***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 
    ***DOCUMENTATION*** 
    ***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 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 Objective The authors determined the effect of glutamine-supplementation of TPN on postoperative peripheral blood T-cell response and proinflammatory cytokine production in patients undergoing colorectal resection . Summary Background Data Several vital tissues , including the immune system , are very dependent on glutamine ; however , this amino acid , which may be essential in conditions of stress , only now is becoming formulated suitably for incorporation into TPN . The effects of such supplementation on the immune function of stressed surgical patients is unknown . Methods Patients ( n = 20 ) were r and omized to receive conventional TPN ( 0.2 g nitrogen/kg/d ) or an isonitrogenous/isocaloric regimen with 0.18 g of glutamine/kg/d from days 1 to 6 postoperatively . T-cell DNA synthesis and interleukin (IL)-2 production and peripheral blood mononuclear cell IL-6 and tumor necrosis factor ( TNF ) production were measured in vitro preoperatively and on days 1 and 6 postoperatively . Results T-cell DNA synthesis after 5 days of TPN was increased compared with preoperative values in the glutamine-supplemented group ( median preoperative tritiated thymidine uptake : 78.3 X 103 cpm , day 6 : 95.0 X 103 cpm , p < 0.05 ) . There was no such increase in the control TPN group ( preoperative : 89.0 X 103 cpm , day 6 : 69.4 X 103 cpm , p > 0.05 ) . Glutamine supplementation did not influence IL-2 production or the production of TNF or IL-6 . Conclusions Glutamine supplementation may be a method of enhancing T-cell function in the surgical patient receiving TPN 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 Abstract Background & Aim : to analyze the clinical impact and cost-effectiveness of parenteral immunonutrition ( PN ) . Methods : prospect i ve clinical trial of a group of 105 patients operated on for gastric carcinoma between 2001 - 2003 . During the postoperative period , patients were r and omly allocated to one of three groups : st and ard PN ( A ) , PN + glu-tamine ( B ) and PN + omega-3-FA ( C ) . The rate and type of complications , hepatic and renal function , cost and treatment tolerance in all groups were analyzed . Results : postoperative complications were observed in 11 patients ( 36,6 % ) in group A , in 7 ( 23,3 % ) in B and in 8 ( 26,6 % ) in C. The most common complication was pneumonia . Prealbumin concentration and TLC increased faster in groups B and C. The length of hospital stay was significantly shorter in the immunonutrition groups . The cost of PN was highest in C group , while cost of hospital stay was longer in A. Conclusions : immunostimulating parenteral nutrition helps to reduce the number of infectious complications , improves the function of the immune system , and has no influence on surgical complications , hepatic and renal function and protein synthesis . The cost of immunostimulating treatment based on omega-3-unsaturated fatty acids is higher than st and ard Objective : Heat shock protein ( HSP ) expression is vital to cellular and tissue protection after stress or injury . However , application of this powerful tool in human disease has been limited , as known enhancers of HSPs are toxic and not clinical ly relevant . Glutamine ( GLN ) can enhance HSP expression in non– clinical ly relevant animal injury models . The aim of this study was to assess the ability of GLN to enhance pulmonary HSP expression , attenuate lung injury , and improve survival after sepsis in the rat . Design : Prospect i ve , r and omized , controlled animal trial . Setting : University research laboratory . Subjects : Male Sprague-Dawley rats . Interventions : We utilized a rat model of cecal ligation and puncture to induce sepsis . GLN or saline was administered 1 hr after initiation of sepsis via single tail-vein injection . We analyzed heat shock factor-1 phosphorylation , HSP-70 , and HSP-25 via Western blot . Tissue metabolism was assayed by magnetic resonance spectroscopy . Occurrence of lung injury was determined via histopathologic examination . An inhibitor of HSP expression , quercetin , was utilized to assess role of HSP expression in prevention of sepsis-related mortality . Measurements and Main Results : GLN , given after initiation of sepsis , enhanced pulmonary heat shock factor-1 phosphorylation , HSP-70 , HSP-25 , and attenuated lung injury after sepsis . Further , GLN improved indices of lung tissue metabolic function ( adenosine 5-triphosphate/adenosine 5-diphosphate ratio , nicotinamide adenine dinucleotide ) after sepsis . No significant effect of GLN on lung tissue-reduced glutathione was observed . GLN treatment led to a significant decrease in mortality ( 33 % [ 6 of 18 ] GLN-treated rats vs. 78 % [ 14 of 17 ] saline-treated rats ) . Administration of the HSP inhibitor quercetin blocked GLN-mediated enhancement of HSP expression and abrogated GLN ’s survival benefit . Conclusions : GLN has been safely administered to critically ill patients and shown 
    Output:
    
The present systematic review has found trends to suggest that parenteral and enteral glutamine supplementation reduce mortality , the development of infection and organ failure in critical illness .
Trials of parenteral nutrition containing glutamine with patients after elective surgery also suggest reduction of infection , but it is unlikely that glutamine-containing parenteral nutrition would be used for such patients .