***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
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    Input: 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 Objective Glutamine is recognized as a conditionally indispensable amino acid . The purpose of the current study was to investigate whether supplemental l-alanyl-l-glutamine to parenteral nutrition can alter clinical outcome in intensive care unit patients . Design Prospect i ve , open , r and omized trial . Setting Postoperative intensive care unit of a university hospital . Patients Male and female critically ill patients with indications for parenteral nutrition and an expected stay on intensive care unit for ≥5 days . Interventions Patients were r and omized to receive either st and ard parenteral nutrition or supplemented parenteral nutrition with l-alanyl-l-glutamine ( 0.3 g·kg−1·body weight−1 [ bw ] per day ) . Total amount of amino acids comprised 1.5 g·kg−1·bw−1 per day . Caloric support was managed by metabolic variables ( glucose and triglyceride plasma values ) . Target values for energy supply were 3 g·kg−1·bw−1 carbohydrates and 1 g·kg−1·bw−1 fat per day . Measurements and Main Results Medical treatment , nutritional therapy , vital variables , and biochemical data were recorded . Clinical outcome was measured by average length of stay in the intensive care unit and hospital and the mortality in the intensive care unit and within 30 days and 6 months . A total of 144 patients were r and omized ; 95 patients were treated for ≥5 days and 68 patients for ≥9 days under st and ardized conditions . In the treatment group , plasma glutamine concentrations significantly increased within 6–9 days . Six-month survival was significantly improved for patients treated for ≥9 days ( 66.7 % [ glutamine supplemented ] vs. 40 % [ control ] ) . Conclusion Study results support the hypothesis that replacement of glutamine deficiency may correct the excess mortality in intensive care unit patients caused by inadequate parenteral nutrition To determine the acute immunologic reaction , mediated by cytokines , interleukines ( ILs ) and growth factors and the susceptibility to infections and sepsis after severe burn injury a prospect i ve , single unit , longitudinal study of acute phase reactants and mediators who performed . After approval by the ethics committee of our hospital , we investigated the  plasma concentrations of IL-2 , -6 , -8 , -10 , and -13 , the soluble IL-2 receptor ( sIL-2R ) , and the acute phase proteins procalcitonin ( PCT ) and C-reactive protein ( CRP )  at admission and every 3 days in 24 patients over a time course of 28 days after thermal injury and categorized by percent burn : < or = 30 % ( group 1 ; n=12 ) and > 30 % ( group 2 ; n=12 ) . Shortly after burn injury we found higher concentrations of IL-2 , -6 , -10 and PCT in those patients > 30 % TBSA . During the study period , we found significant higher levels of acute phase proteins , IL-6 and -8 in patients > 30 % TBSA . The incidence of SIRS and MODS was three times increased in patients > 30 % TBSA . Our results show different patterns of cytokines and acute phase proteins in patients with different burned surface areas over a long time and continuous monitoring of a more distinct inflammatory response in these patients Abstract Objective : To evaluate whether low plasma glutamine ( PG ) is related to severity of illness , and actual and predicted hospital mortality . Design : Prospect i ve cohort study . Setting : 18-bed closed format general intensive care unit ( ICU ) of a teaching hospital . Patients : Cohort of 80 seriously ill patients non-electively admitted to the ICU . Interventions : Blood sampling for the determination of PG at ICU admission . Measurements and results : Severity of illness and predicted mortality were calculated using the locally vali date d APACHE II , SAPS II , and MPM II 0 and 24 systems . Illness scores , and actual and predicted hospital mortality were compared between patients with total PG<0.420 mmol/l ( " low PG " ) and patients with PG≥0.420 mmol/l . Mean total PG was 0.523 mmol/l , range 0.220–1.780 mmol/l . Low PG ( n=25 ) was associated with higher age ( P=0.03 ) , shock as primary diagnosis , and higher actual hospital mortality ( 60 % vs 29 % , P=0.01 ) . Normal to high PG was associated with high plasma creatine phosphokinase ( P=0.007 ) There was a non-significant trend towards higher severity of illness scores and predicted mortality rates in the low PG group . The presence of low PG significantly improved mortality prediction when added as a factor to the APACHE II predicted mortality rate ( P=0.02 ) . Conclusions : Low PG at acute ICU admission is related to higher age , shock as primary diagnosis , and higher hospital mortality . Low PG represents a risk of poor outcome , not fully reflected in the presently used mortality prediction systems OBJECTIVE Glutamine is a nonessential amino acid that , in recent years , has been found to play important roles in several metabolic and immunologic processes . It has been theorized that , in a stressed state , it may become " conditionally essential " because the patient 's ability to manufacture glutamine may not be adequate to meet their needs under this condition . We chose to evaluate the ability of 48 hours of enteral glutamine to enhance immediate nitrogen accretion in stressed pediatric burn patients . METHODS Nine children with serious burns who were tolerating tube feedings  were enrolled in a human studies committee-approved protocol in which they received 48 hours of enteral feedings with glutamine replacing 20 % of essential and nonessential amino acids and 48 hours of isonitrogenous , isocaloric st and ard enteral feedings . This interval was chosen to help ensure that the study periods were comparable from a metabolic perspective . At the end of each period , protein kinetics were determined by a primed constant infusion of L-[1-(13)C ] leucine tracer . The order of the studies was r and omized . Seven children completed both phases of the study . Results were compared by paired t test and are presented as mean + /- st and ard error of the mean . RESULTS During the glutamine feeding period , the leucine flux and leucine oxidation rate were significantly lower than those in the conventional feeding period . This reflects a reduction in total leucine intake from 80 + /- 11 to 62 + /- 10 micromol/kg per hour . However , there was no significant difference in the net balance of leucine accretion into proteins between these 2 dietary periods , which indicated that enriched glutamine feeding for 48 hours did not result in an immediate whole body protein gain in this group of pediatric patients . In addition , plasma glutamine concentration showed a moderate increase after 48 hours of supplementation but did not reach significance . CONCLUSION Rapid protein accretion does not occur with short-term enteral glutamine supplementation . Several days of glutamine supplementation may be required to restore plasma glutamine levels and stimulate protein synthesis OBJECTIVE To observe the protective effect of oral feeding of glutamine ( Gln ) granules on intestinal mucous membrane during early postburn stage . METHODS Twenty burn patients were r and omly divided into test ( T ) and control ( G ) groups with 10 patients in each group .  Gln granules and placebo were administered in a dose of 10 grams three times a day for 10 days to patients in the two groups respectively . Blood levels of Gln , diamine oxidase ( DAO ) activity , endotoxin ( LPS ) and intestinal permeability were monitored before and after the administration of the agents . at the same time , the changes in blood and urine routine and hepatic and renal functional indices were also observed . RESULTS There was no difference of the general data and the hepatic and renal functional indices between the two groups . The plasma level of Gln before the administration was much lower than that thereafter ( P < 0.01 ) in T group , but all of the values were higher than that in C group ( P < 0.05 ) . The DAO activity , intestinal permeability and LPS levels before the administration were much higher than those after it ( P < 0.01 ) in T group . CONCLUSION Gln might be good to burn patients due to its protective effect on intestinal mucous membrane when given during early postburn stage OBJECTIVE To determine the effect of glutamine dipeptide on gut permeability in severe burns . METHODS Twenty-four severe burn patients were r and omly divided into two groups : control group and GLN group . All patients received enteral nutrition for 12 days after burn . Both groups were isocaloric and isonitrogen . GLN group patients were given nutrition solution enriched with glutamine dipeptide at a dosage at 0.5 g.kg-1.day-1 ( equivalent to L-glutamine 0.3 mg.kg-1.day-1 ) . On the day 1 and 12 after burn , the plasma amino acid was measured by a st and ard amino acid analyzer . On the day 1 , 3 , 6 and 12 , the gut permeability was detected with Lactulose and Manitol assay by HPLC-PED , and then wound healing rate of burn area was determined on the day 30 and hospital stay was recorded . ANOVA was done for data analysis . RESULTS The plasma GLN concentrations decreased in both groups on day 1 , ( control group : 361.3 + /- 70.8 microns/L , GLN group : 348.6 + /- 52.5 microns/L , P = 0.624 , normal value : 659.5 + /- 35.0 microns/L ) , and the GLN group showed high plasma GLN concentration on day 12 ( 566.4 + /- 128.3 microns/L ) , with significant difference between control group ( 417.6 + /- 74.8 microns/L , P = 0.002 ) . On day 1 , L/M ratio value was the highest in both groups . On day 3 , L/M ratio in the GLN group became lower than that of control group , and returned to normal on day 6 and maintained to day 12 . There were significant differences of wound healing rate between the two groups and the length of hospital stay on day 30 ( CONTROL GROUP : ( 81 + /- 7)% , GLN group : ( 89 + /- 7)% , 0.018 ) ( CONTROL GROUP : 68 + /- 27 days , GLN group : 49 + /- 13 days , P = 0.049 ) . CONCLUSION The glutamine-dipeptide enriched enteral nutrition can improve the plasma GLN level after severe burn , decrease the gut permeability from early stage , ameliorate wound healing rate on day 30 , and reduce hospital stay An abundant amino acid in the human body , glutamine ( Gln ) has many important metabolic roles that may protect or promote tissue integrity and enhance the immune system . Low plasma and tissue levels of Gln in the critically ill suggest that dem and may exceed endogenous supply . A relative deficiency of Gln in such patients could compromise recovery and result in prolonged illness and an increase in late mortality . This study examines this hypothesis . Using a prospect i ve , block-r and omized , double- 
    Output:
    
R and omized controlled trials in burns suggest significant clinical benefit in terms of morbidity , mortality , and length of stay but are limited by sample size .
In large burns , inflammation and hypermetabolism may persist well beyond 4 weeks of injury .