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Firstly, our study further strengthen the evidence of well-designed RCTs of ALC in HE and introduce the view and methodology of evidence-based medicine (EBM) when compared with a previous review included 3 clinical trials reported in 2008.28 Secondly, perhaps more and more investigators from different countries will be interested and highlight the role of ALC and conduct studies with far more important findings, so as to provide another choice drug for HE

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