Vitamin C (single-ingredient oral L-ascorbic acid) × Change in symptomatic stone recurrence in adults with prior calcium-oxalate stones

Required evidence, verification status and materials actually read
Item	AVerification status	BReading scope	CReview item	DCurrent findings	EWhy unverified	FRequired materials and conditions	GFurther research
1	Met	Full text not readStored summary read	N01 · Claim and boundaries of the independent questionWhich adults, oral intervention and recurrent-stone event does this table address?Required	The current claim concerns change in symptomatic new-stone recurrence in adults with a confirmed history of calcium-oxalate stones. The question compares added single-ingredient pure oral L-ascorbic acid with no addition, placebo or matched care. The actual dose, duration and direct comparative values are unverified.	The original claim's identity and exclusion boundaries have been linked. Met does not mean that an eligible trial or a recurrence effect has been verified.	The original /ko/effect and question specifications for population, ingredient, route, event, comparison and time	Subsequent research should define symptomatic new calcium-oxalate stone recurrence as the main outcome and report imaging-only events, residual-stone growth and first incident stones separately.
2	Met	Full text not readStored summary read	N02 · Reference date and reading scopeWhat materials were actually read this time, and what are the historical access records?Required	The retained evidence through 2026-09-16 was transformed on 2026-10-05. The 17 Korean fields, designated structure and 17 sources/bibliographic entries were actually read in that work. Reading S01's 6-page PDF, part of S10 on p.1563 and official documents is recorded in the historical manuscript; all external materials remain unread this time.	Current summary reading and historical access levels have been separated by material. No new searches or reading of original full texts or old separate logs were performed.	The retained summary's evidence cutoff, access records for each source, locations actually read in the current work and file SHA	For subsequent material verification, separately record material type, version, access attempts, sections actually read and the SHA of acquired files, and cross-check them against historical summaries.
3	Met	Full text not readStored summary read	N03 · Reports and study familiesHave the 17 reports been kept from being double-counted as independent recurrence trials?Required	The 17 sources are linked to the 10 families in the retained ledger. S04 and S17 were grouped in F04 because of possible but unresolved overlap. S08's 3 cohorts, reviews and cited material are not added as other independent recurrence trials. The count of 0 verified eligible comparisons pertains to the scope at that time. S01 S02 S04 S08 S11 S17	The distinctions among reports, families and reviews have been preserved. This is not exhaustive confirmation of the number of unique studies or participants.	A mapping of each report's source_id to study family, cohort, endpoint and repeat citations	Create an overlap ledger that cross-checks original participant recruitment, registration, study locations and timing to verify Chai/Massey overlap and cohort reuse.
4	Met	Full text not readStored summary read	N04 · Ingredient, formulation and routeHas the question's pure oral L-ascorbic acid been distinguished from other forms?Required	The question concerns single-ingredient pure oral L-ascorbic acid. Sodium/calcium ascorbate, foods/juice, combination products and intravenous injections are excluded. This boundary does not mean that an actual eligible study product has been verified. S12	The question boundaries between the pure oral preparation and other exposures have been preserved. Directly eligible product verification remains unverified under the next criterion.	Product ingredient list, L isomer, salts, single/combined ingredients and actual administration route	Subsequent comparisons should verify batch-specific ingredients, salts/isomers, added ingredients and administration routes, distinguishing them from food/injection exposures.
5	Unverified	Full text not readStored summary read	N05 · Actual product identityHave the product, source and single-ingredient status of a directly eligible recurrence study been verified?Required	The product and manufacturing source for a directly eligible recurrence comparison are unverified. S01 also records that single-ingredient L-isomer purity, product and source could not be established. S01	The current retained scope lacks material to verify the question's pure oral L formulation as the actual trial product.	Product, batch, manufacturing source, purity, ingredient list and original methods for a direct recurrence comparison	Design research linking product analysis or verifiable ingredient lists to the actual comparison groups and administration records.
6	Unverified	Full text not readStored summary read	N06 · Population and stone historyIs this direct evidence about adults with a confirmed history of calcium-oxalate stones?Required	The question's population is adults with a confirmed history of calcium-oxalate stones. S01 concerns alkaline urine and mixed stones, while S02 is a short-term metabolic study in calcium-oxalate stone formers. Comparative symptomatic-recurrence values matching this population have not been verified. S01 S02	Although related human data exist, a direct result meeting the population, endpoint and comparison criteria together remains unverified.	Age, prior stone diagnosis/composition, recurrence history, baseline status and inclusion/exclusion table	Analyze prior stone composition and verify history before recruitment, reporting data for adults with a calcium-oxalate stone history separately from other compositions.
7	Partly verified	Full text not readStored summary read	N07 · S01 selection and composition denominatorsHow are S01's 43 identified, 24 included and 17 composition-verified participants distinguished?Required	S01 identified 43 patients and included 24. Mean age was 60.6 years (95% CI 52.7–68.5), and 11/24 were women. Among the 17 with baseline composition verified, 9 had struvite, 6 carbonate apatite and 2 calcium oxalate. Among the 3 with follow-up composition verified, 2 had struvite and 1 carbonate apatite; the calcium-oxalate cell of 0 does not provide a denominator establishing 0 recurrences. S01	The retained selection and composition counts can be distinguished, but the analysis of symptomatic recurrence confined to calcium-oxalate stones and the details of missingness and selection are unverified.	Patient selection flow, age, sex, stone-composition testing table and reasons for exclusion	Subsequent research should disclose participant-level flow and missing tests from recruitment through composition testing and event adjudication.
8	Partly verified	Full text not readStored summary read	N08 · S01 composite eventsWhat outcome and follow-up period do the 8/24 events in S01 represent?Required	In S01, a composite event of new stones or growth/progression of existing stones was observed in 8/24 participants (33.3%). Median follow-up was 22.6 months (range 19.7–32.1 months), and the original main endpoint was urinary pH. This value is neither a symptomatic recurrence rate confined to calcium-oxalate stones nor a causal effect of vitamin C. S01	The composite events and follow-up summary are retained, but a direct comparative result for the target event cannot be separately verified.	Event tables by new-stone and residual-stone-growth component, symptom status, composition, and median or fixed follow-up information	Comparative studies are needed that adjudicate new stones, growth of existing stones, and symptomatic events separately, and distinguish prespecified fixed-time outcomes from time to first recurrence.
9	Partly verified	Full text not readStored summary read	N09 · S01 nominal exposureIs the dose in S01 a regimen from a directly eligible trial?Required	The median daily dose of ascorbic acid in S01 was 1000 mg/day (range 500–2000 mg/day). The product, L-form purity, administration frequency, meal timing, and sustained adherence are unverified. These values were not used to fill in a dose for a directly eligible recurrence study or an individual prescription. S01	Only the nominal daily dose from an indirect report is verified; there is no directly eligible exposure information.	Nominal daily dose, product, dose per administration/frequency, meal timing, actual intake, and administration records	Obtain the product and daily and per-administration dosing records, adherence, and changes in exposure by group to compare nominal dose with actual exposure.
10	Unverified	Full text not readStored summary read	N10 · Direct comparatorHas a recurrence comparator involving no addition, placebo, or the same care been verified?Required	No addition, placebo, and the same usual care are the comparator question in this table. S01 has no unexposed recurrence comparator, and the placebo in S02 is a short-term metabolic comparison. A directly eligible recurrence comparator is unverified. S01 S02 S03	There is no retained result that verifies the question's comparator as an actually observed eligible group.	Comparators, care, concomitant interventions, event counts, and correspondence with the exposure group in the same population	Compare an added single-ingredient oral preparation with no addition/placebo on top of the same usual care, and record events by group together with differences in care.
11	Unverified	Full text not readStored summary read	N11 · Duration and principal follow-up timeHave the treatment duration and principal follow-up time for comparing recurrence been verified?Required	The treatment duration and principal follow-up time of a directly eligible recurrence comparison are unverified. The 22.6 months in S01 is median follow-up, not a fixed 24-month endpoint. The 6 days per period in S02 and the 3 days in S03 are metabolic exposure periods. S01 S02 S03	There are no direct comparative data with which to establish the principal recurrence time point and exposure duration.	Actual treatment start/end, discontinuation, follow-up/censoring, and prespecified principal follow-up time	Prespecify a defensible principal time point considering event accumulation and discontinuation/censoring, and report treatment duration separately from follow-up duration.
12	Unverified	Full text not readStored summary read	N12 · Event definition and measurementCan symptomatic new stones be distinguished from imaging-only events and residual-stone growth?Required	The question's endpoint is symptomatic new calcium-oxalate stone recurrence. The manuscript does not combine new stones/residual-stone growth, imaging-only events, emergency care/procedures, and time to first recurrence. A separate result meeting this target definition was not verified within the composite events in S01. S01	The question's definition is fixed, but the target event actually measured and adjudicated in a directly eligible comparison is unverified.	Symptoms, imaging/diagnosis, stone composition, adjudicators, definitions of new and residual stones, and event collection procedures	Apply event adjudication with group information masked where possible and standardized procedures for verifying symptoms, imaging, and composition.
13	Unverified	Full text not readStored summary read	N13 · Direct effect and uncertaintyHave an effect estimate, CI, and P value for an eligible recurrence comparison been verified?Required	In the original primary_result, source_id, estimate, CI, P, and n are all empty values, and the direction is unknown. Numerators/denominators, risk ratios/risk differences/hazard ratios/HRs, person-years, and censoring for eligible recurrence are also unverified. S01 8/24, S02 P<0.001, and the S08 HR were not transferred into these empty fields.	A directly eligible comparative estimate cannot be verified within the retained material currently read. This does not mean an effect of 0.	Events/denominators and time by group, original risk ratio/risk difference/HR, CI, P value, and analysis definition	Report relative and absolute effects and intervals for prespecified symptomatic recurrence using the same analysis population and a fixed time point or a time-to-event model.
14	Unverified	Full text not readStored summary read	N14 · Design, allocation, and confoundingHave an actual design and allocation that support a causal comparison of recurrence been verified?Required	S01 is a retrospective report of an exposure group alone, S02 is a randomized double-blind metabolic crossover trial, and S08 is an observational analysis of first stones. Allocation, concealment, and baseline balance in a direct recurrence comparison were not verified. S01 S02 S08	The actual existence of other designs does not establish a causal comparison for the target clinical event.	Direct comparison methods, allocation/concealment, baseline risk, observational-study confounding/selection, and models	Prespecify a randomized comparison on top of the same usual care or an appropriate comparative design that explicitly addresses confounding and selection pathways.
15	Unverified	Full text not readStored summary read	N15 · Concomitant interventions, adherence, and contributionCan common treatments, deviations from medication use, and concomitant interventions be separated from vitamin C's contribution?Required	In S01, sustained adherence, product, and frequency are unverified, and discontinuation/dose reduction related to hyperoxaluria is recorded. The acute dissolution in S09 is a case combining concurrent exposure to antibiotics and stenting with different exposure after discharge. The effects of concomitant interventions and deviations in a direct comparison are unverified. S01 S09	There is no eligible recurrence analysis that separates common care and exposure changes by group.	Fluid intake/diet, medications/procedures, rescue treatment, adherence, exposure changes, and their handling in analysis by group	Collect fluid intake, diet, concurrent medications/procedures, rescue treatments, and actual medication use/discontinuation by group, and analyze them in accordance with the prespecified effect of interest.
16	Unverified	Full text not readStored summary read	N16 · Denominators and events/peopleHave recurrence events, people, exposure time, and analysis denominators been verified?Required	The 8/24 in S01 is the reported value for composite events in the exposure group. Numerators/denominators by group, event counts/person counts, person-years, and censoring for directly eligible recurrence were not verified. The 2 people with spontaneous passage or populations with other stone compositions are not added to a new-recurrence numerator. S01 S05	The target event unit and the comparative analysis denominator are not verified within the currently retained scope.	Numbers allocated/exposed, completing follow-up, and analyzed; recurrent events/people with events; follow-up time; and censoring tables	Separate people with events from recurrent events using participant IDs and a time axis, and disclose denominators and censoring for first-recurrence and recurrent-event analyses.
17	Unverified	Full text not readStored summary read	N17 · Missing data, selection, and censoringWho was included, lost to follow-up, or censored, and how was the target outcome handled?Required	The 43 people identified and 24 included in S01 are retained, but missingness, censoring, and their handling for the target recurrence by group are unverified. Because an actually eligible comparison has not been verified, these values cannot be designated as an ITT denominator. S01	The retained inclusion flow alone cannot establish the impact of missingness/censoring on the target comparison.	Participant flow, missing outcomes, censoring, reasons for exclusion, and analysis/sensitivity-analysis plans	Disclose losses to follow-up, missing event ascertainment, and reasons for censoring by group, and perform prespecified sensitivity analyses for missing data.
18	Unverified	Full text not readStored summary read	N18 · Differences in detection and adjudicationWere symptom assessment, imaging, and event adjudication conducted under the same conditions across groups?Required	The retained manuscript distinguishes symptomatic new stones, imaging-only findings, growth, and urinary measures. Whether the same examination schedule, assessor masking, and event adjudication were applied in a direct comparison is unverified. S01	There are no direct data with which to compare the actual collection and measurement procedures for the target recurrence.	Examination schedules, symptom collection, imaging/composition testing, masking/adjudicators, and detection/reporting pathways	Apply the same follow-up/symptom contacts and prespecified event adjudication procedures across groups, and disclose examination frequency together with missing adjudication.
19	Unverified	Full text not readStored summary read	N19 · Precision and important differencesCan the reported interval and a clinically important difference in recurrence be interpreted?Required	The CI and effect estimate for eligible recurrence are unverified (the historical manuscript's explanation of CX/EX). A sample of 24 participants or a large sample in another cohort was not treated as sufficient precision for recurrence. An important difference and an appropriate minimum duration are also undetermined.	Without a direct interval and a justified criterion for clinical importance, their relationship to evidence sufficiency cannot be assessed.	Direct recurrence effect, CI, events/denominators, and a justified criterion for an important difference	Prespecify a difference in recurrence justified from clinical and patient perspectives, and report the effect interval and basis for precision for that event and follow-up.
20	Unverified	Full text not readStored summary read	N20 · Planning, registration, and reportingHave prespecified recurrence endpoints, the principal time point, and analyses been compared with actual reporting?Required	Registration, protocol, and analysis plan for directly eligible recurrence are unverified. Preserve urinary pH as the original main endpoint and stones as a secondary endpoint in S01; unverified registration does not establish whether selective reporting occurred. Historical access to the official S15 record reached only a shell. S01 S15	The current scope contains no records with which to compare planned and actual endpoints and analyses for the target comparison.	Registration, protocol, analysis plan, amendment history, and actual results tables for the direct trial	Disclose the recurrence event definition, principal time point, comparator, analysis/interval, missing-data handling, and reasons for changes in advance, and compare them with the final results.
21	Partly verified	Full text not readStored summary read	N21 · Short-term crossover and urinary outcomesWhich population, exposure, and comparison does the crossover metabolic result in S02 describe?Supplementary; required for attributing indirect results	S02 compared ascorbic acid 1 g twice daily with a matching placebo during two 6-day controlled-diet periods in 12 calcium-oxalate stone formers and 12 nonformers. Testing during the final 2 days of each period reported urinary oxalate of 41.0 mg versus 30.5 mg in stone formers, P < 0.001. The authors' description of a 33% increase is preserved as originally reported and was not recalculated. This is not a recurrence event result. S02	The metabolic crossover result is included in the current extraction, but it does not answer an eligible symptomatic recurrence comparison.	Original S02 methods/results tables, population, duration, sample, crossover contrast, and urinary oxalate units	For metabolic crossover trials, disclose the original paired comparison, diet, and sequence; assess the clinical recurrence question through separate long-term event follow-up and comparisons.
22	Unverified	Full text not readStored summary read	N22 · Crossover sequence and paired uncertaintyHave the sequence, washout period, paired variance, and carryover effects in S02 been verified?Supplementary; required for interpreting crossover results	S02 was indexed as a randomized double-blind crossover trial, but detailed values for washout, sequence, paired variance, product, and adverse events were not verified in the abstract accessed. The two populations of 12 participants each were not treated as a 24-participant parallel-group comparison of recurrence, and no new CI was calculated for the urinary outcome. S02	The current abstract extraction alone cannot verify paired uncertainty between crossover periods or the handling of carryover and sequence.	S02 full text, allocation sequence, washout period, results by period, paired variance, and carryover/deviation analyses	Report participant-level period contrasts, period/sequence, carryover effects, and missingness from the original crossover data according to the prespecified plan, and disclose the necessary paired uncertainty.
23	Partly verified	Full text not readStored summary read	N23 · Short-term before–after and healthy-participant comparisonWhat was compared in the before–after metabolic study S03?Supplementary; required for interpreting indirect data	S03 provides before–after data from 47 adult calcium stone formers, of whom 23 received 1 g/day and 24 received 2 g/day for 3 days, plus data from 20 healthy participants receiving 1 g/day. It addresses urinary oxalate, pH, and the Tiselius crystallization index, not a long-term recurrence comparison. The healthy participants are not recurrence comparators for patients with prior stones, and the stone-former population was not verified as consisting entirely of calcium-oxalate stones. S03	The population and short-term metabolic role are retained, but the population, event, and comparison for the target recurrence are not verified.	Original S03 methods/results, stone composition, exposure/testing by group, the role of healthy participants, and paired data	Disclose paired comparisons, composition, and diet/exposure for short-term metabolic data; study recurrence in adults with verified prior stones using a separate comparator receiving the same care.
24	Unverified	Full text not readStored summary read	N24 · Bibliography and unresolved duplicationHave detailed results and participant overlap between S04 and S17 been verified?Supplementary; required for interpreting duplication and existence	For S04 Massey 2005 and S17 Chai 2004, only indexed titles/bibliographic information from the original publications is retained; detailed results, samples, and doses are not verified in this work. Participant overlap remains unresolved, so they remain in a conservative single cluster, F04. The DOI/PMID for S17 are empty values, and the two papers were not added as independent replications. S04 S17	Because detailed original results and the overlap relationship have not been acquired, actual replication or recurrence results cannot be verified.	Full texts of both original reports, populations/recruitment, study IDs, participant overlap, and original results tables	Compare recruitment periods, institutions, participants, and designs in the two original reports to verify whether they belong to the same family, and update only the scope for which results have actually been acquired.
25	Partly verified	Full text not readStored summary read	N25 · Cystine recurrence and passageHow are the cystine course and spontaneous passage in S05 distinguished?Supplementary; required for interpreting unfavorable results and scope	The translated abstract of S05 reports that, among 17 people with cystine stones receiving 5 g/day, recurrence remained unchanged in 5 people and another strategy was needed. The 2 people with spontaneous passage are not a recurrence numerator. Children are also indexed, and the adult-only denominator, duration, and matched comparator are unverified. This shows that human event data exist, but it is not a direct calcium-oxalate comparison. S05	The unfavorable event description is retained, but composition, age, comparator, and event definition differ from the target question or are unverified.	S05 German full text, composition, ages, event definitions, exposure/time, comparators, and complete participant flow	For cystine data, separately verify composition, age, recurrence versus passage, concomitant interventions/exposure, and follow-up in the original report, and analyze them separately from calcium-oxalate studies.
26	Partly verified	Full text not readStored summary read	N26 · Favorable small reportTo what extent has the favorable report of 4 people in S06 been verified?Supplementary; required for retaining positive evidence	S06 retains a description from an indexed abstract excerpt that ascorbic acid monotherapy was favorable in 4 young patients with cystinuria. Exact ages, doses, event denominators, comparators, and follow-up in the original full text are unverified. The existence of a favorable result is not erased, and it is not promoted to recurrence efficacy for this question. S06	A favorable small-scale description exists, but eligibility regarding composition, age, events, exposure, and comparison is not verified.	S06 full text, exact ages, exposure/product, events, denominators, comparison, follow-up, and concomitant interventions	Verify the identity, ages, composition, exposure, events/time, and comparator in the original small report, then attribute the result only to the scope of the corresponding question.
27	Partly verified	Full text not readStored summary read	N27 · Urinary cystine and publication timingHave the favorable urinary result in S07 and the original report date been distinguished?Supplementary; required for interpreting indirect evidence and identity	The original publisher abstract for S07 records 31 people with cystinuria, 5 g/day, and favorable urinary cystine results. Controlled longitudinal recurrence is not verified. The later digitization date does not indicate a new study in 2010; the original report dates to 1982. S07	The favorable urinary description and original publication identity are retained, but this is not a clinical recurrence comparison for the target composition.	Original 1982 S07 report, clinical events/follow-up, composition, exposure, and publication/digital identity	Compare the original publication identity with the actual patient data, and verify cystine urinary measures and clinical recurrence as separate outcomes and follow-up.
28	Partly verified	Full text not readStored summary read	N28 · First occurrence and observational associationHow does the first-stone cohort result in S08 differ from the recurrence question?Supplementary; required for interpreting observational and indirect results	S08 is an observational analysis reporting 6,245 first stones among 156,735 women and 40,536 men, with median follow-up of 11.3–11.7 years. For supplemental vitamin C ≥ 1,000 mg/day versus no supplementation in men, the adjusted HR was 1.19 (95% CI 1.01–1.40), with a trend P = 0.001; the abstract did not report an association in women. Distinguish dietary C, supplements, and sex, and do not use the first-occurrence association as a causal effect on recurrence in people with prior calcium-oxalate stones. S08	The first-occurrence association and reported values from the large cohorts are retained, but the population, event, and design differ from a direct recurrence comparison.	Original S08 population/history, sex, exposure, covariates, events/time, HR/CI, and records of cohort reuse	Verify exclusions based on stone history, exposure/formulation, covariates, events/follow-up by sex, and reuse of the original cohorts; study the causal recurrence question through a separate comparison in a population with prior stones.
29	Partly verified	Full text not readStored summary read	N29 · Acute dissolution and concomitant-treatment case reportTo which interventions and event is the acute dissolution course in S09 attributable?Supplementary; required for attributing case-report findings	S09 describes the acute dissolution course in 1 older man, with antibiotics, stenting, and ascorbic acid used concurrently and different exposure after discharge. Stone composition was inferred, and these are not controlled recurrence data. The retained title is a descriptive label, not a transcription of the exact original title. S09	The case's course and limitations are retained, but it is not a comparison that isolates the recurrence effect of a single ingredient.	Original S09 case report, exact title/bibliographic information, stone composition, concurrent/subsequent exposure, and acute/recurrence follow-up	Separately verify the exposure timeline, concomitant interventions, composition confirmation, and acute dissolution versus long-term recurrence in the original case report, and assess the isolated contribution through an appropriate separate comparison.
30	Partly verified	Full text not readStored summary read	N30 · Partial page and other treatmentsHave the page actually verified in S10 and recurrence under other treatments been distinguished?Supplementary; required for partial-reading status and attribution	S10 discusses several treatments for cystinuria; the original abstract and a single page, p.1563, were historically verified. This is not recorded as reading the entire article's full text. A controlled recurrence result for vitamin C alone was not verified, and results from other treatments or cited articles are not transferred to C-alone results. S10	The role of the partial original page is linked, but this is not verification of the target recurrence result for the single ingredient alone.	Original S10 full text, populations/compositions by treatment, exposure, comparison/recurrence, and cited original reports	Compare original exposures, denominators, and recurrence by treatment and the cited families, and clearly record the page/full-text scope actually verified.
31	Partly verified	Full text not readStored summary read	N31 · Review and search timingWhat evidence map and time frame does the S11 review provide?Supplementary; required for interpreting the review and timing	S11 is an online review dated 2026-07-31, preceding the evidence cutoff date of 2026-09-16. Its abstract/reference list was used as an evidence map of urinary-risk studies; it is not a new recurrence trial. A review with an earlier search end date does not establish that the current search is exhaustive, nor does it provide replication independent in funding. S11	The review's mapping and timing roles are retained, but these are neither direct recurrence results nor current exhaustive acquisition.	S11 review full text, search end date/scope, original reference list, inclusion/exclusion, and funding	Compare the review's search end date and inclusion scope with the identities of the original reports, and update the observations in the corresponding row only when a new direct comparison has actually been acquired.
32	Unverified	Full text not readStored summary read	N32 · Registration shell and mirror identityHave the registration leads in S15 and S16 been distinguished from the content actually verified?Supplementary; required for registration identity	For S15 NCT06989320, only the official registration shell was historically accessed; substantive fields, registration timing, and results are unverified. S16 Carbon-13 Ascorbic Acid oral loading is a discovery lead from a 3rd-party mirror, and the official ID/version is unverified. They are not linked as the same trial, and lack of access is not turned into a completed negative search or absence of recurrence trials. S15 S16	The substantive original registrations/protocols/results and the identities of the two leads could not be verified.	Complete official S15 registration/amendment history, original official S16 ID/version, protocols, and results	Verify each lead's official identity, original version, population/exposure, recurrence endpoint, and result availability, and link them only after actually checking whether they are the same study.
33	Partly verified	Full text not readStored summary read	N33 · Contrary results and differences between recordsAre favorable/unfavorable results and bibliographic differences being mistaken for conflicts about the same effect?Supplementary; required for interpreting contrary evidence and conflicts	Favorable cystine urinary results and small-scale clinical courses are retained alongside unchanged recurrence, hyperoxaluria, and first-occurrence associations. Different compositions, endpoints, and designs are not turned into statistical conflicts about the same recurrence effect. For S01, a historical bibliographic difference is recorded in which the original PDF's 2017 publication identity took precedence, but the exact value on the other page and whether a correction occurred are currently unverified. S01 S05 S06 S07 S08	Indirect evidence in the contrary direction and bibliographic differences are retained, but a conflict concerning the same directly eligible effect is not verified.	Actual contrasts, events/compositions, durations, bibliographic versions, and contrary/corrected material for each original report	Compare original populations, ingredients, contrasts, time points, and outcomes/versions to establish whether a conflict concerns the same question/analysis, and verify bibliographic corrections against original evidence.
34	Unverified	Full text not readStored summary read	N34 · Funding, provision, and independenceHave funding, product provision, roles, and conflicts of interest for the direct evidence been verified?Required	Because there is no directly eligible recurrence evidence, the current independence axis is an empty value. Funding records in each evidence entry and historical access to the declaration section of S01 are retained. The package's I1 is a trace of a delivery default and is not used as verification of actual mixed funding or as a new independence score. S01 S02 S05 S08	Funding/provision and roles for directly eligible evidence could not be verified, and the package designation alone cannot support an assessment.	Funding/conflicts of interest, internal support, product provision, and design/analysis/publication roles in original eligible reports	Verify funding, product provision, and actual design/analysis/publication roles for the original eligible comparison, and separately disclose unverified items and the independence of linked families.
35	Partly verified	Full text not readStored summary read	N35 · Hyperoxaluria and exposure changesHave safety events in S01 been distinguished from comparative risk?Supplementary; required for interpreting harm signals	S01 records hyperoxaluria-related exposure changes in 2 of 24 people (1 discontinuation and 1 dose reduction). This is a retained safety signal, not a recurrence numerator from the same report or a risk estimate by comparator. Event definitions, risk by exposure time, and complete collection of other adverse events are unverified. S01	Exposure changes are present in the verifiable extraction, but direct comparative risk and comprehensive harm surveillance are not verified.	S01 event definitions, exposure time, original flow of 2 people/24 people, comparator, dose reduction/discontinuation, and safety follow-up	Collect hyperoxaluria/clinical harms and discontinuations/dose reductions by group under the same formulation, exposure-time, and testing criteria, and disclose events together with exposed participant counts and time.
36	Partly verified	Full text not readStored summary read	N36 · High-dose gastritis and ageWhich population, dose, and duration does the report of gastritis-related discontinuation in S05 concern?Supplementary; required for retaining unfavorable harm findings	The translated abstract of S05 records 3 gastritis-related treatment discontinuations among 17 people with cystine stones receiving 5 g/day. Pediatric indexing is included, and the adult-only denominator, duration, and comparator are unverified. This is not used as a comparative risk rate in the target adult calcium-oxalate population. S05	The unfavorable discontinuation report is retained, but directness regarding population, time, and comparator is not verified.	S05 gastritis definition, flow of 3 people/17 people, adults/children, 5 g/day, duration, and other treatments/risks	Verify original ages, definitions of gastritis/discontinuation, exposure time, concurrent treatments, and events/denominators; study harms for the target formulation/population through separate comparative surveillance.
37	Partly verified	Full text not readStored summary read	N37 · Intravenous label and limits of applicabilityHave the warnings in the official injection label S12 been separated from oral evidence?Supplementary; required for interpreting harms by route	The S12 ASCOR injection label records warnings concerning intravenous oxalate nephropathy/stones, impaired renal function, dialysis, and prior oxalate stones. G6PD-related hemolysis belongs to the high-dose/intravenous context. This is a buffered intravenous preparation for short-term treatment of scurvy, distinct from a pure oral supplement, so intravenous event rates or safety are not transferred to oral use. S12	The routes and populations of the historical official warnings are retained, but they do not constitute a quantitative comparison of the target oral risk.	Route/formulation, warnings, and at-risk populations in the original ASCOR label, and actual comparative data on oral harms	Verify route, formulation, at-risk populations, and event definitions in the official label, and study renal/hemolytic harms of the target oral exposure through separate exposure-specific comparisons and surveillance.
38	Partly verified	Full text not readStored summary read	N38 · General upper limit, gastrointestinal effects, and ironHave the general upper limit and harms in S13 been distinguished from an assurance of safety for stone patients?Supplementary; required for interpreting upper limits and general harms	S13 records diarrhea, nausea, and abdominal pain from the NIH consumer document, together with the context of high-dose iron overload in hemochromatosis. The adult upper limit of 2,000 mg/day is a general limit for the total from all sources, not an assurance of safety for stone patients. The consumer document was historically read; this is distinguished from the failed access to the health-professional page. S13	General official information is retained, but it does not verify comparative safety or a prescription for the target patients/exposure.	Upper limit/population and gastrointestinal/iron warnings in the NIH consumer material, and actual exposure-specific safety data in the target patients	Separately verify total dietary/supplemental exposure, stone history, and iron metabolism/symptoms, and assess patient-specific safety questions through actual exposure- and population-specific comparisons/surveillance.
39	Partly verified	Full text not readStored summary read	N39 · Guideline caution and quantitative resultsWhat outcome does the guidance to avoid excessive intake in S14 verify?Supplementary; required for interpreting guidelines	The S14 EAU section advises calcium-oxalate stone formers to avoid excessive vitamin C and explains that stone risk is controversial. This provides context for caution; it does not provide a randomized quantitative recurrence effect or a safety threshold dose for a pure single-ingredient oral preparation. S14	Guideline caution is linked, but it is neither a quantitative comparison of the target recurrence/harms nor a safe prescription.	Original EAU section, population, evidence/warnings, and actual comparative recurrence/harm data for the target oral formulation	Compare the original evidence cited by the guideline, formulation/population, and dose context, and assess quantitative recurrence/harm questions using actual comparative data.
40	Unverified	Full text not readStored summary read	N40 · Special populations and long-term gapsHave gaps concerning renal risk, special populations, and long-term exposure been retained?Supplementary; required for limits on safety applicability	The current safety designation is Caution. Uncertainties concerning impaired renal function, dialysis, oxalate nephropathy, high-dose/intravenous G6PD, iron overload, pregnancy, lactation, children, and long-term high-dose exposure are retained separately. Historical reports of 500–2,000 mg/day or 5 g/day are not used as safe prescriptions for the target patients. S01 S05 S12 S13 S14	The current scope contains no data that verify comparative harms of the target oral preparation in special populations or over the long term.	Formulation- and route-specific data on renal risks, dialysis, prior oxalate stones/G6PD, iron, pregnancy/lactation, children, and long-term harms	Prespecify special populations, independently monitor total exposure/duration, renal function/hemolysis/iron, and gastrointestinal/stone events, and disclose adequate follow-up and denominators.
41	Met	Full text not readStored summary read	N41 · Preservation of the original assessment and calculationsHave the current assessment and package/calculator designations been distinguished with their original values preserved?Required for preservation and traceability; not a condition establishing efficacy	The current grade ?, empty score, and safety Caution are maintained. Eligible effect, SE, CI, P, and n remain empty values, and no calculation is performed in this work. Distinguish the unassigned current axes from the package's I1/EX/CX and the raw C resulting from the calculator's format error. Completion of a technical transformation is not independent clinical/methodological certification.	The boundaries between the original assessment, historical designations, current unverified information, and absence of new calculations are preserved. This does not mean that recurrence efficacy has been established.	Original records of current grade/score, axes, primary_result, historical package/calculations, and editorial decisions	If new direct evidence is actually acquired, handle any update to the original assessment under separate authorization, versioning, and evidence review; this transformation table only links the original content and change events.

No items match your search or filter.

41 itemsWhat the statuses mean

Assessment scope

Stored-material review date: 2026-10-05
Original evidence cut-off: 2026-09-16
Scope actually checked: Stored Korean and English manuscripts and case-specific criteria and application records. Full papers, supplements, registrations, plans and original data were not read.
What the dates mean: This is the date the stored materials were checked, not the date of an up-to-date clinical literature search.
Population: Adults with a confirmed history of calcium-oxalate stones
Ingredient, formulation and route: Single-ingredient pure ascorbic acid; salts, foods and combination products excluded · Oral
Dose: Unverified: no directly eligible recurrence comparison verified
Comparator: No added vitamin C, placebo or matched usual care (question boundary; actual eligible groups unverified)
Measured outcome: Symptomatic new calcium-oxalate stone recurrence; residual-stone growth and urinary markers excluded
Duration: Treatment duration and principal follow-up time unverified; no fixed duration invented
Questions outside this scope: S01 mixed-stone composite of new stones/residual-stone growth and urinary pH; S02/S03 short-term urinary oxalate and Tiselius index; S04/S17 metabolic reports and unresolved overlap; S05–S07/S10 cystine stones, metabolic markers/other treatments; S08 observational association with first incident stones in the general population; S09 acute stone dissolution during combined treatment; S12 IV harms in the injection prescribing information; S15/S16 registration leads with unverified content

Evidence and sources

The links below lead to the sources. A link alone does not mean the original source was read or its latest publication status verified.

S01 · Noureldin et al. Is it safe to prescribe ascorbic acid for urinary acidification in stone-forming patients with alkaline urine? Turk J Urol 2017;43:183–188.

Source

Material type: Retrospective exposure-group report involving mixed stones and alkaline urine
Materials actually read: Summary read: the corresponding bibliography, extraction, limitations, and historical access in the currently stored manuscript were read. The external original material was not read in this work.
Findings recorded in the stored summary: There were 43 people identified and 24 included, with a mean age of 60.6 years (95% CI 52.7–68.5); 11/24 were women. The median dose was 1,000 mg/day (range 500–2,000), median follow-up was 22.6 months (range 19.7–32.1), and 8/24 people experienced the composite event of growth/progression of existing stones or new stones. Among the 17 with baseline composition verified, 2 had calcium-oxalate stones; a 0 in the calcium-oxalate cell among the 3 with follow-up composition does not mean 0 recurrences among the 24 people. Urinary pH was the main outcome, and hyperoxaluria led to 1 discontinuation and 1 dose reduction.
Record level: Noncomparative composite events and safety context in mixed stones; not the target direct comparison; within the scope of the retained 2026-09-16 record, not direct verification of original clinical material in this work
Study overlap and independent replication: None

Public availability, access and reading status by material
Material	Public availability	Access status	Actually read	Notes
Full-text article Open material ↗	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.
Study protocol and raw analysis data Material URL unverified	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.

S02 · Traxer et al. Effect of ascorbic acid consumption on urinary stone risk factors. J Urol 2003;170:397–401.

Source

Material type: Randomized placebo-controlled crossover metabolic trial
Materials actually read: Summary read: the corresponding bibliography, extraction, limitations, and historical access in the currently stored manuscript were read. The external original material was not read in this work.
Findings recorded in the stored summary: In 12 calcium-oxalate stone formers and 12 nonformers, 1 g twice daily was compared with a matching placebo during two 6-day periods. Urinary oxalate in stone formers during the final 2 days of each period was 41.0 mg versus 30.5 mg, P < 0.001. The authors' description of a 33% increase is preserved as originally reported, with no recalculation in this work. Crossover sequence/washout, paired variance, and recurrence results are unverified.
Record level: Short-term urinary oxalate comparison; not symptomatic recurrence; within the scope of the retained 2026-09-16 record, not direct verification of original clinical material in this work
Study overlap and independent replication: None

Public availability, access and reading status by material
Material	Public availability	Access status	Actually read	Notes
Article abstract and bibliographic information Open material ↗	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.
Full-text article Material URL unverified	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.

S03 · Baxmann et al. Effect of vitamin C supplements on urinary oxalate and pH in calcium stone-forming patients. Kidney Int 2003;63:1066–1071.

Source

Material type: 3-day before–after metabolic study
Materials actually read: Summary read: the corresponding bibliography, extraction, limitations, and historical access in the currently stored manuscript were read. The external original material was not read in this work.
Findings recorded in the stored summary: Among 47 adult calcium stone formers, 23 received 1 g/day and 24 received 2 g/day for 3 days; 20 healthy participants received 1 g/day. These are before–after data on urinary oxalate, pH, and the Tiselius index, and the healthy participants are not recurrence comparators for patients with prior stones. The stone-former population has not been verified as consisting entirely of calcium-oxalate stones, and clinical recurrence remains unverified.
Record level: Before–after urinary measures in calcium stone formers/healthy participants; composition and directness for recurrence unverified; within the scope of the retained 2026-09-16 record, not direct verification of original clinical material in this work
Study overlap and independent replication: None

Public availability, access and reading status by material
Material	Public availability	Access status	Actually read	Notes
Article abstract and bibliographic information Open material ↗	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.
Full-text article Material URL unverified	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.

S04 · Massey et al. Ascorbate increases human oxaluria and kidney stone risk. J Nutr 2005;135:1673–1677.

Source

Material type: Index and bibliographic information for an original metabolic study
Materials actually read: Summary read: the corresponding bibliography, extraction, limitations, and historical access in the currently stored manuscript were read. The external original material was not read in this work.
Findings recorded in the stored summary: Title and bibliographic leads are retained, but detailed N, dose, recurrence, and funding were not verified. Possible participant overlap with S17 Chai 2004 remains unresolved; they are kept in a conservative single F04 cluster and are not counted as independent replication.
Record level: F04 cluster with only metadata acquired; overlap with S17 unresolved; within the scope of the retained 2026-09-16 record, not direct verification of original clinical material in this work
Study overlap and independent replication: None

Public availability, access and reading status by material
Material	Public availability	Access status	Actually read	Notes
Article index and bibliographic information Open material ↗	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.
Full-text article Material URL unverified	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.

S05 · Brundig et al. [Possibilities and limits in the treatment of cystine calculus diathesis with high-dose ascorbic acid. Results of a combined study with 17 patients]. Z Urol Nephrol 1986;79:137–146.

Source

Material type: Translated abstract on high-dose treatment for cystine stones
Materials actually read: Summary read: the corresponding bibliography, extraction, limitations, and historical access in the currently stored manuscript were read. The external original material was not read in this work.
Findings recorded in the stored summary: The report concerns 17 people with cystine stones receiving 5 g/day; recurrence remained unchanged in 5 people, requiring another strategy. The 2 people with spontaneous passage are not a recurrence numerator. The 3 gastritis-related discontinuations are retained, along with pediatric indexing and unverified adult-only denominator, duration, and matched comparator information.
Record level: Recurrence/discontinuation context limited by different composition, age/duration, and comparison; within the scope of the retained 2026-09-16 record, not direct verification of original clinical material in this work
Study overlap and independent replication: None

Public availability, access and reading status by material
Material	Public availability	Access status	Actually read	Notes
Translated article abstract and bibliographic information Open material ↗	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.
Full-text article Material URL unverified	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.

S06 · Lux and May. Long-term observation of young cystinuric patients under ascorbic acid therapy. Urol Int 1983;38:91–94.

Source

Material type: Favorable indexed abstract on a small cystine series
Materials actually read: Summary read: the corresponding bibliography, extraction, limitations, and historical access in the currently stored manuscript were read. The external original material was not read in this work.
Findings recorded in the stored summary: A retained excerpt describes favorable ascorbic acid monotherapy in 4 young patients with cystinuria. Exact ages, doses, events/denominators, comparators, follow-up, and the original full text remain unverified.
Record level: Favorable course in 4 young patients; target eligibility unverified; within the scope of the retained 2026-09-16 record, not direct verification of original clinical material in this work
Study overlap and independent replication: None

Public availability, access and reading status by material
Material	Public availability	Access status	Actually read	Notes
Indexed article abstract excerpt Open material ↗	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.
Full-text article Material URL unverified	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.

S07 · Asper and Schmucki. Cystinurietherapie mit Ascorbinsäure. Urol Int 1982;37:91–109.

Source

Material type: Publisher abstract on urinary cystine outcomes
Materials actually read: Summary read: the corresponding bibliography, extraction, limitations, and historical access in the currently stored manuscript were read. The external original material was not read in this work.
Findings recorded in the stored summary: Favorable urinary cystine results are reported in 31 people with cystinuria receiving 5 g/day. Controlled longitudinal recurrence was not verified, and the digitization date is not counted as a new study in 2010.
Record level: Favorable urinary measures and original 1982 publication identity; not clinical recurrence; within the scope of the retained 2026-09-16 record, not direct verification of original clinical material in this work
Study overlap and independent replication: None

Public availability, access and reading status by material
Material	Public availability	Access status	Actually read	Notes
Publisher article abstract Open material ↗	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.
Full-text article Material URL unverified	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.

S08 · Ferraro et al. Total, Dietary, and Supplemental Vitamin C Intake and Risk of Incident Kidney Stones. Am J Kidney Dis 2016;67:400–407.

Source

Material type: Prospective cohort analysis of first-stone occurrence
Materials actually read: Summary read: the corresponding bibliography, extraction, limitations, and historical access in the currently stored manuscript were read. The external original material was not read in this work.
Findings recorded in the stored summary: There were 156,735 women, 40,536 men, 6,245 first stones, and median follow-up of 11.3–11.7 years. In men, supplementation ≥ 1,000 mg/day versus no supplementation had an adjusted HR of 1.19 (95% CI 1.01–1.40), with a trend P = 0.001; the abstract did not report an association in women. Dietary C and supplemental exposure are separated, and cohort reuse and the distinction between first occurrence and recurrence are retained.
Record level: Observational association with first occurrence in the general population, by sex/supplemental exposure; not recurrence causation; within the scope of the retained 2026-09-16 record, not direct verification of original clinical material in this work
Study overlap and independent replication: None

Public availability, access and reading status by material
Material	Public availability	Access status	Actually read	Notes
Article abstract and figure captions Open material ↗	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.
Full-text article Material URL unverified	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.

S09 · Yoshikawa et al. [Descriptive label: ascorbic acid during treatment of infected obstructing stones]. Urol Case Rep, online 2024.

Source

Material type: Index and partial course of an acute dissolution case
Materials actually read: Summary read: the corresponding bibliography, extraction, limitations, and historical access in the currently stored manuscript were read. The external original material was not read in this work.
Findings recorded in the stored summary: Acute dissolution in 1 older man involved concurrent exposure to antibiotics, stenting, and ascorbic acid, with different exposure after discharge. Composition was inferred, and these are not quantitative recurrence-efficacy data. The title is a descriptive label rather than a transcription of the exact original title.
Record level: Concomitant antibiotics/stenting, inferred composition, and a single person; not recurrence prevention; within the scope of the retained 2026-09-16 record, not direct verification of original clinical material in this work
Study overlap and independent replication: None

Public availability, access and reading status by material
Material	Public availability	Access status	Actually read	Notes
Case-report index and partial clinical course Open material ↗	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.
Full-text article Material URL unverified	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.

S10 · Mori et al. Clinical study on cystinuria. Jpn J Urol 1986;77:1559–1565.

Source

Material type: Original abstract and partial page on cystine treatment
Materials actually read: Summary read: the corresponding bibliography, extraction, limitations, and historical access in the currently stored manuscript were read. The external original material was not read in this work.
Findings recorded in the stored summary: A discussion of several treatments for cystinuria and the original abstract/partial page p.1563 are historically retained. A controlled recurrence comparison of vitamin C alone is unverified, and other treatments or cited articles are not counted as new C recurrence data.
Record level: Discussion of several treatments and partial verification of p.1563; C-alone recurrence comparison unverified; within the scope of the retained 2026-09-16 record, not direct verification of original clinical material in this work
Study overlap and independent replication: None

Public availability, access and reading status by material
Material	Public availability	Access status	Actually read	Notes
Article abstract and partial page Open material ↗	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.
Full-text article Material URL unverified	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.

S11 · Farkouh et al. The Effect of Vitamin C Supplements on Urinary Stone Risk. Online July 31, 2026.

Source

Material type: Urinary-risk review abstract and citation map
Materials actually read: Summary read: the corresponding bibliography, extraction, limitations, and historical access in the currently stored manuscript were read. The external original material was not read in this work.
Findings recorded in the stored summary: This is an evidence map from a review used to locate intervention studies on urinary risk. The online date, 2026-07-31, precedes the cutoff date, but the search ended earlier and does not establish current exhaustive acquisition of studies. It is not counted as a new comparative trial, unique participants, or replication independent in funding.
Record level: Mapping role of the 2026-07-31 review; not a new recurrence trial; within the scope of the retained 2026-09-16 record, not direct verification of original clinical material in this work
Study overlap and independent replication: None

Public availability, access and reading status by material
Material	Public availability	Access status	Actually read	Notes
Review article abstract and reference list Open material ↗	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.
Full-text article Material URL unverified	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.

S12 · DailyMed. ASCOR (ascorbic acid injection), label revised July 2022.

Source

Material type: Official ASCOR intravenous injection label
Materials actually read: Summary read: the corresponding bibliography, extraction, limitations, and historical access in the currently stored manuscript were read. The external original material was not read in this work.
Findings recorded in the stored summary: The intravenous label contains risk contexts concerning oxalate nephropathy/stones, impaired renal function, dialysis, and prior oxalate stones, and a warning about high-dose/parenteral G6PD-related hemolysis. The buffered injectable preparation for short-term scurvy treatment differs from a pure oral preparation, and event rates or individual safety are not transferred to oral use.
Record level: Intravenous/high-dose warnings and a different formulation/indication; not oral risk rates; within the scope of the retained 2026-09-16 record, not direct verification of original clinical material in this work
Study overlap and independent replication: None

Public availability, access and reading status by material
Material	Public availability	Access status	Actually read	Notes
Full official web document Open material ↗	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.

S13 · NIH Office of Dietary Supplements. Vitamin C: Fact Sheet for Consumers.

Source

Material type: Official NIH consumer web document
Materials actually read: Summary read: the corresponding bibliography, extraction, limitations, and historical access in the currently stored manuscript were read. The external original material was not read in this work.
Findings recorded in the stored summary: This records diarrhea, nausea, and abdominal pain with excessive intake, the adult upper limit of 2,000 mg/day from all sources combined, and iron overload in hemochromatosis. The upper limit is not an assurance of safety for stone patients. Historical reading of the consumer document is distinguished from failed access to the health-professional page.
Record level: General upper limit and gastrointestinal/iron context; not an assurance of safety for stone patients; within the scope of the retained 2026-09-16 record, not direct verification of original clinical material in this work
Study overlap and independent replication: None

Public availability, access and reading status by material
Material	Public availability	Access status	Actually read	Notes
Full official web document Open material ↗	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.

S14 · European Association of Urology. Urolithiasis: Metabolic Evaluation and Recurrence Prevention, accessed 2026-09-16.

Source

Material type: Official EAU guideline web document
Materials actually read: Summary read: the corresponding bibliography, extraction, limitations, and historical access in the currently stored manuscript were read. The external original material was not read in this work.
Findings recorded in the stored summary: This advises calcium-oxalate stone formers to avoid excessive vitamin C and explains that its role in risk is controversial. It does not verify a quantitative randomized recurrence effect, risk rate, or safety threshold dose for a pure single-ingredient oral preparation.
Record level: Context of avoiding excessive intake and controversy; not a quantitative recurrence comparison; within the scope of the retained 2026-09-16 record, not direct verification of original clinical material in this work
Study overlap and independent replication: None

Public availability, access and reading status by material
Material	Public availability	Access status	Actually read	Notes
Full official web document Open material ↗	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.

S15 · ClinicalTrials.gov NCT06989320 registry lead.

Source

Material type: Official trial-registration shell lead
Materials actually read: Summary read: the corresponding bibliography, extraction, limitations, and historical access in the currently stored manuscript were read. The external original material was not read in this work.
Findings recorded in the stored summary: Only the official registration shell was historically accessed; substantive fields, registration timing, and results for the endogenous-oxalate research lead are unverified. The existence of a URL/number is not presented as an eligible completed recurrence trial.
Record level: NCT06989320 identity lead; substantive registration/results unverified; within the scope of the retained 2026-09-16 record, not direct verification of original clinical material in this work
Study overlap and independent replication: None

Public availability, access and reading status by material
Material	Public availability	Access status	Actually read	Notes
Full official trial-registration web document Open material ↗	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.
Official registration amendment history, protocol, and results documents Material URL unverified	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.

S16 · Registry mirror lead: Carbon-13 Ascorbic Acid oral load.

Source

Material type: 3rd-party registration mirror lead
Materials actually read: Summary read: the corresponding bibliography, extraction, limitations, and historical access in the currently stored manuscript were read. The external original material was not read in this work.
Findings recorded in the stored summary: This is a 3rd-party mirror lead for Carbon-13 Ascorbic Acid oral loading. The linked metabolic lead was not adopted as a decisive result, and the official ID/version is unverified. It is not assumed to be the same trial as S15.
Record level: Discovery-level lead for Carbon-13 oral loading; official ID/version unverified; within the scope of the retained 2026-09-16 record, not direct verification of original clinical material in this work
Study overlap and independent replication: None

Public availability, access and reading status by material
Material	Public availability	Access status	Actually read	Notes
Full 3rd-party registration mirror web document Open material ↗	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.
Full official trial-registration web document Material URL unverified	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.

S17 · Chai et al. Oxalate absorption and endogenous oxalate synthesis from ascorbate in calcium oxalate stone formers and non-stone formers. Am J Kidney Dis 2004;44:1060–1069.

Source

Material type: Index and bibliographic information for an original metabolic study
Materials actually read: Summary read: the corresponding bibliography, extraction, limitations, and historical access in the currently stored manuscript were read. The external original material was not read in this work.
Findings recorded in the stored summary: The original publisher's title/bibliographic information is retained, but the DOI/PMID and detailed results are unverified, with empty values and an empty extraction preserved. Participant overlap with Massey 2005 remains unresolved, and this is not added as independent replication or new recurrence participants.
Record level: F04 cluster with detailed results not acquired and overlap with S04 unresolved; within the scope of the retained 2026-09-16 record, not direct verification of original clinical material in this work
Study overlap and independent replication: None

Public availability, access and reading status by material
Material	Public availability	Access status	Actually read	Notes
Article index and bibliographic information Open material ↗	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.
Full-text article Material URL unverified	Currently unverified (no external lookup)	Access not attempted	Not read	Distinguish reading the currently stored summary and historical access from not reading the actual original material of the specified type in this work.

Report counts versus independent study counts

These are report links from the stored manuscript. F01 (S01): {"study_id": "F01", "Linked source list": ["S01"], "design": "retrospective uncontrolled recurrence-related series", "selection": "excluded: comparator/composition/endpoint mismatch", "overlap_audit": "One original article across publisher/PMC/PubMed; not three studies.", "eligible_recurrence_participants_counted": 0, "trial_count_for_grade": 0} · Retained families and eligibility/exclusion/overlap scope; not a new sum of independent trials or unique participants / F02 (S02): {"study_id": "F02", "Linked source list": ["S02"], "design": "randomized placebo crossover, metabolic endpoints", "selection": "excluded: no recurrence result", "overlap_audit": "Preminger PMID 12853785 is commentary, not another trial.", "eligible_recurrence_participants_counted": 0, "trial_count_for_grade": 0} · Retained families and eligibility/exclusion/overlap scope; not a new sum of independent trials or unique participants / F03 (S03): {"study_id": "F03", "Linked source list": ["S03"], "design": "three-day before/after metabolic study", "selection": "excluded: surrogate and no matching event comparator", "overlap_audit": "No reuse of its 47 patients as a recurrence trial.", "eligible_recurrence_participants_counted": 0, "trial_count_for_grade": 0} · Retained families and eligibility/exclusion/overlap scope; not a new sum of independent trials or unique participants / F04 (S04, S17): {"study_id": "F04", "Linked source list": ["S04", "S17"], "design": "metabolic-study publication cluster, details partly inaccessible", "selection": "not decisive; no verified recurrence result", "overlap_audit": "Possible Chai/Massey participant overlap unresolved; conservative single cluster, not assumed proven identity.", "eligible_recurrence_participants_counted": 0, "trial_count_for_grade": 0} · Retained families and eligibility/exclusion/overlap scope; not a new sum of independent trials or unique participants / F05 (S05): {"study_id": "F05", "Linked source list": ["S05"], "design": "cystine stone treatment series", "selection": "excluded: composition, age, comparator and endpoint-definition limitations", "overlap_audit": "No linkage to other cystinuria series established; not pooled.", "eligible_recurrence_participants_counted": 0, "trial_count_for_grade": 0} · Retained families and eligibility/exclusion/overlap scope; not a new sum of independent trials or unique participants / F06 (S06): {"study_id": "F06", "Linked source list": ["S06"], "design": "small favorable cystinuria series", "selection": "excluded; detailed eligibility inaccessible", "overlap_audit": "No independence or participant overlap asserted.", "eligible_recurrence_participants_counted": 0, "trial_count_for_grade": 0} · Retained families and eligibility/exclusion/overlap scope; not a new sum of independent trials or unique participants / F07 (S07): {"study_id": "F07", "Linked source list": ["S07"], "design": "cystinuria metabolic report", "selection": "excluded: urinary endpoint and wrong composition", "overlap_audit": "Earlier descriptions cited elsewhere are not counted as replication.", "eligible_recurrence_participants_counted": 0, "trial_count_for_grade": 0} · Retained families and eligibility/exclusion/overlap scope; not a new sum of independent trials or unique participants / F08 (S08): {"study_id": "F08", "Linked source list": ["S08"], "design": "three prospective incident-stone cohorts", "selection": "excluded: incidence, not verified prior-stone recurrence; observational association only", "overlap_audit": "NHS I, NHS II, HPFS; earlier publications may reuse cohorts. Never add populations across reports.", "eligible_recurrence_participants_counted": 0, "trial_count_for_grade": 0} · Retained families and eligibility/exclusion/overlap scope; not a new sum of independent trials or unique participants / F09 (S09): {"study_id": "F09", "Linked source list": ["S09"], "design": "acute dissolution case report", "selection": "excluded: dissolution, cointerventions, composition uncertainty", "overlap_audit": "One person, not longitudinal comparative recurrence prevention.", "eligible_recurrence_participants_counted": 0, "trial_count_for_grade": 0} · Retained families and eligibility/exclusion/overlap scope; not a new sum of independent trials or unique participants / F10 (S10): {"study_id": "F10", "Linked source list": ["S10"], "design": "cystinuria series/reviewed treatments", "selection": "excluded: vitamin-C-specific comparator not verified", "overlap_audit": "Cited vitamin-C papers mapped to their own families, not new data.", "eligible_recurrence_participants_counted": 0, "trial_count_for_grade": 0} · Retained families and eligibility/exclusion/overlap scope; not a new sum of independent trials or unique participants. The total number of unique trials and the total number of participants are unverified. Verification of the stored summaries is distinguished from not reading the original materials in this work, and report/family labels are not summed as total trials or participants.

Review criteria

Version NGM-v3116-ORAL-C-SYMPTOMATIC-CAOX-RECURRENCE-1.0 · Criteria record date 2026-10-05. These are Chamgap's own application conditions, informed by the referenced methods. They do not constitute official assessment-tool certification or a new efficacy score.

N01 · Which adults, oral intervention and recurrent-stone event does this table address?

Required materials and conditions: The original /ko/effect and question specifications for population, ingredient, route, event, comparison and time
Conditions for verification: Link the single question of comparative change in symptomatic new stones in adults with a calcium-oxalate stone history receiving pure single-ingredient oral L-ascorbic acid to the excluded questions.
Requirement and applicability: Required
Application exceptions: The question definition alone does not establish a recurrence direction, dose or duration as a verified effect or prescription. The absence of a subclaims field is also preserved.
Why this condition is needed: Needed to avoid converting stone risk factors or first incident stones into symptomatic recurrence in patients with a history of stones.
Referenced methods: Principles for clarifying the question in M03 §3.1, §3.2.1–3.2.4; detailed separation rules are internally designed; M03 §3.2.1; detailed population criteria are internally designed; M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation for testing are internally designed; M03 §3.2.4, M15 §15.3.1–15.3.3; outcome adaptation for each question is internally designed; M03 §3.2.4; internally defined limits on extrapolation

N02 · What materials were actually read this time, and what are the historical access records?

Required materials and conditions: The retained summary's evidence cutoff, access records for each source, locations actually read in the current work and file SHA
Conditions for verification: Separate reading of the current local stored summary from not having read clinical original texts, registrations and official documents this time, material by material.
Requirement and applicability: Required
Application exceptions: Current external access not attempted is not labeled as access failure. Past failures stated in the manuscript are retained only as historical records.
Why this condition is needed: Needed to avoid presenting past full-text/abstract access on 2026-09-16 as full-text reading performed this time.
Referenced methods: Principles for data collection/selection in M04 §4.5–4.6; separation of access from reading and the hyperlink contract are internally designed; M04 §4.5, §4.6.3; limits on the current data transformation follow the user-defined scope and internal design

N03 · Have the 17 reports been kept from being double-counted as independent recurrence trials?

Required materials and conditions: A mapping of each report's source_id to study family, cohort, endpoint and repeat citations
Conditions for verification: Link the roles of the 10 retained families and S11–S16 documents without creating an unverified unique-participant total.
Requirement and applicability: Required
Application exceptions: Retain the possible S04/S17 overlap as a single conservative cluster, without confirming that they involve the same participants.
Why this condition is needed: Needed to avoid counting publisher, PubMed and PMC versions, reviews and related metabolic reports as separate trials.
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 harms material is internally designed

N04 · Has the question's pure oral L-ascorbic acid been distinguished from other forms?

Required materials and conditions: Product ingredient list, L isomer, salts, single/combined ingredients and actual administration route
Conditions for verification: Identify the question's formulation boundary and distinguish it from verification of actual study-product eligibility.
Requirement and applicability: Required
Application exceptions: Harms from injections may be retained as a separate context, but are not transferred as effects or incidence for the single-ingredient oral preparation.
Why this condition is needed: Needed to avoid importing foods, salts, combination products or injections as recurrence effects of the pure oral preparation.
Referenced methods: M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation for testing are internally designed; M03 §3.2.3, M08 §8.2.2–8.2.3; internal application; M19 §19.2.2–19.2.4, M03 §3.2.3; internal application

N05 · Have the product, source and single-ingredient status of a directly eligible recurrence study been verified?

Required materials and conditions: Product, batch, manufacturing source, purity, ingredient list and original methods for a direct recurrence comparison
Conditions for verification: Use original data to verify whether the actual product in the selected direct comparison matches the question's formulation.
Requirement and applicability: Required
Application exceptions: Preserve nominal ingredients in indirect reports unchanged, without using them to fill gaps in the eligible product.
Why this condition is needed: Because the name ascorbic acid alone cannot establish eligibility as a pure L single ingredient.
Referenced methods: M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation for testing are internally designed; M03 §3.2.3, M08 §8.2.2–8.2.3; internal application

N06 · Is this direct evidence about adults with a confirmed history of calcium-oxalate stones?

Required materials and conditions: Age, prior stone diagnosis/composition, recurrence history, baseline status and inclusion/exclusion table
Conditions for verification: Verify the actual population's age, prior stone composition and diagnosis, and whether it matches the question's population.
Requirement and applicability: Required
Application exceptions: The question's editorial boundary of adulthood at age 18 is not transferred as the actual minimum age in each study.
Why this condition is needed: Needed to avoid recasting general-population, cystine-stone or mixed-stone groups as adults with a calcium-oxalate stone history.
Referenced methods: M03 §3.2.1; detailed population criteria are internally designed; M19 §19.1.2–19.2.4; detailed distinctions are internally designed

N07 · How are S01's 43 identified, 24 included and 17 composition-verified participants distinguished?

Required materials and conditions: Patient selection flow, age, sex, stone-composition testing table and reasons for exclusion
Conditions for verification: Link S01's recruited, included, composition-verified and event groups separately within the original reporting scope.
Requirement and applicability: Required
Application exceptions: A calcium-oxalate cell of 0 in the follow-up composition table is not interpreted as 0 calcium-oxalate recurrences among all 24 participants.
Why this condition is needed: Needed to avoid using the total identified population, included group and composition-tested group as the same recurrence-analysis denominator.
Referenced methods: M03 §3.2.1; detailed population criteria are internally designed; M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; adaptations by design are internally designed; M19 §19.1.2–19.2.4; internal application

N08 · What outcome and follow-up period do the 8/24 events in S01 represent?

Required materials and conditions: Event tables by new-stone and residual-stone-growth component, symptom status, composition, and median or fixed follow-up information
Conditions for verification: Attribute 8/24, 33.3%, and the median follow-up of 22.6 months only to the original composite outcome.
Requirement and applicability: Required
Application exceptions: Preserve the fact that urinary pH was the original study's main endpoint and stone events were a secondary endpoint. Do not turn pH or oxalate P values into recurrence P values.
Why this condition is needed: This is needed to avoid presenting a mixed composite event as a symptomatic calcium-oxalate recurrence rate or a causal effect.
Referenced methods: M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; design-specific adaptations were internally designed; M03 §3.2.4; internally defined limits on extension; M19 §19.1.2–19.2.4; detailed distinctions were internally designed

N09 · Is the dose in S01 a regimen from a directly eligible trial?

Required materials and conditions: Nominal daily dose, product, dose per administration/frequency, meal timing, actual intake, and administration records
Conditions for verification: Distinguish the verified nominal dose in S01 from the unverified product, frequency, and duration of intake.
Requirement and applicability: Required
Application exceptions: Do not turn the median of 1000 mg/day and range of 500–2000 mg/day into an individual recommendation or a direct dose comparison.
Why this condition is needed: This is needed to avoid using a dose from an indirect report involving mixed stone types as an established regimen for the target population.
Referenced methods: M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation for testing were internally designed; M03 §3.2.3, M08 §8.2.2–8.2.3; internal application; M03 §3.2.1–3.2.4; details concerning dose, duration, and effect modification were internally designed

N10 · Has a recurrence comparator involving no addition, placebo, or the same care been verified?

Required materials and conditions: Comparators, care, concomitant interventions, event counts, and correspondence with the exposure group in the same population
Conditions for verification: Link the actual comparator for the target event and the effect of interest to the original result.
Requirement and applicability: Required
Application exceptions: The metabolic placebo condition in S02 and the healthy participants in S03 do not replace a comparator for the recurrence question.
Why this condition is needed: This is needed to avoid mistaking events observed in an exposure group for a between-group increase or decrease in risk.
Referenced methods: M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation for testing were internally designed; M08 §8.1–8.2.3; internal application; M03 §3.2.3, M08 §8.2.2–8.2.3; internal application; M19 §19.2.2–19.2.4, M03 §3.2.3; internal application

N11 · Have the treatment duration and principal follow-up time for comparing recurrence been verified?

Required materials and conditions: Actual treatment start/end, discontinuation, follow-up/censoring, and prespecified principal follow-up time
Conditions for verification: Distinguish the treatment duration, fixed time point, and time-to-event analysis of a directly eligible comparison within the verified scope.
Requirement and applicability: Required
Application exceptions: Do not create a common minimum duration. Do not round a median of 22.6 months into a fixed 24-month result.
Why this condition is needed: This is needed to avoid turning median follow-up or 3/6-day metabolic exposure into a fixed clinical recurrence period.
Referenced methods: M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation for testing were internally designed; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; design-specific adaptations were internally designed; M03 §3.2.1–3.2.4; details concerning dose, duration, and effect modification were internally designed; design-specific harms questions in M19 §19.2; details of temporal relationships were internally designed

N12 · Can symptomatic new stones be distinguished from imaging-only events and residual-stone growth?

Required materials and conditions: Symptoms, imaging/diagnosis, stone composition, adjudicators, definitions of new and residual stones, and event collection procedures
Conditions for verification: Link the definition, diagnosis, and adjudication of the target event and its distinction from other events to the direct result.
Requirement and applicability: Required
Application exceptions: Emergency care, procedures, and time to first recurrence are separate outcomes and are not all added together as a single event.
Why this condition is needed: This is needed to avoid combining different clinical and imaging events as the same recurrence outcome.
Referenced methods: M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; M08 Table 8.2.a, M03 §3.2.4; internal application; M03 §3.2.4; internally defined limits on extension; M19 §19.1.2–19.2.4; detailed distinctions were internally designed

N13 · Have an effect estimate, CI, and P value for an eligible recurrence comparison been verified?

Required materials and conditions: Events/denominators and time by group, original risk ratio/risk difference/HR, CI, P value, and analysis definition
Conditions for verification: Attribute the estimate, direction, measure, and interval of a directly eligible comparison to its event and time point.
Requirement and applicability: Required
Application exceptions: Preserve unverified values as empty values and do not make new calculations from rounded proportions or other outcomes.
Why this condition is needed: This is needed to avoid filling in a recurrence comparison effect with indirect proportions, metabolic-measure P values, or first-stone HRs.
Referenced methods: M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; design-specific adaptations were internally designed; M08 §8.2.2, M15 §15.3.1; internal application; M15 §15.3.1–15.3.3; internal application; M19 §19.2.2–19.2.4, M03 §3.2.3; internal application; M19 §19.1.2–19.2.4; internal application

N14 · Have an actual design and allocation that support a causal comparison of recurrence been verified?

Required materials and conditions: Direct comparison methods, allocation/concealment, baseline risk, observational-study confounding/selection, and models
Conditions for verification: Verify actual design, allocation, and confounding information for the target outcome, and distinguish the axes that must remain unverified.
Requirement and applicability: Required
Application exceptions: Retain metabolic crossover trials and observational reports while distinguishing them from designs addressing the target event.
Why this condition is needed: This is needed to avoid claiming that a causal comparison of the target recurrence has been resolved merely because a related study is labeled an RCT.
Referenced methods: M08 §8.1–8.2.3; internal application; M08 §8.2.2, M15 §15.3.1; internal application; design considerations in M19 §19.2.2–19.2.4; detailed confounding records were internally designed

N15 · Can common treatments, deviations from medication use, and concomitant interventions be separated from vitamin C's contribution?

Required materials and conditions: Fluid intake/diet, medications/procedures, rescue treatment, adherence, exposure changes, and their handling in analysis by group
Conditions for verification: Distinguish actual concomitant interventions and deviations from exposure needed to define the effect of interest from the unverified scope.
Requirement and applicability: Required
Application exceptions: Do not assume that there were no concurrent changes. The acute course with antibiotics/stenting in S09 is not an effect on recurrence prevention.
Why this condition is needed: This is needed to avoid attributing the results of concomitant treatments or exposure changes to the contribution of a single-ingredient oral preparation.
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; design considerations in M19 §19.2.2–19.2.4; detailed confounding records were internally designed

N16 · Have recurrence events, people, exposure time, and analysis denominators been verified?

Required materials and conditions: Numbers allocated/exposed, completing follow-up, and analyzed; recurrent events/people with events; follow-up time; and censoring tables
Conditions for verification: Verify the analysis denominator, event unit, time, and interval of the direct result together.
Requirement and applicability: Required
Application exceptions: Do not turn the 8/24 count of people with composite events into an eligible incidence rate or a denominator specific to calcium-oxalate recurrence.
Why this condition is needed: This is needed to avoid confusing data in which a person experiences multiple events with proportions of people or incidence rates.
Referenced methods: M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; design-specific adaptations were internally designed; M19 §19.1.2–19.2.4; internal application; M08 §8.2.2, M15 §15.3.1; internal application

N17 · Who was included, lost to follow-up, or censored, and how was the target outcome handled?

Required materials and conditions: Participant flow, missing outcomes, censoring, reasons for exclusion, and analysis/sensitivity-analysis plans
Conditions for verification: Distinguish actual participant flow from missingness/censoring of the target recurrence, and explicitly identify unverified handling.
Requirement and applicability: Required
Application exceptions: Do not present unverified full texts or flow diagrams as evidence of no missing data or a definite magnitude of bias.
Why this condition is needed: This is needed to avoid extending observations limited to the included exposure group to the entire recruited population or presenting them as results without missing data.
Referenced methods: M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; design-specific adaptations were internally designed; M08 §8.2.2, M15 §15.3.1; internal application; M19 §19.1.2–19.2.4, M04 §4.6.3; internal application

N18 · Were symptom assessment, imaging, and event adjudication conducted under the same conditions across groups?

Required materials and conditions: Examination schedules, symptom collection, imaging/composition testing, masking/adjudicators, and detection/reporting pathways
Conditions for verification: Explain the collection, adjudication, and detection conditions for the direct target event and what remains unverified.
Requirement and applicability: Required
Application exceptions: Do not mark masking or equivalent detection as met merely because imaging data are objective.
Why this condition is needed: This is needed to avoid mistaking imaging findings in a more frequently examined group for an actual difference in symptomatic recurrence.
Referenced methods: M08 Table 8.2.a, M03 §3.2.4; internal application; M19 §19.1.2–19.2.4; detailed distinctions were internally designed; M19 §19.1.2–19.2.4, M04 §4.6.3; internal application

N19 · Can the reported interval and a clinically important difference in recurrence be interpreted?

Required materials and conditions: Direct recurrence effect, CI, events/denominators, and a justified criterion for an important difference
Conditions for verification: Record the relationship between the interval for the selected event and the importance criterion, or the reason this remains unverified.
Requirement and applicability: Required
Application exceptions: Do not create uniform minimum participant counts, minimum durations, or numerical thresholds for important differences. Do not calculate an absent CI from indirect reports.
Why this condition is needed: This is needed to avoid declaring recurrence evidence sufficient on the basis of publication count, sample size, or statistical significance alone.
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; design-specific adaptations were internally designed

N20 · Have prespecified recurrence endpoints, the principal time point, and analyses been compared with actual reporting?

Required materials and conditions: Registration, protocol, analysis plan, amendment history, and actual results tables for the direct trial
Conditions for verification: Explain prespecification status and the parts not compared at each relevant location.
Requirement and applicability: Required
Application exceptions: Do not use a registration shell or a mirror lead as an actually eligible recurrence protocol.
Why this condition is needed: This is needed to avoid turning unavailable planning materials into a definite conclusion of nonregistration or selective reporting.
Referenced methods: M08 Table 8.2.a, M04 §4.6.3; internal application; M04 §4.5, §4.6.3; limits on the current data transformation reflect the user-defined scope and internal design

N21 · Which population, exposure, and comparison does the crossover metabolic result in S02 describe?

Required materials and conditions: Original S02 methods/results tables, population, duration, sample, crossover contrast, and urinary oxalate units
Conditions for verification: Distinguish the actual roles of the 12 calcium-oxalate stone formers and 12 nonformers, 6-day periods, 1 g twice daily, 41.0/30.5 mg, and P.
Requirement and applicability: Supplementary; required for attributing indirect results
Application exceptions: Do not turn urinary oxalate or the authors' description of a 33% increase into a probability of symptomatic recurrence.
Why this condition is needed: This is needed to retain controlled short-term urinary results while distinguishing them from clinical recurrence outcomes.
Referenced methods: M03 §3.2.1; detailed population criteria were internally designed; M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation for testing were internally designed; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; design-specific adaptations were internally designed; M08 §8.1–8.2.3; internal application; M03 §3.2.4; internally defined limits on extension

N22 · Have the sequence, washout period, paired variance, and carryover effects in S02 been verified?

Required materials and conditions: S02 full text, allocation sequence, washout period, results by period, paired variance, and carryover/deviation analyses
Conditions for verification: State the boundary between the currently verified crossover design and the unverified sequence and paired uncertainty.
Requirement and applicability: Supplementary; required for interpreting crossover results
Application exceptions: Do not fill unavailable methods with assumptions of no washout, definite carryover, or paired variance of 0.
Why this condition is needed: This is needed to avoid calculating a parallel-group CI or a clinical event difference from crossover sample sizes and means alone.
Referenced methods: M08 §8.1–8.2.3; internal application; M08 §8.2.2, M15 §15.3.1; internal application; M15 §15.3.1–15.3.3; internal application; M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; design-specific adaptations were internally designed

N23 · What was compared in the before–after metabolic study S03?

Required materials and conditions: Original S03 methods/results, stone composition, exposure/testing by group, the role of healthy participants, and paired data
Conditions for verification: Preserve the role of the 3-day urinary measures for the groups of 23/24 among the 47 stone formers and for the 20 healthy participants, and separate them from the target event.
Requirement and applicability: Supplementary; required for interpreting indirect data
Application exceptions: The description 'calcium stone formers' alone does not establish that everyone had a verified history of calcium-oxalate recurrence.
Why this condition is needed: This is needed to avoid using healthy participants as recurrence comparators for people with prior stones or extending before–after changes into an effect of adding treatment.
Referenced methods: M03 §3.2.1; detailed population criteria were internally designed; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; design-specific adaptations were internally designed; M08 §8.2.2, M15 §15.3.1; internal application; M03 §3.2.4; internally defined limits on extension

N24 · Have detailed results and participant overlap between S04 and S17 been verified?

Required materials and conditions: Full texts of both original reports, populations/recruitment, study IDs, participant overlap, and original results tables
Conditions for verification: Separate the titles/bibliographic information actually read from unverified methods, numbers, and duplication, and do not sum participants or trials.
Requirement and applicability: Supplementary; required for interpreting duplication and existence
Application exceptions: A conservative single cluster is not a conclusion proving that the participants were the same. Leave unverified DOI/PMID information as it is.
Why this condition is needed: This is needed to avoid counting the existence of metadata as acquisition of actual results or as two independent replications.
Referenced methods: The 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; the separation of access and reading and the hyperlink contract were internally designed; M04 §4.6.1–4.6.2, M15 §15.3.1; internal application

N25 · How are the cystine course and spontaneous passage in S05 distinguished?

Required materials and conditions: S05 German full text, composition, ages, event definitions, exposure/time, comparators, and complete participant flow
Conditions for verification: Preserve the respective roles of the 17 participants, 5 g/day, 5 people with unchanged recurrence, 2 people with spontaneous passage, and the limitations concerning pediatric indexing and duration.
Requirement and applicability: Supplementary; required for interpreting unfavorable results and scope
Application exceptions: Do not add the 2 people with spontaneous passage to new-recurrence events or turn the 17 participants into a denominator for adult calcium-oxalate recurrence.
Why this condition is needed: This is needed to retain contrary or unfavorable human results without mixing other stone compositions and events into the target recurrence.
Referenced methods: M03 §3.2.1; detailed population criteria were internally designed; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; design-specific adaptations were internally designed; M04 §4.6.1–4.6.2, M15 §15.3.1; internal application; M19 §19.1.2–19.2.4; internal application

N26 · To what extent has the favorable report of 4 people in S06 been verified?

Required materials and conditions: S06 full text, exact ages, exposure/product, events, denominators, comparison, follow-up, and concomitant interventions
Conditions for verification: Record both the existence of the favorable description involving 4 people and the unverified detailed eligibility and original numerical values.
Requirement and applicability: Supplementary; required for retaining positive evidence
Application exceptions: Do not treat the description 'young patients with cystinuria' as equivalent to adults with prior calcium-oxalate stones.
Why this condition is needed: This is needed to retain a favorable report without filling in unavailable conditions as evidence of target efficacy.
Referenced methods: M03 §3.2.1; detailed population criteria were internally designed; M04 §4.6.3, M15 §15.3.1–15.3.3; the separation of statuses was internally designed; M04 §4.6.1–4.6.2, M15 §15.3.1; internal application

N27 · Have the favorable urinary result in S07 and the original report date been distinguished?

Required materials and conditions: Original 1982 S07 report, clinical events/follow-up, composition, exposure, and publication/digital identity
Conditions for verification: Distinguish the original 1982 report from the digitization date, and distinguish the scope of the 31 participants, 5 g/day, and urinary outcomes.
Requirement and applicability: Supplementary; required for interpreting indirect evidence and identity
Application exceptions: Do not turn the description of urinary cystine and sediment in 31 people into a controlled clinical recurrence result.
Why this condition is needed: This is needed to avoid transferring improvements in urinary measures to improved recurrence or counting a digital date as a new study.
Referenced methods: The distinction between studies and reports in M04 §4.6.1–4.6.2; cohort/outcome linkage is an internal application; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; M04 §4.6.3, M15 §15.3.1–15.3.3; the separation of statuses was internally designed; M03 §3.2.4; internally defined limits on extension

N28 · How does the first-stone cohort result in S08 differ from the recurrence question?

Required materials and conditions: Original S08 population/history, sex, exposure, covariates, events/time, HR/CI, and records of cohort reuse
Conditions for verification: Preserve the actual roles of the 156,735 women, 40,536 men, 6,245 events, median 11.3–11.7 years, and the supplement contrast in men.
Requirement and applicability: Supplementary; required for interpreting observational and indirect results
Application exceptions: Do not create a combined effect or denominator that erases sex differences, unverified formulations, or cohort reuse.
Why this condition is needed: This is needed to avoid transferring a first-occurrence association in a large observational sample to a causal effect on recurrence in people with prior stones.
Referenced methods: M03 §3.2.1; detailed population criteria were internally designed; M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation for testing were internally designed; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; design-specific adaptations were internally designed; M08 §8.2.2, M15 §15.3.1; internal application; M04 §4.6.1–4.6.2, M15 §15.3.1; internal application; 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 were internally designed

N29 · To which interventions and event is the acute dissolution course in S09 attributable?

Required materials and conditions: Original S09 case report, exact title/bibliographic information, stone composition, concurrent/subsequent exposure, and acute/recurrence follow-up
Conditions for verification: Preserve the acute course with concomitant treatments in 1 older man, different exposure after discharge, uncertainty about composition, and the title's status.
Requirement and applicability: Supplementary; required for attributing case-report findings
Application exceptions: Do not present a descriptive title as the exact title of the original article or turn inferred composition into confirmed composition.
Why this condition is needed: This is needed to avoid attributing the course involving antibiotics, stenting, and acidification in a single case to recurrence prevention by a single-ingredient oral preparation.
Referenced methods: M03 §3.2.1; detailed population criteria were internally designed; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; 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 were internally designed

N30 · Have the page actually verified in S10 and recurrence under other treatments been distinguished?

Required materials and conditions: Original S10 full text, populations/compositions by treatment, exposure, comparison/recurrence, and cited original reports
Conditions for verification: Preserve partial verification of the abstract and p.1563 and the unverified comparison of C alone.
Requirement and applicability: Supplementary; required for partial-reading status and attribution
Application exceptions: Do not count cited studies as new patients or assign recurrence values from other treatments to vitamin C.
Why this condition is needed: This is needed to avoid presenting a discussion of cystine treatment on a single page as verification of the entire full text or as a recurrence comparison of C alone.
Referenced methods: The 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; the separation of access and reading and the hyperlink contract were internally designed; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; M03 §3.2.4; internally defined limits on extension

N31 · What evidence map and time frame does the S11 review provide?

Required materials and conditions: S11 review full text, search end date/scope, original reference list, inclusion/exclusion, and funding
Conditions for verification: Preserve the review's map of urinary risks, the roles of the original trials, and the limitations of access and search scope.
Requirement and applicability: Supplementary; required for interpreting the review and timing
Application exceptions: Even though the online publication on 2026-07-31 preceded the evidence cutoff date, it does not mean that all studies have currently been verified.
Why this condition is needed: This is needed to avoid counting the review as an independent new trial or as completion of a current exhaustive search.
Referenced methods: The distinction between studies and reports in M04 §4.6.1–4.6.2; cohort/outcome linkage is an internal application; M04 §4.5, §4.6.3; limits on the current data transformation reflect the user-defined scope and internal design; M04 §4.6.1–4.6.2, M15 §15.3.1; internal application

N32 · Have the registration leads in S15 and S16 been distinguished from the content actually verified?

Required materials and conditions: Complete official S15 registration/amendment history, original official S16 ID/version, protocols, and results
Conditions for verification: Record access failures involving the official shell, the mirror's status as a discovery lead, and the unverified ID at their respective locations.
Requirement and applicability: Supplementary; required for registration identity
Application exceptions: Do not assume that NCT06989320 and the Carbon-13 oral-loading mirror are the same trial.
Why this condition is needed: This is needed to avoid turning an official record shell and a 3rd-party mirror lead into an eligible completed trial or a negative search.
Referenced methods: Data collection/selection principles in M04 §4.5–4.6; the separation of access and reading and the hyperlink contract were internally designed; M04 §4.5, §4.6.3; limits on the current data transformation reflect the user-defined scope and internal design; M08 Table 8.2.a, M04 §4.6.3; internal application

N33 · Are favorable/unfavorable results and bibliographic differences being mistaken for conflicts about the same effect?

Required materials and conditions: Actual contrasts, events/compositions, durations, bibliographic versions, and contrary/corrected material for each original report
Conditions for verification: Distinguish the direct and indirect roles of unfavorable/favorable results from differences between records and unverified information.
Requirement and applicability: Supplementary; required for interpreting contrary evidence and conflicts
Application exceptions: If the other exact value underlying the publication-identity difference in S01 is unavailable, do not invent a new year or a correction event.
Why this condition is needed: This is needed to avoid selectively retaining only favorable evidence or turning different outcomes into a statistical conflict about the same effect.
Referenced methods: M04 §4.6.3, M15 §15.3.1–15.3.3; the separation of statuses was internally designed; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; M04 §4.6.1–4.6.2, M15 §15.3.1; internal application

N34 · Have funding, product provision, roles, and conflicts of interest for the direct evidence been verified?

Required materials and conditions: Funding/conflicts of interest, internal support, product provision, and design/analysis/publication roles in original eligible reports
Conditions for verification: Distinguish declarations actually read from unverified information, ineligible roles, and historical designations.
Requirement and applicability: Required
Application exceptions: The delivery package's default I1 designation is not an empirically verified finding of mixed funding. Do not create an independence score without eligible evidence.
Why this condition is needed: This is needed to avoid turning unverified information into absence of support or conflicts of interest, or into independent replication.
Referenced methods: Chamgap's own independence and attribution criteria. The official methods sections used in this pilot do not substantiate every detail of this item.

N35 · Have safety events in S01 been distinguished from comparative risk?

Required materials and conditions: S01 event definitions, exposure time, original flow of 2 people/24 people, comparator, dose reduction/discontinuation, and safety follow-up
Conditions for verification: Preserve the 1 discontinuation and 1 dose reduction, the noncomparative/mixed population, and the limitations concerning exposure duration.
Requirement and applicability: Supplementary; required for interpreting harm signals
Application exceptions: Do not turn the 2 people with hyperoxaluria-related changes into 2 clinical new-stone events or a between-group risk difference.
Why this condition is needed: This is needed to retain observed exposure changes without mistaking them for causal risk estimates or the proportion with any adverse event.
Referenced methods: M19 §19.1.2–19.2.4; detailed distinctions were internally designed; design-specific harms questions in M19 §19.2; details of temporal relationships were internally designed; M19 §19.2.2–19.2.4, M03 §3.2.3; internal application; M19 §19.1.2–19.2.4; internal application; M19 §19.1.2–19.2.4; internal application

N36 · Which population, dose, and duration does the report of gastritis-related discontinuation in S05 concern?

Required materials and conditions: S05 gastritis definition, flow of 3 people/17 people, adults/children, 5 g/day, duration, and other treatments/risks
Conditions for verification: Retain the 17 people with cystine stones, 5 g/day, and 3 gastritis-related discontinuations together with unverified age/duration and comparator information.
Requirement and applicability: Supplementary; required for retaining unfavorable harm findings
Application exceptions: Do not calculate the 3 discontinuations as a risk rate over a defined period in adults with calcium-oxalate stones.
Why this condition is needed: This is needed to avoid omitting a safety report from a high-dose population with another stone type or transferring it to comparative risk in the target adults.
Referenced methods: M19 §19.1.2–19.2.4; detailed distinctions were internally designed; M19 §19.1.2–19.2.4; internal application; M19 §19.1.2–19.2.4; internal application; M19 §19.1.2–19.2.4; internal application

N37 · Have the warnings in the official injection label S12 been separated from oral evidence?

Required materials and conditions: Route/formulation, warnings, and at-risk populations in the original ASCOR label, and actual comparative data on oral harms
Conditions for verification: Distinguish intravenous oxalate nephropathy/stones, renal function/dialysis/prior history, and the high-dose/intravenous G6PD context.
Requirement and applicability: Supplementary; required for interpreting harms by route
Application exceptions: Warnings for a buffered intravenous scurvy preparation are neither event rates nor assurances of safety for a pure oral preparation.
Why this condition is needed: This is needed to preserve official warnings without transferring risk frequencies or efficacy from another route to this oral preparation.
Referenced methods: M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation for testing were internally designed; M19 §19.1.2–19.2.4; internal application; Chamgap's own interpretive boundary. M19 principles are referenced; no formal causality tool was applied; M19 §19.1.2–19.2.4; internal application

N38 · Have the general upper limit and harms in S13 been distinguished from an assurance of safety for stone patients?

Required materials and conditions: Upper limit/population and gastrointestinal/iron warnings in the NIH consumer material, and actual exposure-specific safety data in the target patients
Conditions for verification: Preserve the total of 2,000 mg/day from all sources and the context of diarrhea/nausea/abdominal pain and iron overload.
Requirement and applicability: Supplementary; required for interpreting upper limits and general harms
Application exceptions: Do not represent reading the full consumer document as reading the health-professional page. Intake below the upper limit does not assure stone safety.
Why this condition is needed: This is needed to avoid mistaking the general adult upper limit for a safe prescribed dose or a no-harm threshold in stone patients.
Referenced methods: M19 §19.1.2–19.2.4; internal application; Chamgap's own interpretive boundary. M19 principles are referenced; no formal causality tool was applied; M19 §19.1.2–19.2.4; internal application

N39 · What outcome does the guidance to avoid excessive intake in S14 verify?

Required materials and conditions: Original EAU section, population, evidence/warnings, and actual comparative recurrence/harm data for the target oral formulation
Conditions for verification: Preserve the context of advice to calcium-oxalate stone formers to avoid excessive intake and the unverified quantitative direct recurrence result.
Requirement and applicability: Supplementary; required for interpreting guidelines
Application exceptions: Do not create a new threshold dose or a quantitative reduction in recurrence from statements about disputed risk and avoidance of excessive intake.
Why this condition is needed: This is needed to avoid turning guideline caution into a randomized recurrence effect or an individual safety assessment.
Referenced methods: M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; Chamgap's own interpretive boundary. M19 principles are referenced; no formal causality tool was applied; M19 §19.1.2–19.2.4; internal application

N40 · Have gaps concerning renal risk, special populations, and long-term exposure been retained?

Required materials and conditions: Formulation- and route-specific data on renal risks, dialysis, prior oxalate stones/G6PD, iron, pregnancy/lactation, children, and long-term harms
Conditions for verification: State the current caution, unverified information by population, route, and duration, and the separation of efficacy and safety.
Requirement and applicability: Supplementary; required for limits on safety applicability
Application exceptions: This table is not an individual diagnosis, prescription, or safety assessment, and reported doses are not turned into recommended doses.
Why this condition is needed: This is needed to avoid treating populations with weak evidence or long-term high-dose exposure as safe on the basis of the general adult upper limit or data from other routes.
Referenced methods: M19 §19.1.2–19.2.4; internal application; Chamgap's own interpretive boundary. M19 principles are referenced; no formal causality tool was applied; M03 §3.2.1–3.2.4; details concerning dose, duration, and effect modification were internally designed; M19 §19.1.2–19.2.4; internal application

N41 · Have the current assessment and package/calculator designations been distinguished with their original values preserved?

Required materials and conditions: Original records of current grade/score, axes, primary_result, historical package/calculations, and editorial decisions
Conditions for verification: Preserve the current ?, empty value, and Caution, the original designations, the absence of calculations, and the boundary that this is not independent verification.
Requirement and applicability: Required for preservation and traceability; not a condition establishing efficacy
Application exceptions: Do not use the package's I1/EX/CX or the raw C from a format error as a valid new assessment, and do not fill empty values with 0.
Why this condition is needed: This is needed to avoid mistaking table production or a structural PASS for confirmation of a clinical grade or effect.
Referenced methods: M04 §4.5, §4.6.3; limits on the current data transformation reflect the user-defined scope and internal design; Chamgap's own independence and attribution criteria. The official methods sections used in this pilot do not substantiate every detail of this item; M04 §4.6.3, M15 §15.3.1–15.3.3; the separation of statuses was internally designed

Referenced methods and the sections actually reviewed

M03 · Cochrane Handbook 6.5 (2024), chapter updated 2023-08

Official methodology · §3.1, §3.2.1–3.2.3, MECIR C5/C7/C13

Referenced principle: Clearly record the question, eligibility criteria and reasons for changes, and distinguish variations in the intervention.
Extent of review: Historical reuse of the actual retained HTML copy and SHA from 1585 and the methodological principles from that time. This is not new reading of the methods full text, a formal application, or clinical certification in this work.

M04 · Cochrane Handbook 6.5.1 (2025), chapter updated 2025-03

Official methodology · §4.5, §4.6.1–4.6.3, MECIR C42

Referenced principle: Distinguish and link studies and reports, and do not omit a study solely because its outcomes are not reported.
Extent of review: Historical reuse of the actual retained HTML copy and SHA from 1585 and the methodological principles from that time. This is not new reading of the methods full text, a formal application, or clinical certification in this work.

M08 · Cochrane Handbook 6.5 (2024), chapter updated 2019-10

Official methodology · §8.1–8.2.3, Table 8.2.a

Referenced principle: Hold the outcome and effect of interest fixed, then assess randomization, deviations, missing data, measurement and selective reporting.
Extent of review: Historical reuse of the actual retained HTML copy and SHA from 1585 and the methodological principles from that time. This is not new reading of the methods full text, a formal application, or clinical certification in this work.

M15 · Cochrane Handbook 6.5 (2024), chapter updated 2023-08

Official methodology · §15.2.4, §15.3.1–15.3.3

Referenced principle: Distinguish effect estimates, intervals, importance and applicability. Sample size alone does not determine precision.
Extent of review: Historical reuse of the actual retained HTML copy and SHA from 1585 and the methodological principles from that time. This is not new reading of the methods full text, a formal application, or clinical certification in this work.

M19 · Cochrane Handbook 6.5 (2024), chapter updated 2019-10

Official methodology · §19.1.2, §19.2.1–19.2.4

Referenced principle: Questions about harms may require designs, populations and follow-up different from efficacy questions. Case reports do not establish incidence.
Extent of review: Historical reuse of the actual retained HTML copy and SHA from 1585 and the methodological principles from that time. This is not new reading of the methods full text, a formal application, or clinical certification in this work.

What the statuses mean

Met: Verification of the relevant retained/question condition; not confirmation of a clinical effect
Unverified: Required direct material/values are not verified within the current scope
Conflicting information: Used when an actual conflict concerning the same material/value is linked
Not met: Used when the required condition does not match what was actually verified
Not applicable: Used when a condition is not imposed on the particular question
Not read: The external original material was not actually read in this work
Access failed: Used only when an actual access failure occurred in this work
Partly verified: Some verified content coexists with gaps in applicability or data

Change history

2026-11-06 · Public page/material version 1.0

A public-facing display and data were prepared from the existing 41 items. No new clinical searches, changes to verification statuses, or scoring were performed.

The stored-material review date (2026-10-05) and original evidence cut-off (2026-09-16) were retained unchanged.

Researcher downloads

These materials provide the same evidence, scope and verification status as this page.

View all item details

N01 · Which adults, oral intervention and recurrent-stone event does this table address?

Current findings: The current claim concerns change in symptomatic new-stone recurrence in adults with a confirmed history of calcium-oxalate stones. The question compares added single-ingredient pure oral L-ascorbic acid with no addition, placebo or matched care. The actual dose, duration and direct comparative values are unverified.
Verification status: Met
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The original claim's identity and exclusion boundaries have been linked. Met does not mean that an eligible trial or a recurrence effect has been verified.
Reason for missing information: The current source has no subclaims field. No new subquestions or combinations of all axes were created to increase the number of independent tables.
Required materials and conditions: The original /ko/effect and question specifications for population, ingredient, route, event, comparison and time
Materials to obtain first: The original /ko/effect and question specifications for population, ingredient, route, event, comparison and time
Further research: Subsequent research should define symptomatic new calcium-oxalate stone recurrence as the main outcome and report imaging-only events, residual-stone growth and first incident stones separately.
Remaining uncertainty: The current source has no subclaims field. No new subquestions or combinations of all axes were created to increase the number of independent tables.
Conditions for verification: Link the single question of comparative change in symptomatic new stones in adults with a calcium-oxalate stone history receiving pure single-ingredient oral L-ascorbic acid to the excluded questions.
Why this condition is needed: Needed to avoid converting stone risk factors or first incident stones into symptomatic recurrence in patients with a history of stones.
Application exceptions: The question definition alone does not establish a recurrence direction, dose or duration as a verified effect or prescription. The absence of a subclaims field is also preserved.
Referenced methods: Principles for clarifying the question in M03 §3.1, §3.2.1–3.2.4; detailed separation rules are internally designed; M03 §3.2.1; detailed population criteria are internally designed; M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation for testing are internally designed; M03 §3.2.4, M15 §15.3.1–15.3.3; outcome adaptation for each question is internally designed; M03 §3.2.4; internally defined limits on extrapolation

Related sources

N02 · What materials were actually read this time, and what are the historical access records?

Current findings: The retained evidence through 2026-09-16 was transformed on 2026-10-05. The 17 Korean fields, designated structure and 17 sources/bibliographic entries were actually read in that work. Reading S01's 6-page PDF, part of S10 on p.1563 and official documents is recorded in the historical manuscript; all external materials remain unread this time.
Verification status: Met
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: Current summary reading and historical access levels have been separated by material. No new searches or reading of original full texts or old separate logs were performed.
Reason for missing information: The historical source's external-byte hashes are empty. The methods HTML copies referenced here are not presented as copies of original clinical articles.
Required materials and conditions: The retained summary's evidence cutoff, access records for each source, locations actually read in the current work and file SHA
Materials to obtain first: The retained summary's evidence cutoff, access records for each source, locations actually read in the current work and file SHA
Further research: For subsequent material verification, separately record material type, version, access attempts, sections actually read and the SHA of acquired files, and cross-check them against historical summaries.
Remaining uncertainty: The historical source's external-byte hashes are empty. The methods HTML copies referenced here are not presented as copies of original clinical articles.
Conditions for verification: Separate reading of the current local stored summary from not having read clinical original texts, registrations and official documents this time, material by material.
Why this condition is needed: Needed to avoid presenting past full-text/abstract access on 2026-09-16 as full-text reading performed this time.
Application exceptions: Current external access not attempted is not labeled as access failure. Past failures stated in the manuscript are retained only as historical records.
Referenced methods: Principles for data collection/selection in M04 §4.5–4.6; separation of access from reading and the hyperlink contract are internally designed; M04 §4.5, §4.6.3; limits on the current data transformation follow the user-defined scope and internal design

Related sources

N03 · Have the 17 reports been kept from being double-counted as independent recurrence trials?

Current findings: The 17 sources are linked to the 10 families in the retained ledger. S04 and S17 were grouped in F04 because of possible but unresolved overlap. S08's 3 cohorts, reviews and cited material are not added as other independent recurrence trials. The count of 0 verified eligible comparisons pertains to the scope at that time.
Verification status: Met
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The distinctions among reports, families and reviews have been preserved. This is not exhaustive confirmation of the number of unique studies or participants.
Reason for missing information: Participant overlap between Chai/Massey and overlap with earlier cohort reports are unverified. The verified overall participant total is left empty.
Required materials and conditions: A mapping of each report's source_id to study family, cohort, endpoint and repeat citations
Materials to obtain first: A mapping of each report's source_id to study family, cohort, endpoint and repeat citations
Further research: Create an overlap ledger that cross-checks original participant recruitment, registration, study locations and timing to verify Chai/Massey overlap and cohort reuse.
Remaining uncertainty: Participant overlap between Chai/Massey and overlap with earlier cohort reports are unverified. The verified overall participant total is left empty.
Conditions for verification: Link the roles of the 10 retained families and S11–S16 documents without creating an unverified unique-participant total.
Why this condition is needed: Needed to avoid counting publisher, PubMed and PMC versions, reviews and related metabolic reports as separate trials.
Application exceptions: Retain the possible S04/S17 overlap as a single conservative cluster, without confirming that they involve the same participants.
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 harms material is internally designed

Related sources S01 S02 S04 S08 S11 S17

N04 · Has the question's pure oral L-ascorbic acid been distinguished from other forms?

Current findings: The question concerns single-ingredient pure oral L-ascorbic acid. Sodium/calcium ascorbate, foods/juice, combination products and intravenous injections are excluded. This boundary does not mean that an actual eligible study product has been verified.
Verification status: Met
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The question boundaries between the pure oral preparation and other exposures have been preserved. Directly eligible product verification remains unverified under the next criterion.
Reason for missing information: The eligible product, manufacturing source, salt/isomer and batch identity have not been verified.
Required materials and conditions: Product ingredient list, L isomer, salts, single/combined ingredients and actual administration route
Materials to obtain first: Product ingredient list, L isomer, salts, single/combined ingredients and actual administration route
Further research: Subsequent comparisons should verify batch-specific ingredients, salts/isomers, added ingredients and administration routes, distinguishing them from food/injection exposures.
Remaining uncertainty: The eligible product, manufacturing source, salt/isomer and batch identity have not been verified.
Conditions for verification: Identify the question's formulation boundary and distinguish it from verification of actual study-product eligibility.
Why this condition is needed: Needed to avoid importing foods, salts, combination products or injections as recurrence effects of the pure oral preparation.
Application exceptions: Harms from injections may be retained as a separate context, but are not transferred as effects or incidence for the single-ingredient oral preparation.
Referenced methods: M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation for testing are internally designed; M03 §3.2.3, M08 §8.2.2–8.2.3; internal application; M19 §19.2.2–19.2.4, M03 §3.2.3; internal application

Related sources S12

N05 · Have the product, source and single-ingredient status of a directly eligible recurrence study been verified?

Current findings: The product and manufacturing source for a directly eligible recurrence comparison are unverified. S01 also records that single-ingredient L-isomer purity, product and source could not be established.
Verification status: Unverified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The current retained scope lacks material to verify the question's pure oral L formulation as the actual trial product.
Reason for missing information: Agreement between nominal ascorbic acid and the actual single ingredient, isomer and manufacturing source is unverified.
Required materials and conditions: Product, batch, manufacturing source, purity, ingredient list and original methods for a direct recurrence comparison
Materials to obtain first: Product, batch, manufacturing source, purity, ingredient list and original methods for a direct recurrence comparison
Further research: Design research linking product analysis or verifiable ingredient lists to the actual comparison groups and administration records.
Remaining uncertainty: Agreement between nominal ascorbic acid and the actual single ingredient, isomer and manufacturing source is unverified.
Conditions for verification: Use original data to verify whether the actual product in the selected direct comparison matches the question's formulation.
Why this condition is needed: Because the name ascorbic acid alone cannot establish eligibility as a pure L single ingredient.
Application exceptions: Preserve nominal ingredients in indirect reports unchanged, without using them to fill gaps in the eligible product.
Referenced methods: M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation for testing are internally designed; M03 §3.2.3, M08 §8.2.2–8.2.3; internal application

Related sources S01

N06 · Is this direct evidence about adults with a confirmed history of calcium-oxalate stones?

Current findings: The question's population is adults with a confirmed history of calcium-oxalate stones. S01 concerns alkaline urine and mixed stones, while S02 is a short-term metabolic study in calcium-oxalate stone formers. Comparative symptomatic-recurrence values matching this population have not been verified.
Verification status: Unverified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: Although related human data exist, a direct result meeting the population, endpoint and comparison criteria together remains unverified.
Reason for missing information: The age boundary, number/timing of prior episodes, composition verification and baseline risk for an actual eligible comparison are unknown.
Required materials and conditions: Age, prior stone diagnosis/composition, recurrence history, baseline status and inclusion/exclusion table
Materials to obtain first: Age, prior stone diagnosis/composition, recurrence history, baseline status and inclusion/exclusion table
Further research: Analyze prior stone composition and verify history before recruitment, reporting data for adults with a calcium-oxalate stone history separately from other compositions.
Remaining uncertainty: The age boundary, number/timing of prior episodes, composition verification and baseline risk for an actual eligible comparison are unknown.
Conditions for verification: Verify the actual population's age, prior stone composition and diagnosis, and whether it matches the question's population.
Why this condition is needed: Needed to avoid recasting general-population, cystine-stone or mixed-stone groups as adults with a calcium-oxalate stone history.
Application exceptions: The question's editorial boundary of adulthood at age 18 is not transferred as the actual minimum age in each study.
Referenced methods: M03 §3.2.1; detailed population criteria are internally designed; M19 §19.1.2–19.2.4; detailed distinctions are internally designed

Related sources S01 S02

N07 · How are S01's 43 identified, 24 included and 17 composition-verified participants distinguished?

Current findings: S01 identified 43 patients and included 24. Mean age was 60.6 years (95% CI 52.7–68.5), and 11/24 were women. Among the 17 with baseline composition verified, 9 had struvite, 6 carbonate apatite and 2 calcium oxalate. Among the 3 with follow-up composition verified, 2 had struvite and 1 carbonate apatite; the calcium-oxalate cell of 0 does not provide a denominator establishing 0 recurrences.
Verification status: Partly verified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The retained selection and composition counts can be distinguished, but the analysis of symptomatic recurrence confined to calcium-oxalate stones and the details of missingness and selection are unverified.
Reason for missing information: The minimum adult age, reasons for inclusion and exclusion, missing composition testing, and comparator-specific event results confined to calcium-oxalate stones are unverified.
Required materials and conditions: Patient selection flow, age, sex, stone-composition testing table and reasons for exclusion
Materials to obtain first: Patient selection flow, age, sex, stone-composition testing table and reasons for exclusion
Further research: Subsequent research should disclose participant-level flow and missing tests from recruitment through composition testing and event adjudication.
Remaining uncertainty: The minimum adult age, reasons for inclusion and exclusion, missing composition testing, and comparator-specific event results confined to calcium-oxalate stones are unverified.
Conditions for verification: Link S01's recruited, included, composition-verified and event groups separately within the original reporting scope.
Why this condition is needed: Needed to avoid using the total identified population, included group and composition-tested group as the same recurrence-analysis denominator.
Application exceptions: A calcium-oxalate cell of 0 in the follow-up composition table is not interpreted as 0 calcium-oxalate recurrences among all 24 participants.
Referenced methods: M03 §3.2.1; detailed population criteria are internally designed; M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; adaptations by design are internally designed; M19 §19.1.2–19.2.4; internal application

Related sources S01

N08 · What outcome and follow-up period do the 8/24 events in S01 represent?

Current findings: In S01, a composite event of new stones or growth/progression of existing stones was observed in 8/24 participants (33.3%). Median follow-up was 22.6 months (range 19.7–32.1 months), and the original main endpoint was urinary pH. This value is neither a symptomatic recurrence rate confined to calcium-oxalate stones nor a causal effect of vitamin C.
Verification status: Partly verified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The composite events and follow-up summary are retained, but a direct comparative result for the target event cannot be separately verified.
Reason for missing information: Counts by new-stone/growth component, symptoms, recurrence by composition, a fixed time point, and a comparison with no addition are unverified.
Required materials and conditions: Event tables by new-stone and residual-stone-growth component, symptom status, composition, and median or fixed follow-up information
Materials to obtain first: Event tables by new-stone and residual-stone-growth component, symptom status, composition, and median or fixed follow-up information
Further research: Comparative studies are needed that adjudicate new stones, growth of existing stones, and symptomatic events separately, and distinguish prespecified fixed-time outcomes from time to first recurrence.
Remaining uncertainty: Counts by new-stone/growth component, symptoms, recurrence by composition, a fixed time point, and a comparison with no addition are unverified.
Conditions for verification: Attribute 8/24, 33.3%, and the median follow-up of 22.6 months only to the original composite outcome.
Why this condition is needed: This is needed to avoid presenting a mixed composite event as a symptomatic calcium-oxalate recurrence rate or a causal effect.
Application exceptions: Preserve the fact that urinary pH was the original study's main endpoint and stone events were a secondary endpoint. Do not turn pH or oxalate P values into recurrence P values.
Referenced methods: M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; design-specific adaptations were internally designed; M03 §3.2.4; internally defined limits on extension; M19 §19.1.2–19.2.4; detailed distinctions were internally designed

Related sources S01

N09 · Is the dose in S01 a regimen from a directly eligible trial?

Current findings: The median daily dose of ascorbic acid in S01 was 1000 mg/day (range 500–2000 mg/day). The product, L-form purity, administration frequency, meal timing, and sustained adherence are unverified. These values were not used to fill in a dose for a directly eligible recurrence study or an individual prescription.
Verification status: Partly verified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: Only the nominal daily dose from an indirect report is verified; there is no directly eligible exposure information.
Reason for missing information: The actual eligible product, dose per administration/frequency, meal timing, treatment duration, medication adherence, and comparative effects by dose are unverified.
Required materials and conditions: Nominal daily dose, product, dose per administration/frequency, meal timing, actual intake, and administration records
Materials to obtain first: Nominal daily dose, product, dose per administration/frequency, meal timing, actual intake, and administration records
Further research: Obtain the product and daily and per-administration dosing records, adherence, and changes in exposure by group to compare nominal dose with actual exposure.
Remaining uncertainty: The actual eligible product, dose per administration/frequency, meal timing, treatment duration, medication adherence, and comparative effects by dose are unverified.
Conditions for verification: Distinguish the verified nominal dose in S01 from the unverified product, frequency, and duration of intake.
Why this condition is needed: This is needed to avoid using a dose from an indirect report involving mixed stone types as an established regimen for the target population.
Application exceptions: Do not turn the median of 1000 mg/day and range of 500–2000 mg/day into an individual recommendation or a direct dose comparison.
Referenced methods: M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation for testing were internally designed; M03 §3.2.3, M08 §8.2.2–8.2.3; internal application; M03 §3.2.1–3.2.4; details concerning dose, duration, and effect modification were internally designed

Related sources S01

N10 · Has a recurrence comparator involving no addition, placebo, or the same care been verified?

Current findings: No addition, placebo, and the same usual care are the comparator question in this table. S01 has no unexposed recurrence comparator, and the placebo in S02 is a short-term metabolic comparison. A directly eligible recurrence comparator is unverified.
Verification status: Unverified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: There is no retained result that verifies the question's comparator as an actually observed eligible group.
Reason for missing information: Exposure by group, common treatment, baseline risk, and recurrence numerators and denominators are unverified.
Required materials and conditions: Comparators, care, concomitant interventions, event counts, and correspondence with the exposure group in the same population
Materials to obtain first: Comparators, care, concomitant interventions, event counts, and correspondence with the exposure group in the same population
Further research: Compare an added single-ingredient oral preparation with no addition/placebo on top of the same usual care, and record events by group together with differences in care.
Remaining uncertainty: Exposure by group, common treatment, baseline risk, and recurrence numerators and denominators are unverified.
Conditions for verification: Link the actual comparator for the target event and the effect of interest to the original result.
Why this condition is needed: This is needed to avoid mistaking events observed in an exposure group for a between-group increase or decrease in risk.
Application exceptions: The metabolic placebo condition in S02 and the healthy participants in S03 do not replace a comparator for the recurrence question.
Referenced methods: M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation for testing were internally designed; M08 §8.1–8.2.3; internal application; M03 §3.2.3, M08 §8.2.2–8.2.3; internal application; M19 §19.2.2–19.2.4, M03 §3.2.3; internal application

Related sources S01 S02 S03

N11 · Have the treatment duration and principal follow-up time for comparing recurrence been verified?

Current findings: The treatment duration and principal follow-up time of a directly eligible recurrence comparison are unverified. The 22.6 months in S01 is median follow-up, not a fixed 24-month endpoint. The 6 days per period in S02 and the 3 days in S03 are metabolic exposure periods.
Verification status: Unverified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: There are no direct comparative data with which to establish the principal recurrence time point and exposure duration.
Reason for missing information: Eligible treatment duration, cumulative exposure, recurrence after discontinuation, fixed follow-up, and person-years/censoring information are unverified.
Required materials and conditions: Actual treatment start/end, discontinuation, follow-up/censoring, and prespecified principal follow-up time
Materials to obtain first: Actual treatment start/end, discontinuation, follow-up/censoring, and prespecified principal follow-up time
Further research: Prespecify a defensible principal time point considering event accumulation and discontinuation/censoring, and report treatment duration separately from follow-up duration.
Remaining uncertainty: Eligible treatment duration, cumulative exposure, recurrence after discontinuation, fixed follow-up, and person-years/censoring information are unverified.
Conditions for verification: Distinguish the treatment duration, fixed time point, and time-to-event analysis of a directly eligible comparison within the verified scope.
Why this condition is needed: This is needed to avoid turning median follow-up or 3/6-day metabolic exposure into a fixed clinical recurrence period.
Application exceptions: Do not create a common minimum duration. Do not round a median of 22.6 months into a fixed 24-month result.
Referenced methods: M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation for testing were internally designed; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; design-specific adaptations were internally designed; M03 §3.2.1–3.2.4; details concerning dose, duration, and effect modification were internally designed; design-specific harms questions in M19 §19.2; details of temporal relationships were internally designed

Related sources S01 S02 S03

N12 · Can symptomatic new stones be distinguished from imaging-only events and residual-stone growth?

Current findings: The question's endpoint is symptomatic new calcium-oxalate stone recurrence. The manuscript does not combine new stones/residual-stone growth, imaging-only events, emergency care/procedures, and time to first recurrence. A separate result meeting this target definition was not verified within the composite events in S01.
Verification status: Unverified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The question's definition is fixed, but the target event actually measured and adjudicated in a directly eligible comparison is unverified.
Reason for missing information: Symptom adjudication, composition verification, assessor masking, differences in detection during follow-up, and overlap between event categories are unverified.
Required materials and conditions: Symptoms, imaging/diagnosis, stone composition, adjudicators, definitions of new and residual stones, and event collection procedures
Materials to obtain first: Symptoms, imaging/diagnosis, stone composition, adjudicators, definitions of new and residual stones, and event collection procedures
Further research: Apply event adjudication with group information masked where possible and standardized procedures for verifying symptoms, imaging, and composition.
Remaining uncertainty: Symptom adjudication, composition verification, assessor masking, differences in detection during follow-up, and overlap between event categories are unverified.
Conditions for verification: Link the definition, diagnosis, and adjudication of the target event and its distinction from other events to the direct result.
Why this condition is needed: This is needed to avoid combining different clinical and imaging events as the same recurrence outcome.
Application exceptions: Emergency care, procedures, and time to first recurrence are separate outcomes and are not all added together as a single event.
Referenced methods: M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; M08 Table 8.2.a, M03 §3.2.4; internal application; M03 §3.2.4; internally defined limits on extension; M19 §19.1.2–19.2.4; detailed distinctions were internally designed

Related sources S01

N13 · Have an effect estimate, CI, and P value for an eligible recurrence comparison been verified?

Current findings: In the original primary_result, source_id, estimate, CI, P, and n are all empty values, and the direction is unknown. Numerators/denominators, risk ratios/risk differences/hazard ratios/HRs, person-years, and censoring for eligible recurrence are also unverified. S01 8/24, S02 P<0.001, and the S08 HR were not transferred into these empty fields.
Verification status: Unverified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: A directly eligible comparative estimate cannot be verified within the retained material currently read. This does not mean an effect of 0.
Reason for missing information: The original estimate, interval, denominator, time, and effect of interest for the target event are unverified.
Required materials and conditions: Events/denominators and time by group, original risk ratio/risk difference/HR, CI, P value, and analysis definition
Materials to obtain first: Events/denominators and time by group, original risk ratio/risk difference/HR, CI, P value, and analysis definition
Further research: Report relative and absolute effects and intervals for prespecified symptomatic recurrence using the same analysis population and a fixed time point or a time-to-event model.
Remaining uncertainty: The original estimate, interval, denominator, time, and effect of interest for the target event are unverified.
Conditions for verification: Attribute the estimate, direction, measure, and interval of a directly eligible comparison to its event and time point.
Why this condition is needed: This is needed to avoid filling in a recurrence comparison effect with indirect proportions, metabolic-measure P values, or first-stone HRs.
Application exceptions: Preserve unverified values as empty values and do not make new calculations from rounded proportions or other outcomes.
Referenced methods: M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; design-specific adaptations were internally designed; M08 §8.2.2, M15 §15.3.1; internal application; M15 §15.3.1–15.3.3; internal application; M19 §19.2.2–19.2.4, M03 §3.2.3; internal application; M19 §19.1.2–19.2.4; internal application

Related sources

N14 · Have an actual design and allocation that support a causal comparison of recurrence been verified?

Current findings: S01 is a retrospective report of an exposure group alone, S02 is a randomized double-blind metabolic crossover trial, and S08 is an observational analysis of first stones. Allocation, concealment, and baseline balance in a direct recurrence comparison were not verified.
Verification status: Unverified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The actual existence of other designs does not establish a causal comparison for the target clinical event.
Reason for missing information: Allocation, concealment, design, confounding adjustment, and baseline balance in a direct recurrence comparison are unknown.
Required materials and conditions: Direct comparison methods, allocation/concealment, baseline risk, observational-study confounding/selection, and models
Materials to obtain first: Direct comparison methods, allocation/concealment, baseline risk, observational-study confounding/selection, and models
Further research: Prespecify a randomized comparison on top of the same usual care or an appropriate comparative design that explicitly addresses confounding and selection pathways.
Remaining uncertainty: Allocation, concealment, design, confounding adjustment, and baseline balance in a direct recurrence comparison are unknown.
Conditions for verification: Verify actual design, allocation, and confounding information for the target outcome, and distinguish the axes that must remain unverified.
Why this condition is needed: This is needed to avoid claiming that a causal comparison of the target recurrence has been resolved merely because a related study is labeled an RCT.
Application exceptions: Retain metabolic crossover trials and observational reports while distinguishing them from designs addressing the target event.
Referenced methods: M08 §8.1–8.2.3; internal application; M08 §8.2.2, M15 §15.3.1; internal application; design considerations in M19 §19.2.2–19.2.4; detailed confounding records were internally designed

Related sources S01 S02 S08

N15 · Can common treatments, deviations from medication use, and concomitant interventions be separated from vitamin C's contribution?

Current findings: In S01, sustained adherence, product, and frequency are unverified, and discontinuation/dose reduction related to hyperoxaluria is recorded. The acute dissolution in S09 is a case combining concurrent exposure to antibiotics and stenting with different exposure after discharge. The effects of concomitant interventions and deviations in a direct comparison are unverified.
Verification status: Unverified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: There is no eligible recurrence analysis that separates common care and exposure changes by group.
Reason for missing information: Fluid intake, diet, medications/procedures, medication adherence, changes by group, and ITT/adherence effects are unverified.
Required materials and conditions: Fluid intake/diet, medications/procedures, rescue treatment, adherence, exposure changes, and their handling in analysis by group
Materials to obtain first: Fluid intake/diet, medications/procedures, rescue treatment, adherence, exposure changes, and their handling in analysis by group
Further research: Collect fluid intake, diet, concurrent medications/procedures, rescue treatments, and actual medication use/discontinuation by group, and analyze them in accordance with the prespecified effect of interest.
Remaining uncertainty: Fluid intake, diet, medications/procedures, medication adherence, changes by group, and ITT/adherence effects are unverified.
Conditions for verification: Distinguish actual concomitant interventions and deviations from exposure needed to define the effect of interest from the unverified scope.
Why this condition is needed: This is needed to avoid attributing the results of concomitant treatments or exposure changes to the contribution of a single-ingredient oral preparation.
Application exceptions: Do not assume that there were no concurrent changes. The acute course with antibiotics/stenting in S09 is not an effect on recurrence prevention.
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; design considerations in M19 §19.2.2–19.2.4; detailed confounding records were internally designed

Related sources S01 S09

N16 · Have recurrence events, people, exposure time, and analysis denominators been verified?

Current findings: The 8/24 in S01 is the reported value for composite events in the exposure group. Numerators/denominators by group, event counts/person counts, person-years, and censoring for directly eligible recurrence were not verified. The 2 people with spontaneous passage or populations with other stone compositions are not added to a new-recurrence numerator.
Verification status: Unverified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The target event unit and the comparative analysis denominator are not verified within the currently retained scope.
Reason for missing information: Units for first/recurrent events, follow-up time, analysis n by group, and censoring are unverified.
Required materials and conditions: Numbers allocated/exposed, completing follow-up, and analyzed; recurrent events/people with events; follow-up time; and censoring tables
Materials to obtain first: Numbers allocated/exposed, completing follow-up, and analyzed; recurrent events/people with events; follow-up time; and censoring tables
Further research: Separate people with events from recurrent events using participant IDs and a time axis, and disclose denominators and censoring for first-recurrence and recurrent-event analyses.
Remaining uncertainty: Units for first/recurrent events, follow-up time, analysis n by group, and censoring are unverified.
Conditions for verification: Verify the analysis denominator, event unit, time, and interval of the direct result together.
Why this condition is needed: This is needed to avoid confusing data in which a person experiences multiple events with proportions of people or incidence rates.
Application exceptions: Do not turn the 8/24 count of people with composite events into an eligible incidence rate or a denominator specific to calcium-oxalate recurrence.
Referenced methods: M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; design-specific adaptations were internally designed; M19 §19.1.2–19.2.4; internal application; M08 §8.2.2, M15 §15.3.1; internal application

Related sources S01 S05

N17 · Who was included, lost to follow-up, or censored, and how was the target outcome handled?

Current findings: The 43 people identified and 24 included in S01 are retained, but missingness, censoring, and their handling for the target recurrence by group are unverified. Because an actually eligible comparison has not been verified, these values cannot be designated as an ITT denominator.
Verification status: Unverified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The retained inclusion flow alone cannot establish the impact of missingness/censoring on the target comparison.
Reason for missing information: The recruitment→exposure→follow-up→analysis flow, reasons for missingness, and sensitivity analyses by group are unverified.
Required materials and conditions: Participant flow, missing outcomes, censoring, reasons for exclusion, and analysis/sensitivity-analysis plans
Materials to obtain first: Participant flow, missing outcomes, censoring, reasons for exclusion, and analysis/sensitivity-analysis plans
Further research: Disclose losses to follow-up, missing event ascertainment, and reasons for censoring by group, and perform prespecified sensitivity analyses for missing data.
Remaining uncertainty: The recruitment→exposure→follow-up→analysis flow, reasons for missingness, and sensitivity analyses by group are unverified.
Conditions for verification: Distinguish actual participant flow from missingness/censoring of the target recurrence, and explicitly identify unverified handling.
Why this condition is needed: This is needed to avoid extending observations limited to the included exposure group to the entire recruited population or presenting them as results without missing data.
Application exceptions: Do not present unverified full texts or flow diagrams as evidence of no missing data or a definite magnitude of bias.
Referenced methods: M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; design-specific adaptations were internally designed; M08 §8.2.2, M15 §15.3.1; internal application; M19 §19.1.2–19.2.4, M04 §4.6.3; internal application

Related sources S01

N18 · Were symptom assessment, imaging, and event adjudication conducted under the same conditions across groups?

Current findings: The retained manuscript distinguishes symptomatic new stones, imaging-only findings, growth, and urinary measures. Whether the same examination schedule, assessor masking, and event adjudication were applied in a direct comparison is unverified.
Verification status: Unverified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: There are no direct data with which to compare the actual collection and measurement procedures for the target recurrence.
Reason for missing information: Imaging frequency, symptom contacts, diagnostic/composition adjudication, and missingness by group are unverified.
Required materials and conditions: Examination schedules, symptom collection, imaging/composition testing, masking/adjudicators, and detection/reporting pathways
Materials to obtain first: Examination schedules, symptom collection, imaging/composition testing, masking/adjudicators, and detection/reporting pathways
Further research: Apply the same follow-up/symptom contacts and prespecified event adjudication procedures across groups, and disclose examination frequency together with missing adjudication.
Remaining uncertainty: Imaging frequency, symptom contacts, diagnostic/composition adjudication, and missingness by group are unverified.
Conditions for verification: Explain the collection, adjudication, and detection conditions for the direct target event and what remains unverified.
Why this condition is needed: This is needed to avoid mistaking imaging findings in a more frequently examined group for an actual difference in symptomatic recurrence.
Application exceptions: Do not mark masking or equivalent detection as met merely because imaging data are objective.
Referenced methods: M08 Table 8.2.a, M03 §3.2.4; internal application; M19 §19.1.2–19.2.4; detailed distinctions were internally designed; M19 §19.1.2–19.2.4, M04 §4.6.3; internal application

Related sources S01

N19 · Can the reported interval and a clinically important difference in recurrence be interpreted?

Current findings: The CI and effect estimate for eligible recurrence are unverified (the historical manuscript's explanation of CX/EX). A sample of 24 participants or a large sample in another cohort was not treated as sufficient precision for recurrence. An important difference and an appropriate minimum duration are also undetermined.
Verification status: Unverified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: Without a direct interval and a justified criterion for clinical importance, their relationship to evidence sufficiency cannot be assessed.
Reason for missing information: The eligible CI, variance/event count, important difference, and design basis for precision are unverified.
Required materials and conditions: Direct recurrence effect, CI, events/denominators, and a justified criterion for an important difference
Materials to obtain first: Direct recurrence effect, CI, events/denominators, and a justified criterion for an important difference
Further research: Prespecify a difference in recurrence justified from clinical and patient perspectives, and report the effect interval and basis for precision for that event and follow-up.
Remaining uncertainty: The eligible CI, variance/event count, important difference, and design basis for precision are unverified.
Conditions for verification: Record the relationship between the interval for the selected event and the importance criterion, or the reason this remains unverified.
Why this condition is needed: This is needed to avoid declaring recurrence evidence sufficient on the basis of publication count, sample size, or statistical significance alone.
Application exceptions: Do not create uniform minimum participant counts, minimum durations, or numerical thresholds for important differences. Do not calculate an absent CI from indirect reports.
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; design-specific adaptations were internally designed

Related sources

N20 · Have prespecified recurrence endpoints, the principal time point, and analyses been compared with actual reporting?

Current findings: Registration, protocol, and analysis plan for directly eligible recurrence are unverified. Preserve urinary pH as the original main endpoint and stones as a secondary endpoint in S01; unverified registration does not establish whether selective reporting occurred. Historical access to the official S15 record reached only a shell.
Verification status: Unverified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The current scope contains no records with which to compare planned and actual endpoints and analyses for the target comparison.
Reason for missing information: The timing of prospective registration, original protocol, principal time point, analysis changes, and consistency with results are unverified.
Required materials and conditions: Registration, protocol, analysis plan, amendment history, and actual results tables for the direct trial
Materials to obtain first: Registration, protocol, analysis plan, amendment history, and actual results tables for the direct trial
Further research: Disclose the recurrence event definition, principal time point, comparator, analysis/interval, missing-data handling, and reasons for changes in advance, and compare them with the final results.
Remaining uncertainty: The timing of prospective registration, original protocol, principal time point, analysis changes, and consistency with results are unverified.
Conditions for verification: Explain prespecification status and the parts not compared at each relevant location.
Why this condition is needed: This is needed to avoid turning unavailable planning materials into a definite conclusion of nonregistration or selective reporting.
Application exceptions: Do not use a registration shell or a mirror lead as an actually eligible recurrence protocol.
Referenced methods: M08 Table 8.2.a, M04 §4.6.3; internal application; M04 §4.5, §4.6.3; limits on the current data transformation reflect the user-defined scope and internal design

Related sources S01 S15

N21 · Which population, exposure, and comparison does the crossover metabolic result in S02 describe?

Current findings: S02 compared ascorbic acid 1 g twice daily with a matching placebo during two 6-day controlled-diet periods in 12 calcium-oxalate stone formers and 12 nonformers. Testing during the final 2 days of each period reported urinary oxalate of 41.0 mg versus 30.5 mg in stone formers, P < 0.001. The authors' description of a 33% increase is preserved as originally reported and was not recalculated. This is not a recurrence event result.
Verification status: Partly verified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The metabolic crossover result is included in the current extraction, but it does not answer an eligible symptomatic recurrence comparison.
Reason for missing information: Direct recurrence events and long-term follow-up are unverified. Detailed methods within the unread full-text scope also remain a separate gap.
Required materials and conditions: Original S02 methods/results tables, population, duration, sample, crossover contrast, and urinary oxalate units
Materials to obtain first: Original S02 methods/results tables, population, duration, sample, crossover contrast, and urinary oxalate units
Further research: For metabolic crossover trials, disclose the original paired comparison, diet, and sequence; assess the clinical recurrence question through separate long-term event follow-up and comparisons.
Remaining uncertainty: Direct recurrence events and long-term follow-up are unverified. Detailed methods within the unread full-text scope also remain a separate gap.
Conditions for verification: Distinguish the actual roles of the 12 calcium-oxalate stone formers and 12 nonformers, 6-day periods, 1 g twice daily, 41.0/30.5 mg, and P.
Why this condition is needed: This is needed to retain controlled short-term urinary results while distinguishing them from clinical recurrence outcomes.
Application exceptions: Do not turn urinary oxalate or the authors' description of a 33% increase into a probability of symptomatic recurrence.
Referenced methods: M03 §3.2.1; detailed population criteria were internally designed; M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation for testing were internally designed; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; design-specific adaptations were internally designed; M08 §8.1–8.2.3; internal application; M03 §3.2.4; internally defined limits on extension

Related sources S02

N22 · Have the sequence, washout period, paired variance, and carryover effects in S02 been verified?

Current findings: S02 was indexed as a randomized double-blind crossover trial, but detailed values for washout, sequence, paired variance, product, and adverse events were not verified in the abstract accessed. The two populations of 12 participants each were not treated as a 24-participant parallel-group comparison of recurrence, and no new CI was calculated for the urinary outcome.
Verification status: Unverified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The current abstract extraction alone cannot verify paired uncertainty between crossover periods or the handling of carryover and sequence.
Reason for missing information: Washout, crossover sequence, paired variance, original analysis, product, and adverse-event counts are unverified.
Required materials and conditions: S02 full text, allocation sequence, washout period, results by period, paired variance, and carryover/deviation analyses
Materials to obtain first: S02 full text, allocation sequence, washout period, results by period, paired variance, and carryover/deviation analyses
Further research: Report participant-level period contrasts, period/sequence, carryover effects, and missingness from the original crossover data according to the prespecified plan, and disclose the necessary paired uncertainty.
Remaining uncertainty: Washout, crossover sequence, paired variance, original analysis, product, and adverse-event counts are unverified.
Conditions for verification: State the boundary between the currently verified crossover design and the unverified sequence and paired uncertainty.
Why this condition is needed: This is needed to avoid calculating a parallel-group CI or a clinical event difference from crossover sample sizes and means alone.
Application exceptions: Do not fill unavailable methods with assumptions of no washout, definite carryover, or paired variance of 0.
Referenced methods: M08 §8.1–8.2.3; internal application; M08 §8.2.2, M15 §15.3.1; internal application; M15 §15.3.1–15.3.3; internal application; M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; design-specific adaptations were internally designed

Related sources S02

N23 · What was compared in the before–after metabolic study S03?

Current findings: S03 provides before–after data from 47 adult calcium stone formers, of whom 23 received 1 g/day and 24 received 2 g/day for 3 days, plus data from 20 healthy participants receiving 1 g/day. It addresses urinary oxalate, pH, and the Tiselius crystallization index, not a long-term recurrence comparison. The healthy participants are not recurrence comparators for patients with prior stones, and the stone-former population was not verified as consisting entirely of calcium-oxalate stones.
Verification status: Partly verified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The population and short-term metabolic role are retained, but the population, event, and comparison for the target recurrence are not verified.
Reason for missing information: The exact formulation, paired uncertainty, adverse events, and symptomatic recurrence comparisons by composition are unverified.
Required materials and conditions: Original S03 methods/results, stone composition, exposure/testing by group, the role of healthy participants, and paired data
Materials to obtain first: Original S03 methods/results, stone composition, exposure/testing by group, the role of healthy participants, and paired data
Further research: Disclose paired comparisons, composition, and diet/exposure for short-term metabolic data; study recurrence in adults with verified prior stones using a separate comparator receiving the same care.
Remaining uncertainty: The exact formulation, paired uncertainty, adverse events, and symptomatic recurrence comparisons by composition are unverified.
Conditions for verification: Preserve the role of the 3-day urinary measures for the groups of 23/24 among the 47 stone formers and for the 20 healthy participants, and separate them from the target event.
Why this condition is needed: This is needed to avoid using healthy participants as recurrence comparators for people with prior stones or extending before–after changes into an effect of adding treatment.
Application exceptions: The description 'calcium stone formers' alone does not establish that everyone had a verified history of calcium-oxalate recurrence.
Referenced methods: M03 §3.2.1; detailed population criteria were internally designed; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; design-specific adaptations were internally designed; M08 §8.2.2, M15 §15.3.1; internal application; M03 §3.2.4; internally defined limits on extension

Related sources S03

N24 · Have detailed results and participant overlap between S04 and S17 been verified?

Current findings: For S04 Massey 2005 and S17 Chai 2004, only indexed titles/bibliographic information from the original publications is retained; detailed results, samples, and doses are not verified in this work. Participant overlap remains unresolved, so they remain in a conservative single cluster, F04. The DOI/PMID for S17 are empty values, and the two papers were not added as independent replications.
Verification status: Unverified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: Because detailed original results and the overlap relationship have not been acquired, actual replication or recurrence results cannot be verified.
Reason for missing information: Original full texts, detailed N/dose/results, funding, and participant overlap between Chai/Massey are unverified.
Required materials and conditions: Full texts of both original reports, populations/recruitment, study IDs, participant overlap, and original results tables
Materials to obtain first: Full texts of both original reports, populations/recruitment, study IDs, participant overlap, and original results tables
Further research: Compare recruitment periods, institutions, participants, and designs in the two original reports to verify whether they belong to the same family, and update only the scope for which results have actually been acquired.
Remaining uncertainty: Original full texts, detailed N/dose/results, funding, and participant overlap between Chai/Massey are unverified.
Conditions for verification: Separate the titles/bibliographic information actually read from unverified methods, numbers, and duplication, and do not sum participants or trials.
Why this condition is needed: This is needed to avoid counting the existence of metadata as acquisition of actual results or as two independent replications.
Application exceptions: A conservative single cluster is not a conclusion proving that the participants were the same. Leave unverified DOI/PMID information as it is.
Referenced methods: The 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; the separation of access and reading and the hyperlink contract were internally designed; M04 §4.6.1–4.6.2, M15 §15.3.1; internal application

Related sources S04 S17

N25 · How are the cystine course and spontaneous passage in S05 distinguished?

Current findings: The translated abstract of S05 reports that, among 17 people with cystine stones receiving 5 g/day, recurrence remained unchanged in 5 people and another strategy was needed. The 2 people with spontaneous passage are not a recurrence numerator. Children are also indexed, and the adult-only denominator, duration, and matched comparator are unverified. This shows that human event data exist, but it is not a direct calcium-oxalate comparison.
Verification status: Partly verified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The unfavorable event description is retained, but composition, age, comparator, and event definition differ from the target question or are unverified.
Reason for missing information: The adult-only denominator, follow-up duration, recurrence definition, concomitant interventions, identity of a pure single-ingredient preparation, and comparator are unverified.
Required materials and conditions: S05 German full text, composition, ages, event definitions, exposure/time, comparators, and complete participant flow
Materials to obtain first: S05 German full text, composition, ages, event definitions, exposure/time, comparators, and complete participant flow
Further research: For cystine data, separately verify composition, age, recurrence versus passage, concomitant interventions/exposure, and follow-up in the original report, and analyze them separately from calcium-oxalate studies.
Remaining uncertainty: The adult-only denominator, follow-up duration, recurrence definition, concomitant interventions, identity of a pure single-ingredient preparation, and comparator are unverified.
Conditions for verification: Preserve the respective roles of the 17 participants, 5 g/day, 5 people with unchanged recurrence, 2 people with spontaneous passage, and the limitations concerning pediatric indexing and duration.
Why this condition is needed: This is needed to retain contrary or unfavorable human results without mixing other stone compositions and events into the target recurrence.
Application exceptions: Do not add the 2 people with spontaneous passage to new-recurrence events or turn the 17 participants into a denominator for adult calcium-oxalate recurrence.
Referenced methods: M03 §3.2.1; detailed population criteria were internally designed; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; design-specific adaptations were internally designed; M04 §4.6.1–4.6.2, M15 §15.3.1; internal application; M19 §19.1.2–19.2.4; internal application

Related sources S05

N26 · To what extent has the favorable report of 4 people in S06 been verified?

Current findings: S06 retains a description from an indexed abstract excerpt that ascorbic acid monotherapy was favorable in 4 young patients with cystinuria. Exact ages, doses, event denominators, comparators, and follow-up in the original full text are unverified. The existence of a favorable result is not erased, and it is not promoted to recurrence efficacy for this question.
Verification status: Partly verified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: A favorable small-scale description exists, but eligibility regarding composition, age, events, exposure, and comparison is not verified.
Reason for missing information: The full text, adult eligibility, dose/duration, event denominators, comparators, follow-up, and concomitant interventions are unverified.
Required materials and conditions: S06 full text, exact ages, exposure/product, events, denominators, comparison, follow-up, and concomitant interventions
Materials to obtain first: S06 full text, exact ages, exposure/product, events, denominators, comparison, follow-up, and concomitant interventions
Further research: Verify the identity, ages, composition, exposure, events/time, and comparator in the original small report, then attribute the result only to the scope of the corresponding question.
Remaining uncertainty: The full text, adult eligibility, dose/duration, event denominators, comparators, follow-up, and concomitant interventions are unverified.
Conditions for verification: Record both the existence of the favorable description involving 4 people and the unverified detailed eligibility and original numerical values.
Why this condition is needed: This is needed to retain a favorable report without filling in unavailable conditions as evidence of target efficacy.
Application exceptions: Do not treat the description 'young patients with cystinuria' as equivalent to adults with prior calcium-oxalate stones.
Referenced methods: M03 §3.2.1; detailed population criteria were internally designed; M04 §4.6.3, M15 §15.3.1–15.3.3; the separation of statuses was internally designed; M04 §4.6.1–4.6.2, M15 §15.3.1; internal application

Related sources S06

N27 · Have the favorable urinary result in S07 and the original report date been distinguished?

Current findings: The original publisher abstract for S07 records 31 people with cystinuria, 5 g/day, and favorable urinary cystine results. Controlled longitudinal recurrence is not verified. The later digitization date does not indicate a new study in 2010; the original report dates to 1982.
Verification status: Partly verified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The favorable urinary description and original publication identity are retained, but this is not a clinical recurrence comparison for the target composition.
Reason for missing information: The original clinical event definition, comparison, follow-up, and adult calcium-oxalate eligibility are unverified.
Required materials and conditions: Original 1982 S07 report, clinical events/follow-up, composition, exposure, and publication/digital identity
Materials to obtain first: Original 1982 S07 report, clinical events/follow-up, composition, exposure, and publication/digital identity
Further research: Compare the original publication identity with the actual patient data, and verify cystine urinary measures and clinical recurrence as separate outcomes and follow-up.
Remaining uncertainty: The original clinical event definition, comparison, follow-up, and adult calcium-oxalate eligibility are unverified.
Conditions for verification: Distinguish the original 1982 report from the digitization date, and distinguish the scope of the 31 participants, 5 g/day, and urinary outcomes.
Why this condition is needed: This is needed to avoid transferring improvements in urinary measures to improved recurrence or counting a digital date as a new study.
Application exceptions: Do not turn the description of urinary cystine and sediment in 31 people into a controlled clinical recurrence result.
Referenced methods: The distinction between studies and reports in M04 §4.6.1–4.6.2; cohort/outcome linkage is an internal application; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; M04 §4.6.3, M15 §15.3.1–15.3.3; the separation of statuses was internally designed; M03 §3.2.4; internally defined limits on extension

Related sources S07

N28 · How does the first-stone cohort result in S08 differ from the recurrence question?

Current findings: S08 is an observational analysis reporting 6,245 first stones among 156,735 women and 40,536 men, with median follow-up of 11.3–11.7 years. For supplemental vitamin C ≥ 1,000 mg/day versus no supplementation in men, the adjusted HR was 1.19 (95% CI 1.01–1.40), with a trend P = 0.001; the abstract did not report an association in women. Distinguish dietary C, supplements, and sex, and do not use the first-occurrence association as a causal effect on recurrence in people with prior calcium-oxalate stones.
Verification status: Partly verified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The first-occurrence association and reported values from the large cohorts are retained, but the population, event, and design differ from a direct recurrence comparison.
Reason for missing information: The original full text, exact supplemental formulation, detailed history-based exclusions/recurrence subgroups, covariates, and overlap are unverified.
Required materials and conditions: Original S08 population/history, sex, exposure, covariates, events/time, HR/CI, and records of cohort reuse
Materials to obtain first: Original S08 population/history, sex, exposure, covariates, events/time, HR/CI, and records of cohort reuse
Further research: Verify exclusions based on stone history, exposure/formulation, covariates, events/follow-up by sex, and reuse of the original cohorts; study the causal recurrence question through a separate comparison in a population with prior stones.
Remaining uncertainty: The original full text, exact supplemental formulation, detailed history-based exclusions/recurrence subgroups, covariates, and overlap are unverified.
Conditions for verification: Preserve the actual roles of the 156,735 women, 40,536 men, 6,245 events, median 11.3–11.7 years, and the supplement contrast in men.
Why this condition is needed: This is needed to avoid transferring a first-occurrence association in a large observational sample to a causal effect on recurrence in people with prior stones.
Application exceptions: Do not create a combined effect or denominator that erases sex differences, unverified formulations, or cohort reuse.
Referenced methods: M03 §3.2.1; detailed population criteria were internally designed; M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation for testing were internally designed; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; design-specific adaptations were internally designed; M08 §8.2.2, M15 §15.3.1; internal application; M04 §4.6.1–4.6.2, M15 §15.3.1; internal application; 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 were internally designed

Related sources S08

N29 · To which interventions and event is the acute dissolution course in S09 attributable?

Current findings: S09 describes the acute dissolution course in 1 older man, with antibiotics, stenting, and ascorbic acid used concurrently and different exposure after discharge. Stone composition was inferred, and these are not controlled recurrence data. The retained title is a descriptive label, not a transcription of the exact original title.
Verification status: Partly verified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The case's course and limitations are retained, but it is not a comparison that isolates the recurrence effect of a single ingredient.
Reason for missing information: The exact original title, composition confirmation, contributions of individual concomitant interventions, long-term comparative recurrence, and full text are unverified.
Required materials and conditions: Original S09 case report, exact title/bibliographic information, stone composition, concurrent/subsequent exposure, and acute/recurrence follow-up
Materials to obtain first: Original S09 case report, exact title/bibliographic information, stone composition, concurrent/subsequent exposure, and acute/recurrence follow-up
Further research: Separately verify the exposure timeline, concomitant interventions, composition confirmation, and acute dissolution versus long-term recurrence in the original case report, and assess the isolated contribution through an appropriate separate comparison.
Remaining uncertainty: The exact original title, composition confirmation, contributions of individual concomitant interventions, long-term comparative recurrence, and full text are unverified.
Conditions for verification: Preserve the acute course with concomitant treatments in 1 older man, different exposure after discharge, uncertainty about composition, and the title's status.
Why this condition is needed: This is needed to avoid attributing the course involving antibiotics, stenting, and acidification in a single case to recurrence prevention by a single-ingredient oral preparation.
Application exceptions: Do not present a descriptive title as the exact title of the original article or turn inferred composition into confirmed composition.
Referenced methods: M03 §3.2.1; detailed population criteria were internally designed; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; 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 were internally designed

Related sources S09

N30 · Have the page actually verified in S10 and recurrence under other treatments been distinguished?

Current findings: S10 discusses several treatments for cystinuria; the original abstract and a single page, p.1563, were historically verified. This is not recorded as reading the entire article's full text. A controlled recurrence result for vitamin C alone was not verified, and results from other treatments or cited articles are not transferred to C-alone results.
Verification status: Partly verified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The role of the partial original page is linked, but this is not verification of the target recurrence result for the single ingredient alone.
Reason for missing information: The complete methods/results, the comparison and events/denominators for C alone, and details of the cited families are unverified.
Required materials and conditions: Original S10 full text, populations/compositions by treatment, exposure, comparison/recurrence, and cited original reports
Materials to obtain first: Original S10 full text, populations/compositions by treatment, exposure, comparison/recurrence, and cited original reports
Further research: Compare original exposures, denominators, and recurrence by treatment and the cited families, and clearly record the page/full-text scope actually verified.
Remaining uncertainty: The complete methods/results, the comparison and events/denominators for C alone, and details of the cited families are unverified.
Conditions for verification: Preserve partial verification of the abstract and p.1563 and the unverified comparison of C alone.
Why this condition is needed: This is needed to avoid presenting a discussion of cystine treatment on a single page as verification of the entire full text or as a recurrence comparison of C alone.
Application exceptions: Do not count cited studies as new patients or assign recurrence values from other treatments to vitamin C.
Referenced methods: The 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; the separation of access and reading and the hyperlink contract were internally designed; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; M03 §3.2.4; internally defined limits on extension

Related sources S10

N31 · What evidence map and time frame does the S11 review provide?

Current findings: S11 is an online review dated 2026-07-31, preceding the evidence cutoff date of 2026-09-16. Its abstract/reference list was used as an evidence map of urinary-risk studies; it is not a new recurrence trial. A review with an earlier search end date does not establish that the current search is exhaustive, nor does it provide replication independent in funding.
Verification status: Partly verified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The review's mapping and timing roles are retained, but these are neither direct recurrence results nor current exhaustive acquisition.
Reason for missing information: The review full text, complete search scope, recent omissions, and eligibility/funding of the original references are unverified.
Required materials and conditions: S11 review full text, search end date/scope, original reference list, inclusion/exclusion, and funding
Materials to obtain first: S11 review full text, search end date/scope, original reference list, inclusion/exclusion, and funding
Further research: Compare the review's search end date and inclusion scope with the identities of the original reports, and update the observations in the corresponding row only when a new direct comparison has actually been acquired.
Remaining uncertainty: The review full text, complete search scope, recent omissions, and eligibility/funding of the original references are unverified.
Conditions for verification: Preserve the review's map of urinary risks, the roles of the original trials, and the limitations of access and search scope.
Why this condition is needed: This is needed to avoid counting the review as an independent new trial or as completion of a current exhaustive search.
Application exceptions: Even though the online publication on 2026-07-31 preceded the evidence cutoff date, it does not mean that all studies have currently been verified.
Referenced methods: The distinction between studies and reports in M04 §4.6.1–4.6.2; cohort/outcome linkage is an internal application; M04 §4.5, §4.6.3; limits on the current data transformation reflect the user-defined scope and internal design; M04 §4.6.1–4.6.2, M15 §15.3.1; internal application

Related sources S11

N32 · Have the registration leads in S15 and S16 been distinguished from the content actually verified?

Current findings: For S15 NCT06989320, only the official registration shell was historically accessed; substantive fields, registration timing, and results are unverified. S16 Carbon-13 Ascorbic Acid oral loading is a discovery lead from a 3rd-party mirror, and the official ID/version is unverified. They are not linked as the same trial, and lack of access is not turned into a completed negative search or absence of recurrence trials.
Verification status: Unverified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The substantive original registrations/protocols/results and the identities of the two leads could not be verified.
Reason for missing information: Official IDs, versions, registration timing, eligible populations/exposures, results, and the identity relationship are unverified.
Required materials and conditions: Complete official S15 registration/amendment history, original official S16 ID/version, protocols, and results
Materials to obtain first: Complete official S15 registration/amendment history, original official S16 ID/version, protocols, and results
Further research: Verify each lead's official identity, original version, population/exposure, recurrence endpoint, and result availability, and link them only after actually checking whether they are the same study.
Remaining uncertainty: Official IDs, versions, registration timing, eligible populations/exposures, results, and the identity relationship are unverified.
Conditions for verification: Record access failures involving the official shell, the mirror's status as a discovery lead, and the unverified ID at their respective locations.
Why this condition is needed: This is needed to avoid turning an official record shell and a 3rd-party mirror lead into an eligible completed trial or a negative search.
Application exceptions: Do not assume that NCT06989320 and the Carbon-13 oral-loading mirror are the same trial.
Referenced methods: Data collection/selection principles in M04 §4.5–4.6; the separation of access and reading and the hyperlink contract were internally designed; M04 §4.5, §4.6.3; limits on the current data transformation reflect the user-defined scope and internal design; M08 Table 8.2.a, M04 §4.6.3; internal application

Related sources S15 S16

N33 · Are favorable/unfavorable results and bibliographic differences being mistaken for conflicts about the same effect?

Current findings: Favorable cystine urinary results and small-scale clinical courses are retained alongside unchanged recurrence, hyperoxaluria, and first-occurrence associations. Different compositions, endpoints, and designs are not turned into statistical conflicts about the same recurrence effect. For S01, a historical bibliographic difference is recorded in which the original PDF's 2017 publication identity took precedence, but the exact value on the other page and whether a correction occurred are currently unverified.
Verification status: Partly verified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: Indirect evidence in the contrary direction and bibliographic differences are retained, but a conflict concerning the same directly eligible effect is not verified.
Reason for missing information: Contrary/unpublished results for the same recurrence contrast, the exact value on the other S01 bibliographic page, and any original correction are unverified.
Required materials and conditions: Actual contrasts, events/compositions, durations, bibliographic versions, and contrary/corrected material for each original report
Materials to obtain first: Actual contrasts, events/compositions, durations, bibliographic versions, and contrary/corrected material for each original report
Further research: Compare original populations, ingredients, contrasts, time points, and outcomes/versions to establish whether a conflict concerns the same question/analysis, and verify bibliographic corrections against original evidence.
Remaining uncertainty: Contrary/unpublished results for the same recurrence contrast, the exact value on the other S01 bibliographic page, and any original correction are unverified.
Conditions for verification: Distinguish the direct and indirect roles of unfavorable/favorable results from differences between records and unverified information.
Why this condition is needed: This is needed to avoid selectively retaining only favorable evidence or turning different outcomes into a statistical conflict about the same effect.
Application exceptions: If the other exact value underlying the publication-identity difference in S01 is unavailable, do not invent a new year or a correction event.
Referenced methods: M04 §4.6.3, M15 §15.3.1–15.3.3; the separation of statuses was internally designed; M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; M04 §4.6.1–4.6.2, M15 §15.3.1; internal application

Related sources S01 S05 S06 S07 S08

N34 · Have funding, product provision, roles, and conflicts of interest for the direct evidence been verified?

Current findings: Because there is no directly eligible recurrence evidence, the current independence axis is an empty value. Funding records in each evidence entry and historical access to the declaration section of S01 are retained. The package's I1 is a trace of a delivery default and is not used as verification of actual mixed funding or as a new independence score.
Verification status: Unverified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: Funding/provision and roles for directly eligible evidence could not be verified, and the package designation alone cannot support an assessment.
Reason for missing information: Funding, internal support, product provision, research roles, and independence of linked families for an eligible comparison are unverified.
Required materials and conditions: Funding/conflicts of interest, internal support, product provision, and design/analysis/publication roles in original eligible reports
Materials to obtain first: Funding/conflicts of interest, internal support, product provision, and design/analysis/publication roles in original eligible reports
Further research: Verify funding, product provision, and actual design/analysis/publication roles for the original eligible comparison, and separately disclose unverified items and the independence of linked families.
Remaining uncertainty: Funding, internal support, product provision, research roles, and independence of linked families for an eligible comparison are unverified.
Conditions for verification: Distinguish declarations actually read from unverified information, ineligible roles, and historical designations.
Why this condition is needed: This is needed to avoid turning unverified information into absence of support or conflicts of interest, or into independent replication.
Application exceptions: The delivery package's default I1 designation is not an empirically verified finding of mixed funding. Do not create an independence score without eligible evidence.
Referenced methods: Chamgap's own independence and attribution criteria. The official methods sections used in this pilot do not substantiate every detail of this item.

Related sources S01 S02 S05 S08

N35 · Have safety events in S01 been distinguished from comparative risk?

Current findings: S01 records hyperoxaluria-related exposure changes in 2 of 24 people (1 discontinuation and 1 dose reduction). This is a retained safety signal, not a recurrence numerator from the same report or a risk estimate by comparator. Event definitions, risk by exposure time, and complete collection of other adverse events are unverified.
Verification status: Partly verified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: Exposure changes are present in the verifiable extraction, but direct comparative risk and comprehensive harm surveillance are not verified.
Reason for missing information: The comparator, equivalent testing/exposure time, distinction of clinical harms, and denominators for all adverse events/discontinuations are unverified.
Required materials and conditions: S01 event definitions, exposure time, original flow of 2 people/24 people, comparator, dose reduction/discontinuation, and safety follow-up
Materials to obtain first: S01 event definitions, exposure time, original flow of 2 people/24 people, comparator, dose reduction/discontinuation, and safety follow-up
Further research: Collect hyperoxaluria/clinical harms and discontinuations/dose reductions by group under the same formulation, exposure-time, and testing criteria, and disclose events together with exposed participant counts and time.
Remaining uncertainty: The comparator, equivalent testing/exposure time, distinction of clinical harms, and denominators for all adverse events/discontinuations are unverified.
Conditions for verification: Preserve the 1 discontinuation and 1 dose reduction, the noncomparative/mixed population, and the limitations concerning exposure duration.
Why this condition is needed: This is needed to retain observed exposure changes without mistaking them for causal risk estimates or the proportion with any adverse event.
Application exceptions: Do not turn the 2 people with hyperoxaluria-related changes into 2 clinical new-stone events or a between-group risk difference.
Referenced methods: M19 §19.1.2–19.2.4; detailed distinctions were internally designed; design-specific harms questions in M19 §19.2; details of temporal relationships were internally designed; M19 §19.2.2–19.2.4, M03 §3.2.3; internal application; M19 §19.1.2–19.2.4; internal application; M19 §19.1.2–19.2.4; internal application

Related sources S01

N36 · Which population, dose, and duration does the report of gastritis-related discontinuation in S05 concern?

Current findings: The translated abstract of S05 records 3 gastritis-related treatment discontinuations among 17 people with cystine stones receiving 5 g/day. Pediatric indexing is included, and the adult-only denominator, duration, and comparator are unverified. This is not used as a comparative risk rate in the target adult calcium-oxalate population.
Verification status: Partly verified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The unfavorable discontinuation report is retained, but directness regarding population, time, and comparator is not verified.
Reason for missing information: The adult analysis denominator, gastritis definition, exposure time, comparator, concomitant interventions, and completeness of event collection are unverified.
Required materials and conditions: S05 gastritis definition, flow of 3 people/17 people, adults/children, 5 g/day, duration, and other treatments/risks
Materials to obtain first: S05 gastritis definition, flow of 3 people/17 people, adults/children, 5 g/day, duration, and other treatments/risks
Further research: Verify original ages, definitions of gastritis/discontinuation, exposure time, concurrent treatments, and events/denominators; study harms for the target formulation/population through separate comparative surveillance.
Remaining uncertainty: The adult analysis denominator, gastritis definition, exposure time, comparator, concomitant interventions, and completeness of event collection are unverified.
Conditions for verification: Retain the 17 people with cystine stones, 5 g/day, and 3 gastritis-related discontinuations together with unverified age/duration and comparator information.
Why this condition is needed: This is needed to avoid omitting a safety report from a high-dose population with another stone type or transferring it to comparative risk in the target adults.
Application exceptions: Do not calculate the 3 discontinuations as a risk rate over a defined period in adults with calcium-oxalate stones.
Referenced methods: M19 §19.1.2–19.2.4; detailed distinctions were internally designed; M19 §19.1.2–19.2.4; internal application; M19 §19.1.2–19.2.4; internal application; M19 §19.1.2–19.2.4; internal application

Related sources S05

N37 · Have the warnings in the official injection label S12 been separated from oral evidence?

Current findings: The S12 ASCOR injection label records warnings concerning intravenous oxalate nephropathy/stones, impaired renal function, dialysis, and prior oxalate stones. G6PD-related hemolysis belongs to the high-dose/intravenous context. This is a buffered intravenous preparation for short-term treatment of scurvy, distinct from a pure oral supplement, so intravenous event rates or safety are not transferred to oral use.
Verification status: Partly verified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The routes and populations of the historical official warnings are retained, but they do not constitute a quantitative comparison of the target oral risk.
Reason for missing information: Renal and hemolytic events, comparator denominators, and special-population risks for the target oral formulation and dose/time are unverified.
Required materials and conditions: Route/formulation, warnings, and at-risk populations in the original ASCOR label, and actual comparative data on oral harms
Materials to obtain first: Route/formulation, warnings, and at-risk populations in the original ASCOR label, and actual comparative data on oral harms
Further research: Verify route, formulation, at-risk populations, and event definitions in the official label, and study renal/hemolytic harms of the target oral exposure through separate exposure-specific comparisons and surveillance.
Remaining uncertainty: Renal and hemolytic events, comparator denominators, and special-population risks for the target oral formulation and dose/time are unverified.
Conditions for verification: Distinguish intravenous oxalate nephropathy/stones, renal function/dialysis/prior history, and the high-dose/intravenous G6PD context.
Why this condition is needed: This is needed to preserve official warnings without transferring risk frequencies or efficacy from another route to this oral preparation.
Application exceptions: Warnings for a buffered intravenous scurvy preparation are neither event rates nor assurances of safety for a pure oral preparation.
Referenced methods: M03 §3.2.2–3.2.3; reverse-direction labeling and adaptation for testing were internally designed; M19 §19.1.2–19.2.4; internal application; Chamgap's own interpretive boundary. M19 principles are referenced; no formal causality tool was applied; M19 §19.1.2–19.2.4; internal application

Related sources S12

N38 · Have the general upper limit and harms in S13 been distinguished from an assurance of safety for stone patients?

Current findings: S13 records diarrhea, nausea, and abdominal pain from the NIH consumer document, together with the context of high-dose iron overload in hemochromatosis. The adult upper limit of 2,000 mg/day is a general limit for the total from all sources, not an assurance of safety for stone patients. The consumer document was historically read; this is distinguished from the failed access to the health-professional page.
Verification status: Partly verified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: General official information is retained, but it does not verify comparative safety or a prescription for the target patients/exposure.
Reason for missing information: Quantitative harms by stone history, total exposure, and iron metabolism, and specific safety data in pregnancy/lactation and children are unverified.
Required materials and conditions: Upper limit/population and gastrointestinal/iron warnings in the NIH consumer material, and actual exposure-specific safety data in the target patients
Materials to obtain first: Upper limit/population and gastrointestinal/iron warnings in the NIH consumer material, and actual exposure-specific safety data in the target patients
Further research: Separately verify total dietary/supplemental exposure, stone history, and iron metabolism/symptoms, and assess patient-specific safety questions through actual exposure- and population-specific comparisons/surveillance.
Remaining uncertainty: Quantitative harms by stone history, total exposure, and iron metabolism, and specific safety data in pregnancy/lactation and children are unverified.
Conditions for verification: Preserve the total of 2,000 mg/day from all sources and the context of diarrhea/nausea/abdominal pain and iron overload.
Why this condition is needed: This is needed to avoid mistaking the general adult upper limit for a safe prescribed dose or a no-harm threshold in stone patients.
Application exceptions: Do not represent reading the full consumer document as reading the health-professional page. Intake below the upper limit does not assure stone safety.
Referenced methods: M19 §19.1.2–19.2.4; internal application; Chamgap's own interpretive boundary. M19 principles are referenced; no formal causality tool was applied; M19 §19.1.2–19.2.4; internal application

Related sources S13

N39 · What outcome does the guidance to avoid excessive intake in S14 verify?

Current findings: The S14 EAU section advises calcium-oxalate stone formers to avoid excessive vitamin C and explains that stone risk is controversial. This provides context for caution; it does not provide a randomized quantitative recurrence effect or a safety threshold dose for a pure single-ingredient oral preparation.
Verification status: Partly verified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: Guideline caution is linked, but it is neither a quantitative comparison of the target recurrence/harms nor a safe prescription.
Reason for missing information: Direct comparative recurrence/harms and a justified safety threshold dose for the target formulation, dose, and duration are unverified.
Required materials and conditions: Original EAU section, population, evidence/warnings, and actual comparative recurrence/harm data for the target oral formulation
Materials to obtain first: Original EAU section, population, evidence/warnings, and actual comparative recurrence/harm data for the target oral formulation
Further research: Compare the original evidence cited by the guideline, formulation/population, and dose context, and assess quantitative recurrence/harm questions using actual comparative data.
Remaining uncertainty: Direct comparative recurrence/harms and a justified safety threshold dose for the target formulation, dose, and duration are unverified.
Conditions for verification: Preserve the context of advice to calcium-oxalate stone formers to avoid excessive intake and the unverified quantitative direct recurrence result.
Why this condition is needed: This is needed to avoid turning guideline caution into a randomized recurrence effect or an individual safety assessment.
Application exceptions: Do not create a new threshold dose or a quantitative reduction in recurrence from statements about disputed risk and avoidance of excessive intake.
Referenced methods: M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptations were internally designed; Chamgap's own interpretive boundary. M19 principles are referenced; no formal causality tool was applied; M19 §19.1.2–19.2.4; internal application

Related sources S14

N40 · Have gaps concerning renal risk, special populations, and long-term exposure been retained?

Current findings: The current safety designation is Caution. Uncertainties concerning impaired renal function, dialysis, oxalate nephropathy, high-dose/intravenous G6PD, iron overload, pregnancy, lactation, children, and long-term high-dose exposure are retained separately. Historical reports of 500–2,000 mg/day or 5 g/day are not used as safe prescriptions for the target patients.
Verification status: Unverified
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The current scope contains no data that verify comparative harms of the target oral preparation in special populations or over the long term.
Reason for missing information: Comparative harms by population/route, total exposure, and duration, and safety in pregnancy/lactation, children, and long-term exposure are unverified.
Required materials and conditions: Formulation- and route-specific data on renal risks, dialysis, prior oxalate stones/G6PD, iron, pregnancy/lactation, children, and long-term harms
Materials to obtain first: Formulation- and route-specific data on renal risks, dialysis, prior oxalate stones/G6PD, iron, pregnancy/lactation, children, and long-term harms
Further research: Prespecify special populations, independently monitor total exposure/duration, renal function/hemolysis/iron, and gastrointestinal/stone events, and disclose adequate follow-up and denominators.
Remaining uncertainty: Comparative harms by population/route, total exposure, and duration, and safety in pregnancy/lactation, children, and long-term exposure are unverified.
Conditions for verification: State the current caution, unverified information by population, route, and duration, and the separation of efficacy and safety.
Why this condition is needed: This is needed to avoid treating populations with weak evidence or long-term high-dose exposure as safe on the basis of the general adult upper limit or data from other routes.
Application exceptions: This table is not an individual diagnosis, prescription, or safety assessment, and reported doses are not turned into recommended doses.
Referenced methods: M19 §19.1.2–19.2.4; internal application; Chamgap's own interpretive boundary. M19 principles are referenced; no formal causality tool was applied; M03 §3.2.1–3.2.4; details concerning dose, duration, and effect modification were internally designed; M19 §19.1.2–19.2.4; internal application

Related sources S01 S05 S12 S13 S14

N41 · Have the current assessment and package/calculator designations been distinguished with their original values preserved?

Current findings: The current grade ?, empty score, and safety Caution are maintained. Eligible effect, SE, CI, P, and n remain empty values, and no calculation is performed in this work. Distinguish the unassigned current axes from the package's I1/EX/CX and the raw C resulting from the calculator's format error. Completion of a technical transformation is not independent clinical/methodological certification.
Verification status: Met
Materials actually read: Summary read: the current Korean/structured stored summary and the relevant locations were actually read. External clinical/official original texts were not read this time.
Why unverified: The boundaries between the original assessment, historical designations, current unverified information, and absence of new calculations are preserved. This does not mean that recurrence efficacy has been established.
Reason for missing information: Effect direction, magnitude, precision, and eligible comparative evidence remain unverified.
Required materials and conditions: Original records of current grade/score, axes, primary_result, historical package/calculations, and editorial decisions
Materials to obtain first: Original records of current grade/score, axes, primary_result, historical package/calculations, and editorial decisions
Further research: If new direct evidence is actually acquired, handle any update to the original assessment under separate authorization, versioning, and evidence review; this transformation table only links the original content and change events.
Remaining uncertainty: Effect direction, magnitude, precision, and eligible comparative evidence remain unverified.
Conditions for verification: Preserve the current ?, empty value, and Caution, the original designations, the absence of calculations, and the boundary that this is not independent verification.
Why this condition is needed: This is needed to avoid mistaking table production or a structural PASS for confirmation of a clinical grade or effect.
Application exceptions: Do not use the package's I1/EX/CX or the raw C from a format error as a valid new assessment, and do not fill empty values with 0.
Referenced methods: M04 §4.5, §4.6.3; limits on the current data transformation reflect the user-defined scope and internal design; Chamgap's own independence and attribution criteria. The official methods sections used in this pilot do not substantiate every detail of this item; M04 §4.6.3, M15 §15.3.1–15.3.3; the separation of statuses was internally designed

Related sources