration/search/patent/official documents/animal data are distinguished; new participant summations performed: 0 | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Preserved archived-summary bibliography, linked summary/historical access | Locally preserved | Acquired | Summary read | The corresponding bibliography and linked summary in the archived manuscript were read. This does not mean that the full text of the original clinical article, protocol, or official document itself was acquired or read. | | Publisher review full-text page | Unverified (external lookups in this review 0) | Access not attempted | Not read | No attempt was made to access this external original material or read its original text in this review. The address recorded in the bibliography is a route to the source; cases with no address or only a domain landing page were also left unchanged. Historical access level in the bibliography: review_full_text. The actual historical access date for each material is unverified. The archived manuscript's review date of 2026-09-15 is not the access date of the original material. Historical location: Study summary and references | ### S210 Nakagawasai et al. Effect of Calcium Pantothenate on Physical Fatigue and Cognitive Dysfunction in Mice [Source](https://cir.nii.ac.jp/crid/1390282681269860864) Materials actually read: The corresponding Korean/English summaries and bibliographic records in the archived manuscript were read. The linked external original materials were not read in this review. Findings recorded in the summary: physical fatigue/cognitive dysfunction; not attributed to human FSS Record level: This is content recorded in the archived manuscript. It is not the result of a fresh comparison against current external original material. Independent replication: 18 bibliographic records ≠ 18 independent trials. The same full text/abstract, potentially overlapping cases/preliminary products, reviews, registration/search/patent/official documents/animal data are distinguished; new participant summations performed: 0 | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Preserved archived-summary bibliography, linked summary/historical access | Locally preserved | Acquired | Summary read | The corresponding bibliography and linked summary in the archived manuscript were read. This does not mean that the full text of the original clinical article, protocol, or official document itself was acquired or read. | | Official scholarly-index page | Unverified (external lookups in this review 0) | Access not attempted | Not read | No attempt was made to access this external original material or read its original text in this review. The address recorded in the bibliography is a route to the source; cases with no address or only a domain landing page were also left unchanged. Historical access level in the bibliography: primary_metadata_and_abstract. The actual historical access date for each material is unverified. The archived manuscript's review date of 2026-09-15 is not the access date of the original material. Historical location: CiNii abstract linked to J-STAGE original | ### S211 Yoshitoshi et al. Pantothenic-acid-deficiency case report [Source](https://www.jstage.jst.go.jp/article/jsnfs1949/16/6/16_6_564/_article/-char/ja) Materials actually read: The corresponding Korean/English summaries and bibliographic records in the archived manuscript were read. The linked external original materials were not read in this review. Findings recorded in the summary: Correction of a specific deficiency; separate from nonspecific persistent fatigue Record level: This is content recorded in the archived manuscript. It is not the result of a fresh comparison against current external original material. Independent replication: 18 bibliographic records ≠ 18 independent trials. The same full text/abstract, potentially overlapping cases/preliminary products, reviews, registration/search/patent/official documents/animal data are distinguished; new participant summations performed: 0 | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Preserved archived-summary bibliography, linked summary/historical access | Locally preserved | Acquired | Summary read | The corresponding bibliography and linked summary in the archived manuscript were read. This does not mean that the full text of the original clinical article, protocol, or official document itself was acquired or read. | | Journal abstract page | Unverified (external lookups in this review 0) | Access not attempted | Not read | No attempt was made to access this external original material or read its original text in this review. The address recorded in the bibliography is a route to the source; cases with no address or only a domain landing page were also left unchanged. Historical access level in the bibliography: primary_abstract_search_index. The actual historical access date for each material is unverified. The archived manuscript's review date of 2026-09-15 is not the access date of the original material. Historical location: J-STAGE abstract, 16(6):564–571 | ### S212 Early sports-vitamin supplementation study [Source](https://pubmed.ncbi.nlm.nih.gov/4238715/) Materials actually read: The corresponding Korean/English summaries and bibliographic records in the archived manuscript were read. The linked external original materials were not read in this review. Findings recorded in the summary: Exercise material; single-active-ingredient FSS details/eligibility unverified Record level: This is content recorded in the archived manuscript. It is not the result of a fresh comparison against current external original material. Independent replication: 18 bibliographic records ≠ 18 independent trials. The same full text/abstract, potentially overlapping cases/preliminary products, reviews, registration/search/patent/official documents/animal data are distinguished; new participant summations performed: 0 | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Preserved archived-summary bibliography, linked summary/historical access | Locally preserved | Acquired | Summary read | The corresponding bibliography and linked summary in the archived manuscript were read. This does not mean that the full text of the original clinical article, protocol, or official document itself was acquired or read. | | PubMed bibliographic page | Unverified (external lookups in this review 0) | Access not attempted | Not read | No attempt was made to access this external original material or read its original text in this review. The address recorded in the bibliography is a route to the source; cases with no address or only a domain landing page were also left unchanged. Historical access level in the bibliography: metadata_and_abstract_search_index. The actual historical access date for each material is unverified. The archived manuscript's review date of 2026-09-15 is not the access date of the original material. Historical location: Indexed abstract; associated publisher abstract | ### S213 ANZCTR. Understanding the behavioural effects of multivitamin supplements: The BEMS study in women [Source](https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365064) Materials actually read: The corresponding Korean/English summaries and bibliographic records in the archived manuscript were read. The linked external original materials were not read in this review. Findings recorded in the summary: Healthy women aged 50~75/secondary Chalder outcome; actual allocation/results unverified Record level: This is content recorded in the archived manuscript. It is not the result of a fresh comparison against current external original material. Independent replication: 18 bibliographic records ≠ 18 independent trials. The same full text/abstract, potentially overlapping cases/preliminary products, reviews, registration/search/patent/official documents/animal data are distinguished; new participant summations performed: 0 | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Preserved archived-summary bibliography, linked summary/historical access | Locally preserved | Acquired | Summary read | The corresponding bibliography and linked summary in the archived manuscript were read. This does not mean that the full text of the original clinical article, protocol, or official document itself was acquired or read. | | ANZCTR registration page | Unverified (external lookups in this review 0) | Access not attempted | Not read | No attempt was made to access this external original material or read its original text in this review. The address recorded in the bibliography is a route to the source; cases with no address or only a domain landing page were also left unchanged. Historical access level in the bibliography: registry_full_text. The actual historical access date for each material is unverified. The archived manuscript's review date of 2026-09-15 is not the access date of the original material. Historical location: Registration number; intervention; eligibility; outcome hierarchy; allocation methods | ### S214 ClinicalTrials.gov. NCT02804828, mitochondrial cocktail/Gulf War illness lead [Source](https://clinicaltrials.gov/study/NCT02804828) Materials actually read: The corresponding Korean/English summaries and bibliographic records in the archived manuscript were read. The linked external original materials were not read in this review. Findings recorded in the summary: Search lead/JS shell at the time; not verification of a single-active-ingredient FSS plan Record level: This is content recorded in the archived manuscript. It is not the result of a fresh comparison against current external original material. Independent replication: 18 bibliographic records ≠ 18 independent trials. The same full text/abstract, potentially overlapping cases/preliminary products, reviews, registration/search/patent/official documents/animal data are distinguished; new participant summations performed: 0 | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Preserved archived-summary bibliography, linked summary/historical access | Locally preserved | Acquired | Summary read | The corresponding bibliography and linked summary in the archived manuscript were read. This does not mean that the full text of the original clinical article, protocol, or official document itself was acquired or read. | | ClinicalTrials.gov registration page | Unverified (external lookups in this review 0) | Access not attempted | Not read | No attempt was made to access this external original material or read its original text in this review. The address recorded in the bibliography is a route to the source; cases with no address or only a domain landing page were also left unchanged. Historical access level in the bibliography: search_index_then_registry_shell. The actual historical access date for each material is unverified. The archived manuscript's review date of 2026-09-15 is not the access date of the original material. Historical location: Search-index intervention lead; direct page JavaScript shell | ### S215 ClinicalTrials.gov. NCT07271316, Alii supplement study lead [Source](https://clinicaltrials.gov/study/NCT07271316) Materials actually read: The corresponding Korean/English summaries and bibliographic records in the archived manuscript were read. The linked external original materials were not read in this review. Findings recorded in the summary: Search lead/JS shell at the time; actual results unverified Record level: This is content recorded in the archived manuscript. It is not the result of a fresh comparison against current external original material. Independent replication: 18 bibliographic records ≠ 18 independent trials. The same full text/abstract, potentially overlapping cases/preliminary products, reviews, registration/search/patent/official documents/animal data are distinguished; new participant summations performed: 0 | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Preserved archived-summary bibliography, linked summary/historical access | Locally preserved | Acquired | Summary read | The corresponding bibliography and linked summary in the archived manuscript were read. This does not mean that the full text of the original clinical article, protocol, or official document itself was acquired or read. | | ClinicalTrials.gov registration page | Unverified (external lookups in this review 0) | Access not attempted | Not read | No attempt was made to access this external original material or read its original text in this review. The address recorded in the bibliography is a route to the source; cases with no address or only a domain landing page were also left unchanged. Historical access level in the bibliography: search_index_then_registry_shell. The actual historical access date for each material is unverified. The archived manuscript's review date of 2026-09-15 is not the access date of the original material. Historical location: Search-index mixed-product lead; direct page JavaScript shell | ### S216 ME/CFS metabolomics report [Source](https://pmc.ncbi.nlm.nih.gov/articles/PMC6030047/) Materials actually read: The corresponding Korean/English summaries and bibliographic records in the archived manuscript were read. The linked external original materials were not read in this review. Findings recorded in the summary: Historical search index/CAPTCHA; must not be reversed into an FSS intervention effect Record level: This is content recorded in the archived manuscript. It is not the result of a fresh comparison against current external original material. Independent replication: 18 bibliographic records ≠ 18 independent trials. The same full text/abstract, potentially overlapping cases/preliminary products, reviews, registration/search/patent/official documents/animal data are distinguished; new participant summations performed: 0 | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Preserved archived-summary bibliography, linked summary/historical access | Locally preserved | Acquired | Summary read | The corresponding bibliography and linked summary in the archived manuscript were read. This does not mean that the full text of the original clinical article, protocol, or official document itself was acquired or read. | | PMC full-text page | Unverified (external lookups in this review 0) | Access not attempted | Not read | No attempt was made to access this external original material or read its original text in this review. The address recorded in the bibliography is a route to the source; cases with no address or only a domain landing page were also left unchanged. Historical access level in the bibliography: search_index_then_captcha. The actual historical access date for each material is unverified. The archived manuscript's review date of 2026-09-15 is not the access date of the original material. Historical location: Search-index metabolomics description only | ### S217 US5304574A patent [Source](https://patents.google.com/patent/US5304574A/en) Materials actually read: The corresponding Korean/English summaries and bibliographic records in the archived manuscript were read. The linked external original materials were not read in this review. Findings recorded in the summary: Patent examples; independent clinical results/sample unverified Record level: This is content recorded in the archived manuscript. It is not the result of a fresh comparison against current external original material. Independent replication: 18 bibliographic records ≠ 18 independent trials. The same full text/abstract, potentially overlapping cases/preliminary products, reviews, registration/search/patent/official documents/animal data are distinguished; new participant summations performed: 0 | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Preserved archived-summary bibliography, linked summary/historical access | Locally preserved | Acquired | Summary read | The corresponding bibliography and linked summary in the archived manuscript were read. This does not mean that the full text of the original clinical article, protocol, or official document itself was acquired or read. | | Patent web page | Unverified (external lookups in this review 0) | Access not attempted | Not read | No attempt was made to access this external original material or read its original text in this review. The address recorded in the bibliography is a route to the source; cases with no address or only a domain landing page were also left unchanged. Historical access level in the bibliography: patent_search_index. The actual historical access date for each material is unverified. The archived manuscript's review date of 2026-09-15 is not the access date of the original material. Historical location: Patent examples | ## Review criteria and methods These are Chamgap's own application conditions, informed by the relevant sections of official methodological guidance. They do not constitute official assessment-tool certification or a new efficacy score. - M03 [Cochrane Handbook 6.5 (2024), chapter updated 2023-08](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-03) · §3.1, §3.2.1–3.2.3, MECIR C5/C7/C13 · Clearly record the question, eligibility conditions, and reasons for changes, and distinguish variations of the intervention. · Reuse of preserved methodological principles/version from 1585 and actual original-byte copies of 5 HTML files; not new reading of methodological full texts or application of official tools in this review - M04 [Cochrane Handbook 6.5.1 (2025), chapter updated 2025-03](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-04) · §4.5, §4.6.1–4.6.3, MECIR C42 · Distinguish and link studies and reports, and do not omit a study merely because an outcome is unreported. · Reuse of preserved methodological principles/version from 1585 and actual original-byte copies of 5 HTML files; not new reading of methodological full texts or application of official tools in this review - M08 [Cochrane Handbook 6.5 (2024), chapter updated 2019-10](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-08) · §8.1–8.2.3, Table 8.2.a · Fix the outcome and effect of interest, and review randomization, deviations, missingness, measurement, and selective reporting. · Reuse of preserved methodological principles/version from 1585 and actual original-byte copies of 5 HTML files; not new reading of methodological full texts or application of official tools in this review - M15 [Cochrane Handbook 6.5 (2024), chapter updated 2023-08](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-15) · §15.2.4, §15.3.1–15.3.3 · Distinguish effect estimates, intervals, importance, and applicability. Sample size alone does not determine precision. · Reuse of preserved methodological principles/version from 1585 and actual original-byte copies of 5 HTML files; not new reading of methodological full texts or application of official tools in this review - M19 [Cochrane Handbook 6.5 (2024), chapter updated 2019-10](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-19) · §19.1.2, §19.2.1–19.2.4 · A harm question may require designs, populations, and follow-up different from those for efficacy. Case reports do not establish incidence rates. · Reuse of preserved methodological principles/version from 1585 and actual original-byte copies of 5 HTML files; not new reading of methodological full texts or application of official tools in this review ## What the statuses mean - Partly verified: Some related material/bibliographic/historical information exists, but gaps remain in direct comparisons, products/denominators/plans, and access/harms - Unverified: The selected direct result or necessary material could not be verified within the preserved scope; this does not mean no effect or 0 studies - Review incomplete: Original-material comparison/search was not performed within the permitted scope - Not reported: A scope-limited status meaning that the item was not stated in the specific material/section read - Inaccessible: Used only for material for which access was actually attempted and failed. Not assigned to clinical material in this review - Insufficient evidence meeting the conditions: Used only when evidence is insufficient to answer a condition after relevant studies within the defined scope have been reviewed. Not applied comprehensively in this review - Not applicable: Extensions to optimal dose, persistence, all populations/clinical events are not imposed as additional requirements for the original FSS question; this does not substitute for other unverified matters - Conflicting information: When materials that are difficult to reconcile for the same question, time point, and analysis have been compared. Not assigned merely because a review reports different numerical values - Met: Verification of the stated preservation, boundaries/attribution, and linkage conditions; not direct FSS efficacy, original full-text reading, or safety certification ## Change history 2026-11-02 · Public page/materials 1.0. A public view and data were prepared from the existing 40 items. No new clinical search, change in verification status, or scoring was performed.