human
***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: In a r and omised , double-blind placebo-controlled trial , the effects of the administration of oral L-carnitine ( 2 g/day ) for 28 days were compared in the management of 51 ( carnitine group ) and 50 ( placebo group ) patients with suspected acute myocardial infa rct ion . At study entry , the extent of cardiac disease , cardiac enzymes and lipid peroxides were comparable between the groups , although both groups showed an increase in cardiac enzymes and lipid peroxides . At the end of the 28-day treatment period , the mean infa rct size assessed by cardiac enzymes showed a significant reduction in the carnitine group compared to placebo . Electrocardiographic assessment of infa rct size revealed that the QRS-score was significantly less in the carnitine group compared to placebo ( 7.4 + /- 1.2 vs 10.7 + /- 2.0 ) , while serum aspartate transaminase and lipid peroxides showed significant reduction in the carnitine group . Lactate dehydrogenase measured on the sixth or seventh day following infa rct ion showed a smaller rise in the carnitine group compared to placebo . Angina pectoris ( 17.6 vs 36.0 % ) , New York Heart Association class III and IV heart failure plus left ventricular enlargement ( 23.4 vs 36.0 % ) and total arrhythmias ( 13.7 vs 28.0 % ) were significantly less in the carnitine group compared to placebo . Total cardiac events including cardiac deaths and nonfatal infa rct ion were 15.6 % in the carnitine group vs 26.0 % in the placebo group . It is possible that L-carnitine supplementation in patients with suspected acute myocardial infa rct ion may be protective against cardiac necrosis and complications during the first 28 days Non-alcoholic fatty liver disease ( NAFLD ) consists of a range of complication . The disease describes clinical , para clinical and pathological conditions from simple steatosis in non-alcoholic steato hepatitis ( NASH ) to fibrosis , cirrhosis and hepato cellular carcinoma . Therefore , it is of interest to evaluate the grade of fatty liver and Liver Function Test in NAFLD patients . We collected sample s and data from 80 patients referred to gastrointestinal clinic of Emam Reza hospital with sonography diagnosed NAFLD and were evaluated in two groups in a r and omized clinical trial . The effects of L-Carnitine ( 500 mg ) prescription twice a day on liver enzymes and echogenicity changes in case group was documented and compared with the control group . The mean age of the patients was 40.7±8 in the age range of 25 to 62 years old with 66 ( 82.5 % ) male and 14 ( 17.5 % ) female patients . Data show that fatty liver changes were not significantly different in the two groups ( P=0.23 ) . It is observed that the ALT was the only enzyme with significant changes ( P=0.01 ) after a 24-week interval . It is also noted that the difference in fatty liver sonographic grading was also significant in the two groups ( P=0.0001 ) . Thus , proper therapeutic protocol s can be adopted beside diet and weight loss to control the disease trend in consideration to the significant changes observed both in enzymatic levels and sonographic grading between the two groups of patients with NAFLD The prevalence of and the risk factors for fatty liver have not undergone a formal evaluation in a representative sample of the general population . We therefore performed a cross-sectional study in the town of Campogalliano ( Modena , Italy ) , within the context of the Dionysos Project . Of 5,780 eligible persons aged 18 to 75 years , 3,345 ( 58 % ) agreed to participate in the study . Subjects with suspected liver disease ( SLD ) , defined on the basis of elevated serum alanine aminotransferase ( ALT ) and gamma-glutamyl-transferase ( GGT ) activity , hepatitis B surface antigen ( HBsAg ) , or hepatitis C virus (HCV)-RNA positivity , were matched with r and omly selected subjects of the same age and sex without SLD . A total of 311 subjects with and 287 without SLD underwent a detailed clinical , laboratory , and anthropometrical evaluation . Fatty liver was diagnosed by ultrasonography , and alcohol intake was assessed by using a 7-day diary . Multinomial logistic regression was used to detect risk factors for normal liver versus nonalcoholic fatty liver disease ( NAFLD ) and for alcoholic fatty liver ( AFLD ) versus NAFLD . The prevalence of NAFLD was similar in subjects with and without SLD ( 25 vs. 20 % , P = .203 ) . At multivariable analysis , normal liver was more likely than NAFLD in older subjects and less likely in the presence of obesity , hyperglycemia , hyperinsulinemia , hypertriglyceridemia , and systolic hypertension ; AFLD was more likely than NAFLD in older subjects , males , and in the presence of elevated GGT and hypertriglyceridemia , and less likely in the presence of obesity and hyperglycemia . In conclusion , NAFLD is highly prevalent in the general population , is not associated with SLD , but is associated with many features of the metabolic syndrome Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Aim : It was the aim of this study to evaluate the effect of oral L-carnitine administration on insulin sensitivity and lipid profile in subjects with type 2 diabetes mellitus . Subjects and Methods : A r and omized , double-blind , placebo-controlled clinical trial was carried out in 12 subjects with type 2 diabetes . Six subjects received L-carnitine 1 g orally 3 times a day before meals for a period of 4 weeks . Six other individuals took a placebo for the same period of time , as the control group . Before and after the intervention , insulin sensitivity and the lipid profile were estimated . To assess insulin sensitivity , the euglycemic-hyperinsulinemic clamp technique was performed . Wilcoxon ’s signed rank and the Mann-Whitney U test were used for the statistical analyses . Results : There were no significant differences in basal clinical characteristics between the 2 groups . Insulin sensitivity and the basal lipid profile were similar . There were no significant changes in either group after the intervention in insulin sensitivity ( 3.2 ± 1.2 vs. 4.5 ± 1.7 mg/kg/min , p = 0.115 , and 3.5 ± 0.6 vs. 3.5 ± 0.4 mg/kg/min , p = 0.917 , for the placebo and L-carnitine groups , respectively ) and in lipid profile . Conclusion : L-Carnitine orally administered for a period of 4 weeks did not modify insulin sensitivity or the lipid profile Background / Aims Carnitine and vitamin complex ( Godex ® ) is widely used in patients with chronic liver disease who show elevated liver enzyme in South Korea . The purpose of this study is to identify the efficacy and safety of carnitine from entecavir combination therapy in Alanine aminotransferase ( ALT ) elevated Chronic Hepatitis B ( CHB ) patients . Methods 130 treatment-naïve patients with CHB were enrolled from 13 sites . The patients were r and omly selected to the entecavir and the complex of entecavir and carnitine . The primary endpoint of the study is ALT normalization level after 12 months . Results Among the 130 patients , 119 patients completed the study treatment . The ALT normalization at 3 months was 58.9 % for the monotherapy and 95.2 % for the combination therapy ( P<0.0001 ) . ALT normalization rate at 12 months was 85.7 % for the monotherapy and 100 % for the combination group ( P=0.0019 ) . The rate of less than HBV DNA 300 copies/mL at 12 months was not statistically significant ( P=0.5318 ) 75.9 % for the monotherapy , 70.7 % for the combination and it was . Quantification of HBsAg level was not different from the monotherapy to combination at 12 months . Changes of ELISPOT value to evaluate the INF-γ secretion by HBsAg showed the increasing trend of combination therapy compare to mono-treatment . Conclusions ALT normalization rate was higher in carnitine complex combination group than entecavir group in CHB . Combination group was faster than entecavir mono-treatment group on ALT normalization rate . HBV DNA normalization rate and the serum HBV-DNA level were not changed by carnitine complex treatment BACKGROUND / AIMS Functional and anatomical abnormalities of mitochondria play an important role in developing steatohepatitis . Carnitine is essential for enhanced mitochondrial beta oxidation through the transfer of long-chain fatty acids into the mitochondria . We examined the impact of carnitine complex on liver function and peripheral blood mitochondria copy number in NAFLD patients . METHODS Forty-five NAFLD patients were enrolled . Patients were categorized into the carnitine complex-administered group and control group . Before and 3 months after drug administration , a liver function test and peripheral blood mitochondrial DNA and 8-oxo-dG quantitive analysis were conducted . RESULTS In carnitine treatment group , ALT , AST , and total bilirubin were reduced after medication . There was no difference in AST , ALT , and total bilirubin between before and after treatment in control group . In carnitine group , peripheral mitochondrial DNA copy number was significantly increased from 158.8+/-69.5 copy to 241.6+/-180.6 copy ( p=0.025 ) . While in control group the mitochondrial copy number was slightly reduced from 205.5+/-142.3 to 150.0+/-109.7 . 8-oxo-dG level was also tended to decrease in carnitine group ( p=0.23 ) and tended to increase in control group ( p=0.07 ) . CONCLUSIONS In NAFLD , the carnitine improved liver profile and peripheral blood mitochondrial DNA copy number . This results suggest that carnitine activate the mitochondria , thereby contributing to the improvement of NAFLD BACKGROUND Patients with cystic acne ( CA ) on Isotretinoin ( Iso ) therapy  might present muscular symptoms as side effect of the drug . Myalgia , weakness , hypotension are also some of the main characteristics of carnitine ( car ) deficiency . METHODS Two hundred and thirty ( N = 230 ) patients with CA were treated with Isotretinoin ( 0.5 mg/kg per 24 h ) . All the patients were requested to visit our out-patient department at the onset of muscular symptoms . Laboratory tests including car ( total , free , acylcarnitine ) were determined in blood and urine before treatment , at the onset of muscular symptoms and after the end of a 45 day study . Fifty percent of the patients with muscular involvement received L-carnitine ( 100 mg/kg per 24 h per os ) ( group C ) and 50 % placebo ( group P ) . RESULTS Their laboratory tests showed the well known increases of their liver enzymes and lipids , whereas car blood levels were remarkably decreased at the onset of their muscular symptoms and or at the end of the study . Their supplementation with L-car , in patients of group C ( N = 20 ) without Iso discontinuation or reduction , result ed in the disappearance of their muscular symptoms within 5 - 6 days and normalisation not only of the increased levels of their liver enzymes but also those of car , at the 45 day of their therapy . Additionally , the patients who received placebo ( group P , N = 20 ) continued complaining for mualgias . The rest of the patients ( group A , N = 190 ) did not experience any muscular symptoms , their laboratory tests showed elevation of liver enzymes and lipids and a decrease in car levels in the blood whereas a remarkable increase of car excretion was determined in their urine . CONCLUSIONS Iso therapy decreases car blood levels in patients with CA . L-car supplementation might treat liver and muscular side effects of the drug . These hopeful preliminary results need further investigation OBJECTIVES : Nonalcoholic steatohepatitis ( NASH ) is a known metabolic disorder of the liver . No treatment has been conclusively shown to improve NASH or prevent disease progression . The function of L-carnitine to modulate lipid profile , glucose metabolism , oxidative stress , and inflammatory responses has been shown . The aim of this study was to evaluate the effects of L-carnitine 's supplementation on regression of NASH . METHODS : In patients with NASH and control subjects , we r and omly dispensed one 1-g L-carnitine tablet after breakfast plus diet and one 1 g tablet after dinner plus diet for 24 weeks or diet alone at the same dosage and regimen . We evaluated liver enzymes , lipid profile , fasting plasma glucose , C-reactive protein ( CRP ) , tumor necrosis factor (TNF)-α , homeostasis model assessment (HOMA)- 
    Output:
    
agent
However , carnitine supplementation at dosages of ≤ 1000 mg/day ( p = 0.035 ) or equal to 2000 mg/day ( p = 0.013 ) result ed in significant reduction in ALT level , while doses more than 2000 mg/day did not change ALT  significantly .
Carnitine exerts its reducing effect on serum ALT and AST levels only when these aminotransferases are raised or when the duration of supplementation lasts at least 3 months .
Results of the current meta- analysis showed that carnitine supplementation can decrease serum AST and ALT levels significantly , especially when supplementation lasts 3 months or more in patients with elevated serum aminotransferase levels
***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: In a r and omised , double-blind placebo-controlled trial , the effects of the administration of oral L-carnitine ( 2 g/day ) for 28 days were compared in the management of 51 ( carnitine group ) and 50 ( placebo group ) patients with suspected acute myocardial infa rct ion . At study entry , the extent of cardiac disease , cardiac enzymes and lipid peroxides were comparable between the groups , although both groups showed an increase in cardiac enzymes and lipid peroxides . At the end of the 28-day treatment period , the mean infa rct size assessed by cardiac enzymes showed a significant reduction in the carnitine group compared to placebo . Electrocardiographic assessment of infa rct size revealed that the QRS-score was significantly less in the carnitine group compared to placebo ( 7.4 + /- 1.2 vs 10.7 + /- 2.0 ) , while serum aspartate transaminase and lipid peroxides showed significant reduction in the carnitine group . Lactate dehydrogenase measured on the sixth or seventh day following infa rct ion showed a smaller rise in the carnitine group compared to placebo . Angina pectoris ( 17.6 vs 36.0 % ) , New York Heart Association class III and IV heart failure plus left ventricular enlargement ( 23.4 vs 36.0 % ) and total arrhythmias ( 13.7 vs 28.0 % ) were significantly less in the carnitine group compared to placebo . Total cardiac events including cardiac deaths and nonfatal infa rct ion were 15.6 % in the carnitine group vs 26.0 % in the placebo group . It is possible that L-carnitine supplementation in patients with suspected acute myocardial infa rct ion may be protective against cardiac necrosis and complications during the first 28 days Non-alcoholic fatty liver disease ( NAFLD ) consists of a range of complication . The disease describes clinical , para clinical and pathological conditions from simple steatosis in non-alcoholic steato hepatitis ( NASH ) to fibrosis , cirrhosis and hepato cellular carcinoma . Therefore , it is of interest to evaluate the grade of fatty liver and Liver Function Test in NAFLD patients . We collected sample s and data from 80 patients referred to gastrointestinal clinic of Emam Reza hospital with sonography diagnosed NAFLD and were evaluated in two groups in a r and omized clinical trial . The effects of L-Carnitine ( 500 mg ) prescription twice a day on liver enzymes and echogenicity changes in case group was documented and compared with the control group . The mean age of the patients was 40.7±8 in the age range of 25 to 62 years old with 66 ( 82.5 % ) male and 14 ( 17.5 % ) female patients . Data show that fatty liver changes were not significantly different in the two groups ( P=0.23 ) . It is observed that the ALT was the only enzyme with significant changes ( P=0.01 ) after a 24-week interval . It is also noted that the difference in fatty liver sonographic grading was also significant in the two groups ( P=0.0001 ) . Thus , proper therapeutic protocol s can be adopted beside diet and weight loss to control the disease trend in consideration to the significant changes observed both in enzymatic levels and sonographic grading between the two groups of patients with NAFLD The prevalence of and the risk factors for fatty liver have not undergone a formal evaluation in a representative sample of the general population . We therefore performed a cross-sectional study in the town of Campogalliano ( Modena , Italy ) , within the context of the Dionysos Project . Of 5,780 eligible persons aged 18 to 75 years , 3,345 ( 58 % ) agreed to participate in the study . Subjects with suspected liver disease ( SLD ) , defined on the basis of elevated serum alanine aminotransferase ( ALT ) and gamma-glutamyl-transferase ( GGT ) activity , hepatitis B surface antigen ( HBsAg ) , or hepatitis C virus (HCV)-RNA positivity , were matched with r and omly selected subjects of the same age and sex without SLD . A total of 311 subjects with and 287 without SLD underwent a detailed clinical , laboratory , and anthropometrical evaluation . Fatty liver was diagnosed by ultrasonography , and alcohol intake was assessed by using a 7-day diary . Multinomial logistic regression was used to detect risk factors for normal liver versus nonalcoholic fatty liver disease ( NAFLD ) and for alcoholic fatty liver ( AFLD ) versus NAFLD . The prevalence of NAFLD was similar in subjects with and without SLD ( 25 vs. 20 % , P = .203 ) . At multivariable analysis , normal liver was more likely than NAFLD in older subjects and less likely in the presence of obesity , hyperglycemia , hyperinsulinemia , hypertriglyceridemia , and systolic hypertension ; AFLD was more likely than NAFLD in older subjects , males , and in the presence of elevated GGT and hypertriglyceridemia , and less likely in the presence of obesity and hyperglycemia . In conclusion , NAFLD is highly prevalent in the general population , is not associated with SLD , but is associated with many features of the metabolic syndrome Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Aim : It was the aim of this study to evaluate the effect of oral L-carnitine administration on insulin sensitivity and lipid profile in subjects with type 2 diabetes mellitus . Subjects and Methods : A r and omized , double-blind , placebo-controlled clinical trial was carried out in 12 subjects with type 2 diabetes . Six subjects received L-carnitine 1 g orally 3 times a day before meals for a period of 4 weeks . Six other individuals took a placebo for the same period of time , as the control group . Before and after the intervention , insulin sensitivity and the lipid profile were estimated . To assess insulin sensitivity , the euglycemic-hyperinsulinemic clamp technique was performed . Wilcoxon ’s signed rank and the Mann-Whitney U test were used for the statistical analyses . Results : There were no significant differences in basal clinical characteristics between the 2 groups . Insulin sensitivity and the basal lipid profile were similar . There were no significant changes in either group after the intervention in insulin sensitivity ( 3.2 ± 1.2 vs. 4.5 ± 1.7 mg/kg/min , p = 0.115 , and 3.5 ± 0.6 vs. 3.5 ± 0.4 mg/kg/min , p = 0.917 , for the placebo and L-carnitine groups , respectively ) and in lipid profile . Conclusion : L-Carnitine orally administered for a period of 4 weeks did not modify insulin sensitivity or the lipid profile Background / Aims Carnitine and vitamin complex ( Godex ® ) is widely used in patients with chronic liver disease who show elevated liver enzyme in South Korea . The purpose of this study is to identify the efficacy and safety of carnitine from entecavir combination therapy in Alanine aminotransferase ( ALT ) elevated Chronic Hepatitis B ( CHB ) patients . Methods 130 treatment-naïve patients with CHB were enrolled from 13 sites . The patients were r and omly selected to the entecavir and the complex of entecavir and carnitine . The primary endpoint of the study is ALT normalization level after 12 months . Results Among the 130 patients , 119 patients completed the study treatment . The ALT normalization at 3 months was 58.9 % for the monotherapy and 95.2 % for the combination therapy ( P<0.0001 ) . ALT normalization rate at 12 months was 85.7 % for the monotherapy and 100 % for the combination group ( P=0.0019 ) . The rate of less than HBV DNA 300 copies/mL at 12 months was not statistically significant ( P=0.5318 ) 75.9 % for the monotherapy , 70.7 % for the combination and it was . Quantification of HBsAg level was not different from the monotherapy to combination at 12 months . Changes of ELISPOT value to evaluate the INF-γ secretion by HBsAg showed the increasing trend of combination therapy compare to mono-treatment . Conclusions ALT normalization rate was higher in carnitine complex combination group than entecavir group in CHB . Combination group was faster than entecavir mono-treatment group on ALT normalization rate . HBV DNA normalization rate and the serum HBV-DNA level were not changed by carnitine complex treatment BACKGROUND / AIMS Functional and anatomical abnormalities of mitochondria play an important role in developing steatohepatitis . Carnitine is essential for enhanced mitochondrial beta oxidation through the transfer of long-chain fatty acids into the mitochondria . We examined the impact of carnitine complex on liver function and peripheral blood mitochondria copy number in NAFLD patients . METHODS Forty-five NAFLD patients were enrolled . Patients were categorized into the carnitine complex-administered group and control group . Before and 3 months after drug administration , a liver function test and peripheral blood mitochondrial DNA and 8-oxo-dG quantitive analysis were conducted . RESULTS In carnitine treatment group , ALT , AST , and total bilirubin were reduced after medication . There was no difference in AST , ALT , and total bilirubin between before and after treatment in control group . In carnitine group , peripheral mitochondrial DNA copy number was significantly increased from 158.8+/-69.5 copy to 241.6+/-180.6 copy ( p=0.025 ) . While in control group the mitochondrial copy number was slightly reduced from 205.5+/-142.3 to 150.0+/-109.7 . 8-oxo-dG level was also tended to decrease in carnitine group ( p=0.23 ) and tended to increase in control group ( p=0.07 ) . CONCLUSIONS In NAFLD , the carnitine improved liver profile and peripheral blood mitochondrial DNA copy number . This results suggest that carnitine activate the mitochondria , thereby contributing to the improvement of NAFLD BACKGROUND Patients with cystic acne ( CA ) on Isotretinoin ( Iso ) therapy  might present muscular symptoms as side effect of the drug . Myalgia , weakness , hypotension are also some of the main characteristics of carnitine ( car ) deficiency . METHODS Two hundred and thirty ( N = 230 ) patients with CA were treated with Isotretinoin ( 0.5 mg/kg per 24 h ) . All the patients were requested to visit our out-patient department at the onset of muscular symptoms . Laboratory tests including car ( total , free , acylcarnitine ) were determined in blood and urine before treatment , at the onset of muscular symptoms and after the end of a 45 day study . Fifty percent of the patients with muscular involvement received L-carnitine ( 100 mg/kg per 24 h per os ) ( group C ) and 50 % placebo ( group P ) . RESULTS Their laboratory tests showed the well known increases of their liver enzymes and lipids , whereas car blood levels were remarkably decreased at the onset of their muscular symptoms and or at the end of the study . Their supplementation with L-car , in patients of group C ( N = 20 ) without Iso discontinuation or reduction , result ed in the disappearance of their muscular symptoms within 5 - 6 days and normalisation not only of the increased levels of their liver enzymes but also those of car , at the 45 day of their therapy . Additionally , the patients who received placebo ( group P , N = 20 ) continued complaining for mualgias . The rest of the patients ( group A , N = 190 ) did not experience any muscular symptoms , their laboratory tests showed elevation of liver enzymes and lipids and a decrease in car levels in the blood whereas a remarkable increase of car excretion was determined in their urine . CONCLUSIONS Iso therapy decreases car blood levels in patients with CA . L-car supplementation might treat liver and muscular side effects of the drug . These hopeful preliminary results need further investigation OBJECTIVES : Nonalcoholic steatohepatitis ( NASH ) is a known metabolic disorder of the liver . No treatment has been conclusively shown to improve NASH or prevent disease progression . The function of L-carnitine to modulate lipid profile , glucose metabolism , oxidative stress , and inflammatory responses has been shown . The aim of this study was to evaluate the effects of L-carnitine 's supplementation on regression of NASH . METHODS : In patients with NASH and control subjects , we r and omly dispensed one 1-g L-carnitine tablet after breakfast plus diet and one 1 g tablet after dinner plus diet for 24 weeks or diet alone at the same dosage and regimen . We evaluated liver enzymes , lipid profile , fasting plasma glucose , C-reactive protein ( CRP ) , tumor necrosis factor (TNF)-α , homeostasis model assessment (HOMA)- 
    Output:
    