***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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    ***EXAMPLES*** 
    Input: BACKGROUND AND AIMS To determine whether the inclusion of 20 g free glutamine as part of the nitrogen source of parenteral feeds reduces length of hospital stay or mortality . METHODS In a r and omised , double blind , controlled trial in 168 patients clinical ly accepted for parenteral nutrition , st and ard feeds were compared with feeds in which 3.8 g of the total nitrogen was replaced with the equivalent 20 g glutamine . A minimum of 11 g nitrogen/day was used in all patients . Daily intakes of energy and nitrogen were determined using a vali date d computer protocol and were similar for the two groups . All feeds included trace elements , vitamins , electrolytes , and minerals . RESULTS A total of 85 patients received a median of eight ( interquartile range 5–13 ) daily feeds containing glutamine while 83 received a median of eight ( 5–15 ) st and ard feeds . No difference between groups was detected for infective complications .  Twenty control patients and 14 who had received glutamine  died during their hospital stay ( NS ) . Median length of stay was 32 ( 23–52 ) days on glutamine , which was not significantly different from the control value of 35 ( 25–55 ) days . Glutamine was associated with a significant ( p<0.03 ) reduction in length of stay in surgical patients ( 45 days ( range 29–81 ) versus 30 days ( range 19–54 ) ) . CONCLUSION The benefit from glutamine supplementation of parenteral feeds as used in this trial has not been proved . Supplementation may have advantages in surgical patients and in haematological malignancy . Further trials are required Objective To determine the effect of intravenous glutamine supplementation vs. an isonitrogenous control on infectious morbidity in severely burned patients . Previous clinical studies in seriously ill patients suggest a beneficial effect of glutamine on infectious morbidity , but no trials have examined possible clinical benefits in severely burned patients . Design Prospect i ve , double-blind , r and omized trial . Setting Burn intensive care unit of a university hospital . Patients Twenty-six severe burn patients with total burn surface area of 25 % to 90 % and presence of full-thickness burns . Patients were evaluated for occurrence of bacteremia and antibiotic use during the first 30 days of their burn unit admission . Nutritional status and overall inflammation were also measured . Intervention Either intravenous glutamine or an isonitrogenous control amino acid solution was administered as a continuous infusion during burn intensive care unit stay . Measurements and Main Results The incidence of Gram-negative bacteremia was significantly reduced in the glutamine-supplemented group ( 8 % ) vs. control ( 43%;p < .04 ) . No difference was seen in the incidence of Gram-positive bacteremia or fungemia . Average number of positive blood cultures , antibiotic usage , and mortality rates also were reduced but did not reach statistical significance . Significant improvements in serum transferrin and prealbumin were observed in glutamine-supplemented patients at 14 days after burn injury ( p < .01 and .04 , respectively ) . C-reactive protein was also significantly reduced at 14 days after burn injury in the glutamine group ( p < .01 ) . Conclusions Significantly fewer bacteremic episodes with Gram-negative organisms occurred in the glutamine-supplemented patients . Glutamine supplementation improved measures of nutrition and decreased measures of overall inflammation . In addition , a trend toward lower mortality rate , decreased overall bacteremia incidence , and antibiotic usage in the glutamine group was observed . Glutamine ’s beneficial effects may be a result of improved gut integrity or immune function , but the precise mechanism of glutamine ’s protection is unknown BACKGROUND S/ AIMS In our former study we investigated the effect of glutamine-rich ( I ) and glutamine-poor ( II ) jejunal diet in operated patients with acute pancreatitis . In the glutamine-rich diet group clinical benefit and fast recovery of IgG , IgM , serum proteins , retinol-binding protein , albumin could be measured . In the present study the effects of the two types of jejunal diets I and II have been compared on the basis of changes in some immune parameters of 36 patients treated with subtotal esophagectomy for malignancy . METHODOLOGY In r and omized controlled trial data of two groups , I. patients with glutamine-rich Stresson Multi Fibre diet ( 23 patients ) and II . patients with Nutrison Multi Fibre glutamine-poor diet ( 13 patients ) were analyzed . Levels of serum proteins were measured by laser nephelometry , CD markers of lymphocytes by flow cytometry , phagocyte activity by chemiluminescence . RESULTS Level of proteins decreased on the 2nd postoperative day in both groups , then gradually increased postoperatively . In increase of level of serum protein , retinol-binding protein , prealbumin there was no difference between the two groups . CONCLUSIONS In patients treated with subtotal esophagectomy , the glutamine-rich enteric diet did not result in faster recovery in levels of prealbumin , retinol-binding protein , immunoglobulins and in outcome of patients than the glutamine-poor nutriment OBJECTIVE To assess the efficacy of glutamine ( Gln ) dipeptide-enriched total parenteral nutrition ( TPN ) on selected metabolic , immunologic , and clinical variables in surgical patients . SUMMARY BACKGROUND DATA Depletion of Gln stores might lead to severe clinical complications . Recent studies indicate that the parenteral provision of Gln or Gln-containing dipeptides improves nitrogen balance , maintains the intracellular Gln pool , preserves intestinal permeability and absorption , and shortens hospital stay . METHODS Twenty-eight patients ( age range , 42 - 86 years , mean 68 years ) undergoing elective abdominal surgery were allocated , after r and omization , to two groups to receive isonitrogenous ( 0.24 g nitrogen kg(-1 ) day(-1 ) ) and isoenergetic ( 29 kcal/122 kJ kg(-1 ) day(-1 ) ) TPN over 5 days . Controls received 1.5 g of amino acids kg(-1 ) day(-1 ) , and the test group received 1.2 g of amino acids and 0.3 g of L-alanyl-L-glutamine ( Ala-Gln ) kg(-1 ) day(-1 ) . Venous heparinized blood sample s were obtained before surgery and on days 1 , 3 , and 6 after surgery for routine clinical chemistry and for the measurement of plasma free amino acids . Lymphocytes were counted and the generation of cysteinyl-leukotrienes from polymorphonuclear neutrophil granulocytes was analyzed before surgery and on days 1 and 6 after surgery . Nitrogen balances were calculated postoperatively on days 2 , 3 , 4 , and 5 . RESULTS No side effects or complaints were noted . Patients receiving Gln dipeptide revealed improved nitrogen balances ( cumulative balance over 5 days : -7.9 + /- 3.6 vs. -23.0 + /- 2.6 g nitrogen ) , improved lymphocyte recovery on day 6 ( 2.41 + /- 0.27 vs. 1.52 + /- 0.17 lymphocytes/nL ) and improved generation of cysteinyl-leukotrienes from polymorphonuclear neutrophil granulocytes ( 25.7 + /- 4.89 vs. 5.03 + /- 3.11 ng/mL ) . Postoperative hospital stay was 6.2 days shorter in the dipeptide-supplemented group . CONCLUSION We confirm the beneficial effects of Gln dipeptide-supplemented TPN on nitrogen economy , maintenance of plasma Gln concentration , lymphocyte recovery , cysteinyl-leukotriene generation , and shortened hospital stay in surgical patients We investigated the effect of a glutamine-enriched enteral diet on intestinal permeability and infectious morbidity and mortality in critically ill patients who developed systemic inflammatory response syndrome after an acute event . Eleven intensive care units in tertiary-care hospitals participated in a prospect i ve , r and omized , single blind , multicenter trial . Eighty-four patients with systemic inflammatory response syndrome of any etiology were r and omly allocated to receive a glutamine-enriched enteral diet or a control diet without glutamine . Most patients received the planned caloric intake . The number of infected patients was smaller in the glutamine group than in the control group ( 11 versus 17 patients , P < 0.05 ) , with a relative risk of 0.5 ( 95 % confidence interval = 0.3 - 0.9 ) . The most frequent infection was nosocomial pneumonia , with 11 ( 33 % ) patients in the control group and 6 ( 14 % ) in the glutamine group . There were no differences with respect to other infections , mortality , or length of stay . Intestinal permeability as assessed by the lactulose-mannitol test was unchanged in both groups . Glutamine-enriched enteral diets can decrease nosocomial infections in patients with systemic inflammatory response syndrome Objective : To evaluate the effect of four doses of intravenous glutamine supplementation on skeletal muscle metabolism . Design : A prospect i ve , blinded , r and omized study . Setting : The general Intensive Care Unit ( ICU ) of a university hospital . Patients : ICU patients with multiple organ failure ( n=40 ) , who were expected to stay in the unit for more than five days . Intervention : Patients received 0 , 0.28 , 0.57 or 0.86 g of glutamine per kg bodyweight per day intravenously for five days as part of an isocaloric , isonitrogenous and isovolumetric diet . Results : Plasma glutamine concentration responded to glutamine supplementation with normalization of plasma levels in a dose-dependent way , while free muscle glutamine concentration , as well as muscle protein synthesis and muscle protein content , did not change significantly . Conclusion : Intravenous glutamine supplementation to ICU patients for a period of five days result ed in normalization of plasma glutamine concentrations in a dose-dependent way whereas muscle glutamine concentrations were unaffected The aim of this study was to investigate the effect of glutamine-(Gln)-enriched enteral nutrition ( EN ) on human leukocyte antigen (HLA)-DR and FcgammaR1/CD64 expression on monocytes and plasma glutamine concentrations in multi-trauma patients . HLA-DR expression on monocytes is crucial in the presentation of foreign antigen to the immune system and is severely reduced in trauma patients . In vitro monocyte HLA-DR and FcgammaRI/CD64 expression is dependent on glutamine availability . To study the effect of glutamine supplemented enteral nutrition on HLA-DR and FcgammaRI/CD64 expression on CD14(+ ) monocytes , 55 multi-trauma patients were studied in a r and omized , double-blinded , controlled trial . Trauma patients received either a Gln-enriched EN ( glutamine group , n = 28 ) or an isocaloric , isonitrogenous control EN ( control group , n = 27 ) and were compared with a group of age-matched healthy volunteers ( healthy volunteers , n = 53 ) . On d 1 , 5 , 9 and 14 after trauma , expressions of HLA-DR and FcgammaRI/CD64 were determined on CD14(+ ) monocytes using FACS analysis . Plasma glutamine levels were measured using HPLC . Plasma glutamine was lower in both trauma patient groups compared with healthy volunteers and from d 3 to d 5 ; glutamine was higher in the glutamine group than in the control group . On d 1 , HLA-DR expression was much lower in both trauma patient groups than in healthy volunteers . HLA-DR expression was greater on d 5 , 9 and 14 in the glutamine group than in the control group . FcgammaRI/CD64 expression on monocytes of trauma patients was not different than the expression of healthy volunteers . This study showed that glutamine-enriched enteral nutrition was associated with a higher HLA-DR expression on CD14(+ ) monocytes of trauma patients . No difference in monocyte FcgammaRI/CD64 expression was detected between patients that received the two enteral diets and between trauma patients and the healthy volunteers . Increased HLA-DR expression may improve cellular immune function and may be involved in the beneficial effect of glutamine on the occurrence of infections in trauma patients BACKGROUND Taurine is a unique amino acid with antioxidant and osmolytic properties . Glutamine serves as the preferred fuel for the gut , liver , and immune cells and as a precursor for antioxidants . Trauma patients have low glutamine concentrations . OBJECTIVES We investigated the effect of glutamine-enriched enteral nutrition on plasma taurine concentrations in patients with severe trauma ( injury severity score > 20 ) . Additionally , plasma taurine concentrations and organ fluxes were studied in a stressed rat model . DESIGN Twenty-nine patients with multiple trauma received glutamine-enriched nutr 
    Output:
    
This review found moderate evidence that glutamine supplementation reduced the infection rate and days on mechanical ventilation , and low quality evidence that glutamine supplementation reduced length of hospital stay in critically ill or surgical patients .
It seems to have little or no effect on the risk of mortality and length of ICU stay , however .