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It should be noted that the musculoskeletal evidence base remains preclinical, a 2025 scoping review by McGuire and colleagues in Current Reviews in Musculoskeletal Medicine found no adequately powered randomised controlled trials

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Evidence-based : Ensuring clinicians understand the difference between serum B12 levels and clinically active B12 stores, and other suitable tests to determine deficiency as well as symptom resolution with sufficiently frequent treatment

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2003;284(6):E1112-1118