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The interaction of free electrons with intense laser beams in vacuum is studied using a 3D test particle simulation model that solves the relativistic Newton-Lorentz equations of motion in analytically specified laser fields. Recently, a group of solutions was found for very intense laser fields that show interesting and unusual characteristics. In particular, it was found that an electron can be captured within the high-intensity laser region, rather than expelled from it, and the captured electron can be accelerated to GeV energies with acceleration gradients on the order of tens of GeV/cm. This phenomenon is termed the capture and acceleration scenario (CAS) and is studied in detail in this paper. The maximum net energy exchange by the CAS mechanism is found to be approximately proportional to a 2_o, in the regime where a_o > 100, where a_o = eE_o/m_ewc is a dimensionless parameter specifying the magnitude of the laser field. The accelerated GeV electron bunch is a macro-pulse, with duration equal or less than that of the laser pulse, which is composed of many micro-pulses that are periodic at the laser frequency. The energy spectrum of the CAS electron bunch is presented. The dependence of the energy exchange in the CAS on various parameters, e.g., a 2_o (laser intensity), w_o (laser radius at focus), tao (laser pulse duration), b_o (the impact parameter), and theta_i (the injection angle with respect to the laser propagation direction), are explored in detail. A comparison with diverse theoretical models is also presented, including a classical model based on phase velocities and a quantum model based on nonlinear Compton scattering.

EMPA-REG OUTCOME is recognised by international guidelines as a landmark study that showed a significant cardioprotective benefit with empagliflozin in patients with type 2 diabetes (T2D) and cardiovascular disease. To assess the impact of empagliflozin in routine clinical practice, the ongoing EMPRISE study is collecting real-world evidence to compare effectiveness, safety and health economic outcomes between empagliflozin and DPP-4 inhibitors. A planned interim analysis of EMPRISE was recently published, confirming a substantial reduction in hospitalisation for heart failure with empagliflozin across a diverse patient population. In this commentary article, we discuss the new data in the context of current evidence and clinical guidelines, as clinicians experienced in managing cardiovascular risk in patients with T2D. We also look forward to what future insights EMPRISE may offer, as evidence is accumulated over the next years to complement the important findings of EMPA-REG OUTCOME.

Background: For patients with type 2 diabetes (T2D), cardiovascular disease (CVD) is the single most common cause of mortality. In 2008 and 2012, the Federal Drug Administration (FDA) and the European Medicines Agency (EMA) respectively mandated cardiovascular outcomes trials (CVOTs) on all new anti-diabetic agents, as prospective trials statistically powered to rule out excess cardiovascular risk in patients with T2D. Unexpectedly, some of these CVOTs have demonstrated not only cardiovascular safety, but also cardioprotective effects, as was first shown for the SGLT2 inhibitor empagliflozin in EMPA-REG OUTCOME., Expert Opinion: To debate newly available CVOT data and to put them into context, we convened as a group of medical experts from the Central and Eastern European Region. Here we describe our discussions, focusing on the conclusions we can draw from EMPA-REG OUTCOME and other SGLT2 inhibitor CVOTs, including when considered alongside real-world evidence., Conclusion: CVOTs investigating SGLT2 inhibitors have suggested benefits beyond glucose lowering that have been confirmed in real-world evidence studies.