***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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    Input: BACKGROUND Total parenteral nutrition ( TPN ) supplemented with glutamine ( GLN ) has been reported to be effective for patients with bone marrow transplantation ( BMT ) . Our aim was to evaluate enteral and parenteral glutamine in patients undergoing BMT . METHODS For evaluation of GLN in BMT , 66 patients with 43 hematologic and 23 solid malignancies ( 21 breast carcinomas ) , were r and omized , double-blinded , to either oral GLN ( n = 35 ) or glycine-control ( GLY ) ( n = 31 ) , 10 g three times daily . When TPN became necessary , patients who received GLN orally were given TPN with GLN ( 0.57 g/kg ) . Those who received GLY received st and ard TPN , isocaloric and isonitrogenous . Patients with hematologic malignancies received high-dose chemotherapy , total body irradiation , and either allogeneic ( ALLO ) BMT ( n = 18 ) or autologous ( AUTO ) stem cell transplantation ( n = 25 ) . Patients with solid malignancies ( n = 23 ) received AUTO . RESULTS There were 14 in-hospital deaths without relationship to GLN administration . For respective comparisons of ALLO and AUTO transplants in the GLN and GLY hematologic groups and AUTO in the solid tumor groups , there were no significant differences in hospital stay , duration of stay after BMT , TPN days , neutrophil recovery > 500/mm3 , incidence of positive blood cultures , sepsis , mucositis , and diarrhea . Acute graft us host disease occurred in 1 of 10 hematologic patients receiving GLN and in 3 of 8 patients receiving GLY placebo ( p > .05 ) . Possible reduction in need for TPN and a suggestion of improved long-term survival were associated with GLN . CONCLUSIONS Oral and parenteral GLN seemed to be of limited benefit for patients having AUTO or ALLO BMT for hematologic or solid malignancies . Further study of long-term effects of GLN in BMT seems warranted Painful oral mucositis is a common complication after  bone marrow transplantation ( BMT ) . Glutamine is a nutrient for rapidly dividing cells and the major energy source for intestinal epithelium . This study tested whether an oral glutamine preparation could decrease the severity of oral mucositis in patients undergoing BMT . Glutamine or a placebo ( glycine ) were administered from admission until day + 28 in 193 BMT patients in a r and omized , double-blind , placebo-controlled study at a dose of 1.0 g amino acid/m2/dose swish and swallow four times a day . In  autologous BMT patients ( n = 87 ) glutamine was associated with significantly less mouth pain by self report and by opiate use ( 5.0 ± 6.2 days of morphine for glutamine vs 10.3 ± 9.8 days for placebo ; P = 0.005 ) . Matched sibling BMT patients had no effect by self report and an increased duration of opiate use ( 23.2 ± 5.7 days for glutamine vs 16.3 ± 8.3 days for placebo ) ( P = 0.002 ) . However , day 28 survival of allogeneic patients was improved by glutamine . No significant differences in TPN use , rate of relapse or progression of malignancy , parenteral antibiotic use , acute or chronic GVHD , or days of hospitalization were observed in either autologous or allogeneic recipients . No toxicity of glutamine was observed . We conclude that oral glutamine can decrease the severity and duration of oropharyngeal mucositis in autologous BMT patients but not in allogeneic BMT patients , possibly due to interaction with methotrexate Experimental data have implicated intravenous lipids as being immunosuppressive , yet evidence that lipids are associated with an increase in clinical ly documented infections is sparse . A prospect i ve trial conducted in patients with hematologic malignancies who were undergoing bone marrow transplantation compared the incidence of bacteremia and fungemia during the first month after the transplant . Patients ( n = 512 ) were r and omly assigned to receive 6 - 8 % ( low dose ) or 25 - 30 % ( st and ard dose ) of total daily energy as a 20 % lipid emulsion . An adaptive r and omization scheme stratified for treatments that might influence infection outcome ( hematopoietic growth factors , fluconazole , graft-versus-host disease prophylaxis with steroids , pentoxifylline , intravenous immunoglobulin , and total body irradiation ) . The transplant type ( autologous , related family donor , or unrelated donor ) did not differ in distribution between treatment groups . Of the evaluable patients ( n = 482 ) , 55 patients in the st and ard-dose  lipid  group developed bacteremia or fungemia compared with 54 in the low-dose lipid group . The log-rank test comparing the time to first infection found no association between the incidence of bacteremia or fungemia and intravenous lipid ( P = 0.95 ) . Similar results were found when analyzed as intent-to-treat ( P = 0.98 ) , when bacterial or fungal infections at all sites were included ( P = 0.94 ) , and when the observation period was extended to 60 d ( P = 0.58 for blood infections , P = 0.77 for infections at all sites ) . These data indicate that moderate amounts of intravenous lipid rich in linoleic acid are not associated with an increased incidence of bacterial or fungal infections in patients undergoing bone marrow transplantation and receiving total parenteral nutrition The aim of this prospect i ve , r and omized clinical trial was to compare the efficacy of parenteral nutrition ( PN ) in adult bone marrow transplant ( BMT ) patients on a continuous ( CON ) versus a cyclic ( CYC ) regimen . Twelve patients received CON PN and 12 CYC PN . The groups were homogeneous . CON PN received 27.2 + /- 3.7 kcal/kg/day and for CYC PN 25.9 + /- 4.2 kcal/kg/day ( P= 0.45 ) . The duration of PN was 20.4 + /- 7.9 days and 27.3 + /- 13.4 days respectively ( P = 0.14 ) . There were no differences between initial and final body weights , either within or between groups . The initial pre-albumin levels were 16.1 + /- 7.5 mg/dl and 20.1 + /- 4.9 mg/dl in CON PN and CYC PN , respectively ( P= 0.22 ) , and these were maintained throughout the study . Blood glucose levels did not differ between groups . Measures of liver function were moderately increased , but with no significant differences between groups . There were no significant differences regarding the efficacy of PN or the appearance of complications between CON PN and CYC PN in patients with BMT Although st and ard supportive care for bone marrow transplant ( BMT ) recipients includes total parenteral nutrition ( TPN ) , it has not been shown that this is the most appropriate method of nutritional support . To determine whether current BMT recipients require TPN during the early recovery period , we conducted a prospect i ve , r and omized clinical trial comparing TPN and an individualized enteral feeding program ( counseling , high protein snacks and /or tube feeding ) . Nutritional assessment included measurement of serum proteins , anthropometry , and body composition analysis . For the latter , total body water and extracellular fluid were measured by st and ard radioisotope dilution techniques and used to quantitate body cell mass and body fat plus extracellular solids ( FAT + ECS ) . In 27 TPN patients , body composition 28 days after BMT , expressed as a percentage of baseline , was body cell mass , 100 % , extracellular fluid , 108 % , FAT + ECS , 108 % , and in 30 enteral feeding program patients , was body cell mass , 93 % , extracellular fluid , 104 % , and FAT + ECS , 94 % . Only the difference in FAT + ECS was statistically significant ( p less than 0.01 ) . Compared to the enteral feeding program , TPN was associated with more days of diuretic use , more frequent hyperglycemia , and more frequent catheter removal ( prompted by catheter-related complications ) , but less frequent hypomagnesemia . There were no significant differences in the rate of hematopoietic recovery , length of hospitalization , or survival , but nutrition-related costs were 2.3 times greater in the TPN group . We conclude that TPN is not clearly superior to individualized enteral feeding and recommend that TPN be reserved for BMT patients who demonstrate intolerance to enteral feeding OBJECTIVE Glutamine ( Gln ) is a non-essential amino acid that plays an important role in energy metabolism for gastrointestinal epithelia and other cells with rapid turnover . We evaluated the effects of enteral supplementation with Gln in infants undergoing surgery for congenital or acquired gastrointestinal disease . METHODS This was a r and omized , double-masked , controlled clinical trial . RESULTS Twenty infants were r and omly assigned to receive Gln ( n = 9 ) or placebo amino acid ( n = 11 ) , with a goal of supplemental amino acid intake of 0.4 g.kg(-1).d(-1 ) . Infants were weaned from parenteral nutrition , and enteral feeds were started according to a st and ardized feeding protocol . Median ( interquartile range ) duration s of parenteral nutrition were 39 d ( 12 to 99 ) in the Gln group and 21 d ( 6 to 59 ) in the control group ( P = 0.201 ) . Median ( interquartile range ) duration s needed to reach 80 % of the US recommended dietary allowance for energy with enteral nutrition were 24 d ( 8 to 55 ) in the Gln group and 12.5 d ( 5 to 32 ) in the control group ( P = 0.313 ) . There were no differences in the occurrence of infections between groups . Among all infants enrolled , significant correlations were found between duration of parenteral nutrition and residual small bowel length , peak concentrations of direct bilirubin , and alanine aminotransferase . Peak direct bilirubin was associated with longer duration of parenteral nutrition , shorter gestation , older age before feeds were started , shorter bowel length , and larger amounts of parenteral energy and protein intake . CONCLUSIONS In this pilot trial , enteral Gln supplementation was well tolerated among infants with surgical gastrointestinal disease . There was no effect observed on the duration of parenteral nutrition , tolerance of enteral feeds , or intestinal absorptive or barrier function . Larger , multicenter trials in infants with surgical gastrointestinal disease are needed due to the variability in important outcome measurements Glutamine ( Gln ) is an important nutrient substrate for lymphocytes and macrophages in vitro . This pilot study evaluated effects of Gln supplementation on circulating lymphocytes and lymphocyte subsets after allogeneic bone marrow transplantation ( BMT ) . Adult patients received either parenteral nutrition supplemented by L-Gln ( Gln-PN ) or st and ard Gln-free PN after BMT .  Leukocyte and total lymphocyte counts were determined during hospitalization , and flow cytometry studies of peripheral mononuclear cells were performed 1 to 2 weeks after hospital discharge . The  Gln-PN group demonstrated a higher percentage of blood lymphocytes during hospitalization . At flow cytometry , patients who received Gln-PN had an increased total lymphocyte count ( 332 + /- 50 versus 590 + /- 71 cells/microL , P = 0.010 ) ; greater numbers of total T lymphocytes ( 54 + /- 19 versus 229 + /- 70 cells/microL , P = 0.030 ) ; and higher CD4 + and CD8 + T-lymphocyte counts in peripheral blood compared with controls . Gln-PN may support lymphocyte recovery after BMT OBJECTIVE In a r and omized , double-blind , prospect i ve clinical trial , we evaluated the metabolic effects of glutamine-supplemented parenteral nutrition in patients with bone marrow transplants . We compared hospital charge and cost data for the two groups of patients in the trial . DESIGN Retrospective review . SETTING Bone Marrow Transplant Unit , Brigham and Women 's Hospital , Boston , Mass. SUBJECTS Forty-three patients admitted to the Bone Marrow Transplant Unit were assigned r and omly to receive either st and ard parenteral nutrition or an isocaloric , isonitrogenous parenteral nutrition solution containing glutamine starting on day 1 after bone marrow transplant . The two groups were well matched for diagnosis , antineoplastic treatment , and sex . MEASURES The primary clinical end points evaluated were nitrogen balance , length of hospitalization , incidence of infection , and results of microbial culture . After completion of the study , we compared the hospital charges for the categories of room and board , surgery , laboratory , pharmacy , radiology , ancillary , and miscellaneous between the two groups of patients . STATISTICAL ANALYSIS PERFORMED The two groups were compared using the unpaired t test 
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As reported in the original review there remains no evaluable data to properly compare PN with EN .
In this up date an additional study that compared PN and Glutamine versus st and ard PN showed that the certain benefits of parenteral nutrition with added glutamine compared to st and ard PN for reducing hospital stay are no longer definite .
When PN with glutamine is compared with st and ard PN , patients may not leave hospital earlier , but do have reduced incidence of positive blood cultures , than those receiving st and ard PN .