Umsatzsteuerpflicht bei ästhetischen Operationen

Abstrakt  1. ?sthetische Operationen unterliegen der Umsatzsteuerpflicht. 2. Ums?tze aus der T?tigkeit als Arzt sind nur dann umsatzsteuerfrei, wenn sie der Diagnose, Behandlung und Heilung von Krankheiten oder Gesundheitsst?rungen dienen.     

Dietary (n-3) fatty acids alter fatty acid composition and prostaglandin synthesis in rat testis

The objective of this study was to determine the efficacy of linolenic acid [18:3(n-3)], compared with the long-chain (n-3) fatty acids in fish oil, in suppressing arachidonic acid [20:4(n-6)] metabolism in rat testis. Six groups of rats were fed three levels of 18:3(n-3) or fish oil, and the fatty acid composition of testis parenchyma lipids and prostaglandin (PG) I2 synthesis by tunica were determined after 12 wk. Levels of docosapentaenoic acid [22:5(n-6)], the major 22-carbon fatty acid in rat testis lipids, were significantly depressed compared with the control by both linolenic acid and fish oil; however, testis weights were not affected significantly. Arachidonic acid levels also were depressed significantly in testis lipids by dietary (n-3) fatty acids, but the decreases were not as pronounced as those observed in other tissues. The synthesis of PGI2 was significantly reduced compared with the control by (n-3) fatty acid feeding, but there were no differences among the experimental groups. Both 18:3(n-3) and the longer-chain (n-3) fatty acids from fish oil reduce levels of 20:4(n-6) and 22:5(n-6) in testis lipids and the capacity of the tunica to synthesize PGI2, but these fatty acids seem to cause no defect in testicular development as indicated by weight.     

Characterization of a Tn5382-like transposon containing the vanB2 gene cluster in a Clostridium strain isolated from human faeces

OBJECTIVES: During a hospital surveillance programme to detect VRE carriers, an anaerobic vancomycin-resistant bacterial strain CCRI-9842 containing a vanB gene was isolated from a human faecal specimen. In this study, we have characterized this strain and its vanB-containing element. METHODS: Strain CCRI-9842 was characterized by 16S rDNA sequencing and susceptibility testing. PCR mapping and sequencing of the vanB-containing element, as well as plasmid extraction and mating experiments, were carried out to investigate the genetic basis of vancomycin resistance in this strain. RESULTS: Strain CCRI-9842 was identified as a Clostridium species closely related to Clostridium bolteae (96.8% 16S rDNA identity). This strain was resistant to a high level of vancomycin (MIC of 256 mg/L), but was susceptible to teicoplanin and ampicillin. The complete sequence of the CCRI-9842 vanB gene exhibited 99.1% identity with that of vanB2. PCR mapping and sequencing showed that the genetic element carrying vanB2 was similar to transposon Tn5382/Tn1549. This Tn5382-like transposon forms circular intermediates and is flanked on the left and right ends by repeat sequences of at least 700 bp in the opposite direction. No plasmid was detected in this strain, suggesting that the Tn5382-like transposon was integrated into the chromosome. The vancomycin resistance was not transferable to enterococci. CONCLUSIONS: Our report shows for the first time the presence of a Tn5382-like transposon carrying vanB2 in a Clostridium species of the human intestinal flora. This suggests that the vanB2 Tn5382-like transposon is an important vector for the spread of vancomycin resistance in several bacterial species.     

两种荧光显微成像系统亚细胞定位的对比

目的:应用高分辨率荧光显微成像系统采集细胞器探针图像,并与激光共聚焦显微成像系统进行对比。方法:实验于2003-05/2004-01在解放军总医院完成。①实验材料:鼠肺毛细血管内皮细胞株(1H11)由上海复旦张江生物公司提供;荧光探针Rhodamine-123,Lucifer Yellow,DiOC6[3],BODIPY(美国Sigma公司)。②细胞培养及荧光探针染色:细胞培养采用含体积分数为0.2胎牛血清的低糖DMEM培养基,密度5×107L-1。选择Rhodamine-123作为细胞线粒体特异性荧光探针,选择DiOC6[3]作为细胞内质网特异性荧光探针,选择BODIPY作为细胞高尔基体特异性荧光探针,选择Lucifer Yellow作为细胞溶酶体探针。前3个探针在完全避光条件下与培养的细胞共同孵育0.5h,后者则共同孵育15h。③高分辨率荧光成像系统的图像采集:线粒体荧光图像采集,选取经Rhodamine-123共孵育完成的细胞,选择激发滤色镜为BP460-490,吸收滤色镜为BA515,分光镜为DM500,另加一绿通道液晶滤光片,激发出Rhodamine-123的荧光。电荷耦合器件采集图像并送入计算机。重复上述步骤,采用DiOC6[3]标记内质网,BODIPY标记高尔基体,Lucifer Yellow标记细胞溶酶体,激发条件同Rhodamine-123。分别采集同一视野靶细胞DiOC6[3]、BODIPY或Lucifer Yellow的荧光图像,完成全部图像采集并储存在计算机中。④激光共聚焦显微成像系统的图像采集:选择经4种探针染色的靶细胞,使用氩离子激光器在488nm激发Rhodamine-123,Rhodamine-123荧光通过配置有530/60-G发射滤光片的通道1探测。重复上述步骤,在488nm激发DiOC6[3]和BODIPY,在457nm激发Lucifer yellow,3种荧光均由通道1探测,后2个探针的发射滤光片的配置为515/30-G,DiOC6[3]选择530/60-G。由光电倍增管接收信号并传输入计算机成像。结果:①高分辨率荧光成像系统所采集图像,靶细胞中由荧光探针Rhodamine-123染色的线粒体呈多个典型的小棒状或卵圆状,聚集在核周;Lucifer yellow染色的溶酶体呈多个非对称球型,在胞浆内随机分布,颗粒尺寸通常大于线粒体;荧光探针DiOC6[3]着色的内质网占据胞浆的很大空间,以囊状聚集为特征;BODIPY特异性地结合在高尔基体上,荧光图像显示围绕在细胞核周围呈条索状。②与高分辨率荧光成像系统比较,激光共聚焦显微成像系统所采集的图像其荧光强度基本相同,但分辨率低、细节显示模糊、胞浆中细胞器的准确分布信息和形态特征显示效果欠佳。结论:两种荧光显微成像系统均可采集到细胞器探针的荧光图像。但高分辨率荧光成像系统采集的荧光图像具有细节清晰、分辨度高、准确显示胞浆中细胞器的分布信息和形态特征等优点。     

The importance of physician listening from the patients' perspective: enhancing diagnosis, healing, and the doctor-patient relationship

ObjectiveThe research findings reported here describe the importance and various functions of physician listening according to patients.MethodsFifty-eight patients of the McGill University Health Centre were interviewed using a qualitative, interpretive design approach.ResultsPatients explained why listening was important to them and these findings were organized into three themes: (a) listening as an essential component of clinical data gathering and diagnosis; (b) listening as a healing and therapeutic agent; and (c) listening as a means of fostering and strengthening the doctor–patient relationship. The findings are presented along with a conceptual model on the functions of physician listening.ConclusionElucidating the multiple functions of listening in the clinical encounter from patient perspectives can assist physicians in improving their listening approach.Practice implicationsFor training purposes, we recommend that a module on listening should lead to a discussion not only about the skill required in listening attentively, but also to the values, beliefs, attitudes, and intentions of physicians who choose to listen to their patients. This teaching objective may be facilitated by future research that explores the concept of ‘authenticity’ in a physician's listening approach, which we argue is central to successful clinical outcomes.     

Involvement of insula and cingulate cortices in control and suppression of natural urges

The physiology of control and suppression of natural urges isnot well understood. We used [¹⁵O]H₂O positron-emission tomographyimaging to identify neural circuits involved in suppressionof spontaneous blinking as a model of normal urges. Suppressionof blinking was associated with prominent activation of bilateralinsular-claustrum regions, right more than left; activationwas also found in bilateral anterior cingulate cortex (ACC),supplementary motor areas, and the face area of the primarymotor cortex bilaterally. These results suggest a central rolefor the insula possibly together with ACC in suppression ofblinking.     

Leukocyte Telomere Length Is Not Associated With BMD,Osteoporosis, or Fracture in Older Adults: Results From the Health,Aging and Body Composition Study

Short leukocyte telomere length (TL), low BMD, and osteoporosis have been associated with increased inflammation. Previous reports suggest an association between TL, BMD, and osteoporosis in women. We sought to verify these associations and to determine whether TL is related to fracture in a cohort of older men and women. Participants included 2750 community‐dwelling older persons from the longitudinal Health, Aging, and Body Composition Study (Health ABC) in who average leukocyte TL was measured at baseline using qPCR. We used unconditional logistic regression to determine the association of TL with prevalent fracture, Cox proportional hazards regression for the association with 7‐yr incident fracture, and mixed linear models for the association with BMD, change in BMD, and the number of incident fractures. TL was negatively correlated with age, weight, fasting insulin, and fasting glucose in men and women, and additionally, with C‐reactive protein and IL‐6 in men. TL was not associated with BMD; change in BMD over 1, 3, or 5 yr; osteoporosis; baseline fracture; or 7‐yr incident fracture, before or after adjustment for age, race, smoking, and health characteristics. TL is not associated with BMD, osteoporosis, or fracture in older men or women in this sample.     

High hepatitis C virus prevalence and incidence among Canadian intravenous drug users

We used data and leftover samples collected through the SurvUDI network to describe the epidemiology of hepatitis C virus (HCV) infection among injection drug users (IDUs) in Eastern Central Canada. Among the 1380 selected IDUs, having participated twice or more between 1997 and 2003, the overall HCV prevalence rate was 60.4% (95% confidence interval [CI]: 57.7-63.0%). Among the 543 initially uninfected participants, the HCV incidence rate was 27.1 per 100 person-years (95% CI: 23.4-30.9 per 100 person-years). Independent predictors of seroconversion, identified among 359 participants, were age, injecting for a year or less, injecting with a syringe previously used by someone else, injecting most often cocaine, engaging in prostitution, and being recruited in a major urban centre. The HCV epidemic severely affects IDUs in this area. Actions to prevent HCV transmission, such as distribution of sterile injection equipment, have to be reinforced. Special efforts have to be targeted towards starting IDUs.