***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 
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    Input: Background and aims Hepatic encephalopathy ( HE ) is associated with a poor prognosis . There is no study on the prevention of recurrence of encephalopathy with L-ornithine L-aspartate ( LOLA ) . Patients and methods We conducted a double-blind r and omized controlled trial at a tertiary center . Consecutive patients with cirrhosis who had recovered from HE were r and omized to receive LOLA ( 6 g thrice daily ) or similar amount of placebo by computer-based r and omization for 6 months . Patients were assessed by psychometric HE scores using five paper – pencil tests , critical flicker frequency test , arterial ammonia , and sickness impact profile scores at inclusion . Primary end point was development of overt HE . Results Of 306 patients , 150 patients were enrolled .  HE recurred in nine ( 12.3 % ) of 73 and in 20 ( 27.7 % ) of 72 patients receiving LOLA and placebo , respectively ( P=0.02 ) , with hazard ratio of 0.389 ( 95 % confidence interval=0.174–0.870 ) . Mortality was similar in both groups ( 6.8 vs. 13.8 % , P=0.18 ) . At 6 months follow-up , there was a significant change in the psychometric hepatic encephalopathy score ( 2.53±2.18 vs. −0.01±1.92 , P<0.001 ) , ammonia level ( −23.58±14.8 vs. 1.41±13.34 & mgr;mol/l , P<0.001 ) , CFF ( 5.85±4.82 vs. 0.58±4.53 , P<0.001 ) , and SIP scores ( −7.89±5.52 vs. −0.95±4.25 , P<0.001 ) in patients treated with LOLA compared with placebo . On multivariate analysis , only MELD score predicted the recurrence of overt HE , with odds ratio of 2.21 ( 95 % confidence interval : 1.526–3.204 , P<0.001 ) . Conclusion LOLA is effective in the secondary prophylaxis of HE and is associated with significant improvements in psychometric hepatic encephalopathy score , ammonia level , critical flicker frequency scores , and health-related quality of life AIM Evaluate efficacy/safety of oral l-ornithine-l-aspartate ( LOLA ) in controlling minimal hepatic encephalopathy ( MHE ) . METHODS Consecutive cirrhotic out patients with MHE ( defined by psychometric number connection tests A/B [ NCT-A/B ] and digit symbol substitution test [ DSST ] score of > 2 st and ard deviations ) were r and omized to a 60-day oral LOLA ( 5 g t.i.d ) or placebo group . Critical flicker frequency test ( CFF ) , quantitative electroencephalogram ( qEEG ) , arterial ammonia ( NH3 ) , Beck 's anxiety-depression forms and liver disease quality of life ( LD-QOL ) were assessed . Patients were followed for 6 months after the end of the study to assess LOLA prophylactic role on overt hepatic encephalopathy ( OHE ) . RESULTS Sixty-four patients were included , 63 ( 98.4 % ) with MHE . In six of these patients , CFT was less than 39 Hz ( 9.52 % ) ; NH3 was increased in 32 ( 50.8 % ) ; 25 % had abnormal qEEG . Age , sex , scholarship , Child-Pugh ( CP ) , Model for End-Stage Liver Disease , NCT-A/B , DSST , CFF and NH3 were similar in both groups at the baseline . LOLA led to a significant improvement in NCT-B age-controlled z-score ( 3.4 ± 3.4 vs 1.5 ± 2.3 , P = 0.01 ) and CFF ( 42.2 ± 5.8 vs 45.2 ± 5.8 , P = 0.02 ) , comparing the first and the last visit , but there were no differences between LOLA and placebo regarding the whole psychometric battery , CFF , LD-QOL and Beck 's forms . No serious adverse effects occurred . Patients taking LOLA had less episodes of OHE at 6 months ( 5 % vs 37.9 % , P = 0.016 ) , as they have significant improvement on liver function assessed by CP ( P < 0.001 ) . CONCLUSION A 60-day oral LOLA course was not better than placebo in treating MHE , but was useful in preventing further episodes of OHE Background Minimal hepatic encephalopathy ( MHE ) impairs daily functioning and health-related quality of life ( HRQoL ) . The modalities of treatment of MHE have not been adequately studied . Aims To compare lactulose , probiotics , and L-ornithine L-aspartate ( LOLA ) in treatment of MHE and effect on HRQoL by Sickness Impact Profile question naire . Methods Consecutive patients with cirrhosis were screened for MHE . MHE was diagnosed by two or more abnormal psychometric tests ( number/figure connection tests A and B , block design test , picture completion test ) . Patients were r and omized to no treatment ( GpA ) , lactulose 30–60 ml/twice per day ( GpB ) , probiotics 110 billion colony forming units twice in a day ( GpC ) , LOLA 6 g three times per day ( GpD ) for 3 months . Arterial ammonia and HRQoL assessment using SIP question naire was done at baseline and at 3 months . Results One hundred and sixty ( 49.69 % ) of 322 patients with cirrhosis had MHE . After 3 months , MHE recovered in GpA four ( 10 % ) , GpB 19 ( 47.5 % ) , GpC 14 ( 35 % ) , and GpD 14 ( 35 % ) . MHE improved significantly in all three treatment groups ( GpB , GpC , GpD ) compared with no treatment ( GpA ) ( P=0.006 ) . Overt hepatic encephalopathy developed in nine ( 5.6 % ) of 160 patients ; GpA four ( 10 % ) , GpB one ( 2.5 % ) , GpC two ( 5 % ) , and GpD two ( 5 % ) , respectively . There was significant improvement in SIP score in GpB ( 6.98±4.1 ) , GpC ( 6.24±3.4 ) , and GpD ( 7.33±3.8 ) versus GpA ( 1.05±2.6 ) , P value of less than 0.001 . The decrease in SIP score correlated with an improvement in MHE on multivariate analysis but there was no correlation with the type of intervention offered . There was no significant change in arterial ammonia level after therapy in GpA ( −0.52±7.8 & mgr;mol/l ) . Arterial ammonia level in GpB ( −8.47±5.8 & mgr;mol/l ) , GpC ( −7.31±7.9 & mgr;mol/l ) , and GpD ( −9.61±9.3 & mgr;mol/l ) were significantly more than GpA ( P<0.0001 ) . Conclusion Lactulose , probiotics , and LOLA  significantly improve MHE and HRQoL in patients with chronic liver disease BACKGROUND / AIMS Hepatic encephalopathy is a frequent event after transjugular-intrahepatic-portosystemic-shunt ( TIPS ) , especially during the first months . Aim of this study was to compare two different treatments ( lactitol 60 g/day , rifaximin 1200 mg/day ) with no-treatment in the prevention of post-TIPS hepatic encephalopathy . METHODS Seventy-five consecutive cirrhotics su bmi tted to TIPS were r and omized to receive either one of the above treatments or no-treatment . The main end-point was the occurrence of an episode of overt hepatic encephalopathy during the first month post-TIPS . Before the procedure and weekly thereafter the patients were evaluated by examining their mental status , asterixis , ammonia and trail-making-test Part-A ( TMT-A ) . RESULTS The three groups were comparable for age , sex , etiology , Child-Pugh-score , post-TIPS porto-systemic gradient , previous hepatic encephalopathy , basal values of ammonia and psychometric performance . Twenty-five patients developed hepatic encephalopathy ( 33 % , CI 95%=22 - 45 % ) . One-month incidence was similar in the three groups ( P=0.97 ) . Previous hepatic encephalopathy ( Relative Hazard=3.79;1.27 - 11.31 ) and basal-TMT-A Z-score>1.5 ( RH=3.55;1.24 - 10.2 ) were predictors of post-TIPS encephalopathy at multivariate analysis . A < 5 mmHg porto-systemic gradient was also significantly related to the occurrence of encephalopathy . CONCLUSIONS Our data show that treatment with lactitol or rifaximin is not effective in the prophylaxis of hepatic encephalopathy during the first month after a TIPS In the current Model for End-Stage Liver Disease allocation system , patients are at risk of suffering repeated episodes of hepatic encephalopathy ( HE ) while waiting for an orthotopic liver transplantation ( OLT ) ; the posttransplantation impact of these episodes has not been well explored . We evaluated the cognitive function and quality of life in a group of OLT recipients ( n = 25 ) who had suffered from overt HE prior to their procedure ( HE-PreLT group ) and compared their performance to that of a similar group of patients ( n = 14 ) without overt HE ( No HE-PreLT group ) as well as to controls . Patients were selected from a cohort of 280 patients who underwent OLT during this period ; the presence of clinical confounders excluded many of the remaining subjects . Demographic and clinical characteristics were balanced among groups . At an average of 18 months after OLT , we administered 2 neuropsychological batteries [ Psychometric Hepatic Encephalopathy Score ( PHES ) test  battery and Repeatable Battery  for the Assessment of Neuropsychological Status ( RBANS ) ] ; a pyschophysiological test ( critical flicker frequency ) ; and the SF-36 quality of life score . The HE-PreLT group scored below controls in 5 of 6 cognitive domains tested by RBANS , 3 of 6 PHES subtests , as well as the critical flicker frequency test . The No HE-PreLT group scored below the controls in 1 of the 6 cognitive domains tested by RBANS . The more severe neurocognitive abnormalities seen in the HE-PreLT group did not appear to affect quality of life , as lower values than normative data were only found in 1 of the 8 SF-36 scales . In conclusion , neurocognitive abnormalities were more severe in liver transplant recipients that had suffered from overt HE prior to OLT . Prospect i ve studies of neurocognitive function pre-OLT and post-OLT are needed to fully determine the impact of such abnormalities OBJECTIVE To evaluate the efficacy of L-ornithine-L-aspartate ( LOLA ) as an adjuvant therapy in cirrhotic patients with hepatic encephalopathy ( HE ) . STUDY DESIGN R and omized placebo controlled study . PLACE AND DURATION OF STUDY The Aga Khan University Hospital , Karachi in the year 2003 - 2004 . METHODOLOGY Patients with HE were r and omized to receive LOLA or placebo medicine as an adjuvant to treatment of HE . Number connection test-A ( NCT-A ) , ammonia level , clinical grade of HE and duration of hospitalization were assessed . RESULTS Out of 120 patients , there were 62 males with mean age of 57 ± 11 years . Improvement in HE was higher ( n=40 , 66.7 % ) in LOLA group as compared to the placebo group ( n=28 , 46.7 % , p=0.027 ) . In patients with grade I or less encephalopathy , improvement was seen in 6 ( 35.3 % ) and 3 ( 20 % ) patients in LOLA and placebo groups respectively ( p=0.667 ) . Patients with HE grade II and above showed improvement in 34 ( 79.1 % ) and 25 ( 55.6 % ) cases in LOLA and placebo group respectively ( p=0.019 ) . On multivariate analysis patients with HE of grade II and above showed prothrombin time , creatinine level and use of LOLA influencing the outcome . Duration of hospitalization was 93.6 ± 25.7 hours and 135.2 ± 103.5 hours in LOLA and placebo groups respectively ( p=0.025 ) . No side effects were observed in either groups . CONCLUSION In cirrhotic patients with advanced hepatic encephalopathy  treatment with LOLA was safe and associated with relatively rapid improvement and shorter hospital stay Background and Aim Variceal bleeding is the second most important precip 
    Output:
    
OHE prevention/prophylaxis was accompanied by significant reductions of blood ammonia .
Both oral and intravenous formulations of LOLA appeared to be effective for the prevention of progression to OHE in patients with MHE .
These findings provide the first direct evidence of potential benefit of LOLA for the prevention of OHE in cirrhosis across a range of clinical presentations