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Electronic databases including the Cochrane Controlled Trials Register on the Cochrane Library, MEDLINE, EMBASE.com, Science Citation Index, Google search and the China Biological Medicine Database (CBMdisc) (January 1978-June 2012) using the terms carnitine, L-acyl-carnitine, hepatic encephalopathy and by limiting the searches to RCTs were searched with a cutoff date of 30 June, 2012