***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: Abstract Background Accumulation of epicardial fat ( EF ) is associated with increased cardio-metabolic risks and coronary events , independently of traditional cardiovascular risk factors . Therefore , the reduction of EF volume ( EFV ) may be associated with reduced cardio-metabolic risks and future cardiovascular events . Sodium-glucose co-transporter-2 ( SGLT2 ) inhibitors reduce body fat including visceral fat and cardiovascular events in patients with type 2 diabetes . However , it has still been unknown whether SGLT2 inhibitors can reduce EFV . Methods Type 2 diabetic patients with HbA1c 6.5–9.0 % and body mass index ( BMI , kg/m2 ) ≥25.0 were enrolled in this single arm pilot study . Participants were administered luseogliflozin 2.5 mg daily and the dosage was tolerated to be increased up to 5.0 mg daily . EFV [ median ( interquartile range ) , cm3 ] was measured by magnetic resonance imaging . Primary endpoint was the decrease in EFV at 12 weeks . Visceral fat area ( VFA , cm2 ) and liver attenuation index ( LAI ) measured by the abdominal computed tomography , and skeletal muscle index ( SMI ) and body fat ( % ) measured by the whole body dual-energy X-ray absorptiometry were also determined at baseline and at 12 weeks . Results Nineteen patients ( mean age : 55 ± 12 years ; 26 % female ) completed this study . Luseogliflozin treatment significantly reduced EFV at 12 weeks [ 117 ( 96–136 ) to 111 ( 88–134 ) , p = 0.048 ] . The body weight , BMI , systolic and diastolic blood pressure , HbA1c , fasting plasma glucose , insulin , homeostasis model assessment -insulin resistance ( HOMA-IR ) , triglycerides , SMI , and body fat were significantly reduced by luseogliflozin at 12 weeks . The reduction of EFV was significantly correlated with the reduction of C-reactive protein ( r = 0.493 , p = 0.019 ) . Neither VFA nor LAI were significantly reduced by the luseogliflozin treatment . No severe adverse events were observed . Conclusions Our data suggest that luseogliflozin could reduce the EFV in parallel with the improvement of systemic micro-inflammation and the reduction of body weight in Japanese patients with type 2 diabetes . The reduction of muscle mass after the administration of SGLT2 inhibitors may require a particular attention . Trial registration umin.ac.jp , BACKGROUND We investigated the adipokines adiponectin , leptin and resistin as serum biomarkers of beta-cell function in patients with type 1 diabetes . METHODS One hundred and eighteen patients with type 1 diabetes ( 20.3 ± 7.5 years ) diagnosed < 5 years underwent st and ardized mixed meal test ( MMTT ) for 2 h.  Systemic concentrations of C-peptide , adiponectin , leptin and resistin obtained during MMTT were measured and compared between patient groups by multiple regression analysis . RESULTS Patients were divided by their adipokine levels in subgroups above or below the median level ( ' high versus low ' ) . High adiponectin levels ( > 10.6 µg/mL ) were associated with lower C-peptide compared to the low adiponectin subgroup ( p < 0.03 ) . Increased leptin or resistin concentrations associated positively with beta-cell function even after adjustment for metabolic confounders ( p < 0.04 ) . The described associations between adipokines and C-peptide concentrations persisted in Spearman correlation tests ( p < 0.05 ) . Serum adipokines fell during MMTT ( p < 0.05 ) . CONCLUSIONS Serum adipokine levels differentially correlate with beta-cell function in type 1 diabetes independent of BMI or metabolic control . Serum adipokines should be investigated as biomarkers of beta-cell function in prospect i ve studies and intervention trials in type 1 diabetes Background Glycosuria produced by sodium – glucose co-transporter-2 ( SGLT-2 ) inhibitors is associated with weight loss . SGLT-2 inhibitors reportedly might reduce the occurrence of cardiovascular events . Epicardial adipose tissue ( EAT ) is a pathogenic fat depot that may be associated with coronary atherosclerosis . The present study evaluated the relationship between an SGLT-2 inhibitor ( dapagliflozin ) and EAT volume . Methods In 40 diabetes mellitus patients with coronary artery disease ( 10 women and 30 men ; mean age of all 40 patients was 67.2 ± 5.4 years ) , EAT volume was compared prospect ively between the dapagliflozin treatment group ( DG ; n = 20 ) and conventional treatment group ( CTG ; n = 20 ) during a 6-month period . EAT was defined as any pixel that had computed tomography attenuation of − 150 to − 30 Hounsfield units within the pericardial sac . Metabolic parameters , including HbA1c , tumor necrotic factor-α ( TNF-α ) , and plasminogen activator inhibitor-1 ( PAI-1 ) levels , were measured at both baseline and 6-months thereafter . Results There were no significant differences at baseline of EAT volume and HbA1c , PAI-1 , and TNF-α levels between the two treatment groups . After a 6-month follow-up , the change in HbA1c levels in the DG decreased significantly from 7.2 to 6.8 % , while body weight decreased significantly in the DG compared with the CTG ( − 2.9 ± 3.4 vs. 0.2 ± 2.4 kg , p = 0.01 ) . At the 6-month follow-up , serum PAI-1 levels tended to decline in the DG . In addition , the change in the TNF-α level in the DG was significantly greater than that in the CTG ( − 0.5 ± 0.7 vs. 0.03 ± 0.3 pg/ml , p = 0.03 ) . Furthermore , EAT volume significantly decreased in the DG at the 6-month follow-up compared with the CTG ( − 16.4 ± 8.3 vs. 4.7 ± 8.8 cm3 , p = 0.01 ) . Not only the changes in the EAT volume and body weight , but also those in the EAT volume and TNF-α level , showed significantly positive correlation . Conclusion Treatment with dapagliflozin might improve systemic metabolic parameters and decrease the EAT volume in diabetes mellitus patients , possibly contributing to risk reduction in cardiovascular events Background Discrepancies are present in the literature on resting myocardial mechanics in patients with uncomplicated type 2 diabetes mellitus ( T2DM ) . Data are noticeably sparse regarding circumferential function and torsional mechanics . Resting deformation imaging may not be sensitive enough to detect subtle dysfunctions . The aim of this study was thus to comprehensively evaluate myocardial mechanics in patients with T2DM at rest and to investigate whether dobutamine stress echocardiography could unmask functional alterations that would remain otherwise subtle at rest . Methods Forty‐four patients with T2DM and 35 healthy control subjects of similar age and sex were prospect ively recruited . After conventional echocardiography , myocardial mechanics was evaluated at rest and during low‐dose dobutamine stress echocardiography ( target heart rate , 110 beats/min ) . Results Patients with T2DM presented with altered global diastolic function but preserved systolic function . Deformation imaging indexes were similar between groups at rest , but significant differences were noticed under dobutamine infusion for longitudinal strain ( −21.2 ± 2.4 % vs −24.2 ± 2.5 % , P < .001 ) , circumferential strain ( apex , −32.3 ± 5.3 % vs −36.3 ± 5.3 % , P = .002 ; papillary muscle , −25.6 ± 3.2 % vs −28.0 ± 3.6 % , P = .001 ; base , −23.2 ± 3.6 % vs −25.3 ± 3.8 % , P = .03 ) , apical ( 11.2 ± 4.4 ° vs 14.1 ± 6.3 ° , P = .020 ) and basal ( −12.2 ± 3.3 ° vs −14.3 ± 3.9 ° , P = .021 ) rotation , and twist ( 21.9 ± 5.9 ° vs 26.8 ± 8.3 ° , P = .007 ) . Multivariate analysis identified epicardial fat , dyslipidemia , and fasting glycaemia as significant contributors to the changes from rest to dobutamine . Conclusions These findings demonstrate the usefulness of dobutamine stress echocardiography in establishing impairments in myocardial mechanics in patients with uncomplicated T2DM . Systemic metabolic disturbances and epicardial fat act as the main contributors to the blunted response to dobutamine stress in these patients . HighlightsRegional myocardial dysfunction is imperceptible at rest in patients with uncomplicated T2DM.DB stress reveals early regional myocardial dysfunction and can serve as a diagnostic tool . Cardiac functional reserve is lost in response to myocardial stress . Factors responsible for the blunted myocardial response to & bgr;‐adrenergic stimulation are delineated . These findings enable better underst and ing of the central origin of exercise intolerance in patients with T2DM BACKGROUND Epicardial fat thickness ( EFT ) is associated with increased cardio metabolic risk . Recent studies have suggested that there is a strong relationship between diabetes and EFT . Although the relationship between EFT and coronary artery disease ( CAD ) is well known , the possible impact of diabetes on the relationship between EFT and extent and complexity of CAD was not fully investigated . AIM We aim ed to investigate the relationship between EFT and extent and complexity of CAD in patients with non-ST elevation myocardial infa rct ion ( NSTEMI ) with and without diabetes . METHODS We prospect ively included 454 patients with NSTEMI ( mean age : 61.8 ± 10.4 years ) in the present study . Patients were classified into two groups according to their diabetes status ( diabetic group and non-diabetic group )  . EFT  was measured by transthoracic echocardiography on the right ventricle in individuals having the left lateral decubitus position . SYNTAX score was used to define the extent and complexity of CAD . High-sensitivity C-reactive protein ( hs-CRP ) and other biochemical markers were measured in all participants . RESULTS Diabetic patients had higher EFT values compared with non-diabetics ( p < 0.05 ) . EFT is independently associated with diabetes , SYNTAX score , and hs-CRP in all patients ( p < 0.05 , for all ) . When patients were divided into two groups , as diabetic and non-diabetic , the association between EFT and SYNTAX score was stronger in diabetic patients compared with non-diabetics ( r = 0.635 ; p < 0.001 vs. r = 0.179 ; p = 0.003 ) . CONCLUSIONS Epicardial fat thickness is associated with SYNTAX score in both diabetic and non-diabetic patients . Furthermore , there is a stricter relationship between EFT and SYNTAX score in diabetic patients We report a method of fast adipose tissue ( FAT ) assessment to characterize the quantity , and distribution of abdominal adipose tissue . Whole-volume coverage of the abdomen was obtained using 31 contiguous transverse T(1)-weighted images from 16 obese females . A radiologist manually traced all adipose tissue volumes in the images , while a physiologist used an automated method to measure adipose tissue in a single image at the level of the umbilicus . Automated analysis of the umbilicus-level image was significantly correlated with values obtained by manual analysis of the entire abdomen ( p < 0 . 001 ) . There was good agreement between the automated umbilicus-level image method and the manual whole abdomen method for subcutaneous adipose tissue ( r(2 ) = 0.958 ) , visceral adipose tissue ( r(2 ) = 0 . 753 ) , and total adipose tissue ( r(2 ) = 0.941 ) . The automated method required 6 min vs 2 h for the manual method CONTEXT Hyperglycemia and insulin resistance frequently occur in critically ill patients even without a history of diabetes . OBJECTIVE Our objective was to study the role of adipose tissue hormonal production in the development of insulin resistance in cardiac surgery patients . PARTICIPANTS , INTERVENTIONS , AND SETTING S : Fifteen patients with elective cardiac surgery underwent blood sampling before , at the end , and 6 , 12 , 24 , 48 , and 120 h after the end of their operation . Epicardial and sc adipose tissue sampling was done at the beginning and at the end of surgery in the Department of Cardiac Surgery . MAIN OUTCOME MEASURES We measured serum concentrations and sc and epicardial adipose tissue mRNA expression of IL-6 , monocyte chemoattractant protein 
    Output:
    
Conclusions Our meta- analysis suggests that the amount of EFT is significantly higher in DM patients than in non-DM patients