Purpose: This study aimed to investigate the progression and natural course of aortic stenosis (AS), including aortic valve sclerosis and mild AS, and its relationship with the morphology of left ventricular hypertrophy.

Subjects and Method: We included 501 patients with aortic valve sclerosis and AS, including those classified as mild to severe, along with patients who had undergone ＞3 transthoracic echocardiography recordings. According to the maximum AS jet velocity (Vmax) at the first examination, all patients were classified into the following four groups: group A (Vmax ＜2 m/s), group B (2≤ Vmax ＜3 m/s), group C (3≤ Vmax ＜4 m/s), and group D (Vmax ≥4 m/s). The left ventricular (LV) morphology was classified into four groups based on the relative wall thickness and LV mass index. We then evaluated the relationship between LV morphology and AS progression.

Results and Discussion: Intergroup (A–D) progression rates differed significantly; furthermore, significantly more number of patients presenting with a progression of ＞0.3 m/s/year being allocated in the more severe category. A logistic regression analysis demonstrated that a higher AS severity was associated with a higher the risk of progression in the following three groups: group B (odds ratio 2.08, p＝0.021), group C (odds ratio 3.79, p＜0.001), and group D (odds ratio 6.41, p＜0.001). The LV concentric hypertrophic pattern was also considered a significant factor (odds ratio 2.12, p＝0.001). In addition, the AS progression was divided into three groups based on the tertiles, and the fastest progressing group (≥0.2 m/s/year) had a significantly higher percentage of patients with LV concentric hypertrophy than that in the other two groups.

Conclusion: These results suggest that AS may progress more rapidly in patients with severe AS and in those with LV concentric hypertrophy.

Purpose: Although the factors and mechanisms behind the formation of gallbladder stones (gallstones) have been studied for many years, few investigations have focused on the relationship between gallbladder morphology and the presence of gallstones. Therefore, this study was performed to obtain this information by comparing the presence or absence of gallstones and type of gallstone with the different morphological types of gallbladders, to determine the factors most commonly linked to the presence of gallstones.

Subjects and Methods: In total, we evaluated 144 subjects (78 men and 66 women; mean age, 75±13 years; range, 34–95 years) who underwent an abdominal ultrasound at our hospital to screen for gallstones, between April and October 2019. Gallbladder morphology was classified into pyriform, hourglass-shaped, and flexed types, and the presence or absence of gallstones was compared among these types. Gallstones were classified as large and small, and their prevalence was compared according to gallbladder morphology. The relationship between the presence or absence of gallstones and age, body mass index, diabetes, dyslipidemia, and gallbladder morphology was determined.

Results and Discussion: Regarding gallbladder morphology, 97 subjects had the pyriform-type, 26 had the hourglass-type, and 21 had the flexed-type. Gallstones were found in 11, 5, and 12 subjects with pyriform, hourglass, and flexed types, respectively. Furthermore, subjects with a flexed-type gallbladder had a significantly higher prevalence（p＜0.001），which was thought to be related to bile congestion. No significant differences were observed in the prevalence of large or small gallstones among the gallbladder morphological types. Flexed-type gallbladder morphology was significantly associated with the presence of gallstones (odds ratio, 10.35; 95% confidence interval 3.42–31.32; p＜0.001).

Conclusion: Flexed-type gallbladder was most significantly associated with the presence of gallstones, suggesting that gallbladder morphology determined by ultrasound is an indicator of the presence of gallstones.

The Japanese Society of Sonographers Superficial Organs Technical Committee developed a practical breast ultrasound phantom (hereafter, phantom) for practical training. The phantom reproduced the difficulty of scanning due to the shape and softness, and the interior part of the phantom was made up of multiple glandular lobes that look real by placing targets of mimic lesions, such as benign and malignant tumors and distorted architecture (Japanese Patent No. 6651164).

In 2018, we conducted four seminars using phantoms to provide lectures on the examination methods, practical techniques for scanning, and image interpretation to verify the effects of training.

The training effect was verified on 74 participants before and after the training based on (1) scanning time required for screening, (2) recording of a still image of the malignant tumor target, and (3) determination of the presence or absence of distortion in case videos. The results of the three tests were compared. (1) The scanning time was significantly shortened after the training (p＝0.002). (2) Three instructors evaluated the floating image of the probe, deviation in the target-rendering position, clarity of boundary, and quality of the selected image in three stages for the still image of the malignant tumor, and evaluation after the training was significantly improved (p＜0.0001). (3) The presence or absence of distortion was shown by changing the order of the same video before and after the course, and the sensitivity, specificity, and accuracy were significantly higher after the course (sensitivity, p＝0.032; specificity and accuracy, p＜0.0001).

Students also evaluated the phantoms better than the real ones. The results were as follows using the scale: similar 5 to dissimilar 1; surface hardness, 4.0; internal hardness, 4.0; nipple attenuation, 3.5; glandular lobe structure, 3.4; benign tumor, 4.5; malignant tumor, 4.2; segmental lesion, 3.9; and distortion, 3.7.