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Long-term effects of L-carnitine on hyperammonemia and hepatic encephalopathy in patients with liver cirrhosis: a multicenter retrospective study Joji Tani a Akio Moriya b Tetsu Tomonari c Chikara Ogawa d Akemi Tsutsui e Asahiro Morishita a Teppei Sakamoto f Hiroki Tai a Rie Yano a Mai Nakahara a Kyoko Oura a Tomoko Tadokoro a Koji Fujita a Shima Mimura a Takashi Himoto g Hironori Tanaka c Ryosuke Imado d Takushi Manabe d Kei Takuma a Takuya Nagano e Koichi Takaguchi e Tetsuji Takayama c Hideki Kobara a Objective Long-term efficacy data for L-carnitine in managing blood ammonia concentration (BAC) and preventing hepatic encephalopathy recurrence remain limited

54 Some have hypothesized that abnormalities in zinc and copper metabolism could result in poor metallothionein function, leading to susceptibility to environmental toxicants through increased oxidative stress or mitochondrial dysfunction

doi: 10.1016/j.ccell.2018.03.015 133

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In view of the conflicting results presented above, future research should be conducted in larger samples

Parameters were estimated by restricted maximum likelihood (REML), and p -values were obtained using Satterthwaites approximation (lmerTest package)