ImportanceIn patients with severe aortic valve stenosis at intermediate surgical risk, transcatheter aortic valve replacement (TAVR) with a self-expanding supra-annular valve was noninferior to surgery for all-cause mortality or disabling stroke at 2 years. Comparisons of longer-term clinical and hemodynamic outcomes in these patients are limited.ObjectiveTo report prespecified secondary 5-year outcomes from the Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement (SURTAVI) randomized clinical trial.Design, Setting, and ParticipantsSURTAVI is a prospective randomized, unblinded clinical trial. Randomization was stratified by investigational site and need for revascularization determined by the local heart teams. Patients with severe aortic valve stenosis deemed to be at intermediate risk of 30-day surgical mortality were enrolled at 87 centers from June 19, 2012, to June 30, 2016, in Europe and North America. Analysis took place between August and October 2021.InterventionPatients were randomized to TAVR with a self-expanding, supra-annular transcatheter or a surgical bioprosthesis.Main Outcomes and MeasuresThe prespecified secondary end points of death or disabling stroke and other adverse events and hemodynamic findings at 5 years. An independent clinical event committee adjudicated all serious adverse events and an independent echocardiographic core laboratory evaluated all echocardiograms at 5 years.ResultsA total of 1660 individuals underwent an attempted TAVR (n = 864) or surgical (n = 796) procedure. The mean (SD) age was 79.8 (6.2) years, 724 (43.6%) were female, and the mean (SD) Society of Thoracic Surgery Predicted Risk of Mortality score was 4.5% (1.6%). At 5 years, the rates of death or disabling stroke were similar (TAVR, 31.3% vs surgery, 30.8%; hazard ratio, 1.02 [95% CI, 0.85-1.22]; P = .85). Transprosthetic gradients remained lower (mean [SD], 8.6 [5.5] mm Hg vs 11.2 [6.0] mm Hg; P < .001) and aortic valve areas were higher (mean [SD], 2.2 [0.7] cm2 vs 1.8 [0.6] cm2; P < .001) with TAVR vs surgery. More patients had moderate/severe paravalvular leak with TAVR than surgery (11 [3.0%] vs 2 [0.7%]; risk difference, 2.37% [95% CI, 0.17%- 4.85%]; P = .05). New pacemaker implantation rates were higher for TAVR than surgery at 5 years (289 [39.1%] vs 94 [15.1%]; hazard ratio, 3.30 [95% CI, 2.61-4.17]; log-rank P < .001), as were valve reintervention rates (27 [3.5%] vs 11 [1.9%]; hazard ratio, 2.21 [95% CI, 1.10-4.45]; log-rank P = .02), although between 2 and 5 years only 6 patients who underwent TAVR and 7 who underwent surgery required a reintervention.Conclusions and RelevanceAmong intermediate-risk patients with symptomatic severe aortic stenosis, major clinical outcomes at 5 years were similar for TAVR and surgery. TAVR was associated with superior hemodynamic valve performance but also with more paravalvular leak and valve reinterventions.

Pada makalah ini, aliran konveksi bebas dan aliran konveksi paksa berperan penting pada aliran konveksi campuran. Dalam hal ini, pengaruh gaya tekanan (pressure forces) dan gaya apung (buoyant forces) pada aliran konveksi bebas menjadi signifikan. Aliran konveksi campuran dapat digunakan pada teknologi reaksi reaktor dan pendingin elektronik. Dalam makalah ini, persamaan lapisan batas (boundary layer) dari aliran konveksi campuran fluida viskoelastik yang melewati permukaan sebuah bola berpori awalnya ditransformasikan kedalam bentuk non-dimensi, kemudian ditransformasikan kedalam bentuk persamaan lapisan batas non-similar yang diselesaikan secara numerik menggunakan metode beda hingga Keller-Box. Hasil numerik pada makalah ini adalah profil kecepatan (

We are interested in the existence and stability of traveling waves of arbitrary amplitudes to a chemotaxis model with porous medium diffusion. We first make a complete classification of traveling waves under specific relations among the biological parameters. Then we show all these traveling waves are asymptotically stable under appropriate perturbations. The proof is based on a Cole-Hopf transformation and the energy method.

In this paper, the numerical results of mixed convection flow over a flat plate with the imposed heat and different angles of inclination are established by applying the finite difference method of Crank-Nicolson. We further compare these numerical results with the case of non-mixed convection flow.  The velocity and temperature profiles are decreased when the different values of the Prandtl number (Pr) are increased. Meanwhile, the velocity profiles are increased, when the different values of angle of inclination (alfa) and mixed convection parameter (lambda) are increased. The mixed convection flow case (lambda=1.5) is affected by the external force, so the velocity of convection flow is higher than the non-mixed case (lambda=0).

Mixed convection is the combination of a free convection caused by the buoyancy forces due to the different density and a forced convection due to external forces that increase the heat exchange rate. This means that, in free convection, the effect of external forces is significant besides buoyancy forces. In this study the fluid type with viscoelastic effect is non-Newtonian. The viscoelastic fluids that pass over a surface of a sphere form a thin layer, which due to their dominant viscosity is called by the border layer. The obtained limiting layer is analyzed with the thickness of the boundary layer-  near the lower stagnating point, then obtained dimensional boundary layer equations, continuity, momentum, and energy equations. These dimensional boundary layer equations are then transformed into non-dimensional boundary layer equations by using non-dimensional variables. Further, the non-dimensional boundary layer equations are transformed into ordinary differential equations by using stream function, so that obtained the non-similar boundary layer equations. These non-similar boundary layer equations are solved numerically by using finite difference method of Keller-Box. The discretization results are non-linear and it should be linearized using newton linearization technique. The numerical solutions are analyzed the effect of Prandtl number, viscoelastic, mixed convection, and MHD parameters towards velocity profile, temperature profile, and wall temperature.