VML 28 §:n soveltaminen debt push down -järjestelyihin Euroopan unionin tuomioistuimen oikeuskäytännön valossa

Tutkielmassa käsitellään Euroopan unionin tuomioistuimen tuomion C-484/19, Lexel AB, vaikutusta yleisen veronkiertosäännöksen, verotusmenettelylain 28 §:n, soveltamiskäytäntöön debt push down -järjestelyissä. Tutkielmassa hyödynnettyä lähdeaineistoa ovat Euroopan unionin tuomioistuimen tuomiot sekä korkeimman hallinto-oikeuden ja hallinto-oikeuksien ratkaisut sekä kotimainen ja ulkomainen oikeuskirjallisuus. Tutkimusmetodina on lainoppi eli oikeusdogmatiikka. EUT:n aiemmassa oikeuskäytännössä veronkierron estäminen on hyväksytty oikeuttamisperusteena unionin perusvapautta rajoittavalle toimenpiteelle, mikäli rajoittava toimenpide on kohdistunut vain puhtaasti keinotekoisiin ja fiktiivisiin järjestelyihin. Järjestelyn keinotekoisuuden arviointi nousi keskeisenä esille myös EUT:n Lexel-tuomiossa. EUT lausui tuomiossaan, ettei markkinaehtoisesti toteutettuja liiketoimia voida pitää puhtaasti keinotekoisina taikka fiktiivisinä järjestelyinä. Pelkästään sillä, että yhtiö haluaa vähentää korot rajat ylittävässä tilanteessa ilman minkäänlaista keinotekoista siirtoa, ei voida oikeuttaa toimenpidettä, jolla loukataan SEUT 49 artiklassa määrättyä sijoittautumisvapautta. Tätä vastoin kotimaisessa oikeuskäytännössä kokonaisarvioinnin kautta todettu keinotekoisuus on ollut perusteluna sille, miksi korkojen vähennysoikeuden epäämistä ei ole pidetty unionin oikeuden vastaisena. Kuitenkaan erityisempää huomiota kansallisen oikeuskäytännön perusteluissa ei ole annettu järjestelyn markkinaehtoisuuden arvioinnille, joka Lexel-tuomion perusteella tulisi olla olennaisessa asemassa arvioitaessa keinotekoisuutta. Lähtökohtaisesti tutkielman asetelmassa on siten havaittavissa jännitettä. Tutkielman pääasiallisena tarkoituksena on selvittää, tuleeko Lexel-tuomio muuttamaan kansallisen oikeus- ja verotuskäytännön tulkintalinjaa koskien yleisen veronkiertosäännöksen soveltumisesta debt push down -järjestelyihin. Tutkielma osoittaa, että VML 28 §:n soveltamisalan laajentuminen debt push down -järjestelyihin on moneltakin osaa EU-oikeudellisesti ongelmallista. Viimeistään Lexel-tuomion antamisen jälkeen voidaan todeta, että kansallisessa oikeuskäytännössä keinotekoisuuden arviointi EU-oikeudellisesta näkökulmasta on ollut puutteellista, mikä on johtanut siihen, ettei väitettyjä keinotekoisia järjestelyjä voida kuitenkaan vakuuttavasti nähdä EU-oikeuden kannalta tosiasiassa keinotekoisiksi taikka fiktiivisiksi. Veronkierron estämistä ei siten voida hyväksyä oikeuttamisperusteena VML 28 §:n soveltamiskäytännölle, joka on muodostunut perusvapautta rajoittavaksi

Diabetes and ischaemic stroke outcome

AimTo compare all‐cause mortality, stroke recurrence and functional outcomes in people who have experienced stroke, with and without diabetes.MethodsWe captured data on population‐based ischaemic strokes (2006–2012) in Nueces County, Texas. Data were collected from participant interviews and medical records. Differences in cumulative mortality and stroke recurrence risk by diabetes status were estimated at 30 days and 1 year using Cox models. Differences in 90‐day functional outcomes (activities of daily living/instrumental activities of daily living score: range 1–4; higher scores worse) by diabetes status were assessed using Tobit regression. Effect modification by ethnicity was examined.ResultsThere were 1301 ischaemic strokes, 46% with history of known diabetes. The median (interquartile range) age was 70 (58–81) years and 61% were Mexican American. People with diabetes were younger and more likely to be Mexican American compared with those without diabetes. After adjustment, diabetes predicted mortality (30‐day hazard ratio 1.44, 95% CI 0.97–2.12; 1‐year hazard ratio 1.47, 95% CI 1.09–1.97) but not stroke recurrence (1‐year hazard ratio 1.27, 95% CI 0.78–2.07). People with diabetes had a worse functional outcome score that was explained by cardiovascular risk factors and pre‐stroke factors. Diabetes was not associated with functional outcome in the fully adjusted model (final adjusted activities of daily living/instrumental activities of daily living score difference 0.11, 95% CI –0.07 to 0.30). Effect modification by ethnicity was not significant (P>0.3 for all models).ConclusionsDiabetes was associated with higher mortality and worse functional outcome but not stroke recurrence. Interventions are needed to decrease the adverse outcomes associated with diabetes, particularly in Mexican‐American people.What’s new?Although diabetes is an established risk factor for incident ischaemic stroke, its role in stroke outcomes remains uncertain, with inconsistent findings across studies and limited data from diverse, population‐based studies.In our ethnically diverse population‐based study, we found that diabetes was associated with higher stroke mortality and worse functional outcome but not with stroke recurrence.Results suggest that interventions are needed to decrease the adverse stroke outcomes associated with diabetes, particularly in Mexican‐American people who experience a high prevalence of diabetes.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145551/1/dme13665_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/145551/2/dme13665.pd

Increased hemorrhagic transformation and altered infarct size and localization after experimental stroke in a rat model type 2 diabetes

<p>Abstract</p> <p>Background</p> <p>Interruption of flow through of cerebral blood vessels results in acute ischemic stroke. Subsequent breakdown of the blood brain barrier increases cerebral injury by the development of vasogenic edema and secondary hemorrhage known as hemorrhagic transformation (HT). Diabetes is a risk factor for stroke as well as poor outcome of stroke. The current study tested the hypothesis that diabetes-induced changes in the cerebral vasculature increase the risk of HT and augment ischemic injury.</p> <p>Methods</p> <p>Diabetic Goto-Kakizaki (GK) or control rats underwent 3 hours of middle cerebral artery occlusion and 21 h reperfusion followed by evaluation of infarct size, hemorrhage and neurological outcome.</p> <p>Results</p> <p>Infarct size was significantly smaller in GK rats (10 ± 2 vs 30 ± 4%, p < 0.001). There was significantly more frequent hematoma formation in the ischemic hemisphere in GK rats as opposed to controls. Cerebrovascular tortuosity index was increased in the GK model (1.13 ± 0.01 vs 1.34 ± 0.06, P < 0.001) indicative of changes in vessel architecture.</p> <p>Conclusion</p> <p>These findings provide evidence that there is cerebrovascular remodeling in diabetes. While diabetes-induced remodeling appears to prevent infarct expansion, these changes in blood vessels increase the risk for HT possibly exacerbating neurovascular damage due to cerebral ischemia/reperfusion in diabetes.</p

Comparison of the impact of atrial fibrillation on the risk of early death after stroke in women versus men

BACKGROUND: Atrial fibrillation (AF) is considered a predictive factor of poor clinical outcome in patients with an ischemic stroke (IS). This study addressed whether the impact of AF on the in-hospital mortality after first ever IS is different according to the patient’s gender. METHODS: We prospectively studied 1678 patients with first ever IS consecutively admitted to two University Hospitals. We recorded demographic data, vascular risk factors, and the stroke severity (NIHSS) at admission analyzing their impact on the in-hospital mortality and on the combined mortality-dependency at discharge using a Cox proportional hazards model. Two variable interactions between those factors independently related to in-hospital mortality and combined mortality-dependency at discharge were tested. RESULTS: Overall in-hospital mortality was 11.3%. Cox proportional hazards model showed that NIHSS at admission (HR: 1.178 [95% CI 1.149–1.207]), age (HR: 1.044 [95% CI 1.026–1.061]), AF (HR: 1.416 [95% CI 1.048–1.913]), male gender (HR: 1.853 [95% CI 1.323–2.192) and ischemic heart disease (HR: 1.527 [95% CI 1.063–2.192]) were independent predictors of in-hospital mortality. A significant interaction between gender and AF was found (p = 0.017). Data were stratified by gender, showing that AF was an independent predictor of poor outcome just for woman (HR: 2.183 [95% CI 1.403–3.396]; p < 0.001). The independent predictors of combined mortality-disability at discharge were NIHSS at admission (HR: 1.052 [95% CI 1.041–1.063]), age (HR: 1.011 [95% CI 1.004–1.018]), AF (HR: 1.197 [95% CI 1.031–1.390]), ischemic heart disease (HR: 1.222 [95% CI 1.004–1.488]), and smoking (HR: 1.262 [95% CI 1.033–1.541]). CONCLUSIONS: The impact of AF is different in the twogenders and appears as a specific ischemic stroke predictor of in-hospital mortality just for women