***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 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 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 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 BACKGROUND / AIMS Long-term total parenteral nutrition is accompanied with mucosal atrophy and subsequent malabsorption syndrome . Current information attests the important role of glutamine in maintaining intestinal structure and function . The aim of this study was to investigate the effect of glutamine dipeptide supplementation on small intestinal absorption capacity during critical illness . METHODS Twelve intensive care unit patients were uniformly r and omized to receive isonitrogenous ( 0.26 g nitrogen.kg-1.day-1 ) and isoenergetic ( 155 kJ.kg-1.day-1 ) parenteral nutrition over 9 days . The control group received a conventional amino acid solution ( 1.5 g amino acids.kg-1.day-1 ) , and the test group received a complete amino acid solution containing the dipeptide L-alanyl-L-glutamine ( 20 g/L ) . On days 8 and 9 , a modified D-xylose test was performed . RESULTS Excretion of D-xylose during the 5-hour test period was 7.4 + /- 1.1 g ( test ) vs. 3.8 + /- 0.9 g ( control ) ( P < 0.05 ) . The 2-hour serum D-xylose concentration was 38.7 + /- 3.0 ( test ) vs. 27.8 + /- 2.9 mg/100 mL ( control ) ( P < 0.05 ) . Kinetic evaluation showed higher maximum D-xylose blood concentration and higher values for the area under the curve with the peptide . CONCLUSIONS The results strongly suggest that glutamine dipeptide-containing total parenteral nutrition prevents intestinal atrophy and increased permeability associated with glutamine-free parenteral nutrition Glutamine seems to play an important role in metabolism and function of immunologic cells and therefore could also influence postoperative immunosuppression in surgical patients . Nevertheless , the influence of glutamine substitution in postoperative total parenteral nutrition on immunologic function and postoperative morbidity of patients is still unknown . Therefore , the impact of glutamine substitution on postoperative immunosuppression and incidence of complications was investigated in patients with surgical interventions on esophagus or stomach and total parenteral nutrition in a prospect i ve r and omized trial . To analyse the immunologic competence of the patients , the expression of CD-3 , CD-4 , and CD-8 on lymphocytes as well as the expression of HLA-DR and CD-14 on monocytes were evaluated before , 1 , 2 , 4 , 7 days after surgery . Furthermore , plasma levels of IL-6 and IL-10 were analysed during the perioperative course . Actually , 34 patients have been included ( with glutamine : n = 18 vs. without glutamine : n = 16 ) in the study . Patients with glutamine substitution showed non significantly decreased systemic inflammation ( IL-6-plasma levels , leucocytosis ) and significantly faster compensation of postoperative immunosuppression ( HLA-DR-monocytes ) . Incidence of postoperative complications was decreased after glutamine substitution compared with the control group . Patients without postoperative complications showed no significant difference in postoperative immunosuppression . Although additional substitution of the amino acid glutamine might possibly decrease incidence of postoperative complications in patients with total parenteral nutrition a general advantage in postoperative immune function could not be demonstrated 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 Glutamine is normally an abundant amino acid in the 
    Output:
    
Although there were no statistically significant subgroup differences detected , there were some important trends .
CONCLUSION In surgical patients , glutamine supplementation may be associated with a reduction in infectious complication rates and shorter hospital stay without any adverse effect on mortality .
In critically ill patients , glutamine supplementation may be associated with a reduction in complication and mortality rates .
The greatest benefit was observed in patients receiving high-dose , parenteral glutamine