***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: In this review we sought to appraise the true method ological quality of nutritional support studies conducted in critically ill patients and to compare these findings to the method ological quality of sepsis trials . An extensive literature search revealed 111 r and omized controlled trials conducted in critically ill patients evaluating the impact of nutritional support interventions on clinical ly meaningful outcomes . Compared with sepsis trials , nutritional support studies were significantly less likely to use blinding ( 32 of 40 versus 35 of 111 , P < 0.001 ) or present an intention-to-treat analysis ( 37 of 40 versus 64 of 111 , P < 0.001 ) . There was a trend toward the less frequent use of r and omization methods that are known to maintain allocation concealment ( 12 of 40 versus 19 of 111 , P = 0.10 ) . Although nutritional support studies demonstrated a significant increase in the use of blinding after the publication of the CONSORT statement in 1996 ( 9 of 47 versus 26 of 64 post-CONSORT , P = 0.023 ) , there were no improvements in other key areas . Previous publications have described the overall method ological quality of sepsis trials as “ poor . ” Nutritional support studies were significantly worse than sepsis trials in all aspects of method ological quality , and there were few improvements noted over time . To detect important differences in clinical ly meaningful outcomes in critical care , the method ological quality of future studies must be improved 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 To examine the effect of enteral administration of glutamine in patients with peritonitis or abdominal trauma . METHODS In a prospect i ve , interventional , observer-blind , r and omized clinical trial , 120 patients , aged 18 - 60 years , were r and omized to receive either enteral glutamine 45 g/day for 5 days in addition to st and ard care ( n=63 ; group A ) or st and ard care alone ( n=57 ; group B ) . Surgical intervention was done as needed . RESULTS The two groups were comparable for sex and severity of illness scores . Following treatment , serum malondialdehyde ( MDA ) levels in group A increased from 4.4 ( 8.0 ) to 7.2 ( 4.8 ) mmol/mL , whereas those in group B decreased from 3.9 ( 4.9 ) to 3.1 ( 5.0 ) mmol/mL ; these changes were not statistically significant . Reduced glutathione levels increased from 0.03 ( 0.04 ) to 0.06 ( 0.12 ) mg/g Hb ( p=0.032 ) after treatment in group A and from 0.03 ( 0.03 ) to 0.05 ( 0.04 ) mg/g Hb ( p=0.001 ) in group B. Infectious complications were equally frequent in the two groups ( group A : 44 ; group B : 37 ; p=0.571 ) . Survival rate and duration of hospital stay were also comparable in the two groups . CONCLUSION Enteral glutamine supplementation offers no advantage in patients with peritonitis or abdominal trauma 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 70 ( HSP-70 ) is protective against cellular and tissue injury . Increased serum HSP-70 levels are associated with decreased mortality in trauma patients .  Glutamine ( Gln ) administration increases serum and tissue HSP-70 expression in experimental models of sepsis . Gln has been safely administered to critically ill patients and can improve clinical outcomes , but the effect of Gln administration on HSP-70 expression in humans is unknown . We examined whether Gln-supplemented parenteral nutrition ( PN ) increases serum HSP-70 levels in critically ill patients . Design and setting R and omized , controlled , double-blind study in surgical intensive care units ( SICU ) in a university hospital . Patients 29 patients admitted to the SICU and requiring PN for more than 7 days . Interventions Patients received either Gln-PN ( containing alanyl-glutamine dipeptide ; 0 
    Output:
    
There is no evidence to suggest that glutamine is harmful in terms of organ failure and parenteral glutamine may reduce the development of organ failure