***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Acute hepatic encephalopathy in 70 cirrhotic patients was monitored during parenteral administration of  amino acids  between January 1979 and January 1984 . The diagnosis of cirrhosis was confirmed by needle biopsy , and HE by conventional clinical and EEG parameters . The infusion of AA solutions was initiated 48 h after admission and during a 5-day period : 34 patients received a control aminoacid solution , a commercially available AA mixture ( Azonutril ) , and 36 patients a modified solution enriched in BAA prepared from crystallized AA dissolved in distilled water . The calorie intake for both groups was 1600 calories per day from glucose and lipid emulsion . No significant difference was noted based on clinical evolution , even though the plasma AAA/BAA ratio was corrected using the modified AA solution . Of the 34 patients in Group 1 : 10 improved , 14 were unchanged , 10 deteriorated and 7 died . Of the 36 patients in Group 2 : 12 improved , 14 were unchanged , 10 deteriorated and 7 died . EEG tracing evolved in parallel fashion . The authors conclude that modified AA solutions are ineffective in the treatment of acute hepatic encephalopathy in cirrhotic patients The influence of intravenous infusion of branched-chain amino acids ( BCAAs ) on brain function in patients with liver cirrhosis and acute hepatic encephalopathy was examined using a double-blind , r and omized study design . Five medical centers in France and Sweden participated , and 50 patients were studied . The patients received either BCAAs ( 40 gm per day ) in 5 % glucose or 5 % glucose alone ( placebo ) for 5 days or until " wake up " . Nutritional support was provided with equal proportions of carbohydrate and fat . During BCAA administration , plasma concentrations of aromatic amino acids and methionine fell ( 20 to 40 % , p less than 0.05 to 0.01 ) , and the ratio of BCAAs to aromatic amino acid concentrations increased significantly . Clinical improvement was seen in 14 of 25 BCAA-treated patients and in 12 of 25 patients receiving placebo ( N.S. ) . EEG responses were similar in the two groups during treatment . In the BCAA group , 10 of 25 patients died in the course of the study , compared to 5 of 25 in the placebo group ( N.S. ) ; six patients died from encephalopathy in the BCAA group as compared to three among placebo-treated patients . It is concluded that BCAA administration , in the dose and composition employed in the present study , reduces the concentrations of aromatic amino acids but neither improves cerebral function nor decreases mortality in patients with hepatic encephalopathy In a double blind r and omized study , branched-chain amino acids and placebo ( casein ) were compared as a treatment for chronic hepatic encephalopathy in cirrhosis . After a 15-day run-in period with controlled diet ( 45 - 65 g protein ) , the patients were administered , in addition to their diet ,  branched-chain amino acids ( 0.24 g/kg , 30 patients ) or an equinitrogenous amount of casein ( 34 patients ) . One patient on branched-chain amino acids and two on casein were lost to the study . After 3 months , the index of portal-systemic encephalopathy significantly improved in patients on active treatment ( from 40 [ S.D. 14]% to 21 [ 17 ] ) , but was not in subjects receiving casein ( from 37 [13]% to 36 [ 12 ] ) . Two or more parameters of the index improved in 24 patients treated with amino acids ( 80 % ; confidence limits , 61 - 92 % ) , and only in 12 receiving casein ( 35 % ; confidence limits , 20 - 54 % ; p less than 0.001 ) . Patients who did not improve were given an alternative treatment for 3 more months .  Casein-treated patients given branched-chain amino acids rapidly improved . The changes in neuropsychologic function were associated with an improvement in semiquantitative nitrogen balance , which became consistently positive in amino acid-treated subjects ; there was also a mild improvement in nutritional parameters and in liver function tests . The supplementation of oral branched-chain amino acids to the diet is superior to casein as a treatment for providing adequate nitrogen supply and improving the mental state of cirrhotic patients with chronic encephalopathy This trial was undertaken to assess the safety and efficacy of long-term oral supplementation with branched-chain amino acids as an adjunct to conventional therapy in patients with stable cirrhosis and latent encephalopathy . Latent encephalopathy was diagnosed by psychometric testing , used to assess automobile driving capacity . Seventeen patients with impaired driving capacity received either branched-chain amino acids or placebo for 8 weeks before being crossed over to the other regimen for an equal period . Branched-chain amino acids but not placebo significantly improved psychomotor disturbances ( p < 0.01 ) and driving capacity ( p < 0.002 ) . No adverse reactions were observed . We conclude that long-term branched-chain amino acid supplementation is well tolerated and effective in the treatment of impaired automobile driving capacity associated with latent portosystemic encephalopathy We studied the effects of infusion of a branched chain enriched amino acid mixture versus glucose on  acute hepatic encephalopathy in patients with cirrhosis . Sixty-five patients were r and omly treated with 1 g/kg per day of an amino acid mixture with 40 % branched chain contents ( 32 patients ) , or isocaloric glucose ( 33 patients ) for a maximum of 16 days . The regimens further included glucose infusion to a total of 26.5 kcal/kg per day and lactulose . The patients took part in the study for 5 - 6 days . In each group 17 patients woke up . In the amino acid group eleven died and four developed renal failure . In the glucose group ten died , three developed renal and two respiratory failure , and one remained encephalopathic . The coma score worsened in three of the patients who died in the amino acid group , but in all patients who died in the glucose group . The negative nitrogen balance on entry reversed in the amino acid group , but not in the glucose group . Thus , the branched chain enriched amino acid supplement did not change the prognosis for wake-up , but had other effects on the cerebral state and on nitrogen homeostasis BACKGROUND & AIMS The role of oral supplementation with branched-chain amino acids ( BCAA ) in advanced cirrhosis is far from settled . A nutritional approach might prevent progressive liver failure and improve nutritional parameters and quality of life . METHODS A multicenter , r and omized study comparing 1-year nutritional supplementation with BCAA against lactoalbumin or maltodextrins was performed in 174 patients with advanced cirrhosis . Primary outcomes were the prevention of a combined end point ( death and deterioration to exclusion criteria ) , the need for hospital admission , and the duration of hospital stay . Secondary outcomes were nutritional parameters , laboratory data and Child-Pugh score , anorexia , health-related quality of life , and need for therapy . RESULTS Treatment with BCAA significantly reduced the combined event rates compared with lactoalbumin ( odds ratio , 0.43 ; 95 % confidence interval , 0.19 - 0.96 ; P = 0.039 ) and nonsignificantly compared with maltodextrins ( odds ratio , 0.51 ; 95 % confidence interval , 0.23 - 1.17 ; P = 0.108 ) . The average hospital admission rate was lower in the BCAA arm compared with control treatments ( P = 0.006 and P = 0.003 , respectively ) . In patients who remained in the study , nutritional parameters and liver function tests were , on average , stable or improved during treatment with BCAA and the Child-Pugh score decreased ( P = 0.013 ) . Also , anorexia and health-related quality of life ( SF-36 question naire ) improved . Long-term compliance with BCAA was poor . CONCLUSIONS In advanced cirrhosis , long-term nutritional supplementation with oral BCAA is useful to prevent progressive hepatic failure and to improve surrogate markers and perceived health status . New formulas are needed to increase compliance BACKGROUND / AIMS The value of paper-pencil tests and West-Haven- criteria for assessment of low- grade hepatic encephalopathy under conditions of a r and omized , double-blind , placebo-controlled , clinical trial was evaluated in a cohort of 217 cirrhotics . METHODS Patients were grade d at least twice clinical ly for severity of hepatic encephalopathy and tested concomitantly with a recommended psychometric test battery . RESULTS Re-evaluation of the study documentation showed that at study entry 33 % and during the study even 50 % of the patients were wrongly allocated to minimal or overt hepatic encephalopathy . Despite the participating physicians ' training , 31 % of the number-connection-tests-A , 20 % of the number-connection-tests-B and 28 % of the line-tracing-test were in retrospect considered invalid by an independent psychologist . Neither the Portosystemic-Encephalopathy-Syndrome ( PSE ) test nor the Psychometric-Hepatic-Encephalopathy-Sum (PHES)-score reliably picked up clinical improvement in the individual patient . Although these test scores could statistically differentiate between patients with minimal and overt hepatic encephalopathy , the clinical classification of individual patients into one of the groups will have a high rate of error . The PHES-Score was less balanced than the score derived from the PSE-Syndrome-Test . CONCLUSIONS Inaccuracies in conducting paper-pencil tests together with the subjectivity and incorrectness of clinical HE-grading question the usefulness of West-Haven- criteria and paper-pencil tests including related scores for quantification of low- grade HE at least in multicenter approaches OBJECTIVES To analyze sources search ed in Cochrane review s , to determine the proportion of trials included in review s that are indexed in major data bases , and to compare the quality of these trials with those from other sources . METHODS All new systematic review s in the Cochrane Library , Issue1 2001 , that were restricted to r and omized controlled trials ( RCTs ) or quasi- RCTs were selected . The sources search ed in the review s were recorded , and the trials included were checked to see whether they were indexed in four major data bases . Trials not indexed were checked to determine how they could be identified . The quality of trials found in major data bases was compared with those found from other sources . RESULTS The range in the number of data bases search ed per review ranged between one and twenty-seven . The proportion of the trials in the four data bases were Cochrane Controlled Trials Register = 78.5 % , MEDLINE = 68.8 % , Embase = 65.0 % , and Science/Social Sciences Citation Index = 60.7 % . Search ing another twenty-six data bases after Cochrane Controlled Trials Register ( CCTR ) , MEDLINE , and Embase only found 2.4 % additional trials . There was no significant difference between trials found in the CCTR , MEDLINE , and Embase compared with other trials , with respect to adequate allocation concealment or sample size . CONCLUSIONS There was a large variation between review s in the exhaustiveness of the literature search es . CCTR was the single best source of RCTs . Additional data base search ing retrieved only a small percentage of extra trials . Contacting authors and manufacturers to find unpublished trials appeared to be a more effective method of obtaining the additional better quality trials This multicenter study compared the effects of branched-chain amino acid granules ( Livact((R ) ) Granules , LIV ) and an enteral nutrient for chronic hepatic failure ( Aminoleban((R ) ) EN , EN ) on serum albumin in patients with decompensated liver cirrhosis . This study enrolled " patients with decompensated liver cirrhosis associated with hepatic encephalopathy who were suffering from hypoalbuminemia in spite of adequate food intake , " a condition for which both drugs are indicated . Enrolled patients were r and omized to the two groups according to the central registration method . This study continued for 24 weeks . Selected foods were supplied to each patient in principle so that caloric and protein intakes were st and ardized between the two groups . A total of 281 patients were enrolled .  LIV was not inferior to EN concerning the primary efficacy endpoint changes in serum albumin OBJECTIVES : Protein intake impacts on nutritional status and may determine the recurrence of hepatic encephalopathy ( HE ) . A low-protein diet has been considered the st and ard treatment after an episode of HE , while branched-chain amino acids ( BCAA ) have been shown to improve minimal HE . We performed a study to investigate the long-term effects of supplementing a protein-controlled diet with BCAA . METHODS : A r and omized , double-blind , multicenter study that included 116 patients with cirrhosis and a previous episode of HE was conducted in four tertiary care hospitals . All patients received a st and ard diet of 35 kcal/kg per day and 0.7 g of proteins/kg per day and a supplement of 30 g of BCAA ( BCAA group ) or m 
    Output:
    
We found no beneficial or detrimental effects of BCAA  on nausea or vomiting in a r and om-effects meta- analysis or on quality of life or nutritional parameters .